CT 2 Flashcards
COPD adventitious breath sounds:
Wheezing and crackles
COPD patient, limbs and neck
thin limbs
thick neck
COPD: fingers and toes
clubbing
COPD: Dependent edema secondary to
right-sided heart failure
COPD: hematocrit
An increased hematocrit level is due to low oxygenation levels.
COPD: Hypoxemia as evidenced by
PaO2 less than 80
COPD: Hypercarbia as evidenced by
PaCO2 greater than 45
enzyme used to detect COPD
AAT (alpha1 antitrypsin)
Pursed lip breathing instructions
Take a breath in through the nose and out through the lips/mouth.
Don’t puff cheeks
COPD: Clients who have chronically increased PaCO2 levels usually require ___ L/min of oxygen via nasal cannula
1 to 2
Positive Expiratory Pressure Device assists client to
remove airway secretions
COPD: how much should the client walk
20 min daily 2 to 3 times weekly
Cholinergic antagonists (anticholinergic medications), such as ipratropium are used for
long acting prevention of attacks
COPD: a medication that requires close monitoring of serum medication levels due to narrow therapeutic ranges. Use only when other treatments are ineffective.
Methylxanthines,
COPD: instructions for steroids
take with food
Right-sided heart failure (cor pulmonale) is caused by
airways collapsing/stiff alveoli
this leads to blood backing up to the right side
Right-sided heart failure (cor pulmonale) sign: enlarged and tender
liver
Right-sided heart failure (cor pulmonale) sign: ___ edema
dependent
Right-sided heart failure (cor pulmonale) sign: distended
neck veins
Right-sided heart failure (cor pulmonale): Administer __ __ and ____ to maintain fluid balance.
IV fluids and diuretics
The continuum from angina to myocardial infarction (MI) is termed
acute coronary syndrome
Symptoms of acute coronary syndrome are due to
an imbalance between myocardial oxygen supply and demand
Research shows improved outcomes following an MI in clients treated with these 3 medications
aspirin, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors.
what causes the pain in an MI
When blood flow to the heart is compromised, ischemia causes chest pain
occurs with exercise or emotional stress and is relieved by rest or nitroglycerin
Stable angina
occurs with exercise or emotional stress, but it increases in occurrence, severity, and duration over time
Unstable angina
is due to a coronary artery spasm, often occurring during periods of rest.
Variant angina (Prinzmetal’s angina)
what differentiates an MI from angina
Pain unrelieved by rest or nitroglycerin and lasting for more than 15 min
Is ischemia and infarction reversible?
Ischemia is reversible. An infarction results in permanent damage.
2 Metabolic disorders that are risks for MI
(diabetes mellitus, hyperthyroidism)
Earliest marker of injury to cardiac or skeletal muscle
Myoglobin
Myoglobin levels no longer evident after
24 hr
Peaks around 24 hr after onset of chest pain
CKMB
Troponin I or T
Any positive value indicates damage to cardiac tissue and should be reported
ST depression and/or T-wave inversion indicates presence of
ischemia
ST-segment elevation indicates
injury
Thallium scan
Assesses for ischemia or necrosis (which appear as cold spots)
coronary angiogram aka cardiac catheterization or Angiography
2 different diagnostic procedures to check for blocks
Angiography: assess client for
iodine/shellfish allergy
coronary angiogram aka cardiac catheterization or Angiography client instructions
NPO for 8 hours
Nitroglycerin actions
prevents coronary artery vasospasm
reduces preload and afterload, decreasing myocardial oxygen demand.
Beta-blockers decrease the imbalance between myocardial oxygen supply and demand by
reducing afterload and slowing heart rate
In an acute MI, beta-blockers
decrease infarct size and improve short- and long-term survival rates.
Streptokinase (Streptase) and alteplase (Activase) are used to
break up blood clots
clopidogrel (Plavix) prevent
platelets from forming together (same effect as aspirin)
should be administered with nitroglycerin at the onset of chest pain.
aspirin
can be a sign of aspirin toxicity
Tinnitus, ringing in the ears
MI patient: Encourage the client to use aspirin tablets with
enteric coating and to take with food
Heparin and enoxaparin contraindication: h/o
CVA
Injury to the left ventricle can lead to
decreased cardiac output and heart failure.
Progressive heart failure can lead to
cardiogenic shock
Heart failure/cardiogenic shock: IV administration of morphine, diuretics, and/or nitroglycerin to decrease
preload
Heart failure/cardiogenic shock: IV administration of vasopressors and/or positive inotropes to increase
cardiac output
An inferior wall MI may lead to an injury to the AV node, resulting in bradycardia and
second-degree AV heart block
An anterior wall MI may lead to an injury to the ventricle, resulting in
complete heart block
Diverticulitis is inflammation and infection of the bowel mucosa caused by bacteria or fecal matter trapped in one or more
diverticula
Diverticulitis is not to be confused with diverticulosis, which is
the presence of many small pouches in the colon with or without inflammation
Many clients who have diverticulosis never develop
diverticulitis
Teach the diverticulitis client to avoid indigestable material, which can block diverticulum such as
(nuts, popcorn, seeds)
Instruct the diverticulitis client to avoid irritating the bowel. For example
avoid alcohol, limit fat to 30% of daily calorie intake
Provide client with instructions to promote normal bowel function and consistency: the only kind of enema they should take is
bulk-forming laxatives
Provide client with instructions to promote normal bowel function and consistency: avoid use of
enemas
Diverticulitis: H and H findings
decreased
Diverticulitis: WBC findings
increased (it’s an infection)
barium enema and diverticulitis
contraindicated due to the risk of perforation.
Diverticulitis: abx dose should be decreased for client with ___ impairment
renal
Diverticulitis: a side effect of abx tx that you don’t need to worry about
discolored urine
A tension pneumothorax occurs when
air enters the pleural space during inspiration through a one-way valve and is not able to exit upon expiration
tension pneumothorax: the increase in pressure compresses blood vessels and limits venous return, leading to
a decrease in cardiac output
pneumothorax where death can result if not treated immediately
tension pneumothorax
____ pneumothorax can occur when there has been no trauma
spontaneous pneumothorax
A small bleb on the lung ruptures and air enters the pleural space.
spontaneous pneumothorax
with pneumothorax, the BP can
decrease because of decreased cardiac output
Chest Tube Insertion: Prep the insertion site with
povidone-iodine
For pneumothorax, the chest tube tip is positioned
up toward the shoulder
The chest tube is sutured to the chest wall, and an ___ dressing is placed over the puncture wound.
airtight
Chest tube client: every 2 hours encourage
coughing and DB
Chest tube client: Report excessive drainage (greater than ____)
70 mL in an hour
continuous bubbling should only be
in the suction chamber
What should be going on in the water seal chamber
tidaling
Chest tube: If the tubing separates, the client is instructed to
exhale as much as possible and to cough to remove as much air as possible from the pleural space
If the chest tube drainage system is compromised, the nurse
immerses the end of the tube in sterile water to restore the water seal
Provide ___ medication 30 min before removing chest tubes.
pain
Chest Tube Removal: Instruct the client to
take a deep breath, exhale, and bear down (Valsalva maneuver)
or to take a deep breath and hold it
Chest Tube Removal: Apply airtight sterile
petroleum jelly gauze dressing
The client does not need to wear a ___ following a pneumothorax
mask
