CT 2 Flashcards by Richard smith

COPD adventitious breath sounds:

Wheezing and crackles

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COPD patient, limbs and neck

thin limbs

thick neck

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COPD: fingers and toes

clubbing

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COPD: Dependent edema secondary to

right-sided heart failure

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COPD: hematocrit

An increased hematocrit level is due to low oxygenation levels.

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COPD: Hypoxemia as evidenced by

PaO2 less than 80

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COPD: Hypercarbia as evidenced by

PaCO2 greater than 45

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enzyme used to detect COPD

AAT (alpha1 antitrypsin)

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Pursed lip breathing instructions

Take a breath in through the nose and out through the lips/mouth.

Don’t puff cheeks

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COPD: Clients who have chronically increased PaCO2 levels usually require ___ L/min of oxygen via nasal cannula

1 to 2

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Positive Expiratory Pressure Device assists client to

remove airway secretions

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COPD: how much should the client walk

20 min daily 2 to 3 times weekly

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Cholinergic antagonists (anticholinergic medications), such as ipratropium are used for

long acting prevention of attacks

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COPD: a medication that requires close monitoring of serum medication levels due to narrow therapeutic ranges. Use only when other treatments are ineffective.

Methylxanthines,

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COPD: instructions for steroids

take with food

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Right-sided heart failure (cor pulmonale) is caused by

airways collapsing/stiff alveoli

this leads to blood backing up to the right side

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Right-sided heart failure (cor pulmonale) sign: enlarged and tender

liver

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Right-sided heart failure (cor pulmonale) sign: ___ edema

dependent

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Right-sided heart failure (cor pulmonale) sign: distended

neck veins

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Right-sided heart failure (cor pulmonale): Administer __ __ and ____ to maintain fluid balance.

IV fluids and diuretics

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The continuum from angina to myocardial infarction (MI) is termed

acute coronary syndrome

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Symptoms of acute coronary syndrome are due to

an imbalance between myocardial oxygen supply and demand

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Research shows improved outcomes following an MI in clients treated with these 3 medications

aspirin, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors.

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what causes the pain in an MI

When blood flow to the heart is compromised, ischemia causes chest pain

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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