Exam 1 Flashcards
What are unilateral leg pain, calf tenderness, and swelling manifestations of?
deep vein thrombosis
How can the risk for coronary artery disease be reduced?
-decreasing LDL level (weight loss program)
- regular exercise (increases HDL)
- increase omega-3 fatty acid intake
What does troponin test indicate?
troponin appears in the bloodstream when there is damage to the heart (myocardial infarction)
Which diagnostic tests could the nurse suspect in the confirmation of DVT diagnosis?
venous duplex ultrasound and d-dimer
What post-surgical complication is a client at risk for following a hip arthroplasty?
deep-vein thrombosis (this may also occur from gynecological and urological procedures)
Which portion of the ECG strip would represent the time it takes for ventricular depolarization and repolarization combined (ventricular cycle)?
QT interval
What tests should the nurse prepare to obtain for a client that reports chest pressure and SOB?
troponin (MI)
Why should massaging be avoided in those at risk for VTE (venous thromboembolism)?
blood clot could detach and become an embolus
If a patient has a confirmed case of sepsis and is hypotensive, how much fluid should the nurse administer IV?
30 mL/kg
Is medicating the client for pain part of the 1hr bundle in sepsis treatment?
No, but drawing lactate, admin ABX, IV fluids, blood cultures, and vasopressors if needed all are
What lab is indicative of sepsis?
increased lactate
What are the hallmarks of sepsis?
increased serum lactate and increased bands
- inc. procalcitonin (in response to inflammatory cytokines)
- abnormal WBC
What is a priority for the nurse to ensure when administering ABX in a patient who has sepsis?
drawing blood cultures
If a patient has a urinary output of 15 mL/hr what may be indicated?
organ dysfunction
(renal dysfunction r/t poor perfusion in septic clients)
When is an example of a time that the nurse should notify the provider in regards to assessing surgical incision/site?
redness at surgical site, as this may indicate infection
what are examples of modifiable risk factors for cardiovascular disease?
personal lifestyle, smoking, physical inactivity, obesity, and psychological variables (stress, anger, etc)
What are some factors that may contribute to the likelihood of cardiovascular disease that cannot be changed?
pts age, gender, ethnic origin, family hx of CVD
What does the P- wave on an EKG represent?
atrial depolarization (contraction)
What represents the combination of ventricular depolarization (contraction) and atrial repolarization (relaxation)?
QRS complex
What does the T- wave represent on an EKG?
ventricular repolarization
What is considered a normal cholesterol level?
less than 200 mg/dL
What are the four steps of the electrical conduction in the heart?
- SA node
- AV node
- bundle of HIS
- purkinje fibers
What is the preferred diagnostic test for DVT?
venous duplex ultrasound
The nurse should monitor for which lab while a patient is receiving IV heparin?
aPTT
When and how often should aPTT be monitored while patient is receiving IV heparin?
6 hr after initiation, 6 hr after ANY dose changes, and at least daily
Which medication should PT/INR be evaluated while administering?
warfarin
What is the antidote for warfarin?
Vitamin K
What may early ambulation prevent in post-surgical patients?
DVTs
What is the benefit of novel (direct) oral anticoagulants?
ex. dabigatran, rivaroxaban, apixaban, and edoxaban
fixed dosing without the need for frequent lab monitoring
In case of a heparin overdose, the nurse should have what available?
protamine sulfate (antidote)
How does the onset of pain usually occur for DVTs?
sudden
Name an example of a gram + bacteria.
staphylococcus
What is considered a therapeutic INR while taking warfarin?
< 2
What body temp indicates SIRS?
> 100.5 or < 96.8 F
What respiratory rate indicates positive SIRS?
> 20 BPM or < 32 mmHg PaCO2
What HR parameter is given for SIRS criteria?
90 bpm
What is considered shock in a patient with sepsis?
hypotension regardless of administration of vasopressors
Which wave represents atrial depolarization (contraction)?
P-wave
What type of medications cause the heart to beat more slowly and with less force?
beta-blockers
What are some symptoms that a patient may have with a PE (pulmonary embolism)?
-dyspnea, tachypnea and chest pain
-acute confusion, restlessness
-crackles
- decrease SpO2
What may be used as drug therapy for DVT prevention?
heparin, warfarin, enoxaparin
What is the therapeutic INR for a patient with a DVT?
1.5-2
What should the nurse do if the output of a chest tube is > 70mL/ hr?
contact the provider
What is important for positioning the chest tube drainage system?
keep the system below the level of the chest
What are 2 supplies that should always be at the bedside in case of an emergency with a chest tube?
sterile water and occlusive dressing
Why should sterile water be kept at the bedside of a patient with a chest tube?
if the tube disconnects, place tip into 2 in of water to create a seal, preventing air from entering the patient
How would Vaseline gauze be used for a chest tube emergency?
tubing disconnects from patient
When would NPPV (like CPAP and BiPAP) be contraindicated/used with great caution?
patients with nausea, thick secretions, or emesis. If the throw up it’ll likely be blown back into their airway (aspiration)
What consumption instructions should be given prior to a PFT (pulmonary function test)?
no smoking 6-8 hr before and
no bronchodilators 4-6 hr before
How long should a patient be NPO prior to a scheduled bronchoscopy?
4-8 hr before
What is the normal time for the PR interval?
0.12-0.2 secs
What is the normal time for the QRS compex?
0.6- 0.10 sec (<0.10 secs)
what is normal for the normal time for the QT interval?
<0.44 sec
What drug may given to a patient with sinus bradycardia?
atropine
What are the 3 components of Virchow’s triad that increase the risk for a patient developing a VTE?
hypercoagulable state
stasis of blood
endothelial blood
What are some factors that may cause stasis of blood
immobility, atrial fibrillation, venous insufficiency, venous obstruction, heart failure
What may be some causes of endothelial injuries?
surgery (hip, knee, and prostate)
trauma
atherosclerosis
smoking
catheter
What is Homan’s sign?
pain with dorsiflex that may indicate DVT
(this often has false positives)
What may be indicated by elevated lactate levels in a septic client?
poor perfusion and/or oxygenation to tissues
What interventions should the nurse implement to prevent atelectasis?
turn, cough, deep breathe
incentive spirometry use
How often should an incentive spirometer be utilized?
10 times per hour
What is a serious complication that patients receiving benzocaine for a bronchoscopy should be monitored for?
methemoglobinemia
If methemoglobinemia is recognized, what should the nurse do?
call rapid response and prepare to admin methylene blue
What may a patient with methemoglobinemia present with?
chocolate-colored blood and hypoxia that does not respond to O2 therapy
What difference may the nurse note while percussing the chest wall of a client with a pleural effusion?
dullness with percussion
How may the trachea appear with a tension pneumothorax?
deviation to unaffected side
What can the nurse offer to a client experiencing a sore throat following a bronchoscopy?
gargle salt water and lozenges
