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NUR 340 > Exam 2: week 5 & 6 > Flashcards

Exam 2: week 5 & 6 Flashcards

1
Q

A patient has chest pain when they lie down. This can be indicative of what

A

esophagitis

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2
Q

A patient has chest pain due to trauma. This can be indicative of what

A
  • chest contusion
  • rib fractures
  • pneumothorax
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3
Q

A patient has chest pain with activity. This can be indicative of what

A

angina

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4
Q

What are the unmodifiable risk factors of coronary artery disease

A
  • age
  • genetics
  • race
  • sex
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5
Q

What are the modifiable risk factors of coronary artery disease

A
  • smoking
  • high cholesterol
  • hypertension
  • sedentary lifestyle
  • obesity
  • diabetes
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6
Q

When a patient comes in with chest pain, which symptoms would lead you to believe they are having an MI

A
  • N/V
  • diaphoresis
  • SOB
  • syncope
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7
Q

When a patient comes in with chest pain, which symptoms would lead you to believe they have a PE

A
  • SOB
  • apprehension
  • hemoptysis (coughing up blood)
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8
Q

When a patient comes in with chest pain, which symptoms would lead you to believe they have pneumonia

A
  • fever
  • cough
  • sputum change
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9
Q

When a patient comes in with chest pain, which symptoms would lead you to believe they have pericarditis

A

If they also have an autoimmune disease

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10
Q

When a patient comes in with chest pain, which symptoms would lead you to believe they have cholecystitis

A

Right sided chest pain that radiates to the right shoulder and upper back

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11
Q

When a patient comes in with chest pain, which symptoms would lead you to believe they have a peptic ulcer

A

blood in emesis

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12
Q

When a patient comes in with chest pain, which symptoms would lead you to believe they have pancreatitis

A

excruciating, constant left upper quadrant pain radiating to chest, shoulder, and arm. Also associated with hypertension

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13
Q

When a patient comes in with chest pain, which symptoms would lead you to believe they have herpes zoster (Shingles)

A

unilateral burning, pruritic (itching), or stabbing pain in one dermatome (area of skin innervated by one specific nerve section)
This can be without the presence of a rash because the rash appears several days after the pain begins

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14
Q

When a patient comes in with chest pain, which symptoms would lead you to believe they have arthritis of the spine

A

pain with ROM

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15
Q

What is ischemia

A

lack of blood flow to the tissue

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16
Q

What is infarction

A

Death of tissue due to complete loss of blood flow

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17
Q

What does this show

A

Myocardial ischemia
(due to inverted T wave when everything else looks normal)

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18
Q

What does this show

A

Myocardial injury
More than ischemia but not quite infarction
(due to the elevation of the S wave but still normal Q wave)

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19
Q

What does this show

A

Myocardial infarction
(due to the dip in the Q wave, elevation of the S wave, and inversion of the T wave)

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20
Q

What are some atypical symptoms that women have that can mean they are having an MI

A
  • nausea
  • vomiting
  • dyspnea
  • fatigue
  • neck pain
  • abnormal pain location
    (will still have chest pain)
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21
Q

What is the acronym used for chest pain evaluation

A

OPQRST

O - onset
P - precipitating factors
Q - quality
R - region/radiation
S - severity
T - time

also ask about relieving factors, aggravating factors, and associated symptoms like you do in all pain assessments

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22
Q

What are the different types of angina

A
  • stable
  • unstable
  • variant
  • silent ischemia
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23
Q

What is stable angina

A

typical chest pain caused by exercise
pain relieved with rest and nitro

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24
Q

What is unstable angina

A

Change in pattern and more severe
pain wakes you up
need more nitro than usual

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25
Q

What is variant angina

A

Pain at rest at the same time every day
exacerbated by smoking, drinking, or doing cocaine
ST segment elevation

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26
Q

What is silent ischemia

A

No chest pain
EKG evidence of ischemia
Type II diabetics are vulnerable to this
- may take nausea and diaphoresis as sugar imbalance
- neuropathy causes them to not feel the chest pain

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27
Q

As a nurse, what do you do for someone experiencing stable angina

A
  • educate about nitro use
  • identify aggravating and relieving factors
  • educate them on when to call 911
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28
Q

As a nurse, what do you do for someone experiencing unstable angina

A
  • may need more nitro
  • educate one when to call 911 (pain lasting more than 5 minutes)
  • instruct patient to take one regular aspirin (if not taken already that day)
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29
Q

What is used to diagnose an acute MI

A
  • EKG
  • patient symptoms
  • Biomarkers (myoglobin, creatine kinase, and troponin)
  • if they come to the ED immediately, the biomarkers may not be elevated yet, so EKG and symptoms are used to diagnose
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30
Q

How long after an acute MI does myoglobin elevate and return to normal

A

elevates - 1 hour post MI
peaks - 4-12 hours
returns - immediately (after peak)

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31
Q

How long after an acute MI does creatine kinase (CK-MB) elevate and return to normal

A

elevates - 4-8 hours
peaks - 24 hours
returns - 2-3 days

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32
Q

How long after an acute MI does Troponin elevate and return to normal

A

Troponin has two types- Tn1 and TnT
elevates - 3 hours (both)
peaks - 24 hours (Tn1) 12-48 hours (TnT)
returns - 5-10 days (Tn1) 5-14 days (TnT)

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33
Q

What are the branches of the right coronary artery and where do they supply blood to the heart

A

marginal branch - R atrium and R ventricle
posterior descending branch - walls of both ventricles
RCA feeds - SA node and AV node (not in everyone but dont need to know percentages)

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34
Q

What are the branches of the left coronary artery and where do they supply blood to the heart

A

Left anterior descending (LAD) - anterior/lateral wall of left ventricle
Circumflex - posterior/lateral wall of left ventricle

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35
Q

What is the most dangerous type of heart attack

A

Anterior wall MI
- blockage of the LAD
- affects left ventricle
- affects anterior portion of heart
- leads V2-V4

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36
Q

What is a lateral MI

A

Circumflex artery infarct
- left lateral leads (I, aVL, V5, V6)
- usually accompanies anterior or inferior MI

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37
Q

What is an inferior wall MI

A

Right coronary artery (RCA) infarct
- leads II, III, AvF
- can lead to R ventricle failure or bundle branch block

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38
Q

A patient comes in with chest pain. What are going to do immediately

A
  • take vitals
  • 12-lead ECG
  • Cardiac monitor set up
  • start 1-2 IVs
  • draw blood
  • chest X-ray
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39
Q

ECG, blood, and chest X ray show that the patient is having an MI. What are you going to do immediately

A

Give in this order
- Aspirin (160-325 mg chew and swallow)
- Oxygen (4L)
- Nitro (sublingual or IV)
- Morphine (2-4 mg every 5-10 min PRN)

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40
Q

What are the two types of therapies for STEMI or bundle branch blocks

A

Adjunctive
Reperfusion

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41
Q

What is adjunctive therapy

A
  • beta blockers
  • ACE inhibitors
  • Glycoprotein inhibitors
  • heparin
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42
Q

What is reperfusion therapy

A
  • fibrinolytic therapy
  • percutaneous coronary intervention (PCI)
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43
Q

What is PCI

A

percutaneous coronary intervention
- angioplasty with or without a stent
- first choice if cardiogenic shock is present

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44
Q

What is fibrinolytic therapy and when would you use this over PCI

A

Drugs that dissolve fibrin bonds by converting plasminogen to plasmin
Use these over PCI if:
- onset of symptoms <12 hours ago
- ST elevation > or = to 1 mm in two consecutive leads
- no contraindications
- patient is < 75 years old

45
Q

What are some drug classes for treating an MI

A
  • fibrinolytics (door to drug in <30 minutes)
  • anticoagulants
  • antiplatelets
46
Q

How do you assess for reperfusion in a patient receiving drug therapy for MI

A
  • reperfusion dysrhythmias
  • ST segment normalization
47
Q

What are some major complications that can occur with PCI

A
  • Acute closure/reocclusion of stent
  • groin hematoma
  • retroperitoneal hematoma (low back pain)
48
Q

What is therapeutic hypothermia

A

A technique applied to patients who are going through cardiac arrest
- reduces the body’s need for oxygen
- lower temp to 32-34 degrees
- improves mortality and neurological function

49
Q

What is wolff-parkinson white syndrome

A

When the electrical signals in the heart bypass the SA node.

50
Q

What is a bundle branch block

A

A conduction delay within the ventricles
- QRS is > 0.12

51
Q

What are the different levels of sedation

A
  • minimal sedation (anxiolysis)
  • moderate sedation/analgesia
  • deep sedation/analgesia
  • general anesthesia
52
Q

What are the characteristics of minimal sedation
(LOC, Airway, spontaneous ventilation/CV function)

A

LOC: Normal (conscious)
Airway: unaffected
ventilation/CV: unaffected

53
Q

What are the characteristics of moderate sedation
(LOC, Airway, spontaneous ventilation/CV function)

A

LOC: respond to verbal or tactile stimuli
Airway: no intervention required
ventilation/CV: adequate/maintained

54
Q

What are the characteristics of deep sedation
(LOC, Airway, spontaneous ventilation/CV function)

A

LOC: respond to painful stimuli
Airway: intervention may be required
ventilation/CV: may be inadequate/usually maintained

55
Q

What are the characteristics of general sedation
(LOC, Airway, spontaneous ventilation/CV function)

A

LOC: unarousable
Airway: intervention often required
ventilation/CV: inadequate/may be impaired

56
Q

During your assessment, what part of the history could affect sedation

A

patients taking benzos or opiates can affect dosing

57
Q

What are the ASA classifications

A

American society of anesthesiologists
classes I-V
- how anesthesiologists classify patients and how they react to sedation

58
Q

Who would be placed in ASA Class I

A

Normal healthy patient with no problems

59
Q

Who would be placed in ASA class II

A

Patient with slight health problems
- well controlled HTN
- anemia
- smoker w/o respiratory disease
- well controlled diabetes
- chronic bronchitis
- age <1 or >70
- pregnancy

60
Q

Who would be placed in ASA Class III

A

Patient with severe health problems
- angina
- poorly maintained HTN
- Past MI with mild/moderate symptoms
- symptomatic respiratory disease (COPD, asthma)

61
Q

Who would be placed in ASA Class IV

A

patient with severe/life-threatening disease
- unstable angina
- CHF
- debilitating respiratory disease
- hepatorenal failure (needs dialysis)

62
Q

Who would be placed in ASA Class V

A

A person on the brink of death who will die without the procedure
- ruptured aneurysm
- major cerebral trauma with rapidly increasing ICP
- massive PE

63
Q

What type of sedation occurs with the use of propofol and/or ketamine

A

ALWAYS moderate/deep sedation
- doctors must push this

64
Q

What are some sedatives used in sedation

A
  • propofol (non-barb)
  • versed (benzo)
  • valium (benzo)
  • ativan (benzo)
65
Q

What must you give with a sedative when sedating a patient for a procedure

A

Pain medication (opioids)
- dilaudid
- morphine
- fentanyl

66
Q

What kind of care is required during a procedure when the patient is sedated

A

Monitoring
- vitals Q 5 minutes
- continuous pulse Ox
- one nurse to monitor and one nurse to assist w/procedure
Rescue capacity
- IV access and IV fluids running
- crash cart/bag valve mask
- suction
- intubation equipment
- reversal agents

67
Q

Which reversal agents need to be readily available for a patient under sedation

A

Narcan (opiate antidote)
Romazicon (benzo antidote)

68
Q

When monitoring a patient under sedation, what are you looking for

A
  • relaxation of facial expressions
  • slurred speech
  • unconsciousness
  • respiratory/airway changes
  • deteriorating O2 levels/ hypoxemia
  • hypoventilation
  • CO2 retention
  • hypotension
69
Q

What do you do if you notice a negative change in your patient under anesthesia

A
  • stop sedation
  • check level of consciousness
  • maintain airway (chin lift)
  • ventilate with bag mask
  • reversal agents
  • call anesthesia STAT
70
Q

When can you discharge a patient after being under anesthesia

A
  • vital signs within pre-procedure limits
  • CV and airway stable
  • patient is alert
  • return to pre-sedation mental status
  • patient returns to baseline muscle control
  • observe for min of 2 hours if reversal was given
  • Aldrete score >9
71
Q

What is the Aldrete scoring system

A

Gives a score for the following functions:
- activity
- breathing
- consciousness
- circulation
- SpO2
score of >9 needed for discharge

72
Q

How do you perform the sedation awakening trial

A
  • turn off sedation once daily
  • stop analgesics
  • assess patient using RASS or SAS scale (agitation/sedation scales)
  • assess LOC
73
Q

What are some things we can do for a patient experiencing delirium

A

Drugs
- Haldol
Non-pharm (prevention)
- spontaneous awakening trials
- early mobility
- daily delirium monitoring
- sleep protocols

74
Q

What scale do we use to screen patients who we suspect are withdrawing from alcohol

A

CIWA scale
- N/V
- tremor
- sweats
- anxiety
- agitation
- tactile disturbances
- auditory disturbances
- visual disturbances
- headache
- orientation/brain fog
Max score is 67
assess how much ativan to give

75
Q

What do we give a patient to manage alcohol withdrawal symptoms

A
  • multivitamins
  • long-acting benzos (valium/ativan)
76
Q

What are the symptoms of alcohol withdrawal

A

day 1: hangover symptoms
day 2: night sweats
day 3: tremors
day 4: paranoia
day 5: relief
day 6: brain fog
day 7: cravings
day 8: better sleep

77
Q

What is something to avoid giving to patients experiencing delirium

A

Benzos

78
Q

What are some abnormal breath sounds that can be heard during a respiratory exam

A

Fine crackles
Coarse crackles
wheeze
rhonchi (snoring/moaning sound)
pleural friction rub (surface rubbing sound)

79
Q

What are the characteristics of a nasal cannula

A
  • delivers 1-6 L of O2 (28-44%)
  • use humidification for >2L
  • can use at home
80
Q

What are the characteristics of high flow nasal cannula

A
  • delivers up to 100% heated and humidified O2
  • up to 60 L per min
  • modified nasal cannula
  • uses PEEP (positive end-expiratory pressure) to open alveoli
81
Q

What are the characteristics of a venturi mask

A
  • delivers 40-60% O2
  • most accurate
  • valves based on how much O2
  • used in COPD or where accurate amount of O2 is needed
  • no humidification needed
82
Q

What are the characteristics of a non-rebreather mask

A
  • highest O2 delivery with low flow
  • meter should be set to 10-15 L
  • Close to 100% O2
  • Fill bag with O2 before placing on patient
  • bag ensures pt doesn’t inhale exhaled CO2
83
Q

When looking at blood labs, what are “segs”

A

Mature white blood cells in circulation

84
Q

When looking at blood labs, what are bands

A

Immature white blood cells in circulation
these are ineffective at fighting infection

85
Q

What does “shift to the left” mean when looking at blood labs

A

a high level of bands that form in response to an infection

86
Q

What are the normal levels for pH, PCO2, and HCO3

A

pH = 7.4 (7.35-7.45)
PCO2 = 35-45
HCO3 = 22-26

87
Q

How can we determine if the acidosis/alkalosis is metabolic or respiratory

A

ROME
Respiratory Opposite (pH and CO2 arrows opposite)
Metabolic Equal (pH and CO2 arrows same direction)

88
Q

How do you determine compensation for ABGs

A

If HCO3 changes in order to even out the abnormal PCO2
(Met Acid = low pH, low PCO2 = low HCO3 to compensate)

89
Q

What is a non-invasive technique to help someone who is having trouble breathing but is still conscious

A

BiPaP
- positive airway pressure
- keeps alveoli open
- provides different levels of pressure

90
Q

A patient is on a BiPap and is still struggling to breathe. What do you do

A

Intubate and place on a mechanical ventilator
- insert an endotracheal tube
- insert orally unless unavailable
- inserting nasally has a high chance of sinus infections
- ET tubes are good for several weeks

91
Q

What are the different types of ventilators

A

volume cycled
pressure cycled

92
Q

What are the characteristics of a volume cycled ventilator

A
  • delivers a constant volume of air every time
  • most common in ICU
  • all breaths positive pressure
  • constant rate (respiratory rate) (12-20 breaths/min)
  • constant volume (tidal volume) (based on wt)
  • full assist
93
Q

What are the characteristics of a pressure cycled ventilator

A
  • applies small amount of pressure to encourage active breathing
  • patient regulates respiratory rate
  • step between volume cycled and extubation
94
Q

What are the different settings on a ventilator

A

Respiratory rate
tidal volume
FiO2 (want to keep below 50%)
PEEP (between 5-10)

95
Q

What is FiO2

A

It’s the fraction of oxygen in the inspired air
room air = 21%

96
Q

What do you do if the ventilator is alarming

A

Check the patient first

high pressure alarm = increased resistance from pt coughing, needing to be suctioned, tubing popped off

Low pressure alarm = disconnect of tubing somewhere

97
Q

What is the weaning criteria for someone on a vent

A
  • acceptable ABGs
  • patient breathing on their own
  • intact gag
  • ability to cough
  • ability to take a deep breath
  • FiO2 < 50%
98
Q

What is Homan’s sign

A

Test for DVT
pain in calf on dorsiflexion is a positive sign of DVT

99
Q

What is this

A

Right mid lung pneumonia

100
Q

What is this

A

Left lung atelectasis

101
Q

What is this

A

COVID - acute respiratory distress syndrome (ARDS)

102
Q

Which of the pulmonary function tests are used to determine readiness to be weaned from a vent

A

Even more helpful if you have baseline PFT data
- tidal volume
- vital capacity
- negative inspiratory force

103
Q

What are some symptoms of acute respiratory distress in a patient who is on a vent

A
  • agitation
  • extreme anxiety
  • chest pain
  • mental status change
  • CV decompensation
  • sweating
  • change in respiratory pattern
  • arrhythmias
104
Q

What are some specific causes of acute respiratory distress in a vented patient

A
  • right main stem intubation (hear less or no breath sounds on left)
  • esophageal intubation (see abdominal distention)
  • self extubation
  • mucus plug
  • barotrauma (pneumothorax)
  • GI-bleeding (stress ulcer)
  • patient-ventilator asynchrony
  • failure to wean
105
Q

What is ventilator associated pneumonia

A

Pneumonia caused by an infection related to poor vent care
- Considered a never event
- increases length of stay
- insurance wont cover it; hospital pays

106
Q

What are some (non-preventable) risk factors of VAP

A
  • being on a ventilator
  • advanced age
  • pre-existing lung disease
  • immune suppression
  • malnutrition
  • NG tubes
107
Q

How do we prevent VAP

A
  • hand washing
  • maintain HOB > 30 degrees
  • oral hygiene w/chlorohexidine
  • secretion management
108
Q

What is SBAR

A

Communication for handoff of patients to next shift nurse
S - situation
B - background
A - Assessment
R - recommendation

NUR 340 (10 decks)

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