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nur 356 peridot > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Cardiac Output = ? x ?

A

CO= HR x SV

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2
Q

What is Cardiac Output?

A

The amount of blood pumped by each ventricle in one minute.

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3
Q

What is Stroke Volume?

A

The amount of blood ejected from the ventricle with each cardiac cycle

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4
Q

What is ejection fraction?

A

the measurement of the percentage of blood leaving your heart each time it contracts (how much blood is actually leaving the heart. is calculated by dividing the stroke volume by the end diastolic volume)

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5
Q

What are some labs for the diagnosis of hypertension?

A 
BP
Urinalysis
BUN and serum creatinine
Creatinine clearance
Serum electrolytes and glucose
Serum lipid profile (cholesterol)
Uric acid levels
ECG (electrical current of heart)
Echocardiogram (look at flow of blood in heart)
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6
Q

Hypertension complications: what organs can hypertension affect/damage?

A 
Heart
Brain
Vasculature (peripheral vascular disease)
Kidney
Eyes
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7
Q

What are some ways to control/reverse hypertension?

A 
Weight reduction
DASH eating plan
Dietary sodium reduction
Limit alcohol intake
Physical activity
Avoidance of tobacco products
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8
Q

Furosemide

  1. What is it?
  2. Complications?
  3. Contraindications?
  4. What to monitor?
  5. When to administer?
A
  1. Loop Diuretic, diuresis for 8 hours
  2. Complications: hypotension, dizziness, dehydration, electrolyte imbalance, hypokalemia, hypoglycemia (think insulin and K+), urinary frequency
  3. Contraindications: ototoxic meds, h/o CV disease, diabetes, lithium, digoxin, other antihypertensives (risk of hypotension)
  4. Monitor: BP (always take BP before administering a BP med), daily weight (water loss/gain), lung sounds, glucose levels, electrolyte levels. Make sure patient supplements with potassium-rich foods
  5. Administer in morning to avoid nocturia.
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9
Q

What is something you should always educate the patient on with antihypertensive medicines?

A

Orthostatic hypotension. High risk from laying to sitting and from sitting to standing.

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10
Q

Beta Blockers

  1. List some examples
  2. What do they do?
  3. Complications?
  4. Nursing Implications/Monitor?
  5. What is special about Carvedilol?
A
  1. Metoprolol; Carvedilol
  2. Beta blockers reduce blood pressure by blocking epinephrine which causes the heart to beat more slowly/with less force. This lowers the BP.
  3. Complications: bradycardia, hypotension, decreased heart contractility
  4. Monitor: BP, HR, cardiac rhythm, orthostatic hypotension.
  5. Carvedilol offers cerebral protection and protects the vasculature in the brain.
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11
Q

ACE Inhibitors

  1. Example
  2. What do they do? How do they work?
  3. Risks?
  4. Monitor?
  5. What is a common side effect?
A
  1. Lisinopril
  2. Vasodilation. ACE inhibitors blocks ACE in the body (ACE causes the blood vessels to tighten), and as a result, the blood vessels tighten. This lowers the blood pressure and increases the supply of blood and O2 to the heart. It can also be used to treat heart failure
  3. Risks: dry cough, hypotension, hyperkalemia (RAAS system effects), angioedema
  4. Monitor: BP, HR, Cough, Labs
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12
Q

Vasodilators

  1. Example?
  2. What do they do and how?
  3. Risks?
  4. Monitor?
A
  1. Hydralazine
  2. Reduces the circulating blood volume and improves coronary artery circulation by causing arteriolar dilation in smooth muscle.
  3. Risks: dizziness, weakness, hypotension
  4. Monitor: BP and mental status
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13
Q

Digoxin/Digitalis

  1. What is it? What does it do and how?
A
  1. Positive inotrope. Increases heart contraction, alters electrical activity and neurohormonal systems.
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14
Q

Morphine

What does it do and how?

A

Reduces pulmonary congestion and anxiety by vasodilating and decreasing the chemoreceptor response to hypoxia.

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15
Q

What is a hypertensive crisis?

A

Systolic > 180 mmHg
and/or
Diastolic > 110 mmHg

Can be greater than 220/140.

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16
Q

What is the normal ejection fraction?

A

60%

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17
Q

Right sided HF

What is it?

S/S?

A

blood backs up into venous system (body)

Peripheral edema, sudden weight gain, abdominal distension

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18
Q

Left-sided heart failure

What is it?
S/S?

A

Blood backs up into lungs

This is the most common HF!!! Left almost always fails first because it pumps blood out of the heart and it is bigger so it needs more muscle.

S/S: pulmonary edema (crackles/wheezing, abnormal S3 or S4, frothy blood-tinged sputum), use of accessory muscles, anxiety, cool/clammy skin, dyspnea, orthopnea, tachypnea, cough.

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19
Q

Chronic Heart Failure.

FACES

A 
F: fatigue
A:  limitation of Activities
C:  Chest congestion/Cough
E:  Edema (3rd spacing)
S:  Shortness of breath
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20
Q

What is the P wave?

A

Visual representation of the electrical impulse over the Atria

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21
Q

How many seconds should the P wave be?
How many boxes?

What should the shape of the P wave be?

A

Less than .12 seconds.
Less than 3 small boxes
Small, round

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22
Q

What is the PR interval?

Normal PR interval time?

A

Time between the start of the P wave and the start of the QRS complex
Normal time: .12-.20 seconds (3 to 5 small boxes)

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23
Q

What is the PR interval?

Normal PR interval time?

A

Time between the start of the P wave and the start of the QRS complex
Normal time: .12-.20 seconds (3 to 5 small boxes)

24
Q

What is the QRS complex?

What should it look like?

Normal time for it.

A

Representation of the electrical impulse over the ventricles. Represents the “shooting out” super fast up through the purkinje fibers.

Should look Tall, sharp, and skinny, like a “supermodel”

Should be 0.6-0.11 seconds.

25
Q

ST segment

What shape should it be?

A

Should be flat! (isoelectric)

26
Q

T wave
What does it represent?
What should it look like?

A

Represents the relaxation of the ventricles before the next cardiac cycle. (Filling of the ventricles!!!)

Should appear upright, round, and roughly 2-3 times larger than the P wave.

27
Q

QT interval
What does it represent?
Where does it start/end?
What is the normal time range?

A

Represents the entire VENTRICULAR cycle!

Begins at the start of the QRS complex and ends at the END of the T wave.

Normal time range: .36-.44 seconds. Critical cut off is greater than .50 seconds.

28
Q

Normal measurement of PR interval

A

0.12-.20 seconds

29
Q

Normal QRS Complex measurement:

A

0.6-.11 seconds

30
Q

Normal measurement for QT interval:

A

0.36-.44 seconds. Needs to be less than 0.50 seconds.

30 ish to 40ish seconds.

31
Q

What are the 3 things you should MEASURE in an ECG?

A
  1. PR interval
  2. QRS complex
  3. QT interval
32
Q

What is atrial rhythm?

A

When the rhythm is generated in either atria, either an entire rhythm or an individual beat. P wave will look abnormal.

33
Q

How many liters O2 can you use with nasal cannula?

When do you add humidification

A

1-6L/min.

Add humidification after 4L per minute

34
Q

Bag valve mask

How many liters does it deliver?

A

15 L/min

90-95% inspired O2 concentration

35
Q

Simple face mask

How many liters O2 does it deliver?

A

6-10 L/min

40-60% inspired O2 concentrations

36
Q

What is PaO2?

A

Partial pressure of O2 in arterial blood. This is the O2 dissolved in plasma.

Expressed in mmHg

Arterial Blood gasses (ABGs)

37
Q

What is SaO2?

A

Arterial oxygen saturation. This is the amount of O2 bound to hemoglobin

Expressed in a percentage. This would be the pulse-oximeter.

38
Q

What is ventilation?

A

Process by which we inhale and exhale

39
Q

What is elastic recoil?

A

the tendency of lungs to return to their original size. This will depend on lung tissue and the available space within ITC.

40
Q

Compliance and resistance

A

measure the ease of expansion of muscle use around the rib cage.

41
Q

Subjective data of a repsiratory assessment

A

Past health Hx, medication, surgery, other treatments.

Ask about shortness of breath, pain with breathing, cough, sputum production/color, wheezing.

42
Q

Objective data in a respiratory assessment

A 
Respirations (rate, quality, pattern)
Accessory muscle use
Mouth/nose breathing
position of trachea
Shape/symmetry/movement of chest wall
skin/nails for integrity and color
palpate chest/back for abnormalities
ausculate lung sounds
Diagnostics:  ABGs, CXR, Hbg, Hct.
43
Q

Normal hemoglobin levels

A

?

44
Q

Normal hematocrit levels

A

?

45
Q

What is Pneumonia?

A

Acute infection of lung parenchyma. Results when defense mechanism become incompetent or overwhelmed resulting in a decrease cough and epiglottal reflexes which may allow aspiration.

46
Q

What are the 3 ways pneumonia can occur/organisms can reach the lungs?

A
  • Aspiration: from nasopharynx or oropharynx
  • Inhalation: of microbes
  • Hematogenous: spread from primary infection elsewhere in the body
47
Q

2 types of pneumonia

A

CAP/Community- acquired Pneumonia

HAP/Hospital-Acquired Pneumonia

48
Q

What classifies HAP?

A

Pneumonia occurring 48 hours or longer after hospitalization and was not present at time of admission.

49
Q

What classified CAP?

A

pneumonia occurring in patients who have NOT been hospitalized or resided in a long term care facility within 14 days of the onset of symptoms. This can be treated at home or in the hospital, depending on Pt condition. Start empiric ABX therapy asap.

50
Q

Clinical manifestations of PNA

A 
Cough
Fever
Chills
Dyspnea
Tachypnea
Pleuritic chest pain (pain with deep breaths)
green/yellow/rust colored sputum
confusion in older adults
nonspecific manifestations
51
Q

What are some things you would typically find in a physical examination of someone with PNA?

A
52
Q

What is hematocrit?

Normal Hematocrit levels M and F:

A

Rapid measurement of RBC number and volume
M: 42-52%
F: 37-47%

53
Q

Hemoglobin
(measurement of total hemoglobin in circulating blood)
Normal Hemoglobin values, M and F:

A

M: 14-18 g/dL
F: 12-16 g/dL

Think puberty

54
Q

Normal WBC lab values:

A

5,000-10,0000

55
Q

Normal platelets lab value:

A

150,000-400,000

56
Q

Normal blood glucose value

A

74-106 mg/dL

Critical values: <40 or >450

nur 356 peridot (2 decks)

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