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Med Surge > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Why are disease modifying antiheumatic drugs used to treat RA?

A

Because it is an immuno suppressant that slows progression

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2
Q

What drug is given to manage pain for patients with a hip fracture?

A

Morphine

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3
Q

What age does type 2 diabetes typically affect?

A

Middle to older adults

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4
Q

What is normal range for PT?

A

11-12.5 seconds

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5
Q

What is fosamax?

A

A biophosphanate given to patients with osteoporosis as a precaution

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6
Q

What is a major complication of left sided heart failure?

A

Pulmonary edema

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7
Q

Describe Skeletal traction

A

Done through pins and wires attached to bone coming through skin. It is important to do pin care on these patients.

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8
Q

Describe the contraction of the heart muscle.

A

SA Node fires within the top right atria which causes the atria to contract then sending an electrical signal to the AV Node located at the bottom of the atria.
The AV node sends an electoral signal to the Bundle of His which then travels down and breaks into the left and right bundle branch.
The left and right bundle branch then travel to the Purkinje fibers causing them to fire.
The firing of the Purkinje fibers is what causes the ventricles to contract

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9
Q

How do you treat symptomatic sinus bradycardia?

A

Atropine, oxygen, treat underlying problem, pacemaker

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10
Q

Why are beta-blockers given to HF patients?

A

Beta blockers increase EF over time

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11
Q

What part of the body is affected in Buerger’s Disease?

A

Distal extremeties (hands/ feet)

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12
Q

Describe arthroplasty.

A

A routine surgery that also involved an open reduction internal fixation (ORIF)

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13
Q

What causes Raynaud’s phenomenon?

A

Vasospasms that cut off blood supply

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14
Q

Describe ventricular fibrillation

A

A chaotic rhythm.
No P,QRS, and T wave
No BP, No HR, No RR

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15
Q

How often should a patient do calf pumps when driving or flying long distances?

A

Once an hour

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16
Q

What can cause sinus bradycardia?

A

Valsalva maneuver or rectal stimulation

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17
Q

How do you treat v-tach?

A 
Check ABCs
Call for help
Check a pulse
Start CPR if needed
Use defibrillator if needed
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18
Q

Why are NSAIDs a last resort of treatment for osteoarthritis?

A

Because it is so harsh on organs – especially the stomach

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19
Q

What are the clinical manifestations of right sided heart failure?

A 
SOB
Chest pain
JVD
Increased abdomen girth
Dependent edema
Hepatomegaly
Ascites
Edema
Weight (most reliable indicator of fluid gain/loss)
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20
Q

Which type of arthritis is a degenerative joint disease that progresses over time?

A

Osteoarthritis

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21
Q

What is another name for asynchronized shock?

A

Defibrillator shock

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22
Q

What type of insulin is Humulin NPH?

A

Intermediate acting insulin.

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23
Q

How do you prevent hip dislocations post op?

A

Abduction pillow

Straight alignment

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24
Q

What are late symptoms of RA?

A

Joint deformities
Severe pain
Weight loss

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25
Q

Why is diabetes type 1 considered an autonomic disorder?

A

Because patients are born with the disease. The pancreas does not have enough insulin to secrete.

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26
Q

What happens to the heart when the EF range is less than 50%?

A

There is less perfusion because blood pressure is dropping and the heart is not beating hard enough.

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27
Q

What are complications of osteoporosis?

A

Bone fractures

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28
Q

When can a diabetic patient not exercise?

A

When they are positive for ketones, when blood glucose is higher than 250 or lower than 80, with in one hour of peak insulin time or when they develop fruity breath or kussmaul respirations

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29
Q

How do you clean skeletal tractions?

A

Cleanse with NS or 50/50 NS and peroxide. Rinse with NS.

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30
Q

What surgery is done for osteoarthritis?

A

Arthroplasty (joint replacement)

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31
Q

What are three things that alter venous flow?

A

Thrombus
Defective valves
Non-contracting muscles.

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32
Q

Why is early treatment so potent for RA?

A

Because the goal is to prevent deformities

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33
Q

What is the treatment for osteomylitis?

A

Antibiotic therapy for weeks

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34
Q

How is type 2 diabetes treated?

A

First with pills and then insulin if needed.

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35
Q

What age group are hip fractures most common in?

A

Older adults

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36
Q

What are the risk factors for type 2 diabetes?

A

Overweight, no exercise, office workers, smoking, heart disease, age

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37
Q

Why does the patient with HF need to do calf pumps?

A

To help prevent DVT’s in legs and helps reduce swelling in ankles

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38
Q

Describe Normal Sinus Rhythm

A

Normal P,QRS, and T wave, Rate is between 60 and 100bpm and no PVCs

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39
Q

When a patient is hemodynamically unstable, who do you call for help?

A

Rapid

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40
Q

What is damaged in left sided heart failure and where do you exhibit symptoms?

A

The rest of the body is damaged in left sided heart failure and the symptoms are shown in relation to the lungs (SOB–crackles due to fluid back up in the lungs)

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41
Q

What are the four different types of medications that are used to treat diabetes?

A

Sulfonylurea agents, Biguanides, Insulin Sensitives, and Insulin

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42
Q

How are DVT’s diagnosed?

A

Ultrasound of extremity

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43
Q

How is atropine administered? What happens if atropine is not administered correctly?

A

Atropine must be pushed fast. If it is not pushed fast, it has a paradoxical effect – makes the heart rate even slower

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44
Q

What is the purpose of insulin?

A

to move glucose from blood to the muscles and cells for energy

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45
Q

How would you treat a patient who is having a hypoglycemic episode?

A

Juice or hard candy followed by protein

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46
Q

Which type of arthritis is crippling?

A

RA

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47
Q

Describe fem/pop bypass procedure for managing PAD

A

Dilating a balloon

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48
Q

What is normal range for glucose tolerance test?

A

Less than 140

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49
Q

Define afterload

A

Amount of tension in the left ventricle during systole

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50
Q

For the HF patient, how much sodium can they intake in a day?

A

2-3 grams a day

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51
Q

What A1C level is needed to diagnose diabetes?

A

Greater than 6.5%

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52
Q

What are signs and symptoms of sinus tachycardia?

A 
Fatigue/ weak
SOB or orthopnea
Decreased pulse ox stat
Hypotension
Chest pain
Dehydration
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53
Q

What is Humulin 70/30?

A

a combination of Regular and Isophane insulin.

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54
Q

What are some post op nursing considerations for hip replacements?

A 
Assess patient for high risk for falls
Assess for confusion
Early ambulation
Prevent skin breakdown
Anticoagulant therapy
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55
Q

After a cast is placed, what is the nurse responsible for?

A

Neurovascular check

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56
Q

When do you hold beta blockers, calcium channel blockers and digoxin and call the doctor?

A

When the heart rate is less than 55

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57
Q

What medications are given to HF patients?

A 
Venous vasodilators
Morphine
Diuretics
ACE/ARBs
Beta blockers
Digoxin
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58
Q

What is normal HDL levels?

A

Men: >45
Women: >55

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59
Q

Where does the left ventricle get blood from and where does it send blood to?

A

It gets blood from the lungs and pumps to the body

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60
Q

What is the second step when treating hypotension?

A

Give fluids

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61
Q

What is normal triglyceride levels?

A

Men: 40-160
Women: 35-135

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62
Q

What is the therapeutic level of digoxin?

A

0.5-2

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63
Q

Why is osteoporosis referred to as the silent disease?

A

Because the first signs in most people follow some kind of fracture.

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64
Q

Describe the onset of type 2 diabetes.

A

Slower and progressive

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65
Q

How much carbohydrates should a diabetic patient consume?

A

45% of intake should be carbohydrates

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66
Q

What is the priority for a patient who is in v fib?

A

Defibrillate as soon as possible.

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67
Q

If your patient is in v tach and not responsive, what should you do?

A

Call code blue and start compressions

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68
Q

Which type of arthritis is a non inflammatory disease?

A

Osteoarthritis

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69
Q

What type of diabetes is Glipizide used for?

A

Type 2

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70
Q

Where does the right atrium get blood from and where does it send blood to?

A

It gets blood from the body and sends to the lungs

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71
Q

Describe atrial fibrillation

A

Atria have more electoral contractions. These contractions cause the quivering between the QRS segments seen on an EKG strip.

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72
Q

How are flexion contractures treated?

A

Prone position 2-3 times a days. Gravity will help straighten it out.

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73
Q

What are some non surgical ways you can manage peripheral arterial disease?

A

Exercise and positioning
Promote vasodilation
Antiplatelet agents

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74
Q

How do you treat DVTs?

A 
Bed rest
Elevate leg
NO SCDs
Do not massage
Give heparin
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75
Q

What is peripheral venous disease?

A

When the veins do not operate properly

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76
Q

What are the sick day rules?

A

Notify health care provider
Monitor your blood glucose levels every 4 hours
Test urine for ketones if BS is >240
Continue to take insulin and oral diabetic agents
Drink 8-12 oz of sugar free fluids
Try to eat regularly
Get plenty of rest
Call for help if you have persistent N/V, ketones, or a temp higher then 101.5

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77
Q

What causes heart failure?

A

Hypertension
MI
Valve insufficiency

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78
Q

What is the main fuel for the central nervous system?

A

Glucose

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79
Q

What is the formula for calculating heartbeats per minute?

A

number of QRS segments multiplied by 10 (this works with a 6 second strip)

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80
Q

Is NPH clear or cloudy?

A

Cloudy

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81
Q

What are some post op considerations for arthroplasty on the knee?

A

CMP machine, PT, OT, CMS checks

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82
Q

Describe a stasis ulcer

A

Never circular, deep all the way down, looks like and even crater

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83
Q

Where should unused insulin be stored?

A

in the refrigerator

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84
Q

Describe Sinus bradycardia

A

Normal P,QRS, and T wave

Rate is less than 60 bpm

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85
Q

How many days is a bottle of insulin good for after opening?

A

28 days

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86
Q

What is the level needed to diagnose diabetes for fasting blood glucose?

A

greater than 126

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87
Q

When is it appropriate to administer 1 mg of glucagon?

A

When a patient is severely hypoglycemic (<20 blood glucose)

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88
Q

What is the number 1 goal for patients with osteoporosis?

A

Prevent broken bones and promote patient safety

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89
Q

Short acting insulin onset?

A

30-90 minues

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90
Q

What type of insulin is Lispro?

A

Rapid acting insulin (regular)

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91
Q

What is the downside to using disease modifying antiheumatic drugs to treat RA?

A

It increases the risk for infection.

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92
Q

What is malignant hypertension?

A

Hypertension that occurs during sleep time and the patient does not know that is is extremely high.

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93
Q

Short acting insulin peak?

A

2-5 hours

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94
Q

Which type of arthritis affects bilateral joints?

A

RA

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95
Q

What are some side effects associated with Pioglitazone?

A

Increased risk of heart failure, bone fracture, macular edema, liver impairment and bladder cancer.

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96
Q

What are the two types of heart failure

A

Left sided and right sided

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97
Q

Define preload

A

Amount of stretch in the ventricle just before systole (contraction)

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98
Q

Rapid acting insulin onset?

A

15-20 minutes

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99
Q

What can cause PVC’s to occur?

A

Hypokalemia, stress, hypoxia, irritability

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100
Q

Why do HF patients need to have their electrolytes tested?

A

because many HF patients are on diuretics and will need replacement of mainly potassium if not others.

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101
Q

What glucose level is considered severe hypoglycemia?

A

Less than 20

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102
Q

How would you treat a patient who is having a hyperglycemic episode?

A

Water and insulin

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103
Q

How long are pre filled insulin syringes good for?

A

30 days

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104
Q

What are the risk factors associated with RA?

A

Females
Possible genetics
Smoking
Other immune disease diagnosis

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105
Q

What is neuropathy?

A

Damage to the nerves

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106
Q

If a patient is on potassium, what do they also have to be on?

A

Telemetry

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107
Q

When do you administer a small dose of heparin?

A

When you a preventing a patient from getting a DVT

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108
Q

For the HF patient, what are restrictions to weight gain?

A

Do not gain more than 2 lbs in a day or 3 lbs in a week

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109
Q

What are signs and symptoms to hypertension

A

Headaches
Facial flushing
Dizziness
Fainting

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110
Q

Describe Skin (Bucks traction)

A

A weight system with a sling on the patient.Weights are suspended in the air to cause traction on the joint through the use of wraps pulling the joint in the desired direction.

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111
Q

What is normal range for PTT for a patient who is on heparin?

A

1.5 -2.5 times the normal control

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112
Q

What tests are done to diagnose Osteoarthritis?

A

X Rays and MRIs because they show the inflammation (blood work is only done to rule out other problems)

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113
Q

What is the mode of action of Biguanides?

A

Increases insulin sensitivity

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114
Q

What are triggers of Raynaud’s phenomenon?

A

Cold and stress

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115
Q

How do you treat v fib?

A

If there is no pulse, still check patient!
Call for help
Do CPR
Defibrillate!

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116
Q 
Cool and clammy
Anxious/ nervous
Mental confusion
Weakness
Blurred vision
Tachycardia
Seizures
Coma
Hunger
Palpitations
Glucose <70

are signs and symptoms of what?

A

Hypoglycemia

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117
Q

What insulin can be mixed?

A

All insulins can be mixed using the clear to cloudy method except Lantus. Lantus cannot be mixed with anything.

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Perfectly
118
Q

What are the proper steps for doing an accucheck?

A 
Wipe area with alcohol
Wait for area to dry (do not blow on it)
Get rid of first drop of blood
Wipe with clean gauze
Fill strip completely
Leave mete on flat surface while it reads
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119
Q

What are some side effects of glipizide?

A

hypoglycemia, weight gain (also interacts with many other medications)

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120
Q

True/False: An opened insulin bottle must be kept refrigerated.

A

FALSE

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121
Q

What kind of diet should a patient with osteoporosis be on?

A

A healthy diet in calcium and vitamin D

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122
Q

Intermediate acting insulin duration?

A

16-24+ hours

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123
Q

Why do patients with peripheral arterial disease lose hair in the legs?

A

Because their is poor circulation so the nutrients needed for the hair follicle to survive are never delivered which causes the hair to fall out.

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124
Q

Long acting insulin onset?

A

2-4 hours

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125
Q

What can neuropathy lead to if not taken care of?

A

Amputation

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126
Q

How is digoxin excreted?

A

It binds to potassium and leaves the body through urine

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127
Q

How is fosamax given to patients?

A

Pts must be sitting upright during and 30 - 60 minutes after to reduce the risk of gerd and aspiration. It must also be given with a full glass of water

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128
Q

What labs should be monitored when a patient is on metformin?

A

BUN/ creatine

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129
Q

What is the recommended time a diabetic patient should spend exercising?

A

150 minutes a week for moderate exercise or 75 minutes a week for vigorous exercise

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130
Q

What are the risk factors associated with Osteoarthritis?

A 
Age
Female
Smoking
Obesity
Repetitive motion
Joint injuries
Wear and tear
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131
Q

How do you treat asymptomatic PVCs?

A

Just monitor the patient.

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132
Q

Besides nitrates, what is another vasodilator?

A

Isorbide Dinitrate

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133
Q

Describe aortoiliac or aortofemoral bypass procedure for managing PAD

A

Rerouting blood flow to different area. You reroute it to bypass the plaque.

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134
Q

If the patient complains that the potassium is burning, what can the nurse do?

A

Slow down the rate or call pharmacy and ask them to dilute it with lidocaine

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135
Q

What is another name for typical venous disease?

A

Peripheral venous disease.

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136
Q

Why is B-type natriuretic peptide (BNP) tested for patients suspected of HF?

A

Because BNP is an enzyme that is released by the heart muscles when they are under preload. This enzyme is a degree of HF the patient is in.

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137
Q

Is type 1 or type 2 diabetes more rare?

A

Type 1 is more rare.

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138
Q

Why do patients who are hypoglycemic exhibit mental confusion?

A

Because there is a lack of glucose getting to the brain.

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139
Q

Long acting insulin duration?

A

24 hours

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140
Q

What shows depolarization on an EKG?

A

The p wave and the QRS complex

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141
Q

What is normal range for INR?

A

0.9-1.2 seconds

142
Q

What is normal range for A1C?

A

4-6%

143
Q

What is type 1 diabetes treated with?

A

Insulin only

144
Q

What is the mode of action of sulfonylureas?

A

Releases insulin

145
Q

Which diabetic medications is extremely harsh on the patient’s kidneys?

A

Metformin (glucophage)

146
Q

What is a normal level for BNP?

A

less than 100

147
Q

What part of the body usually experiences signs and symptoms of neuropathy first?

A

The toes

148
Q

What are the two types of arthritis?

A

Osteoarthritis and Rheumatoid Arthritis

149
Q

How much fiber should a diabetic patient consume?

A

25g for women

38g for men

150
Q

What is the purpose of an urinalysis to diagnose a patient with HF?

A

To get the specific gravity level. It will show the concentration of urine. The specific gravity will increase in patients with HF due to the lack of urine that is being produced.

151
Q

Intermediate acting insulin onset?

A

1.5 hr-4 hours

152
Q

Describe prefilled syringes

A

Insulins that are within pens that are prefilled with a certain amount of insulin.

153
Q

Which type of arthritis is an autoimmune disease where the patient’s body destroys the joints?

A

RA

154
Q

How do you treat asymptomatic sinus bradycardia?

A

Do nothing!!

155
Q

What tests are done to diagnose RA?

A 
RA factor
ANA
ESR (sed rate)
X Rays
Bone scans/ CT Scans
156
Q

Why do you elevate the leg when a patient has a DVT?

A

To allow blood flow to go back

157
Q

Why is tylenol used for treating Osteoarthritis?

A

Because it blocks pain

158
Q

How is RA treated?

A

Anti-inflammatories
Analgesic
Disease modifying antiheumatic drugs

159
Q

What are the assessments done for a neurovascular check?

A 
Color/ cap refill
Movement
Sensation
Temperature
Pulse
160
Q

What type of disorder is type 2 diabetes?

A

Progressive

161
Q

True/False: A diabetic patient can exercise vigorously on a routinely basis.

A

FALSE

162
Q

Describe an incomplete facture.

A

Bone only broken part way through

163
Q

How do you treat asymptomatic sinus tachycardia?

A

Do nothing!

164
Q

What is another name for capillary blood glucose?

A

Accuchecks!

165
Q

What are signs and symptoms of severe arterial disease?

A

Cold and cyanotic
Pallor may occur with extremity elevation
Dependent rubor with dangling

166
Q

What are signs and symptoms of dig toxicity?

A

Bradycardia, halos, visual disturbances, excessive night time urinating

167
Q

Which insulin is the only insulin type that can be given IV?

A

Regular!

168
Q

What are the risk factors associated with osteoporosis?

A 
Age
Family history
Low body weight
Chronic low calcium and vitamin D
Lack of exercise
169
Q

How can a diabetic patient prevent nephropathy?

A 
Control blood sugar
Control hypertension
Stop smoking
Prevent UTI's
Avoid contrast dyes
Avoid Nephrotoxic drugs
170
Q

Describe ventricular tachycardia

A

No visible P,QRS, and T waves

Rate is usually 130-150 bpm (sometimes without a pulse)

171
Q

What can atherosclerosis lead to?

A

Coronary artery disease

172
Q

What specific electrolyte needs to be monitored for patients that are on digoxin?

A

Potassium

173
Q

Why is it important to control blood pressure (especially for diabetics?)

A

Because kidneys help regulate blood pressure so controlling blood pressure will help kidneys out.

174
Q

What would give off a positive result for orthostats?

A

If there is a 20 mmHg drop in systolic and/ or a 10 mmHg drop in diastolic

175
Q

Describe an open reduction.

A

Done in a surgical setting where a surgeon realigns the bone and places rods, pins and screws if necessary.

176
Q

What are the signs/ symptoms of neuropathy?

A

Pain, tingling, numbness in extremeties

177
Q

Intermediate acting insulin peak?

A

4-12 hours

178
Q

Describe and Open/ Compound fracture.

A

Bone protruding through the skin

179
Q

How much potassium can be administered through a central line?

A

20 mEq/ hr

180
Q

What is the level needed to diagnose diabetes for glucose tolerance test?

A

greater than 200

181
Q

Short acting insulin duration?

A

5-8 hours

182
Q

How much protein should a diabetic patient consume?

A

15-20% of intake should be protein

183
Q

What are symptoms of Osteoarthritis?

A

Inflammation
Joint pain and tenderness
Stiffness (usually in the morning)
Crepitus of the joint (cracking of the cartilage)
Stiffness in the morning that gets better as the day goes on

184
Q

Polyuria, polydipsia, polyphagia, vomiting, abdominal pain, dehydration, weakness, confusion, shock and coma are all classic manifestations of what?

A

DKA

185
Q

What are the clinical manifestations of phlebitis?

A

Area is reddened and warm

186
Q

Describe osteoporosis.

A

a chronic metabolic disease in which bone loss causes decreased bone density and increases the risk of fractures.

187
Q

What are the two classifications of fractures?

A

Open/ Compound or

Closed/ Simple

188
Q

How much sugar should a diabetic patient consume?

A

NO SUGAR!!

189
Q

What are symptoms of phelbitis?

A

Painful, radiating up arm

190
Q

What are some side effects of metformin?

A

abdominal discomfort, lactic acidosis, interacts with contrast dye and can cause kidney failure.

191
Q

What is normal range for APTT

A

30-40 seconds

192
Q

What type of exercising should a patient with osteoporosis consider?

A

Weight bearing and muscle strengthing

193
Q

What is normal range for APTT for a patient who is on heparin?

A

1.5 -2.5 times the normal control

194
Q

What is the greatest concern for VTE?

A

Thrombus

Embolism

195
Q

What should a diabetic patient eat before exercising?

A

Carbs

196
Q

What must be checked before giving insulin?

A

Glucose

197
Q

Why can’t older patients receive demerol?

A

Because it causes confusion and confusion is also a sign on infection

198
Q

How do you treat compartment syndrome?

A

Treatment is to slice the skin open and release the pressure.

199
Q

What are signs and symptoms of v-tach?

A

Palpitations, SOB, dizziness, chest pain

200
Q

How can diabetic patients prevent neuropathy?

A

Control blood sugar

201
Q

How do you administer prefilled syringes?

A

Dial the chamber to the units that are desired for administration

202
Q

Describe phlebitis.

A

Inflammation of superficial veins

203
Q

What are some complications of fractures?

A

Fat embolisms and compartment syndrome

204
Q

What is normal range for blood sugar?

A

70-110

205
Q

Can type 1 diabetics receive PO medication for treatment?

A

No, they are treated with insulin only!

206
Q

What shows repolarization on an EKG?

A

The PR interval and the T wave

207
Q

What is the age of onset for type 1 diabetes?

A

Usually less than 30 years old

208
Q

What are some health promotion topics related to DVTs?

A 
Oral contraceptives
No smoking
Drinking fluids
Doing leg exercises
Walking
Wearing SCD's
Calf pumps
Phlebitis from IV sites
209
Q

What is another name for typical arterial disease?

A

Peripheral arterial disease.

210
Q

Why is an echocardiogram performed on a patient with HF?

A

Because it is the only definitive way of seeing the patients EF without invasive procedures

211
Q

Describe Buerger’s Disease

A

Occlusion of vasculature caused by an allergic reaction to smoking

212
Q

How is osteoporosis diagnosed?

A

Dual x ray absorptionmetry – DXA

213
Q

What are some invasive interventions to help manage peripheral arterial disease?

A

Percutaneous translumal angioplasty
Atherectomy
Fem/Pop bypass
Aortoiliac or aortofemoral bypass

214
Q

What is osteomylitis?

A

Infection of the bone

215
Q

What drug class is Nitrates?

A

Venous vasodilators

216
Q

What does a patient need to check before taking their calcium channel blocker or beta blocker medication?

A

Heart rate and blood pressure

217
Q

What is the range for fasting blood glucose that is considered pre-diabetic?

A

100-126

218
Q

What is normal LDL levels?

A

60-180

219
Q

What is the first step for trying to treat hypotension?

A

Lay flat

220
Q

When should the needle be changed on a CSII pump to reduce skin irritation and infection?

A

Every 2 to 3 days

221
Q

What is the purpose of CMP machine?

A

it is used to flex and extend the knee joint

222
Q

Which type of arthritis is an inflammatory disease?

A

RA

223
Q

Describe a Closed/ Simple fracture.

A

Bone kept within the skin layers

224
Q

Which patient will be attended to first? Hyperglycemic or hypoglycemic?

A

Hypoglycemic

225
Q

Describe Asystole

A

No electrical firing of the heart

226
Q

What types of fat must be avoided for diabetic patients?

A

Saturated fats like butter and shortening oil

227
Q

Define ejection fraction

A

The percentage of blood ejected from the heart during systole.

228
Q

What types of food should a patient with atherosclerosis stick to?

A 
Fruits
Vegetables
Whole grains
Fat-Free and Low fat dairy
Lean meats
229
Q

What can happen if malignant hypertension is left untreated?

A

It can lead to renal failure and puts the patient at a high risk for strokes

230
Q

What is the mode of action of insulin sensitizes?

A

Decreases glucose production

231
Q

What are the nursing interventions for heart failure patients?

A 
Minimal fluids or saline lock
Monitor I's &amp; O's
Low sodium diet
Rest
SCD's
Oxygen
Bedside commode or bedpan
Fluid restriction
Don't overexert
232
Q

What are complication of hypertension?

A

Stroke, coronary artery disease, valve disease, headaches, fatigue, activity intolerance

233
Q

What is atherosclerosis?

A

Plaque buildup in the arteries

234
Q

Describe how you would mix insulin

A

Administer air of units into cloudy
Administer air of units into clear
Draw clear into syringe of desired units
Draw cloudy insulin into syringe of desired units.

235
Q

Describe premature ventricular contractions (PVC’S)?

A

the ventricle prematurely contracts when they are supposed to be at rest.

236
Q

What are basic leg exercises that the HF patient cant do?

A

Calf pumps

237
Q

What are signs and symptoms of DVT’s?

A

Calf or groin pain
Unilateral swelling
Redness and warmth
Painful

238
Q

What is the main symptom of malignant hypertension?

A

Headaches in the morning and blurred vision

239
Q

Rapid acting insulin duration?

A

3-5 hours

240
Q

Why is it important for the HF patient to ambulate slowly?

A

to reduce tiredness

241
Q

Rapid acting insulin peak?

A

1-3 hours

242
Q

What drug class is Pioglitazone?

A

Insulin sensitizes

243
Q

When should a diabetic patient test their glucose when exercising?

A

Before, during and after.

244
Q

What class of medication is glipizide?

A

Sulfonylurea

245
Q

What is the importance of early treatment for RA?

A

To prevent deformities

246
Q

Describe a complete fracture.

A

Bone severed all the way through

247
Q

Is hyperglycemia type 1 or type 2 diabetes?

A

type 1

248
Q

What is the range for pre-diabetic A1C level?

A

6.01-6.5%

249
Q

What kind of disorder is type 1 diabetes?

A

Autonomic

250
Q

What are indications of worsening or recurrent R/L sided heart failure?

A 
Rapid weight gain
Decrease in exercise tolerance
Excessive awakening at night to urinate
Development of dyspnea/ angina at rest
Increased edema in feet, ankles, hands
251
Q

Describe supine position

A

Laying flat

252
Q

Besides fosamax, what are two other medications given to patients with osteoporosis?

A

Boniva and actonel

253
Q

What does the T wave represent?

A

Repolarization of the ventricle.

254
Q

Why are bone scans and CT scans done to diagnose RA?

A

because you can see the joints twisting

255
Q

What are early symptoms of RA?

A

Inflammation
Joint pain and tenderness
Fatigue
Anorexia

256
Q

What are the three different types of treatments for fractures?

A

Casts and Immobilizations
Open/ Closed reductions
Traction

257
Q

Describe how you would take orthostatic vitals

A

Blood pressure is taken in three positions.
First lying down, then sitting up with feet dangling and then standing up. There would be a 2-5 minutes break in between each reading.

258
Q

What are the two types of traction used for fractures?

A

Skin (Bucks traction)

Skeletal

259
Q

Describe Kussmaul respirations

A

deep and rapid respirations

260
Q

What are co morbidities and what are some associated with diabetes?

A

Another disease process on top of what they already have. Hypertension, hyperlipidemia, metabolic syndrome

261
Q

What does a CXR test for?

A

Fluid in the lungs caused by HF

262
Q

What is the normal range for fasting blood glucose?

A

less than 100

263
Q

When are fat embolisms seen?

A

In a long bone break like the femur a fat embolism will form at the break.

264
Q

What is nephropathy?

A

Damage to the kidneys

265
Q

What can diabetic patients do to prevent injury to feet?

A

Wear shoes at all times, inspect feet daily, trim nails straight across, don’t soak feet

266
Q

Describe compartment syndrome.

A

Tissues become necrotic due to increased pressure against the fascia.

267
Q

How are flexion contractures prevented?

A

Range of motion

268
Q

Describe closed reduction.

A

Done in an ER or office setting. Bone is realigned with the help of force. The patient is sedated and through pulling of the limb (joing) in different directions by medical personal, the joint is put back into alignment.

269
Q

What happens if a patient does not know what triggered their acutre hf?

A

Change their medications

270
Q

What is the range for glucose tolerance test that is considered pre-diabetic?

A

141-200

271
Q

How much alcohol can a diabetic patient consume?

A

1 glass for women and 2 glasses for men

272
Q

What does peripheral vascular disease do to the body?

A

It alters natural flow of blood flow through arteries and veins of the peripheral circulation

273
Q

What are signs and symptoms of Buerger’s Disease?

A

red, painful sore

274
Q

What does the QRS complex represent?

A

Ventricle contraction

275
Q

What is normal range for ejection fraction?

A

50-70%

276
Q 
Warm and moist
Kussmaul Respirations
Obtunded/ stupor
Abdominal cramps
N/V
Ketones in urine
Metabolic acidosis
Glucose >250

are signs and symptoms of what?

A

Hyperglycemia

277
Q

What type of drug class is Methotrexate?

A

Disease modifying antirheumatic drug

278
Q

What supplements need to be given with a diuretic for a HF patient?

A

electrolyte supplements

279
Q

When a patient is experiencing sinus bradycardia and having chest pain, who do you call for help?

A

Rapid

280
Q

What are the characteristics associated with metabolic syndrome, a co-morbidity of diabetes?

A

Abdominal syndrome, hyperglycemia, A1C 5.5-6.0, hypertension, hyperlipidemia

281
Q

Is low preload and low afterload good or bad?

A

Good!

282
Q

What drug therapies are used for treating osteoarthritis?

A 
Tylenol
Topical lidoderm
NSAIDs
COX-2 Inhibitors
Cortisone injections
Muscle relaxants
283
Q

Which type of diabetes destroys beta cells?

A

Type 1

284
Q

What are the life threatening rhythms?

A

V tach, V fib, Asystole

285
Q

What glucose level is considered mild hypoglycemia?

A

Less than 60

286
Q

What are signs of sinus bradycardia?

A

Syncope, dizziness, confusion, hypotension, SOB, check pain

287
Q

True/False: Calcium treats and prevents osteoporosis from worsening.

A

False. Calcium just helps prevent from worsening

288
Q

What type of drug class is celebrex?

A

COX-2 inhibitors

289
Q

How are nerovascular checks is regards to cast placement?

A

They are done proximal and distal to break

290
Q

What are the benefits to exercise?

A

Because it decreases hypertention, body weight, insulin resistance, glucose tolerance, cardiovascular disease.

291
Q

How is osteoarthritis treated?

A

Start with least invasive and lowest drug treatment plan.

  1. Thermal Modalities
  2. Drug therapies
  3. Surgery
292
Q

Why is digoxin considered a last resort medication for patients?

A

Because of a small therapeutic window.

293
Q

Describe external insulin pumps.

A

Continuous subcutaneous infusion which normally has rapid acting insulin that is connected to the patient by an infusion set

294
Q

What is Humilin 70/30 used for?

A

To treat uncontrolled diabetes

295
Q

What is the normal blood glucose level?

A

70-110

296
Q

What does an EKG show?

A

The rate and rhythm that the patient’s heart is in.

297
Q

Why is hypertension often referred to as the silent killer?

A

Because there are many times where there are no signs and symptoms but the problem is still very much there and very dangerous.

298
Q

What does the lab test ESR measure?

A

Inflammation

299
Q

How do you treat symptomatic sinus tachycardia?

A

ABC’s (rapid response team) oxygen, correct underling problem, Calcium channel blockers, beta blockers

300
Q

What are the clinical manifestations of left sided heart failure?

A 
Pink frothy sputum
Weakness
Fatigue
Dizziness
Pulmonary congestion
SOB
Oligura (100-400 m:/24 hr of urine)
301
Q

What are some lifestyle changes that can be made to control hypertension?

A 
Sodium restriction
Weight reduction
Reduce alcohol intake
Exercise
Decrease stress levels
Stop smoking
302
Q

Why do hip fractures have a high mortality rate?

A

Because of the complications

303
Q

What does morphine do to the heart for it to be a treatment for acute HF?

A

Reduces preload of the heart

304
Q

What is an important consideration to how you provide pin care?

A

It must be done using the sterile technique

305
Q

Describe Atherectomy procedure for managing PAD

A

Scraping the plaque off

306
Q

What class of medication is metformin?

A

Biguanides

307
Q

What is retinopathy?

A

Retina atrophy – blurred vision and can lead to blindness.

308
Q

What types of drugs are prescribed for patients with atherosclerosis?

A

Statins (zocor)

309
Q

Why are patients with A fib on anticoagulates?

A

To prevent clots from dislodging

310
Q

Which peripheral vascular disease will exhibit edema?

A

Venous

311
Q

Describe depolarization

A

When the atria and ventricle is contracting

312
Q

What will happen if a patient with Buerger’s Disease does not stop smoking?

A

They will lose fingers, toes and possibly legs

313
Q

What signs and symptoms should a patient exhibit if they have a glucose level of less than 20?

A

Patient will be lethargic, obtunded

314
Q

What are signs and symptoms of peripheral arterial disease

A 
Intermittent claudication (early s/s) pain when walking but subsides at rest
Numbness or burning
Hair loss in lower leg
Dry, scaly, mottled skin
Thickened toenails
Weak or absent pulses in extremeties 
Stasis ulcers
Pain that occurs even at rest (late s/s)
315
Q

What kind of medication can a diabetic patient take to reduce albumin levels in the urine?

A

ACE and ARB’s

316
Q

Long acting insulin peak?

A

NONE!

317
Q

What position should the patient with HF be in?

A

High fowlers

318
Q

When is NPH used?

A

to cover blood sugar increases between meals and during the night

319
Q

Describe sinus tachycardia.

A

Normal P,QRS, and T wave and rate is greater than 100 bpm

320
Q

What type of medications cannot be given when a patient is receiving morphine for HF?

A

Diuretics because morphine helps pull fluid out of the heart

321
Q

What are chronic complications of diabetes?

A 
Nephropathy
Neuropathy
Retinopathy
Cardiovascular disease
Cerebrovascular
322
Q

What labs are used to diagnose R/L sided heart failure?

A

Electrolytes, BNP, Urinalysis

323
Q

Why is a fat embolism considered a complication of fracture?

A

Because it can break off and can travel to the lungs causing a P.E.

324
Q

Describe repolarization

A

when the atria and the ventricle are relaxed

325
Q

What glucose level is considered moderate hypoglycemia?

A

Less than 40

326
Q

What type of people prefer to be in sinus bradycardia?

A

Athletes!

327
Q

When do the perkinje fibers kick in?

A

When the ventrivles stop contracting

328
Q

What is normal range for PTT

A

60-70 seconds

329
Q

What can prevent DVT’s?

A

Ambulation

330
Q

Which type of arthritis affects single or multiple joints?

A

Osteoarthritis

331
Q

What happens to finger tips of a patient having Raynaud’s phenomenon?

A

They turn white and sometimes blue if prolonged

332
Q

What system controls blood pressure?

A

RAS

333
Q

How much fat should a diabetic patient consume?

A

20-30% of intake should be fat

334
Q

What should a patient do if protein or albumin is present?

A

Decrease protein intake

335
Q

How do you treat symptomatic PVCs?

A

Treat the underlying cause
Lidocaine
Amiodarone

336
Q

What is damaged in right sided heart failure and where do you exhibit symptoms?

A

The damage is done to the lungs because blood is not able to go in that direction while the body (mainly extremeties) will show signs and symptoms (edema from fluid back up)

337
Q

What does the P wave represent?

A

Atrial contraction

338
Q

What are the ranges for systolic and diastolic associated with malignant hypertension

A

Systolic >200

Diastolic >150

339
Q

How much potassium can be administered through a peripheral IV?

A

10 mEq/ hr

340
Q

True/ False: Type 1 and type 2 diabetes will have the same complications

A

True

341
Q

Where should pre filled insulin syringes be stored?

A

in refrigerator

342
Q

Besised labs, what other tests are done to diagnose HF?

A

ABG’s, CXR, Echocardiogram, EKG

343
Q

True/ False: Positive orthostats occur when there is an increase and decrease in numbers.

A

False, only going down – not up.

344
Q

What does the PR segment represent?

A

Repolarization of the Atria

345
Q

How is phlebitis treated?

A

Move IV site!! It will usually heal on its own but warm and moist soaks will help.

346
Q

If a patient is on lidocaine or amiodarone drip, what must they also be on?

A

Telemetry

347
Q

How do you assess for osteomylitis?

A

REEDA
Check fever
Assess pain (patient will be in severe pain)

348
Q

Describe mixed insulin

A

Insulins that are mixed by pharmaceutical companies and come in certain percentages of certain insulins

349
Q

When do you administer a big dose of heparin?

A

For a patient that already has a DVT

350
Q

For the HF patient, how much fluid can they intake in a day?

A

1000-1500 mL a day

Med Surge (4 decks)

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