Final Flashcards
1
Q
Cardiac Output
A
4-8 L/min
Amount of blood pumped from left ventricle in 1 minute
SV x HR
2
Q
Cardiac Index
A
2.2 - 4 < 1.5 = grave prognosis 1.5 - 2.0 = cardiogenic shock more accurate cardiac output based on body surface area
3
Q
Central Venous Pressure (CVP)
A
2-6 mm Hg
preload for right side of heart
fluid volume status
low CVP indicates the patient is hypovolemic
high CVP indicates the patient is hypervolemic
4
Q
Pulmonary Artery Pressure (PAP)
A
15/5
25/15
5
Q
Pulmonary Artery Wedge Pressure (PAWP)
A
4-12 mm Hg
indicates left ventricle preload
PAD pressure equivalent when no pulmonary disease is present
6
Q
Systemic Vascular Resistance (SVR)
A
afterload for left ventricle
800 - 1400 dynes/sec
7
Q
Pulmonary Vascular Resistance (PVR)
A
afterload for right ventricle
100 - 250 dynes/sec
8
Q
Cardiogenic Shock
initial stage
A
Decreased cardiac output S/S: systolic BP <90 decreased LOC pale, cool, moist skin decreased urine output chest pain (not absolute)
9
Q
Cardiogenic Shock
compensatory phase
A
SNS initiated S/S: tachycardia tachypnea crackles (LV failure) s3 and s4 (LV failure) peripheral edema (RV failure) JVD (RV failure)
10
Q
Cardiogenic Shock
Progressive stage
A
Continued myocardial ischemia -dysrrhythmias -chest pain respiratory distress -metabolic and respiratory acidosis -hypoxia neurologic deterioration -decreased LOC
11
Q
Medical Management of Cardiogenic Shock
A
Medical management treat underlying cause pharmacologic agents angioplasty enhance effectiveness of pump increase oxygen supply decrease oxygen demand improve tissue perfusion IAPB VAD
12
Q
Intra-aortic balloon pump
use
A
improves coronary artery perfusion
inflated during diastole
decreases after load
used for heart failure, cardiomyopathy
13
Q
When caring for a patient in cardiogenic shock your first nursing priority would be:
A
to administer IV fluids and (positive) inotropic agents
positive inotropic agents improve cardiac contractility. ex: digoxin, milritrone, and dobutamine
14
Q
Adenosine (Adenocard)
A
antidysrhythmic to treat paroxysmal supraventricular tachycardia (PSVT)
slows conduction through AV node, interrupts dysrhythmia producing re-entry pathways and can restore NSR
cardiac monitoring and vital signs
S/E: hypotension, dysrhythmias, short period of asystole following injection
Push FAST!
15
Q
Verapamil (Calan, Isoptin)
A
antidysrhythmic to treat supraventricular tachydysrhythmias (SVT)
calcium channel blocker (negative chronotropic and inotropic) also used to treat angina
monitor HR and BP
S/E:
headache, bradycardia and hypotension
16
Q
Diltiazem (Cardizem, Dilacor XR)
A
antidysrhythmic to treate PSVT, A fib/flutter (with increased rate)
calcium channel blocker (negative chronotropic and inotropic agent) also used to treat angina
Monitor BP and HR
S/E:
myocardial depression, bradycardia and can increase digoxin levels
17
Q
Lidocaine
A
Antidysrhytmic to treat ventricular dysrhythmias
a fast sodium channel blocker, class 1B
local anesthetic effect on heart; decreased myocardial inability
monitor cardiac and assess for s/s of toxicity (confusion, drowsiness, hearing impairment, conduction defects, myocardial depression, muscle
metabolized in the liver
18
Q
P Wave
A
First wave in cardiac cycle
denotes depolarization of atria
measures: no more than 0.11 sec long and 0.2 - 0.3 v in height
upright = normal depolarization from atria
inverted = coming from AV node
19
Q
During physical assessment of patient with the nurse would suspect A fib when palpation of the radial pulse reveals:
A
an irregular pulse rhythm
A fib = irregularly, irregular pulse
no regularity to rhythm
20
Q
Stroke volume
A
amount of blood ejected per heartbeat
21
Q
A client who is hemorrhaging has decreased preload. What physiologic event will follow?
A
Decreased cardiac output
22
Q
Normal ejection fraction
A
50-70
percentage of blood ejected with systole
23
Q
Which of the following discharge instructions should the nurse stress to a patient with stable angina?
A
sit or lie down when taking sublingual nitroglycerin (NTG)
coronary vasodilator, also dilates vessels in brain, can cause dizziness, risk for falling
If on patch, patch on 12 and off 12
If pain not controlled after first dose, call 9-1-1 and take second dose
24
Q
PR Interval (PRI)
A
P wave with adjoining straight, flat line
Denotes time from SA node to AV node
measures 0.12 - 0.20
25
QRS Complex
Depolarization of the ventricles
| measures <0.10
26
ST segment
early phase of ventricular depolarization
measures 0.12 seconds or less
T wave is actual ventricular repolarization phase
T wave measures: 0.20 seconds or less
27
QT Interval
Ventricular depolarization through ventricular depolarization
Mesures: 0.36 - 0.44 seconds
28
EKG Time and Measurements
small squares = 0.04 seconds
large squares = 0.20 seconds
5 small squares = 1 large square
29
To calculate the rate with EKG
```
# of R to R intervals in 6 second strip and multiply by 10
# of large boxes between 2 QRS complexes and divide by 300
# small boxes between 2 QRS complexes and divide by 1500
```
30
Premature Ventricular Contractions (PVC)
ectopic (irritable) foci in ventricular myocardium
initiates depolarization from cell to cell, not via a pathway
etiology: hypoxia, ischemia, electrolyte imbalance, acid - base imbalance
31
Ventricular Tachycardia
Etiology:
same as PVCs
allowed to repeatedly occur
32
Ventricular Fibrillation
Etiology:
multiple foci independently causing separate sections of ventricular myocardium to contract in unorganized fashion
VT frequently proceeds to V fib
33
Asystole
lack of electrical activity
"flat line"
may masquerade as fine v-fib
verify in two separate leads
34
The best indicator of fluid balance is:
weight
| 2.2 lb = 1 kg = 1 L of fluid
35
Heart failure
inability of the heart to work effectively as a pump
36
On initial assessment of a patient with acute myocardial infarction (AMI), the nurse would most likely find:
hypertension
cardiac arrhythmias
sympathetic nervous system kicks in and causes HTN and tachycardia
37
Left Sided Heart Failure
AKA congestive heart failure
typically caused by: hypertensive, coronary arter, valvular disease
2 types: systolic and diastolic
38
Right-Sided Heart Failure
Causes: left ventricular failure, right ventricular MI, pulmonary hypertension
Right ventricle cannot empty completely
Increased volume and pressure in venous system and peripheral edema
39
When teaching a patient about complications of A fib, the nurse understands that the complications can be caused by:
statsis of blood in the atria
40
In planning care for a patient with acure myocardial infarction (AMI), the nurse identifies the highest priority goal of care as:
relief of pain
| pain indicates ischemia to the heart muscle
41
The nurse recognizes second-degree AV block, type II (Mobitz II) and intervenes appropriately when s/he:
prepares for temporary pacemaker insertion
Atropine can also be used for this patient while waiting on pacemaker
42
A common abnormality associated with the development of peripheral vascular disease (PVD) is:
High serum lipids
atherosclerosis clogs your vessels
43
arteriosclerosis
thickening or hardening of arterial wall often associated with aging
44
Atherosclerosis
Type of arteriosclerosis involving formation of palque within arterial wall
45
Atherosclerosis
| Physical assessment/Clinical Manifestations
Monitor BP
Palpate pulses in all major sites of the body
assess for prolonged capillary refill
assess for bruit
46
Atherosclerosis
| Lab assessment
lipid level, including cholesterol and triglycerides, elevated
HDL and LDL
High serum levels of homocysteine can allow cell walls to become vulnerable to plaque buildup
47
The client admitted with PVD (peripheral vascular disease) asks the nurse why her legs hurt when she walks. The nurse bases a response on the knowledge that the main characteristic of PVD is:
Decreased blood flow
| to muscle; O2 demand greater than O2 supply
This is called intermittant claudication
48
The nurse is assessing the lower extremeties of the client with PVD. The nurse would expect to find:
Mottled skin
d/t decreased blood flow
TX: vasodilators, plavix, eventually surgery
49
Atherosclerosis
| Interventions
```
Evaluate total serum cholesterol levels and lifestyle changes
nutrition therapy
drug therapy
smoking cessation
exercise
complementary and alternative therapies
```
50
Six P's of arterial insufficiency
```
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
Poikilothermia (coolness)
```
51
Acute Peripheral Arterial Occlusion
Embolus - most common cause of occlusions, although local thrombus may be cause
May affect upper extremities but most common in lower extremities
Drug therapy
Surgical therapy
Nursing care
52
Aneurysms of the Peripheral Arteries
Femoral and popliteal aneurysms
S/S: limb ischemia, diminished or absent pulses, cool to cold skin, pain
TX: surgery
Post Op care: monitor for pain
53
The nurse should instruct a patient who has been diagnosed with Raynaud's disease to:
wear gloves when handling ice or frozen foods
54
What is a positive result of using PEEP in the treatment of ARDS?
Alveoli remain open
55
A patient states that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse explains that tidal volume is the amount of air:
Exhaled normally after a normal inspiration
| Amount of air you are breathing in and out
56
Patient with chest tube and nurse notes that the fluid in the water seal column is fluctuating with each breath that the client takes. What is the significance of this fluctuation?
The chest tube system is functioning properly (tidaling).
| [The suction chamber should have continuous bubbling]
57
What condition can place a patient at increased risk for ARDS?
Septic Shock
| also acute pancreatitis, pneumonia
58
ARDS is also known as:
ALI (acute lung injury)
59
Normal ABG levels:
pH 7.35 - 7.45
PaCO2 35 - 45
HCO3 21 - 28
Quick method draw arrow up or down for pH. up indicates alkalosis, down acidosis.
next look at resp (PCO), draw an arrow high or low. If arrows in opposite direction problem is respiratory in nature. Next look at HCO if arrow in same direction problem is metabolic in nature
60
Chest Tube Chambers:
Chamber 1: collects fluid draining from patient
Chamber 2: water seal prevents air from re-entering patient't pleural space
Chamber 3: suction control of system
61
Iron Deficiency Anemia
| Microcytic
common type of anemia resulting from blood loss, poor intestinal absorption or inadequate diet
if mild - s/s of weakness and pallor
evaluate adult patients for abnormal bleeding, esp from GI tract
TX: increase oral inteake of iron from food sources, oral iron supplements or IM iron solutions
62
What process is initiated between oxygen and hemoglobin as body temperature increases?
Oxygen unloading is enhanced
63
Vitamin B12 Deficiency Anemia
| Macrocytic
lack of B12 causes improper DNA synthesis of RBCs
Causes: poor intake of foods containing B12, small bowel resection, tapeworm, overgrowth of intestinal bacteria
64
Pernicious Anemia
Anemia resulting from failure to absorb vitamin B12
Caused by a deficiency of intrinsic factor
65
Folic Acid Deficiency Anemia
Manifestation similar to those of vitamin B12 deficiency, but nervous system function remains normal
common causes - poor nutrition, malabsorption and drugs
66
Serum Electrolyte Levels
| Sodium
135 - 145
67
Serum Electrolyte Levels
| Potassium
3.5 - 5
68
Serum Electrolyte Levels
| Calcium
8.5 - 10.2
69
Aplastic Anemia
dificiency of circulating RBCs because of failure of bone marrow to produce these cells
pancytopenia common
TX: blood transfusions
immunosuppressant therapy
splenectomy
70
Pancytopenia
Deficiency of RBC, WBCs and platelets
71
Thrombotic Thrombocytopenia Purpura (TTP)
rare disorder; platelets clump together abnormally in capillaries, and too few platelets remain in circulation
inappropriate clotting, yet blood fails to clot properly when trauma occurs
TX: plasmapheresis, fresh frozen plasma, aspirin, alprostadil, plicamycin, and immunosupressive therapy
72
Heparin Induced Thrombocytopenia (HIT)
serious immune-medicated clotting disorder that features an explained platelet count after Heparin administration
increasing because of the increased use of Heparin
can occur in any patient that receives Heparin therapy:
- unfractioned heparin
- low molecule weight heparin
73
Disseminated Intravascular Coagulation (DIC)
forms thousands of small clots in the tiny capillaries of the liver, kidneys, brain, spleen and heart
reduces oxygenation and decreases o2 saturation causing hypoxemia and ischemia
the clots use clotting factors and fibrinogen faster than they can be produced
occurs with septic shock
with continued capillary leak, the bleeding causes hypovolemia and a drastic decrease in cardiac output, blood pressure and pulse pressures
74
When caring for a patient with CREST syndrome associated with scleroderma, the nurse teaches the patient to:
Encourage small frequent meals in upright position
difficulty swallowing with scleroderma due to esohphageal dysmotility and decreased peristalsis
75
During the emergent phase of burn management, what diagnostic test resutl should the nurse expect to find?
```
increased H&H
decreased serum albumin
increased serum potassium
increased BUN
decreased serum sodium
```
76
Parkland Formula
4 ml x patient wt in kg x % of body burned = total fluid replacement for 24 hours.
give 1/2 in first 8 hours and other 1/2 over the next 16 hours
if patient came to ER 1 hour ago, give first 1/2
77
Treatment of Psoriasis
```
Corticosteroids
Tar preparations
other topical therapies
ultraviolet light therapy
systemic therapy
emotional support
```
78
A patient with a major burn is receiving silver sulfadiazine (Silvadene) to treat the burns. What nursing action should be implemented when using this medication?
Monitor WBC count daily
Silvadene causes transient leukopenia
79
For a patient with a major burn, which evaluation criteria indicate that fluid resuscitation is effective during the first 24 hours of care?
Urine output of 30 - 50 ml/h
80
What is the complication of systemic lupus erythematosus (SLE) that is most common and the leading cause of death?
Nephritis
| over 50% of SLE pts develop renal disease
81
In assessing a female patient with moderate anemia, the nurse would expect to find which of the following?
Complaints of shortness of breath with exercise (or feeling tired all the time)
anemia is usually developed slowly over time
82
Management of Skin Cancer
surgical: cryosurgery, curettage and electrodesiccation, excision, Mohs' surgery, wide excision
non surgical: drug therapy and radiation therapy
83
Lupus Erythematosus
chronic, progressive, inflammatory connective tissue disorder
can cause major body organs/systems to fail
spontaneous remissions and exacerbations
autoimmune process
some degree of kidney involvement
84
Lupus clincial manifestations
```
skin involvement:
-butterfly rash
polyarthritis
osteonecrosis
muscle atrophy
fever and fatigue
Renal invovement
pleural effusions
Raynaud's phenonmenon
neurologic manifestations
serositis
```
85
Scleroderma
```
chronic, inflammatory, autoimmune connective tissue disease
not always progressive
hardening of the skin
classifications:
-diffuse cutaneous
-limited cutaneous
```
86
CREST Syndrome
```
C = calcinosis
R = Raynaud's phenomenon
E = esophageal dysmotility
S = sclerodactyly (localized thickening and tightness of the skin of the fingers or toes)
T = telangiectasia (spidery, red appearance of capillaries)
```
**hands and forearm edema with bilateral carpal tunnel syndrome usually first symptoms to occur
87
Scleroderma Clinical Manifestations
arthralgia
renal and cardiac system involvement
problems with GI tract
lung involvement
88
Scleroderma Interventions
```
drug therapy
identify early organ involvement
skin protective measures
comfort
GI management
mobility
```
89
The nurse is caring for a patient with acute myeloid leukemia. Which interventions should the nurse include in her plan of care during hospitalization?
1. place pt in private room
2. assist with oral hygiene after meals
3. request soft, bland diet
90
The nurse observes reddish-purple spots and areas of purple bruising on a newly admitted pt with chronic myelogenous leukemia (CML). Which lab result will support this assessment finding:
Low platelets
91
Normal Platelet
150,000 - 400,000
92
The nurse is administering fresh frozen plasma to a pt with DIC and she understands that the intended effect of this treatment is to:
replace specific clotting factors
93
Resucitation/Early Phase of Burn injury
```
continues for about 24 - 48 hours
Goals of management:
-secure airway
-support circulation - fluid replacement
-prevent infection
-maintain body temperature
-provide emotional support
```
94
Inujuries to the Respiratory System d/t burn
```
direct airway injury
carbon monoxide poisoning
thermal injury
smoke poisoning
pulmonary fluid overload
external factors
```
95
Pulmonary Fluid Overload
occurs even when lung tissues have not been damaged directly
histamine, other inflammatory mediators cause capillaries to leak fluid into pulmonary tissue space
96
What nursing diagnosis would be of highest priority for a pt hospitalized for a bone marrow transplant to treat a relapse of acute myelocytic leukemia?
ineffective protection (risk for infection)
97
The nurse observes a slight facial tic in a patient. Which cranial nerve should the nurse assess?
VII
98
Burn: Cardiovascular Assessment
hypovolemic shock common cause of death in early phase of pts with serious injuries
vital signs
cardiac status, esp in cases of electrical burns
99
Burn: Skin Assessment
size and depth of injury
percentage of total body surface area affected
"Rule of Nines" using multiples of 9% of total BSA
100
The nurse is caring for a pt in ICU with ICP monitoring system. While providing hygiene measures for the pt, the nurse observes that the ICP is reading 25 mm Hg. What action should the nurse take?
Cease stimulating the patient
we don't want ICP higher than 20
make sure HOB elevated
head is in good alignment
and if those don't bring ICP down mannitol may be given
101
A pt with a craniotomy develops a urine output of 300 ml/hr, dry skin, and dry mucous membranes. What would be the nurse's best intervention?
evaluate urine specific gravity
s/s of diabetes insipidus - urine will be very dilute and specific gravity will be low
Expect dr to order vasopressin or desmopressin
102
What are the typical clinical manifestations of MS?
double vision
weakness in extremities
numbness and tingling
103
While in the ER, a pt with C8 quadriplegia develops a BP of 80/44, pulse of 48 bpm, and rr of 18. The nurse suspects what condition?
Neurogenic shock
interruption in sympathetic nervous system and unopposed parasympathetic
104
When the nurse stimulates Babinski's sign in an adult, the big toe moves upward and the other toes fan out. This finding indicates:
Upper motor neuron disease
spasticity and hyperreflexity
105
Lower motor neuron disease sign
pt will be flaccid
106
What lab finding leads the nurse to suspect that the patient may have systemic lupus erythematosus?
Elevated ANA and ESR
C reactive protein may be elevated as well
107
A pt is newly diagnosed with psoriasis. Which of the following medications would the nurse expect the physician to order for initial therapy?
Anthralin
(wear gloves, put on lesion, do not put on normal skin)
PUVA therapy another therapy used.
108
Seizure v. Epilepsy
Seizure: generalized, partial, unclassified, secondary seizures
Epilepsy: primary or idopathic
109
Seizure risks:
```
may result from:
metabolic disorders
acute alcohol withdrawal
electrolyte disturbances
heart disease
stroke
substance abuse
```
110
Seizure precautions
```
oxygen
suchtion equipment at bedside
airway
IV access
siderails up
no tongue blades
```
111
Seizure management
observation and documentation
patient safety
side-laying position
no retraints
112
Acute Seizure Management
Lorazepam (Ativan)
Diazepam (Valium)
Diastat
IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)
113
ALS (Lou Gehrig's Disease)
| Concerns
respiratory concerns
swallowing concerns
musculoskeletal concerns
114
Guillain-Barre Syndrome (GBS)
```
demylination of peripheral nerves
result of immune-mediated pathologic processes
S/S:
-initial muscle weakness and pain
-ascending paralysis
-autonomic dysfunction
```
115
GBS Plan of Care
```
diagnostic testing
priority nursing care:
-respiratory care
-pain management
-communication and emotional support
-nutritional
involvement of family and other team members
education
```
116
GBS interventions
Drug therapy
plasmapheresis (removal of blood plasma from body, separating it and tranferring it back into body)
monitoring respiratory status and managing airway
managing cardiac dysfunction
improving mobility and preventing complications of immobility
managing pain
117
Bell's Palsy
```
seventh cranial nerve
interventions:
-medical management
-prednisone, analgesics, acyclovir
-protection of eye
-nutrition
-massage, warm/moist heat, facial exercises
```
118
Stroke (Brain Attack)
a change in the normal blood supply to the brain
ischemic - interruption in blood flow to the brain
hemorrhagic - bleeding w/in or around the brain
The brain is unable to store oxygen or glucose and must receive a constant flow of blood to function
119
Types of strokes
ischemic
thrombolytic
embolitic
hemorrhagic - resulting from ruptured aneurysm, arteriovenous malformation
120
Hypopituitarism
deficiency of one or more anterior pituitary hormones
results in metabolic problems, sexual dysfunction
Most life-threatening deficiencies ACTH and TSH
requires life-long replacement of deficient hormones
121
Causes of Hyperpituitarism
hormone oversecretion occurs with pituitary tumors or hyperplasia
genetic considerations
pituitary adenoma
122
Post op care for pituitary removal
```
monitor neurological response
assess for postnasal drip
elevate HOB
assess nasal drainage
avoid coughing soon after surgery
assess for meningitis
hormone replacement
avoid bending
avoid straining at stool
avoid toothbrushing (oral rinsing best)
numbness in area of the incision
decreased sense of smell
Vasopressin
```
123
SIADH
Vasopressin secreted even when plasma osmolarity is low or normal
feedback mechanisms do not function properly
water is retained, results in hyponatremia (decreased serum sodium level)
124
SIADH Assessment
```
Findings:
recent head trauma
cerebrovascular disease
TB or other pulmonary disease
cancer
all past and current drug use
decrease in serum sodium levels
```
125
SIADH Interventions
```
fluid restriction
drug therapy (diuretics, hypertonic saline, demeclocycline)
monitor for fluid overload
safe environment
neurologic assessment
```
126
Addison's Disease
Primary
Secondary
-sudden cessation of long-term, high-dose glucocorticoid therapy
127
Acute Adrenal Insufficiency/Addisonian Crisis
Life-threatening even; need for cortisol and aldosterone is greater than available supply
usually occurs in response to stressful event
128
Adrenal Gland Hyperfunction
hypersecretion by adrenal cortex results in cushing's syndrome/disease, hypercortisolism or excessive androgen production
129
Hypercortisolism (Cushing's Disease)
| Assessment
clinical manifestations: skin changes, cardiac changes, musculoskeletal changes, glucose metabolism, immune changes
Lab tests - blood, salivary, urine cortisol levels
130
Gastroesophageal Reflux Disease
```
esophageal assessment
evidence-based information
-noninvasive diagnostic procedures
-antacids, histamine antagonists
priority nursing interventions
```
131
Complications of Acute Pancreatitis
```
hypovolemia
hemorrhage
acute kidney failure
paralytic ileus
hypovolemic or septic shock
Pleural effusion, respiratory distress syndrome, pneumonia
mutlisystem organ failure
disseminated intravascular coagulation
diabetes mellitus
```
132
Chronic Pancreatitis
progressive destructive disease of pancreas characterized by remissions and exacerbations
133
Non-Surgical Managment of Chronic Pancreatitis
```
drug therapy
analgesic administration
enzyme replacement
insulin therapy
nutrition therapy
```
134
Side effect of Catopril
persistent, dry cough
135
Neupogen action
increases WBC
136
Nevinega action
increases platelets
137
Atropine action and what used for
increases heartrate
| treat pts with bradycardia
138
Amiodarone used for
pt with v tach
139
Procrit action
increases RBCs
140
Lidocaine treats
PVCs
141
This med won't cure MS disease only treats and slows progress
Avonex
142
```
Beta-Blockers: Action
metoprolol = Lopressor
atenolol = tenormin
propanolol = inderal
labetalol = normadyne
```
Inhibits SNS
| Competes with epinephrine and norepinephrine for adrenergic receptor sites
143
Beta-Blockers: Uses
```
Treats:
HTN
ventricular dysrhythmias
reduce mortality in HF
reduce reinfarction post MI
```
144
Beta-Blockers: Side Effects
bradycardia, hypotension
heart block
dizziness
145
Beta-Blockers: Nursing Interventions
Monitor HR and BP - orthostatic BPs
if given with ACE inhibitor, administer at different times
Teach: pt not to discontinue abruptly
146
```
Calcium Channel Blockers: Action
verapamil = calan, isoptin
diltiazem = cardizem
felodipine = renedil
amlodipine = norvasc
nifedipine = procardia
```
Blocks influx of calcium across cardiac and smooth muscle cells
relaxes and dilates coronary arteries
slows conduction SA - AV node
dilates peripheral arteries
147
Calcium Channel Blockers: Uses
chronic stable angina
tachy dysrhythmias
unstable and vasospastic angina
HTN
148
Calcium Channel Blockers: Side Effects
Bradycardia, hypotension
edema - can worsen HF
Headache
fatigue
149
Calcium Channel Blockers: Nursing INterventions
monitor HR, BP, and s/s of CHF
150
```
ACE Inhibitors: Action
catopril = capoten
enalapril = vasotec
lisinopril = zestril
ramipril = altace
quinapril = accupril
```
Blocks conversion of angiotensin I to angiotensin II (vasodilates)
Blocks release of aldosterone (decrease Na an H2O retention, increases serum K by blocking K excretion)
151
ACE Inhibitors: USES
decrease symptoms of CHF
post MI decrease risk of CHF
treat HTN (vasodilates and diuresis)
152
ACE Inhibitors: Side Effects
cough
decrease BP
increase K
decrease renal function
153
ACE Inhibitors: Nursing Interventions
```
monitor BP (orthostatic BPs)
monitor K
Monitor kidney function (BUN and Creatinine)
```
154
ARBs: Actions
losartan = Cozaar
valsartan = diovan
Blocks binding of angiotensin II to AT 1 receptors
| blocks the vasoconstrictive and aldosterone secreting effects of angiotension II
155
ARBs: Uses
treat HTN
diuresis
alternative to ACE inhibitors in pts with cough
156
ARBs: Side Effects
decreased BP
increased K
decreased renal function
157
ARBs: Nursing Interventions
monitor BP
monitor K
monitor kidney function (BUN and Creatinine)
158
Alpha 1 Adrenergic Blockers: Action
prazosin = minipress
phentolamine = regitine
tamsulosin = flomax
Blocks aplha adrenergic receptors
| dilates veins and arteries = vasodilator
159
Alpha 1 adrenergic Blockers: Uses
HTN
BPH
Extravasatoins of IV vasoconstrictors
pheochromocytoma
160
Alpha 1 adrenergic Blockers: Side Effects
hypotension, tachycardia
nasal congestion
GI upset
fluid and Na retention
161
Alpha 1 adrenergic Blockers: Nursing Interventions
monitor BP, electrolytes
avoid alcohol
give with food or milk
162
Alpha 2 adrenergic Blockers: Action
clonidine = catapress
methyldopa = aldomet
Central acting sympatholytics
decrease sympathetic activity
increase parasympathetic activity
prevents pain signal transmission in CNS
163
Alpha 2 adrenergic Blockers: Uses
HTN
| severe pain
164
Alpha 2 adrenergic Blockers: Side Effect
decreased BP (orthostatic)
dizziness
dry mouth
sodium and water retention
165
Alpha 2 adrenergic Blockers: Nursing Interventions
monitor BP
monitor for edema
monitor for pain
teach patient not to discontinue suddenly
166
Biological modifiers
Granulocyte Colony Stimulating Factors (CSF)
Filgrastim (Neupogen) and sargramostim (Leukine)
Filgrastim (Neupogen) and sargramostim (Leukine)
| Treat neutropenia
167
Biological modifiers
| Hormone
epoetin (EPO, Epogen, Procrit)
| treat anemia
168
Biological modifiers
| CSF and Interleukin
oprelvekin (Neumega)
| treats thrombocytopenia
169
Cholinergics: Action
bethanechol (urecholine)
neostigmine, physostigmine, pyridostigmine (Mestinon)
prevents distruction of acetylcholine
| increases transmission at impulses at myonerual junction
170
Cholinergics: Uses
post op bladder distention and urinary retention
(increases bladder motility, urinary tract stimulant)
post op ileus
(increases GI motility)
171
Cholinergics: Side Effects
N/V, diarrhea, bronchospasm, bradycardia, laryngospasm, hypotension and increase secretions
172
Antidote for cholinergic crisis:
Atropine
173
Anticholinergic: Action
| atropine, glycopyrrolate, scopalamine, oxybutynin (Ditropan)
Inhibit (block) acetycholine at receptor sites
174
Anticholinergic: Uses
decrease secretion before surgery
| decrease GI, billiary and urinary motility
175
Anticholinergic: Side Effects
dry mouth and constipation
176
You should pre-medicate patient before applying this burn medication
Sulfamycin
177
Patient has burns on face and stridor what should be done immediately?
ET tube
178
pH 7.46, CO2 30 =
Respiratory alkalosis
179
pH 7.33, CO2 52 =
Respiratory acidosis
180
What does an A-Line measure
BP
181
Important nursing intervention for patient on Nipride
use of A-Line for continuous BP monitoring
182
What should nurse monitor frequently on patient with A-Line
circulation checks
183
Patient in V Fib, nurse will prepare to
defibrillate
184
Patient in V Fib or V Tach, what med should nurse anticipate
Amiodarone
185
What is a late sign of ICP
widened pulse pressure
186
What is a late sign of cardiac tamponade
JVD
187
Best nursing intervention for patient with CVP disconnected, patient feels dizzy and weak
Sit patient in high fowlers and administer O2
188
Patient in ICU restless and has a nursing diagnosis of sleep deprivation. What's the best nursing intervention?
Cluster care
189
Does unstable angina get better with rest?
no
190
S/S of left-sided heart failure:
dyspnea and crackles
| left = lungs
191
What type of patient would NOT get statins
cirrhosis patient
192
What does PEEP do?
Keeps alveoli open
193
What position will patient be in for paracentesis
HOB elevated
194
Patient with laryngectormy and radical neck needs:
humidified O2
195
Patient with radical neck dissection, what should UAP report to nurse?
Bright red continuous blood from dressing
196
Teaching community about lung cancer prevention
smoking cessation
197
How do you know a chest tube is working?
Tidaling with respirations
198
Patient with tension pneumothorax, list the manifestations:
deviation of trachea, decreased cardiac output
199
Patient on HCTZ, What should nurse instruct patient to report to doctor immediately?
blurred vision
200
Patient with polycythemia will have
splenomegaly and increased RBC
201
If patient has SEVERE anemia, they will have
pallor and tachycardia
202
When patient is taking iron, nurse should instruct patient to
keep taking iron 2-3 months after anemia corrects
203
What patient gets ET tube immediately
stridor and facial burns
204
Patient with vertigo and dizziness has issue with this cranial nerve
VIII
205
Patient with lower motor neuron lesion will have
absent or hyporeflexes
206
Why would the nurse tell a patient who had an MI not to strain for bowel movements
because straining stimulates vagal response
207
Signs and symptoms of hypocalcemia
numbness and tingling in fingers
208
Your patient is having a fluid deprivation test what is the nurse observing
observe for fluid intake
209
Patient with Addison's what would you see
Muscle weakness
210
Patient with Cushing's what would you see
increased serum glucose
| hyperglycemia too many steriods
211
Patient with SIADH what would you monitor
watch for decreased serum sodium
212
Patient with Bell's Palsy, what are their signs and symptoms
sagging (drooping) of face
213
Patient has MS and has urinary retention, what would you teach
self catherization
214
Patient has sensory and motor impairment in leg. What would you include in plan of care?
injury prevention
215
patient arrives with coffee ground emesis, what would the nurse prepare for?
NG tube and lavage
216
Your patient has a peptic ulcer, what would be a sign it's getting better with treatment?
no epigastric pain
217
Your patient refuses to move, what should you encourage?
coughing and deep breathing
218
What does Lidocaine treat?
PVC
219
What is the position for lumbar punctures?
lean forward and fetal position
