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Adult Nursing I (NUR 240) > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Explain Coronary Atherosclerosis

Include signs & symtoms, risk factors & pathology

A

Signs & Symptoms:
* Angina (most common)
* Weakness
* Lightheadedness
* Nausea
* Epigastric, arm, or shoulder pain
* Dyspnea (SOB)

Risk Factors:
Non-Modifiable: family history, gender, race
Modifiable: cholesterol, HTN, DM, tobacco use

Pathology:
* accumulation of lipids (as well as blood components, Ca+, carbs, & fibrous tissue) in the arteries that decreases blood flow

  • affects medium & large arteries
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2
Q

Coronary Atherosclerosis

  • What is it?
  • What are the unique symptoms?
  • What are the risk factors associated with it?
  • What kind of vessels are impacted & what size are they?
A

Accumulation of plaque in arteries that decreases blood flow

  • Non-Modifiable Risks: family hx, gender, race
  • Modifiable Risks: cholesterol, HTN, DM, tobacco

Medium & Large ARTERIES are impacted

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3
Q

What is the most common symptom of coronary atherosclerosis?

A

Angina

weakness, light-headed, epigastric / shoulder / arm pain, SOB

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4
Q

What is ateriosclerosis?

A

Hardening / scarring of small arteries & arterioles

  • due to thickening of muscle fiber & endothelial lining
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5
Q

What is angina?

Types, causes, pathology, & treatment

A

Crushing pain in the chest, neck, upper back, shoulders, arms

Types:
* Stable
* Unstable
* Intractable

Causes:
* Acute coronary syndrome
* Myocardial infarction (MI)
* Arrhythmias
* Cardiac arrest
* Heart failures
* Cardiogenic Shock

Pathology: Low blood supply to the heart (muslces don’t receive enough O2)

Treatments: stop & rest, high fiber / low fat diet

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6
Q

What is Coronary Atherosclerosis & what are the defining characteristics?

A

accumulation of plaque in arteries that decreases blood flow

Defining Characteristics:
* Angina
* Pre-MI

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7
Q

What is Acute Coronary Symdrome (ACS = Acute MI Onset)?

Types, Signs & Symptoms, Risk Factors, & Pathology

A

Sudden, reduced blood flow to the heart

Types:
* Unstable angina
* STEMI (ST-elevated myocardial infarction)
* NSTEMI (non-ST elevated myocardial infarction)

Signs & Symptoms:
* Sudden chest pain (not aleviated w/ rest or meds)
* Dyspnea (SOB)
* Indigestion / nausea
* Anxiety
* Pale, cool skin
* Increased HR / RR / BP
* New murmur
* S3 & S4
* Arrhythmia

Risk Factors:
* Smoking
* Hypertension
* Diabetes
* Hyperlipidemia
* Being male
* Physical inactivity
* Diet / Exercise

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8
Q

What is Acute Coronary Syndrome & what are defining characteristics?

A

Acute loss of blood to the heart

  • Sudden Chest Pain
  • New Murmur

Types = unstable angina, STEMI, & NSTEMI

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9
Q

What is Heart Failure? What is the difference in systolic & diastolic heart failure? What is one of the main causes?

Risk Factors, R & L sided HF symptoms, Treatments

A

Heart can’t pump enough blood to meet metabolic demands

R-Sided HF:
* Visceral & peripheral congestion
* JVD
* Dependent edema
* Hepatomegaly
* Ascites
* Weight Gain

L-Sided HF:
* Pulmonary congestion
* Crackles
* S3
* Dyspnea
* Low O2
* Dry cough
* Oliguria

Risk Factors: smoking, obesity, diabetes, metabolic syndrome

  • Systolic HF: problems with heart contraction
  • Diastolic HF: problems with hear filling
  • Main Causes = atherosclerosis in coronary arteries

Treatment: ACE inhibitors

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10
Q

Key Differences in R-sided & L-sided Heart Failure

A

R-Sided: weight gain, JVD, edema, hepatomegaly, ascites, visceral & peripheral congestion

L-Sided: pulmonary congestion, crackles, S3, dyspnea, low O2, dry cough, oliguria

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11
Q

What is the difference in systolic & diastolic heart failure?

A

Systolic = issue with heart contraction

Diastolic = issue with heart fillling

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12
Q

What is one of the main causes of heart failure?

A

Atherosclerosis in coronary arteries

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13
Q

What do ace inhibitors do to help with heart failure?

A

Vasodilation = decreases afterload

important for systolic HF

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14
Q

Explain each part of the EKG

A
  • P = Atrial Depolarization (atria contract)
  • QRS = Ventricular Depolarization (ventricular contraction)
  • T = Ventricular Repolarization (ventricular contraction)
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15
Q

Explain the electrical conduction pathway through the heart

A
  • SA Node - main pacemaker
  • AV Node - back up pacemaker
  • His Budnle - (Bundle of His)
  • Bundle Branches
  • Purkinje Fibers

Sweet Apples Have A Big Price

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16
Q

What is the difference in ST elevation & ST depression?

A
  • ST Elevation = NO O2
  • ST Depression = LOW O2
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17
Q

Describe the following types of infections:

  • Nosicomial
  • Iatrogenic
A

Nosicomial = hospital acquired infection
* Catheter-associated UTI (CAUTI)
* Surgical site infection (SSI)
* Methicillin-resistant Staph aureus (MRSA)
* C. diff infection (CDI)
* Central line-associated bloodstream infection (CLABSI)

Iatrogenic = infection acquired after a procedure or treatment

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18
Q

Explain the stages of sleep. How long is a sleep cycle & how many sleep cycles does a person have in one night?

A

Non-REM Sleep: Stage I –> Stage II –> Stage III –> Stage IV –> Stage III –> Stage II –> REM –> Stage II –> ETC.

1 Cycle = 90 minutes

  • Person has about 6 cycles per night
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19
Q

Explain the nursing process.

A
  • Assess
  • Diagnose
  • Plan
  • Implement
  • Evaluate
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20
Q

What step of ADPIE are SMART goals used & what are SMART goals?

A

Used in planning phase

  • Specific
  • Measurable
  • Attainable
  • Realistic
  • Timely
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21
Q

What are the four phases of the nursing interview?

A

1.) Preparatory -
2.) Introduction -
3.) Working - longest phase
4.) Termination -

Per Book: (1.) Orientation; (2.) Work; (3.) Termination

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22
Q

What is ISBAR?

A
  • Introduction
  • Situation
  • Background
  • Assessment
  • Recommendations
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23
Q

What are Maslow’s Hierarchy of Human Needs?

highest to lowest priority

A

1.) Physiological needs
2.) Safety needs
3.) Love & belonging
4.) Self-esteem needs
5.) Self-actualization needs

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24
Q

What is the difference in Nociceptive & Neuropathic Pain?

A
  • Nociceptive = aching, throbbing

Neuropathic = tingling, burning, shooting, pins & needles

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25
**What are the 5 Rights of Delegation?**
**Right:** * Task * Circumstances * Person * Directions / communication * Supervision / evaluation
26
**Explain primary, secondary, & tertiary prevention in nursing**
* **Primary: P**revention & education * **Secondary: S**creening * **Tertiary:** Patient already has diagnosis, how do you prevent it from coming back / **treatment**
27
**What is the difference in a contusion, abrasion, laceration, & avulsion?**
* **Contusion:** bruising * **Abrasion:** rubbing or scraping of epidermal layers / some tissue is removed * **Laceration:** cut / tearing of skin * **Avulsion:** structures are removed from normal anatomical position
28
**What is the difference in dehisence & evisceration?**
**Dehisence = ** wound pulls apart at the edges **Evisceration:** intraabdominal contents protrudes from the wound
29
**Describe the stages of pressure injuries**
**Stage I:** non-blanchable, erythema, skin is intact **Stage II:** partial-thickness skin loss with exposed epidermis; errosion **Stage III:** full-thickness skin loss**;** visible adipose tissue (no underlying tissue seen) **Stage IV:** bone, muscle, tendon, etc. (other underlying structures) are visible **Unstageable:** obscured view (usually obscured by eschar **Deep Pressure Injury:** nonblancable**;** red, purple, or maroon color
30
**Explain the different types of wound drainage: serous, sanguineous, serosanguineous, purulent.**
**Serous:** mainly clear & thin (hint of yellow) **Sanguineous:** bright red & slightly thick **Serosanguineous:** pink **Purulent:** thick, viscous pus, yellow or green
31
**What is tidaling in terms of a chest tube?**
Fluid level in the chamber moves up & down with the patients respirations
32
**What does it mean if there is continuous bubbling in a water seal chamber?**
leak in chest tube | **Bubbling is expected in suction control chamber**
33
**Which Oxygen Delivery Device provides the most precise amount of oxygen to be delivered to a patient?**
**Venturi Mask**
34
**What does peak flow meter measure?**
**Forced expiration** / highest airflow during forced expiraiton
35
**What signs & symptoms are the primary indicators of an asthma diagnosis?**
* Cough * Chest tightness * Wheezing * Dyspnea
36
**What is the difference in cardioversion & defibrillation?**
Cardioversion is **synchronized** delivery of energy **Defibrillation** is **asynchronous** delivery of energy
37
**Explain Pulmonary Edema (caused by HF)** | Include risk factors, s&s, & pathology
**Signs & Symptoms:** * Severe hypoxemia * Restlessness / anxiety * Tachypnea * Dyspnea * Cool, clammy skin * Cyanosis * **weak / rapid pulse** * Cough (moist / noisy respirations) * Increased **pink frothy sputum** (blood-tinge) * Fluid overload * S3 (blood rushing into L ventricle) * **Wheezes / Crackles** **Risk Factors:** Heart failure, specifically **L ventricle failure** **Pathology:** blood backs up, pushes with pressure through vessels into alveoli
38
**What are the unique signs & symptoms of Pulmonary Edema (from HF)?**
* **Weak / rapid pulse** * **Pink, frothy sputum** (blood-tinged) * **Crackles / Wheezes**
39
**What kind of oxygen should be given to a patient with Pulmonary Edema from heart failure? What prescriptions can be used & waht should be monitored?**
**Use a Non-Rebreather Mask** (100% O2 concentration) **Rx:** diuretics & vasodilators **Monitor:** I/O & weight
40
**Explain Hypertension** | S&S, Risk factors, & pathology
**Signs & Symptoms:** * Absent or weak pulses (esp. distal) * S3 or S4 heart sounds * **Reginal hemorrhages** * JVD * **Renal artery bruit** **Risk Factors: African American Men**, older age, smoking, obesity, sedentary, dyslipidemia, DM, family hx, microalbuminuria or GFR < 60 **Pathology:** * increased cardiac output (hypervolemia), peripheral resistance, or both * Dysfunction of ANS (increased RAAS) * Insulin resistance * Activates immune system * 95% of cases have no known cause
41
**What are unique defining characteristics of Hypertension?** | S&S, risk factors, & pathology
**Signs & Symptoms:** Retinal Hemorrages, Renal artery bruit **Risk Factors:** African American Men **95% of HTN has no known cause** **In HTN, you must protect vital organs including the brain, heart, & kidneys**
42
**Explain Cardiogenic Shock** | S&S, Risk Factors, & Pathology
**Signs & Symptoms:** * Tachypnea * Dyspnea * **Tachycardia** * Weak pulse * Diaphoresis * Pale skin * **Hypotension** **Risk Factors:** pericardial effusion, cardiac tamponade, MI, PE, End stage HF, cardiomyopathy, arrhythmia **Patho:** Heart can't pump as much blood as the body needs, decreased CO
43
**What is Cardiogenic Shock & what are signs / symptoms?**
**Heart can't pump enough blood throughout the body; decreased CO** **Signs & Symptoms: * Tachycardia * Hypotension**
44
**What is Virchow's Triad and what disease does it deal with?**
* **Intravascular vessel wall damage** * **Stasis of flow** * **Presence of a hypercoagulable state** Deals with Thromboembolism
45
**What are signs & symptoms of DVT / Thromboembolism?**
* Leg Pain * Swelling * Erythema * Warmth
46
**Explain a thromboembolism** | S&S, RF, & Patho
**Signs & Symptoms:** (DVT) * **Leg pain** * **Swelling** * **Arrythmia** * **Warmth** **Risk Factors:** cardiovascular disorder, decreased mobility **Patho:** * **Virchow's Triad:** intravascular vessel wall damage, stasis of flow, & presence of a hypercoagulable state
47
**Explain Pericardial Effusion** | S&S, RF, Patho
**Signs & Symptoms:** * Elevated pressure in all chambers * Dyspnea * **Discomfort breathing when lying down** * Chest pain * Lightheadedness **Risk Factors:** * Heart Failure * Pericarditis * Metastatic Carcinoma * Cardiac Surgery Trauma **Patho:** Increase in fluid in the pericardial sac * may occur over time or suddenly
48
**What is a pericardial effusion & what are unique characteristics?**
**Increase in fluid in pericardial sac that can occur suddenly or over time** * Discomfort when lying down
49
**What is Pulsus Paradoxus?**
BP decreases with inhalation
50
**Explain Cardiac Tamponade** | S&S, RF, Patho
**Signs & Symptoms:** * Chest pain * Pulsus paradoxus (BP decreases with inhalation) * Tachypnea * Dyspnea * Tachycardia * JVD * Hypotension * **Muted Heart Sounds** **Risk Factors:** Heart surgery, injury to the heart, tumors in the heart, MI, HF **Patho:** compression of heart by accumulated fluid in the pericardial sac * related to PE & Cardiogenic shock
51
**What is Cardiac Tamponade & what is unique about it?**
**Commpression of heart by fluid in pericardial sac** * Related to PE & Cardiogenic Shock * **Muted heart sounds**
52
**Explain Cardiomyopathy** | S&S, RF, Patho
**Signs & Symptoms:** * Dyspnea * Fatigue * Dizziness * Arrhythmias * **Murmurs** * **Pulsus paradoxus** * **Weight changes** * JVD * Edema * **S3 / S4 heart sounds** * **Crackles in lungs** **Risk Factors:** Family history, HF, **long-term HTN**, prior MI, CAD, heart infection, obesity **Patho:** Series of progressive events that lead to impaired cardiac output **Na+ is major electrolyte involved**
53
**What is cardiomyopathy & waht is unique about it?**
**Damage to the heart muscle that causes impaired cardiac output** **S&S:** murmur, pulsus paradoxus, weight changes, S3 / S4, crackles **Risk Factors:** Long-term HTN **Sodium = major electrolyte involved**
54
**What is the main electrolyte involved in cardiomyopathy?**
Sodium
55
**Explain Infectious Diseases of the Heart** | S&S, RF, Patho
**Signs & Symptoms:** * Fever * New heart murmur * **Olser nodes (fingers/toes, painful)** * **Janeway lesions (palms/soles, no pain)** * **Roth spots (eyes)** * Cardiomegaly * HF * Tachycardia * **Splenomegaly** * Fatigue * Dyspnea * Syncope * Palpitations **Risk Factors:** bacteria & viruses **Named for layer of heart that's affected:**
56
**List the layers of the heart from outside to inside**
* Pericardial Sac * Epicardium * Myocardium * Endocardium
57
**What is rheumatic endocarditis?** | S&S, who gets it, & what's the cause?
**Bacterial Endocarditis** * Most common in **School aged kids** **Cause = Group A beta-hemolytic strep** **Unique S/S:** hemolytic nail beds
58
**What are common complications of pericarditis?**
**Pericardial effusion:** fluid filling sac around the heart **Cardiac tamponade:** pressure from fluid build-up
59
**What is the cause of Infective Endocarditis? What are common reasons for getting it / associated with?**
**Caused by Bacteria** Associated with: prosthetic heart valve or structural cardiac defects, IV drug abuse, catheters, prolonged IV therapy
60
**What is the common cause of myocarditis?**
Virus
61
**What is the difference in these valve disorders:** * **Regurgitation** * **Stenosis** * **Prolapse**
* **R**egurgitation = **Backflow** * **S**tenosis = **Narrowing** * **P**rolapse = **Relaxes into atrium**
62
**Explain Aneurysms** | S&S, RF, Patho
**Signs & Symptoms:** * Nausea / Vomiting * **Stiff neck** * Blurred vision * Sensitivity to light * **Seizures** * Drooping eyelid * LOC **Risk Factors:** * Triple A: atherosclerosis in aorta * Congenital * Infection * Inflammation * Pregnancy-related * Trauma **Patho:** Abnormal Dilation of Blood Vessels
63
**What is the difference in Saccular & Fusiform aneurysms? What are unique signs & symptoms?**
**S&S:** * Stiff Neck * Seizures **Saccular:** balloon on ONE side **Fusiform:** balloon on BOTH sides
64
**What is the difference in a STEMI & NSTEMI myocardial infarction?**
**STEMI: total occlusion** (**S**erious) **NSTEMI: partial occlusion** (blood flow is restricted, not stopped)
65
**Explain Reynaud's Phenomenon**
**Intermittent arterial vasoocclusion of fingers & toes (vasospasm)** * color changes in fingers & toes * numbness, tingling, burning
66
**Explain Peripheral Artery Disease (PAD)** | S&S, RF, Patho
**Signs & Symptoms:** * **Intermittent Claudication -** aching, cramping, inducing fatigue or weakness with exercise of distal occlusion; relief with rest * rest pain is due to ischemia * Elevation increases pain * Unequal pulses in limbs **Risk Factors:** Atherosclerosis **Patho:**Mainly caused by buildup of fatty plaque in arteries (atherosclerosis) **Extremities are cold / numb** **Round, punched-out wound ulcer**
67
**Explain Venous Stasis**
**Stasis =** blood **stays** in legs **Signs & Symptoms:** * Tan legs * Ulcers with clean edges, but odorous * Higher risk for DVT
68
**What is the difference in Lymphagitis, Lymphadenitis, & Lymphedema?**
* **Lymphagitis -** inflammation or infection of **lymph channels** * **Lymphadenitis -** inflammation or infection of **lymph nodes** * **Lymphedema -** swelling related to obstruction of lymphatic flow
69
**What is the main function of the following electrolytes?** * Potassium * Sodium * Calcium * Magnesium * Phosphate
* **K+ = Heart** * **Na+ = dehydration** (Cl+ = same as Na+) * maintain BP, blood volume, & pH * **Ca+ = bones, blood,** (clotting factors** & beats** (heart beats) * **Mg+ = muscles** * torsades de pointe * **P+ = bone & teeth formation; regulates Ca+** | **P+ & Ca+ are inverse**
70
**What occurs with hyperkalemia & hypokalemia?**
**Hyper = irregular heartbeat, hypotension, bradycardia, muscle & GI contraction** *Hypo =* * *Low & slow GI & muscles*
71
**What occurs with hypernatremia & hyponatremia?**
**Hypernatremia = red skin, edema, low grade fever, polydipsia**(excessive thirst) *Hyponatremia* * *seizures & coma* * *tachycardia & weak, thready pulses* * *respiratory arrest* | Late Hyper Sings = N/V, swollen dry tongue, increased muscle tone
72
**What occurs with hypermagnesemia & hypomagnesemia?**
**Hyermagnesemia = CALM & QUIET** * bradycardia, hypotension, hyporeflexia, depressed / shallow respirations, hypoactive bowel sounds *Hypomagnesemia* * *tachycardia, V-fib, torsades de pointe* * *hyporeflexia (increased DTR)* * *abnormal eye movements* * *diarrhea*
73
**What occurs with hypercalcemia & hypocalcemia??**
**Hypercalcemia = swollen & slow (moans, groans, & stones)** * **constipation** * **bone pains** * **kidney stones** * **decreased dtr** *Hypocalcemia* * *Trousseau's signs* * *Chvostek's sign* (cheek) * *diarrhea* * *tingling around mouth* * *weak bones* * *risk for bleeding* * *cardiac dysrhythmias*

Adult Nursing I (NUR 240) (6 decks)

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