M3 F/E Comfort Flashcards

1
Q

Nociceptive vs Neuropathic

A

Nociceptive - pain response to noxious stimuli, “normal” pain

Neuropathic - abnormal processing of sensory input by nerves

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2
Q

NSAIDS that inhibit both COX 1 and 2
NSIAD that inhibits only COX 2

A

Ibuprofen, naproxen, diclofenac, ketorolac
Celecoxib

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3
Q

FACES pain scale can be used in children as young as

A

3

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4
Q

OPQRST

A

Onset
Provocation
Quality
Region/Radiation
Severity
Time

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5
Q

Hierarchy of pain measures

A

Attempt to obtain report
Consider pt condition
Observe - grimace, crying, restlessness
Observe vitals
Conduct analgesic trial

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6
Q

FLACC

A

For young children

Facial expression
Leg movement
Activity
Crying
Consolability

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7
Q

PAINAD

A

FLACC for patient sin AD

advanced dementia

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8
Q

CPOT

A

For patients in critical care who can not self report
Patterned after FLACC

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9
Q

Max acetaminophen

A

4000mg

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10
Q

Max ibuprofen

A

3200mg

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11
Q

NSAID toxicity effects

A

Gastric bleeding
Ulcerations

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12
Q

NSAIDS inhibit prostaglandins which can cause

A

Cardio Vascular problems
MI

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13
Q

pt with CAD
Coronary artery disease
can take NSAIDS?

A

NO

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14
Q

Opioid mu agonist
Opioid mu antagonist

A

Morphine
Hydromorphone
Fentanyl

Naloxone

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15
Q

Opioid induced hyperalgesia

A

Pain due to opioid meds

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16
Q

Drug used to wean people off opioids

A

Methadone

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17
Q

Basic adverse effects of opioids

A

NV
Pruritus
Hypotention
Constipation

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18
Q

Major opioid effects

A

Over sedation
Respiratory distress

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19
Q

Med to prevent nausea
GOOD FOR POST OP

A

Ondansetron

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20
Q

in pt with pruritus post op due to opioids, give

or

A

antihistamines - loratadine, cetirizine

just lower the opioid given

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21
Q

Recover pt from resp depression and over sedation using what drug

A

Naloxone

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22
Q

Pasero opioid scale

A

S-sleep easy to arouse
1 - awake/alert
2 - slightly drowsy, easy to arouse
3 - frequently drowsy, drifts off during conversation (UNACCEPTABLE)
4 - Somnolent not responsive (UNACCEPTABLE)

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23
Q

Neuropathic pain first line meds

A

Anticonvulsant
GABApentin and pregabalin

calcium channel blockers

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24
Q

NSAID or Acetaminophen for older adults

A

Acetaminophen

Greater risk for bleeds with nsaids

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25
Q

Acute kidney injury

A

Rapid loss of renal function

can result in metabolic acidosis and electrolyte imbalances like HYPERKALEMIA

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26
Q

Urine with AKI can be

A

Normal
Oliguria
Anuria

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27
Q

Oliguria numbers

A

Less than 400ml a day

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28
Q

Anuria

A

Less than 50ml a day

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29
Q

AKI can be caused by

A

hypovolemia
hypotension
reduced cardiac output
obstruction of kidney tubes by tumor, blood clot, kidney stone

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30
Q

AKI and RIFLE classification system

A

Risk
Injury
Failure
Loss
ESKD

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31
Q

GFM
ESKD

A

Glomerular filtration rate
End stage kidney disease

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32
Q

RIF

A

Risk - creatinine 1.5x baseline, GFR v 25%
Injury - creatinine 2x baseline, GFR v 50%
Failure - creatinine 3x baseline, GFR v 75%

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33
Q

LE

A

Loss - persistent acute kidney injury longer than 4 weeks
ESKD - injury longer than 3months

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34
Q

Phases of AKI

Initiation
Oliguria
Diuresis
Recovery

A

Initiation - start
Oliguria - serum concentration develops, THIS IS WHERE HYPERKALEMIA STARTS
Diuresis - glomerular filtration starts to recover, risk for dehydration which will re-raise creatinine and BUN
Recovery - 3-12 months for renal return, 1-3% reduction in GFR

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35
Q

AKI S/S

A

Oliguria
Anuria
Hypoperfusion
Shock

Low specific gravity

high BUN
HYPERKALEMIA
METABOLIC ACIDOSIS

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36
Q

Hyperkalemia leads to

Monitor

A

Cardiac arrhythmias
Ventricular tachycardia
Cardiac arrest

HEART

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37
Q

Metabolic acidosis occurs in AKI because

A

Kidney cant get rid of acid type metabolic waste

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38
Q

RRT

A

renal replacement therapy

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39
Q

AKI risk factors

A

Severity of injury
RRT requirement
Age
Comorbidities - kidney vascular respiratory diseases

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40
Q

Antibiotic med that impact kidneys

A

VamcoMYCIN
GentaMYCIN
TobraMYCIN

cyclosporine

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41
Q

Interstitial nephritis - inflammation in kidney can also be caused by what analgesic

A

NSAID’s

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42
Q

Managing AKI

A

Fluid balance based on daily weight
Monitor for fluid excess - give furosemide (diuretic)
Dialysis - hemodialysis HD or CRRT

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43
Q

Fluid excess indicators

A

Dyspnea
Tachycardia
Crackles
Distended neck veins

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44
Q

CRRT

A

Continuous renal replacement therapy

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45
Q

Most lifethreatening problems with AKI

A

Hyperkalemia

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46
Q

ECG to watch for in hyperkalemia

A

Tall, tented or peaked T waves

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47
Q

Hyperkalemia S/S
MURDER

A

Muscle weakness
Urine output increase
Respiratory failure
Decreased cardiac contractility -v in HR and pulse
Early on muscle twitches and cramps
Rhythm changes - Peak T waves, Prolonged PR interval

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48
Q

As potassium level rises cardiac and other muscle function

A

DECLINES

MED EMERGENCY

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49
Q

Med for hyperkalemia

take _h to work

A

Kayexalate
(sodium polystyrene sulfonate)

6

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50
Q

When ECG changes occur with hyperkalemia give this combination IV

it will

watch for

arrange for

A

Dex50%
Insulin
Calcium

shift potassium back to cells

hypoglycemia

emergency dialysis

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51
Q

AKI pt may go into metabolic acidosis, may need what med

A

Sodium bicarbonate

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52
Q

In AKI, phosphate may rise, control with

A

calcium

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53
Q

hyperphosphatemia S/S
same as hypocalcemia

A

Paresthesia
Tetany
cramps
spasms

Numbness around MOUTH (CIRCUMORAL)

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54
Q

If pt gains or does not lose weight with AKI suspect

A

hypertension

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55
Q

AKI diet

what not to eat

A

High CARB, will spare protein for recovery

NO sodium potassium or phosphorus
(bananas, citrus or dairy)

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56
Q

Nursing with AKI

A

Monitor Fluids and Electrolytes -know aforementioned S/S

Reduce metabolic rate -by preventing infections, do blood and urine cultures regularly and act promptly

Promote pulmonary function -turn cough and prevent atelectasis

Provide skin care -breakdown due to edema, excoriation due to deposits, bathe in cool water

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57
Q

Reduce metabolic rate AKI

A

-by preventing infections, do blood and urine cultures regularly and act promptly

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58
Q

Promote pulmonary function AKI

A

turn cough and prevent atelectasis

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59
Q

Provide skin care

A

-breakdown due to edema, excoriation due to deposits, bathe in cool water

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60
Q

Erythropoietin is produced by the kidneys so a chronic kidney disease will result in

A

ANEMIA

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61
Q

What electrolytes go up with Kidney diseases

A

Potassium Sodium Phosphorus

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62
Q

With kidney failure, an increase in urea causes blood uremia. This damages what organ and creates what injurys

A

Heart

Pericarditis - s/s friction rub
Pericardial effusion/tamponade - s/s paradoxical pulse, hypotension, JVD

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63
Q

1 complication of dialisis and CKD

A

Cardiovascular disease

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64
Q

other dialysis complications that are worsened by procedure

A

HF
CAD
Stroke

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65
Q

When pt is on dialysis give meds

A

AFTER

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66
Q

Propofol med type

A

Anesthetic

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67
Q

B2 agonists and K+

A

Decrease potassium levels

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68
Q

GABApentin and other anticonvulsant Calcium Chanel Blockers can be used for what pain

A

BURNS

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69
Q

First thing to give a pt suspected of MI

other MI meds

A

Low dose aspirin

beta blockers
ace inhibitors

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70
Q

HF
Heart failure 101

A

heart is unable to pump enough blood to meet body’s needs

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71
Q

Primary cause of HF

A

CAD

deprives heart of O2

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72
Q

Other causes of HF

A

MIs
Hypertension
Cardiomyopathy (disease of myocardium)
Valvular failure
Kidney failure

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73
Q

Which layer is myocardium

A

Middle Muscle

74
Q

Most common HF is _

results in decreased….

A

Systolic

blood ejected from ventricles

75
Q

As this progresses it strains heart causing it to enlarge and dilates chambers, this causes apoptosis of cells and fibrosis.

Which then leads to _ heart failure
Heart failing to properly _

A

Diastolic

fill

76
Q

Left side HF blood backs up into _

Right side HF blood backs up into _

A

Lungs

Body

77
Q

Heart sound indicating Left HF

A

S3

78
Q

Orthopnea

S/S of

A

Difficulty breathing when lying flat

LHF

79
Q

Dry hacking cough

becomes full of frothy pink/tan sputum over time

A

LHF

80
Q

Where does blood collect in Right HF

A

JVD
Dependent Edema
Ascites
Hepatomegaly

81
Q

both L and R failure is called

A

Congestive HF

82
Q

HF treatment goals

A

Improve cardiac function
Reduce symptoms
Stabilize patient condition
Delay HF progress
Promote heart health

83
Q

Diuretics for HF

A

Loop
Thiazide
Aldosterone antagonist

84
Q

Loop diuretic

A

Furosemide

Good for severe overload

85
Q

Thiazide diuretic

A

HCTZ
Metolazone

Lowers K+ quickly

86
Q

Aldosterone antagonists

A

Spironolactone

Potassium sparing diuretic

87
Q

ACE inhibitors
April

A

Angiotensin system blockers
promote vasodilation and diuresis

Retain Potassium

88
Q

ACE inhibitor adverse effect

A

Cough not responding to treatment
Increased K+
Increased Creatinine

89
Q

ARBs MOA

ending

A

work on angiotensin renin system like ACE inhibitors, but specifically stop things at angiotensin II as opposed to the whole system

artan

90
Q

Remembering ARBs endings

A

ARBs ArTan

91
Q

ARBs and K+

A

will also increase

92
Q

Beta-blocker MOA

A

Block adverse effects of Sympathetic nervous system

Relax blood vessels

93
Q

Beta Blocker med ending

A

beta bLOLckers

lol

94
Q

Beta blockers can cause _
so are contraindicated in diseases such as

A

Bronchiole constriction

Bronchospasms, asthma

95
Q

Dioxin moa

A

Increases FORCE of contractions

Slows conduction through AV nodes

96
Q

Digoxin is a TOXIN
S/S

A

Nausea
Visual disturbances
Confusion
Bradycardia

97
Q

Hypokalemia and digoxin

A

Will INCREASE Digoxin toxicity

98
Q

Digoxin can not be given if pt has _ failure

A

Renal

99
Q

Sodium amount with HF

A

2g/day

100
Q

Prolonged QRS indicates

treated with

A

desynchronization of right and left ventricles

Pacemaker

101
Q

Cardiac arrest

associated with

A

Heart stop

Hyperkalemia

102
Q

Potassium sparing diuretic
Spironolactone can lead to

A

Hyperkalemia

103
Q

B2 agonists cause potassium level to _
via…

A

decrease

shift back into cells

104
Q

Calcium gluconate

A

manage cariad arrest
cardiotoxicity
hypocalcemia

due to hyperkalemia or hypermagnesemia

105
Q

Severe hyperkalemia first line agent

A

Calcium gluconate

106
Q

Calcium gluconate 101

A

Increases threshold potential thus restoring normal gradient of K+

107
Q

PRE renal failure
Categories

failure before the renal system

A

Volume depletion - GI loss, hemorrhage, diuresis

Impaired cardiac efficiency - Shock, HF, MI

Vasodilation - Anaphylaxis, sepsis, antihypertensive meds

108
Q

Intra renal failure
Failure within the renal system

causes

A

Ischemia - Hemoglobinuria, Rhabdomyolysis, Pigment nephropathy

Nephrotoxic agents - Aminoglycosides, ACEs, Heavy metals, NSAIDs, Radiopaque contrast

Ineffective processes - glomerulonephritis, pyelonephritis

109
Q

Hemoglobinuria causes

A

Transfusion reaction
Anemia

110
Q

Rhabdomyolysis/myoglobinuria causes

A

Trauma
Crush injury
Burn

111
Q

Aminoglycoside antibiotics

A

Gentamicin Tobramycin

112
Q

Postrenal failure
System past the kidneys

Causes

A

BPH
Blood clots
Calculi
Tumors

113
Q

4 Phases of Acute Kidney injury

A

Initiation
Oliguria
Diuresis
Recover

114
Q

AKI initiation

A

Initial insult

ends with oliguria

115
Q

AKI oliguria

A

Increase in serum concentration
CREATININE
uric acid
POTASSIUM
MAGNESIUM

400ml or less output in 24h

116
Q

AKI Diuresis

A

signals that GFR is recovering

Labs will stabilize, then DECREASE

Observe for DEHYDRATION,
if this happens uremic symptoms will increase

117
Q

AKI Recovery

A

Lasts 3 to 12months

Lab values return to normal

118
Q

AKI S/S

A

DROWSINESS
Dry skin and mucous membrane
Headache
Muscle twitching
Seizures

119
Q

AKI prevention

A

PAY SPECIAL ATTENTION to wounds burns and other precursors of sepsis

Treat infections and shock PROMPTLY
antibiotic and fluids

MONITOR renal function

120
Q

Monitor renal function

A

Urine output
Lab values

121
Q

Maintenance of fluid balance is based on

A

DAILY BODY WEIGHT
BP
I&O

122
Q

AKI Fluid excess S/S

A

Dyspnea
Tachycardia
JVD
Crackles

123
Q

Diuresis meds

A

Furosemide
Mannitol
Spironolactone

124
Q

Dialysis types

A

Hemodialysis
Peritoneal dialysis
CRRT

125
Q

Hemodialysis

A

Circulates large volumes

not for vascular compromised patients

126
Q

CRRT

A

filters small volumes good for vascular compromised pts

127
Q

Peritoneal

A

Hypertonic fluid goes in belly for a time

then it is removed

high chance of infection, leakage, bleeding

128
Q

In peritoneal, what goes in

A

must come out

129
Q

Peritoneal dialysis can ambulate T/F

A

T

130
Q

Dialysis Diet restrictions

A

Protein
Potassium
Sodium

131
Q

Can you use dialysis cites for draws

A

NO
only dialysis

132
Q

Dialysis complications

A

Clots
Cell lysis
Infection
Fluid balance

133
Q

Most life threatening problems with AKI

A

Hyperkalemia

134
Q

^K+ and ECG

A

Peak T
Prolonged QR interval

135
Q

^K+ S/S

A

IRRITABILITY
abdominal cramping
diarrhea
paresthesia
muscle weakness

136
Q

^K+ and muscle weakness

A

slurred speech
hypoxemia
paralysis

as K+ increases
CARDIAC FUCTION DECLINES

137
Q

^K+, give

A

Kayexalate

Sorbitol

138
Q

If pt has ^K+ and is hemodynamically unstable give

A

IV D50, insulin, Calcium replacement

139
Q

As calcium goes up what goes down

A

Phosphorus

140
Q

Since most meds filter though kidneys, in AKI doses will be

A

REDUCED

141
Q

PT with severe acidosis may need what med

what procedure

A

Sodium Bicarbonate

dialysis

142
Q

AKI weight is done

A

daily

143
Q

Diet for AKI

A

HIGH CARB

after diuretic phase also HIGH PROTEIN

144
Q

Foods to avoid in AKI

A

Potassium (citrus, bananas)
Phosphorus (coffee)

145
Q

AKI nursing management

A

Monitor F/E
Reduce metab rate (BEDREST)
Promote pulm function
Prevent infection
Provide skin care

146
Q

Pulm function

A

Turn
Cough
Take deep breaths

147
Q

Prevent infection

A

Avoid urinary cath

148
Q

Heart FAILURE

A

Faulty valves
Arrhythmias
Infarction
Lineage
Uncontrolled BP
Recreational drugs
Envadors

149
Q

Most common cause of Right HF

A

Left HF

150
Q

strongest ventricle

A

Left

151
Q

Low ejection fraction is anything less than

A

40

152
Q

Left HF S/S
DROWNING

A

Dyspnea
Rales (crackles)
Orthopnea (sit to breath)
Weakness
Nocturnal dyspnea
Increased HR
Nagging cough
Gaining weight

153
Q

Right HF S/S
SWELLING

A

Swelling of extremities and LIVER
Weight gain
Edema (pitting)
Large neck veins JVD
Lethargy
Irregular HR, A fib
Nocturia
Girth increase

154
Q

HF tests

A

BNP
CXR
Echocardiogram
Heart cath
Nuclear stress test

155
Q

HF can be exacerbated by

A

Na increase
Fluid increase
Infection
Renal failure

156
Q

HF can be maintained with

A

Meds
Diet
Treatments

157
Q

Nursing interventions for HF

A

Assess peripheral swelling
Assess pulmonary issues
Assess responsiveness to meds
Check labs
Assess diet
Assess safety

158
Q

Response to HF meds assessment

A

DAILY WEIGHT
BP - ace arbs
HR - digoxin

159
Q

Check labs and HF

A

Hypokalemia
Hyperkalemia
due to ace arbs or potassium sparing diuretics

BUN
Creatinine
Digoxin level
BNP

160
Q

Cardiac and fluid restrictions for HF
normal
record

A

Normal amount is 2L
I&O

161
Q

Edema treatment for HF

A

elevate legs - venous return
high fowlers - breathing

162
Q

Vasodilators with HF can cause

A

Orthostatic Hypotension
FALL RISK

163
Q

Dietary sodium restrictions

A

2g a day

164
Q

HF vaccinations

A

Flu
Pneumonia

illness exacerbates HF

165
Q

HF daily maintenance

A

Aerobic exercise
DONT stop meds
STOP smoking/drinking
Teach early signs of HF problems

166
Q

Early signs of HF problems

A

Can not tolerate normal activity (SOB)
Need pillow at night to sit up and breath
Rapid unexplained weight gain

167
Q

Meds for HF
Always Administer Drugs Before A Ventricle Dies

A

Ace inhibitors
Arbs
Diuretics
Beta blockers
Anticoagulants
Vasodilators
Digoxin

168
Q

First line med for HF

A

ACE

169
Q

S/S of digoxin toxicity

A

VISION changes
yellow green halos

NV

170
Q

Digoxin range

A

0.5 to 2

171
Q

With digoxin monitor what vital

A

PULSE
no less than 60

172
Q

Types of pain

A

Surgical
Injury
Burn
Disease

173
Q

Categories of pain

A

Persistent
Acute
Intermittent
Chronic

174
Q

Negative effects of pain on body

A

Stress
Immune system v
infection ^
wound healing v
vasoconstriction = v perfusion
hypermetabolism = hyperglycemia

175
Q

Indicators of pain

A

Facial expression
Body movement
Muscle tension

176
Q

Anion gap is the difference between _ and _

A

Cations (sodium, potassium)
Anions (chloride bicarbonate)

177
Q

Predominant cation

predominant aniona

A

Sodium

Chloride

178
Q

^ in anion gap indicates

A

metabolic acidosis

179
Q

v in anion gap =

A

metabolic alkalosis

180
Q

AKI and anion gap

A

increase in gap due to retention of acids

181
Q

Anion gap is a rapid measurement of identifying acid base _

A

IMPALANCES