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BSN: 3rd Quarter > MED/SURG FINAL EXAM > Flashcards

MED/SURG FINAL EXAM Flashcards

1
Q

EXTRA CREDIT (WEEK 3)
ALL THE CARDIAC STRIPS
PQRST
HEART BLOOD FLOW

A
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2
Q

37 cardiac output & tissue perfusion
2 cognition & sensation
4 excretion
9 immunity
9 GI
1 integumentary
9 mobility
21 O2’ion
16 endocrine

Areas breakdown:
1 Fundamentals
76 adult m/s
5 caring of children
1 leadership
18 pharmacology
11 nutrition

A
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3
Q

Pathways of bloodflow through the heart

A

Superior/Inferior vena cava –> [deO2’d] R atrium –> Tricuspid/atrioventricular valve –> R ventricle –> Pulmonary semilunar valve –> Pulmonary arteries –> [out to lungs and converted to O2’d blood] –> Pulmonary veins –> L atrium –> Mitral/bicuspid valve –> L ventricle –> Aortic semilunar valve –> Aorta –> Arteries –> Capillaries –> Veins

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4
Q

Cardiac conduction system in order

A

SA node –> AV node –> Bundle of His –> L/R bundle branches –> Purkinje fibers

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5
Q

Modifiable risks for coronary artery disease

A

LIPIDS:
— cholesterol <200mg/dL
— triglycerides <150mg/dL
— LDL cholesterol <130mg/dL (think: “lethal”; low down dirty shame)
— HDL cholesterol >40mg/dL (men), >50mg/dL (women) (think: “healthy”)
— DM
— Tobacco use
— Physical inactivity
— Obesity: weight circumference >102cm or >40 in (men), >88cm/>35in (women)
— Psychosocial risk factors (e.g. depression, hostility)
— HIGH homocysteine levels
— Substance abuse

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6
Q

Intervention for COPD patients

A

— Position in high-Fowler’s to maximize ventilation
— Increase fluid intake and drink 2-3L/day to liquefy mucus
— Take walks 20 minutes daily 2-3x/wk
— O2 2-4L/min (nasal cannula) OR up to 40% Venturi mask
— Chronically increased PaO2 levels will usually need 1-2L/min O2 via nasal cannula
— O2 maintained b/w 88-92%

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7
Q

Care of patient with subtotal thyroidectomy (post-op)

A
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8
Q

HIV lab values

A

– Normal range CD4+T: 800-1200 cells/uL
– Immune problems start @ CD4+ T cell: <500 cells/uL
Full-blown AIDS happens once CD4+T reaches <200 cells/uL

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9
Q

Transmission of HIV

A

– Unprotected sex
– Dirty needles (watch out phlebotomy)
– Sharing drug-using paraphernalia is highly risky
– Routine screening of blood donors have improved blood supply safety
– Puncture wounds are most common means of work-related HIV transmission

– Can occur during pregnancy, delivery, or breastfeeding
– On average, 25% of infants born to women with untreated HIV will be born with the infection
– Treatment can reduce rate of transmission to less than 2%

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10
Q

What lab test monitors effectiveness of treatment during HIV?

A

Quantitative RNA assay: measures the viral load and tracks the disease progression and Tx

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11
Q

Initial manifestations of HIV

A

– Flu-like
– Later: fungal infection, kaposi sarcoma

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12
Q

Manifestations of systemic lupus erythematous (SLS)

A

Fatigue & Malaise
Depression
Blurred vision
Wt loss
Joint Pain & Tenderness with Swelling
Weakness
Fever
Anemia
Lymphadenopathy
Butterfly rash on nose & cheeks
Raynaud’s Phenomenon
Pericarditis
During Exacerbation: multiple body systems affected

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13
Q

Risk Factors of Systemic Lupus Erythematous (SLS)

A

autoimmune condition resulting in chronic inflammation

RF: Females 20-40 y/o; Asian, Hispanic, Native American descent; Onset delayed/hidden by other conditions, triggered by genetic/environmental factors

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14
Q

Lab monitoring for systemic lupus erythematous

A

Diagnosis
Immunologic Tests
Antinuclear Antibodies (ANA) will be positive

Erythrocyte Sedimentation Rate (ESR) elevated r/t inflammation

dsNDA (Specific for SLE)

Other Findings
BUN & Creatinine increased
Urinalysis +protein
CBC- Pancytopenia

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15
Q

Treatment for Systemic Lupus Erythematous (SLS)

A

– NSAIDs
– Corticosteroids
– Immunosuppressant agents
– Antimalarial

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16
Q

Education for Systemic Lupus Erythematous (SLS)

A

– Avoid prolonged sun exposure
– Use steroid creams for rash
– Use Mild soap & shampoo
– Avoid Crowds (Risk of Infection r/t immunosuppression)

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17
Q

Diet considerations for management of gout

A

– Low purine diet
– Limit EtOH
– Avoid starvation dieting
– Avoid ASA & Diuretics
– Increase fluids
– Manage stress
FOODS HIGH IN PURINES: liver, sardines, shellfish

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18
Q

Risk factors for person with gout

A

– CKD
– Chemo
– Diuretics
– Starvation Dieting
– Trauma
– Post-menopause
– Obesity
– Genetics

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19
Q

Gout clients should avoid what type of medications

A

– Limit EtOH
– Low purine diet
– Avoid Salicylates (ASA) & Diuretics
– MEDS: Antigout agents (Allopurinol), NSAIDs, Corticosteroids

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20
Q

Fibromyalgia Education

A

– Pain all over
– Exercise: low aerobic activities
– NO INCREASE CAFFEINE
– Take Cymbalta b/c makes you sleepy
– DO NOT take Duloxetine in morning

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21
Q

Nursing education for clients with Rheumatoid Arthritis

A

– autoimmune
– pat sponge to wash dishes
– 2-3L especially when taking methotrexate

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22
Q

Manifestations of rheumatoid arthritis

A

– Joint swelling & deformity
– Subcutaneous nodules
– Muscle weakness
– Fatigue
– Anorexia
– Paresthesia
– Xerostomia

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23
Q

Pharmacological treatment for Rheumatoid Arthritis

A

– NSAIDS
– COX-2 Inhibitors
– Corticosteroids
– DMARDS (Disease Modifying Anti-Rheumatic Drugs

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24
Q

What are is the late manifestations of having rheumatoid arthritis (RA)?

A

Deformity of hands

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25
Q

Diagnostic tests to prove you have rheumatoid arthritis

A

– Anti CCP antibodies
– RF antibody
– ESR
– CRP
– ANA
– Elevated WBC
– Arthrocentesis
– XR

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26
Q

Nursing care and education for RA

A

– Encourage foods high in vitamins, proteins & iron
– Eat small, frequent meals
– Assist with physical activity
– Maximize function (Morning hot showers for stiffness, frequent rests)
– Minimize Pain (Non-pharm & Pharm)
– Monitor skin

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27
Q

Fibromyalgia risk factors

A

described as “burning, gnawing”

– Females 30-50
– Hx of rheumatological conditions
– Chronic fatigue
– Lyme’s Disease
– Influenza-like illness and trauma
– Sleep deprivation plays a role

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28
Q

Complications of RA

A

– Sjogren’s Syndrome
– Secondary Osteoporosis
– Vasculitis
– Respiratory Issues (PNA, pulmonary HTN, interstitial fibrosis)
– Cardiac Issues (Pericarditis / Myocarditis)

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29
Q

Expected findings for fibromyalgia

A

– Cardiovascular manifestations
– Fatigue
– Sleep disturbances
– Numbness / tingling of extremities
– Headache
– Depression / Cognitive disturbances
– GI manifestations

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30
Q

Fibromyalgia pharmacological treatment

A

– SNRIs
– Anticonvulsant
– NSAIDS
– TCA

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31
Q

Education for patients with fibromyalgia

A
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32
Q

How do you know a client’s lung as re-expanded when they have a closed chest drainage system?

A
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33
Q

Atropine vs Adenosine vs. Amiodarone

A

Atropine = Tx S/Sx’ic bradycardia
Adenosine = SHOCK TO THE HEART to STOP; Tx: SVT
Amiodarone = “Ami-SLOW-darone” = For WIDE complex Tachy = Tx pulseless VFIB, VTACH RVR

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34
Q

Manifestations of pneumonia

A

– sounds like crepitus upon percussing
– Fever, sweating shaking
– Rapid, shallow breathing
– Sharp, stabbing c/p when breathing in/coughing deeply

Tx: ABX

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35
Q

Treatment for pneumothorax

A

Needle decompression

– Tension pneumothorax can develop after mechanical ventilation or traumatic chest injury
– S/Sx: SOB, acute C/P, decrease BP/Blood O2, increase HR, hypoxia

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36
Q

What allergy must you assess for prior to administering influenza vaccine

A

Eggs

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37
Q

Steps the nurse should take when suctioning a client via nasotracheal passage

A
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38
Q

How to prevent aspiration pneumonia

A

ELEVATE HEAD-OF-BED 30 DEGREES AND HAVE SIT UP FOR ALL
MEALS
* ASSIST WITH EATING, DRINKING, TAKING MEDS AS NEEDED
* ASSESS FOR GAG REFLEX
* MONITOR REFLUX AND GASTRIC RESIDUALS (NG TUBE)
* EARLY MOBILIZATION
* COUGH AND DEEP BREATHE, INCENTIVE SPIROMETRY
* TWICE-DAILY ORAL HYGIENE

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39
Q

COPD – manifestations, management, shape of chest

A

ADPIE it out: assess FIRST
– barrel chest
– teach about pursed-lipped breathing

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40
Q

Bubbling in water seal of chest tube means

A

AIR LEAK = problem!
– Intermittent bubbling = GOOD
– Continuous bubbling = BAD

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41
Q

Bubbling in DRY SUCTION chest tube means

A

ANY BUBBLES IN DRY = BAD BAD BAD

42
Q

Treatment for Asthma

A

Beta-2-adrenergic
– do not give _____ during asthma attack

43
Q

Client education for TB medication regimen

A

Treatment meds
– family must be treated prophylactically

44
Q

TB skin test for healthy client

A

> 10mm

45
Q

What herbal supplement can interact with TB treatment

A
46
Q

Herbals that impact someone w/ CAD

A

— Feverfew:
— Aloe vera:
— Flax seed:
– Cranberries: not for diuretics (will pee more)
– Omega-3-fatty acids: tofu, walnuts, tuna
–

47
Q

Review bronchoscopy procedure, considerations

A
48
Q

Flexible bronchoscopy

A

gag reflex

49
Q

Review thoracentesis complications

A
50
Q

HD food considerations

A

LOW NA,
eggs, beans, milk, liver = best low in fat

51
Q

Antidotes/Drug reversals for: Benzodiazepines, Opioids, Digoxin, Tylenol

A

Benzodiazepines = Flumazenil
Opioids = Narcan
Digoxin = Digi-Immune/Digiban/Fab antibodies
Tylenol (Acetaminophen) = N-Acetylcysteine (NAC)
Heparin = Protamine Sulfate
Warfarin = Vitamin K

52
Q

Decipher brand vs generic drug names

A

Tylenol (Acetaminophen)
— Tylenol = brand | Acetaminophen = generic
Benadryl (Diphenhydramine)
— Benadryl = brand| Diphenhydramine = generic
Lipitor (Atorvastatin)
— Lipitor = brand | Atorvastatin = generic name
Cymbalta (Duloxetine)
— Duloxetine = generic | Cymbalta = brand name

53
Q

Digoxin antidote

A

Fab antibodies (digiban)

54
Q

Ulcer + foods needed to help with recovery

A

poultry, fish, eggs, beef (complete proteins)
HIGH PROTEIN: soy beans, chicken, tofu

55
Q

What are the nutrition considerations for- carbohydrates, fats, proteins, examples of each, how to count calories of each (15 g carbs, 4 g proteins, 10 g fat =?) Review BMI standards

A

1 gram of carbohydrate = 4 calories.
1 gram of protein = 4 calories.
1 gram of fat = 9 calories

EXAMPLE:
15g carbs x 4 = 60 calories
4g proteins x 4 = 16 calories
10g fat x 9 = 90 calories
TOTAL = 165 calories

56
Q

Daily percentage of servings of foods

A
57
Q

How to compute your total daily energy expenditure (TDEE) [total # of calories you burn in a day]

A

accounts for your resting energy expenditure (REE)

Using Mifflin-St. Jeor formula:

— Women: (10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) - 161

— Men: (10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) + 5

58
Q

How to calculate how many calories you burn

A
  1. Total daily energy expenditure (TDEE) —> Resting energy expenditure (REE)
  2. Consider your activity level: sedentary, lightly active, moderately active, very active, extremely active
  3. End up with the # of calories that you NEED every day
59
Q

How to compute macronutrient intake

A

— Carbohydrate: 45% x 1,500 calories / 4 calories = 168.75 grams per day

— Protein: 25% x 1,500 calories / 4 calories = 93.75 grams per day

— Fat: 30% x 1,500 calories / 9 calories = 50 grams per day

60
Q

Ideal macronutrient distribution

A

— Carbohydrates = 45-65% of total calories
— Protein: 10-35% of total calories
— Fats: 20-35% of total calories

61
Q

How to calculate BMI + example

A

IMPERIAL:
Weight = 167lb | Height^2 = 6ft = 72” (6x12inches)
703 x (167/ (72^2)) —> BMI = 22.6

METRIC:
Weight = 64.5kg | Height^2 =1.65^2
(65)/(1.65^2) —-> BMI = 23.691 = 23.7 (rounded)

62
Q

Interact with Warfarin is bad with which herbal supplement?

A

Saint John’s Worts

Testing: pT, INR

63
Q

Fire safety

A

R – rescue
A – alarm
C – confine
E – extinguish

64
Q

Examples of low cholesterol foods

A
65
Q

Bacterial endocarditis interventions

A

Bacterial endocarditis = long term antibiotic, do not exercise strenuously, PICC line, dental hygiene always, obtain echocardiogram, blood cultures

66
Q

Heart Failure, MI, PAD, HTN, VTE, CAD Dysrhythmias, Hyperlipidemia, Asthma, COPD, TB, PNA, Pneumothorax, all Endocrine Disorders, DM

A

PAD: no heating pad, increase temp in room; intermittent claudication (early sign)
PVD: venous insufficiency = wear tedhose, legs up
LDL, HDL, Triglycerides levels

67
Q

DM to help with hypoglycemia

A

4tsp sugar, 1TBS honey, 8oz skim milk, 3 graham crackers, 4 oz juice

68
Q

How to determine for kidney disease

A

creatinine

69
Q

Flexible bronchoscopy

A

gag reflex

70
Q

AFIB problem

A

pulmonary eboli, irregular, blood clot

71
Q

Reports has VTACH, what to do

A

elective cardioversion b/c not pulseless

72
Q

How do we know if IV dopamine is working?

A

Used to treat shock and heart failure, increases myocardial contractility, INCREASED UOP

73
Q

HIGH cholesterol

A

Statins
Adverse effects: Rhabdomyolysis (muscle weakness)

74
Q

Review Tx for HF

A

Lasix (decrease K)

75
Q

HYPERthyroidism

A

– bulging eyes,
– diarrhea
– hot
– PTU, methiamezol
– high risk for agranulocytosis –> infection

76
Q

Cushings vs. Addisons,

A

Cushing’s (TOO MUCH CORTISOL)
– Increased: BP, rosy cheeks, hyperpigmentation, infxn, hair, ACTH, weight (truncal), Na
– Decreased: K+
– DIET wants: high protein, Ca, K, Vit D; low Na + carbs
– Check for: JVD, fluid overload, incr. BG, incr. weight

Addison’s (ABSENCE OF STEROIDS) = TAN SKINNY BETCH
– Decreased: Na+, glucose, weight, hair, BP, periods,
– Increased: pigmentation, K+,
– DIET wants: high in Na, avoid K+ | MEDS: IV fluids and steroids

77
Q

SIADH vs. DI

A

SIADH: “soaked inside,” incr. ADH, low Na, thicck pee (inc 1.030+), incr. BP | Tx: Give Na+, daily weights

DI: “dry inside,” decr. ADH, polyuria, polydipsia, incr. Na, decr. BP | Tx: Desmopressin be pressin on the kidneys to hold onto H2O (watch out for HYPONa+)

78
Q

ACID-BASE BALANCE

A

– Respiratory acidosis: decr. pH, incr. HCO3, incr. PaCO2 | e.g.= HYPOventilation, rapid shallow respirations, anesthesia, COPD, PNA

– Respiratory alkalosis: HYPERventilation, deep, rapid breathing

– Metabolic acidosis: low pH, low HCO3, KUSSMAUL breathing (DKA), kidney failure

– Metabolic alkalosis: DIARRHEA, VOMIT, GI SUCTIONING, DIURETICS incr. pH/HCO

79
Q

BMI standards

A
80
Q

TB + herbals interaction

A

Ashwaghanda good, Echinacea bad

81
Q

Smoker at home + education

A

– no wool/synthetic material
– 6 feet from heater

82
Q

Diagnostic tests to prove you have rheumatoid arthritis

A

– Anti CCP antibodies
– RF antibody
– ESR
– CRP
– ANA
– Elevated WBC
– Arthrocentesis
– XR

83
Q

Component of the electrical sequence component
______________
P-wave
PR Interval
QRS Complex
ST Segment
T-wave

A

P-wave: Firing of the SA node + depolarization of the atria
_____________
PR Interval: delay of the electrical impulse @ the AV node + depolarization of the atrium
_________________

QRS Complex: ventricular depolarization
– Q-wave: 1st negative deflection
– R-wave: 1st positive deflection
– S-wave: 2nd negative (-) deflection
_____________________
ST Segment: the beginning of ventricular repolarization. Should be isoelectric (flat @ baseline)
____________________
T-wave: ventricular repolarization

84
Q
A

Normal sinus rhythm

— P-wave precedes every QRS & a QRS that follows every p-wave
— HR = 60-100bpm
— Normal PR interval = 0.12-0.20sec
— Tx? NOPE

85
Q
A

Sinus Bradycardia

—<60bpm
— Causes: athletic, taking BBs/CCBs, aging, HYPOthyroidism
— Tx? YES (if S/Sx’c: syncopy, fatigue) —> ATROPINE, pacemaker, find underlying cause

86
Q
A

Sinus tachycardia
— HR >100bpm
— S/Sx: dizziness, dyspnea, HoTN, angina in CAD pts.
— Tx? YES: VAGAL MANEUVER, BBs/CCBs, Adenosine, synchronized cardioversion

87
Q
A

Torsade de Pointes

—Tx? YES Magnesium sulfate

88
Q
A

Supraventricular tachycardia (SVT)
— AV node narrow complex b/c delayed for millisec.
— Can be 2ndary to supratherapeutic Digoxin
— HR = >160bpm
— NO p-wave

Tx> YES! CARDIOVERSION, carotid massage

89
Q
A

Atrial flutter
— aka “sawtooth” or “undulating” appearance
— NO p-waves, atria contracts very rapidly
— Causes: MI, heart surgery, overactive thyroid

Tx: CCBs (Diltiazem), BBs (Propanolol), Digoxin (Digi-Immune/Digiban/Fab antibodies)

90
Q
A

atrial fibrillation (AFIB)
— No p-wave, most common dysrhythmia, irregular R-R

Tx? YES —> Digoxin, Cardioversion +O2, BBs/CCBs, Antiarrhythmic (Amiodarone), Anticoagulants

91
Q
A

Ventricular fibrillation (VFIB)
— SHOCKABLE RHYTHM
– wavy, unmeasureable HR, highly irregular
– NO p-wave, PR interval unmeasurable, no discernable QRS complex
Tx: Begin CPR –> DEFIB

92
Q
A

Ventricular tachycardia (VTACH)
— NO p-wave
— >100bpm
— SHOCKABLE RHYTHM
– Bizarre, looks like artifact, looks like soundwaves
— Check carotid pulse, provide CPR
Tx? YES, BBS, AMIODARONE

93
Q
A

Asystole
— DEAD DED
— NOT SHOCKABLE RHYTHM

94
Q
A

Artifact
— Sometimes due to movement of patient/wires

95
Q

Lab values to watch out for when taking anticoagulants

A

Heparin — Lovenox; aPTT, PTT,
Warfarin — Eliquis; PT, INR

96
Q

Education for when taking anticoagulants

A

— Bleeding; black tarry stools = normal
— No 6P’s, shaving with single use blade, brush teeth with SOFT bristled brush

97
Q

Herbals that increase risk of bleeding

A

Garlic, saw palmetto, ginkgo, echinacea, St. John’s wort, Alfalfa, ginger, Bilberry, Ginseng

98
Q

Fat animal products vs. Non-animal products

A

Fat animal: milk, egg, liver (high in cholesterol)
Non-animal (good fats): SOY, avocado, lentils

99
Q

HF diet considerations

A

<1500 Na+, less red meat, more fish, fruits, and veggies
Shredded wheat has LESS Na+ than yogurt
Plain rice, pasta oatmeal

100
Q

How to calculate your total daily energy expenditure (TDEE) [total # of calories you burn in a day]

A

accounts for your resting energy expenditure (REE)

BSN: 3rd Quarter (13 decks)

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