MED/SURG FINAL EXAM Flashcards
EXTRA CREDIT (WEEK 3)
ALL THE CARDIAC STRIPS
PQRST
HEART BLOOD FLOW
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
Pathways of bloodflow through the heart
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
Cardiac conduction system in order
SA node –> AV node –> Bundle of His –> L/R bundle branches –> Purkinje fibers
Modifiable risks for coronary artery disease
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
Intervention for COPD patients
— 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%
Care of patient with subtotal thyroidectomy (post-op)
HIV lab values
– 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
Transmission of HIV
– 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%
What lab test monitors effectiveness of treatment during HIV?
Quantitative RNA assay: measures the viral load and tracks the disease progression and Tx
Initial manifestations of HIV
– Flu-like
– Later: fungal infection, kaposi sarcoma
Manifestations of systemic lupus erythematous (SLS)
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
Risk Factors of Systemic Lupus Erythematous (SLS)
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
Lab monitoring for systemic lupus erythematous
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
Treatment for Systemic Lupus Erythematous (SLS)
– NSAIDs
– Corticosteroids
– Immunosuppressant agents
– Antimalarial
Education for Systemic Lupus Erythematous (SLS)
– Avoid prolonged sun exposure
– Use steroid creams for rash
– Use Mild soap & shampoo
– Avoid Crowds (Risk of Infection r/t immunosuppression)
Diet considerations for management of gout
– Low purine diet
– Limit EtOH
– Avoid starvation dieting
– Avoid ASA & Diuretics
– Increase fluids
– Manage stress
FOODS HIGH IN PURINES: liver, sardines, shellfish
Risk factors for person with gout
– CKD
– Chemo
– Diuretics
– Starvation Dieting
– Trauma
– Post-menopause
– Obesity
– Genetics
Gout clients should avoid what type of medications
– Limit EtOH
– Low purine diet
– Avoid Salicylates (ASA) & Diuretics
– MEDS: Antigout agents (Allopurinol), NSAIDs, Corticosteroids
Fibromyalgia Education
– Pain all over
– Exercise: low aerobic activities
– NO INCREASE CAFFEINE
– Take Cymbalta b/c makes you sleepy
– DO NOT take Duloxetine in morning
Nursing education for clients with Rheumatoid Arthritis
– autoimmune
– pat sponge to wash dishes
– 2-3L especially when taking methotrexate
Manifestations of rheumatoid arthritis
– Joint swelling & deformity
– Subcutaneous nodules
– Muscle weakness
– Fatigue
– Anorexia
– Paresthesia
– Xerostomia
Pharmacological treatment for Rheumatoid Arthritis
– NSAIDS
– COX-2 Inhibitors
– Corticosteroids
– DMARDS (Disease Modifying Anti-Rheumatic Drugs
What are is the late manifestations of having rheumatoid arthritis (RA)?
Deformity of hands
Diagnostic tests to prove you have rheumatoid arthritis
– Anti CCP antibodies
– RF antibody
– ESR
– CRP
– ANA
– Elevated WBC
– Arthrocentesis
– XR
Nursing care and education for RA
– 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
Fibromyalgia risk factors
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
Complications of RA
– Sjogren’s Syndrome
– Secondary Osteoporosis
– Vasculitis
– Respiratory Issues (PNA, pulmonary HTN, interstitial fibrosis)
– Cardiac Issues (Pericarditis / Myocarditis)
Expected findings for fibromyalgia
– Cardiovascular manifestations
– Fatigue
– Sleep disturbances
– Numbness / tingling of extremities
– Headache
– Depression / Cognitive disturbances
– GI manifestations
Fibromyalgia pharmacological treatment
– SNRIs
– Anticonvulsant
– NSAIDS
– TCA
Education for patients with fibromyalgia
How do you know a client’s lung as re-expanded when they have a closed chest drainage system?
Atropine vs Adenosine vs. Amiodarone
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
Manifestations of pneumonia
– sounds like crepitus upon percussing
– Fever, sweating shaking
– Rapid, shallow breathing
– Sharp, stabbing c/p when breathing in/coughing deeply
Tx: ABX
Treatment for pneumothorax
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
What allergy must you assess for prior to administering influenza vaccine
Eggs
Steps the nurse should take when suctioning a client via nasotracheal passage
How to prevent aspiration pneumonia
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
COPD – manifestations, management, shape of chest
ADPIE it out: assess FIRST
– barrel chest
– teach about pursed-lipped breathing
Bubbling in water seal of chest tube means
AIR LEAK = problem!
– Intermittent bubbling = GOOD
– Continuous bubbling = BAD
Bubbling in DRY SUCTION chest tube means
ANY BUBBLES IN DRY = BAD BAD BAD
Treatment for Asthma
Beta-2-adrenergic
– do not give _____ during asthma attack
Client education for TB medication regimen
Treatment meds
– family must be treated prophylactically
TB skin test for healthy client
> 10mm
What herbal supplement can interact with TB treatment
Herbals that impact someone w/ CAD
— Feverfew:
— Aloe vera:
— Flax seed:
– Cranberries: not for diuretics (will pee more)
– Omega-3-fatty acids: tofu, walnuts, tuna
–
Review bronchoscopy procedure, considerations
Flexible bronchoscopy
gag reflex
Review thoracentesis complications
HD food considerations
LOW NA,
eggs, beans, milk, liver = best low in fat
Antidotes/Drug reversals for: Benzodiazepines, Opioids, Digoxin, Tylenol
Benzodiazepines = Flumazenil
Opioids = Narcan
Digoxin = Digi-Immune/Digiban/Fab antibodies
Tylenol (Acetaminophen) = N-Acetylcysteine (NAC)
Heparin = Protamine Sulfate
Warfarin = Vitamin K
Decipher brand vs generic drug names
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
Digoxin antidote
Fab antibodies (digiban)
Ulcer + foods needed to help with recovery
poultry, fish, eggs, beef (complete proteins)
HIGH PROTEIN: soy beans, chicken, tofu
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
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
Daily percentage of servings of foods
How to compute your total daily energy expenditure (TDEE) [total # of calories you burn in a day]
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
How to calculate how many calories you burn
- Total daily energy expenditure (TDEE) —> Resting energy expenditure (REE)
- Consider your activity level: sedentary, lightly active, moderately active, very active, extremely active
- End up with the # of calories that you NEED every day
How to compute macronutrient intake
— 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
Ideal macronutrient distribution
— Carbohydrates = 45-65% of total calories
— Protein: 10-35% of total calories
— Fats: 20-35% of total calories
How to calculate BMI + example
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)
Interact with Warfarin is bad with which herbal supplement?
Saint John’s Worts
Testing: pT, INR
Fire safety
R – rescue
A – alarm
C – confine
E – extinguish
Examples of low cholesterol foods
Bacterial endocarditis interventions
Bacterial endocarditis = long term antibiotic, do not exercise strenuously, PICC line, dental hygiene always, obtain echocardiogram, blood cultures
Heart Failure, MI, PAD, HTN, VTE, CAD Dysrhythmias, Hyperlipidemia, Asthma, COPD, TB, PNA, Pneumothorax, all Endocrine Disorders, DM
PAD: no heating pad, increase temp in room; intermittent claudication (early sign)
PVD: venous insufficiency = wear tedhose, legs up
LDL, HDL, Triglycerides levels
DM to help with hypoglycemia
4tsp sugar, 1TBS honey, 8oz skim milk, 3 graham crackers, 4 oz juice
How to determine for kidney disease
creatinine
Flexible bronchoscopy
gag reflex
AFIB problem
pulmonary eboli, irregular, blood clot
Reports has VTACH, what to do
elective cardioversion b/c not pulseless
How do we know if IV dopamine is working?
Used to treat shock and heart failure, increases myocardial contractility, INCREASED UOP
HIGH cholesterol
Statins
Adverse effects: Rhabdomyolysis (muscle weakness)
Review Tx for HF
Lasix (decrease K)
HYPERthyroidism
– bulging eyes,
– diarrhea
– hot
– PTU, methiamezol
– high risk for agranulocytosis –> infection
Cushings vs. Addisons,
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
SIADH vs. DI
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+)
ACID-BASE BALANCE
– 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
BMI standards
TB + herbals interaction
Ashwaghanda good, Echinacea bad
Smoker at home + education
– no wool/synthetic material
– 6 feet from heater
Diagnostic tests to prove you have rheumatoid arthritis
– Anti CCP antibodies
– RF antibody
– ESR
– CRP
– ANA
– Elevated WBC
– Arthrocentesis
– XR
Component of the electrical sequence component
______________
P-wave
PR Interval
QRS Complex
ST Segment
T-wave
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
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
Sinus Bradycardia
—<60bpm
— Causes: athletic, taking BBs/CCBs, aging, HYPOthyroidism
— Tx? YES (if S/Sx’c: syncopy, fatigue) —> ATROPINE, pacemaker, find underlying cause
Sinus tachycardia
— HR >100bpm
— S/Sx: dizziness, dyspnea, HoTN, angina in CAD pts.
— Tx? YES: VAGAL MANEUVER, BBs/CCBs, Adenosine, synchronized cardioversion
Torsade de Pointes
—Tx? YES Magnesium sulfate
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
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)
atrial fibrillation (AFIB)
— No p-wave, most common dysrhythmia, irregular R-R
Tx? YES —> Digoxin, Cardioversion +O2, BBs/CCBs, Antiarrhythmic (Amiodarone), Anticoagulants
Ventricular fibrillation (VFIB)
— SHOCKABLE RHYTHM
– wavy, unmeasureable HR, highly irregular
– NO p-wave, PR interval unmeasurable, no discernable QRS complex
Tx: Begin CPR –> DEFIB
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
Asystole
— DEAD DED
— NOT SHOCKABLE RHYTHM
Artifact
— Sometimes due to movement of patient/wires
Lab values to watch out for when taking anticoagulants
Heparin — Lovenox; aPTT, PTT,
Warfarin — Eliquis; PT, INR
Education for when taking anticoagulants
— Bleeding; black tarry stools = normal
— No 6P’s, shaving with single use blade, brush teeth with SOFT bristled brush
Herbals that increase risk of bleeding
Garlic, saw palmetto, ginkgo, echinacea, St. John’s wort, Alfalfa, ginger, Bilberry, Ginseng
Fat animal products vs. Non-animal products
Fat animal: milk, egg, liver (high in cholesterol)
Non-animal (good fats): SOY, avocado, lentils
HF diet considerations
<1500 Na+, less red meat, more fish, fruits, and veggies
Shredded wheat has LESS Na+ than yogurt
Plain rice, pasta oatmeal
How to calculate your total daily energy expenditure (TDEE) [total # of calories you burn in a day]
accounts for your resting energy expenditure (REE)
