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semester 3 > medsurg test 2 > Flashcards

medsurg test 2 Flashcards

1
Q

the purpose of a lipid panel

A

to take cholesterol level or early detection of heart disease

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2
Q

fasting for a lipid panel

A

12-14 hours per ATI (which is wrong but whatever)

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3
Q

cholesterol (total) expected range

A

less than 200 mg/dL

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4
Q

LDL expected range

A

less than 130 mg/dL (bad cholesterol. the loser kind)

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5
Q

HDL expected range

A

female: greater than 55 mg/dL
male: greater than 45 mg/dL
(good cholesterol. the happy kind)

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6
Q

triglycerides expected range

A

female: 35-135 mg/dL
male: 40-160 mg/dL

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7
Q

creatine kinase MB isoenzyme expected range

A

0% of total CK (30-170 units/L)

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8
Q

troponin T expected range

A

less than 0.1 ng/mL

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9
Q

troponin T expected duration of elevated levels

A

10-14 days. T stands for up to twice as long

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10
Q

troponin I expected range

A

less than 0.3 ng/mL

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11
Q

troponin I expected duration of elevated levels

A

7-10 days. I stands for idk less than the other one thats for sure

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12
Q

transthoracic echocardiography

A

the non-invasive kind. used to diagnose valve disorders and cardiomyopathy. can evaluate size, shape, and motion of the heart. CAN MEASURE EJECTION FRACTURE

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13
Q

transesophageal echocardiography

A

provides clearer ultrasonic images by sticking the fucking probe down your throat to look at your heart from the back

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14
Q

medications used for pharmacological stress testing

A

dipyridamole, adenosine, regadenoson, dobutamine

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15
Q

hemodynamic monitoring involves

A

indwelling catheters that provide information about blood volume, perfusion, fluid status and how well the heart is pumping

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16
Q

where are atrial lines placed

A

radial (most common), brachial or femoral arteries

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17
Q

pulmonary artery catheters

A

inserted into a large vein and threaded through the right atria and ventricle into a branch of the pulmonary artery

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18
Q

angiography, also called cardiac catheterization

A

an invasive procedure used to evaluate the presence and degree of coronary artery blockage. uses contrast so hold metformin

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19
Q

nontunneled percutaneous central venous catheter (CVC)
or central line for those of us who speak english

A

inserted into subclavian vein, jugular vein.
indicated for blood transfusion, long term chemo, antibiotics and total parenteral nutrition
SHORT TERM USE

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20
Q

peripherally inserted central catheter (PICC)

A

inserted into basilic or cephalic vein
indicated for blood transfusion, long term chemo, antibiotics and total parenteral nutrition
LONG TERM USE

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21
Q

defibrillation

A

delivery of an unsynchronized, direct countershock to the heart. it stops all electrical activity of the heart, allowing the SA node to take over and do its job right this time.

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22
Q

Indications for defibrillation

A

V-Fib or pulseless ventricular tachycardia

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23
Q

indications for cardioversion

A

atrial dysrhythmias, supraventricular tachycardia, and ventricular tachycardia with a pulse. its the treatment of choice and can be elective

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24
Q

indications for defibrillation

A

v-fib

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25
cardioversion therapy preparation
when the duration is unknown they must be on anticoagulants for 4-6 months prior so there is no throwing clots around
26
treatment for bradycardia
medication: atropine, dopamine, epinephrine electrical: pacemaker
27
treatment for A-Fib, supraventricular tachycardia and ventricular tachycardia with a pulse
medication: amiodarone, adenosine, and verapamil electrical: synchronized cardioversion
28
treatment for ventricular tachycardia without a pulse or v-fib
medication: amiodarone, lidocaine and epinephrine electrical: d-fib
29
cardioversion documentation
preprocedural rhythm, number of attempts, energy settings, time and response, patient's LOC post procedure, and skin condition under the electrodes
30
external (transcutaneous) pacemaker
temporary. delivered through the thoracic musculature to the heart via two electrode patches. takes a lot of electricity so its painful af. used when a symptomatic bradycardia patient is unresponsive to medications
31
epicardial pacemaker
temporary. when the pacemaker leads are attached directly to the heart during open heart surgery. used during and immediately after surgery
32
endocardial (transvenous) pacemaker
temporary. when the pacing wires are passed through a large central vein and lodged into the right ventricle, right atrium or both chambers
33
pacemaker mode: fixed rate (asynchronous)
fires at a constant rate, does not give a fuck about the heart's own electrical activity
34
pacemaker mode: demand mode (synchronous)
it detects the heart's electrical impulses and fires only if it is below a certain level can be inhibited: does not fire or triggered: fires
35
pacemaker mode: tachydysrhythmia function
can overpace a tachydysrhythmia and/or deliver an electric shock
36
implantable cardioverter/defibrillator indications
for survivors of sudden cardiac death syndrome, risk for sudden cardiac death and spontaneous or symptomatic ventricular dysrhythmias
37
pacemaker indications
symptomatic bradycardia, complete heart block, sick sinus syndrome, sinus attack, asystole, and atrial tachydysrhythmias
38
ICD indications
ventricular tachydysrthythmias, MI with left ventricular dysfunction
39
special care for a temporary pacemaker includes
don't fuck with it's settings and keep it dry (do not shower)
40
permanent pacemaker battery life
about 10 years
41
ICD battery life
about 9 years
42
permanent pacemaker post procedure care includes
chest x-ray to asses for pneumothorax, hemothorax or pleural effusion minimize shoulder movement so the leads can anchor assess for hiccups (can be that its pacing the diaphragm) inspect for thermal burns
43
what do patients need to report after permanent pacemaker placement?
dizziness, fainting, fatigue, weakness, chest pain, hiccupping, palpitations, difficulty breathing or weight gain
44
is the shock of an ICD device harmful to people touching the patient?
no. they might feel the impulse but it is not harmful
45
items that can fuck with a pacemaker generator
garage door opener, burglar alarms, strong magnets, generators and other powerful transmitters, large stereo speakers
46
atherectomy
breaks up and remove plaque within the cardiac vessels
47
stent
placement of a mesh wire device that contains no medication to hold an artery open and prevent restenosis
48
percutaneous transluminal coronary angioplasty (or just angioplasty)
involves inflating a balloon to dialate the arterial lumen and the adhering plaque, thus widening the arterial lumen. can include a stent placement while they're up in there
49
percutaneous coronary intervention (PCI) is usually performed
4-6 hours after a N-STEMI or within 60-90 minutes after a STEMI
50
artery dissection
perforation of an artery by the catheter might cause cardiac tamponade or require emergency bypass surgery. s/s severe hypotension and tachycardia
51
cardiac tamponade - what is it and s/s
can happen from fluid accumulation in the pericardial sac s/s: hypotension, jugular vein distention, muffled heart sounds, and paradoxical pulse
52
paradoxical pulse
variance of 10 mm Hg or more in systolic blood pressure between expiration and inspiration
53
cardiac tamponade nursing implications
IV fluids for hypotension, x-ray/echo, prepare the patient for pericardiocentesis
54
retroperitoneal bleeding
bleeding in that space (abdominal cavity behind the peritoneum) can occur due to femoral artery puncture assess for flank pain and hypotension
55
retroperitoneal bleeding education
apply pressure to the site, keep legs straight, report chest pain, SOB, and cardiac symptoms
56
coronary artery bypass grafts
invasive surgical procedure to restore vascularization of the myocardium. most effective when the patient's ejection fracture is greater than 50%
57
peripheral bypass grafts
aims to restore blood flow to the areas affected by peripheral artery disease like coronary artery bypass grafts but for the rest of the body
58
potential complications of peripheral bypass grafts
graft occlusion, compartment syndrome, infection
59
potential complications of coronary artery bypass grafts
atelectasis, pneumonia, pulmonary edema, hypothermia, decreased cardiac output, cardiac tamponade, hypovolemia, left sided heart failure, electrolyte disturbances, neurologic deficits
60
ischemia vs infacrtion
ischemia is reversible while infarction is permanent damage
61
stable (exertional) angina
occurs with exercise or emotional stress and is relieved by rest or nitroglycerine
62
unstable (periinfarction) angina
occurs with exercise of at rest, but increases in occurrence, severity and duration over time
63
variant (prinzmetal's) angina
is due to a coronary artery spasm, often occurring during periods of rest
64
angina and MI expected findings
anxiety, chest pain (may radiate), nausea, dizziness, pallor, cool and clammy skin, tachycardia, palpitations, tachypnea, SOB, diaphoresis, vomiting, decreased LOC
65
what should hourly urine output be greater than?
30 mL/hr why do I always forget this
66
special skills of beta blockers
alongside being antihypertensive, it is also an antidysrhythmic and can reduce afterload and slow the heart rate
67
thrombolytic agent examples
alteplaase and reteplase. used to break up blood clots
68
new york heart association's heart failure scale
class i: no manifestations with activity class ii: manifestations with ordinary exertion class iii: manifestations with minimal exertion class iv: manifestations at rest
69
left sided heart failure symptoms
dyspnea, orthopnea (sob while lying down), fatigue, displaced apical pulse, s3 heart sound, pulmonary congestion, frothy sputum, altered mental status, manifestations of organ failure, nocturia
70
right sided heart failure symptoms
jugular vein distention, ascending dependent edema, abdominal distention, fatigue, nausea, anorexia, polyuria at rest, liver enlargement and tenderness, weight gain
71
hBNP
less than 300 pg/mL indicates no heart failure 300 indicates mild HF 600 indicates moderate HF 900 severe HF
72
ventricular assist device (VAD)
a mechanical pump that assists a heart that is too weak to pump blood through the body. used for patients waiting for a heart transplant or those who are not candidates for one
73
valvular heart disease: stenosis
narrowed opening impedes blood moving forward
74
valvular heart disease: insufficiency/improper closure
some blood flows backward (regurgitation)
75
congenital valvular heart disease
can affect all four valves and cause either stenosis or insufficiency
76
acquired degenerative valvular heart disease
due to damage over time from mechanical stress, atherosclerosis and hypertension
77
rheumatic valvular heart disease
acquired. gradual fibrotic changes with calcification of valve cusps
78
ineffective endocarditis valvular heart disease
infectious organisms destroy the valve. streptococcal infections are the cause
79
patient education for valvular heart disease
prophylactic antibiotics for dental work, notify doctor of 3lb weight gain, avoid caffeine, alcohol and epinephrine, preserve energy
80
pericarditis
inflammation of the pericardium, commonly follows a respiratory infection, but can be due to MI or acute exacerbation of a systemic connective tissue disease
81
pericarditis expected findings
chest pressure/pain made worse with breathing, coughing and swallowing pericardial friction rub, SOB, relief of pain when sitting and leaning forward
82
myocarditis
inflammation of the myocardium can be due to viral, fungal, or bacterial infection or a systematic inflammatory response
83
myocarditis expected findings
tachycardia, murmur, friction rub, cardiomegaly, chest pin and dysrhythmias
84
rheumatic endocarditis
infection of the endocardium due to a complication of rheumatic fever preceded by streptococcal pharyngitis. produces lesions in the heart
85
rheumatic endocarditis expected findings
fever, chest pain, joint pain, tachycardia, SOB, rash on trunk and extremities, friction rub, murmur, muscle spasms
86
infective endocarditis
infection of the endocardium. most common in patients with cardiac malformations, cardiac implants (pacemaker or prosthetics), or IV drug use
87
infective endocarditis expected findings
fever, flu like manifestations, murmur, petechiae, positive blood cultures, splinter hemorrhages (red streaks under fingernails)
88
beta blockers and hypoglycemia
they can mask some manifestations such as tachycardia. you have to look at other indications

semester 3 (9 decks)

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