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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
Q

cardioversion therapy preparation

A

when the duration is unknown they must be on anticoagulants for 4-6 months prior so there is no throwing clots around

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26
Q

treatment for bradycardia

A

medication: atropine, dopamine, epinephrine
electrical: pacemaker

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27
Q

treatment for A-Fib, supraventricular tachycardia and ventricular tachycardia with a pulse

A

medication: amiodarone, adenosine, and verapamil
electrical: synchronized cardioversion

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28
Q

treatment for ventricular tachycardia without a pulse or v-fib

A

medication: amiodarone, lidocaine and epinephrine
electrical: d-fib

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29
Q

cardioversion documentation

A

preprocedural rhythm, number of attempts, energy settings, time and response, patient’s LOC post procedure, and skin condition under the electrodes

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30
Q

external (transcutaneous) pacemaker

A

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

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31
Q

epicardial pacemaker

A

temporary. when the pacemaker leads are attached directly to the heart during open heart surgery. used during and immediately after surgery

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32
Q

endocardial (transvenous) pacemaker

A

temporary. when the pacing wires are passed through a large central vein and lodged into the right ventricle, right atrium or both chambers

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33
Q

pacemaker mode: fixed rate (asynchronous)

A

fires at a constant rate, does not give a fuck about the heart’s own electrical activity

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34
Q

pacemaker mode: demand mode (synchronous)

A

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

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35
Q

pacemaker mode: tachydysrhythmia function

A

can overpace a tachydysrhythmia and/or deliver an electric shock

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36
Q

implantable cardioverter/defibrillator indications

A

for survivors of sudden cardiac death syndrome, risk for sudden cardiac death and spontaneous or symptomatic ventricular dysrhythmias

37
Q

pacemaker indications

A

symptomatic bradycardia, complete heart block, sick sinus syndrome, sinus attack, asystole, and atrial tachydysrhythmias

38
Q

ICD indications

A

ventricular tachydysrthythmias, MI with left ventricular dysfunction

39
Q

special care for a temporary pacemaker includes

A

don’t fuck with it’s settings and keep it dry (do not shower)

40
Q

permanent pacemaker battery life

A

about 10 years

41
Q

ICD battery life

A

about 9 years

42
Q

permanent pacemaker post procedure care includes

A

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
Q

what do patients need to report after permanent pacemaker placement?

A

dizziness, fainting, fatigue, weakness, chest pain, hiccupping, palpitations, difficulty breathing or weight gain

44
Q

is the shock of an ICD device harmful to people touching the patient?

A

no. they might feel the impulse but it is not harmful

45
Q

items that can fuck with a pacemaker generator

A

garage door opener, burglar alarms, strong magnets, generators and other powerful transmitters, large stereo speakers

46
Q

atherectomy

A

breaks up and remove plaque within the cardiac vessels

47
Q

stent

A

placement of a mesh wire device that contains no medication to hold an artery open and prevent restenosis

48
Q

percutaneous transluminal coronary angioplasty (or just angioplasty)

A

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
Q

percutaneous coronary intervention (PCI) is usually performed

A

4-6 hours after a N-STEMI
or within 60-90 minutes after a STEMI

50
Q

artery dissection

A

perforation of an artery by the catheter might cause cardiac tamponade or require emergency bypass surgery.
s/s severe hypotension and tachycardia

51
Q

cardiac tamponade - what is it and s/s

A

can happen from fluid accumulation in the pericardial sac
s/s: hypotension, jugular vein distention, muffled heart sounds, and paradoxical pulse

52
Q

paradoxical pulse

A

variance of 10 mm Hg or more in systolic blood pressure between expiration and inspiration

53
Q

cardiac tamponade nursing implications

A

IV fluids for hypotension, x-ray/echo, prepare the patient for pericardiocentesis

54
Q

retroperitoneal bleeding

A

bleeding in that space (abdominal cavity behind the peritoneum) can occur due to femoral artery puncture
assess for flank pain and hypotension

55
Q

retroperitoneal bleeding education

A

apply pressure to the site, keep legs straight, report chest pain, SOB, and cardiac symptoms

56
Q

coronary artery bypass grafts

A

invasive surgical procedure to restore vascularization of the myocardium. most effective when the patient’s ejection fracture is greater than 50%

57
Q

peripheral bypass grafts

A

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
Q

potential complications of peripheral bypass grafts

A

graft occlusion, compartment syndrome, infection

59
Q

potential complications of coronary artery bypass grafts

A

atelectasis, pneumonia, pulmonary edema, hypothermia, decreased cardiac output, cardiac tamponade, hypovolemia, left sided heart failure, electrolyte disturbances, neurologic deficits

60
Q

ischemia vs infacrtion

A

ischemia is reversible while infarction is permanent damage

61
Q

stable (exertional) angina

A

occurs with exercise or emotional stress and is relieved by rest or nitroglycerine

62
Q

unstable (periinfarction) angina

A

occurs with exercise of at rest, but increases in occurrence, severity and duration over time

63
Q

variant (prinzmetal’s) angina

A

is due to a coronary artery spasm, often occurring during periods of rest

64
Q

angina and MI expected findings

A

anxiety, chest pain (may radiate), nausea, dizziness, pallor, cool and clammy skin, tachycardia, palpitations, tachypnea, SOB, diaphoresis, vomiting, decreased LOC

65
Q

what should hourly urine output be greater than?

A

30 mL/hr why do I always forget this

66
Q

special skills of beta blockers

A

alongside being antihypertensive, it is also an antidysrhythmic and can reduce afterload and slow the heart rate

67
Q

thrombolytic agent examples

A

alteplaase and reteplase. used to break up blood clots

68
Q

new york heart association’s heart failure scale

A

class i: no manifestations with activity
class ii: manifestations with ordinary exertion
class iii: manifestations with minimal exertion
class iv: manifestations at rest

69
Q

left sided heart failure symptoms

A

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
Q

right sided heart failure symptoms

A

jugular vein distention, ascending dependent edema, abdominal distention, fatigue, nausea, anorexia, polyuria at rest, liver enlargement and tenderness, weight gain

71
Q

hBNP

A

less than 300 pg/mL indicates no heart failure
300 indicates mild HF
600 indicates moderate HF
900 severe HF

72
Q

ventricular assist device (VAD)

A

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
Q

valvular heart disease: stenosis

A

narrowed opening impedes blood moving forward

74
Q

valvular heart disease: insufficiency/improper closure

A

some blood flows backward (regurgitation)

75
Q

congenital valvular heart disease

A

can affect all four valves and cause either stenosis or insufficiency

76
Q

acquired degenerative valvular heart disease

A

due to damage over time from mechanical stress, atherosclerosis and hypertension

77
Q

rheumatic valvular heart disease

A

acquired. gradual fibrotic changes with calcification of valve cusps

78
Q

ineffective endocarditis valvular heart disease

A

infectious organisms destroy the valve. streptococcal infections are the cause

79
Q

patient education for valvular heart disease

A

prophylactic antibiotics for dental work, notify doctor of 3lb weight gain, avoid caffeine, alcohol and epinephrine, preserve energy

80
Q

pericarditis

A

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
Q

pericarditis expected findings

A

chest pressure/pain made worse with breathing, coughing and swallowing
pericardial friction rub, SOB, relief of pain when sitting and leaning forward

82
Q

myocarditis

A

inflammation of the myocardium can be due to viral, fungal, or bacterial infection or a systematic inflammatory response

83
Q

myocarditis expected findings

A

tachycardia, murmur, friction rub, cardiomegaly, chest pin and dysrhythmias

84
Q

rheumatic endocarditis

A

infection of the endocardium due to a complication of rheumatic fever preceded by streptococcal pharyngitis. produces lesions in the heart

85
Q

rheumatic endocarditis expected findings

A

fever, chest pain, joint pain, tachycardia, SOB, rash on trunk and extremities, friction rub, murmur, muscle spasms

86
Q

infective endocarditis

A

infection of the endocardium. most common in patients with cardiac malformations, cardiac implants (pacemaker or prosthetics), or IV drug use

87
Q

infective endocarditis expected findings

A

fever, flu like manifestations, murmur, petechiae, positive blood cultures, splinter hemorrhages (red streaks under fingernails)

88
Q

beta blockers and hypoglycemia

A

they can mask some manifestations such as tachycardia. you have to look at other indications

semester 3 (9 decks)

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