More Adult 3 Unit 2 Review And Some Med Math Flashcards
1
Q
What is a common positioning strategy for ARDS patients?
A
Prone positioning is commonly used for ARDS patients to improve oxygenation.
2
Q
What components are used to dictate blood gas?
A
The components are pH, CO2, and bicarbonate (HCO3).
3
Q
What is the significance of the 50/50 rule in blood gas interpretation?
A
If the PAO2 is below 50 and the CO2 is above 50, it indicates a severe respiratory issue.
4
Q
What is the main focus when managing a patient on a ventilator?
A
The management of the patient on the ventilator is more important than the specific mode of ventilation.
5
Q
What is the difference between assist control and SIMV on a ventilator?
A
In assist control, spontaneous breaths receive a set tidal volume, while in SIMV, the patient can determine their tidal volume on spontaneous breaths.
6
Q
What is a key intervention for ARDS patients?
A
Mechanical ventilation is indicated for severe ARDS patients, with a focus on lower tidal volumes and higher PEEP.
7
Q
What should be considered when working on quality improvement projects?
A
Focus on improving processes rather than just describing procedures.
8
Q
What medications may be given for asystole?
A
Epinephrine or vasopressin may be given, but this is outside of ACLS protocol.
9
Q
What should be monitored when administering nitroglycerin?
A
Monitor for hypotension, dizziness, tachycardia, and headaches.
10
Q
What are the monitoring concerns for antiplatelet medications?
A
Monitor for bleeding and bruising.
11
Q
What precautions should be taken for patients on anticoagulants?
A
Put patients on fall precautions and monitor for bleeding.
12
Q
What type of toothbrush should patients on anticoagulants use?
A
Patients should use a soft-bristled toothbrush.
13
Q
What are anticoagulants used for?
A
Anticoagulants are used to prevent blood clots and monitor for bleeding complications.
Monitor for bruising, bleeding gums, and increase in bruise size.
14
Q
What are thrombolytics commonly referred to as?
A
Thrombolytics are commonly referred to as clot busters.
They need to be administered within six hours of presentation.
15
Q
What should be monitored when administering thrombolytics?
A
Monitor for reperfusion arrhythmias and bleeding complications.
Watch the ST segment for changes indicating perfusion return.
16
Q
What are the potential complications of thrombolytics?
A
Complications can include previous surgeries, strokes, or GI bleeds that may lead to bleeding issues.
17
Q
What should be monitored with diuretics like Lasix?
A
Monitor for hypokalemia and ototoxicity.
18
Q
What side effects should be discussed with patients taking statins?
A
Patients should be educated about sleep issues and muscle pain, as statins can be hard on the liver.
19
Q
What should be monitored with anti-platelet drugs?
A
Monitor for bleeding, bruising, and platelet counts.
Patients should be on fall precautions.
20
Q
What are common side effects of Entresto in heart failure management?
A
Common side effects include hypotension, cough, hyperkalemia, and dizziness.
21
Q
What is the general monitoring focus for anticoagulants?
A
The focus is on monitoring for bleeding and bruising.
22
Q
What vital signs should be monitored with beta blockers?
A
Monitor heart rate and blood pressure.
23
Q
What does CABG stand for?
A
CABG stands for Coronary Artery Bypass Grafting.
24
Q
What is the primary goal of interventions like CABG?
A
The primary goal is to prevent ischemic damage to the heart muscle.
25
What is ischemic cardiomyopathy?
Ischemic cardiomyopathy is a condition characterized by weakened heart muscles due to lack of oxygen.
26
What is a sternotomy?
A sternotomy is a surgical procedure that involves cracking the chest open to access the heart.
27
What is an anastomosis?
An anastomosis is where two vessels are attached together during a bypass procedure.
28
What are the optimal vessels for bypassing in CABG?
The optimal vessels for bypassing are the right internal mammary artery (RIMA) and left internal mammary artery (LIMA).
29
What is the purpose of cardiopulmonary bypass during CABG?
The purpose is to temporarily take over the function of the heart and lungs during surgery.
30
What happens to the heart during the CABG procedure?
The heart is chemically halted using potassium to allow for surgical intervention.
31
What are common scenarios for a patient arriving for CABG?
Patients may arrive after an acute MI, be stabilized from another facility, or have a scheduled procedure.
32
What are comorbidities?
Comorbidities are multiple health conditions that a patient may have simultaneously.
33
What is the typical recovery process after CABG?
Patients typically start in the ICU for tight monitoring before moving to a step-down unit.
34
What is incentive spirometry and why is it important?
Incentive spirometry is a device used to encourage deep breathing post-surgery to prevent lung complications.
35
What is the significance of patient education before CABG?
Patient education is crucial for preparing them for surgery and recovery, including understanding the procedure and potential complications.
36
What is the purpose of incentive spirometry?
Incentive spirometry is used to encourage patients to breathe deeply and improve lung function postoperatively.
37
What should patients do on post-operative day one?
Patients should get up, move around, turn, cough, and deep breathe.
38
What is dual antiplatelet therapy (DAPT)?
DAPT typically involves the use of aspirin and another medication like Plavix.
39
What should patients be educated about preoperatively?
Patients should be informed about potential new medications and their purposes.
40
How should care plans in textbooks be read?
Care plans should be read in a linear fashion across the columns, not straight down.
41
What indicates good cardiac output?
Good cardiac output can be assessed through oral mucosa color and other signs like skin tone.
42
What is important for adequate gas exchange postoperatively?
Adequate gas exchange occurs in the alveoli of the lungs, which may be compromised after surgery.
43
Why is fluid and electrolyte balance critical?
Electrolytes support electrical function in the heart, which is vital for its operation.
44
What should be monitored in elderly patients post-anesthesia?
Monitor for confusion or delirium, as they may not return to their baseline personality.
45
What is the key to preventing opioid addiction post-surgery?
Patients should take pain medications as prescribed and not for no reason.
46
What should patients avoid doing after surgery?
Patients should avoid lifting, pushing, or pulling anything over 10 pounds.
47
What is the importance of daily weight checks?
Daily weight checks help monitor fluid status and can indicate complications.
48
What is transition of care teaching?
Transition of care teaching involves educating patients about their care as they move from hospital to home.
49
What should patients do regarding medication compliance?
Patients should take their medications as prescribed and be aware of the importance of anticoagulants.
50
What are common complications to monitor post-surgery?
Common complications include bleeding, stroke, and pericarditis.
51
What is cardiac rehab and its benefits?
Cardiac rehab improves exercise tolerance, reduces the risk of a second MI, and decreases the death rate post-CABG.
52
What dietary changes are recommended post-surgery?
Patients should follow a low-fat diet and a low-salt diet, emphasizing that low salt does not mean no salt.
53
What does low salt mean?
Low salt does not mean no salt; you still need some salt in your diet.
54
What is the difference between low fats and no fats?
Low fats means reducing fat intake, but not eliminating it completely.
55
What is a common joke about cardiac diets?
A joke is that when your family orders pizza, you get to eat the box, highlighting the blandness of a cardiac diet.
56
What should be used to lower salt intake?
Use herbs and alternatives like Mrs. Dash to lower salt without completely eliminating it.
57
What are the two types of heart failure?
Right-sided heart failure and left-sided heart failure.
58
Where does fluid back up in right-sided heart failure?
Fluid backs up in the body.
59
Where does fluid back up in left-sided heart failure?
Fluid backs up in the lungs.
60
What are some symptoms of right-sided heart failure?
Symptoms include jugular vein distension (JVD), ascites, anorexia, and generalized weakness.
61
What is pulmonary edema?
Pulmonary edema is an emergent condition where fluid accumulates in the lungs, potentially causing frothy, pink-tinged sputum.
62
What medications are commonly used for heart failure?
Common medications include ACE inhibitors, ARBs, and RNAs.
63
What is an LVAD?
An LVAD (Left Ventricular Assist Device) is a permanent implantation to assist the left side of the heart.
64
What are some restrictions for LVAD patients?
Restrictions include no swimming, no contact sports, no MRI, and no smoking or drinking.
65
What is a significant risk associated with LVADs?
Patients are at high risk for driveline infections and require strict aseptic technique.
66
What is the expected survival duration for LVAD patients?
Typically, LVAD support is a bridge to transplant, with a survival expectation of about five years.
67
What can result from right heart failure?
Right heart failure can lead to left heart failure, contributing to congestive heart failure.
68
69
What is the first step when a patient comes in?
We do our assessment first, which includes getting medical history and looking for signs and symptoms.
70
Why is it important to get baseline vital signs?
Baseline vital signs help us understand where the patient starts at the beginning of the shift.
71
What should a nurse do before entering vital signs into the computer?
A nurse should see a copy of the vital signs to be aware of the patient's condition.
72
What is the issue with measuring blood pressure in patients with atrial fibrillation?
Blood pressure machines are calibrated for regular rhythms, which can lead to inaccurate readings in patients with AFib.
73
What is the importance of having bilateral IVs?
Bilateral IVs are necessary for administering different medications, blood products, or for surgery.
74
What does 'work smarter, not harder' mean in the context of blood draws?
It means to draw all necessary blood samples at once to minimize discomfort and reduce the risk of infection.
75
What does MONA stand for in medication administration?
MONA is an acronym used to remember medications, but it is not taught as a strict protocol anymore.
76
What is clopidogrel also known as?
Clopidogrel is also known as Plavix, an antiplatelet drug.
77
What is the purpose of heparin?
Heparin is an anticoagulant that inhibits clotting factors in the clotting cascade.
78
What do ACE inhibitors prevent?
ACE inhibitors prevent the development of heart failure and ventricular remodeling.
79
What is the role of oxygen in patient care?
Oxygen is used to increase blood oxygen levels and can help reduce patient anxiety.
80
Why is morphine administered to patients?
Morphine is given for pain relief and to decrease the workload on the heart.
81
What do beta blockers primarily affect?
Beta blockers primarily affect heart rate and can also impact blood pressure.
82
What is PCI in the context of interventions?
PCI stands for Percutaneous Coronary Intervention, which involves putting stents in to open coronary arteries.
83
What is the purpose of nitroglycerin?
Nitroglycerin is a vasodilator and smooth muscle relaxant used to open coronary arteries.
## Footnote
It can be administered sublingually or via IV drip.
84
What side effects should be monitored when administering nitroglycerin?
Side effects include dizziness, tachycardia, headaches, and hypotension.
85
What is the acronym MONA in cardiac care?
MONA stands for Morphine, Oxygen, Nitroglycerin, and Aspirin.
86
How should aspirin be administered in a cardiac emergency?
Aspirin can be given as four baby aspirins to chew for faster absorption.
## Footnote
This helps prevent platelet aggregation.
87
What are the risks associated with thrombolytics?
Thrombolytics can cause bleeding, especially if the patient has a history of head bleeds or recent surgeries.
88
What is the importance of timing when administering thrombolytics?
Thrombolytics should be given within the first six hours of chest pain onset.
89
What are D2D3A inhibitors used for?
D2D3A inhibitors, such as ReoPro, are potent platelet inhibitors used after stent placement to prevent occlusion.
90
What should be monitored after a patient undergoes a percutaneous coronary intervention (PCI)?
Monitor for bleeding at the insertion site, peripheral pulses, and signs of stroke.
91
What is the role of acetylcysteine in cardiac care?
Acetylcysteine is used to protect the kidneys from dye used during cardiac procedures.
92
What position should a patient be in after a femoral artery procedure?
The patient should remain flat and supine for a period of time to prevent bleeding.
93
What is the purpose of monitoring ACT levels post-procedure?
ACT levels indicate how long it takes for blood to clot, guiding when to remove sheaths.
94
What should be done if a patient feels like they have wet themselves after a PCI?
This may indicate bleeding from the femoral artery, requiring immediate assessment.
95
What is required in the procedure room?
There needs to be two nurses in the procedure room: one observing and documenting, and the other holding pressure.
96
What should you do before starting the procedure?
Go to the bathroom and take off your rings and watches.
97
How long do you typically hold pressure after pulling the sheath?
You hold pressure for an hour to an hour and fifteen minutes, depending on whether it's arterial or venous.
98
What happens if bleeding starts again while holding pressure?
If bleeding starts again, your time starts over.
99
What should you avoid while holding pressure?
Don't lock your knees.
100
Why is it important to have two nurses present?
If one nurse falls out, the patient could start bleeding from their femoral artery.
101
What should be done after holding pressure for the required time?
Put a pressure dressing on and keep the patient flat for another four to six hours.
102
What complications can arise from a bad cardiologist?
A bad cardiologist can perforate the artery, leading to severe complications.
103
What should you monitor for during the procedure?
Monitor for blood pressure and heart rate changes.
104
What is the outcome if the procedure is not handled correctly?
The patient could bleed out if not responded to properly.
105
What allergies should be noted before the procedure?
Aller iodine allergies, BUN, creatinine, and acetylcysteine.
106
What is the next step if a stent cannot be placed?
The patient must go for bypass surgery.
107
What is the left anterior descending artery commonly nicknamed?
The left anterior descending artery is commonly nicknamed the widowmaker.
108
What should you focus on when studying content?
Focus on the things you don't know.
109
What is coronary artery disease?
Coronary artery disease is a disease that decreases the coronary arteries' ability to supply blood, oxygen, and nutrients to the heart and body.
110
What are some risk factors for coronary artery disease?
Risk factors include smoking, hypertension, increased lipid levels, diabetes, high triglycerides, and metabolic syndrome.
111
What is HDL?
HDL is good cholesterol.
112
What is the relationship between the heart, lungs, and kidneys?
They are interconnected; a problem with one can affect the others.
113
What is the primary focus when assessing coronary artery disease?
The primary focus is on left ventricular issues.
114
What is chronic stable angina?
Chronic stable angina is predictable chest pain usually brought on by exertion and lasts less than fifteen minutes.
115
What should a patient do if their chest pain does not resolve after taking nitroglycerin?
If chest pain does not resolve after taking nitroglycerin, they should call 911.
116
What is unstable angina?
Unstable angina can occur at rest or with exertion and leads to activity limitations.
117
What is the significance of unstable angina?
Unstable angina is a precursor to myocardial infarction (MI).
118
What should be monitored in a patient with unstable angina?
Monitor for changes in EKG and lab values indicating tissue damage.
119
What is the recommended exercise for patients at risk for coronary artery disease?
Encourage patients to get up and walk for fifteen to twenty minutes.
120
What is the impact of socioeconomic factors on health in Arkansas?
Socioeconomic factors contribute to higher rates of sudden cardiac death and obesity.
121
What is the role of education in managing coronary artery disease?
Education is crucial for preventing readmissions and managing risk factors.
122
What is the purpose of opening coronary arteries?
To improve blood flow to cardiac tissue.
123
What symptoms did Mr. Jones present with?
Chest pain in the midabigastric area, pressure sensation, nausea, and dizziness.
124
What were Mr. Jones' vital signs?
Blood pressure: 148/92, heart rate: 90, respiratory rate: 24, oxygen saturation: 90.
125
What is the significance of ST segment depression?
It indicates potential myocardial ischemia.
126
What is the risk factor associated with Mr. Jones?
He is a smoker, weighs 350 pounds, has a family history of CAD, and is a social drinker.
127
How do myocardial infarctions (MIs) present?
They can present differently based on blockage location, severity, gender, and age.
128
What is the 'door to table' time?
The time taken to get a patient from the ambulance to the cath lab table; quicker is better because 'time is muscle'.
129
What happens to myocardial tissue during an infarction?
It is abruptly and severely deprived of oxygen and nutrients, leading to cellular death.
130
What analogy is used to explain coronary artery blockage?
Traffic flow analogy: open lanes represent normal blood flow, while closed lanes represent blockages.
131
What is the body's response to an injury in the coronary artery?
An inflammatory response that leads to platelet aggregation and clot formation.
132
What symptoms may indicate a myocardial infarction?
Chest pain, shortness of breath, nausea, anxiety, weakness, and ashen appearance.
133
What is the significance of a patient stating they feel like they are going to die?
It should be taken seriously as it may indicate a severe cardiac issue.
134
What are common pain descriptions in MI patients?
Pressure, squeezing, or crushing sensations; sharp pain is generally not associated with cardiac issues.
135
What can cause confusion in diagnosing chest pain?
Gastrointestinal issues can mimic cardiac symptoms, such as esophageal spasms.
136
What is the role of nitroglycerin in chest pain?
It acts as a vasodilator and smooth muscle relaxant, which can relieve both cardiac and GI-related pain.
137
What are common signs of an MI in terms of skin appearance?
Cool, clammy, diaphoretic skin and a gray, ashen appearance.
138
What is the significance of decreased urinary output in MI patients?
It may indicate decreased renal function due to poor perfusion.
139
What lab test is crucial for diagnosing myocardial infarction?
Troponin levels, as they are cardiac specific and indicate a cardiac problem.
140
What is troponin?
Troponin is cardiac specific and indicates a cardiac problem, specifically cardiac cellular death.
141
What are the common cardiac enzymes measured?
Common cardiac enzymes include CK, CK-MB, and troponin.
142
What does an elevated CK indicate?
An elevated CK can indicate muscle working hard, such as after running a marathon, and is not specific to cardiac issues.
143
What does CK-MB stand for?
CK-MB stands for creatine kinase myocardial band, which is more cardiac specific than CK.
144
What can cause elevated CK-MB levels?
Elevated CK-MB levels can occur due to conditions like SVT or sustained sinus tachycardia.
145
What does an elevated white blood cell count indicate in the context of an MI?
An elevated white blood cell count indicates an inflammatory response due to injury, not infection.
146
Why is potassium important in the context of myocardial infarction?
Potassium levels can rise when cells die, increasing the risk for dysrhythmias.
147
What are the risks associated with renal insufficiency during a heart cath?
Renal insufficiency can prevent the kidneys from clearing contrast dye, potentially causing further kidney damage.
148
What lab values are monitored for renal function?
BUN and creatinine are monitored to assess renal function.
149
What do PTT, BT, and INR measure?
PTT, BT, and INR are clotting factors that help assess coagulation status.
150
Why is a chest x-ray performed on MI patients?
A chest x-ray is performed to assess heart size and check for fluid buildup in the lungs.
151
What is the relationship between MI size and heart failure risk?
The larger the MI, the greater the risk for developing heart failure due to more extensive damage.
152
What is the pH range for normal arterial blood gases?
7.35 - 7.45
153
What indicates acidosis in arterial blood gases?
pH < 7.35
154
What indicates alkalosis in arterial blood gases?
pH > 7.45
155
What is the normal range for PaCO2?
35 - 45 mmHg
Remember: >45 =acid and <35 = alkaline, so up is acid and down is alkaline for CO2
156
What is the normal range for HCO3?
22 - 28 mEq/L
157
What does 'R' stand for in respiratory compensation?
Opposite
158
What does 'M' stand for in metabolic compensation?
Equal
159
What is the condition when pH is normal but other values are abnormal?
Compensated
160
What is the condition when either PaCO2 or HCO3 is normal?
Uncompensated
161
What is the condition when no values are normal?
Partially Compensated
162
What are the expected side effects of propofol?
Hypotension and bradycardia
163
What do the client's ABG results indicate? (pH-7.36, CO2—47, HCO3—24, Pa02—73)
Place the client on a nasal cannula per standing healthcare provider orders
164
What is the best action for a client with ABG: pH-7.2, CO2-58, HCO3-23, paO2-49?
Call the healthcare provider and prepare for intubation
165
What should the nurse do first for a client with SpO2 of 74% and labored breathing?
Call the healthcare provider and prepare for chest tube insertion
166
Interpret the following ABG: pH-7.49, CO2-50, HCO3-30, O2-73.
Partially compensated metabolic alkalosis
167
Interpret the following ABC: pH-7.37, CO2-53, HCO3-28, O2-81
Fully compensated respiratory acidosis
168
Interpret the following ABG: pH-7.31, CO2-38, HCO3-19, O2-78
Uncompensated metabolic acidosis
169
What should the nurse do for an intubated patient on propofol drip with HR-126, BP-144/80, and anxious behavior, raising up in bed?
Titrate the propofol infusion up
170
Critical drip calculations for weight-based infusions
Dosage X Weight in Kg X 60min X Fluid Vol all divided by concentration in mcg
171
Ordered: Dopamine 5mcg/kg/min
Available: 400mg/250ml
Weight: 198lbs
198/2.2=90kg
5mcg/kg/min x 90kg x 60min x 250ml/400,000mcg =16.9ml/hr
172
Ordered: Norepinephrine 5mcg/min
Available: 25mg/250ml
Pt weights: 180lbs
5mcg/min /25,000mcg x 250ml=0.5 x 60min =3ml/hr
173
Ordered: Nitroglycerin 10mcg/min
Available: 25mg/250ml
10mcg/min /25,000mcg x250ml= 0.1x60min =6ml/hr
174
What 3 questions should we ask ourselves before interpreting an ABG?
Is this a respiratory or metabolic problem?
Do we have acidosis or alkalosis?
Do we have compensation: uncompensated, partial, or full compensation?
175
ARDS
Priority nursing diagnosis
Impaired Gas Exchange
176
Priority intervention for ARDS
Mechanical ventilation
PEEP (positive end-expiratory pressure)
177
A.R.F - Acute Respiratory Failure
2 types:
HypOXemic failure LOW O2
(PaO2 60 or LESS)
HyperCapnic failure HIGH CO2
(PaCO2 over 50)
178
ARDS & ARF
S/S
REsistant to Oxygen
REfractory Hypoxemia
Hypoxemia LOW O2
#1 sign= Altered mental status
Agitation
Restlessness
Confusion
ARDS key sign:
Refractory Hypoxemia
Low PaO2= Despite Oxygen Delivery
179
ARDS
ABG (arterial blood gas)
LOW PaO2 HIGH CO2
Look for lowest O2 value first then highest carbon dioxide value.
PaO2 (80-100)
PaCO2 (35-45)
PH. (7.35-7.45)
180
Respiratory Distress Interventions
HOLY
HOB up- High Fowler’s position
Oral suction & oxygen
Listen to lung sounds
Yell for help! Notify HCP “provider”
