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Nursing school pt 3 > NR 463: Exam 1//Rev > Flashcards

NR 463: Exam 1//Rev Flashcards

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1
Q

When to call the physician…x7

A
  1. Numbness/Tingling
  2. Bronchospasms
  3. Chest Pain post cath procedure
  4. If systolic drops below 100 or 25 lower than previous reading
  5. Bleeding Post Cath
  6. Urine Output lower than 30-50 mL/hr
  7. Pulse ox lower than 91%
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2
Q
  1. Respiratory Assessment
  2. What is hypoxemia
  3. Intervention
A
  1. pulse ox, lung sounds, sputum, dypsnea, hemoptysis, skin color, chest, ABGs clubbing
  2. normal oxygen levels, but not enough iron
  3. Turn, cough deep breath
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3
Q
  1. Early Signs of Hypoxia
  2. Late Signs of Hypoxia
  3. Testings
A
  1. Restless, Anxiety, Tachycardia/Tachypnea
  2. Bradycardia, extreme restlessness, dyspnea (CYANOSIS)
  3. Xray, Sputum, Bronchoscopy
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4
Q
  1. What is a bronchoscopy
  2. Pre Procedure Bronchoscopy
  3. Post Procedure Bronchoscopy
A
  1. inserted thru nose/mouth to visualize bronchi
  2. NPO, Vitals, coagulation studies, remove dentures, eye glasses, suction prep, IV access, med for sedation, CPR ready
  3. Semi Fowlers, Gag reflex, NPO until gag returns, emesis basin for sputum, bloody sputum,. Respers. bronchospasms, perforation-crepitus, dysrhthmias, hemorrhage, hypoxemia, pneumothorax.
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5
Q
  1. Lung Cancer Diagnostics
  2. Early Signs
  3. Late Signs
A
  1. Mediastinoscopy, VATS, Pulmonary Angiography, CT scan, MRI, Bronchoscopy, Sputum
  2. Chest pain, Dyspnea, Wheezing, FLS
  3. Anorexia, Hoarseness, palpable, pleural effucion, pericardial effusion, tamponade
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6
Q
  1. Lung Cancer Staging
  2. TNM
  3. Collaborative Care
A
  1. Small cell NO staging, NSC-TNM
  2. Tumor, Node, Metastases
  3. Surgery, Radiation, Chemo, Palliative
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7
Q
  1. Lung Cancer Patient Education
  2. Priority nursing diagnoses
A
  1. Smoking Cessation, follow up hemoptysis, dysphagia, hoarseness, hospice info
  2. Impaired Gas Exchange-r/t lung tissue removal
    1. Ineffective Airway Clearance-viscous secretions
    2. Acute pain-surgical incision, chest tubes
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8
Q
  1. Lung Cancer Nursing Intervetions
  2. What is Thoracentesis
  3. Lung Cancer and positioning
A
  1. breath pattern, respiratory impairment, hemoptysis, tracheal deviation, analgesics, fowler’s position, pulse ox, oxygen with humidification, bronchodilator, corticosteroids, good diet
  2. removal of fluid, relieve hypoxia
  3. Avoid lateral turning, ask doc
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9
Q
  1. Post Surgery pulmonary toilet
  2. Incentive Spriometer Directions
A
  1. C&DB, IS, SPlinting of incision, HOB, Ambulation
  2. upright, inhale slow, 10 times every hour, hold breath for 5 sec
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10
Q
  1. Classic TB signs
  2. Latent
  3. Active
A
  1. Yellow, blood tinged cough, night sweats, rales, crackles, anorexia
  2. Positive PPD, negative sputum and negative chest, NOT infectious
  3. Positive xray, sputum x 3
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11
Q
  1. How is TB diagnosed
  2. Collaborative Care
  3. Transmission
A
  1. Sputum, Acid Fast bacilli 3 consectuvie, 3 xrays. Red raised lump, within 48 hours, granuloma
  2. Hospitilization, drug therapy, encourage homeless to a shelter.
  3. Airborn, N95 mask
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12
Q
  1. Drug Therapy TB
  2. When does it stop being contagious
  3. Labs for TB
A
  1. Observation, 6-9 mnths Rifampin, INH, Pyrazinamide, Ethambutol, if no signs, treated with interferon
  2. After 2-3 weeks of meds.
  3. CBC, Erythrocyte Segment Rate, Decreased immune rsponse r/t PPD, liver transplant, steroids, or HIV.
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13
Q
  1. What is Pneumothorax
  2. What is Open Pneumothorax
  3. What is Closed Pneumothorax
A
  1. Air in pleural space
  2. Chest wall open wound, gun shot stabbing
  3. Common in smoker, blebs, mechanical ventilation INSIDE
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14
Q
  1. How do you treat pneumothorax
  2. How do you treat an open chest sucking wound
  3. Signs and Symptoms of pneumothorax
A
  1. Chest tube with fullter valve or drainage system
  2. 3 sided dressing
  3. Dyspnea, unequal chest expansion, no breath sound
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15
Q
  1. How do you treat hemothorax
  2. major symptom of hemothorax
  3. What happens with tension pneumothorax
A
  1. Autotransfusion, chest tube drainage sys
  2. decreased hgb, shock. Third spacing
  3. urgent, tension on heart, dec c.outpu, medistinal shift, tracheal deviation, JVD, cyanosis, Respriatory distress.
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16
Q
  1. With chest tube what should you watch for with dressing
  2. What is the most common chest trauma?
  3. What is the priority for rib fracture
A
  1. tape only three side so air can escape
  2. Rib Fracture
  3. PAIN, NSAIDS, Opioids. BREATH!!
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17
Q
  1. Flail chest characteristics
  2. Flail chest Tx
A
  1. paradoxicl respiration, severe pain, unstable chest wall, inadequate ventilation. Respiratory distress
  2. Fowler’s position, humidified air, CDP, bed rest, mechanical ventilation.(CPAP, BiPAP)
18
Q
  1. What is the largest chamber of the heart
  2. What do S3 sounds represent
  3. What do S4 sounds represent
A
  1. Left ventricle, pumps into systemic circl
  2. Ventricular wall compiance is decreased. HF, vavular regurg
  3. Atrial systole, hypertrophy, dises or injury to ventricular wall
19
Q
  1. CAD.Angina Priorities
  2. Stable Angina
  3. Unstable Angina
A
  1. Oxygen demand, exceeds oxygen supply. OXYGEN, rest, pulse ox, 12 lead ECG, pain relief with nitrate, then opioid.
  2. pain on exertion
  3. 1/2 way down the hall, relaxed- ACS stage 2
20
Q
  1. Stages of heart blockage
  2. Role of Nitro Therapy
  3. Role of Beta Blockers
A
  1. CAD, plaque build up, ACS, when relaxed ischemia, Stage 3 MI
  2. short acting, dilate arterisa dec preload and afterload
  3. Reduce blood pressure, force, rate of AV conduction
21
Q
  1. Role of Calcium Channel Blockers
  2. ACE inhibitors
  3. Contractility means
A
  1. dilate arteries reduse spasm, dec contractility, conductivity, dec oxy demand.
  2. decrease peripheral resistance
  3. sympathetic stimulation, increases means increased stroke volume.
22
Q
  1. What is a classic sign of MI
  2. How might women present EKG
  3. How long until phys changes occur after infarction
  4. How long until infarct turns gray with yellow streaks
A
  1. Dysrhthmia
  2. NONSTEMI, non elevated St segment
  3. 6 hours
  4. 48 hours
23
Q
  1. What is heart rate
  2. Angina S/Sx
  3. How long do you have for ischemia before MI
  4. What is the prominent cause of ischemia
A
  1. faster, less time to fill, CO decreases, increase
  2. Diaphoresis, GI disturbances, pain, pallor, tachy
  3. 20 minutes
  4. Thrombus formation
24
Q
  1. what happens to troponin for MI
  2. What happens to CK-MB levels
  3. What happens to myoglobin
  4. What happens to Q wave
A
  1. elevate within 3 hours, remain 7-10days
  2. peak at 18 hours after, return to normal
  3. rise within 2 hours, rapid decline afer 7hrs
  4. ST elevation (STEMI), Q wave remains permanent
25
Q
  1. Sign/SX of MI
  2. Priorit Nursing Care
  3. Complications
A
  1. Crackles, wheezing, pain, tachycardia, PVC’s, low BP
  2. Pain relief to increase oxy supply. MORPHINE, when did chest pain begin (> 30minutes), antidysthmic, thrombolytics (time*)
  3. dysthmias, HF, Pulmonary Edema, Cardiogenic shock, thrombophlebitis, pericarditis, dressler’s syndrome
26
Q
  1. MONA
  2. what happens after MONA
  3. Pre-op General
A
  1. Morphine, Oxygen, Nitro (potent vasodilator), Asprin.
  2. Calcium Channel Blockers, Beta Blockers
  3. Allergies, Meds, Past Hx, Last Meal, Events around injury
27
Q
  1. Protective barrier pre-op for kidney
  2. sedation for pre op catherization
  3. What is plavix used for catheterization
A
  1. Mucomyst
  2. dilaudi, fentayl, benzodiatamine
  3. Antiplatelet
28
Q
  1. Post Procedure Catheterization
  2. Wha happens when dye is injected
  3. What is PTCA?
A
  1. lay flat 4-6 hours, SUPINE. prevent arterial oclusion. Pulses, motor, sensation, cap refill, vitals ever 20 min, chest pain, hematoma, bleeding.
  2. flushed feeling
  3. Percutaneous transluminal coronary angioplasy. Baloon catheter to open vessel.
29
Q
  1. What does open heart surgery involve
  2. Types of Grafts
  3. Purpose of mediastinal chest tubes
A
  1. sternal incision, 2 chest tubes, foley iv fluid. Mech ventilation
  2. CABG- vein/artery, Minimally invasive, No stenotomy, thorascopy, slow heart with b-blocker, Off pump CAB, beating heart
  3. drain post op bleeding and pericardial effusion
30
Q
  1. How long should bypass surgery take to heal?
  2. How long on mechanical ventilation
  3. post op fluids
A
  1. 6 - 8 weeks
  2. 6 to 24 hours
  3. restriced due to edema (1500-2000)
31
Q
  1. What should you monitor that would cause JVD, after CABG
  2. Signs/Sx of Aortic Aneurism
  3. Modifiable care measures of aneurism
A
  1. Cardiac Tamponade, cessation of drainage
  2. hoarseness, difficulty swallowing, mass, tenderness, inc hr
  3. lower blood pressure
32
Q
  1. Tests for Aortic Aneurim
  2. Patient teaching aneurism
  3. What should you monitor post op aneurism
A
  1. ultrasound, CT scan, arteriography
  2. Report immediately if chest/back pain, SOB, hoarseness, difficulty swallowing
  3. Urine output, CMS pulses,paralytic ileus, NG, NPO, antibiotics, BP monitoring
33
Q
  1. Types of Procedurees for Peripheral Vascular
  2. Why CMS assess for Peripheral V Surgery
  3. Complications
A
  1. PTCA, Athrectomy, Cyroplasty (balloon,cold), PAbypass, Endarectomy, Patch graft, angioplasty, Amputation
  2. movement of extremity, avoid knee flexed position, cap refill color
  3. amputation, dealyed healing, atrophy
34
Q
  1. What does an echocardiogram do?
  2. What happens druing a stress test
  3. What should you evaluate for a patient prior to procedure
A
  1. ultrasound, measures heart chamber size, ejection fraction, flow gradient across valves
  2. arteries constrict when you work out, more arteries close, increase demand. Detects CAD
  3. if they can lie still
35
Q
  1. Hemoglobin levels
  2. Hematocrit Levels
  3. Platelet Norms
A
  1. 15
  2. 45%
  3. 150,000-400,000
36
Q
  1. CK-MB level
  2. Troponin I
A
  1. 0-5%
  2. Lower than 0.6 ng/mL
37
Q
  1. Tropnin T
  2. Myoglobin
A
  1. lower than 0.1-0.2 ng/mL
  2. lower than 90 mcg/L
38
Q
  1. Cholesterol
  2. LDL
  3. HDL
A
  1. 200 mg/dL
  2. <130mg/dL
  3. 30-70 mg/dL
39
Q
  1. P wave
  2. PR interval
  3. QRS Complex
  4. ST Segmant
A
  1. atrial depolarization
  2. impulse from atria thru AV node and bundle branches
  3. ventricular depolarization
  4. ventricular Repolarization
40
Q
  1. 3 components of chest tubes
  2. why does tidaling occur
A
  1. collection, water seal, suction control
  2. permits fluid to flow into the collection chamber as air flows into the water chamber. accurate measure of chest drainage

Nursing school pt 3 (13 decks)

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