NUR 240 Final Exam Flashcards
1
Q
What are the main chronic pulmonary diseases
A
COPD
- chronic bronchitis
- emphysema
Bronchiectasis
Asthma
Cystic Fibrosis
2
Q
What are the symptoms of chronic bronchitis
A
- cough w/sputum production for at least three month in at least 2 consecutive years
3
Q
What are the major symptoms of COPD
A
- chronic cough
- sputum production
- dyspnea
- barrel chest
- weight loss due to dyspnea
- anxiety
4
Q
What are the complications of COPD
A
- Respiratory failure
- pneumonia
- atelectasis
- pneumothorax
- Cor pulmonale
5
Q
What is Cor pulmonale
A
hypertension of the pulmonary arteries and veins that lead to right sided heart failure
6
Q
What are the risk factors for getting COPD
A
- smoking
- history of childhood respiratory infections
- occupational exposure
- exposure to second hand smoke
- older than 40
- pollution
7
Q
Medications to treat COPD
A
- corticosteroids
- beta-adrenergic agonists
- muscarinic antagonists
- mucolytics
- antitussives
- antibiotics
8
Q
What is a bullectomy
A
surgery to remove air pockets in the lungs for patients with COPD
9
Q
What is bronchiectasis
A
a chronic, irreversible dilation of the bronchi and bronchioles
10
Q
What are the symptoms of bronchiectasis
A
- chronic cough
- lots of purulent sputum
- clubbing of the fingers
11
Q
What are some medical management techniques to manage bronchiectasis
A
- postural drainage
- chest physiotherapy
12
Q
What is asthma
A
Chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production
13
Q
What is the strongest predisposing risk factor for asthma
A
allergies
14
Q
What are the signs and symptoms of asthma
A
- cough
- chest tightness
- dyspnea
- wheezing
- diaphoresis
- tachycardia
- hypoxemia
- central cyanosis
15
Q
What are some medications to treat asthma
A
short acting medications
- beta-2 adrenergic agonists
- anticholenergics
long acting medications
- corticosteroids
- long acting beta-2 adrenergic agonists
- leukotriene modifiers
16
Q
What is cystic fibrosis
A
Most common autosomal recessive disease among the Caucasian population
Genetic mutation changes chloride transport which leads to thick, viscous secretions in the lungs, pancreas, liver, intestines, and reproductive tract
17
Q
What are some medications to treat cystic fibrosis
A
- anti-inflammatories
- corticosteroids
- bronchodilators
- pancreatic enzyme supplements
- CFTR modulators
18
Q
What are some nursing techniques to help cystic fibrosis
A
- chest physiotherapy
- breathing exercises
19
Q
What is hypoxia
A
a decrease in oxygen supply to the tissues and cells
20
Q
What is hypoxemia
A
a decrease of oxygen in the blood
21
Q
How much oxygen should you administer to a patient with COPD
A
greater than 21%
22
Q
What is oxygen toxicity
A
too much oxygen administered (greater than 50%)
23
Q
What are the symptoms of oxygen toxicity
A
- substernal discomfort
- paresthesia
- dyspnea
- restlessness
- fatigue
- malaise
- refractory hypoxemia
- atelectasis
- alveolar infiltrates on X-ray
24
Q
What is an arrhythmia
A
Disorders of formation or conduction (or both) of electrical impulses within heart
can be atrial or ventricular
25
What are some examples of atrial arrhythmias
- premature atrial complex
- atrial flutter
- atrial fibrillation
26
What are some examples of ventricular arrhythmias
- Premature ventricular complex
- Ventricular tachycardia
- Ventricular fibrillation
- Ventricular asystole
27
What is the difference between systole and diastole
Systole - depolarization (stimulation)
Diastole - repolarization (relaxation)
28
What is sinus rhythm
The heartbeat determined by the SA node
29
What are the two types of sinus arrhythmias
Sinus bradycardia
Sinus tachycardia
30
What are the different waves of the ECG
P wave
QRS complex
T wave
31
What are the different intervals in an ECG
PR interval
ST segment
QT interval
TP interval
PP interval
32
What are the signs and symptoms seen in a patient with an arrhythmia
Fatigue
Dizziness
Fainting
tachycardia
Shortness of breath
anxiety
Chest pain
Alternating fast and slow heart rate
Sweating
33
What are some potential complications of an arrhythmia
Cardiac arrest
Heart failure
thromboembolism (especially with A-fib)
34
What is the 6 minute walk test
Walk at a normal pace for 6 minutes to see how the heart responds
35
What are some supplemental modalities used when medications are not enough to treat arrhythmias
pacemakers
cardioversion
defibrillation
36
What is a pacemaker
Electronic device that provides electrical stimuli to heart muscle
can be permanent or temporary
37
Where is the lead of a pacemaker placed in the heart
lead is fed through the external jugular vein and lodged into the apex of the right ventricle
38
What are some complications associated with using a pacemaker
Infection
Bleeding or hematoma formation
Dislocation of lead
Skeletal muscle or phrenic nerve stimulation
Cardiac tamponade
Pacemaker malfunction
39
What is cardiac tamponade
Pressure on the heart that occurs when fluid builds up in the pericardium that keeps the heart from beating
40
What is defibrillation
Applying a shock to the heart in order to bring it back to normal sinus rhythm
treats tachyarrhythmias
unsynchronized delivery
41
What is cardioversion
procedure that uses quick, low-energy shocks to restore a regular heart rhythm
treats tachyarrhythmias
synchronized delivery
42
Which cardiovascular disease is the most prevalent in adults in the united states
coronary artery disease (CAD)
43
What is coronary atherosclerosis
Buildup of lipids in the coronary artery leading to decreased blood flow to the heart
44
What is the leading cause of death in the united states for all genders and ethnic groups
Cardiovascular disease (CVD)
45
What are the symptoms of atherosclerosis
Angina pectoris (most common)
Nausea/vomiting
pain that radiates to jaw or left arm
Shortness of breath
(Atypical symptoms in women)
46
What can atherosclerosis lead to
myocardial infarction
heart failure
sudden cardiac death
47
What are the four modifiable risk factors for coronary artery disease
smoking
hypertension
diabetes
high cholesterol (high LDL)
48
What are the non-modifiable risk factors for coronary artery disease
Age
Gender
Ethnicity
Genetics
- hs-CRP (high sensitivity to C reactive protein)
- metabolic syndrome
49
What are the six medication classes used to lower cholesterol
1. HMG-Co-A reductase inhibitors (Statins)
2. Nicotinic acids
3. Fibrates
4. Bile acid sequestrants (resins)
5. Cholesterols absorption inhibitors
6. Omega-3 fatty acids
50
What are the 5 types of angina
stable
unstable
intractable/refractory
variant
silent ischemia
51
What is stable angina
Pain that occurs on exertion and is relieved by rest or nitroglycerin
52
What is unstable angina
Pain that increases in severity and frequency and may not be relieved by rest or nitroglycerin
53
What is intractable/refractory angina
severe, incapacitating chest pain
54
What is variant angina
Pain at rest with reversible ST-segment elevation (thought to be caused by coronary artery vasospasm)
55
What is silent ischemia
Ischemia (heart tissue damage) seen on ECG during stress test but no pain
56
What is angina pectoris
Chest pain caused by insufficient coronary blood flow (blood flow to the heart)
oxygen demands are higher than what is available
57
What is relevant to know about angina in older adults
diminished pain transmission (Silent CAD)
teach patient how to spot their "chest pain like" symptoms in other ways (weakness, nausea, vomiting etc.)
58
What is the main goal in treating angina pectoris
decrease oxygen demand of the heart and
increase the oxygen supply to the heart
59
What are 7 medications used to treat angina
1. nitroglycerin
2. beta blockers
3. calcium channel blockers
4. antiplatelet (clopidogrel, ticlopidine)
5. anticoagulants (heparin)
6. aspirin
7. Glycoprotein IIb/IIIa agents
60
What is acute coronary syndrome
Describes many conditions due to reduced blood flow to the heart (such as a myocardial infarction)
61
What is cardiogenic shock
When the heart cannot pump enough blood (oxygen) to the brain and other organs
62
What does the ECG look like in a person who had an MI
elevation of the ST segment in two contiguous leads (usually V3 and V4)
63
Which labs would be abnormal in a patient who had an MI
cardiac enzymes
troponin
creatine kinase
myoglobin
64
What is pericardial effusion
A buildup of fluid in the pericardium leading to cardiac tamponade
65
Patients who have an MI are at higher risk of developing which conditions
pulmonary edema
heart failure
arrhythmias
cardiogenic shock
cardiac arrest
pericardial effusion and cardiac tamponade
66
What is percutaneous transluminal coronary angioplasty (PTCA)
An invasive cardiac procedure that opens the occluded coronary artery by inflating a balloon and flattening the buildup against the artery wall
67
What is a coronary artery stent
A surgical procedure where a balloon is inflated to open the occluded coronary artery, and then a wire mesh is placed to keep the artery open.
68
What is coronary artery bypass graft (CABG)
A surgical procedure where a healthy vein from somewhere else in the body (leg, chest, wrist etc.) is surgically placed at the beginning and end of the portion of the artery that is blocked in order to allow blood an alternate route to flow
69
Which vein is most commonly used in CABG procedures
Great saphenous vein
70
What are three disorders seen in the heart valves
regurgitation (aortic & mitral)
stenosis (aortic & mitral)
prolapse (mitral)
71
What is cardiomyopathy
An acquired or hereditary disease of heart muscle, this condition makes it hard for the heart to deliver blood to the body, and can lead to heart failure.
72
What are the 5 types of cardiomyopathy
1. Dilated (DCM)
2. Hypertrophic (HCM)
3. Restrictive/constrictive (RCM)
4. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)
5. Unclassified
73
Which cardiomyopathies lead to congestive heart failure
Dilated
Hypertrophic
Restrictive
74
What is dilated cardiomyopathy
Most common type of cardiomyopathy
heart muscles become weak and chambers become enlarged causing a decrease in cardiac output
75
What is hypertrophic cardiomyopathy
Mostly asymptomatic
heart muscles become enlarged and chambers become smaller causing a decrease in heart volume
76
What is restrictive/constrictive cardiomyopathy
Heart muscle becomes stiff and although it can pump well, it cannot relax completely resulting in reduced volume of blood in the chambers of the heart
77
What is arrhythmogenic right ventricular cardiomyopathy/dysplasia
A rare genetic disorder that may cause ventricular tachycardia and sudden cardiac death in young, apparently healthy individuals. The clinical hallmark of the disease is ventricular arrhythmias, arising predominantly from the right ventricle.
78
What metabolite is most associated with cardiomyopathy
Sodium
cardiomyopathy usually leads to heart failure due to fluid overload
79
What is pulsus paradoxus
A dramatic drop in blood pressure when breathing in
could be a sign of cardiomyopathy
80
Cardiomyopathy can lead to which conditions
Heart failure
arrhythmias
Pulmonary embolism
Cerebral embolism
Valvular dysfunction
81
What are the four infections that can occur in the heart
Rheumatic endocarditis
Infective endocarditis
Pericarditis
Myocarditis
82
What is rheumatic endocarditis
Occurs mostly in school age children who had strep throat and then developed rheumatic fever
83
What is infective endocarditis
occurs in patients who have:
- prosthetic heart valves
- IV drug addictions
- debilitating diseases
- indwelling catheters
- prolonged IV therapy
84
What is pericarditis
Inflammation of the pericardium
can be caused by many things
can lead to pericardial effusion and cardiac tamponade
85
What is myocarditis
Inflammation of the myocardium due to a viral infection
can lead to cardiomyopathy and heart failure
86
What are the signs and symptoms of infectious disease of the heart
- fever
- new heart murmur
- friction rub heard at left lower sternal border (pericarditis)
- Osler nodes & Janeway lesions (lesions on the palms and soles) (endocarditis)
- Roth spots (retinal hemorrhages)
- Splinter hemorrhages in nailbeds (Rheumatic)
- fatigue
- dyspnea
- syncope
- palpitations
- chest pain (myocarditis)
87
What are some things we can do to prevent infectious diseases of the heart
- oral hygiene
- antibiotics before certain procedures
- removal of catheters when not in use
- immunizations
- women at risk urged not to get IUDs
88
What is heart failure
Myocardial disease, in which there is a problem with the contraction of the heart (systolic dysfunction) or filling of the heart (diastolic dysfunction)
May cause pulmonary or systemic congestion
89
What are the signs and symptoms of right sided heart failure
- peripheral congestion and edema
- Jugular venous distention (JVD)
- hepatomegaly
- ascites
- weight gain
90
What are the signs and symptoms of left sided heart failure
- pulmonary congestion (crackles)
- S3 sounds (ventricular gallop)
- dyspnea on exertion
- low O2 saturation
- dry, non-productive cough
- oliguria (small amounts of urine)
91
What are the treatments for heart failure
surgical - heart transplant, defibrillator implant
supplemental O2
lifestyle changes
medications
92
What oral medications are used to treat heart failure
- diuretics
- ACE inhibitors (for systolic dysfunction)
- Angiotensin II receptor blockers
- Beta Blockers
- Ivabradine (lowers HR)
- Hydralazine (lowers BP)
- isosorbide dinitrate (treats angina)
- digitalis (digoxin)
93
What IV medications are used to treat heart failure
Dopamine (used with loop diuretics; to increase BP)
Dobutamine (for left ventricular dysfunction)
Milrinone (decreases preload and afterload)
Vasodilators (nitro)
94
What are some special considerations for older patients being treated for heart failure
- May present with atypical signs and symptoms (fatigue, weakness, and increased sleepiness)
- Decreased renal function may make them resistant to diuretics and more sensitive to fluid volume changes
- When giving diuretics to older men, must assess for bladder distention due retention due to enlarged prostate
95
What are some complications that can develop in a patient with heart failure
- pulmonary edema
- hypotension
- poor perfusion
- cardiogenic shock
- arrhythmias
- thromboembolism
- pericardial effusion
96
What is pulmonary edema
A complication of heart failure
As left ventricle begins to fail, blood backs up into the pulmonary circulation causing edema
results in severe hypoxemia
97
What are the signs and symptoms of pulmonary edema
- frothy, blood-tinged sputum
- cough
- tachypnea
- dyspnea
- cool, clammy skin
- cyanosis
- weak, rapid pulse
- restlessness
- anxiety
98
What are the treatments for pulmonary edema
EASIER TO PREVENT THAN IT IS TO TREAT
- oxygen with non-rebreather
- minimize exertion
- optimal positioning (upright with legs dangling)
- medications (furosemide [diuretic] and nitroglycerin [vasodilator])
99
What are the signs and symptoms of pericardial effusion
- vague chest pain or fullness
- pulsus paradoxus
- engorged neck veins
- low blood pressure
- shortness of breath
100
What are the signs and symptoms of cardiac tamponade
- falling systolic blood pressure
- narrowing pulse pressure (lower MAP)
- rising venous pressure
- distant heart sounds
101
What are the treatments for pericardial effusion
Pericardiocentesis- puncture and remove fluid with syringe
Pericardiotomy- removal of pericardial tissue to allow fluid to drain to lymph system
102
How does the blood flow through the heart
from body to right atrium to right ventricle to pulmonary circulation to left atrium to left ventricle to aorta to body
103
What cardiovascular changes are expected in the aging adult
- increased blood pressure
- impaired blood flow due to lower volume
- increased left ventricular workload
104
What are some ways to increase peripheral arterial circulation
Exercise - walking, graded isometric exercise
Position changes - body part below the heart
Temperature - heat increases circulation and cold reduces it
Nicotine - reduce or quit
Reduce stress
105
What are some arterial disorders
- arteriosclerosis and atherosclerosis
- peripheral artery disease
- upper extremity arterial disease
- aortoiliac disease
- aneurisms
- aortic dissection
- arterial embolism/thrombosis
- Raynaud's phenomenon
106
What is the difference between arteriosclerosis and atherosclerosis
Arteriosclerosis - hardening of the arteries
Atherosclerosis - buildup of lipid plaques in the arteries
107
What is peripheral artery disease
ischemia of distal extremities due to lack of circulation
108
What are the signs and symptoms of peripheral artery disease
Intermittent claudication (pain during activity that resolves with rest). Usually worse at night and wakes the patient up at night.
109
What are the risk factors for atherosclerosis and peripheral artery disease (they are the same risk factors)
- smoking
- diabetes
- hypertension
- high cholesterol
- stress
- sedentary lifestyle
- C-reactive protein
- Hyperhomocysteinemia
- increasing age
- genetics
110
What are some medications used to treat peripheral artery disease
- Phosphodiesterase III inhibitor (Cilostazol)
- Antiplatelet drugs (Aspirin, Clopidogrel)
- Statins
111
What is an aneurysm
Dilation formed at a weak point in the wall of an artery
- Saccular (one side of the artery bulges)
- Fusiform (whole portion of artery bulges)
112
What is Raynaud's phenomenon
Intermittent occlusion of arteries usually at the fingers or toes brought on by a trigger such as cold or stress
- disease (unknown cause)
- syndrome (resulting from another disease; eg. scleroderma)
113
What are the signs and symptoms of Raynaud's phenomenon
- color change
- numbness
- tingling
- burning pain
114
What are some venous disorders
Venous thromboembolism (VTE)
- DVT and PE
Chronic venous insufficiency/postthrombotic syndrome
Leg ulcers
Varicose veins
115
How can we prevent venous thromboembolisms
Early ambulation after surgery
Compression stockings
Intermittent pneumatic compression devices (SCDs)
Heparin therapy
lifestyle changes
- weight loss
- exercise
- quit smoking
116
What are some risk factors for venous thromboembolism
- older than 65
- undergoing surgery
- central venous catheter placement
- septicemia
- pregnancy
117
What is the proper way to manage a patient with leg ulcers
- oral antibiotics (depending on infective agent)
- compression therapy
- debridement of the wound
- dressings
118
What are some complications that can occur with a patient with leg ulcers
Gangrene
Infection
119
What is the main driving force of dehydration
Sodium imbalance
120
What are the different types of oxygen masks
Venturi mask
non-rebreather mask
nasal cannula
121
What is a venturi mask
An oxygen mask the covers both the mouth and nose and delivers an amount of oxygen based on the valve used
122
What is a non-rebreather mask
An oxygen mask that covers both the mouth and nose and has a one-way valve to an inflatable bag attached. This is the ensure that exhaled CO2 is not inhaled with the next breath. This mask allows for room air to be inhaled as well as 100% oxygen from the mask.
123
What are the different wound stages
Stage 1
Stage 2
Stage 3
Stage 4
Unstageable
Deep pressure injury
124
What are the characteristics of a stage 1 wound
red, non-blanchable, intact skin
125
What are the characteristics of a stage 2 wound
Partial thickness skin loss with a red wound bed of exposed dermis. (like the skin under a popped blister)
126
What are the characteristics of a stage 3 wound
Full thickness skin and tissue loss, visible fat, granulation tissue, slough and eschar tissue visible
127
What are the characteristics of a stage 4 wound
Full thickness skin and tissue loss with exposed bone, tendon, muscle etc. Slough and eschar tissue also visible
128
What are the characteristics of an unstageable wound
Full thickness skin and tissue loss with a wound bed that is obscured by slough or eschar tissue by more than 50%
129
What are the characteristics of a deep tissue pressure injury
Intact, non-blanchable skin that is deep red, purple, or maroon in color
130
What are the stages of the sleep cycle
NREM Sleep
- Stage I
- Stage II
- Stage III
- Stage IV
REM Sleep
131
What are the characteristics of stage I NREM sleep
- between being awake and asleep
- involuntary muscle jerks
- can be arouse easily
- 5% of sleep
132
What are the characteristics of stage II NREM sleep
- falls into a stage of sleep
- can be aroused somewhat easily
- 50-55% of sleep
133
What are the characteristics of stage III NREM sleep
- Depth of sleep increases
- becomes increasingly more difficult to arouse
- 10% of sleep
134
What are the characteristics of stage IV NREM sleep
- Deepest sleep also called delta sleep
- difficult to arouse
- muscles relax
- pulse, BP, RR, and brain waves slow
- metabolism slows
- temperature is low
- 10% of sleep
135
What are the characteristics of REM sleep
- eyes dart back and forth
- small muscle twitching
- large muscle immobility
- rapid, irregular RR, pulse, BP
- metabolism and temp increases
- enters and exits this stage during stage II NREM sleep
- 20-25% of sleep
136
What are the most important things to know about caring for the elderly
- Neurological function is slowed
- urinary function is increased
137
When prioritizing care for a patient, what is most important
A- airway
B- breathing
C- circulation
S- safety
138
What are the steps of the infection cycle
incubation
prodromal
full stage of illness
convalescent
139
What are the characteristics of the incubation step of the infection cycle
- no symptoms
- bacteria (or virus, fungi, etc.) has infected the host and is
replicating
140
What are the characteristics of the prodromal step of the infection cycle
- most infectious/contagious at this step
- vague/non-specific symptoms
- can last hours-days
141
What are the characteristics of the full stage of illness step of the infection cycle
- symptoms specific to type of infection
- can be localized or systemic symptoms
142
What are the characteristics of the convalescent step of the infection cycle
- recovery
- return to baseline
143
What are some alternative pain management techniques
- breathing exercises
- TENS machine
- guided imagery
144
What are the characteristics of a tension headache
- bilateral
- lasts longer than 30 mins (typically 4-6 hours)
- constant pain
- bandlike pain
145
What are the characteristics of a cluster headache
- unilateral
- lasts 15 min-3 hours
- repetitive pain that goes away and then comes back
- excruciating periorbital pain
- more common in males
146
What are the characteristics of a migraine headache
- unilateral
- last 4-72 hours
- pulsating pain
- N/V, photophobia
- aura
147
What are the different types of headaches
- tension
- cluster
- Migraine
148
What are the different lung capacity measurements
- Vital capacity
- Inspiratory capacity
- Functional residual capacity
- Total lung capacity
149
What is vital capacity
The maximum amount of air exhaled after a maximum inhale
150
What is inspiratory capacity
The maximum amount of air inhaled after a normal exhale
151
What is functional residual capacity
The amount of air left in the lungs after a normal exhale
152
What is total lung capacity
The amount of air in the lungs after a maximum inhale
153
What are the different lung volume measurements
- tidal volume
- inspiratory reserve volume
- expiratory reserve volume
- residual volume
154
what is tidal volume
the volume of air inhaled and exhaled with each breath
155
What is inspiratory reserve volume
The maximum amount of air that can be inhaled after a normal inhale
156
What is expiratory reserve volume
The maximum amount of air that can be forcibly exhaled after a normal exhale
157
What is residual volume
The amount of air left in the lungs after a maximum exhale
158
What is the difference between rheumatoid arthritis and osteoarthritis
RA: Autoimmune disorder that attacks joints; inflammatory
OA: wearing away of cartilage in the joints; non-inflammatory
159
What are the steps to performing wound care (SIMS)
- check order in chart
- gather supplies
- wash hands (don PPE if necessary)
- identify patient
- provide privacy
- position bed to appropriate height
- position patient in a comfortable position on their side where
the saline wash will drain from the clean end to the dirtier
end
- place an absorbent pad under the patient
- change gloves
- remove soiled dressing
- assess the amount, color, odor, and type of drainage on the
dressing before discarding
- Assess wound for stage, presence of eschar or slough,
granulation, undermining, tunneling, and drainage
- measure the wound
- put on clean gloves
- prepare new dressings (soak in saline or whatever the order
says)
- irrigate/clean the wound according to the order
- pack wound making sure to get any tunneling or undermining
- put dry gauze over wet gauze
- place ABD pad over gauze
- tape
- remove gloves
- date, time, initials
160
What is Sickle Cell
An inherited hemolytic anemia
recessive autosomal disease involving the HbS gene affecting hemoglobin.
Seen mostly in people of African decent
161
What are the risk factors of getting sickle cell disease
since it is caused by an autosomal recessive mutation, in order to get this disease, the patient would have to receive the mutated gene from both their mother and father. If they receive one mutated gene and not the other, they are considered to have sickle cell trait.
162
What are the signs and symptoms of Sickle Cell disease
pain
jaundice
enlarged bones in face and skull
symptoms of anemia due to hemolyzed RBCs
- tachycardia
- cardiac murmurs
- cardiomegaly
163
What are the three types of Sickle Cell crisis
Acute vaso-occlusive crisis
Aplastic crisis
Sequestration crisis
164
What are the characteristics of acute vaso-occlusive crisis
- Most common
- very painful
- caused by accumulation of blood cells in the small vessels
restricting blood flow to the vessels causing hypoxia,
inflammation, and necrosis
165
What are the characteristics of aplastic crisis
- results from infection by human parvovirus
166
What are the characteristics of sequestration crisis
- When sickled cells pool in the organs
- most common organ in children is the spleen; by the age
of 10, spleen is usually infarcted and non-functional
- most common organs in adults are the liver and lungs
167
What are the treatments for Sickle Cell Disease
Hematopoietic stem cell transplant
Blood transfusions
Pharmacologic
168
What medications are available to help treat Sickle Cell Disease
- hydroxyurea: chemotherapeutic agent to destroy damaged
RBCs
- folic acid: promotes erythropoiesis
- antibiotics: infection is a common complication
- vaccinations: patient should get the pneumonia vaccine as
well as a yearly flu shot
- pain medications pain is excruciating and management is
high priority
169
What is the difference between primary, secondary, and tertiary patient care
Primary: prevention of disease (vaccination, education)
Secondary: screening for disease (colonoscopy, mammogram)
Tertiary: Reduce suffering, back to baseline (treatment of disease)
170
What is considered a positive Manitou TB skin test
wheal or induration larger than 5 mm
171
When do you assess a TB test spot, how long do you wait after the test is administered
48-72 hours
172
What is the normal range for sodium
135-145
173
What is the normal range for potassium
3.5-5
174
What is the normal range for calcium
8.5-10.2
175
What is the normal range for magnesium
1.3-2.3
176
What is the normal range for chloride
97-107
177
What is the normal range for phosphate
2.5-4.5
178
What is the function of sodium in the body
- Regulates extracellular fluid volume
- Role in muscle contraction
- Affects serum osmolality
179
What is the function of potassium in the body
- Controls intracellular osmolality
- Regulates cellular enzyme activity
- Role in transmission of electrical impulses in nerves and
muscles
180
What is the function of calcium in the body
- blood coagulation
- transmission of nerve impulses
- Regulated muscle contraction/relaxation
- Major component in bones
181
What is the function of magnesium in the body
- Metabolism of carbs and proteins
- Neuromuscular function
- Vasodilation of cardiovascular system
182
What is the function of chloride in the body
- Major component in body fluids
- works with sodium to maintain osmotic pressure
- Produces HCl
183
What is the function of phosphate in the body
- Acid-base balance as a buffer
- Promotes energy storage
- Carb, protein, and fat metabolism
- bone formation
- Muscle and RBC function
184
What are the signs and symptoms of hyponatremia
confusion
hypotension
edema
muscle cramps/weakness
dry skin
Severe (<120) signs of increasing intracranial pressure:
- lethargy
- muscle twitching
- hyperreflexia
- coma
- seizures
- death
185
What are the signs and symptoms of hypernatremia
Signs of neurologic impairment:
- restlessness
- agitation
- weakness
- disorientation
- delusions
- hallucinations
- seizures
186
What are the signs and symptoms of hypokalemia
- muscle weakness
- leg cramps
- fatigue
- paresthesias
- dysrhythmias
187
What are the signs and symptoms of hyperkalemia
- skeletal muscle weakness
- parasthesias
- paralysis
- cardiac irregularities
- cardiac arrest
188
What are the signs and symptoms of hypocalcemia
- numbness/tingling of fingers, mouth, or feet
- tetany
- muscle cramps
- seizures
positive chvostek sign (touch in front of ear and pt will smile)
189
What are the signs and symptoms of hypercalcemia
- nausea
- vomiting
- constipation
- bone pain
- excessive urination
- thirst
- confusion
- lethargy
- slurred speech
Inversely related to PO4 (one goes up the other goes down)
190
What are the signs and symptoms of hypomagnesemia
- muscle weakness
- tremors
- tetany
- seizures
- arrhythmias
- altered mental status
- HYPERactive deep tendon reflexes
- respiratory paralysis
Can cause torsade de pointes
191
What are the signs and symptoms of hypermagnesemia
- nausea
- vomiting
- weakness
- flushing
- lethargy
- HYPOactive deep tendon reflexes
- respiratory depression
- coma
- cardiac arrest
192
What are the signs and symptoms of hypophosphatemia
- muscle weakness
- slurred speech
- dysphagia
- decreased respiratory effort
- parasthesias
- irritability
- confusion
- seizures
- coma
193
What are the signs and symptoms of hyperphosphatemia
- hyperreflexia
- anorexia
- muscle weakness
- decreased mental status
- dysrhythmias
194
What are the signs and symptoms of hypochloremia
- hyperexcitability of muscles
- tetany
- HYPERactive deep tendon reflexes
- weakness
- muscle cramps
- seizures
- coma
- respiratory arrest
195
What are the signs and symptoms of hyperchloremia
- tachypnea
- weakness
- lethargy
- diminished cognitive ability
- decreased cardiac output
- dysrhythmias
- coma
196
What is the normal rage for HCO3
22-26
197
What is the normal range for PaCO2
35-45
198
What is happening during the P wave of the ECG
atrial depolarization (contraction)
199
What is happening during the QRS complex of the ECG
Q: depolarization of interventricular septum
R: depolarization of the main mass of the ventricles
S: depolarization of the ventricles at the base of the heart
200
What is happening during the T wave of the ECG
ventricular repolarization
201
At what point in the ECG do the atria repolarize
sometime during the QRS segment (not seen as a wave because it is masked by the major depolarization of the ventricles)
202
What is the best snack to eat before bed
cheese and crackers
203
What is polycythemia
excess RBCs
204
What is the proper procedure when suctioning a patient with a tracheostomy
- sterile technique
- insert suction catheter until gag reflex is triggered
- hold thumb over hole to suction on the way out
205
What are the four types of shock
hypovolemic
cardiogenic
obstructive
distributive
206
What is shock
Lack of blood flow to tissues (inadequate tissue perfusion)
207
What is hypovolemic shock
Decreased tissue perfusion due to low amounts of fluid in the vessels due to fluid loss
208
What is cardiogenic shock
Decreased tissue perfusion due to impaired or failure of the myocardium
209
What is obstructive shock
Decreased tissue perfusion due to an obstruction blocking venous return to the left side of the heart
210
What is distributive shock
Decreased tissue perfusion due to blood pooling in the peripheral vessels and low volume returning to the heart
Includes:
- septic shock
- neurogenic shock
- anaphylactic shock
211
What is anaphylaxis
A severe allergic reaction caused by a systemic antigen-antibody response mediated by IgE
- causes mast cells to release histamine and bradykinin
- most common allergens are foods, medications, insect
stings/bites
212
What are the three defining characteristics of anaphylaxis
1. acute onset of symptoms
2. presence of two or more symptoms:
- respiratory compromise
- reduced BP
- GI distress
- skin/mucosal tissue irritation
3. cardiovascular compromise from min-hrs after exposure to
allergen
213
What are the signs and symptoms of anaphylaxis
- headache
- lightheadedness
- nausea
- vomiting
- abdominal pain
- pruritis (itching)
- feeling of impending doom
- redness
- dyspnea
- bronchospasm
- arrhythmias
- hypotension
214
What are the treatments for anaphylaxis
IM epinephrine immediately- vasoconstriction
IV Diphenhydramine- antihistamine
Nebulized albuterol- reverses histamine-induced bronchospasm
Rebound anaphylaxis may occur 4 hours after epi administration
215
Ampicillin
Class: Beta lactam antibiotic
Brand name: Amcill
Indications: bacterial infections
Actions: Attacks bacterial cell wall
Adverse effects: N/V/D, allergic rxns
216
Calcium Gluconate
Class: Calcium supplement
Brand name: Gluconate
Indications: hypocalcemia, hyperphosphatemia,
Actions: increases serum calcium
Adverse effects: hypercalcemia, paresthesia, bradycardia, N/V, constipation, thirst, polyuria, kidney stones
217
Enoxaparin
Class: LMWH, anticoagulant
Brand name: Lovenox
Indications: prevent PE and DVT
Actions: stops the blood clotting process
Adverse effects: hemorrhage, thrombocytopenia, edema, fever, anemia
218
Epinephrine
Class: vasopressor/adrenergics
Brand name: Adrenalin, EpiPen
Indications: Anaphylaxis, septic shock, cardiac arrest
Actions: stimulates aloha and beta receptors which relaxes
bronchial smooth muscle (beta2), and activates the sympathetic nervous system (alpha&beta)
Adverse effects: stroke, arrhythmias, tremor, anxiety, SAH, Cerebral hemorrhage, Vfib, HTN, tachycardia
219
Furosemide
Class: loop diuretic
Brand name: Lasix
Indications: edema, pulmonary edema, HTN
Actions: inhibits sodium and chloride reabsorption in the kidney tubules resulting in an increase of urine output
Adverse effects: orthostatic hypotension, hyponatremia, hypocalcemia, hypomagnesemia, hypokalemia, hyperglycemia
220
Insulin (short acting)
Class: insulin
Brand name: Humulin, Novolog
Indications: diabetes
Actions: lowers blood sugar by stimulating glucose uptake, inhibiting glucose production, inhibiting lipolysis and proteolysis, and promoting protein synthesis
Adverse effects: hypoglycemia
221
Insulin (long acting)
Class: insulin
Brand name: Lantus
Indications: Diabetes
Actions: lowers blood sugar by stimulating glucose uptake, inhibiting glucose production, inhibiting lipolysis and proteolysis, and promoting protein synthesis
Adverse effects: Hypoglycemia
222
Metformin
Class: Biguanide antidiabetic
Brand name: Glucophage
Indications: prediabetes or type 2 diabetes
Actions: decreases glucose production, decreases intenstinal absorption of glucose, and increases insulin sensitivity
Adverse effects: N/V/D, hypoglycemia, anorexia
223
Morphine
Class: Opioid analgesic
Brand name: MS Contin
Indications: Severe pain
Actions: activates inhibitory pathway in CNS and inhibits nociceptor neurons in PNS
Adverse effects: respiratory depression, constipation, orthostatic hypotension, bradycardia, cardiac arrest, dependence
224
Nitroglycerin
Class: Nitrate vasodilator/antianginal
Brand name: Nitro
Indications: angina
Actions: reduces cardiac oxygen demand by lowering both preload and afterload
Adverse effects: syncope, hypotension, bradycardia, N/V, dyspnea
225
NSAIDS
Class: analgesics
Brand name: Advil, Aleve
Indications: mild to moderate pain
Actions: inhibits COX 2 to stop inflammation and reduce pain
Adverse effects: edema, N/V, tarry stools, jaundice, bleeding, MI, stroke
226
Senna
Class: Stimulant laxative
Brand name: Senokot
Indications: constipation
Actions: increases intestinal activity
Adverse effects: abdominal pain/cramps
227
Thiazide
Class: Thiazide diuretics
Brand name: Microzide
Indications: edema, hypertension
Actions: inhibit sodium and chloride reabsorption at the renal tubule resulting in increased urine production
Adverse effects: electrolyte imbalances, hypotension, dehydration
228
What is emphysema
impaired gas exchange due to destruction of the walls of overdistended alveoli
229
What are the different types of anemia
hypoproliferative
blood loss
hemolytic
230
What is hypoproliferative anemia
When the bone marrow doesn't make enough blood cells due to medications, chemicals, lack of erythropoietin, or lack of nutrients such as iron, vitamin B12, and folic acid
pernicious anemia is due to a B12 deficiency
231
What is blood loss anemia
Anemia due to blood loss from trauma
232
What is hemolytic anemia
Anemia due to the destruction of the RBCs due to an abnormality
sickle cell anemia is one of the malformations than can cause this
233
What is thalassemia
An inherited type of hemolytic anemia where hemoglobin is formed with a reduced amount of globulin chains leading to early hemolysis
234
What is the content of lactated ringers IV fluid
sodium
chloride
potassium
calcium
lactate
235
What are the different types of white blood cells
leukocyte
neutrophil
monocyte
eosinophil
basophil
lymphocytes (T&B)
236
What is the normal range for leukocytes
5,000-10,000
237
What is the normal range for neutrophils
60-70%
238
What is the normal range for monocytes
2-8%
239
What is the normal range for eosinophils
1-4%
240
What is the normal range for basophils
0.5-1%
241
What is the normal range for lymphocytes
20-40%
242
What are the steps of the nursing process
A- assessment
D- diagnosis
P- planning
I- implementation
E- evaluation
243
When asking a patient about their history, which symptoms would lead you to believe they have hypertension
headache and tinnitus
244
What do you do for a patient with ruddy colored skin
blood pooling
elevate the legs
245
What do you do for a patient with pale skin on their legs
lack of blood flow
dangle legs off the side of the bed to encourage blood flow via gravity
246
What is the assessment process while giving a blood transfusion
- monitor vital signs every 15 minutes
- check for acute hemolytic reaction
- if reaction occurs, stop infusion immediately, flush the line, then administer epinephrine
247
What are the symptoms of an acute hemolytic reacting
- fever
- chills
- low back pain
- nausea
- chest tightness
- dyspnea
- anxiety
