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NUR 240 > NUR 240 Final Exam > Flashcards

NUR 240 Final Exam Flashcards

1
Q

What are the main chronic pulmonary diseases

A

COPD
- chronic bronchitis
- emphysema
Bronchiectasis
Asthma
Cystic Fibrosis

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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
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3
Q

What are the major symptoms of COPD

A
  • chronic cough
  • sputum production
  • dyspnea
  • barrel chest
  • weight loss due to dyspnea
  • anxiety
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4
Q

What are the complications of COPD

A
  • Respiratory failure
  • pneumonia
  • atelectasis
  • pneumothorax
  • Cor pulmonale
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5
Q

What is Cor pulmonale

A

hypertension of the pulmonary arteries and veins that lead to right sided heart failure

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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
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7
Q

Medications to treat COPD

A
  • corticosteroids
  • beta-adrenergic agonists
  • muscarinic antagonists
  • mucolytics
  • antitussives
  • antibiotics
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8
Q

What is a bullectomy

A

surgery to remove air pockets in the lungs for patients with COPD

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9
Q

What is bronchiectasis

A

a chronic, irreversible dilation of the bronchi and bronchioles

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10
Q

What are the symptoms of bronchiectasis

A
  • chronic cough
  • lots of purulent sputum
  • clubbing of the fingers
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11
Q

What are some medical management techniques to manage bronchiectasis

A
  • postural drainage
  • chest physiotherapy
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12
Q

What is asthma

A

Chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production

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13
Q

What is the strongest predisposing risk factor for asthma

A

allergies

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14
Q

What are the signs and symptoms of asthma

A
  • cough
  • chest tightness
  • dyspnea
  • wheezing
  • diaphoresis
  • tachycardia
  • hypoxemia
  • central cyanosis
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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

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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

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17
Q

What are some medications to treat cystic fibrosis

A
  • anti-inflammatories
  • corticosteroids
  • bronchodilators
  • pancreatic enzyme supplements
  • CFTR modulators
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18
Q

What are some nursing techniques to help cystic fibrosis

A
  • chest physiotherapy
  • breathing exercises
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19
Q

What is hypoxia

A

a decrease in oxygen supply to the tissues and cells

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20
Q

What is hypoxemia

A

a decrease of oxygen in the blood

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21
Q

How much oxygen should you administer to a patient with COPD

A

greater than 21%

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22
Q

What is oxygen toxicity

A

too much oxygen administered (greater than 50%)

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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
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24
Q

What is an arrhythmia

A

Disorders of formation or conduction (or both) of electrical impulses within heart

can be atrial or ventricular

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25
Q

What are some examples of atrial arrhythmias

A
  • premature atrial complex
  • atrial flutter
  • atrial fibrillation
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26
Q

What are some examples of ventricular arrhythmias

A
  • Premature ventricular complex
  • Ventricular tachycardia
  • Ventricular fibrillation
  • Ventricular asystole
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27
Q

What is the difference between systole and diastole

A

Systole - depolarization (stimulation)
Diastole - repolarization (relaxation)

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28
Q

What is sinus rhythm

A

The heartbeat determined by the SA node

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29
Q

What are the two types of sinus arrhythmias

A

Sinus bradycardia
Sinus tachycardia

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30
Q

What are the different waves of the ECG

A

P wave
QRS complex
T wave

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31
Q

What are the different intervals in an ECG

A

PR interval
ST segment
QT interval
TP interval
PP interval

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32
Q

What are the signs and symptoms seen in a patient with an arrhythmia

A

Fatigue
Dizziness
Fainting
tachycardia
Shortness of breath
anxiety
Chest pain
Alternating fast and slow heart rate
Sweating

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33
Q

What are some potential complications of an arrhythmia

A

Cardiac arrest
Heart failure
thromboembolism (especially with A-fib)

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34
Q

What is the 6 minute walk test

A

Walk at a normal pace for 6 minutes to see how the heart responds

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35
Q

What are some supplemental modalities used when medications are not enough to treat arrhythmias

A

pacemakers
cardioversion
defibrillation

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36
Q

What is a pacemaker

A

Electronic device that provides electrical stimuli to heart muscle
can be permanent or temporary

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37
Q

Where is the lead of a pacemaker placed in the heart

A

lead is fed through the external jugular vein and lodged into the apex of the right ventricle

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38
Q

What are some complications associated with using a pacemaker

A

Infection
Bleeding or hematoma formation
Dislocation of lead
Skeletal muscle or phrenic nerve stimulation
Cardiac tamponade
Pacemaker malfunction

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39
Q

What is cardiac tamponade

A

Pressure on the heart that occurs when fluid builds up in the pericardium that keeps the heart from beating

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40
Q

What is defibrillation

A

Applying a shock to the heart in order to bring it back to normal sinus rhythm

treats tachyarrhythmias

unsynchronized delivery

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41
Q

What is cardioversion

A

procedure that uses quick, low-energy shocks to restore a regular heart rhythm

treats tachyarrhythmias

synchronized delivery

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42
Q

Which cardiovascular disease is the most prevalent in adults in the united states

A

coronary artery disease (CAD)

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43
Q

What is coronary atherosclerosis

A

Buildup of lipids in the coronary artery leading to decreased blood flow to the heart

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44
Q

What is the leading cause of death in the united states for all genders and ethnic groups

A

Cardiovascular disease (CVD)

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45
Q

What are the symptoms of atherosclerosis

A

Angina pectoris (most common)
Nausea/vomiting
pain that radiates to jaw or left arm
Shortness of breath
(Atypical symptoms in women)

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46
Q

What can atherosclerosis lead to

A

myocardial infarction
heart failure
sudden cardiac death

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47
Q

What are the four modifiable risk factors for coronary artery disease

A

smoking
hypertension
diabetes
high cholesterol (high LDL)

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48
Q

What are the non-modifiable risk factors for coronary artery disease

A

Age
Gender
Ethnicity
Genetics
- hs-CRP (high sensitivity to C reactive protein)
- metabolic syndrome

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49
Q

What are the six medication classes used to lower cholesterol

A
  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
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50
Q

What are the 5 types of angina

A

stable
unstable
intractable/refractory
variant
silent ischemia

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51
Q

What is stable angina

A

Pain that occurs on exertion and is relieved by rest or nitroglycerin

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52
Q

What is unstable angina

A

Pain that increases in severity and frequency and may not be relieved by rest or nitroglycerin

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53
Q

What is intractable/refractory angina

A

severe, incapacitating chest pain

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54
Q

What is variant angina

A

Pain at rest with reversible ST-segment elevation (thought to be caused by coronary artery vasospasm)

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55
Q

What is silent ischemia

A

Ischemia (heart tissue damage) seen on ECG during stress test but no pain

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56
Q

What is angina pectoris

A

Chest pain caused by insufficient coronary blood flow (blood flow to the heart)
oxygen demands are higher than what is available

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57
Q

What is relevant to know about angina in older adults

A

diminished pain transmission (Silent CAD)
teach patient how to spot their “chest pain like” symptoms in other ways (weakness, nausea, vomiting etc.)

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58
Q

What is the main goal in treating angina pectoris

A

decrease oxygen demand of the heart and
increase the oxygen supply to the heart

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59
Q

What are 7 medications used to treat angina

A
  1. nitroglycerin
  2. beta blockers
  3. calcium channel blockers
  4. antiplatelet (clopidogrel, ticlopidine)
  5. anticoagulants (heparin)
  6. aspirin
  7. Glycoprotein IIb/IIIa agents
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60
Q

What is acute coronary syndrome

A

Describes many conditions due to reduced blood flow to the heart (such as a myocardial infarction)

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61
Q

What is cardiogenic shock

A

When the heart cannot pump enough blood (oxygen) to the brain and other organs

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62
Q

What does the ECG look like in a person who had an MI

A

elevation of the ST segment in two contiguous leads (usually V3 and V4)

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63
Q

Which labs would be abnormal in a patient who had an MI

A

cardiac enzymes
troponin
creatine kinase
myoglobin

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64
Q

What is pericardial effusion

A

A buildup of fluid in the pericardium leading to cardiac tamponade

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65
Q

Patients who have an MI are at higher risk of developing which conditions

A

pulmonary edema
heart failure
arrhythmias
cardiogenic shock
cardiac arrest
pericardial effusion and cardiac tamponade

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66
Q

What is percutaneous transluminal coronary angioplasty (PTCA)

A

An invasive cardiac procedure that opens the occluded coronary artery by inflating a balloon and flattening the buildup against the artery wall

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67
Q

What is a coronary artery stent

A

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.

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68
Q

What is coronary artery bypass graft (CABG)

A

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

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69
Q

Which vein is most commonly used in CABG procedures

A

Great saphenous vein

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70
Q

What are three disorders seen in the heart valves

A

regurgitation (aortic & mitral)
stenosis (aortic & mitral)
prolapse (mitral)

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71
Q

What is cardiomyopathy

A

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.

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72
Q

What are the 5 types of cardiomyopathy

A
  1. Dilated (DCM)
  2. Hypertrophic (HCM)
  3. Restrictive/constrictive (RCM)
  4. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)
  5. Unclassified
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73
Q

Which cardiomyopathies lead to congestive heart failure

A

Dilated
Hypertrophic
Restrictive

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74
Q

What is dilated cardiomyopathy

A

Most common type of cardiomyopathy
heart muscles become weak and chambers become enlarged causing a decrease in cardiac output

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75
Q

What is hypertrophic cardiomyopathy

A

Mostly asymptomatic
heart muscles become enlarged and chambers become smaller causing a decrease in heart volume

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76
Q

What is restrictive/constrictive cardiomyopathy

A

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

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77
Q

What is arrhythmogenic right ventricular cardiomyopathy/dysplasia

A

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.

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78
Q

What metabolite is most associated with cardiomyopathy

A

Sodium
cardiomyopathy usually leads to heart failure due to fluid overload

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79
Q

What is pulsus paradoxus

A

A dramatic drop in blood pressure when breathing in
could be a sign of cardiomyopathy

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80
Q

Cardiomyopathy can lead to which conditions

A

Heart failure
arrhythmias
Pulmonary embolism
Cerebral embolism
Valvular dysfunction

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81
Q

What are the four infections that can occur in the heart

A

Rheumatic endocarditis
Infective endocarditis
Pericarditis
Myocarditis

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82
Q

What is rheumatic endocarditis

A

Occurs mostly in school age children who had strep throat and then developed rheumatic fever

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83
Q

What is infective endocarditis

A

occurs in patients who have:
- prosthetic heart valves
- IV drug addictions
- debilitating diseases
- indwelling catheters
- prolonged IV therapy

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84
Q

What is pericarditis

A

Inflammation of the pericardium
can be caused by many things
can lead to pericardial effusion and cardiac tamponade

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85
Q

What is myocarditis

A

Inflammation of the myocardium due to a viral infection
can lead to cardiomyopathy and heart failure

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86
Q

What are the signs and symptoms of infectious disease of the heart

A
  • 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)
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87
Q

What are some things we can do to prevent infectious diseases of the heart

A
  • oral hygiene
  • antibiotics before certain procedures
  • removal of catheters when not in use
  • immunizations
  • women at risk urged not to get IUDs
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88
Q

What is heart failure

A

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

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89
Q

What are the signs and symptoms of right sided heart failure

A
  • peripheral congestion and edema
  • Jugular venous distention (JVD)
  • hepatomegaly
  • ascites
  • weight gain
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90
Q

What are the signs and symptoms of left sided heart failure

A
  • pulmonary congestion (crackles)
  • S3 sounds (ventricular gallop)
  • dyspnea on exertion
  • low O2 saturation
  • dry, non-productive cough
  • oliguria (small amounts of urine)
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91
Q

What are the treatments for heart failure

A

surgical - heart transplant, defibrillator implant
supplemental O2
lifestyle changes
medications

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92
Q

What oral medications are used to treat heart failure

A
  • diuretics
  • ACE inhibitors (for systolic dysfunction)
  • Angiotensin II receptor blockers
  • Beta Blockers
  • Ivabradine (lowers HR)
  • Hydralazine (lowers BP)
  • isosorbide dinitrate (treats angina)
  • digitalis (digoxin)
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93
Q

What IV medications are used to treat heart failure

A

Dopamine (used with loop diuretics; to increase BP)
Dobutamine (for left ventricular dysfunction)
Milrinone (decreases preload and afterload)
Vasodilators (nitro)

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94
Q

What are some special considerations for older patients being treated for heart failure

A
  • 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
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95
Q

What are some complications that can develop in a patient with heart failure

A
  • pulmonary edema
  • hypotension
  • poor perfusion
  • cardiogenic shock
  • arrhythmias
  • thromboembolism
  • pericardial effusion
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96
Q

What is pulmonary edema

A

A complication of heart failure

As left ventricle begins to fail, blood backs up into the pulmonary circulation causing edema

results in severe hypoxemia

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97
Q

What are the signs and symptoms of pulmonary edema

A
  • frothy, blood-tinged sputum
  • cough
  • tachypnea
  • dyspnea
  • cool, clammy skin
  • cyanosis
  • weak, rapid pulse
  • restlessness
  • anxiety
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98
Q

What are the treatments for pulmonary edema

A

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])

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99
Q

What are the signs and symptoms of pericardial effusion

A
  • vague chest pain or fullness
  • pulsus paradoxus
  • engorged neck veins
  • low blood pressure
  • shortness of breath
100
Q

What are the signs and symptoms of cardiac tamponade

A
  • falling systolic blood pressure
  • narrowing pulse pressure (lower MAP)
  • rising venous pressure
  • distant heart sounds
101
Q

What are the treatments for pericardial effusion

A

Pericardiocentesis- puncture and remove fluid with syringe
Pericardiotomy- removal of pericardial tissue to allow fluid to drain to lymph system

102
Q

How does the blood flow through the heart

A

from body to right atrium to right ventricle to pulmonary circulation to left atrium to left ventricle to aorta to body

103
Q

What cardiovascular changes are expected in the aging adult

A
  • increased blood pressure
  • impaired blood flow due to lower volume
  • increased left ventricular workload
104
Q

What are some ways to increase peripheral arterial circulation

A

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
Q

What are some arterial disorders

A
  • arteriosclerosis and atherosclerosis
  • peripheral artery disease
  • upper extremity arterial disease
  • aortoiliac disease
  • aneurisms
  • aortic dissection
  • arterial embolism/thrombosis
  • Raynaud’s phenomenon
106
Q

What is the difference between arteriosclerosis and atherosclerosis

A

Arteriosclerosis - hardening of the arteries
Atherosclerosis - buildup of lipid plaques in the arteries

107
Q

What is peripheral artery disease

A

ischemia of distal extremities due to lack of circulation

108
Q

What are the signs and symptoms of peripheral artery disease

A

Intermittent claudication (pain during activity that resolves with rest). Usually worse at night and wakes the patient up at night.

109
Q

What are the risk factors for atherosclerosis and peripheral artery disease (they are the same risk factors)

A
  • smoking
  • diabetes
  • hypertension
  • high cholesterol
  • stress
  • sedentary lifestyle
  • C-reactive protein
  • Hyperhomocysteinemia
  • increasing age
  • genetics
110
Q

What are some medications used to treat peripheral artery disease

A
  • Phosphodiesterase III inhibitor (Cilostazol)
  • Antiplatelet drugs (Aspirin, Clopidogrel)
  • Statins
111
Q

What is an aneurysm

A

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
Q

What is Raynaud’s phenomenon

A

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
Q

What are the signs and symptoms of Raynaud’s phenomenon

A
  • color change
  • numbness
  • tingling
  • burning pain
114
Q

What are some venous disorders

A

Venous thromboembolism (VTE)
- DVT and PE
Chronic venous insufficiency/postthrombotic syndrome
Leg ulcers
Varicose veins

115
Q

How can we prevent venous thromboembolisms

A

Early ambulation after surgery
Compression stockings
Intermittent pneumatic compression devices (SCDs)
Heparin therapy
lifestyle changes
- weight loss
- exercise
- quit smoking

116
Q

What are some risk factors for venous thromboembolism

A
  • older than 65
  • undergoing surgery
  • central venous catheter placement
  • septicemia
  • pregnancy
117
Q

What is the proper way to manage a patient with leg ulcers

A
  • oral antibiotics (depending on infective agent)
  • compression therapy
  • debridement of the wound
  • dressings
118
Q

What are some complications that can occur with a patient with leg ulcers

A

Gangrene
Infection

119
Q

What is the main driving force of dehydration

A

Sodium imbalance

120
Q

What are the different types of oxygen masks

A

Venturi mask
non-rebreather mask
nasal cannula

121
Q

What is a venturi mask

A

An oxygen mask the covers both the mouth and nose and delivers an amount of oxygen based on the valve used

122
Q

What is a non-rebreather mask

A

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
Q

What are the different wound stages

A

Stage 1
Stage 2
Stage 3
Stage 4
Unstageable
Deep pressure injury

124
Q

What are the characteristics of a stage 1 wound

A

red, non-blanchable, intact skin

125
Q

What are the characteristics of a stage 2 wound

A

Partial thickness skin loss with a red wound bed of exposed dermis. (like the skin under a popped blister)

126
Q

What are the characteristics of a stage 3 wound

A

Full thickness skin and tissue loss, visible fat, granulation tissue, slough and eschar tissue visible

127
Q

What are the characteristics of a stage 4 wound

A

Full thickness skin and tissue loss with exposed bone, tendon, muscle etc. Slough and eschar tissue also visible

128
Q

What are the characteristics of an unstageable wound

A

Full thickness skin and tissue loss with a wound bed that is obscured by slough or eschar tissue by more than 50%

129
Q

What are the characteristics of a deep tissue pressure injury

A

Intact, non-blanchable skin that is deep red, purple, or maroon in color

130
Q

What are the stages of the sleep cycle

A

NREM Sleep
- Stage I
- Stage II
- Stage III
- Stage IV
REM Sleep

131
Q

What are the characteristics of stage I NREM sleep

A
  • between being awake and asleep
  • involuntary muscle jerks
  • can be arouse easily
  • 5% of sleep
132
Q

What are the characteristics of stage II NREM sleep

A
  • falls into a stage of sleep
  • can be aroused somewhat easily
  • 50-55% of sleep
133
Q

What are the characteristics of stage III NREM sleep

A
  • Depth of sleep increases
  • becomes increasingly more difficult to arouse
  • 10% of sleep
134
Q

What are the characteristics of stage IV NREM sleep

A
  • 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
Q

What are the characteristics of REM sleep

A
  • 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
Q

What are the most important things to know about caring for the elderly

A
  • Neurological function is slowed
  • urinary function is increased
137
Q

When prioritizing care for a patient, what is most important

A

A- airway
B- breathing
C- circulation
S- safety

138
Q

What are the steps of the infection cycle

A

incubation
prodromal
full stage of illness
convalescent

139
Q

What are the characteristics of the incubation step of the infection cycle

A
  • no symptoms
  • bacteria (or virus, fungi, etc.) has infected the host and is
    replicating
140
Q

What are the characteristics of the prodromal step of the infection cycle

A
  • most infectious/contagious at this step
  • vague/non-specific symptoms
  • can last hours-days
141
Q

What are the characteristics of the full stage of illness step of the infection cycle

A
  • symptoms specific to type of infection
  • can be localized or systemic symptoms
142
Q

What are the characteristics of the convalescent step of the infection cycle

A
  • recovery
  • return to baseline
143
Q

What are some alternative pain management techniques

A
  • breathing exercises
  • TENS machine
  • guided imagery
144
Q

What are the characteristics of a tension headache

A
  • bilateral
  • lasts longer than 30 mins (typically 4-6 hours)
  • constant pain
  • bandlike pain
145
Q

What are the characteristics of a cluster headache

A
  • unilateral
  • lasts 15 min-3 hours
  • repetitive pain that goes away and then comes back
  • excruciating periorbital pain
  • more common in males
146
Q

What are the characteristics of a migraine headache

A
  • unilateral
  • last 4-72 hours
  • pulsating pain
  • N/V, photophobia
  • aura
147
Q

What are the different types of headaches

A
  • tension
  • cluster
  • Migraine
148
Q

What are the different lung capacity measurements

A
  • Vital capacity
  • Inspiratory capacity
  • Functional residual capacity
  • Total lung capacity
149
Q

What is vital capacity

A

The maximum amount of air exhaled after a maximum inhale

150
Q

What is inspiratory capacity

A

The maximum amount of air inhaled after a normal exhale

151
Q

What is functional residual capacity

A

The amount of air left in the lungs after a normal exhale

152
Q

What is total lung capacity

A

The amount of air in the lungs after a maximum inhale

153
Q

What are the different lung volume measurements

A
  • tidal volume
  • inspiratory reserve volume
  • expiratory reserve volume
  • residual volume
154
Q

what is tidal volume

A

the volume of air inhaled and exhaled with each breath

155
Q

What is inspiratory reserve volume

A

The maximum amount of air that can be inhaled after a normal inhale

156
Q

What is expiratory reserve volume

A

The maximum amount of air that can be forcibly exhaled after a normal exhale

157
Q

What is residual volume

A

The amount of air left in the lungs after a maximum exhale

158
Q

What is the difference between rheumatoid arthritis and osteoarthritis

A

RA: Autoimmune disorder that attacks joints; inflammatory
OA: wearing away of cartilage in the joints; non-inflammatory

159
Q

What are the steps to performing wound care (SIMS)

A
  • 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
Q

What is Sickle Cell

A

An inherited hemolytic anemia
recessive autosomal disease involving the HbS gene affecting hemoglobin.
Seen mostly in people of African decent

161
Q

What are the risk factors of getting sickle cell disease

A

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
Q

What are the signs and symptoms of Sickle Cell disease

A

pain
jaundice
enlarged bones in face and skull
symptoms of anemia due to hemolyzed RBCs
- tachycardia
- cardiac murmurs
- cardiomegaly

163
Q

What are the three types of Sickle Cell crisis

A

Acute vaso-occlusive crisis
Aplastic crisis
Sequestration crisis

164
Q

What are the characteristics of acute vaso-occlusive crisis

A
  • 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
Q

What are the characteristics of aplastic crisis

A
  • results from infection by human parvovirus
166
Q

What are the characteristics of sequestration crisis

A
  • 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
Q

What are the treatments for Sickle Cell Disease

A

Hematopoietic stem cell transplant
Blood transfusions
Pharmacologic

168
Q

What medications are available to help treat Sickle Cell Disease

A
  • 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
Q

What is the difference between primary, secondary, and tertiary patient care

A

Primary: prevention of disease (vaccination, education)
Secondary: screening for disease (colonoscopy, mammogram)
Tertiary: Reduce suffering, back to baseline (treatment of disease)

170
Q

What is considered a positive Manitou TB skin test

A

wheal or induration larger than 5 mm

171
Q

When do you assess a TB test spot, how long do you wait after the test is administered

A

48-72 hours

172
Q

What is the normal range for sodium

A

135-145

173
Q

What is the normal range for potassium

A

3.5-5

174
Q

What is the normal range for calcium

A

8.5-10.2

175
Q

What is the normal range for magnesium

A

1.3-2.3

176
Q

What is the normal range for chloride

A

97-107

177
Q

What is the normal range for phosphate

A

2.5-4.5

178
Q

What is the function of sodium in the body

A
  • Regulates extracellular fluid volume
  • Role in muscle contraction
  • Affects serum osmolality
179
Q

What is the function of potassium in the body

A
  • Controls intracellular osmolality
  • Regulates cellular enzyme activity
  • Role in transmission of electrical impulses in nerves and
    muscles
180
Q

What is the function of calcium in the body

A
  • blood coagulation
  • transmission of nerve impulses
  • Regulated muscle contraction/relaxation
  • Major component in bones
181
Q

What is the function of magnesium in the body

A
  • Metabolism of carbs and proteins
  • Neuromuscular function
  • Vasodilation of cardiovascular system
182
Q

What is the function of chloride in the body

A
  • Major component in body fluids
  • works with sodium to maintain osmotic pressure
  • Produces HCl
183
Q

What is the function of phosphate in the body

A
  • Acid-base balance as a buffer
  • Promotes energy storage
  • Carb, protein, and fat metabolism
  • bone formation
  • Muscle and RBC function
184
Q

What are the signs and symptoms of hyponatremia

A

confusion
hypotension
edema
muscle cramps/weakness
dry skin

Severe (<120) signs of increasing intracranial pressure:
- lethargy
- muscle twitching
- hyperreflexia
- coma
- seizures
- death

185
Q

What are the signs and symptoms of hypernatremia

A

Signs of neurologic impairment:
- restlessness
- agitation
- weakness
- disorientation
- delusions
- hallucinations
- seizures

186
Q

What are the signs and symptoms of hypokalemia

A
  • muscle weakness
  • leg cramps
  • fatigue
  • paresthesias
  • dysrhythmias
187
Q

What are the signs and symptoms of hyperkalemia

A
  • skeletal muscle weakness
  • parasthesias
  • paralysis
  • cardiac irregularities
  • cardiac arrest
188
Q

What are the signs and symptoms of hypocalcemia

A
  • numbness/tingling of fingers, mouth, or feet
  • tetany
  • muscle cramps
  • seizures

positive chvostek sign (touch in front of ear and pt will smile)

189
Q

What are the signs and symptoms of hypercalcemia

A
  • nausea
  • vomiting
  • constipation
  • bone pain
  • excessive urination
  • thirst
  • confusion
  • lethargy
  • slurred speech

Inversely related to PO4 (one goes up the other goes down)

190
Q

What are the signs and symptoms of hypomagnesemia

A
  • muscle weakness
  • tremors
  • tetany
  • seizures
  • arrhythmias
  • altered mental status
  • HYPERactive deep tendon reflexes
  • respiratory paralysis

Can cause torsade de pointes

191
Q

What are the signs and symptoms of hypermagnesemia

A
  • nausea
  • vomiting
  • weakness
  • flushing
  • lethargy
  • HYPOactive deep tendon reflexes
  • respiratory depression
  • coma
  • cardiac arrest
192
Q

What are the signs and symptoms of hypophosphatemia

A
  • muscle weakness
  • slurred speech
  • dysphagia
  • decreased respiratory effort
  • parasthesias
  • irritability
  • confusion
  • seizures
  • coma
193
Q

What are the signs and symptoms of hyperphosphatemia

A
  • hyperreflexia
  • anorexia
  • muscle weakness
  • decreased mental status
  • dysrhythmias
194
Q

What are the signs and symptoms of hypochloremia

A
  • hyperexcitability of muscles
  • tetany
  • HYPERactive deep tendon reflexes
  • weakness
  • muscle cramps
  • seizures
  • coma
  • respiratory arrest
195
Q

What are the signs and symptoms of hyperchloremia

A
  • tachypnea
  • weakness
  • lethargy
  • diminished cognitive ability
  • decreased cardiac output
  • dysrhythmias
  • coma
196
Q

What is the normal rage for HCO3

A

22-26

197
Q

What is the normal range for PaCO2

A

35-45

198
Q

What is happening during the P wave of the ECG

A

atrial depolarization (contraction)

199
Q

What is happening during the QRS complex of the ECG

A

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
Q

What is happening during the T wave of the ECG

A

ventricular repolarization

201
Q

At what point in the ECG do the atria repolarize

A

sometime during the QRS segment (not seen as a wave because it is masked by the major depolarization of the ventricles)

202
Q

What is the best snack to eat before bed

A

cheese and crackers

203
Q

What is polycythemia

A

excess RBCs

204
Q

What is the proper procedure when suctioning a patient with a tracheostomy

A
  • sterile technique
  • insert suction catheter until gag reflex is triggered
  • hold thumb over hole to suction on the way out
205
Q

What are the four types of shock

A

hypovolemic
cardiogenic
obstructive
distributive

206
Q

What is shock

A

Lack of blood flow to tissues (inadequate tissue perfusion)

207
Q

What is hypovolemic shock

A

Decreased tissue perfusion due to low amounts of fluid in the vessels due to fluid loss

208
Q

What is cardiogenic shock

A

Decreased tissue perfusion due to impaired or failure of the myocardium

209
Q

What is obstructive shock

A

Decreased tissue perfusion due to an obstruction blocking venous return to the left side of the heart

210
Q

What is distributive shock

A

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
Q

What is anaphylaxis

A

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
Q

What are the three defining characteristics of anaphylaxis

A
  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
Q

What are the signs and symptoms of anaphylaxis

A
  • headache
  • lightheadedness
  • nausea
  • vomiting
  • abdominal pain
  • pruritis (itching)
  • feeling of impending doom
  • redness
  • dyspnea
  • bronchospasm
  • arrhythmias
  • hypotension
214
Q

What are the treatments for anaphylaxis

A

IM epinephrine immediately- vasoconstriction
IV Diphenhydramine- antihistamine
Nebulized albuterol- reverses histamine-induced bronchospasm

Rebound anaphylaxis may occur 4 hours after epi administration

215
Q

Ampicillin

A

Class: Beta lactam antibiotic
Brand name: Amcill
Indications: bacterial infections
Actions: Attacks bacterial cell wall
Adverse effects: N/V/D, allergic rxns

216
Q

Calcium Gluconate

A

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
Q

Enoxaparin

A

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
Q

Epinephrine

A

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
Q

Furosemide

A

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
Q

Insulin (short acting)

A

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
Q

Insulin (long acting)

A

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
Q

Metformin

A

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
Q

Morphine

A

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
Q

Nitroglycerin

A

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
Q

NSAIDS

A

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
Q

Senna

A

Class: Stimulant laxative
Brand name: Senokot
Indications: constipation
Actions: increases intestinal activity
Adverse effects: abdominal pain/cramps

227
Q

Thiazide

A

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
Q

What is emphysema

A

impaired gas exchange due to destruction of the walls of overdistended alveoli

229
Q

What are the different types of anemia

A

hypoproliferative
blood loss
hemolytic

230
Q

What is hypoproliferative anemia

A

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
Q

What is blood loss anemia

A

Anemia due to blood loss from trauma

232
Q

What is hemolytic anemia

A

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
Q

What is thalassemia

A

An inherited type of hemolytic anemia where hemoglobin is formed with a reduced amount of globulin chains leading to early hemolysis

234
Q

What is the content of lactated ringers IV fluid

A

sodium
chloride
potassium
calcium
lactate

235
Q

What are the different types of white blood cells

A

leukocyte
neutrophil
monocyte
eosinophil
basophil
lymphocytes (T&B)

236
Q

What is the normal range for leukocytes

A

5,000-10,000

237
Q

What is the normal range for neutrophils

A

60-70%

238
Q

What is the normal range for monocytes

A

2-8%

239
Q

What is the normal range for eosinophils

A

1-4%

240
Q

What is the normal range for basophils

A

0.5-1%

241
Q

What is the normal range for lymphocytes

A

20-40%

242
Q

What are the steps of the nursing process

A

A- assessment
D- diagnosis
P- planning
I- implementation
E- evaluation

243
Q

When asking a patient about their history, which symptoms would lead you to believe they have hypertension

A

headache and tinnitus

244
Q

What do you do for a patient with ruddy colored skin

A

blood pooling
elevate the legs

245
Q

What do you do for a patient with pale skin on their legs

A

lack of blood flow
dangle legs off the side of the bed to encourage blood flow via gravity

246
Q

What is the assessment process while giving a blood transfusion

A
  • monitor vital signs every 15 minutes
  • check for acute hemolytic reaction
  • if reaction occurs, stop infusion immediately, flush the line, then administer epinephrine
247
Q

What are the symptoms of an acute hemolytic reacting

A
  • fever
  • chills
  • low back pain
  • nausea
  • chest tightness
  • dyspnea
  • anxiety

NUR 240 (4 decks)

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