nursing_221-222_20140211031857 Flashcards
What is arteriosclerosis? And what are contributing factors that are non modifiable
Hardening of the artery a loss of elasticity. Non modifiable is age, genetics, gender, menopause, and race.
What is atherosclerosis?
Plaque in the artery. Narrowing vessel. Altered lipid metabolism. Can lead to mi
What are the two main reasons to prescribe aspirin to a cardiac patient?
To reduce platelet aggregation, to decrease temp of inflamed tissues.
A patient has an mi and edema, which meds should you give.
MorphineDiuretics
A new MI patient comes in, what needs to be done?
Give morphine, o2, get iv access established.
A recent MI patient has admitted with chest pain, and nausea. Which is the priority? Emesis basin? Oxygen by cannula? Beta blocker? X-ray?
Oxygen
A patient has admitted with a Bi-ventricular failure, what will the nurse notice?
Dyspnea, JVD, edema
New patient labs have revealed that the patient using heparin, has had his PTT time double. What will the nurse do?1. Hold the next dose.2. Notify the doctor.3. Continue to observe and administer prescribed dose.4. Adjust dose to profuse more quickly.
Continue to observe. Therapeutic doses of heparin will double PTT times.
How do you give lovenox
Abdomen shot, sub q with no aspiration.
A patients dig levels is 1.2 and his k+ is at 4.2, do you give digoxin, LASIX or both? And why
Both. LASIX to reduce the potassium level, and digoxin to bring the dig level up.
What are some side effects of atenolol? Select all that apply1. Anxiety2. Fatigue3. Constipation4. Dyspnea
Fatigue and dyspnea
Which meds will prevent the extension of an mi? Select all thy apply1. Nitro2. Aspirin3. Ace inhibitor4. Beta blockers
Nitro and beta blockers
What are the signs of myocardial ischemia?
Chest pressure ( elephant on chest)Neck or jaw painShoulder pain (referred pain)Clammy skin. SobNausea and vomitting.
What is a side effect of Propranolol?
Bradycardia
What is this?
Ventricular Fibrillation
How does Verapamil work?
Verapamil relaxes the smooth muscle of the heart
What symptoms are consistant with a Venous disease?
Edema, Aches, Heaviness. This is due to a lack of return of blood to the heart.
A Cardiac Alarm has gone off. What should be done first? 1. Check the leads on the machine. 2. Administer morphine (MONAB) 3. Check Patient vitals 4. Administer O2
Check patient first.
What does the nurse hope to accomplish by administering Bumex? 1. Reduce heart Arythmia 2. Stop chest pain 3. Reduce crackles and coughs in lung 4. Cause expansion of avioli
- Reduce crackles and cough due to secretions in the lungs. Bumex or Bumetanide helps to reduce swelling and fluid retntion. Used to help in High BP.
What is a side effect a nurse should monitor for when administering Lipid Lowering Agents?
Hepatoxicity
Your patient (admitted for hypertension) asks for help in ordering their dinner. Which would you select? Chicken Tenders. Hot Dogs. Chicken Stir fry. Baked Turkey Breast.
Baked Turkey Breast. The rest of those items are either fried or high in Sodium.
Which of thses items is high in Sodium, thus contraindicated for a HTN patient? Apple Juice Orange Juice Strawberry Banana Smoothie Tomato Juice
Tomato Juice is the highest in sodium of those listed.
What effect does Tachycardia have on the body and heart?
Increased Cardiac Ouput which in turn causes a higher demand for O2.
The patient tells the nurse, “ I have lost weight since going on Digoxin. The nurse should reply which of the following? 1. Hold your doses and see your doctor immediately 2. That is expected and is an action of the drug 3. This is a side effect and can have serious complications
It is expected that a patient will have weight loss from Digoxin. so 2.
What is the best condtion to guage JVD? 1. Bed Flat 2. Head of Bed at 90 degrees 3. Head of bed at 45 degrees 4. Head of Bed at 30 degrees
The best option is to have the head of bed at 45 degrees.
The final event of an MI is usually what?
Thrombosis
Which of the folllowing drugs are used to prevent the extension of an MI? Slect all that apply 1. NSAIDS 2. Beta Blockers 3. ASA 4. Nitrates
2, 3, 4
What is the antidote for Coumadin? What should be done after administration of antidote and why?
Vitamin K Monitor the INR because coumadin has a long half life.
What are the major actions of Digoxin?
Increases Cardiac output, promotes mild diuresis. Must be held if Pulse is below 60 bpm.
What is a normal Digoxin Level?
Dig levels should be 0.8 - 2.0
List the following heart rhythms from most serious to least serious. 1. Normal Sinus Rhythm 2. PVC 3. A fib 4. V tach 5. V Fib
Vfib, V tach, PVC, A-fib, Normal sinus rhythm.
A patient admits to the ER with chest pain that radiates to the shoulder. What should the nurse do first? 1. X-ray 2. Call lab to take samples for analysis 3. Hook up 12 lead 4. Morphine, O2, Nitrates, ASA
- MONA If you relieve the chest pain you relieve the ischemia.
Why is ASA used as a prophylactic?
It reduces Platelet aggregation. It may also reduce temp secondary to MI.
What is happening when the P wave is seen?
The P wave is the electrical impulse of the Atrium contracting or depolarizing.
What does the QRS wave indicate?
This is the ventricular contraction or depolarization
What is the T wave?
Ventricular relaxation or repolarization.
What does PVC stand for?
Premature Ventricular Contraction. The ventricle has cantracted before it can properly fill.
What does this EKG show?
Normal sinus Rhythm with a large PVC
What is this
V-Tach or Tombstone.
If the PQRST are all present and the beat is 60-100 BPM, What is it considered?
Normal Sinus Rhythm.
What are some signs and symptoms of DIGOXIN TOXICITY?
Halo’s in vision, Color changes in vision, Headache, Lethargy, Nausea, Diarrhea, Bradycardia, Dysrhythmia, Irritable.
What do Vasodialators do?
Decrease preload and afterload
Treatment for new MI?
Morphine, Oxyge, Nitrates, Asperin (ASA), Beta Blockers MONAB
What is Angina Pectoris?
Acute pain located in chest, usually an imbalance between oxygen supply and demand
What is Stable Angina?
Predictable, reversible, pain on exertion as a form of chest pain.
What is Unstable Angina?
New onset, increased frequency and may occur while at risk. If patient goes 6 months without any treatment there is a chance the arteries will close (Infarct)
What is the mager diagnostic finding for an MI?
Troponin will increase 4-6 hours from event. CPK MB will also be positive or increase
EKG changes for a heart attack are?
Deep Q waves mean damaged tissues for 4-6 weeks. ST segment will become elevated. T wave may become inverted, You will also see dysrhythmia, an increase temp and an increase in WBC
What is the normal platelet count?
150000 to 400000
INR values should be?
2-3 whiole on medication and target is 2.5. Unmedicated target is 1
PT Time should be what
Coumadin level should be 12-15.
APTT levels should be?
Normal 30-45 Heparing is 60 - 90 or 2x
Right sided heart failure or Core pulmonale symptoms are?
Fatigue Ascites increased Veinous pressure enlarged liver and spleen JVD Anorexia and complaints of GI Distress Weight gain and edema Oliguria
Left sided heart failure Symptoms are?
Restless and confusion Elevated Bp Orthopnia Dyspnea on exertion Hypoxia Pulmonary congestion, cough, wheezing Blood tinged sputum cyanosis and palor dysrhythmia
MI (Myocardial Infarction) sudden onset?
Crushing or squeezing of chest not relieved by nitro. May radiate to jaw, neck, back, or shoulder. Dyspnea, decreased BP, Extreme weakness, Increased HR Dyaphoresis.
Diagnostics for DVT are?
Blood Studies Platelets, bleeding time, INR, PTT If elevated this will mean underlying blood disease. If decreased polycythemia which will increase heart workload and bllod pressure.
Cardiovascular assesment questions are?
Ask about chest pain, SOB, Alcohol use, anemia, Rheumatic fever, Streptococcyl sore throat (Fever) stroke, HTN, Thrmoboflabytis, Edema (pitting is a sign of Right sided Heart Failure) Assess Respiratory status.
Risk factors for primary hyper tension are?
Age (50% in people over 60), Alcohol, Smoking, Diabetes, elevated serum lipids (cholesterol) Excessive dietary sodium.
Hyper tensive crisis is?
BP 250/120, Headache, chest pain. Stopping Beta Blockers suddenly can cause it.
Coplications of hypertension?
Target organs are Heart, Brain, Eyes, Kidney, and veins. You know treatment is successful when target organs show no indicators of damage.
Nutritional Therapy diet for HTN?
Low sodium diets, No processed foods, restrict fats and cholesterol.
Nursing Diagnosis for HTN most common is?
Deficient knowledge related to management of disease process.
Diuretics are?
Given with morphine in situation of MI and Pulomanary Edma. Usually LAsix to reduce pulmonary crackles and coughs as well as BNP level.
Patients taking Potassium Sparing diuretics such as Aldactone should be taugh what?
Teach paient to avoid k rich foods and monitor for hyper kalemia.
How do ACE Inhibitors (Prils) work?
Stops the Conversion angiotensin I to Angiotensin II by causing sodium and water to leave body and retains Potassium. Patients will become dehydrated. Side effects are dizziness, Cough, Headache, Dehydration, GI Distress, Orthostatic HTN.
How do Beta Blockers (olol’s) work?
Block the beta receptors in the heart, causing decreased heart rate, decreased force of contraction, decrease BP. Side effects are 1. Bradycardia, 2. lethargy 3. CHF
Calcium Channel Blockers are? How do they work?
VND, Verapamil, Nifedipine (procardia), Diltiazem (Cardzem). Relax the smooth muscle in the heart. Decrease contractility and conductivity of the heart which decreases the demand for O2 Side Effects are decreased BP, Bradycardia, Headache, Perpheral Edema, and abdominal discomfort.
Drugs for Bradycardia and decreased BP are?
IDEA. Isoproterenol, Dopamine, Epinephrine, Atropine.
What do Nitrates do?
Decrease pre and after load, which relieves chest pain. Store in a cool area away from body and away from light, sublingual, paste and spray are fast acting. Sublingual will cause tingling. Nurse must wear gloves.
When you have chest pain at home what should you do?
Take nitro 1 time, if no relief call doctor. You can take up to 3 times every five minutes. No more than 3 doses.
What are Streptokinase, and TPA?
These are clot busting agents. Do not give to patients who are prgnant, cerebral anneurisms, or immuno suppressed. Asses for bleeding, bruising and oozing from IV site. If LOC changes withold med. Discontinue of decrease in HGB or dark stool which suggest GI Bleed.
What to do when pt has abdominal aortic aneuryms
-Report complaints of abdominal pain to Dr. immediatly! -DO NOT PALPATE ABDOMEN!
PAD Arterial Symptoms (Starvation)
Peripheral Pulses- decreased or absent Capillary Refill- more than 3 seconds Edema- No edema present Pain- rest pain in foot Skin color- Rubor/pallor Texture- thing, shiny, dry temperature- cool to cooler pruitis- rarely occurs (itching)
PAD Venous Symptoms (Gluttony)
Peripheral pulses- present but difficult to feel Capillary Refill- less than 3 seconds Edema- lower extremity edema skin color- bronze, brown texture- alligator, thick, hard Temperature- warm pruitis- frequently occurs Nails will be thick for both arterial and venous
What is an angiogram?
-Shoots die in artery to look at blockages of artery -Assess color, temp of affected leg post procedure if pedal pulses become weak. -keep leg extended for 2 hours post procedure.
Drug Therapy for Antiplatelet Agents
-Aspirin -Trental (most effective) -Ticlopidine (Ticlid) -Plavix- prevents platelet aggregation
Femoral Popliteal bypass for PAD
-improved blood flow beyond stenosis or occlusion -monitor extremity q15min initially *Assess pedal pulse q15min, complete neurovascular assessment skin color changes (pallor) temp, cap refill, pp distal to operative site avoid flextion of leg (no pillow)
Nursing Diagnosis for PAD
1 Acute Pain - Activity Intolerence
tPA
-Clot buster IMMEDIATELY stop tPA if: hematuria, gingival bleeding, blood oozing from IV, decreased LOC, nosebleed
Ted Hose (for DVT)
-Promotes venous return -make sure elastic band isnt too tight -Apply before getting OUT OF BED ICD’s are used to prevent DVT not for active DVT!
Pulmonary Embolism
-blockage of pulmonary artery by a thrombus Manifestations: sudden change in mental status, appear drowsy **WHEN PRIORITIZING SEE THIS PATIENT FIRST
Intermittent Claudication
-Pain with exercise/ walking -goes away within 10-15 minutes -due to peripheral ischemias and lactic acis (metabolite) accumulation tissues. If patites states burning pain wakes him, the disease is worsening. Control cholesterol, stop smoking (vasodialates)
Why is resting good if a patient is having symptoms of a heart attack?
Because the coronary circulation can keep up with the demand of the body.
Side effect of Atenolol?
Fatigue and Dyspnea
A client has had a recent MI. why is damage to the myocardium a problem for theis patient? a. Damage to this area causes plaque to build up on the heart valves. b. Damage to this layer can decrease the contractile force of the heart c. Damage to this layer can lead to excessive cortisol and endorphin release. d. Damage to this area causes striated heart muscle fibers to release damaging high defense lipoproteins.
b. Damage to this layer can decrease the contractile force of the heart
What does the P wave on an EKG mean?
Depolarization of the atria.
A Nurse notes that the PR interval on a client’s ecg tracing is 0.14 seconds. What action should the nurse take? a. Call the health care provider immediately. b. Administer epinephrine immediately. c. Apply Oxygen via nasal Cannula d. Document the finding as the only action
Answer is D PR interval normally ranges from 0.12 to 0.20
The client with tachycardia is expieriencing all of the following clinical manifestations. Which one alertsthe nurse to the need for immediate intervention. 1. Chest Pain 2. Increased urine output 3. Mild orthostatic pressure 4. ECG tracing with P wave touching the T wave.
- Chest Pain The chest pain is a sign the Tachy may be increasing the coronary workload.
The client is in atrial Fibrillation following cardiac surgery. Which of the following assesment parameters should the nurse monitor for complications associated with dysrhytmias. a. measure urinary output b. assess the shortness of breath c. asses pulse oximetry every hour d. Measure blood pressure in the lying and sitting positions
B. Assess for shortness of breath. Possible PE
Which instruction should be included in the teaching plan for a client with a permanant pacemaker? 1. Baths are not permitted; Take only showers. 2. Report pulse rate lower than your pacemaker setting. 3. If you feel weak, apply pressure over your generator for 30 seconds. 4. Have your pacemaker turned off before having magnetic resonance imaging testing.
B. Report pulse rates lower than pacemaker setting.
Which statement made by a client would alert the nurse to the presence of edema? 1. I seldom sleep soundly at night 2. My shoes seem to be fitting tighter 3. I seem to feel more anxious lately 4. I drink at least two full glasses of water a day
- My shoes are fitting tired. This is a sign of EDEMA
A client with a history of myocardial inarction calls the clinic to report the onset of a cough that is troublesome only at night. What action should the nurse take at this time? 1. Instruct the client to come in to the clinic for evaluation 2. Instruct the client to increase fluid intake during waking hours 3. Instruct the client to use and over the counter cough suppressant before going to bed. 4. instruct the client to use two pillows to facillitate drainage of postnasal secretions
A. Instruct the client to come to the clinic for evaluation Nocturnal cough is an early indicator of Heart failure.
Which statement made by a client would alert the nurse to the possibility of right sided heart failure? I sleep with four pilows every night My shoes fit really tight I wake up coughing every night I have trouble catching my breath
- My shoes fit really tight. This is an early sign of Edema and heart failure.
The client with heart failure is prescribed to take enalapril, an ACE inhibitor. which of the following precautions should the nurse to teach this client regarding drug therapy? Avoid salt substitutes be sure to take this mediaction with food. Avoid aspirin while on this medication Do not take this mediaction if your pulse rate is below 74 BPM.
Ace inhibitors inhibit the excretion of potassium. so A
For which client would drug therapy with lovastatin be contraindicated? The client with Diabetes The client with peptic ulcer disease The client with rheumatoid arthritis The client with cirrhosis of the liver
D. Statins elevate LDL and cholesterol.
What instructions should be given to a client who is about to begin treatment with an HMG-Coa reductase inhibitor such as simvastin? A. This drug can cause constipation B. Take this drug on an empty stomach C. Report any muscle tenderness to your health care provider D You may expierience flushing of the skin with this medication
C. This drug can cause myopathy.
What additional physical assesment parameter should be included in the examination of a client diagnoses with HTN? A. Skin examination for telangiectasis. B Otoscopic examinations of the inner ear C. Fundusopic examination of the Retina D. Neurologic of the cranial nerves.
Anser is C. HTN can effect the appearance of the retina
A patient is scheduled for a cardiac cath before the test, nurse tells the patient …..
a feeling of warmth may be experienced as the contrast material is injected into the catheter
What expected outcome would indicate effective management of a clients HTN? a. The client has not developed pedal edema. B. There is no evidence of sexual dysfunction C.There is no indication of target organ damage D. The client’s blood pressure reading is stable at 148/94
C. This is sign that the HTN is properly being managed.
A client is to begin taking hydrochlorothiazide for contorl of HTN. what instructions should be given to this client before beginning therapy? A. You may develop a sower pulse rate B. You may notice some swelling in your feet. C. You may develop shortness of breath. Your diet should include foods high in potassium
D. Hydrochlorothiazide causes potassium loss.
What would be the most definitive method, or test
PTCA or Cardiac Catheterization
What is the main difference between an MI and Ischemia?
Ishcemia can be reversed
What is most common with an MI?What is the final event of an MI?
Most common complication? pVC or dysrythmia Final event: Thrombus
Name some Calcium Channel blockers and what they do……
Verynicedrugsverapamil, nifederone, diltiazem
To reduce risk of complications associated with TPA
Following clot lysis, heparin and aspirin are prescribed
The client with chronic peripheral artery disease and claudication tells the nurse that burning pain often awkens him from sleep. What is the nurse’s interpretation of this change. A. The client has inflow disease B. The client ahs Outflow Disease. C. The client’s disease is worsening. D. The client’s disease is stable.
C. This is the worsening sign and symptom.
EKG changes associated with coronary ischemia
T wave inversion and ST depression
A client with a diagnosed abdominal aortic aneurysm develops lower back pain radiating to the groin. what is the nurse’s interpretation of this information. a. The aneurysm has become obstructed. b. The aneurysm may be undergoing expansion. c. The client is expieriencing inflammation of aneurysm d. The client is expieriencing normal sensation associated with this condition.
B
In assesing the client with an aortic aneurysm before surgery, a nurse notes that the client’s systolic BP has increased by 30 mm Hg compared with the reading from 1 hour ago. What is the Nurse’s best first action? a. Measure abdominal girth B. Ausculatation of the abdomen C. Increase the IV Rate. D. Measure blood pressure in both arms
A. A sudden increase in BP or HTN can cause enlargement or rupture of the Aneurysm. Bleeding out into the trunk.
A patient is scheduled for a cardiac catheterization with coronary angiopathy. Before the test, the nurse informs the patient that… a. A catheter will be inserted into a vein in the arm or leg and advanced to the heart. b. ECG monitoring will be required for 24 hours following the test to detect any dysrhythmia c. a feeling of warmth may be expierienced as the contrast material is injected into the catheter. d. it will be important to lie completely still during the coronary angiopathy procedure.
C. The iodine being inserted will be a warm feeling.
To assist the patient with CAD to make the appropriate dietary changes, which of these nursing interventions will be most effective. a. Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible. b. Provide the patient with a list of low sodium, low cholesterol foods that should be included in the diet. c. Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary. d.Empahasize the increased risk for cardiac problems unless the patient makes dietary changes
A
A patient with a non-ST segment elevation Myocardial infarction (NSTEMI) is recieving heparin. What is the purpose ofthe heparin? a. Heparin wil dissolve the clot that is blocking flow to the heart. b. Coronary artery plaque size and adherance are decreased with heparin c. Heparin will prevent the development of clots in the coronary arteries. d. Platelet aggregation is enhanced by IV heparin infusion
C
The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for Digoxin, hydrochlorothiazide, and a potassium supplement. Appropriate instructions for the patient include? a. avoid dietary sources of potassium because too much can cause digoxin toxicity b. take the pulse rate daily and never take digoxin if the pulse is below 60 BPM c. take the hydrochlorothiazide before bedtime to maximize activity level during the day. d. notify the health care provider immediatelyif nausea or dificulty breathing occurs.
D. Digoxin toxicity is potentiated by HYPOkalemia.
Following an acute MI, a previously healthy 67 Y.O. patient develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about. a. digitalis preperations, such as digoxin b. Calcium channel blockers, such as diltiazem c. B-Andrenergic agonists, such as dobutamine d. Ace inhibitors, such as captopril
D. Ace inhibitors are recommended to prevent the development of heart failure in MI patients.
To decrease Preload……
Administer Nitroglycerin, Morphine, Elevate HOB 45 degrees
A patient with Diabetes is admitted unresponsive to the ED. initial findings are Potassium 2.8, Sodium 138, Chloride 90, Glucose 628. Cardiac monitoring shows multifocal PVCs. The nurse understands that the patients PVCs are most likely caused by. a. Hyperglycemia b. Hypoxemia c. Dehydration d. Hypokalemia
D. Hypokalemia increases the risk for Ventricula dysrhythmias like PVCs. V tach, and V Fib.
A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that further treatment of the patient will require a. Iv Adenosine b. Electric cardioversion c. Insertion of an implantable cardioverter-defirbrillator. d. anticoagulant therapy with warfarin (Coumadin)
D Fib that has lasted more than 48 hours requires anticoagulation.
What is the normal platelet count?
150,000-400,000
A 36 YO patient who has a history of thromboangiitis obliterans (Buerger;s disease) is admitted to the hospital with a gangrenous lesion of the right small toe. When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient? a. Cessation of smoking b. Maintenance of apropriate weight c. Control of serum lipid levels d. demonstration of meticulous foot care.
A. Smoking cessation. Only complete abstinance of nicotine will help reduce the risk of amputation in clients with Buergers disease.
When on coumadin what two tests should be monitored?
pT & INR Normal pT is 12-15 seconds Normal INR is 2-3 for someone on Coumadin; Target GOAL is 2.5;and0.8-2.0 for normal people not receiving Coagulation
What is the normal pTT or APTT (Activated partial thromboplastin time)
Normal (CONTROL) 30-45 seconds Someone on Heparin (2x the control) or 60-90 seconds
Streptokinase is prescribed for a client with myocardial injury. The therapy should be stopped when client experiences:A. Relief of pain B. oozing of blood from IV site C. Sudden decrease in LOC D. An increase in HR and myocardial contractility
C. Sudden decreases in LOC could be a sign of brain bleed
Normal Bleeding time?
1-6 minutes
Diagnostics of a DVT
Platelet count, bleeding time, INR, APTT if these are elevated, the patient has an underlying blood disease, if they are decreased, the person has in increase in RBC or polycythemia, increased workload of the heart, increased BP,
What would help someone build collateral circulation for intermittent claudication?
walk/exercise
Why would having a streptococcal sore throat be detrimental to someone with a hx of heart failurel?
because it leads to rheumatic fever, which can cause a heart murmur and endocarditis
What Would pitting edema be indicative of?
Right sided heart failure
To assist someone with cultual needs pertaining to diet?
ASSESS what they normally eat, and offer some alternatives, help them list some foods lowest in Na+ and cholesterol from foods they normally consume
Blood pressure increases with age due to?
ARTERIOSCLEROSIS (hardening of the arteries) and loss of elasticity
In order to diagnose HTN?
elevated BP readings must be present on at least 3 consequtive occasions during several weeks
Elevated BP without an indentifiable cause (IDIOPATHIC)
Primary (Essential HTN)
Biggest SE of Atenolol (Tenormin) BETA BLOCKER
Fatigue and Dyspnea
Earliest signs of HTN
Nocturia, early morning headache, fatigue
If you stop a Beta Blocker abruptly
A Hypertensive Crisis can happen
Signs and symptoms of a Hypertensive crisis
BP 250/120, Headache, Chest Pain
Prior to giving Digoxin,you monitor pt’s heart rate and it is
Hold the med recheck apical pulse in an hour and if it is 60 or higher administer the drug
When giving a diuretic what do you always check first?
BP!!!!!!!!!!!
For an acute MI with Pulmonary Edema what would you give?
diuretic and morphine
What is this?
PVC
How would you know that a loop diuretic is working in someone with CHF
decreased crackles in the lungs
Drugs to give to someone in HTN crisis
Labetalol, Nadolol (Combined alpha a and B adrenergic blockers
What does this EKG show?
A-FIB most common dysrhythmia!
The client is discharged on beta blocking agents following an MI. Which of the following instructions are correct for this collect ? (Select all) A. Report abnormal fatigue B. An early sing of CHF is unexplained cough C. Weigh daily D. The medicatiojn may be discontinued if wheezing develops
A, b, c, d
What is the action of Calcium channel blockers and what foods would you tell someone to avoid when on them,?
Cardizem (Diltiazem) relaxes smooth muscle, AVOID GRAPEFRUIT b/c your liver cant eliminate it and it builds up in the body
Calf tenderness would be indicitive of?
DVT
If a patient with intermittent claudication says burning wakes him up from sleep what do you suspect?
the disease is worsening
Which of the following are true about brain natriuretic peptide (BNP) ? select all A. The test is useful in diagnosing CHF, B. The hormone has been shown to increase in response to ventricular volume expansion C. BNP is a marker of ventricular systolic and diastolic dysfunction D. The test is useful in diagnosing a MI
A, B, C
Pt comes to ER and is complaining of calf pain with rapid ambulation r/t a lactic acid accumulation in muscle tissue
Intermittent Claudication
What would someone with arterial insufficiency look like?
STARVATION: thin skin, dependent (redness/rubor) skin then it turns white, cool to touch, thick toenails, they do not bleed and do not have edema cap. refill is more than 3 seconds
What would someone with venous insufficiency look like?
Brawny(Brown) thick skin, warm to touch, normal OR thick toenails, these are the bleeders, these people are in glutany they feel a dull aching pain with heaviness and have lower extremity edema, cap refill less than 3 seconds
Ejection fraction
Left ventricle - 45-65% Cardiac Cath decreases 20%
The client becomes SOB and his lips are dusky. His ❤ rate is 120 and respiration are moist. The nurse administers O2 and places him in high fowlers mainly to: A. Increase BPB. prevent orthostatic hypotension C. Facilitate suctioning D. Decrease the preload
D. Decrease preload
CHF causes
Arthersclerosis, HTN, MI
A client is SOB when he attempts to lie down at night to sleep. He has been sleeping in a recliner. The nurse should suspect:A. Lymphatic pneumonia B. MIC. R vent heart failure D. L side ❤ failure
D. L side ❤ failure
Client taking Lipitor, lopressor, and procardia is going home. What are some appropriate discharge instructions ?
Low sodium low CHO diet, orthostativ\c HTN,mild exrcise, Betas cant be stopped abruptly, monitor liver fx (light stool, light urine, skin color changes, RUQ tener, fatigue).
A client with HTN should avoid which of following foods ?A. Turkey B. chicken. C. Green leafy veggies D. Frozen foods
D frozen foods
Most important assessment following a cardiac Cath is:A. Peripheral pulses B. resp rate C. Measurements for ascites D. Complaints of fatigue
A. Peripheral pulses
Early signs of primary HTN (40% asymptomic )A. End stage renal disease B. blindness C. Early morning headachesD. Loss of peripheral pulses and parathesias
C. Early morning headache. As well as unexplained fatigue and nocturia
Client with left side ❤ failure is Gavin difficulty breathing due to excessive fluid. What would ABGs look like ? A. Ph 7.47. Co2 30, Hco3 25B. Ph 7.33, Co2 50, Hco3 26C. Ph 7.20, Co2 35, Hco3 17D. Ph 7.56, Co2 19, Hco3 24
B. resp acidosis
Client is admitted with acute CHF. Soon after client becomes restless and coughs up pink frothy sputum. The nurse would perform which of the following ?( select all ) A. Administer codeine as cough suppressant B. use corticosteroid inhaler C. Administer IV nitro and morphine sulphate D. Weigh client and measure abdominal girth E. Restrict fluids and administer lasix as order
C and E. as well as elevate HOB, give cardiac stimulate
Most critical assesment of a client with PVD
Pedal Pulses
Discharge Teaching with someone on Coumadin?
-Take med at the same time every day (usually 2pm-5pm) -Use soft toothbrush, electric shaving -Routine lab follow up –Dont eat Vitamin K (antidote) -Wear med alert bracelet -Stop taking it prior to medical procedure -Ask Dr. before taking any drugs including OTC
People prone to getting DVT (venous insufficiency)
-immobile, abdominal surgeries, someone who doesnt change positions alot (truck driver, CRAB BOAT CAPTAINS ON THE BEARING SEA! LOL)
Antidote for Heparin
Protamine Sulfate
First thing people complain of with in an aortic aneurysm?
Excruciating Headache (cerebral) pain (abdominal) Thoracic Aneurysm- its high up so people mistake it as chest pain. PROGNOSIS: DEATH
SE of antihypertensive medications
Beta Blockers- wheezing, bronchospasms, fatigue, hypotension, bradycardia, CHF Ace Inhibitors- Hyperkalemia, hypotension, dry hacking cough, dehydration Calcium Channel Blockers- hypotension, bradycardia
Drugs contraindicated for someone of Coumadin
Aspirin, Nsaids, Motrin, Herbal Remedies or OTC (alot contain vitamin K which is antidote for coumadin) Ex. of herbal remedies : Garlic, Ginger, Ginkgo, Ginseng &OMEGAS
Patient on heparin in the hospital switching to coumadin
Patient cant go home on Heparin so placed on Coumadin Coumadin takes a couple days to kick in With both patient wont hemorrhage Need to get INR regulated before taking off heparin Coumadin is hard to regulate so always have vitamin K available
Ways to administer Heparin and reasons for it
Given IV or Subq -Prevents extension of a clot:: does not dissolve a clot (steptokinase tPa) Monitor PTT. *if ptt is below 55; administer bolus of heparin or increase the rate. If ptt is above 90, turn off hep drip for an hour, ptt should return normal because heparin has a short half life
If pt is admitted with a DVT and is complaining of shortness of breath..
-This patient is PRIORITY! -Elevate HOB, give O2 and suspect a PE (Pulmonary Embolism)
If patient does not want to go home on Coumadin.. an alternative would be..
Lovenox SubQ Nurse would teach pt that shot is in abdomen, no aspirating, or massage. Keep air bubble
Most critical Assessment finding in a client with Arterial PVD?
Absent pulses
A BP reading of 140/90 indicates:
Hypertension
Shiny Skin with decreased hair growth is a symptom of ARTERIAL PVD OR VENOUS PVD?
ARTERIAL PVD
Assessment finding common with a long standing venous (gluttony) disorder?
-Peripheral Edema -Bronze skin -Warm skin -Dilated varicose veins -aching/heaviness
Long term complications of Uncontrolled Hypertension
Renal Failure( kidney) , Stroke ( brain), Vascular Disease,Blindness (eyes)
How long do you have to stay on Antihypertensive meds? and what are common side effects?
Pt should know they will be on these meds for the rest of their life Common s/e are fatigue and male sexual dysfunction
PVCS
PVCS will have wide and bizarre QRS! -Give antirhymatic (Pronestyl, Lidocaine, Rhythmol, Amerodione (this drug is not used often because it causes Irreversible Pulmonary Fibrosis)
Atrial Fibrillation
-Most common dysrhythmia -Normal QRS, irregular P (quivering) Cardiac Output is decreased and blood clots can form since blood is pooling in atrium. Place on Heparin first then Coumadin Pacemaker is not in SA mode so the AV node is selectively letting impulses through.
Ventricular Tachycardia
TOMBSTONE -Filling time is decreased b/c heart is beating so fast, oxygen demand is up while supply is down (supply oxygen to pt) -Treatment: Check pulse, If there is a pulse cardiovert if not DFIB, lidocaine, pronestyl, amioderone Can lead to VFIB which is BADDDDD!
Ventricular Fibrillation
No cardiac output;; patient is technically dead Treatment: D-fib (shock) to try to get some kind of rhthym to work with
Cardiac Cath
-Can be done many times -It is an arterial stick, pt will have sandbag for 4-6 hours, lay flat for 4-6 hours -DO NEUROVASCULAR ASSESSMENT (color, temp, movement, numbness & tingling)
Things that decrease preload
-Elevating HOB -Nitrates (vasodialators) -Morphine
BNP (Brain Natriatic Peptide)
BNP is NOT an indicator of MI. -BNP norm levels 0-100 less than 100 indicates repiratory problem or no problem more than 100 indicates heart failure
*KNOW ST CHANGES ON EKG
ST depression- indicates ischemia ST elevation- indicates injury
(? from supplemental) Which of the following statements are true concerning the administration of NTG paste per chest wall? (SATA) A. Orthostatic Hypotension may occur B. Withhold the drug for BP less than 100/60 C. Withhold the drug for the dx of stable angina or acute coronary syndrome D. Place the NTG paste on the chest wall with each application E. May be used in clients with acute chest pain especially with no IV access is available
A, B, D, E
(? from supplemental) A client with CHF is hospitalized with severe dyspnea and a hacking cough. She has pitting edema in both ankles and her vital signs are 170/100, P 110, RR 28. The nurse recognizes that the clients symptoms indicate A. Venous Return to the heart is impaired causing a decrease in cardiac output B. There is impaired emptying of both right and left ventricles C. the right side of the heart is failing to pump enough blood to the lungs to provide systemic oxygenation D. the myocardium is ischemic
B.
(? from supplemental) The client is a 55 yr old female, admitted with history of MI, valvular disorder, and CHF. The pt presents with weight gain, ascites, heart rate of 104, crackles, complaints of fatigue. The pt complains of chest pain that is radiating down the left arm and the triponin is elevated.What is developing? (SATA) A. Pulmonary Embolism B. Left sided heart failure C. Right sided heart failure D. Biventrical failure E. MI F.Unstable Angina
D, E
(? from supplemental) Beta blockers are ordered. The mechanism of action is A. decrease heart rate, reduce myocardial oxygen demand B. increased cardiac output, increased systemic vascular resistance C.Stimulation of sympathetic nervous system D. Alpha receptor stimulation producing vasoconstriction
A
(? from supplemental) Lasix 40mg is ordered for a pt in the ED. After administering lasix is important for the nurse to: A. check the serum potassium level B. Weigh the client C. Measure the clients output D. Take the clients BP
D (initially)
(? from supplemental) Perry is digitalized with digoxin IVP. which of the following observations indicates effectiveness of digoxin? A. increased ventricular rate B. Decreased urine output C. Serum potassium of 3 D. Weight Loss
D
(? from supplemental) The pt is started on medication Verapimil. The action of the drug is to: A. Decrease serum cholesterol level B. Produce smooth muscle relaxation and decrease BP and Heart rate C. Increase SA and AV node conduction D. Decrease the preload and it adjunct to nitroglycerin E. increase coronary artery circulation
B.
(? from supplemental) Pt is admitted with chest pain and a positive triponin. Dr orders the following medications. Which meds should be given immediatly? (SATA) A. Beta Blockers B. NTG paste 1 inch to the chest wall C. Digitalis D. Hep lock and PRN nitroglycerin drip to control pain E Verapimil
A, B, D
(? from supplemental) 56 year old female is seen in the ED with C/O crushing chest pain radiating to her neck and shoulders . The admitting dx is MI. The following orders are noted: o2 4L nc, chest xray, blood work including triponin and myoglobin levels, EKG, and morphine sulfate 2mg IVP. What shoud the nurse do first? A. Give morphine B. Obtain 12 lead EKG C. Order the chest xray D. Call the lab obtain specimen
A
(? from supplemental) The pt with essential hypertension is started on procardia. The action of procardia includes: A. Blocks stimulation of angiotension I to angiotension II B. Inhibits beta 1 stimulation in the myocardium, decreasing heart rate C. Produces vasodilation, decreasing afterload D. Inhibits sympathetic nervous stimulation, decreasing cardiac output
C.
Hematopoesis
Blood cell production, occurs in red bone marrow of irregular bones
Hematopoetic stem cell
As the cell matures it differentiates and changes production of several different types of cells depending on the demand of the cells.
Erythropoesis
RBC Production. Stimulated by hypoxia needs protein - high protein diet needed for healing, stimulated by the kidney.
Anemia
Low oxygen in the blood
Reticulocyte
Immature RBC, measures rate at which new RBC’s enter the blood stream. Mature in 48 hours of release into blood stream. No nucleus and slightly larger than mature RBC
