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
Hemolysis
Destruction of RBCs
Normal life span of RBCs
120 days
Leukocytes
WBCs Neutrophils, most common acute inflammatory response, monocytes have a large mononuclear cell
Lymphocytes
bcells- fever, night sweats. t cells - decide what to be.
Thrombocytes
Normal count is 150000 - 400000. Aid in blood clotting. activated when exposed to interstitial collagen from injured blood vessel, form clumps, stickiness is called adhesiveness, clumps formation is called aggultination
Coagulation cascade
Heparin acts on intrinsic factor. Coumadin acts on extrinsic factor
Spleen
Recycling center of the body. Filters out old RBCs, reuses iron from hemoglobin and returns to bone marrow. Sickle cell alters splenic function.
Red Bone Marrow and stem cells
Decrease with age, never completely deplete. medications may interfere with clotting time. chemo attacks all rapidly dividing cells (including hair)
Anemia may be related to
Decreased intake of iron, cobalamin, folic acid, and green leafy vegetables
Anemia questions for patients
Age of menarche, clotting, cramping, and amount of bleeding.
Skin in an anemia patient will look like?
skin may be pale (decreased HGB), flushing (increased HGB), jaundice (excessive hemolysis) cyanosis (low HGB, High deoxyhemoglobin) Pruritis (hodgkins), leg ulcers (sickle cell), Petechia (low platelet or clotting factor), eccymosis, hematoma.
The eyes in an anemia patient will have?
Jaundiced sclera due to accumaltion of bile pigment.
What is responsible for Coagulation of the blood?
Platelets
why does a patient who has undergone Gastric bypass surgery develop anemia?
because they cant absorb Vitamin B12 (Cobalamin)
Neutopenia
low WBC’s >4,000
The basis of cellular and humoral immune response………..
Lymphocytes (B+T cells)
Thrombocytopenia
low platelets and low thrombocytes
If you can feel a patients spleen?
STOP PALPATING SICKO
A chemo pt is at risk for?
bleeding, infection, & anemia
WBC count >11,000 WBC < 4,000
Infection Leukopenia
Nursing Responsibility for a Bone Marrow Biopsy
Get consent, Pre-emptive medication (Conscious sedation) Versed, & Morphine, Pressure dressing after (hold for 15 min) do frequent site checks, Assess the site for bleeding (underneath them) Possible Complications: Infections and bleeding
Erythropoetin stimulates?
Bone marrow to make RBC when O2 is low. Anticipate administering Epogen SQ for management of anemia secondary to CRF
A client with case of fever, chills, and left costovertebral pain should have what kind of test started?
Clean catch urine test.
IF you have a female client who has given you a urine test, what can you expect?
If they are on their menarche you can expect RBC’s in the urine.
What is ATN?
Acute Tubular Necropsy.
If urine PH is below 4 what is this a sign of?
Respiratory or METABOLIC ACIDOSIS
If your urine sample comes back positive for streptococci, or is contaminated. What probably happened?
You touched the inside of the cup.
Yellow or brown urine sample is usually?
Pyridium. given for urinary pain. burning and urgency.
What blood chemistries should you check for in a urine sample?
BUN, Creatinine. These are expected in a client in suspected Cancer of pancreas. Run this test before chemo.
Normal urine residual should be?
Renal function can be checked with this? It is a better indictor than BUN.
Serum Creatinine. It is not influenced by protein and exercise.
Normal platelet life is?
9-10 days
BUN level is normally?
10-30 mg/dl
Normal Serum Creatinine levels are?
0.5 - 1.5 mg/dl
Most people in renal failure have what kind of HCO3 levels?
Low HCO3 because they are in metabolic acidosis. Normal levels are 20-30
Some chemotherapies are nephrotoxic. what needs to be monitored when patients are on chemo?
BUN, Creatanine, & Urine output
A potassium level >6 can lead to what?
MM Weakness & cardiac arrythmias. Normal levels are 3.5-5.0
Phosphorus is inversely related to?
Calcium
Nephrotic drugs alter?
Urine function. Advil and Ibuprofin are nephrotoxic.
Azotemia is?
High levels of Nitrogenous waste products in urine. Kidneys are not filtering correctly.
Who is prone for renal disorders?
Smokers, Textile workers, PAinters,
Dehydration can lead to?
UTI, Calculi, Renal failure.
Before using IVP what does the nurse need to asses for?
Seafood allergies. SHRIMP
ARF stands for?
Acute Renal Failure
The most common bacterium in UTI’s is?
E. Coli
MRI’s visualize what?
Soft tissues
Bactrim must be administered how?
On an empty stomach. 1 hour before or two hours after a meal. With a full glass of water.
Bactrim is taken for how long?
3 - 5 days. Taken on an empty stomach
If stone is present should fluids be increased to dilute?
No when stones are present, just hydrate do once stone is gone you can super hydrate to help keep new stones from forming.
While you have a UTI, you should avoid what kind of food or juice?
Citrus. It irritates the bladder.
One of the clinical manifestations of Cystitis is?
Suprapubic pain. Relieved by voiding and frequency.
The most common symptom of early bladder cancer is?
Gross painless hematuria. Either chronic or intermittent.
What is created in a radical cystectomy?
An ileal conduit
Which of the following is not a likely cause of CRF? A. diabetes B. HTN C. Aplastic anermia D. Glomerulonephritis
C. Aplastic anemia All others cause permanent damage to the nephrons–CRF Aplastic anemia, a life-threatening blood disorder, has no effect on the nephrons. It is characterized by pancytopenia, not renal failure
In CRF, the GFR usually is affected when how many nephrons are damaged? A. less then 25% B. 40-50% C. 60-70% D. more than 75%
D. more then 75%, damage of 25-75% = renal insufficiency
Which GI effect is not likely to occur in a client with CRF? A. Nausea B. anorexia C. oral muscousal ulcerations D. Increase Ca+ absorption
D. Increase Ca+ absorption, it is decrease r/t lack of activation of Vit D Uremic toxins accumlate and inflame the GI mucosa–> nausea, anorexia and oral mucosal ulcerations.
CRF causes electrolye imbalnces including? A. hypokalemia B.hypocalcemia C.hypomagnesemia C.hypophosphatemia
B. Hypocalemia r/t kindey inablitity to activate vit D (needed for Ca+ absorption All others occur r/t kidney ability to excrete them into the urine. They then accumlate in the blood
Dietary limitations to prevent complications from CRF should limit all of the following nutrients.. except?? A. sodium B. Calcium C. Potassium D. Phosporous
B.Calcium, CRF patients don’t need to restrict Ca+ because hypocalcemia may occur. Limit all others too prevent hyperkalemia, hypernatremia, and hyperphosphatemia
When assessing for CRF, you should not find? A. lethargy and weakness B. Ruddy skin from increased RBCs C. HTN from Na+ and water retention D. Adventitious breath sounds from uremic toxins
B. Ruddy skin from increased RBCs, CRF pts have anemia from decreased erythropoitin production. They are likely to have pallor. All other s/s are typical for CRF.
Which is the appropriate question to as a 52 y/o male with post renal failure A. Do you have and heart problems? B. Do you have an enlarged prostate? C. Do you have high blood pressure? D. Have you recently had a diagnostic exam that utlized dye?
B. Do you have an enlarged prostate? Post renal failure results from obstruction of urine from the kindey Ask about disorders that can lead to obstruction (renal calculi, blood clots, tumors) Heart problems = prerenal failure HTN & dye reactions = intrarenal failure
Which hormone triggers the conversion of angiotensin I to angiotensin II A. renin B. aldosterone C. antidiuretic hormone D. adrenocorticotropic hormone
A. Renin –> HTN increases blood flow to the kindey Aldosterone is secreted by the adrenal cortex in response to renin. Antidiuretic hormone, screted by the hypothalmus, decrease urine production. Adrenocortiocotropic hormone, from the anterior pititary gland, stimulates corticosteroid secretion
Which statement is INaccurate? A. Each kindey contains millions of nephrons B. The loop of henle is the main kindey filter C. The kindeys receive more than 1L of blood from the heart/min D. The afferent arterioles carry unfiltered blood from the renal artery to the glomerular capillaries
B. The loop of henle is the main kindey filter The glomerulus is the main filtration system in the nephrons Together with the convoluted tubules, the loop of henley concentrates(rather than filters) the urine The kindeys (each of which contain millions of nephrons) receives1.25 liters of unfiltered blood/min The blood is transported from the renal artery to the glomerular capillaires by the afferent arterioles.
Which findings are indictive of flid volume overload? A. palpitations, weakness. leg cramps B. Pericardial friction rub C. Pleural friction rub,fever, DIB(SOB) D. S3
D. S3 palpitations, weakness, leg cramps = electrolyte imblance Pericardial friction rub = pericarditis Pleural friction rub, fever, and DIB = uremic toxins inflame the visceral and parietal pleura of the lung
The risk for developing prerenal failure is greatest in pts with? A. B. Acute pyelonephritis C. Acute glomerulonephritis D. SLE
A. Disorders that decrease cardiac outout ( Renal infections ( pyelonephritits and glomerulonephritis) and SLE = intrarenal failure
In ARF - Kussmauls respirations occur due to the body trying to? A. Decrease the blood pH B. Exhale excess CO2 C. Increase H+ ion excretion D. Increase the CO2 level
B. Exhale the excess CO2 This prcess beings when damged tubules prevent the syntheis of ammonia. The H+ accumulates in the blood since it can’t combine with ammonia. This decrease the blood pH. At first the body compensates by combing the H+ with bicarbs. This forms carbonic acis, which breaks down into water and CO2.
During the oliguric phase of ARF, neurological s/s result from? A.Hypokalemia B. hyponatremia C. Decreased H+ ions in the blood D.Urea and creatinine buildup in the blood
D. Urea and creatinine build up in the blood. Unexcreated urea and creatinine build up in the blood = toxic effects on the CNS = neurological effects (lethargy/confusion)
In the diuretic phase of ARF, which of the following is true? A.Urine output decreases B. Glomerular filtration of blood stops C. THe body retains K+ and Na+ D. The renal tubules cant concentrate urine
D. The renal tubules can’t concentrate urine. During the diuretic phase, the urine output increases, the glomeruli filter the blood and the body excretes (rather then retains) K+ and Na+
Which lab test reflects the oliguric phase of ARF? A. BUN = 34 mg/dL B. Creatinine = 1mg/dL C. Na+ = 158 mEq/L D. K+ = 3.4 mEq/L
A. BUN of 34 The BUN level exceeds 20 mg/dL The creatinine levels exceeds 1.2 mg/dL The Na+ drops below 135 The K+ exceeds 4.5
Preneal (ARF) before the kindey, causes consists of factors outside of kindey, some of them are:
Decreased renovascular blood flow = HTN, decreased urine output, BUN 70, creatinine >2.9, specific gravity >1.040 Hypovolemia Decreased cardica output Decreased peripheral vascular resistance
Intrarenal (ARF) results from conditions that cause direct damage to the renal tissue, some causes are:
Infection, Drugs (mutiple nephrotoxic antibotics: genotamcyin, all mycins), infiltrating tumors, IVP contrast, prolonged prerenal ischemia, nephrotoxic injury, acute glomerulonephritis, toxemia of pregnancy, malignant HTN, systemic lupus erthematosus, interstitial nephrtits, Acute Tubular Necrosis (ATN)
Postrenal (ARF) involve mechancial obstruction of urinary outflow, some causes are:
Benign prostatic hypertrophy (BPH), bladder cancer, calculi formation (nephrolithiasis), neurmuscular disorders, prostate cancer, spinal cord disease, trauma, adhesions from surgery.
Complications of Anemia
Erythrocyte (RBC) disorders lead to hypoxia Hypoxia accounts for and is the underlying cause of the s/s of anemia: -DIB -palpitations -confusion and tachycardia in severe cases
MCV =
Mean corpusular volume (size of cell) -microcytosis (small cells) -macrocytosis (big cells)
MCH=
Mean corpuscular hemoglobin (color of cell) -low is hypochromia (pale) -high is macrocytosis (dark)
Mild symptoms of Anemia
Hgb 10-14, palpitations, dyspnea, diaphoresis
Moderate symptoms of Anemia
HgB 6-10, same symptoms as mild but at rest, dyspnea on exertion, pallor
Sever Anemia symptoms
HgB irritation of oral mucosa, impaired thought processess, tachycardia, chest pain, blurred vision, pallor, depression, theres more but only the bold ones were highlighted.
Nursing diagnosis for Anemia
Ineffectivwe therapeutic regimen management r/t lack of knowledge of meds and nutrition AEB: asking about diet, meds and RX. - Teach to take Fe+ before meals with Vit C -inform client that Fe+ will cause dark stools and constipation -avoid taking with hot coffee/tea -take enteric coated
Nutrition for Anemic patients
Foods high in iron: red meat, spinach, raisins, green-leafy veggies, dried fruits. Eat small frequent meals with snacks.
Iron deficiency Anemia (malabsorption)
Gastric surgery may remove or bypass duodenum, Vit B12 isnt absorbed due to decreased intrinsic factor (cant take B12 oral, must be IM)
Megaloblastic (pernicious) Anemia
Chronic condition r/t impaired DNA synthesis, deficiency of folic acid and/or cobalamin (B12), may cause degenerative changes in the nervous system AEB: numbness and tingling in extermities.
Schilling Test
Used to diagnosis Pernicious Anemia and malabosption syndromes, postitive for pernicious anemia when radioactive B12 is not found in the 1st 24 hr urine.
Aplastic Anemia (pancytopenia)
Decrease of all blood cell types- especially WBCs
Sickle Cell patho
When exposed to decreased O2 (being hig up in an airplane) – RBCs sickle, become rigid, fragile and sticky.
Sickle cell crisis
Severe. S/S= pain first ( aching and swelling in joints of hands and feet - priority nursing intervention is to adminster dilaudid IVP during crisis, get blood cultures for temp > 101.0 = infection!
Complications of Sickle cell crisis
Prone to infection r/t spleen fails to phagocytize foregin substances (pneumonia), chronic leg ulcers.
Treatment of sicke cell disease
Broad-spectrum antibotics, folic acid, exchance blood transfusions(in aplastic crisis), chelation therapy to decrease transfusion-induced iron overload, Oxygen.
Erythropoietin (procrit)
Used in pts not responding to hydroxyurea, can be self administer at home ( teach self injections) someone with leukemia cant take this.
Preventions of Sickle cell
Flu and pneumonia vaccines since they are at risk for injection and to help prevent crisis, avoid hypoxia ( high altitudes, dehydration)
Assessment findings for sickle cell
Increased bilirubin (client scratches skin), DIB (SOB), pale mucous membranes, C/O painful swelling of hands and feet, CHF, hepatomegaly, pneumonia on x-ray
Nursing interventions for sickle cell
Manage pain (PRIORITY), bedrest during exacerbation, increase fluids, IV fluids, O2, teach to avoid: overexertion, high altitudes(moutains), dehydration (drink at least 8-10 glasses of water daily.
Blood administration
Assess the clients lungs before and after, check for allergies, obtain a signed consent, 19 gauage or larger needle, isotonic solution(NS) in one and blood via the other spike, positively ID the donor blood and recipeient ( 2 RNs), check for storage lesions (old blood, temp of blood), takes 2-4 hours.
Adminstration of blood
Remain with patient for first 15 minutes or 50 ml of blood (reactions occur at this time), infuse at rate of no more than 2 ml/min, take no more than 4 hours to administer, may use blood warmer to avoid chills.
What to do for blood transfusion reactions
Stop the infusion immediately (clamp everything off and get another IV), maintain NS IV line (seperate line), monitor vitals and urine output, recheck ID tags and numbers, notify blood bank immediately, send blood bag, tubing and UA to blood bank.
Acute blood transfusion reactions
Antibodies in the recipient’s serum react with anitgens on the donors RBCs -casued by ABO-incompatible blood tye (adminstering to wrong patient)
Anaphylactic/severe allergic reactions to blood transfusions
Wheezing, cyanosis, cardiac arrest, initiate CPR if indicated, epinephrine SQ or IV as ordered, do not restart transfusion, Call Code !
Delayed hemolytic reactions
Occurs 2-14 days after transfusion or as early as 3 days and as late as several months.
Polycythemia- manifestations and major problems.
Thick blood, enhanced blood viscosity and volume, congestion of organs and tissues and splenomegaly. Manifestations- headache, dizziness, vertigo- all due to HTN secondary to hyperviscosity and hypervolemia (fluid volume overload) Major problems- thrombosis(stroke), institute active or passive leg exercises and ambulate to prevent DVT.
Patho of Hodgkin’s disease
Presence of Reed-Sternberg cells in the biopsy speciem ( GIANT, MALIGNANT, MULTINUCLEATED LYMPHOTCYTE)
Hodgkin B symptoms
Worse prognonsis=fever, night sweats, weight loss
Neupogen
Increases WBCs
Erythropeietin (EPO), procrit, Epogen
increases RBCs
Thrombocytopenia
Decreased platelets- teach to avoid injurt (avoid dental floss, hard tooth brushes, question orders in rectum)
Ibritumomab tiuxetan (Zevalin)
A monoclonal antibody that tagets the CD20 antigen on the B cell and B cell tumor, allowing delivery of radiation directly to the malignany cells. (mouse urine)
Multiple myeloma
Slow insidious nature, causes mental changes, series of involuntary muscular contractions, Ca+ is lost from bone, high levels of protein-acute tubular necrosis, bone pain (get help turning patient, give norco, vicodin, loritab, give two tabs if pain is 8, see what they usually take)
Chronic Pyelonephritis s/s
fever, chills, flank pain, and dysuria
Risk factors for pylenephritis
past medical Hx of chronic renal calculi (kidney stones)
Nursing diagnosis for UTI
Acute pain r/t inflammation of mucosal tissue of urinary tract AEB: pain on urination, flank pain, suprapubic pain, lower back pain or bladder spasms.
Urinary tract calculi (nephrolithiasis)
Post-renal disease, Tx for UTI cause by pseudomonas predisposes client to renal calculi further down the road.
Stones are reccurent in..
50% of patients, and more common in summer.
Etiology and patho of stones
Crystals, when in concentrated form, untie to form stones. Keeping urine dilute and free-flowing prevents this !
Lifestyle factors related to kindey stones
prolonged bedrest, prolonged hospitalization, immobility, sedentary occupation.
Types of stones
Calsium oxalate, calcium phosphate, struvite (acidify urine with cran juice), Uric acid (give allupurinol [prevents] ), crystine -genetic defect.
Calcium phosphate dietry suggestion
Diet high in Ca+ may actually lower the risk by decreasing urinary excretion of oxalate (a commone factor in many stones)
what to teach client when going for cystoscopy
They may experience burning and frequency for several hours after. Pyridium may be used after to decrease bladder irritability.
Clinical manifestations of kindey stones
Abdominal flankpain (severe) r/t stone irritation,hematura & renal colic, nausea and vomiting, mild shock (when passing stone)
Pain management for kindey stones
Load em up! opoid analgesics, tamsulosin (flomax) [vasodilates], keep adequately hydrated -overhydration=spams.
What to report with a lithotripsy
WBCs >14,000
Nutrirional therapy before stone removal
Avoid forcing fluids ( Does Not facilitate stone passage, may exacerbate colic.
nutritonal therapy after stone removal
increase fluids to 3,000 ml/d
Most common symptom in early bladder cancer
Gross, painless hematuria (chronic or intermittent). Confirmed by BIOPSY.
Risk factors of getting Bladder cancer
Cigarette smoking (ewwy), exposure to dyes used in some rubbber and cable industries, pt with a PMH of chronic renal lithiasis (recurrent stones), chronic UTIs and chronic cystitis.
Surgical tx for bladder cancer
Radical cystectomy -ileal conduit is created
normal urine color for post op bladder surgery
Pink during 1st several days (should not be bright red)
Nursing intervention post-nephrectomy
meaure urinary output every 1-2 hours to ensure that the remaining KK is functional
Ileal conduit (urinary diversion)
Uretters are anastamosed to a segment of the ileum for urinary drainage. Common to have mucous shreds in urine post op r/t attachment to bowel to maintain blood supply. Make sure ther is drainage in thr bag post-op
Urinary diversion pre-op management
Body image distubrance r/t change in body function
Urinary diversion post op managment
Meticulous skin care around stoma.
Acute Tubular Necrosis (ATN)
Intrarenal, Results when tubular cells do not get enough oxygen (ischemic ATN). These tubules are very metabolically active, they are very dependent on the oxygen that supplies the tubular cells.
Med that can cause ATN
aminoglycosides (mycins), amphotericin B (antifungal), Cisplatin (chemo), radioisotopic contract media (IVP dye)
ATN manifestations
Fluid overload (S3, JVD), decrease urine output or not at all, hyperkalemia, cardiac dysrythmias (life threatening)-abnormally wide QRS complex
Nursing interventions for ATN
diet: increase CHO, decrease protein, decrease Na+, decrease K+ Fluid restrictions, kayexalate to decrease K+ levels (hyperkalemia is life-threatening)
4 phases of ARF
Initiating, oliguric, diuretic, recovery
Oliguric phase of ARF
decrease production of urine ( remember 30 ml/hr is normal), Azotemia (increase accumulation or urea and creatinine), fluid retention (JVD, bounding pluse, pitting edema, S3)
Nursing interventions for pulmonary Edema
Adminster O2, place in semi-fowlers position, DONT cough and deep breath
Sodium balance of oliguric phase
Low Na+!! Avoid excessive intake of sodium, damaged tubules can conserve Na+
K+ excess in oliguric phase
Cardiac muscle is inolerant or acute increase in K+, hyperkalemia creates an elevated T wave, hypokalemia creates and elevated U wave.
Priority of care for hyperkalemia
Management ! K+ (3.5-5.0), IV sodium bicarb to decrease blood ph, causing movement of K+ for the extracellular fluid into the cells in exchange for hydrogen ions.
Hematologic disorders of oliguric phase of ARF
Anemia due to impaired erythropoietin production, WBC alteration- infection is the major cause of death with ARF, encourage cough and deep breathing to prevent pneumonia.
Diuretic phase (big urine)
Gradual increase in urine output to 1-3 liters a day, may reach 3-5 liters (>400 ml/hr), nephrons are still not fully functional, monitor for Na+, K+ levelrs for dehyradtion.
Recovery phase
GFR increase, so BUN and creatinine levels start to stabilize then decrease.
Hemodialysis
Method of choice when rapid changes are requred in a short amount of time. -pt complains of fatigue and is sleeping (azotemia) - emergency situation, SEE PT FIRST ! ISNT sterile
peritoneal dialysis
more simple, but carries the risk of peritonitis Sterile
Nutritional therapy ARF
Decrease protein intake 1.2 to 1.3 g/kg
Acute interventions for ARF
I & O, daily weights, encourage cough and deep breathing, insentive spirometer
Chronic renal failure CRF
Progessive, irreversible, leading causes: HTN and Diabetes
Stages of CRF
1- kindey damage with normal or increased GFR (at or above 90) 2-kindey damage with wild decrease in GFR (60-89) 3- moderate decrease in GFR(30-59) 4- severe decrease in GFR (15-29) 5- kindey failure GFR
Manifestations of CRF
Decrease urinary output with Azotemia(increase in bun and creatinine), arrythmias from hyperkalemia, drug toxicity, renal osteodystrophy (pidgeon chest)- as GFR decreased, phos and Ca+ are impaired, hypocalemia and hyperphosphatemia (trousseau’s, cardiac arrthymias, prolonged clotting time, fracures), pH decreases.
Low potassium diet for CRF
APPLES, pasta, bread, spinachm, cucumber, coffee, peaches, eggs and chicken.
An ounce contains how many mLs?
30 ml !
Uremic frost
Dermatologic manifestations or profound azotemia that occurs when urea and other nitrogenous waste prodcuts accumulate and are excreated via sweat glands–crystallize after evaporation forming crystals on the skin, giving a frosted appearance (usually end stage)
Hematologic manifestions of CRF
Anemia r//t the decreased prodcution by the kidney of the hormone erythropoietin (decrease erythropoesis) -teach self-injections of procrit (erythropoetin) SQ -know ready to d/c when can properly give injection.
CRF labs
K+ increased, phosphate increased, Ca+ decreased, pH decreased !
Treatment of renal osteodystrophy
Calcium acetate (PhosLo) Lowers phosphate -to reat defective done development due to decreased serum Ca+
Fluid restriction for CRF
Restrict Na+ and fluids, includes all PO, IV spread over 24 hrs, 550ml during the day, 300 afternoon, 200 at night.
Nutritional threrapy for CRF
Restrict protein (40gm/day) low protein det is deficient in vitamins- replace water soluble vitamins lost in dialysis, all but ADEK (fat soluble)
Vascular Access sites for dialysis
Internal Arteriovenous Fistula (AVF) -decreased complication rate, no dressing, allows freedom Internal Arteriovenous Graft (AVG) -decreased risk fo bleeding/clothing, no dressing, allows freedom
AVF/AVG complications
Clotting/thrombosis, Steal syndrome: cold hands/fingers, numbness/tingling of giners, may resolve after 6 weeks.
AVF/AVG nursing interventions
Do not measure BP, draw blood, place an IV, or adminster injections in the extermity its in, do not life heavy objects or do anything that compresses extremity. Teach to carry stuff with opposite arm.
Hemodialysis complications
HTN (hold diuretics and antihypertensives), disequillbrium syndrome (causes nausea, confusion, restlessness, and headache, cerebral edema (confusions, alter LOC,jerking, headache), dialysis encephalopathy ( assess mental status and treat with aluminum-chelating agents)
hemodialysis nursing interventions
Assess BP, lung and heart sounds before and after, weigh beofre and after, hold meds that effect BP, hold meds that be dialyzed off (anitbiotics, water soluble vitamins). Ausculate for bruit, palpate for fistula.
Renal diet for hemodiaylsis
low protein, low Na+ ( Toast, Applecause, Rice, Greenbeans) TARG? lol
Peritoneal dialysis-procedure
1-2 L dialysis instilled (gravity fill) over 10-20 minutes, fluid dwells, drains. Aseptic technigue at all times !
Peritoneal dialysis diet
Allowed more protein in the diet because urea and protein are lost in the peritoneal bath.
S/S of Acute rejection of Kindey transplant
Swelling, tenderness at graft site
Immunosuppressive therapy drugs used:
Cyclosporine, corticosteriods, antibodies.
Infections common with immunsupressive therapy
Cytomegalovirus(most troublesome, may result in graft loss and client deth) Herpes virus-treat with acyclovir (Zovirax)
What client should be aware of post-transplant
They will be on immunosuppressants for the rest of their life!!
Clinical manifestations of BPH (benign prostatic hypertrophy)
Feeling of incomplete bladder emptying after urination, may not be noticed for a long while.
Drug therapy for BPH
5a reductase inhibitors (Proscar)-decrease prostate size, decrease level of dihydrotestosterone, 6 months for relief of symptoms, supression of adrogens(hot flashes) A-Adrenergic blockers = Tamsulosin (Flomax) - s/e: Hypotension, dizziness, fatigue (Priority nursing intervention is to assess for those s/e !
Post-op for TURP
high potential for hemorrage, continous bladder irrigation (CBI) used to keep catheter from becoming occluded by blood clots, monitor Hgb and Hct, assess for hematuria in continous drainage bad, decrease irrigation rate of flow in clotting occurs, contact DR to udate any complications.
Home care post op
oral fluids 2-3 quarts a day, avoid heavy lifting ( >10lbs), refrain from driving or intercourse, continue annual rectal exams, use a leg bad during the day if sent home with catheter.
Prostate-specific antigen (PSA)
normal is 0-4, variations can be utilized to determine between BPH and prostate CA, baseline can be utilized to determine cancer Tx, PSA may be normal in some men with prostate CA
Lab results for CKD (Chronic Kidney Disease)
Increased Potassium (K+) Decreased pH, Decreased Calcium (Ca+) Increased Creatinine Increased Phosphorus
Assesment findings during Oliguric stage of ARF?
Acidosis, Kyperkalemia, Hypertension
Most common EARLY complaint of Bladder Cancer?
Gross painless hematuria
Person has Bladder CA, theyve undergone a cystectomy,What is created, and what is expected for the first 2 days?
an Illeal Conduit is created, and mucous shreds in the Urine is expected for the first 2 days
What is the most common complaint of a male with BPH (Benign Prostatic Hyperplasia)
Frequent urination due to a feeling of incomplete bladder emptying
A male has an enlarged prostate, and a PSA level is ordered, if the PSA is increased does this guy have Prostate Cancer?
NO! PSA levels are increased due to prostate pathology but not Cancer. The only way to determine cancer is a BIOPSY
A client is being sent home with an indwelling catheter, what are some things to teach him?
Use a leg bag at night, Clean the Urethral meatus (hole) qday, try to avoid frequent movement
What test is a better indicator of renal fx (BUN or CREATININE)? and why?
Creatinine, and because urea levels are influenced by infections and fluid intake. Normal levels are 0.5-1.5!
Someone is getting an IVP (Intravenous Pyelogram) what is of most concern before the procedure?
Check for iodine sensitivity (allergy) Shellfish, shrimp, seafood, etc.
Client is to begin taking Bactrim for a UTI, how to tell him to take it?
With a full glass of H20, on an empty stomach which is an hour before or 2 hours after a meal. Oh and be sure to take the full prescription to get rid of the UTI ya nasty filthball
What is an expected finding upon assessment of someone with interstitial cystitis?
Suprapubic pain relieved by voiding (PEEIN’ their little hearts out)
Most common nsg diagnosis of renal calculi (Kidney stones)
Pain related to irritation of the stone
Most threatening complication of ATN? and WHY
Hyperkalemia (K+ above 5) and because this causes Cardiac arrythmias and this is serious
Someone taking nephrotoxic drugs to treat a previous condition develops ARF (Acute renal failure) what stage is this?
Intrarenal stage
Someone has nephrolithiasis (Kidney stones) what stage is this in ARF?
postrenal
The kidney can’t excrete ammonia, what will the pH be?
This is ARF, and person will have Metabolic acidosis, so a pH below 7.35 (low) and low HCO3 (Bi-carb)
Why is sodium bicarb the solution of choice to be given to a client with ARF?
To increase the pH of the blood, thus shifting potassium into the cells
Someone with CKD (Chronic kidney disease) how do their Calcium and Phosphorus levels look? What should the nurse exect?
Calcium and Phosphorus levels are inversely realted, so they will have a high phosphorus level and a low calcium level, nurse should watch for Chvoteks, Trousseaus, Bleeding, Arrythmias, and fractures due to the low Calcium
A client is undergoing dialysis, what drugs should be expected to avoid while being on dialysis?
Diuretics and Heart meds, theyre already losing enough fluid and electrolytes due to the dialysis
What exercise should a nurse instruct a patient to do if pt c/o incontinence?
Kegel excercises (it’ll help their sex life too)
Someone with thrombocytopenia should be instructed to avoid?
INJURY!!!!!!!!!!!
Someone with severe anemia will present with what?
confusion and tachycardia
A patient with severe anemia will have what?
Pancytopenia (EVERYTHING LOW)!!!
Someone has amenia they need to consume foods high in iron what are some examples?
Spinach and Raisins!
When administering a blood tranfusion, person develops a blood transfusion rxn, what does the nurse do?
STOP the transfusion, get another line with normal saline, call doc!
what are some nursing interventions for a patient with sickle cell anemia?
Medicate their pain, give 02, encourage fluids, encourage activity but not too much
Rivastigmine(Exelon)
- Treatment to mild to moderate AD and PD- Can be used in later stages- Inhibits AChE selectively in the cortex and the hippocampus more than in other parts of the brain.- This drug is advantageous for patients who do not respond to other anticholinergic drugs or who are in the later stages of AD- Side effects: nausea, vomiting, and dizziness- Transdermal form is effective and has fewer peripheral side effects as compared with the oral form.
tacrine(Cognex)
potential for hepatic toxicity, rarely used because of side effects
donepezil(Aricept)
– it requires only once-per-day dosing. – Enhances cholinergic function by the reversible inhibition of the hydrolysis of Ach by AChE. – Slows progression– Effective when cholinergic neurons are intact.– May produce gastrointestinal side effects by inhibiting AChE in the periphery
Glantamine (Razadyne)
- Treats mild to moderate AD- It is a reversible inhibitor for AChE- It increases the availability of ACh; affects nicotinic cholinergic receptors in such a way that AChE inhibition can theoretically be enhanced- Shown to decrease agitation and to increase cognition- Twice daily dosing
Memantine (Namanda)
- Treats moderate to severe AD- It is an N-methyl-D-aspartate receptor antagonist that blocks the effects of excess glutamate.- Blocks the excitotoxic effects of glutamate while allowing normal glutamate neurotransmission to occur.
Kubler Ross (5 Stages)
- Denial – Shock and disbelief2. Anger – struggling with fate(Why me? Or It’s not fair!)3. Bargaining – making deals with a higher power in the hope of a cure4. Depression and despair – realizing that death is inevitable5. Acceptance – succumbing to fate with relative calmness
Stages of Grief
- Avoidance (numbing and blunting)2. Confrontation (disorganization and despair)3. Reestablishment (reorganization and recovery)
Chronic Sorrow
- a form of grief that often includes characteristics of other forms of grief but that differs with regard to several essential aspects.- 1st chronic sorrow is a response to ongoing loss; 2nd persons who are experiencing chronic sorrow seldom experience disability- Who would be at risk? Parents with children with mental disabilities, schizophrenia, or other chronic illness; spouses of persons with long term chronic illnesses, such as multiple sclerosis alcoholism, or AD; and persons with similar disorders
Primary (Irreversable) Dementia
Alzeimer’s Disease, Vascular Dementia, Picks Disease, Huntington’s DiseaseParkinson’s Dementia, Creutzfeidt-Jakob disease
Dementia: Reversible (secondary)
Delirium, Depression, Amnestic disorders, Tumors, Infection, Trauma, Some cerebral emboli
Recent memory loss but keeps long term memory
Stage 1: Mild (2-4 years)
- Patients have problems naming common items, they repeat things, and they lose things easily, and they get lost frequently.
Stage 1: Mild (2-4 years)
Inability to find words and the use of inappropriate words
Stage 1: Mild (2-4 years)
Neologism – invented and meaningless words
Stage 1: Mild (2-4 years)
Show signs of personality changes
Stage 1: Mild (2-4 years)
They are self awareness of loss that many patients suffer profound depression
Stage 1: Mild (2-4 years)
Intellectual decline continues to increase and includes amnesia, disorientation, apriaxia, aphasia, and depression
Stage 2: Moderate (2-10 years)
Lead to the loss of the ability to care for oneself
Stage 2: Moderate (2-10 years)
Difficulty making decision as a result of decreased concentration
Stage 2: Moderate (2-10 years)
Lack the cognitive skills to make appropriate judgments
Stage 2: Moderate (2-10 years)
Develop delusion that are paranoid in nature
Stage 2: Moderate (2-10 years)
Both short- and long-term memory are affected
Stage 2: Moderate (2-10 years)
Perseveration
Stage 2: Moderate (2-10 years)
Sundowning
Stage 2: Moderate (2-10 years)
Sleep Disturbance
Stage 2: Moderate (2-10 years)
Catastrophic reactions: A sudden or gradual negative change in behavior caused by the inability to understand and cope with environmental stimuli. Reach excessively, out of proportion to the situation, or panic and act out violently.
Stage 2: Moderate (2-10 years)
What is a Catastrophic reaction?
: A sudden or gradual negative change in behavior caused by the inability to understand and cope with environmental stimuli. Reach excessively, out of proportion to the situation, or panic and act out violently.
What is sundowning?
- Increased negative behavioral disturbance such as irritation or confusion occurring during the afternoon or eveninga
What is perseveration?
Repetitive verbalizations or motions
JAMCO
JudgmentAffectMemoryCognitionOrientation
unable to perform motor activities despite intact function
Apraxia
difficulties with object identification
Agnosia
difficulties writing things down
Agraphia
deficits in language functioning
Aphasia
Etiology of AD
Pathological: Cerebral atrophy, neuritic plaques, neurofibrillary tanglesGenetic: chromosome 19, Apolipoprotein E geneNongeneitc: inflammation, decreased folic acid, decreased estrogenNeurochemical: decreased acetylcholine ACh
ACT – crisis intervention approach
• Assess immediate needs and treats• Connect to support groups, social services, disaster relief, etc.• Trauma treatment plans, treatment of acute stress reactions and trauma recovery groups
Psychological stages after a disaster
- Heroic Phase2. Honeymoon Phase (1 week to 3 to 6 months)3. Disillusionment phase (2 months to 2 to 3 years)4. Reconstruction phase (2 months to 1 to 2 years)
real events that threaten physical health or loss
External (Situational)
May not be obvious to someone else: feelings of betrayal or fear, threat to a belief
Internal (Subjective)
(phase of life): e.g. Midlife crisis
Maturational • Old coping skills no longer helpful• Ineffective defense mechanisms until new coping skills develop• Adventitious (disaster): natural or man-made disaster
Unplanned and accidental• Natural disaster (hurricane, car accident), Crime of violence (murder, rape)
Adventitious
Cycle of Violence Phase 1: Tension Building
• Major battering usually does not occur. Perpetrator establishes complete control usually by inflection of emotional abuse
Cycle of Violence Phase 2: Acute Battering
• Tension can no longer be contained and acute battering occurs
Cycle of Violence Phase 3: Honeymoon Stage
• Perpetrator begs for forgiveness, promises never to do it again. Appears to have remorse then tension starts to build and cycle is repeated
Emergency escape plan
• A plan for a fast escape when violence occurs• Identify signs of escalation of violence and designate this as the time to leave• Include in plan a destination and a way to get there• Have the hotline referral telephone number of a shelter or safe house and a contact person• Keep important papers hidden in a place they can be obtained easily
Who is at risk for spousal abuse?
• Spousal: Legal marriage, pregnant, partner who tries to leave the relationship
Who is at risk for child abuse?
under the age of 3, kids who are looked as to be different, child of an unwanted pregnancy, premature kid, child who has a prolonged illness
Atypical medication for eating disorders - Cause weight gain
Zyprexa
SSRI medication for eating disorders
Prozac
Patients cannot use or understand words
Stage 3: Severe (1-3 years)
Cannot recognize themselves or others
Stage 3: Severe (1-3 years)
No longer care for themselves
Stage 3: Severe (1-3 years)
Totally dependent on others
Stage 3: Severe (1-3 years)
Lose weight and bladder control
Stage 3: Severe (1-3 years)
Develop secondary illnesses and conditions
Stage 3: Severe (1-3 years)
Immobility may lead to pneumonia, UTI, and development of pressure ulcers
Stage 3: Severe (1-3 years)
Progressive loss of neurons leads to the loss of the ability to swallow which may lead to aspiration pneumonia
Stage 3: Severe (1-3 years)
Most common symptom in early bladder cancer
Gross, painless hematuria (chronic or intermittent). Confirmed by BIOPSY.
post op care for total laryngectomy
Monitor airway patency, VS, hemodynamic status, and comfrot level. Take VS hourly for first 24 hrs, and then every 2 hrs or according to agency policy until the patient is stable. Once off CCU monitor ever 4 hours.
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.
Major side effect of INH (tb drug)
B6 depletion
When giving a diuretic what do you always check first?
BP!!!!!!!!!!!
ATN manifestations
Fluid overload (S3, JVD), decrease urine output or not at all, hyperkalemia, cardiac dysrythmias (life threatening)-abnormally wide QRS complex
K+ excess in oliguric phase
Cardiac muscle is inolerant or acute increase in K+, hyperkalemia creates an elevated T wave, hypokalemia creates and elevated U wave.
How does Verapamil work?
Verapamil relaxes the smooth muscle of the heart
Risk factors for pylenephritis
past medical Hx of chronic renal calculi (kidney stones)
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!
Sickle Cell patho
When exposed to decreased O2 (being hig up in an airplane) – RBCs sickle, become rigid, fragile and sticky.
‘what will you see with hypocalemia and hyperphosphatemia ?
Trousseau’s sign, cardiac arrhythmias, prolonged clotthing time (uremia shortens lifespan of plts, Ca+ important for clottinh factor cascade), fractures.
AVF/AVG complications
Clotting/thrombosis, Steal syndrome: cold hands/fingers, numbness/tingling of giners, may resolve after 6 weeks.
What are some signs and symptoms of DIGOXIN TOXICITY?
Halo’s in vision, Color changes in vision, Headache, Lethargy, Nausea, Diarrhea, Bradycardia, Dysrhythmia, Irritable.
Lab values for ARF
K+ and phos increase, Ca+ and ph decrease Bun and creatinine increase
Normal Bleeding time?
1-6 minutes
Blood administration
Assess the clients lungs before and after, check for allergies, obtain a signed consent, 19 gauage or larger needle, isotonic solution(NS) in one and blood via the other spike, positively ID the donor blood and recipeient ( 2 RNs), check for storage lesions (old blood, temp of blood), takes 2-4 hours.
intermittent claudication
arterial insufficiency, due to lactic acid accumulation build up in muscle, usually can feel it upon activity and subsides after 10 min
Early s/s of diabetes
3 p’s polydipsia polyuria polyphagia. Classic sign is blurred vision, neuropathy also
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.
(? 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
What is responsible for Coagulation of the blood?
Platelets
Things that decrease preload
-Elevating HOB -Nitrates (vasodialators) -Morphine
Nursing Responsibility for a Bone Marrow Biopsy
Get consent, Pre-emptive medication (Conscious sedation) Versed, & Morphine, Pressure dressing after (hold for 15 min) do frequent site checks, Assess the site for bleeding (underneath them) Possible Complications: Infections and bleeding
EKG changes associated with coronary ischemia
T wave inversion and ST depression
What does this EKG show?
Normal sinus Rhythm with a large PVC
Acute interventions for ARF
I & O, daily weights, encourage cough and deep breathing, insentive spirometer
S/S of Peripheral Artery Disease (PAD)
-withered calf muscle -hair loss -thick toe nails -shiny, tight skin -painful ulcers in the toe that are black and do NOT bleed. -Blood clots can form in some cases(STARVATION)
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.
accucheck coverage what type and why?
rapid or short acting b/c it’s easier to treat hypoglycemic rxn’s with these 2, go by sliding scale
post op care for client after radical prostatectomy?
remain on bed rest, and nothing per rectum.
What is this
V-Tach or Tombstone.
Ventricular Fibrillation
No cardiac output;; patient is technically dead Treatment: D-fib (shock) to try to get some kind of rhthym to work with
Drug therapy for BPH
5a reductase inhibitors (Proscar)-decrease prostate size, decrease level of dihydrotestosterone, 6 months for relief of symptoms, supression of adrogens(hot flashes) A-Adrenergic blockers = Tamsulosin (Flomax) - s/e: Hypotension, dizziness, fatigue (Priority nursing intervention is to assess for those s/e !
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
Intrarenal (ARF) results from conditions that cause direct damage to the renal tissue, some causes are:
Infection, Drugs (mutiple nephrotoxic antibotics: genotamcyin, all mycins), infiltrating tumors, IVP contrast, prolonged prerenal ischemia, nephrotoxic injury, acute glomerulonephritis, toxemia of pregnancy, malignant HTN, systemic lupus erthematosus, interstitial nephrtits, Acute Tubular Necrosis (ATN)
if you believe someone is hypoglycemic but you don’t have an accucheck???
treat as hypoglycemic until proven otherwise, give 6-8 oz of regular pop for hypoglycemia, give hard candy 6-10 pieces, give a complex carb or cheese or protein
Priority of care for hyperkalemia
Management ! K+ (3.5-5.0), IV sodium bicarb to decrease blood ph, causing movement of K+ for the extracellular fluid into the cells in exchange for hydrogen ions.
CHF causes
Arthersclerosis, HTN, MI
Vascular Access sites for dialysis
Internal Arteriovenous Fistula (AVF) -decreased complication rate, no dressing, allows freedom Internal Arteriovenous Graft (AVG) -decreased risk fo bleeding/clothing, no dressing, allows freedom
What is the normal platelet count?
150000 to 400000
c-reactive protein
shows up months before an MI, can possibly prevent an MI, lower # is better, measures the inflamm. Response
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
nutritonal therapy after stone removal
increase fluids to 3,000 ml/d
