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Nurs 107 > Test 1 > Flashcards

Test 1 Flashcards

1
Q

The hallmark of systolic heart failure is

A

Low ejection fraction and ventricular dilation.

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2
Q

What medical disorder is most likely causing the client to have jugular vein distention?

A

Right sided heart failure

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3
Q

What is the antidote for digoxin?

A

Digibind
Digoxin Immune FAB

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4
Q

What are symptoms of digoxin toxicity?

A

Digoxin toxicity may cause visual disturbances (e.g., flickering flashes of light, colored or halo vision, photophobia, blurring, diplopia, and scotomata), central nervous system abnormalities (e.g., headache, fatigue, lethargy, depression, irritability and, if profound, seizures, delusions, hallucinations, and memory loss), and cardiovascular abnormalities (e.g., abnormal heart rate, arrhythmias). Digoxin toxicity doesn’t cause taste and smell alterations.

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5
Q

Why does tachycardia increase risk of myocardial ischemia?

A

Because the heart is perfused during diastole- which makes sense- when it’s squeezing it can’t let blood in- If it is squeezing very fast, there may not be enough time for the blood to make it in before the heart squeezes again. This is even more true if someone has CAD and the pipes are clogged.

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6
Q

What 5 physiological traits of the heart (nodal and purkinje cells) make synchronization happen?

  • He did talk about this, which surprises me. I wouldn’t have expected it to be on the test.
A

Heart has automaticity, excitability, conductivity, contractility, & rhythmicity​

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7
Q

In what order does the elctrical impulse go through the heart?

A

SA node to AV node to bundle of His to purkinje

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8
Q

What is the standard rate for the sa node to fire?
av?
ventricular pacemaker cells?

*Not on test

A

sa- 60-100
av - 40-60
ventricular - 30-40

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9
Q

What is cardiac output?
How is it calculated?

*prob not on test

A

Total amount of blood the ventricle moves, in l per minute

= # of heartbeats per minute times stroke volume

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10
Q

What does an ankle brachial index of .45 indicate?

  • Prob not on test
A

Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.

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11
Q

What is the hallmark symptom of PAD?

A

Intermittent claudication

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11
Q

What are the difference in symptoms between arterial and venous insufficiency?

A

A diminished or absent pulse is a characteristic of arterial insufficiency. Aterial insufficiency looks pale, and is cold. Over time, also hairless, and shiny skin.

Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses. Looks ruddy and swollen.

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11
Q

When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of:

A

1.5 to 2.5 times the baseline control. A normal aPTT level is 21 to 35 seconds. A reading of more than 100 seconds indicates a significant risk of hemorrhage.

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12
Q

What are the uses of protamine sulfate, vitamin k, and Thrombin?

A

Protamine sulfate is the antidote specific to heparin. Phytonadione (vitamin K) is the antidote specific to oral anticoagulants such as warfarin. (Heparin isn’t given orally.) Thrombin is a hemostatic agent used to control local bleeding.

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13
Q

Is heparin given orally?
What about warfarin?

A

No
Yes

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14
Q

What is a reticulocyte?

A

An immature red blood cell

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15
Q

What is an erythrocyte?

A

A red blood cell

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16
Q

What is hemostasis?

A

The process of the body stopping bleeding, either from booboos or intact blood vessels.

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17
Q

What is the difference between primary and secondary hemostasis?

*prob not on test

A

Primary is the constriction of the blood vessel, triggered by the damaged cells of the vessel

Secondary is platelets/fibrin

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18
Q

A focused hematological assessment includes attention to what?

A

*Extreme fatigue (the most common symptom of hematologic disorders)
*Delayed clotting of blood
*Easy or deep bruising
*Abnormal bleeding (e.g., frequent nosebleeds)
*Abdominal pain (hemochromatosis) or joint pain (sickle cell disease)
*Review blood cell counts for abnormalities.
*Assess for presence of illness despite low risk for the illness (e.g., a young adult with a blood clot)
*Ask about family history, medications and herbal supplements

Look at skin, oral cavity, lymph nodes, and spleen

Look at labs: CBC, ptt, pt inr, hgb, hct

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19
Q

What is Hct a measure of, and normal values?

A

How much of the blood is red blood cells.

Males - 42-52
Females - 36-48

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20
Q

Why are lab values of neutrophils important?
What are normal values?

A

Neutrophils, the most abundant type of white blood cell, are the first of the WBCs to respond to infection or inflammation.

The normal value is 3,000 to 7,000/cmm (males) and 1,800 to 7,700/cmm (females).

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21
Q

What kind of cell is responsible for cellular immunity?

For Humoral immunity?

What cells make histamine?

*Don’t need for test

A

T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity.

B lymphocytes are responsible for humoral immunity.

Some B cells grow into plasma cells, and secrete immunoglobulin.

Mast cells and basophils make histamine.

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22
Q

Elevated reticulocytes happen in response to what?

A

Bleeding

23
Q

A left band shift means you should look for what?

A

Infection

24
Q

The three classifications of causes of anemia are:

A

hypoproliferative - didn’t make enough cells

hemolytic anemia - the cells got destroyed

bleeding anemia - you lost the cells you made

25
Q

Symptoms of garden variety anemia include:

Suspect megaloblastic anemia with:

A

pallor, fatigue, weakness, progressing to dyspnea, elevated heart rate
subtle signs are pica, jimmy legs, angular chelitis

iron deficiency anemia: smooth red tongue

megaloblastic anemia: Jaundice, sore red tongue, and brittle spooned nails

26
Q

Food sources of iron include

A

Food sources rich in iron include organ meats (e.g., beef or calf’s liver, chicken liver), other meats, beans (e.g., pinto, black, and garbanzo beans), leafy green vegetables, raisins, and molasses. Eating iron-rich foods with a source of vitamin C (e.g., orange juice) improves iron absorption.

Antacids and dairy products should be avoided with iron as they can greatly diminish its absorption.

27
Q

Suspect anemia in patients with CKD when their GFR is lower than what?
Their creatinine is above what?

Could be treated with what?

A

30
3 mg/100 mL.

Anemia caused by kidney disease is treated with iron and erythropoietin-stimulating agents (ESAs). I

28
Q

What do anemias of inflammation usually look like?

A

Normocytic, normochromic, mild-moderate with hgb above 9, low erythropoietin, not progressive and may not require treatment

Results from age, chronic or critical illness

29
Q

What is aplastic anemia?

A

The t-cells attack the bone marrow. It can’t make erythrocytes, neutropenia and thrombocytopenia (pancytopenia) result

30
Q

What do hemolytic anemia labs look like?

A

Elevated reticulocytes, increased unconjugated bilirubin, decreased haptoglobin

31
Q

What is the difference between conjugated and unconjugated bilirubin?

*don’t need to know for test

A

Conjugated means the liver has facilitated the process, and bound the bilirubin to glucoronic acid. Unconjugated means a blood cell popped, and the bilirubin is just floating around without an escort. Unconjugated means something bad is happening to blood faster than the liver can deal, and is a bad sign. Conjugated is just regular life, a part of poopin.

32
Q

What is thalessemia?

A

A disorder of some of the hemoglobin molecules- akin to sickle cell disease. Sickle cell means you make faulty hemoglobin, HgbS. Thalessemia means you aren’t making as much of parts of the Hgb at all- alpha bits or beta bits, and shit goes sideways. You get microcytic, hypochromic RBCs.

33
Q

What is hydroxyurea?

A

It pushes a body to make more hgbF. Works for sicklers and thalessemia

34
Q

A distinguishing feature of a hemolytic reaction versus sickle cell crisis is :

A

that the patient becomes more anemic after the transfusion than before.

35
Q

What leads to pernicious/megaloblastic anemia?

A

Megaloblastic anemia is caused by low folate or low B12
Pernicous anemia is low B12

Caused by: Resection of the distal ileum results in the impaired absorption of vitamin B12 / Removal of Stomach tissue impairs production of intrinsic factor

Alcoholism, old age, genetics can also affect

36
Q

Your patient’s hgb is below 7.5. What are their symptoms?

A

Fatigue
Shortness of breath with activity
Pallor
Cheilosis
Smooth, red tongue
Pica
Restless Leg Syndrome

37
Q

What is the ejection fraction?
What is a normal EF?

A

Ejection Fraction Percent of end diastolic volume ejected with each heart beat (left ventricle)​

Normal EF 55%-65%​

38
Q

What is preload and afterload?

A

Preload: degree of stretch of cardiac muscle fibers at end of diastole​

Afterload: resistance to ejection of blood from ventricle​

39
Q

Things that increase cardiac contractility are:
Things that decrease cardiac contractility are

A

Increased by activation of the sympathetic nervous system, catecholamine, meds

Decreased by Hypoxemia, acidosis, meds

40
Q

In general, old age does what to hearts/circulatory system?

A

It stiffens (arteriosclerosis), slows, and becomes less responsive.
The heart tissue becomes more fibrous, meaning the pacemaker cells can’t do their job as well, and there aren’t as many of them. The heart is less squishy, so systolic BP creeps up, dyastolic not as much, meaning widening pulse pressures. Baroreceptors don’t work as well, or as fast, so exercise tolerance goes down, recovery time needed goes up. Sometimes the pulse is visible above right clavicle - things are literally saggin and stretching, including the aorta. Valves get stiffer too- murmurs and leaks become a thing.

41
Q

Where is the best place to hear the mitral valve?
Tricupsid?
Aorta?
Pulmonic valve?
Murmurs and extra heart sounds?

Not sure this is going to be on the test but I wouldn’t put it past them.

A

left midclavicular- 5th intercostal
left next to sternum, 4th intercostal
right next to sternum, 2nd intercostal
left next to sternum, 2nd intercostal
right next to sternum, 3rd intercostal (Erb’s point)

42
Q

What things are you looking for in a cardiac assessment?

A

Overall appearance- do they look tired, short of breath, anxious,
BP - orthostatic, widened pulse pressure
Pulses- rhythm, rate, amplitude, equal bilaterally and compare radial to pedal- observe jugular vein
Auscultation - Rhythm, rate, extra sounds
Lungs - Crackles? Hemoptysis?
Weight - + 2lbs in a day, + 5lbs in a week
Skin/nails - Xanthelasma (yellowfat blobs on eyelids), Ulcers? Missing hair on legs? Shiny leg skin? clubbing? blue , ruddy, or swollen legs/fingers?, weird nails?

43
Q

What labs do you watch for Warfarin?
What should values be?

A

PT and INR
PT should be 11-13
INR should be 2 - 3.5 to be therapeutic, normal is .8 - 1.2

44
Q

What lab is run to check for heart failure?

A

BNP - released by ventricles in response to increased pressure, other things too, but generally a value of >100 pg/mL is giving HF

45
Q

What labs do we run to predict risk of heart disease?

A

Lipids (atherosclerosis) , Homocysteine (chance of clotting), BNP (heart failure? or stressed heart), CRP (inflammation), Lytes (risk of arrythmia), and coags (risk for clots or bleeds if too low or high, mostly a measure of whether current heart meds are working)

46
Q

What labs do we run if we suspect MI?

A

CK, CK-MB (enzymes)​
Myoglobin (protein)​
Troponin T and I (protein)​

47
Q

What important education do we give to a patient on continuous EKG?

A

The monitor doesn’t detect shortness of breath, chest pain, or other ACS symptoms. Thus, patients are instructed to report new or worsening symptoms immediately.

48
Q

After any heart procedure, including cath- we basically do what?

A
  • check vitals every 15 minutes for an hour, then slowly decrease
  • Monitor for bleeding from surgical sites
  • Assess peripheral pulses - temperature, color, and capillary refill of affected extremity, like, if they went in right femoral artery, assess right leg. etc…
  • Bed rest 2-6 hours
  • Are they peeing?
  • Monitor vital signs for changes in temperature, pulse, &/or BP​ - arrhythmias? Chest pain?
49
Q

How do you prep and recover patient for transesophageal ultrasound?

A

Make sure administer sedation before- ​

Npo 6 hours before, Don’t resume feeding or drinking till you check the gag reflex after (in real world offer a small drink of water and see how they handle it ) 2 hours after​

​

50
Q

Atherosclerosis and arteriosclerosis affect different sized bloodvessels. Which goes to to big one and which to smaller ones?

A

Arterio goes with smaller ones, Athero goes with bigger ones.

51
Q

How to prevent atherosclerosis?

A

Exercise, Quit smoking, reduce stress, lower fats, reduce sodium/manage BP, lower homocysteine manage blood sugar, the yuzj.

52
Q

How to care for peripheral arterial problems?

How to care for peripheral venous problems?

A

Arteries need help, so we dangle or put the affected part below the heart. Warmth helps, nicotine & stress hurts.

Veins need help, so we elevate the affected parts to get the blood back to the heart.

For both- inspect feet- sensation may be diminished, and be careful with hot liquids like bathwater or coffee-

53
Q

What is the most common cause of aneurysms?

A

Atherosclerosis

54
Q

What are the signs of aneurysm?

How is it treated?

A

There might not be any. If there are, pain is the biggest, but a throbbing/pulsation/bruit can sometimes be assessed where there shouldn’t be one, like near kidneys or in abdomen.

If intact, medically with antuhypertensive meds, if symptomatic may move to surgery, if ruptured probably with a funeral.

55
Q

What nursing intervention can prevent DVTs and takes no special equipment?

A

walking 5-10 minutes every hour.

56
Q
A

Nurs 107 (3 decks)

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