Test 1 Flashcards
What will right sided heart failure effect?
The body. S&S include: Ascites JVD Weight gain Peripheral edema Oliguria
What will left sided heart failure effect?
The lungs. S&S include: Crackles and wheezes Cough Dyspnea Nasal flaring Orthopnea Retractions Tachypnea
What heart rate does the SA node regulate?
60-100
What is a cardiac cycle?
One heartbeat
What does a P wave on an EKG represent?
The contraction of the atrium
The PR interval should be between what time?
0.12-0.2 seconds
What is the QRS complex representing the heart doing?
Contracting the ventricles
Where should the ST segment be?
On the isoelectric line
What is ST segment elevation indicative of?
A heart attack
What is ST segment depression indicative of?
Cardiac ischemia
What is occurring during the T wave?
The ventricles are relaxing. Also known as repolarization
What occurs to the atrium during the QRS complex?
Relaxation and repolarization
What are seven things that should be a normal finding on an EKG strip?
HR is 60-100 R-R interval is evenly and regularly spaced P wave is upright PR interval is 0.12-0.20 seconds QRS complex is <0.12 seconds ST segment is on the isoelectric line T wave is upright
What is an intervention for an ST segment being askew?
Oxygen. An ST wave being off the isoelectric line could indicate cardiac ischemia or a heart attack. administering oxygen would be a primary intervention to try and correct the problem.
What will present on an EKG with an atrial flutter?
An extra P wave. Caused by and ectopic focus that fires off an electrical impulse that disrupts the flow of electricity from the SA to the AV node. T waves will not be present due to the P wave hiding it.
What will present on an EKG with atrial fibrillation?
Many atrial impulses yet no true P waves. QRS complex will be present. There will be many points in the heart where electrical impulses will bounce around until finally reaching the AV node to cause ventricular contraction.
What is supraventricular tachycardia?
HR will be 150-220 BPM. The patient may have a low ejection fraction and distal pulses may not be present due to low cardiac output. Adenosine or adenocard is used to treat.
Adenosine or adenocard
Used to treat supraventricular tachycardia. Begins working in 6 seconds. Completely stops the heart and resets the heart rhythm. Push 6 MG as fast as possible undiluted followed by normal saline; increase dose if needed.
What is the isoelectric line?
The isoelectric line represents zero amplitude within the heart.
What route does electricity flow through the heart to signal contraction?
An electrical impulse is first sent to the SA node which is located in the right atrium signaling it to contract. The electrical impulse is then sent onto the AV node which delays the signal, giving the atrium the time to fully contract. After that the signal is sent into the Bundle of His in which at that point the hearts ventricles contract. Finally, the electrical impulses are sent into the Purkinje fibers where the electrical impulses are sent into the endocardium.
What medication is given in order to prevent clotting in atrial fibrillation and flutters.
Coumadin (warfarin) is given in order to prevent clotting.
What is premature ventricular contraction (PVC)?
A PVC is a condition where your ventricles contract forming an extra heart beat. On an EKG strip, this will appear as an extra QRS complex before a regular one.
What is ventricular tachycardia (V-Tach)?
Ventricular tachycardia is a condition in which abnormal electrical signals in the ventricles cause the heart to beat faster than normal, usually 100 or more beats a minute, out of sync with the upper chambers. This will present on a EKG strip as an evenly spaced wave like rhythm with no discernable P wave.
What is ventricular fibrillation (V-Fib)?
Ventricular fibrillation is where the ventricles of the heart quiver in an abnormal and unsynchronized way. This will present on a EKG strip seemingly as random scribbles with no discernable waves of any kind.
What is an ejection fraction? What are the ranges for ejection fractions? What is used to measure an ejection fraction?
An ejection fraction is a measurement of the amount of blood that is outed from the heart upon each contraction. 55% or above output is considered a normal ejection fraction. blew 54-50% is considered borderline. 49% and below is considered inadequate. To measure the ejection fraction, an echocardiogram is performed.
What is cardiac ischemia?
Cardiac ischemia is caused by a lack of oxygen to the heart. This is represented on an EKG strip by a depressed ST segment.
What is a dysthymia?
An abnormal heart beat.
What is a systole?
The phase of the heartbeat where the heart muscle contracts and pumps blood
What is telemetry?
Cardiac telemetry is the continuous monitoring of the heart and its rhythms.
What is the average weight gain for pregnancy?
25-35 pounds
What does gravida mean?
The number of pregnancies
What does para mean?
Para is a birth after 20 weeks of gestation
What is TPAL?
TPAL stands for Term, Preterm, Abortion, and Living
This is the state of the fetus after delivery
T= >or = to 37 weeks
P=>or= 20-36 weeks
A= <20 weeks
L= Is when the child is actually delivered
Why is a CBC test done during pregnancy?
CBC tests are done to determine a baseline as well as test for infection and clotting factors
What is a VDLR test? Why is a VDRL done during pregnancy?
VDRL tests are done to test for syphilis. Non reactive means the patient is clear of syphilis. If a patient has syphilis the child can contract it as well.
Why is a rubella test done during pregnancy?
To test if a person of childbearing age is immune to rubella. If not the patient will need a booster shot AFTER pregnancy
Why is Hepatitis B test done?
Check immunity to Hep B
Why is an HIV test done?
To test for HIV in a mother. If HIV is detected, antiviral medications can be given and the chances of transmission to the fetus is diminished. HIV positive mothers must not breast feed
Why is a blood type and Rh factor test done?
Incompatible blood types can abort the fetus and cause problems with the pregnancy. Rogham is given during the pregnancy as well as after if the child is found to have an incompatible blood type
Why is a pap smear done?
To screen the patient for uterine associated problems
Why is a GBS culture done? What would be used to treat the associated problem?
To screen for strep. Strep is part of the natural flora of a woman’s body but can cause problems with the child after birth. Antibiotics are used to treat the strep
What should the caloric intake be increased to during pregnancy?
300-500 calories should be added to the diet
What is pseudo anemic pregnancy?
During a pregnancy, fluid volume increases which dilutes the blood, decreasing the RBC count
What is a fundal height test?
Used to measure the Childs growth. It is measured from the top of the mother’s uterus to the top of the mother’s pubic symphysis.
what is IUGR?
Intra-uterine growth restriction. A symmetrical IUGR is better than an asymmetrical IUGR as an asymmetrical IUGR can lead to bigger problems
Why is a blood glucose test done on pregnant patients?
To check for gestational diabetes. This test is performed between 24-28 weeks
What should the fundal height be in relation to the weeks of pregnancy?
The fundal height should equal the gestational weeks in centimeters
What is a nonstress test during pregnancy?
Monitors the fetal heart rate and should increase the heartrate at 15x15 in 15 to 20 mins
how do you calculate a due date after the last normal minstrel cycle?
Subtract 3 months and add seven days. change the year as appropriate
What age is considered to have high risk pregnancies? What are risk factors associated with high risk pregnancies?
After the age of 35. When the patient is high risk the child has a higher chance of developing disorders such as down syndrome or going into preterm labor
What would be a follow-up for a positive AFP test?
Either use a nuchal translucency test or an amniocenteses test
What is a common feeling when a patient is dilating?
Back pain and minstrel like pain that is intermittent
What are the stages of delivery?
First stage which is cervical dilation with onset of contractions
Second stage is where dilation continues and the child is delivered
How do you monitor contractions?
Palpation- nurse uses touch to determine strength
External- used most frequently. Called a toco which measures frequency and duration
What are the levels of fetal heart rate variability (FHR variability)?
Absent variability- amplitude range undetectable
Minimal- <5 BPM
Moderate- 6-25 BPM
Marked- >25 BPM
What are FHR decels?
Early- The heart rate will decrease with the contraction
Variable- Will appear as a V shaped line near the contraction
Late- Heart rate will be out of shape with the contraction
What is occurring during the various FHR decels?
Variable- Cord is being compressed
Early- Head is being compressed
Accels- The oxygen is fine, this is preferred
Late- There is placental insufficiency
What should be assessed at admission of a pregnant patient?
Gestational age Doctor Age and other risk factors Prenatal lab data Allergies Expectations during labor Feeding methods Weight before and during pregnancy Pregnancy history and problems Prenatal care Cultural/religious beliefs Preferred pain control method Support system Suspect domestic abuse Functional needs met Adolescent mother Screen for PIH Medication Drug use Placental location
When should you give narcotics to a pregnant patient?
After a cervical examination. Any narcotics given to the mother are also given to the baby
What are some side effects of an epidural?
Blood pressure will drop- Give fluid bolus
Bleeding if platelet count is low
How would they test if the epidural is not in the vascular system?
Medication with a low dose of epinephrine is administered and if the heart rate increases then the epidural must be replaced
What should be noted when the water has been broken?
Time
Amount
Color an consistency
What is the normal EBL (Estimated blood loss)?
Up to 500 for vaginal delivery and 1000 for C-Section. Over either is considered excessive
What should you assess during postpartum period?
Breast Uterus Bowel Bladder Lochia Episiotomy Homans sign Emotional status
How is blood loss calculated after birth?
Bloody items are weighed and compared to their dried counterparts. 1 gram is equal to 1 ml of blood. The dry weight is then subtracted from the bloodied item and the sum is the amount lost
What should be taught at discharge of a postpartum patient?
DVT prevention Pelvic muscle tone Nutrition Breastfeeding and Not Breastfeeding S&S of Complication Birth Control
What should the threshold be for an infant as far as glucose levels?
45mg/dl or above and within reason
What are some signs and symptoms of hypoglycemia in infants?
Breathing that stops for short periods of time Blue or purple skin color Low body temperature Problems eating well Seizures Sluggish or drowsy behavior
Is it uncommon to see an elevated WBC count after giving birth?
No. WBC counts can be elevated into the high teens and low twenties.
What are the normal vital signs of a neonate?
HR: 85-190
Temp: 98.6 F
R: 30-60
BP 67-84/31-45
What is Succedaneum?
edema that resolves in a few days and crosses the midline
What is Cephalohematoma?
takes several weeks to resolve, subperiosteally collection of blood that does not cross suture lines
What are the three stages of fetal development?
Germinal stage- first two weeks after conception
Embryonic period- the third through eight week of pregnancy
Fetal period- ninth week until birth
What is the function of a placenta?
A placenta provides oxygen and nutrients to a baby in the womb and removes waste products
What is the function of the umbilical cord?
The umbilical cord carries oxygenated blood and nutrients to the baby as well as taking away deoxygenated blood and waste. The umbilical cord is protected by a clear membrane called Wharton’s jelly
What is the function of the amniotic sac and the surrounding fluids?
The amniotic sac acts as a cushion against impact as well as regulating temperature and lubricant for the Childs body
What circulatory functions are different in a fetus than in a delivered child?
Ducts in a fetus do not allow for blood to enter the lungs and liver. These ducts are opened once born
What are three medications given to a child immediately after birth?
Vitamin K
Hep B vaccine
Erythromycin eye gel
What is the diagonal conjugate?
The distance from the undersurface of the pubic arch to sacral promontory
What is occiput?
Occiput is the relation of the back of the childs head to the mothers pelvis
The child can be occiput anterior, posterior, lateral, and transverse
What is the true conjugate?
The shortest diameter which the head must pass in descending the super straight
What measurements should be taken when the child is first born?
The circumference of the head as well as chest should be taken. A premature baby will also have their stomach circumference taken. The length and weight of the child are also recorded
What is a meconium?
Meconium is the earliest stool of an infant. The meconium consists of materials ingested while in utero
What presents with Acrocyanosis?
Hands and feet turn blue on a newborn infant. This is caused by small blood vessel contraction
What is a harlequin sign?
Momentary red color that presents on a newborn. Sharp contrast at midline
What is the cause of infant jaundice? How is it treated?
Infant jaundice is caused by a buildup of bilirubin. The jaundice is treated with UV light which helps to break down the bilirubin
What is the vernix?
Vernix is a waxy or cheese like substance which coats new born babies
What is lanugo?
Fine soft hair that covers a newborn baby. Premature babies will have more as they did not have time to shed the air naturally
What is the let down reflex?
The let down reflex is a reflex that makes milk available for the baby to suckle. The let down reflex is triggered by oxytocin
What is APGAR scoring? How often is it done and how is it scored?
The APGAR is a test that checks a babies HR, muscle tone, appearance, and breathing. The test is performed 1-5 mins after birth. Scores of 7-10 are good, 4-6 needs mild resuscitative efforts, and 0-3 elicits a need for severe resuscitation
What are the normal vital signs of a neonate?
HR: 85-190
Temp:98.6
RR: 30-60
BP: 67-84/31-45
Why would you delay cord clamping after birth? What would you observe after cutting the cord?
Delaying cord clamping would increase hemoglobin levels at birth as well as increase iron scores. Unfortunately, this increases the risk of jaundice though most hospitals are prepared for this outcome. After cutting the cord two arteries and one vein should be observed.
What safety measure is done immediately after delivery?
The child is dried with warm towels and is given skin to skin contact with the mother. This is done to observe APGAR score and preserve heat
What is transient tachypnea?
This occurs when a child retains lung fluids due to impaired clearance mechanisms. This is mostly seen in early or late preterm babies
How would a nurse assess for congenital hip dysplasia?
The nurse would assess using the ortolani sign which produces a click as the leg is rotated
What is tonic neck?
Tonic neck is a reflex found in newborns that occurs when the child turns their head to either side that the corresponding limbs extend. The pose resembles a fencers pose and is also called the “fencers reflex”. The reflex usually disappears in four months
What is palmar grasp reflex?
The palmar grasp reflex is a reflex that makes an infants hand curl around an object placed into their hand
What is Moro in an infant?
Moro is when a child extends their arms and legs while in a dropping motion. This will disappear after 3-6 months
What is rooting?
When a child turns and faces a stimulant while making a suckling motion
What is stepping?
Stepping is when the child is being held upright and makes a walking motion. This reflex disappears after two to three months
What are signs of respiratory distress in a newborn?
Tachypnea Nasal flaring Grunting Stridor Cyanosis Wheezing
What is the normal weight gain pattern for a newborn?
A baby should gain 5-7 ounces per week. Birth weight should double by 5 months
What is the proper method for suctioning with a bulb syringe?
The syringe should be first used on the babies mouth then on the nose and after each suction should be emptied away from the child
What are the different types of discharge after birth and when do they occur?
Lochia Rubra- First discharge. Largely consists of blood and last two to four days
Lochia Serosa- Pink or brown tinged discharge. Contains blood, mucus, and leukocytes. Occurs three to ten days after birth
Lochia Alba- discharge is no longer tinged with blood and can last four to five weeks after birth
What are some problems with urination that can occur in pregnant and postpartum women? What can be done to improve this?
Urinary incontinence can occur in both pregnant women from having the child pressing against the bladder, and in postpartum women from the vaginal muscles weakening. Pregnant women can alleviate this by urinating frequently and postpartum women can perform Kegel exercises to strengthen the vaginal muscles
What is a first degree AV block?
Consistent, prolonged PR interval. Will be > than 0.2. Found commonly in older patients and can progress into higher degrees of AV blocks
What is a second degree AV block type I?
In a second degree AV block the PR interval predictably lengthens until the QRS complex is lost. Also known as a Wenckebach or Mobitz 1. Could be caused by an inflammatory disorder in the heart.
What is a second degree AV block type II?
The QRS complex will be randomly dropped while the PR interval will be normal. Also known as a classical heart block or Mobitz 2. Can progress into third degree
What is a third degree AV block?
No relationship between P and QRS. Most patients will be unconscious during this rhythm. This condition is fatal is not treated. Also known as a complete heart block (CHB)
What is Coronary Artery Disease?
Caused by a build up of plaque. NO S&S. Progressive disease that narrows or occludes the coronary artery (atherosclerosis). Can lead to an MI. Factors that lead to CAD are obesity and lifestyle choices as well as family history, congenital defects, and hyperlipidemia. More common in white males but after 65 male and female CAD rates are equal
What should the total cholesterol level be?
Less than 200
What do “statin” drugs do?
A cholesterol medicine that raise HDL and lower LDL. Should be given before the patient goes to sleep
What is rhabdomyolysis?
A breakdown of skeletal muscle
What is angina? What are the types of angina?
Angina is chest discomfort caused when the myocardium is hypoxic. Can be caused by atherosclerosis, HTN, or coronary artery spasms. Stable angina is predictable and can be treated with nitrates. Unstable angina is unpredictable chest pain and worsens as time goes on. Unstable can occur at rest and is a medical emergency
What are the types of heart failure?
Systolic- The heart cannot pump the blood out of the heart very well
Diastolic- The heart is stiff and does not fill with blood easily
What are some methods to treat heart failure?
Sodium restrictions, smoking cessation, weight loss, cholesterol restrictions, rest, drug treatments, and exercise
What is a pulmonary embolism?
A pulmonary embolism occurs when a clot or other matter lodges in the pulmonary artery system, disrupting the blood flow to a region of the lungs. Can originate from DVT, right ventricle.
Where does a fat emboli come from?
Comes from the breaking of long bones or hip fractures
What are the different types of pulmonary emboli?
Fat Tumors Amniotic fluid Air Foreign bodies
How could you diagnose a pulmonary embolism?
V/Q scan ABG's Spiral CT Pulmonary angiogram DVT studies D-Dimer
What is a CVA?
A stroke
What is a TIA?
Mini stroke. Resolves within 24 hours.
What is FAST?
Facial features will droop
Arm will drop and grip will be weak
Speech will be slurred
Time Is important
How would you diagnose a stroke?
Carotid bruit CT Doppler Cerebral angiogram ECG TEE
What should the weight gain be for a patient with a normal BMI?
25-35 lbs
what is the maximum amount of time before a baby voids is it considered problematic?
48 hrs
