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NSG 210 > Test 2-Perfusion, Metabolism, Gas Exchange > Flashcards

Test 2-Perfusion, Metabolism, Gas Exchange Flashcards

1
Q

What are the parts of an EKG?

A

P wave
QRS complex
T wave

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2
Q

How do you count an EKG?

A

of R waves in 6 seconds (6 large blocks x 10= 1 min rate)

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3
Q

What does left sided heart failure look like?

A

Paroxysmal nocturnal dyspnea, pulmonary congestion, exertional dyspnea

Pt hunched over, cyanotic extremities and lips, restless and confused

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4
Q

What does right sided heart failure look like?

A

“Everything swells”-dependent edema, ascites, enlarged liver and spleen, edema in hands/fingers, JVD

Anorexia/GI discomfort
Fatigue
Can be secondary to chronic pulmonary problems

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5
Q

How do you treat CHF?

A 
(U)pright position
(N)itrates
(L)asix
(O)xygen
(A)ce inhibitors
(D)igoxin

(F)luid decrease
(A)fterload decrease
(S)odium restriction
(T)est digoxin and potassium levels, ABGs

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6
Q

What is ejection fraction? What is a normal ejection fraction?

A

% of blood pumped out of the left ventricle

50-70%

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7
Q

What is the difference between ischemia and infarction?

A

Ischemia: lack of oxygen, reversible
Infarction: necrosis, irreversible

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8
Q

What is the difference in stable and unstable angina?

A

Stable: plaque is partially blocking an artery, causes no issue with mild activity but can cause issue with moderate-intense activity
Unstable: Soft plaque ruptures and causes acute coronary syndrome

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9
Q

How do you educate cardiac patients about their diet?

A

Healthy fat, low sodium, greens, fiber, DASH diet, my plate

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10
Q

If you have chest pain what are indicators you should not be super concerned about it?

A

It gets better with exercise, it is a quick shooting pain, the pain can be pinpointed to one specific location

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11
Q

What type of chest pain should you be immediately concerned about?

A

In conjunction with SOB or new swelling, feelings of squeezing or pressure in the chest (there’s an elephant on my chest, a bear is hugging me), it gets worse with normal activity (such as unloading groceries)

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12
Q

What lab test can show evidence of an MI?

A

Troponin

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13
Q

What is prinzmetal’s angina?

A

Vessel spasms in healthy or unhealthy vessels. Can be caused by stress, smoking, anxiety, drugs

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14
Q

What type of MI is subendocardial?

A

NSTEMI (non st elevation), inner 3rd of the muscle dies, shows an ST depression on EKG

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15
Q

What type of MI is a transmural?

A

STEMI (ST elevated), whole thickness of muscle dies

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16
Q

What type of MI is an Inferior wall MI?

A

STEMI

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17
Q

What is ventricular remodeling?

A

The hear reshapes itself to compensate for one part not pumping the right way

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18
Q

What type of EKG do you use when you suspect an MI?

A

12-lead

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19
Q

What is a normal troponin level?
What is the troponin level usually around when the patient has had an MI?
What else can show an elevated troponin and what level is shown?

A

0-0.033
>1
Heart failure, > 0.033 but <1

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20
Q

Why is nitroglycerin used to treat cardiac pain?

A

It is a vasodilator so vessels dilate to re-oxygenate coronary veins

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21
Q

What other measures are used to treat cardiac pain?

A

Morphine: relief
Oxygen: increase oxygenation to coronary veins
Positioning: semi-fowlers
Quiet and calm environment: you scream, they scream, cardiac demand increases

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22
Q

Why do cardiac patients take aspirin? What else might they be on?

A

To prevent plaque formation as it is an anticoagulant. TPA (thrombolytic) because it is a powerful anticoagulant

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23
Q

What does the acronym MONA mean for cardiac patients?

A

Morphine
Oxygen
Nitroglycerin
ASA

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24
Q

Define preload

A

Volume of blood in ventricles after diastole (relaxed)

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25
Q

Define afterload

A

What the left ventricle is working against

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26
Q

A patient has a stent placed. What must they do for 6-12 mos post-stent (or for a lifetime)? Examples?

A

Anticoagulants

Warfarin, heparin, Eliquis, Lovenox

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27
Q

What are non-modifiable risk factors?

A

Age, genetics, race, gender

28
Q

What does an anti-anginal do? Examples (3)

A

Relieve chest pain

Nitrates (nitroglycerin), beta blockers (-olol drugs), calcium antagonists (-ine, -zem drugs)

29
Q

What does an anti-lipemic do? Examples (3)

A

Lower blood cholesterol levels

Statins, niacin, ezetimibe

30
Q

What do cardio-glycosides do? Examples (3)

A

Treatment of CHF and/or irregular rhythms

Digoxin, digitoxin, bufotoxin

31
Q

What do antihypertensives do? Examples?

A

Lower blood pressure

Calcium channel blocker, ACE inhibitors, angiotensin II receptor blockers, beta blockers

32
Q

What is a CABG and how does it work?

A

Coronary Artery Bypass Graft

Vessels are taken from other parts of the body and connected to go around a blockage in a coronary artery

33
Q

What is a normal BP

A

Systolic <120 AND diastolic <80

34
Q

What is elevated BP

A

Systolic 120=129 AND diastolic <80

35
Q

What is stage 1 HTN?

A

Systolic 130-139 OR diastolic 80-89

36
Q

What is stage 2 HTN?

A

Systolic >/= 140 OR diastolic >/=90

37
Q

What are the different coronary arteries? Where do they supply blood to?

A

Right and left
Right has 1 branch (posterior descending) and supplies blood to the bottom (inferior wall)
Left has 3 branches-Left main, Left anterior descending, and circumflex; supplies blood to lateral and anterior walls

38
Q

Describe conduction through the heart.

A

SA node - atria contract - AV node - Bundle of His - R/L Bundles - Purkinje fibers - Ventricle contraction

39
Q

What are the causes of left sided heart failure?

A

HTN, CAD, valvular disease

40
Q

What are the causes of right sided heart failure?

A

Left ventricular failure, right ventricular MI, pulmonary HTN

41
Q

Describe Addison’s disease.

A

Bronzy skin, hypoglycemia, postural hypotension, weight loss, weakness, GI issues, change in body hair, Adrenal crisis

42
Q

What are the Adrenal gland hormones?

A

3 S’s: Sugar (Glucocorticoids), Salt (Mineralcorticoids), and Sex (Androgens)

43
Q

What are examples of corticosteroids?

A

Methylprednisolone (Solu-Medrol), Dexamethasone (Decadron), Prednisone (Deltasone)

44
Q

What are the “good, bad, and ugly” of corticosteroids?

A

Good: control inflammation by suppressing the immune system
Bad: slow deterioration to the body
Ugly: damage- edema, peptic ulcers, delayed wound healing, osteoporosis, infection

45
Q

Describe Cushing’s disease.

A

Personality changes, moon face, hyperglycemia, edema, fat deposits, CNS irritability, thin skin, stretch marks, no mensuration for women, gynecomastia for menq

46
Q

S/s of hyperthyroidism.

A

Heat intolerance, fine/straight hair, weight loss, menstrual changes, clubbed fingers, tremors, diarrhea, local edema, bulging eyes, goiter, tachycardia, breast enlargement, facial flushing, increased systolic BP

47
Q

S/s of hypothyroidism.

A

Intolerance to cold, hair loss and receding hairline, extreme fatigue, blank expression, apathy, thick tongue, slow speech, anorexia, dry skin, constipation, brittle hair and nails, muscle aches and weakness, weight gain, bradycardia, thickened skin

48
Q

Describe gigantism

A

Growth hormone hypersecretion before puberty

49
Q

What can be causes of over-stimulation of the pituitary?

A

Tumors, hyperplasia, genetics, adenoma

50
Q

What are some results of pituitary deficiency?

A

Metabolic problems, sexual dysfunction, deficient gonadatropins, decreased TSH/ACTH (life threatening)

51
Q

What are inventions for pituitary deficiency?

A

Lifelong replacement of hormones, androgen therapy, growth hormones, estrogen and progesterone, gynecomasty

52
Q

How do they operate on the pituitary? What are post-op considerations.

A

Through the nose

neuro responses, postnasal drip, halo nasal drainage, meningitis, don’t cough, elevate head, asses nasal drainage

53
Q

What drugs are used for the pituitary?

A

Vasopressin

Desmopressin

54
Q

What is diabetes insipidus and what causes it?

A

Water metabolism issue

ADH deficiency

55
Q

What medication can cause DI?

A

Lithium

56
Q

What is SIADH?

A

Syndrom of Inappropriate Antidiuretic Hormone
Vasopressin secreted when plasma osmolarity is unfavorable, feedback mechanisms do not function, water retained -> hyponatremia

57
Q

What does SIADH assessment consist of?

A

Assess for recent head trauma, cerebrovascular disease, TB, other pulmonary disease, cancer, drug use, decreased serum sodium levels

58
Q

What are interventions for SIADH?

A

Fluid restriction, drug therapy, monitor for fluid overload, safe environment, neuro assessment

59
Q

What can cause adrenal hypofunction?

A

Inadequate secretion of ACTH, dysfunctional hypothalamic-pituitary control, adrenal tissue dysfunction, immediate discontinuation of long term glucocorticoids

60
Q

Describe adrenal/addisonian crisis.

A

Profound fatigue, dehydration, vascular collapse (decreased BP), renal shut down, decreased sodium, increased potassium

61
Q

What is prednisone and what is important to remember about it?

A

Glucocorticoid, to not cause adrenal crisis you taper down

62
Q

What can bulging eyes indicate?

A

Hyperthyroidism

63
Q

What is a type of hyperthyroidism?

A

Graves disease

64
Q

What is a goiter? What can it indicate?

A

Enlarged thyroid, hyperthyroidism

65
Q

What labs/diagnostics may be ordered to get a better picture of the thyroid?

A

T3, T4, T3RU, Ultrasound, ECG

NSG 210 (2 decks)

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