Test 4 Flashcards
Holter monitor
is worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor.
TEE post op assessment
has been given conscious sedation and has had the throat numbed with a local anesthetic spray, thus eliminating the gag reflex until the effects wear off. Therefore it is imperative that the nurse assess for gag reflex return before allowing the patient to eat or drink. Vital signs and oxygen saturation are also important assessment parameters resulting from the use of sedation. A TEE does not involve invasive procedures of the circulatory blood vessels. Therefore it is not necessary to monitor the patient’s groin and lower extremities in relation to this procedure or to maintain a flat position.
Heart murmur is from
Turbulent blood flow across the affected valve results in a murmur.
cardiac output for adult at rest
4-8 L/min
ways to take BP
sphygmomanometer and stethoscope (auscultation), with an automated device that uses oscillometric measurements or with doppler ultrasonic flowmeter
poroxysmal nocturnal dyspnea
attacks of shortness of breath especially at night that awaken pt. together with cheyenne stokes breathing are associated with heart failure.
pericardial friction rubs
sounds caused by friction that occurs when inflamed surfaces of the pericardium (pericarditis) move against each other. They are high-pitched, scratchy sounds that may be transient or intermittent and may last several hours to days. Friction rubs are usually heard best at the apex, with the patient upright and leaning forward, and following expiration.
Drugs of choice for Sickle cell pain
Chronic- Asparin
acute crisis: morphine + IV fluids
also for chronic: rest, hydrate, elevate swollen joints, heat massage, relax and breath techs,distraction, PT, whirlpool tub, TENS **support group
increase risk for pain sickle cell
Hot, cold, or low oxygen environment
sickle cell other pain syndromes
hyperalgesia- ab heightened sensitivity to pain
allodynia- pain response to something not painful
neuropathic pain. also can have high tolerance to pain meds from nephron cell death.
Sickle cell patient teaching
screenings, like regular eye and kidney tests, avoid dehydration, hypoxia, cold and hot environments, get prompt tx for things like upper resp infection, teach pain control PT OT, behavioral therapy/support groups for anxiety and depression
non modifiable risk factors for htn
> 60 years old, male, race (Afric Amer), genetic, post menopausal (diabetes, dyslipidemia??)
modifiable risk factors for htn
excessive alcohol, smoking, increased caffeine, salt, fat and cholesterol in diet, stress, obesity, oral contraceptives and inadequate exercise.
IV drugs for hypertensive crisis
Pines, Prils and Lols (nicardopine, labetalol, esmolol, enalapril, clevidipne. less than 60 sec onset, assess BP and pulse q2-3min
Left sided Heart failure sxs
paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, pulmonary congestion (cough, crackles, wheezes, blood tinged sputum, tachypnea, restlessness, confusion, orthopnea, tachycardia, extertional dyspnea, fatigue, cyanosis
opportunistic pneumonia caused by
pneumocytstis jiroveci pneumonia (PCP)
also:cytomegalovirus, other bacterial and viral and fungi
will kill immune suppressed, give lots of steroids
at risk: young, old, HIV, protein malnutrition, chemo/radiation, transplant recipients
PCP Sxs
fever, tachypnea, tachycardia, dyspnea, nonproductive cough, hypoxemia
inhalation pneumonia
mycoplasma pneuoniae (walking), usually viral, cover mouth wash hands
vasodilators
add to diuretic if still hypertensive: ACE inhibitor (Lisinopril - want to ACE LIStIN tO PRIL)- can get bad dry cough
Angiotensin Block
Beta Block (metoprolol -Catch Beta’s with pLOLe)
Calcium Channel block (verapamil- eVERAPArated MILk)
magnesium sulfate
anti seizure for severe eclampsia. normal to feel warm and sweaty and burning at IV site. Toxicity with hypotension, bradycardia, bradypnea give Calcium Gluconate- antidote
