Test Two Flashcards
1
Q
What is included in diet therapy for renal failure patients?
A
- DECREASE PROTEIN, K, Na
- increase CHO/fat and vitamins.
- Fluid rescrictions 700-1000 ml/24 hours
2
Q
Why do you decrease protein in renal failure patients diet therapy?
A
because the byproduct of protein break down is ammonia/nitrogen, so if you give more protein your kidneys have to work harder
3
Q
What is the normal PR interval?
A
the time it takes for the impulse to travel from the SA node to the AV node.
-Atrial contraction (depolarization)
4
Q
What does a long PR interval indicate?
A
1st degree AV block
5
Q
Where is the PR interval measured?
A
from the beginning of the P wave to the beginning of the QRS (right before Q if present)
6
Q
What is the normal time range of a PR interval?
A
0.12 - 0.20 seconds (3-5 small boxes)
7
Q
What is the normal time range of the QRS interval?
A
0.4 - 0.10 seconds (1-2.5 small boxes)
8
Q
What is the QRS interval?
A
the time it takes for the impulse to travel from the AV node, down the bundle of His, through the left and right bundle branches, and down the Purkinje fibers
-ventricle contraction (depolarization)
9
Q
Where is the QRS measured?
A
from the beginning of Q to the end of S
10
Q
What does a long QRS indicate?
A
bundle branch block
11
Q
How long is a normal QT interval?
A
~0.36 seconds
12
Q
Where is the QT interval measured?
A
from the end of S to the end of T-wave
13
Q
What does a long QT indicate?
A
the heart isn’t relaxing soon enough, meds will slow that down, may lead to lethal conditions
14
Q
What does a normal T wave look like?
A
upright, well rounded, and less than 1/2 the height of the QRS complex
15
Q
What is normal sinus rhythm?
A
60-100 bpm, all complexes complete
16
Q
What does one small box represent?
A
0.04 seconds
17
Q
What does one big box (aka 5 small boxes represent)?
A
0.20 seconds
18
Q
What does a peaked T wave mean?
A
hyperkalemia
19
Q
What does a flat T wave mean?
A
hypokalemia or ischemia
20
Q
What constitutes a first degree heart block?
A
WNL except PR >0.20 seconds
- this can progress into second degree heart block and beyond
- delayed transmission of sinus impulses through AV node
21
Q
What is CK?
A
the byproduct of break down of muscle tissue
22
Q
What are the causes of first degree heart block?
A
dig toxicity, acute MI, acute carditis, hyperkalemia with dig
23
Q
Why do we call a junctional rhythm junctional?
A
because if originates in the junctional portion of the heart (aka AV node rhythm)
24
Q
How many bpm in AV node rhythms?
A
40-60 bpm
25
In junctional rhythms, is the PR short or long?
short or even hidden
26
What is the difference between angina and MI?
angina gets better with rest, MI damages the heart tissue, can end up with aneurism, can weaken the walls of the heart
27
What does a stent do?
keep arterial lumen open
28
What are some important things to remember after a stent procedure?
catheterization in the groin, check for bleeding!!), pts can dihiss at the site, put pressure on the site, keep the leg straight, check blood flow to the extremities (watch peripheral pulses! Check leg/extremity pulses!
29
How many bpm can the purkinje fibers fire? (when SA and AV node fail)
20-40 bpm
30
Calcium and ______ have an inverse relationship.
phosphorous
31
When is BNP released?
released in response to atrial and ventricular stretch; it serves as a marker for heart failure
32
What vitamin can't you have while on Coumadin (warfarin)? why?
vitamin K because it's the antidote (decreases levels)
33
Can you drink on Coumadin? Why or why not?
No! It can increase your coumadin levels, make your blood too thin
34
What is a normal ejection fraction?
50-70% in healthy patients
35
Patients with an ejection fraction of less than ______ are considered candidates for ...
30% (decreased tissue perfusion), for an implantable cardioverter/defibrillator
36
What is atherosclerosis?
plaque formation within the arterial wall, leading risk factor for cardiovascular disease
37
In atherosclerosis, blood vessel damage causes ______ response, then ______ appears on the inner lining, then ______ migrates and forms a ______
an inflammatory response, then a fatty streak appears on the inner lining, then collagen migrates over the fatty streak, forming a fibrous plaque
38
What are some of the causes of endothelial (intimal) injury? (14)
elevated lipid levels (high LDLs and low HDLs), elevated toxins in the blood stream (renal failure, carbon monoxide), cigarette smoking, aging and hypertension weaken vessel walls, genetic predisposition, diabetes, increased triglycerides, obesity, sedentary lifestyle, stress, african-american or hispanic ethnicity, oral contraceptives
39
What is PVD?
Any condition that causes partial or complete obstruction of the flow of blood to or from the arteries or veins outside the chest. Peripheral vascular disease includes atherosclerosis of the carotid, aortoiliac, femoral, and axillary arteries, as well as deep venous thromboses of the limbs, pelvis, and vena cava
-complication of hypertension
40
What happens when you give a vasodilating medication?
decrease sympathetic vasoconstrictions (by reducing effects of norepinephrine at peripheral nerve endings) resulting in vasodilation and decreased BP
41
How does renin, angiotensin, and aldosterone affect blood pressure?
Renin causes vasoconstriction
-renin converts angiotensinogen to angiotensin I; angiotensin I is converted to angiotensin II (in lungs); angiotensin II stimulates release of aldosterone (which promotes water and sodium retention by the kidneys therefore increasing blood volume and BP
42
Renin converts ______ to ________. Angiotensin I is converted to ______ in the lungs which stimulates the release of _______
angiotensinogen to angiotensin I,
angiotensin I converts to angiotensin II
angiotensin II releases aldosterone
43
What does aldosterone do?
promotes water and sodium retention by the kidneys, therefore increasing blood volume and BP
44
Which sided heart failure is an emphysema pt most likely to have?
more at risk for right sided failure (left side has a sucking pressure b/c it has a hard time getting blood
45
What are the reasons for prerenal failure? (8)
problem outside the kidney; caused by intravascular volume depletion (hypovolemia), dehydration, decreased cardiac output, decreased peripheral vascular resistance, decreased renovascular blood flow, and prerenal infection or obstruction.
(volume depletion, impaired CO, vasodilation
46
What are the reasons for intrarenal failure? (5)
(within the parenchyma of the kidney) caused by tubular necrosis, prolonged prerenal ischemia, intrarenal infection or obstruction, and nephrotoxicity
47
What are the reasons for postrenal failure?
(between the kidney and urethral meatus ) bladder neck obstruction, bladder cancer, calculi, and postrenal infection
48
What are the 3 types of kidney stones?
Purine, calcium, and oxalate
49
What is dialysis based on?
on principles of diffusion, osmosis and ultrafiltration
Diffusion: remove toxins and wastes from blood to dialysate.
Osmosis: remove excess water from area of higher solute concentration (blood) to lower concentration (dialysate)
Ultrafiltration: water moves from high pressure area to lower pressure.
50
What are the nursing considerations for AV fistula?
assess for bruit, don’t do blood pressure on that side/arm, don’t use it for IV, don’t raise it above the heart b/c it can collapse
51
What is type I diabetes?
Autoimmune disorder, onset is usually <30 y.o.
The immune system sees the insulin-producing beta cells as foreign and destroys them.
-insulin dependent, pancreas produces too little or no insulin (no key)
-irreversible
52
What is type II diabetes?
Progressive disorder, combination of insulin resistance and decreased secretion of insulin by the beta cells.
Insulin not binding to the cell receptors Glucose can’t enter cells.
-non-insulin dependent, pancreas makes insulin but body doesn't properly use it (insulin resistance) (either key is wrong or lock is wrong)
-reversible
53
What are some chronic complications diabetes can cause?
CV disease (HF, MI), CVA, diabetic retinopathy, diabetic neuropathy, ED
54
What electrolyte do you need to monitor in a diabetes pt?
K!
55
When/why would a diabetic pt have hypokalemia?
-Hypokalemia: when you pee out too much after giving insulin, depressed T (smoother and flatter), not as responsive
56
How does biguanides like metformin (Glucophage) work?
decreases amount of glucose released from liver
57
How do Sulfonylureas like Glimepiride (Amaryl) and gluride Glipizide-Glutuctrol work?
stimulates pancreas to release more insulin
58
How do Meglitinide like Repaglinide (Prandin) D-Phenylalanine derivatives work?
Stimulate the pancreas to release more insulin right after a meal
59
How do Thiazolidinediones like Pioglitazone (TZDs) Pioglitazone work?
makes the body more sensitive to the effects of insuin
60
How do DPP-4 Inhibitors like Sitagliptin (Junuvia) Saxagliptin work?
improves insulin level after a meal and lowers the amount of glucose made by the body
61
How to alpha glucosidase inhibitors like Acarbose (Precose) work?
slows the absorption of carbs
62
Pts with insulin pump are at risk for...
hypoglycemia
63
Untreated Diabetes leads to an increase in _________ which leads to _________ which leads to _________.
systemic blood sugar, hyperosmolarity, shrunken cells
64
How to we check kidney function?
check creatinine and protein levels
65
What do A1C levels check?
how you can see the average blood sugar levls over the past 120 days
66
Where is BNP mainly excreted from?
ventricular myocardium
67
What are the basic nursing considerations when treating pts with heart failure?
Assess (everything, electrolyte and fluid balance, BNP levels), admin meds, evaluate treatment effectiveness, education, communication (btwn pt, nurse, dr, and family)
68
Why is checking weights important in heart failure pts?
lets you know how much extra fluid your body is holding on to.
Sudden weight gain may mean that fluid is building up in your body because your heart failure is getting worse
-heart tries to compensate for poor pumping by holding onto Na and water
69
What is the normal blood sugar level?
70 – 140 mg/dL
70
What are the hyperglycemic blood sugar levels? (fasting and non-fasting?) and A1c
fasting: 126 mg/dL or higher
non-fasting: >200 mg/dL after a meal
A1c: >7
71
What are the microvascular complications of diabetes? (3)
retinopathy,neuropathy, and nephropathy (GFR decreases due to sclerosis of glomerulus)
72
What are the macrovascular complications of diabetes? (6)
atherosclerosis (increases CVD and CAD risk), angina, PAD, MI, stroke, TIA (percursor to stroke)
73
How does using insulin and glucose decrease K (nursing intervention for hyperkalemia)?
causes K into the cell (ICF) from ECF
74
What does ketoacidosis cause? (3)
hyperkalemia, acidosis, Kussmaul respirations in attempt to compensate (very deep breathing)
75
What happens to the heart with hypokalemia?
causes increased cardiac instability, ventricular dysrhythmias, and increased risk of dig toxicity
76
What ECG changes occur with hypokalemia?
flattening and inversion of T wave, appearance of a U wave, and ST depression
77
What happens to the heart with hyperkalemia?
causes asystole and ventricular dysrhythmias
78
What ECG changes occur with hyperkalemia?
tall peaked T waves, widened QRS, prolonged PR, or flat P waves
79
What happens to the heart in hypocalcemia?
ventricular dysrhythmias and cardiac arrest
80
What ECG changes happen with hypocalcemia?
prolonged ST and QT intercals
81
What happens to the heart with hypercalcemia?
atrioventricular block, tachycardia or bradycardia, digitalis hypersensitivity, and cardiac arrest
82
What ECG changes happen with hypercalcemia?
shortened ST segment and widened T wave
83
Pts with chronic kidney failure can develop which electrolyte imbalances?
hyperkalemia and hypocalcemia
| -hypocalcemia as a result of high phos levels b/c diseased kidney cannot activate vitamin D
84
What are the correction for PVD?
stop smoking! eat better, exercise, compression stockings, meds, angioplasty or arterial bypass surgery
85
What is intermittent claudication?
Cramping or pain in leg muscles brought on by a predictable amount of walking (or other form of exercise) and relieved by rest
86
What are the 3 Ps of the diabetes triangle?
Polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger)
(type I diabetes)
87
What's the problem/risk with gentamycin
is an ototoxic drug (tinnitus), so watch for side effects, monitor them
88
What are the meds for UTI?
Bactrim, Cipro, gentamycin w/or w/o ampicillin
89
What are the factors that contribute to older adults getting UTIs?
urinary stasis, neuromuscular conditions, anticholinergic drugs (delayed bladder emptying), fecal incontinence, and hypoestrongenism
90
What bpm determines a controlled heart rate?
under 110
91
What are the abnormal ECG changes in A fib?
no discernible p wave, saw tooth in A flutter
