week 2 -- PE, chest trauma, valve diseases, & aneurysms Flashcards

1
Q

common cause of a PE

A

DVT

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2
Q

ABG’s with a PE tell you

A

intubate or escalate O2

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3
Q

D-dimer

A

tells you how much fibrins were relaeased to take apart a clot

**higher # = more likely of a clot

**expected rage is less than 0.4 mcg/mL

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4
Q

if a patient w allergy to iodine/shellfish cannot do angiography to diagnose PE then they will do a

A

ventilation perfusion scan—– shows circulation of air and blood in the lungs

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5
Q

gold standard to diagnose PE

A

pulmonary angiography — allergy to shellfish & iodine

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6
Q

6 ways to diagnose a PE

A
  1. pulmonary angiography (gold standard)
  2. ABG
  3. Ventilation perfusion
  4. Ct Scan
  5. chest x-ray
  6. d- dimer
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7
Q

interventions for PE

A
  1. initiate o2 & high - fowlers (90 degrees)
  2. iv access
  3. vitals
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8
Q

INR range

A

describes blood clotting

0.8 to 1.1

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9
Q

goal of INR when on warfarin

A

2 to 3

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10
Q

normal pT time

A

11 to 12.5 seconds

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11
Q

normal ApTT time

A

30 to 40 seconds but 1.5 to 2.5x more w heparin

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12
Q

low molecular weight heparin

A

enoxaparin

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13
Q

anticoagulants are contraindicated in

A

peptic ulcer disease
uncontrolled HTN
stroke
trauma

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14
Q

thrombolytic agents are used for

A

bigger clots

ALTEPLASE
reteplase
tenecteplase

  • -eplase
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15
Q

therapeutic procedures for a PE

A

embolectomy
vena cava filter

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16
Q

normal PaO2

A

80 to 100 mmhg

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17
Q

vitamin K foods on wafarin

A

do not increase or decrease

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18
Q

teaching to prevent DVT/PE

A

walk 5 min every hour
compression stockings
dorsi-plantar flexion

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19
Q

s/s of decreased cardiac output

A

hypotension
tachycardia
JVD
cyanosis
syncope

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20
Q

antidote for heparin

A

protamine sulphate

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21
Q

antidote for warfarin

A

vitamin K

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22
Q

a nurse is assessing a client who has a pulmonary embolism. Which of the following manifestations should the nurse expect? sap

  1. bradypnea
  2. pleural friction rub
  3. hypertension
  4. petechiae
  5. tachycardia
A
  1. pleural friction rub
  2. petechiae
  3. tachycardia

** tachypnea
**hypotension

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23
Q

client has acute dyspnea & diaphoresis. client states “I am anxious & unable to get enough air”. vitals are HR 117/min, RR 38bpm , temp 101.2, and bp of 100/54. what is the nurses priority?

  1. notify the provider
  2. administer heparin via IV infusion
  3. administer oxygen therapy
  4. obtain a CT scan
A
  1. administer oxygen therapy

**ABC’s

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24
Q

BUN range

A

7 to 20

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25
Q

creatinine range

A

0.7 to 1.3

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26
Q

INR range when on warfarin

A

2 to 3

27
Q

aPTT goal with heparin therapy

A

40 to 60 sec

28
Q

PaO2 range

A

80 to 100 mmhg

29
Q

flail chest is stabilized by

A

positive pressure ventilation

30
Q

tension pneumothorax occurs when

A

air enters on INSPIRATION and cannot exit on expiration

31
Q

lung sounds w a pneumothorax

A

hyper-reasonance

32
Q

lungs sounds w a hemothorax

A

dull percussion

33
Q

key sign of a flail chest

A

paradoxical chest movement

34
Q

patient considerations for a thoracentesis

A
  • sit on edge of bed leaned over side table
  • no coughing, moving, or deep breathing
  • will feel pressure but no pain
35
Q

a nurse is assisting a provider to care for a client who has developed a spontaneous pneumothorax. which of the following actions should the nurse perform first?

  1. assess the client’s pain
  2. prepare a large bore IV needle for decompression
  3. administer lorazepam
  4. prepare for chest tube insertion
A
  1. prepare a large bore IV needle for decompression
36
Q

nursing considerations for an angiography

A

**LYING FLAT
NPO for 8 hrs

*renal function
*iodine/shellfish allergy
*withhold metformin for 48hrs before & after

post op - pressure on site & lay flat

37
Q

considerations for transesophageal echo

A

HOB @ 45 degrees
NPO 6hrs prior
IV access

Post op = GAG reflex

38
Q

client education for angiography

A

report: chest pain, SOB, &changes of colors in extremities

leave dressing in place for 24 hrs

avoid heavy weight & bending at waist

withhold metformin 48 hrs before & after

39
Q

cardiac tamponade nursing interventions

A
  1. notify provider
  2. admin IV fluid (combats hypotension)
  3. obtain CXR / echo
  4. prepare for a pericardiocentesis
40
Q

structures on the left side of the heart

A

left atrium
mitral valve
left ventricle
aorta

41
Q

structures on the right side of the heart

A

tricuspid valve
right atrium
right ventricle
pulmonic arteries

42
Q

foods high in potassium and can be given w/

A
  • thiazide & loop diuretics to prevent hypokalemia

spinach
bananas
potateos
nuts
dried & citrus fruit

43
Q

considerations when taking digoxin

A

apical pulse greater than 60/min
same time every day
separate 2 hrs from antacids

44
Q

digoxin toxicity manifestations

A

visual changes (green halos)
confusion
muscle weakness
fatigue
loss of appetite

45
Q

mechanical valves require

A

life long anti-coagulant therapy

*prothrombin checked on a regular basis
*kids

46
Q

tissue valves require

A

replacement every 7 to 10 years
older ppl

47
Q

a nurse educator is reviewing expected findings who has right-sided valvular heart disease with a group of nurses. which of the following findings should the nurse include in the discussion? sap

  1. dyspnea
  2. client report of fatigue
  3. bradycardia
  4. pleural friction rub
  5. peripheral edema
A
  1. dyspnea
  2. client report of fatigue
  3. peripheral edema
48
Q

expected outcome of a percutaneous balloon valvuloplasty. nurse response

A

this will assist with the ability to perform activities of daily living

49
Q

a nurse is reviewing the health record of a client who is being evaluated for possible valvular disease. The nurse should recognize which of the following data as risk factors for this condition?

  1. surgical repair of an atrial septal defect at age 2
  2. hypertension for 5 years
  3. weight gain of 10 pounds in the last year
  4. diastolic murmur present
A
  1. surgical repair of an atrial septal defect at age 2
  2. hypertension for 5 years
  3. diastolic murmur present
50
Q

a nurse is completing the admission physical assessment of a client who has mitral valve insufficiency. which of the following findings should the nurse expect?

  1. s4 heart sounds
  2. petechiae
  3. neck vein distention
  4. splenomegaly
A
  1. neck vein distention

*s3 heart sounds
*hepatomegaly

51
Q

risk factors for valvular heart disease

A

HYPERTENSION
RHEUMATIC FEVER
marfan syndrome
ineffective endocarditis

52
Q

s/s of MITRAL stenosis

A

**apical DIASTOLIC murmur
JVD
hepatomegaly
dry cough
pitting edema
afib
dyspnea / orthopnea

53
Q

s/s of mitral insufficiency

A

**SYSTOLIC murmur @ apex
atypical chest pain
diminished lung sounds
hepatomegaly
JVD
dyspnea / orthopnea

54
Q

s/s of aortic stenosis

A

SYSTOLIC MURMUR (A.S.S.)
NARROWED pulse pressure
syncope
angina
dyspnea / orthopnea

55
Q

s/s of aortic insufficiency

A

DIASTOLIC murmur
WIDE pulse pressure
bounding pulse
NOCTURNAL angina w diaphoresis
tachycardia
palpitations

56
Q

aneurysm & types

A

widening or ballooning of a blood vessel

*asymptomatic
1. saccular = one side
2. fusiform = both sides – complete circumference

57
Q

risk factors for aneurysms

A

atherosclerosis
HTN
syphillis
hyperlipidemia
males
trauma
tobacco

58
Q

s/s of aortic abdominal aneurysm

A

pulsating abdominal mass
bruit over area
low back pain
constant gnawing feeling in the abdomen

59
Q

s/s of thoracic aortic aneurysm

A

SEVERE BACK PAIN
COUGH
sob
difficulty swallowing
decreased renal function

60
Q

s/s of aortic disection

A

assoc. w marfan syndrome
tearing, ripping, stabbing
hypovolemic shock

61
Q

priority intervention for aneurysms

A

to reduce systolic between 100 and 120

long term to maintain systolic between 130 to 140

62
Q

nursing interventions for caring for aneurysms

A

hob below 45 degrees
warm environment
cough q 2 hrs w splint

63
Q

Beck’s Triad

A
  1. hypotension
  2. JVD
  3. diminshed heart sounds