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med surg midterm
med surg midterm ch 1-4, 6-7, 12, 21-26
| Question | Answer |
|---|---|
| Left side heart failure (Think lungs) | Dsypnea & Shortness of breath Crackles Fatigue Pink, frothy sputum |
| right side heart failure (Think body swell) | Peripheral edema Ascites Juglar vein detention Hepatomegaly |
| where can nitroglycerin patch be placed | chest, back, or abdominal |
| how frequently can nitroglycerin patch be replaced | every 10-12hrs |
| Coumadin (warfarin) Therapeutic test | PT/INR |
| Coumadin (warfarin) antidote | Vitamin K |
| Coumadin (warfarin) client education | Report headaches, bleeding, and dark tarry stool |
| Heparin Therapeutic test | APTT |
| Heparin antidote | Protamine sulfate |
| Heparin client education | Observe for bleeding, increased heart rate, decreased BP, and black tarry stools |
| Prevention technique about Raynaud's phenomenon | protect hands from the cold and avoid vasoconstrictors such as caffeine, smoking, alcohol, and emotional distress |
| Nurse education for a client with unilateral leg edema and pain to elevate the affected leg | Elevate the affected leg to help reduce swelling and improve venous return; avoid massaging, since unilateral edema and pain can suggest DVT |
| characteristics of ECG strip showing atrial fibrillation | rhythm: irregularly irregular, heart rate: Atrial rate not measurable, ventricular rate under 100bpm, controlled response, greater than 100bpm rapid ventricular response; P wave: no identifiable p waves, pri: cant be measured becasue no p waves are seen; |
| Non-modifiable risk factors for atherosclerosis | -family history -aging -race -gender |
| modifiable risk factors for atherosclerosis | -smoking & alcohol use -overweight -Diabetes -high cholesterol -stress -Secondary lifestyle |
| what is happening in P wave | -Atrial depolarization |
| what is happening in QRS complex | Ventricular depolarization |
| what is happening in T wave | Ventricular repolarization |
| ECG demonstrating sinus tachycardia | BP over 100 with a regular rhythm |
| ECG demonstrating atrial flutter | atrial rhythm regular; ventricular rhythm regular or irregular depending on consistency of AV conduction of impulses; heart rate; ventricular rate varies; flutter or F waves with sawtooth patterns |
| Discharge teaching for digoxin (lanoxin) | Hold medication if pulse less then 60 bpm |
| Myocardial Infarction manifestations | Chest pain, cold sweat, shortness of breath, dizziness, and pain that radiates to arm, neck or jaw |
| Clients risk for dysrhythmia | Myocardial infarction, Heart failure, Electrolyte imbalances (hypokalemia, hyperkalemia, hypomagnesemia), Drug toxicity (Digoxin toxicity, Anti-arrhythmic medications), Hypoxia, Acid-base imbalance, Post-cardiac surgery patients, Stress, Stimulant use |
| Stable angina | -occurs during physical exertion -predictable -relieved with nitrates & rest |
| Unstable angina | -occurs at rest & more frequently -usually not relieved with nitrates & rest |
| what is coronary artery disease (CAD) | Narrowing of the coronary arteries due to atherosclerosis (plaque build up in the arteries) |
| Indications nitroglycerin SL tablets are no longer effective | After 5 minutes still having pain |
| Post operative nursing intervention to prevent complications | Encourage deep breathing and coughing, Use incentive spirometer, Assist with early ambulation, Reposition every 2 hours |
| ABG interpretation | |
| List of urgency surguries | emergency: surgery needed immediately to save life; ruptured aortic aneurysm urgent: surgery needed within 24-30 hrs; infected gallbladder elective: planned/scheduled, with no time requirements; joint replacement optional: surgery requested; cosmetic s |
| Atrial flutter manifestations | palpitations, chest discomfort, shortness of breath, fatigue |
| Atrial fibrillation manifestations | palpitations, dizziness, weakness, shortness of breath |
| ECG Charaterictics of ventricular fibrillation | activity is chaotic. There are no discernible waves.The ventricle quivers. It is unable to initiate a contraction |
| ventricular fibrillation Manifestations | Immediate loss of conciousness. No heart sounds, peripheral pulses, or blood pressure readings. These are all indicative of circulatory collapse, respiratory arrest, cyanosis, and pupil dilation occur |
| ECG characteristics of Premature atrial contractions (PAC) | Refers to "early" beat. When looking at ECG strip, a shortened R- to R interval is seen where the premature beat occurs. The R wave preceding the premature atrial contraction (PAC) and the PAC's R wave are close together, followed by a pause, with the nex |
| Premature atrial contractions (PAC) Manifestations | usually no symptoms occur but if several PACs occur the pt may report feeling palpitations (pg 412) |
| Hypotonic IV fluids | Dextrose 2.5% water and 0.33% or 0.45% sodium chloride |
| Isotonic IV fluids | Normal saline 0.9% sodium chloride |
| Hypertonic IV fluids | 5% dextrose in in 0.9% sodium chloride, 3% chloride, calcium chloride 10%, 5% dextrose in lactated Ringer solution, 10% dextrose in water, and albumin 25% |
| Manifestations of pulmonary embolism | Sudden onset, shortness of breath, and chest pain |
| List of Gerontological considerations in maintaining oral hydration | Monitor intake and output, measure urine-specific gravity. Evidence of a dry, furrowed tongue, mucous membranes, sunken eyes, confusion, and upper body muscle weakness may indicate dehydration. Medication administration is a good time to encourage flui |
| Causes of metabolic acidosis | DKA, Severe diarrhea, renal failure, shock, intestinal suctioning |
| Cause of metabolic alkalosis | Overuse of antiacid, diuretics, vomiting, gastric suctioning |
| Ventricular fibrillation treatment | Immediate defibrillation, Begin CPR immediately, Administer epinephrine IV/IO every 3-5 minutes, Anti-arrhythmic medications (Amiodarone, Lidocaine) |
| Complications of heart transplant | Heart rejection, infection, cancer, cataracts, , high cholesterol, diabetes, kidney disease, osteoporosis |
| manifestations of heart failure | Left sided manifestations: Dyspnea, Orthopnea, Crackles in lungs, Cough, Fatigue and weakness, Tachycardia, Pulmonary edema, Decreased oxygen saturation Right sided manifestations: Peripheral edema, Weight gain, Dependent edema |
| Hypertensive emergency and treatment | Occurs when systolic BP is above 180 mm Hg or diastolic BP is above 120 mm Hg. IV nitroprusside is given to reduce BP to prevent decreased blood flow to kidney, heart and brain |
| Clinical manifestations of decreased arterial blood flow | severe pain (worsens with activity), pale skin, diminished or absent peripheral pulses, numbness or tingling, inability to move the limb, limb feels cold |
| IV Infiltration treatment | -Discontinue cannula -Apply compress initially, then warm -Consult RN or HCP if severe |
| IV Infiltration prevention | -Place cannula in appropriate site -Avoid antecubital fossa -Stabilize cannula carefully -Monitor PIV site per policy -Instruct pt to notify nurse immediately if any pain, burning or swelling occurs |
| IV Infiltration Signs and symptoms | -Coolness of skin at site -Taut -Edema above or below site -Absent backflow of blood -Sluggish infusion rate -Pain or burning -Burning (w/ extravasation) |
| IV septicemia treatment | -Restart new IV system -Obtain cultures -Notify RN/HCP -Initiate antimicrobial therapy as ordered -Monitor patient closely |
| IV septicemia prevention | -Use good hand hygiene -Use aseptic techniques -Carefully inspect fluids -Cover infusion sites w/ appropriate dressings -Use appropriate preparation of solutions |
| IV septicemia Signs and symptoms | -Fever and chills -Profuse sweating -Nausea -Headache -Backache -Tachycardia/tachypnea -Hypotension -Altered mental status -Decreased urine output |
| Hypocalcemia manifestations | decreased BP, mental status change, hyperactive deep tendon reflexes, diarrhea, trousseau sign, chvostesk sign |
| Intellectual humility | "I'm not sure about that. i need more information" "I'm not sure but I'll find out" |
| Autonomy | "Just because everyone else is doing it doesn't make it ok" |
| Integrity | values the truth "i am not comfortable talking about a pt" |
| Nursing interventions post op transesophageal echocardiogram | Monitor vital signs until sedation wears off, Maintain NPO status until gag reflex returns to prevent aspiration, Assess level of consciousness after sedation |
| Risk factors of cardiovascular disease | Non-modifiable: Age, Family history, Male sex, Genetics Modifiable: Hypertension, Smoking, High cholesterol, Diabetes, Obesity, Physical inactivity, Unhealthy diet, Excess alcohol use, Chronic stress |
| Leadership style autocratic characteristics | others are told what to do without invitation to input |
| Leadership style Democratic characteristics | participation is encouraged, decisions are made within the group |
| Leadership style Laissez faire characteristics | Minimal Direct Supervision, High trust in team members, Flexible, Open Environment, Limited guidance or feedback |
| Leadership style coaching characteristics | Focuses on Growth and Development, Uses Guidance, not control, builds strong relationships, sets expectations and goals, encourages problem solving and critical thinking. |
| difference between malpractice and negligence | Negligence is: The failure to act as a reasonably prudent person would in a similar situation. Whereas Malpractice is a type of negligence committed by a professional such as nurse, doctor, pharmacist. |
| Hypertension complications | Heart attack, Heart Fail |
| Manifestations of digoxin toxicity | Dysrhythmias, nausea/vomiting, green/yellow vision halos |
| Serum diagnostic test for heart failure | B-type natriuretic peptide (BNP) |
| Serum elevated diagnostic test indicating myocardial infarction | Troponin |
| Serum diagnostic test for thrombophlebitis | D dimer |
| Nursing considerations for client taking diuretics | Daily weight, Intake and output, blood pressure (risk for hypotension), Check electrolytes (potassium), Check kidney function ( BUN, creatinine) |
| Client highest risk for surgical complication | Advanced age, Diabetes, Cardiovascular disease, Chronic lung disease, Obesity, Malnutrition, Smoking history, Immunosuppression, Chronic kidney disease, Use of anticoagulants |
| clients who would benefit from port a cath | Cancer patients receiving chemotherapy, clients needing long-term IV medications, Clients requiring frequent blood draws, Clients receiving long-term TPN, Patients with poor peripheral IV access, Clients needing repeated transfusions |
| Nursing considerations rules for hanging IV infusions | The ideal height for a solution is 3 feet above the level of the patient’s heart. |
| complications of aortic stenosis | Heart failure, Syncope, Angina, Dysrhythmias, Sudden cardiac death, Pulmonary edema |
| Nursing consideration/intervention for suspected DVT | Check peripheral pulses and capillary refill. Tenderness or pain in the calf may be the first indication of a DVT. Leg swelling, warmth, and redness as well as fever Bilateral calf and thigh measurements are taken daily if DVT is suspected or diagnosed. |
| Cause of respiratory alkalosis | Hyperventilation (anxiety or fear) mechanical ventilation, overreactive thyroid |
| Cause of respiratory acidosis | Decreased respiratory stimuli, anesthesia, drug overdose, COPD, pneumonia, Head injuries |
| Signs and symptoms of fluid volume excess | Crackles, edema, bounding pulse, distended neck veins, hypertension, weight gain, Shortness of breath. |
| Treatment for fluid volume excess | Restrict fluids/sodium, diuretics, (ex.lasix), elevate HOB, weights, slow IV rate as ordered. |
| Nursing intervention for fluid volume excess | Measure I&O, asses for edema, look for crackles, administer diuretics, monitor electrolytes, enforce low sodium diet. |
| What is a rheumatic fever | an autoimmune reaction about 2=4 weeks after tonsillopharyngitis due to group A streptococci |
| What is Buerger disease | a rare recurring inflammation and thrombosis of small and medium arteries and veins in the limbs |
| what to avoid in Buerger disease | avoid tobacco and cannabis use |
| ventricular fibrillation treatment | Begin chest compressions, administer defibrillation, administer meds such as epinephrine (as ordered). |
| Nursing intervention orthopnea | Sit the pt upright, teach pursed lip breathing, administer oxygen, monitor vitals, asses for crackles. |
| orthopnea treatment | Administer oxygen as ordered, monitor SpO2, sit pt upright, teach pursed lip breathing. |
| pt teaching on having a pacemaker | I'll teach my pt to keep their incision clean and dry, to report any redness, swelling, drainage, fever, or pain, avoid lifting arm on pacemaker side for several weeks to avoid lead displacement, Avoid heavy lifting. |
| V-fib intervention | Begin CPR, call for the code team/ emergency response, administer Epinephrine or Antiarrhythmics as ordered. |
| Nitroglycerin side effects | Hypotension, headache, dizziness |
| Cardiac rehab sequence | phase 1: occurs in the hospital phase 2: 4-6 weeks after discharge in an outpatient program( returning pt to previous levels of activity) phase 3: pt is encouraged to maintain optimal physical fitness and continue healthy lifestyles |
| aneurysm manifestations | -Flank pain -Back pain -Abdominal fullness -Nausea -Pulsating mass in abdomen -Severe back pain w/ rupture |
| aneurysm nursing intervention | -Monitor growth of aneurysm -Maintain normal BP -Surgical repair and graft |
| What side effects of rosuvastatin needs to be reported to the provider | Muscle pain or weakness and dark urine |
| what side effect of captopril (capoten) needs to be reported to the provider | Difficulty breathing, Dry cough, facial swelling, elevated potassium levels |
| Electrical conduction system of the heart ("sally is a beautiful person" ) | S-SA Node i-internodal tracts A-AV node B-Bundle of HIS P-Purkinje fiber |
Created by:
Penelopejorge12
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