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NUR 171 Test 1

Block 2 Test 1 Study walk about

QuestionAnswer
Name 2 isotonic Solutions Lactated Ringers & Normal Saline
In what cases would you possible see dilutional Hyponatremia? Excess Water, IV med error, SIADH
List 5 foods high in soduium High: Canned foods, frozen foods, fast food, mainly prepacked food
List 5 foods low in soduium Low: Fresh fruit and vegetables, lean meats including fish and chicken
What is classification of medications is most often prescribed "first" with HTN diuretic, hydrochlorothyozide
Compare and cotrast K+ sparing and K+ wasting diuretics. When is each prescribed and why? Give examples of classes and each
What is the daily recommendation of intake of cholesterol? WHY? If you have a cardiovascular disease <200 and in a healthy person <300 to decreasethe risk of cardio vascular disease
arterial ulcers= pale ischemic, well defined edges, found on toes, heels, lateral malleoli.
Venous ulcers= necrotic crater like lesions with slow wound healing.
What do you teach a newly diagnosed heart failure patient? MAWDS; m-meds, a-activities, w-weight, d-diet, s-symptoms. Meds completely and as prescribed, limit sodium, weigh self daily, report changes 2lbs daily 4lbs in week.
•CPK is composed of 3 isoenzymes. Name the 3 •CPK-1 (also called CPK-BB) is found mostly in the brain and lungs •CPK-2 (also called CPK-MB) is found mostly in the heart •CPK-3 (also called CPK-MM) is found mostly in skeletal muscle
CPK Creatinine phosphor-kinase
Define a normal blood pressure Systolic below 120, diastolic below 80. Normal also defined by what is normal and healthy for the particular patient or what is patients baseline.
Whats a serious complication of a DVT DVT may fragment or break loose and travel to the pulmonary (lungs) and cause a Pulmonary Embolism.
Normal phosphorus level P- 2.5-4.5mg/dl Changes reflected in acid base balance and muscle contraction. Levels in contrast to Ca+ and Mg.
Hypophospatremia S/S Hypo= iritablitiy, confusion, seizures.
Hyperphosphatremia S/S Hyper- calcification of soft tissue, and joints.
What follow up lab is important when a patient is taking Coumadin PT/INR Normal values are Prothrombin (PT)= 11-13 seconds / Therapeutic= 13-20 seconds. International normalized ratio (INR)= 1.0-2.0 normal/ therapeutic= 2.0-4.5.
What can cause sinus tachycardia SA nodes -heart to fire rate greater than 100 bpm. Caused by physical activity, psychological stresses, fever, pain, hypotension, hypovolemia, anemia, hypoxia, heart failure, myocardial ischemia, some drugs, and stimulants.
What can cause sinus tachycardia or sinus bradycardia SA nodes fire rate <60bmp. Can be normal for athletes. Other causes- carotid issues, valsalva maneuver, hypothermia, increased intraocular pressure, increased vagal tone, drugs, some disease processes such and hypothyroidism, inferior MI.
Define pleural effusion? Pleural effusion= collection of fluid in pleural space. Not disease but sign. ^hydrostatic pressure pushes fluid out into space.
Empyema pleural effusion with puss. As in pneumonia, tb, abscess, surgical wounds.
Describe why patients with Ca+ imbalances may need seizure precautions?- Hypocalcaemia allows sodium to enter cells causing muscle contractions leading to tetany and potentially seizures.
Define compression stockings and why they are used Deep vein thrombosis (DVT) prophylaxis. Compression stockings (aka antiembolism stocking, TED hose) exert 18mm Hg pressure increasing venous return and blood flow.
What’s the purpose of a bladder irrigation To wash out the bladder, administer medications, or to flush the bladder of blood clots following genitourinary surgery. Most common to use sterile isotonic solution.
Name 3 guidelines for the removal of K? 1- stop potassium intake. 2- Increase the elimination of potassium by diuretics, dialysis, using ion-exchanging resins-kayexalate 3-Increase fluids
Other options for the removal of K? IV insulin to force k into ICF along with glucose to keep patient from becoming hypoglycemic. Administering calcium gluconate can change membrane potential to counter the effects on nerves.
Normal Magnesium level? 1.5-2.5 mEq/L Effects muscle contraction and relaxation. Mg and Ca+ go together and opposite P-
Hypermagnesium S/S Above 2.5 contractions, N/V, bradycardia.
Hypomagnesium S/S Below 1.5 cramps, tetany, irritability.
The upper airways are not sterile so why is sterile technique recommended when suctioning? infectious agents, irritants are not introduced into the lower airways or upper airways that might migrate to lungs and cause infection, pneumonia, or increased gastric secretion.
What teaching is important when a patient is discharged on Coumadin follow up to monitor PT/INR, drug interactions, watch for bleeding tendencies, protect self from injury. Do not increase intake of green leafy vegetables. Vitamin K is antidote.
What complications are associated with suctioning Air obstruction, oxygen saturation levels can fall. Irritation of site, trachea. Trachea and surrounding area can become irritated causing excessive secretion. Other- hypoxemia, trauma to airways, nosocomial infection, cardiac dysrhythmia.
How do you confirm a nasogastric tube is in the stomach aspirate contents to check for stomach fluids, inject air to listen to bubbling in stomach? X-ray to verify placement.
Isotonic solutions isotonic= balance, no change. Increases only ECF.
Hypotonic solutions Hypotonic= excess water intake into cell causes swelling. Provides more water than electrolytes diluting ECF which moves water into ICF.
Hypertonic solutions Hypertonic= deficiency of water causes water from cells causing shrinkage. Raises osmolality of ECF and expands it.
A suction attempt should last ____ seconds? Try and limit suctioning to 10 seconds and to no more than 3 suctions while waiting 1 minute minimum between attempts.
Identify predisposing factors of PVD (arterial) Peripheral Arterial Disease= narrowing and degeneration of arteries as response to atherosclerosis, diabetes, African Americans, men. Leading cause is atherosclerosis.
Identify predisposing factors of PVD (venous) narrowing and degeneration of viens as response to atherosclerosis, diabetes, African Americans, men. S/S DVT, thrombophlebitis, venous thrombosis, stasis, vein damage, and hypercoagulation of blood in vein
Name 3 reasons a patient would have an elevated K excess potassium intake, shift of potassium out of cells, failure to eliminate potassium.
A hissing sound or bubbling in the water seal chamber is also known as- A Leak! Initial ok at start up, Sustained indicates leak in system or patient. (bronchopleural leak)
Name 2 Nursing diagnosis that would be appropriate for a patient with a Ca+ deficit hypocalcaemia. Risk for injury related to tetany and seizures. Activity intolerance related to neuromuscular inability
What labs are drawn for a patient who has a suspected MI- Serum cardiac markers. CK= creatine kinase (AKA CPK, CK2, CK-MB). Troponin T and I
Describe the ongoing assessment for a patient with a CBI Patency of the catheter ensuring free flow, monitor Input and output. Assess for bladder discomfort, spasms, and distention. Color of urine, I+O,
Define tetany nerve excitement and sustained muscle contraction. Common with low ca+ (hypocalcaemia)
Nasogastric Tube NG- feeding tube into nose to the alimentary tract. Traditionally into the stomach.. Short term use both for food and suctioning.
Nasoenteric Tube (aka nasointestinal tube) inserted via nose into upper small intestines. Longer than NG. Better for patients at risk for aspiration.
Purpose of a heart catheterization Diagnostic test, insertion of radiopaque catherter into heart. Measures pressures, camera. Can also be used directly to treat certain problems. For CAD, heart diseases, valves, congenital defects, function.
sequalae of a heart catheterization Sequalae=negative effect Bleeding, hematoma, allergic reaction to contrast, kinking, breaking of catheter. Can puncture ventricles or lungs. Damage to the heart causing stroke, heart attack, and heart failure. Can cause death.
Most common cause of pulmonary emboli- Blockage of pulmonary arteries by thrombus (fat or air). Most common cause is DVT dislodgement traveling to lungs.
Normal Ca+ level is 8.5-10.5
Explain patho of pneumothorax- Pneumothorax= air in pleural space. Partial or complete collapse of lung results. Usually result of trauma chest injury. Closed= no external wound. Open= opening in chest wall.
Why is HTN the silent killer, use details of the patho of this disease Usually asymptomatic until becomes severe and target organ disease has occurred? s/s = fatigue, dizzy, palpitations, angina, dyspnea.
HTN can cause what? Patho- coronary artery disease, ventricular hypertrophy, HF, CV disease, atherosclerosis, PVD, retinal damage.
Describe and explain pathophysiology of heart failure CAD and advancing age primary. Also htn, diabetes, smoking, obesity, high cholesterol.
Describe and explain the classic S/S of right sided heart failure- Signs- weight gain, edema, ascites, Jug vein distention, symptoms= fatigue, anxiety, RUQ pain, anorexia, nausea.
Describe and explain the classic S/S of Left sided heart failure- Signs= pulse changes, tachycardia, crackles, Pleural effusion, ALOC, restless, confusion. Symptoms= weakness, fatigue, anxiety, depression, dyspnea, shallow resp, tachypnea, orthopnea, dry cough, nocturia, frothy pink sputum.
Antidote of Coumadin Vit K
If you suspect hyperkalemia what assessments will you make (physical and Labs) Elevated potassium- N/V, Diarrhea EKG changes (T wave) Labs- BMP
Normal K+ level 3.5-5.0
Explain pathophysiology of intermitten claudication Ischemic muscle due to restricted arterial blood flow. Pain precipitated by activity and relieved by rest. With PAD arteries are narrowed or blocked so oxygen cant get in. Cells give off lactic acid causing pain we feel known as intermittent claudication.
pathophysiology of classic heart failure caused by an interference with normal CO-preload, afterload, myocardial contractility, HR and metabolic rate. Systolic failure most common cause s/s: sudden weight gain(2 in 1 or 4 in 7), edema SOB w/activity, orthopnea, cough, extreme fatigue, oliguria
What is classification of medications is most often prescribed "first" with HTN Diuretics, TZD (hydrochlorothyozide)
Formula for Pack Years PPD x years= Pack years
Why is grapefuit juice commonly contrindicated with cardiac meds? Decreaes metaolism of drug and increases effect of the drug
What diet teacing is important for a person taking spironolactone (Aldactone)? Watch their K+ intake wouldn’t increase K+ watch diet teach pt food high in K+ and have pt monitor K+ intake
"Aldactone" spironolactone= diuretic. For HTN. Not K+spairing. Monitor Electrolytes especially potassium
S/S Digoxin Toxcity Dysrythmias including bradycardia or tachycardia, headache, fatiue, malaise, confusion, convulsions, colored vision ( seeing green, yellow, purple) halo vision, flickering lights, anorxia, nausea, vomiting, diarhea
What function (s) does calcium serve in our body? Bone Density, permability of cell membranes for transmisions of nerve impulses and neuro muscular excitiblity and for normal cardiac function also blood coagulation, activating enzyme reactions and hormone secretion
What labs are monitored with the administration of "statin" drugs? Liver function ALT AST, Cholestorol, triglycerides, kidney- BUN and creatnine HDL, LDL, VLDL
What's the best treatment for early dehydration increase oral fluids intake
Diffrentiate between left and right sided HF. What are early signs of each? Right side perphiral edema "hard time putting on your shoes"! Left side Shortness of breathe and cough! Left side is affecting the pulmoary sytem and right side is affecting the venous circulation.
Why are allergies determined before any procedure? What allergies do the HCT specifically look for? Allergies are determined for patient safety!! Latex,iodine, betaidine, food allergies, drug allergies!
Why are women more apt to die of massive MI then men Women present diffrently then men and generally wait wait medical attention
S/S of HF Tachycardia, fatigue, edema, nocturia,skin changes, chest pain, weight changes, behavioral changes, LOC
nitrates nitroglycerin, isordil. function as vasodilators, especially within the coronary arteries. decrease the afterload on the heart, used to treat angina. NEVER give with ED drugs such as Viarga, or Levitra. Can cause hypotensive crisis.
Calcium Channel Blockers Calcium channel blockers are used to treat hypertension, dysrthymias, etc. not used in 2nd or 3rd degree heart block. they provide muscle relaxation which promotes vasodilation. used in raynauds disease.
ACE inhibitors ACE inhibitors prevent vasoconstriction and release of aldosterone, decreasing both the preload and afterload on the heart. also good for renal function in diabetic patients.
Beta Blockers BB decrease the heart rate and contractility (watch in asthma and COPD patients) which decreased the afterload and oxygen demand on the heart.
Digitalis Digitalis decreases the heart rate to allow for more ventricular filling time, and increased the strength on contracility.
3 chambers of chest tube system collection, water seal, and suction control
In what condition is chvostek's and trousseau's explain patho of this process hypocalcemia, Low ca levels allow na to move into excitable cells, decreasing the thershold of action potentials. Results in increased nerve excitability.
Justify the physician ordering a urine osmolality when there is a specific gravity on the chart urine osmolality is more EXACT measurement of urine concentration because specific gravity depends on the specific weight and gravity of the particles in the urine. Osmolality is greater accuracy over a longer period of time.
Hyperkalemia S/S hyper has a greater effect on cardiac muscle. T wave elevation is seen with hyper, and cardiac arrest may occur. face, tongue,fingers, toes, leg weekness are seen with hyperkalemia.
Hypokalemia S/S hypo is flat or inverted T waves. decreased GI motility is seen with hypo.
Purpose of Halter Monitor recording of EKG rhythm for 24 to 48 hours. Corrlating rhythm changes with symptoms recorded in a diary. Pt activity is encouraged to stimulate conditions that produce symptoms.
Define Empyema A pleural effustion that contains Pus within the pleural cavity. Caused by infection from pneumonia, lung abscess, and infection of surgical wonds of the chest.
Pt teaching tool for CAD read labels, comply with cardiac diet. decreased Na intake, low fat intake, no smoking, no alcohol, exercise, take meds as prescribed, stress reduction. Follow up appointments.
collection chamber fluid or air from chest cavity.
water seal chamber 2cm of water acts as one way valve. Bubbling initial or during coughing ok but sustained not. Tidaling seen here and a good thing. If not present patient healed, kink in tube, or obstruction.
suction control chamber Wet or dry- Wet=20cm of water. Air bubbles up as excess pressure relieved. Dry=Suction set at 20cm.
Chest tube system assessments Assess- tube strait, unit below patient, upright, water levels appropriate, tidling present, constant bubbling means air leak in water seal chamber, tape connections.
Why would someone be prescribed Kaexalate (sodium polystyrene sulfonate) for treatment of hyperkalemia. Works in intestine where K ions are exchaged for Na ions.
Describe how physically nitroglycerin works to prevent angina Nitro is a vasodilator. When it gets into the blood stream it dilates all blood vessels, especially the coronary arteries. Dilated veins and arteries move more oxygen into tissue.
What side effects of beta blocker can mask symptoms of hypoglycemia, in diabetics A hypoglycemic symptoms is tachycardia. Beta blockers decreases the heart rate and therefore can mask one of the symptoms of hypoglycemia.
List risk factors for CAD HTN, >200 cholesterol, low HDL and high LDL, high triglycerides, smoking, excessive alcohol intake, increase Na intake, high fat diet, African American, family history, age.
Are Ted hose prescribed for venous or arerial compromise or both Venous only. Promotes venous return but causes arterial promblems with obstruction of flow.
What is atelectasis Collapse of the alveoli due to decreased surface tension of the alveoli
What is important to prevent atelectasis in your patient teach patients to TCDB. Deep breathing stimulates the secretion of surfactant from the alveoli, keeping them open. Give an IS and tell to do deep breathing exercises 5-10x an hour
Purpose of EKG only test that can tell when an MI is actually occurring. It can detect the rhythm of the heart, activity of a pacemaker, conduction abnormalities, position of the heart, size of atria and ventricles, presence of acture injury, and history of MI.
Identify classification and uses and precautions for ACE inhibitors antihypertensive- prevents fluid retention by agiotensinI conversion process. Good for DM. K sparing, watch for hyperkalemia. causes dry cough.
Most dangerous complication of DVT is? Pulmonary Embolism
Early S/S of PE restlessness and confusion due to decreased oxygen getting to the brain. More severe symptoms may consist of pallor, increased HR, RR, BP and dyspnea, oxygen stats going down, cyanosis, chest pain, etc.
What target organs does HTN hit kidneys, eyes, heart, brain, and peripheral blood vessels
How does HTN effect target organs Damages vessels obstructing/reducing blood flow to organs. Organs starve for blood, eschemic and can injure or die.
DAVE Dangle arterie, Venous elevate
Why do we dangle artery insufficiency and elevate venous insufficiency Dangle artery so blood flow can get down to the legs and feet via gravity, and we elevate venous so that blood can get back to the heart flowing via gravity.
How does aspirin work in the prevention of heart attack Aspirin is an antiplatelet, so prevents those platelets from forming on the plaque, decreasing the risk for a thombotic plaque and blocking of the artery.
Therapeutic value of PT/INR 2-3 secs
What does PT/INR lab monitor Coagulation times achieved with coumadin/warfarin therapy.
reversal agent of coumadin/warfarin Vitamin K
If you suspect hyperkalemia what assessments will you make (physical and lab) EKG, electrolytes, BUN, Creatinine. Check med history, ABG's for acidosis. Assess for numbness or tingling or signs of paralysis.
pneumothorax Air in the pleural space causing increased pressure and possibly the collapse of a lung. It rids the pleural space of its negative pressure, making the pressure in the pleural space positive, potentially collapsing the lung.
hemothroax blood accumulating in the pleural space ridding it of the negative pressure, causing positive pressure and the collapse of a lung. It can be caused by trauma.
Why would you determine allergies before you obtain consent for a cardiac catheterization Latex, contrast medium, iodine, shellfish, metformin, kidney function
Distinguish appropriate situation when a person would be on Coumadin and heparin Post surgery or trauma. Can take 3 days for coumadin levels to reach theraputic levels. Heparin for coverage while waiting.
Infer the triangle of digoxin-Lasix-potassium. How does K+ level effect digoxin levels Lasix removes K so supplement is necessary. Dig can become toxic in improper k levels so monitor is needed. When on dig and lasix, especially important to avoid hypokalemia.
Thereapeutic value of PTT
What IV solution is always hung with blood Normal saline 0.9%NaCl. Avoids fluid shifts and celular shrinking or swelling.
Identify classification and uses and precautions for NTG Nitro, vasodialator, for angina, avoid with ED meds, monitor for hypotensive crisis. Pt- teach moving slow sitting and standing.
Your client is on a "statin" drug, What labs are you planning to follow up on? Liver Panel..elevated AST and ALT may indicate liver damage. Cholesterol, HDL, LDL, VDL, triglycerides It might take 6-8weeks for drug to start working. Can cause rhabdomyelosis so its important to look at kidney function (BUN, Creatinine)
menu that is high in potassium High: Bannanas, spinach, tomatoes, mushrooms, apricots, winter squash
foods that are low in potassium Low: bread cake coffee pies rice tea, bean, cabbage, kale, lettuce, onions, bluberries, watermelon…..Low: sweets, breads, pastas
When assessing a person for possible digoxin toxicity, what symptoms would the nurse specifically look for Yellow/green halos, GI disturbances, confusion, dysrhythmias
What indicators do we have patients montor for when they are sent home agter Dx of HF Medications, Activity, Weight (same time every day), diet, signs and symptoms.
Describe the role of intracellular and extracellular fluids The role of body fluids are to transport nutrients, electrolytes, oxygen to cells, and carry waste products away from cells. Body fluids also lubricate joints, membranes, and are a medium for food digestion.
Name specific intracellular and extracellular electrolytes. ICF - Prevalent (K+) (PO4-) w/sm amts of (Mg+)(Na+)(HCO3-). ECF - Prevalent (Na+)(Cl-) w/sm amts of (K+)(Ca+)(Mg+)(HCO3-)(SO4-)(PO4-)
What is the most commonly prescribed "statin" drug? Atorvastatin (Lipitor) is the most common prescribed class of cholesterol-lowering drug.
Describe "statin" drugs Statins inhibiting the synthesis of cholesterol in the liver by blocking hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase. best administered at bedtime, to correlates with the natural diurnal (daytime) rhythm of cholesterol production in the body.
Isotonic solutions Isotonic - NS (0.9% NaCl), LR (Lactated Ringers), D5W (isotonic in bag, but hypotinic in person!) Administrations expands only the ECF. There is no net loss or gain from the ICF.
Hypotonic solutions A hypotonic solution is a fluid that has a lesser concentration than within the cell, causing the fluid to enter the cell and making it grow and eventually burst.
Hypertonic solutions A hypertonic solution is a fluid that has a greater concentration than within the cell, pulling fluids out, causing the cell to shrink.
If you suspect hyponatremia what assessments will you make (Physical & Lab) Assess for s/s of Confusion (halmark s/s), anorexia, N&V, weakness, lethargy, muscle cramps, twitching, sezures. Labs - Electrolyte Na < 135 mEq/l. Treatment - Restrict fluids (safest)
Why doesn't lovenox (low molicular weight heparin) have to be monitored by lab draws? Lovenox (enoxaparin), is a LMWH (Low molecular heparin), which is synthetic and has a smaller molecular structure than heparin. Lovenox is much more predictable.
If you suspect hypocalcemia what assessments will you make ( physical and Lab)? S/s of positive Trousseau sign & positive Chavostek's sign (Halmark s/s), diarrhea, numbness, tingling of extremites, convulsions, At risk for tetany. Lab - (Ca++ < 8.5 mEq/l)
onset, duration, action and monitoring of Coumadin (warfarin) Coumadin (warfarin)- Onset can take 24-72 hr, duration 2-5 days, monitor with PT/INR, inhibits vit K synthesis in the GI tract.
onset, duration, action and monitoring of heparin Heparin- depending on route onset IV: immediate SubQ: 20-30 min, duration IV: depends on infusion duration SubQ: 8-12 hrs, monitor with aPTT, heparin turns off coagulation pathway.
Identify Classification and uses and precautions for beta blockers hypertension, angina, and acute stages of MI. Blocks stimulation of beta1 adrenergic receptors, also suppresses the activity of renin. Assess for BP, pulse (<60, assess again in 1 hr then notify HCP), weigh daily, edema, skin turgor
arterial diseases S/S and assessments Decreased/absent pulse, loss of hair on legs, capillary refill >3 sec Ulcers-tips of toe, fot, rounded, smooth, minimal drainage, black eschar, intermittent claudication or rest pain in foot, thickened brittle nails, thin, shiny skin, cool to touch.
Venous diseases S/S and assessments present pulses but may be difficult with edema, moderal to large amount of drainage with ulcers (yellow slough), dull ache or heavines in calf or thigh, bronze-brown pigmentation, varicose veins may be present, thick, hardened skin, warm temp, dermatitis
Purpose of stress test Used to monitor cardiac response, cardiac symptoms usually occur with acitivity due to demand on coronary arteries. Minotors vital signs and ECG for ischemic changes to diagnose LV function, CAD.
Define "plasty" Surgical Repair
Normal Na+ level is 135 - 145 mEq/L
Purpose of chest xray Shows contours, heart size, any fluid present (pulmonary congestion, pericardial effusion), anatomic changes
Construct a cardiac diet plan Dietary Approaches to Stop Hypertension (DASH)- NO salt while cooking, Low 1500mg sodium, limit frozen,canned food, milk, cheese, bread, and cereals. Increase fresh fruits/veggies, whole grains, and fiber. Lean meats, fish (salmon), low fat.
List 5 s/s mild respiratory failure Abnormal ABGs, shortness of breath, hyperventilation, Kussmaul respirations, bluish tint, decreasing O2 sats, confustion, irregular HR
List classes of K+ wasting diuretics CAI, Loop, Osmotic, Thiazide
What precautions/assessments will you make with K+ wasting diuretics? Always check K levels, and Bp prior to giving. Watch ECG for arrhythmias, liver function tests, weigh daily, I&Os, skin turgor
Explain the pathophysiology of atrial fibrillation A. Fib=numerous sites in atria fire spontaneoulsy and rapidly. PT- usually underlying heart disease,CAD, rheumatic heart disease, cardiomyopathy, hypertensive, HF,pericarditis. Acute=alcohol intoxication, caffeine use, electrolyte disturbances, stress.
How does Coumadin, digoxin, lasix, and potassium play part in the medical care A-fib pt? Coumadin-help prevent thrombus formation. Digoxin-aide regulating contractility. Lasix-help regulate BP,(HR). K+ supplement needed due to lasix being potassium wasting which can lead to digoxin toxicity with low or high potassium levels.
Antidote of heparin? Protamin sulfate
Identify predisposing factors of PVD (arterial and venous) DM, obesity, HTN, smoking, sedentary lifestyle, stress, hyperlipidemia, advanced age, prolonged stagnation
Created by: 918rider