Medsurg 1 Exam 1

Front 1

Third spacing occurs where?

Back 1

In the transcellular spaces, including pericardial and peritoneal.

Front 2

Ecf consists of what?

Back 2

Intravascular space, interstitial space, transcellular

Front 3

Edema is considered what type of spacing?

Back 3

2nd spacing in the interstitial space.

Front 4

Third spacing may present with what symptoms?

Back 4

Inc hr, decr bp, decr uo, wt gain rapid, I greater than o.

Front 5

how does the pit react to incr osmolality? Decr osmol?

Back 5

Secretes adh to retain water to decrease the concentration of blood = less pee. Decr osmo = less adh to increase blood concentration = more pee

Front 6

What is the def of dehydration?

Back 6

Pure water loss without loss of Na

Front 7

Hypovolemia s/sx

Back 7

Inc hr, decr bp, incr rr, decr uo, decr skin turgor, sudden wt decr, resstlessness, lethargy

Front 8

Nursing int for hypovolemia

Back 8

Assess electros, give fluids

Front 9

Hypervolemia s/sx

Back 9

Incr hr, incr bp, incr wt, incr edema, neck vein distention, crackles, ha, confusion

Front 10

Pt presents with crackles in lungs and confusion with ha. Possible dx?

Back 10

Hypervolemia

Front 11

Pt has vascular dehydration. What orders wood the rn expect?

Back 11

Isotonic solution such as normal saline (0.9% nacl), lactated ringers, or dextrose in water (d5w).

Front 12

Pt has cellular dehydration, the rn expects the md to order what? Explain

Back 12

Hypotonic soltn, ie 0.45% NaCl or 0.33% NaCl. Hypotonic soltn is less concentrated than cells thus fluid enters cells to try and dilute the higher concentrated cells.

Front 13

Pt has cellular dehydration, the rn expects the md to order what? Explain

Back 13

Hypotonic soltn, ie 0.45% NaCl or 0.33% NaCl. Hypotonic soltn is less concentrated than cells thus fluid enters cells to try and dilute the higher concentrated cells.

Front 14

Pt has vascular dehydrarion with edema. Rn expects dr to order what? When would u hold that order and call dr?

Back 14

A hypertonic soltn like d5ns (5% dextrose in ns), 5% dextrrose in 0.45% nacl, (d5 1/2 ns), 5% dextrose in lactated ringers (d5lr), or hypertonic saline 3%:::::::: would hold those orders if pt has kidney or heart disease.or if pt is cellular dehydrated.

Front 15

Pt has vascular dehydrarion with edema. Rn expects dr to order what? When would u hold that order and call dr?

Back 15

A hypertonic soltn like d5ns (5% dextrose in ns), 5% dextrrose in 0.45% nacl, (d5 1/2 ns), 5% dextrose in lactated ringers (d5lr), or hypertonic saline 3%:::::::: would hold those orders if pt has kidney or heart disease.or if pt is cellular dehydrated.

Front 16

How do hypertomic soltns work?

Back 16

They have greater concentration than in the cells, so fluid leaves the cells to try and dilute the vasculature, causing cells to shrink.

Front 17

A pt on lasix loses 4.4 lbs/1 kg in 24 hours. How much fluid loss is this equal to?

Back 17

2 liters. One liter of water weighs 2.2 lbs or 1 kg.

Front 18

Pt at risk for fluid imbalance. Rn should do what seven thing?

Back 18

I&O
Monitor vs, hr, posteral changes in bp of 10% or more
Neuro status
Daily wt
Skin assess
Monitor iv fluids

Front 19

The rn knows that ____ is the primary electrolyte in the ecf?
What is the normal range?

Back 19

Sodium
135-145 mEq

Front 20

a pt with poorly controlled dm (hyperglycemia) is at risk for what electrolyte imbalance?

Back 20

hypernatremia

Front 21

when replacing water in hypernatremia, the RN knows that it is important to replace fluids rapidly or slowly?

Back 21

slowly, or else cells will swell

Front 22

what is the most common electrolyte imbalance seen in hospitalized pts?

Back 22

hyponatremia
from n/v/d, ng suctioning, excessive sweating, diuretics, and too much D5W

Front 23

what does SIADH cause?

Back 23

syndrom of inappropriate antidiuretic hormone is whe adh is released regardless of plasma osmolality.
Causes hyponatremia because of the increased water retention diluting the na concentration.

Front 24

the nurse knows that the elderly are at increased risk of this electrolyte imbalance because of decreased renal function

Back 24

hyponatremia

Front 25

as Na is lost, what is reabsorbed?

Back 25

potassium

Front 26

as potassium is lost, what is reabsorbed?

Back 26

sodium

Front 27

what is the primary route for K loss?

Back 27

kidneys

Front 28

pt presents with a severe crushing injury to the legs, what does the nurse monitor for in electrolytes? what does the rn expect to be ordered?

Back 28

hyperkalemia caused by K released from hemoloyzation.
iv insulin and glucose to drive K+ back into cells

Front 29

pt just had a new ileostomy, what does the rn watch for?

Back 29

hypokalemia

Front 30

when giving potassium, the RN always assesses what before giving?

Back 30

urine output to see if it decreases
and also checks mag levels - if too low the kidneys will excrete K to preserv mag, so replace mag with or before K

Front 31

the nurse knows that as phosporus goes down, what goes up and vice versa?

Back 31

Calcium

Front 32

how does the parathyroid gland regulate Ca levels in serum?

Back 32

releases parathyroid hormone which stims movment of ca from bone to plasma and increases GI absorption of Ca

Front 33

what is needed for pth to regulate Ca?

Back 33

Vit. D

Front 34

pt is hypercalcemic, the nurse expects to do what

Back 34

administer diuretics to promote excretion of Ca
admin IVF to hydrate and dilute Ca and increase renal excretion

Front 35

pt is hypocalcemic, the nurse knows this by what s/sx?

Back 35

positive chvosteks or trousseau's sign
parestesia, numbness, muscle spasm, hyperreflexia progressing to tetany

Front 36

pt is receiving a blood transfusion, what electrolyte imbalance might he have

Back 36

hypocalcemia

Front 37

nursing interventions/collaborative care for hypocalcemia

Back 37

replace Ca+, treat cause
IV Ca give slowly over time, fall preventions

Front 38

acronym for electrolytes with values:

Back 38

Meg's - Mg: 2 (1.5 - 2.5)
Phone - Phosphorus: 2 (2.5-4.5)
Keeps - K (Potassium): 3.5 - 5.0
Calling - Calcium: 8-10
Nancy - Na (Sodium) 135-145

Front 39

pt presents with premature arrhythmias, bradycardia, and heart irritability, fatigue/lethargy, what electrolyte imbalance might he have

Back 39

hypokalemia

Front 40

the nurse knows to do what when giving potassium iv?

Back 40

use a pump and infuse slowly

Front 41

decreased clotting time can be caused by what e- imbalance?

Back 41

hypercalcemia

Front 42

pt presents with slowed cardiac activity and asystole, what e- imbalance could be the cause?

Back 42

hyperkalemia

Front 43

loss of deep tendon reflexes can be caused by what e- imbalance?

Back 43

hypermagnesemia

Front 44

pt with new ileostomy and receiving nasogastric suctioning is feeling lethargic, hr 125 and irregular, bp 90-52, ingling in fingers and toes. What imbalances might be going on.

Back 44

Hypokalemia - ileostomy and ng suctioning can cause na and k loss through fluid loss.

Front 45

Pt on digoxin for arrythmias... what imbalance would you hold his med for?

Back 45

hypokalemia because it increases the risk of dig toxicity

Front 46

what two imbalances can be caused by ng suctioning?

Back 46

hypomagnesemia and
hypokalemia

Front 47

what imbalance can be caused by crushing and burn injuries?

Back 47

hyperkalemia - potassium normally is in the icf but burns tumor lysis or crushing injuries release the K into the ECF

Front 48

addisons disease increases risk of

Back 48

hypomagnesemia

Front 49

hypermagnesemia may be treated how?

Back 49

with IV calcium to restro Ca-Mag balance

Front 50

pt with crushing or burn injury may present with

How treated?

Back 50

muscle weakness

bradycardia, asystole

Hyperkalemia treated with iv insulin and glucose to drive K back into cells

Front 51

WBC normal values

Back 51

5-10

Front 52

Hgb normal values

Back 52

13 - 17 (15)

Front 53

Hct normal values

Back 53

42-52%

Front 54

Platelet normal values

Back 54

140000-400000
Should be above 100,000

Front 55

normal prothrombin time

normal partial thromboplastin time

normal INR

Back 55

11-13 sec

24-32 sec

2-3

Front 56

Normal BUN

Back 56

Bunnies less than twunny (less than 20)

Front 57

Normal creatine

Back 57

creatures blue should be less than two (less than 2)

Front 58

acronym for electrolytes with values:

Back 58

Meg's - Mg: 2 (1.5 - 2.5)
Phone - Phosphorus: 2 (2.5-4.5)
Keeps - K (Potassium): 3.5 - 5.0
Calling - Calcium: 8-10
Nancy - Na (Sodium) 135-145

Front 59

nursing care for the pt with hyponatremia includes what?

Back 59

fluid restriction because water is leaving the ecf and entering the cells causing swelling - we don't want more water adding to the problem

Front 60

a pt receiving loop diuretics should be observed for what symptoms?

Back 60

weak, irregular pulse,, poor muscle tone
sx of dehydration because loop diuretics cause excretion of NaCl, which causes water to follow

Front 61

a pt with renal failure is at high risk of developing what e- imbalance?

Back 61

hypermagnesemia because mag is secreted via kidneys

Front 62

a pt who has just undergone a total thyroidectomy must be assessed for what?

Back 62

positive chvosteks or trousseaus (hypocalcemia) to see if hyperthyroid is intact

Front 63

a pt with hyperphosphatemia will be treated with

Back 63

calcium supplements because as Ca rises in serum, it causes exretion of phosphate

Front 64

hypokalemia is associated with what ECG changes?

Back 64

the presence of a U wave

Front 65

hyperactive bowel sounds are a sx of what imbalance?

Back 65

hyponatremia

Front 66

foods high in potassium include

Back 66

avacado, banana, cantaloupe, carrots, fish, mushrooms, oranges, ptoatoes, raisins, spinach, strawberries, and tomatotoes, pork, beef, veal

Front 67

foods high in calcium include

Back 67

dairy, collard greens, rhubarb, sardines, spinach, tofu

Front 68

rn interventions for anemia

Back 68

O2 admin
blood/blood product admin if symptomatic
drug therapy (iron, erythropoietin)
dietary changes to increase iron intake
education

Front 69

Hgb measures what?

Back 69

the total amount of Hgb in peripheral blood

Front 70

Hct measures what?
Normal value should be?

Back 70

percentage of total blood volume made up of RBCs'
Should be around 40
males 40-54
females 38-47

Front 71

what is TRALI

Back 71

transfusion related lung injury

Front 72

what is TRACO and how does it present differently than TRALI? What common sx does it share with trali?

Back 72

transfusion related circulatory overload
no fever or hyptension
dyspnea, crackles, change in LOC

Front 73

15 minutes after starting a PRBC transfusion, the pt becomes restless and complains of itching. what should the nurse do FIRST?

Back 73

Stop the transfusion!!!!

Then open up saline, get vs and call for help

Front 74

pt has been diagnosed with anemia, what s/sx might the rn expect

Back 74

PALENESS #1 sign
glossitis
cheilitis (inflam of lips)
headache
parasthesias
burning sensation in tongue

Front 75

when and what might the rn give to a pt with his po iron supplement?

Back 75

1 hour before meals with vitamin c/orange juice.
If liquid, give with straw to avoid teeth staining

Front 76

if pt is put on life time iron supplements, what is necessary to monitor?

Back 76

liver function because iron is stored in the liver

Front 77

pts with chronic kidney disease are susceptible to what blood condition? why?

Back 77

anemia, because the kidneys production of erythropoitin is reduced so new blood cell production goes down.

Front 78

why does inflammatory chronic disease cause anemia?

Back 78

cytokines cause macrophages to uptake and retain Fe, leaving inadequate Fe for RBC production

Front 79

definition of thrombocytopenia

Back 79

platelets below 150,000

Front 80

the nurse notices oozing from iv site on her patient, what might she suspect?

Back 80

thrombocytopenia

Front 81

define ecchymoses

Back 81

large purplish lesions, flat or raised, painful and tender, caused by thrombocytopenia

Front 82

thrombotic thrombocytopenic purpura (TTP)

Back 82

agglutination of platelets cause microthrombi that depositi in the vasculature accompanied by bleeding from low platelets and clumping of the ones that do exist.

Front 83

when might a platelet transfusion be performed in a thrombocytopenic pt?

Back 83

when platelets go below 10000

Front 84

what meds might be used in a thrombocytopenic pt?

Back 84

immunosuppressants such as azathioprine (Imuran) or cyclosporine

Front 85

nursing eductation of the thrombocytopenic pt?

Back 85

dab nose instead of blowing it

Front 86

define neutropenia

Back 86

decreased neutrophil count

Front 87

pt has been on long term chemotherapy, what are they at high risk for developing?

Back 87

neutropenia

Front 88

pt presents with an oportunistic infection but has now s/sx of inflammation, no redness, heat, swelling, or puss. What does the nurse suspect?

Back 88

neutropenia

Front 89

in a neutropenic pt, what is the best indicator of infection?

Back 89

fever greater than 100.4

Front 90

appropriate nursing actions when caring for a severely neutropenic pt include

Back 90

strict hand hygiene and frequent VSs

Front 91

pt presents with bleeding gums, petechiae, what does the nurse suspect?

Back 91

thrombocytopenia

Front 92

neutrophil count in normal and neutropenic conditions

Back 92

Normal = 4000 - 10000
neutropenia = <500 or an absolute neutrophil count (ANC) of less than 1000

Front 93

neutropenic precautions and education

Back 93

reverse isolation,
limited visitors, no kids or sick
positive pressure or HEPA filter
no fresh fruits/veg, flowers
no sunburn, avoid public places and animal

Front 94

describe the RBCs in iron-deficiency anemia

Back 94

microcytic and hypochromic

Front 95

what deficiency might result in macrocytic yet normochromic RBCs?

Back 95

Vit B12 or folic acid

Front 96

what is the most important, mature form of WBCs?

Back 96

neutrophils

Front 97

pt presents with splenomegaly, jaundice and pruritus, pallor, tachycardia, and fatigue. What does the nurse suspect?

Back 97

anemia with hemolysis occuring

Front 98

polycythemic pts are at high risk of what?

Back 98

thrombosis

Front 99

describe the RBCs in iron-deficiency anemia

Back 99

microcytic and hypochromic

Front 100

polycythemia

Back 100

stem cell mutation leads to increased productionof rbcs, wbc, and platelets

Front 101

s/sx of polycythemia vera

Back 101

htn, ha, vertigo, tinnitus, visual disturbances,
pruritis (itchiness), parethesias and redness of hands and feet, thrombophlebitis, intermittant claudication

Front 102

tx for polycythemia vera?

Back 102

phlebotomy to reduce Hct to less than 45%, removal of 300-500 mL, iv hydration, myelosuppression (bone marrow activity suppression with drugs), I&O, thrombus prevention

Front 103

Normal arterial blood pH should be between

Back 103

7.35 and 7.45

Front 104

normal PaO2

Back 104

65 - 100

Front 105

nsg interventions for atelectasis

Back 105

prevention
cough/deepbreathing/incentive spriometer (CDB/IS)
turning
ambulation
pain mgmt

Front 106

if PN is hospital acquired, then it occured when

Back 106

greater than 48 hours after hospitalization

Front 107

risk of aspiration increases with what?

Back 107

a decrease in LOC

Front 108

pt presents with coughing of purulent sputum and hemoptysis, decreased bs and crackles, fever, chills pleuratic pain, what does the RN suspect?

Back 108

Lung abscess

Front 109

who is at highest risk of lung abcess?

Back 109

anyone with increased aspiration risk ie from lowered LOC from anesthesia, etc. because most lung abcesses are caused by aspiration of material from the GI tract

Front 110

definition of pulmonary hypertension (PPH)

Back 110

mean pulmonary arterial pressure > 25 mmHg at rest

Normal pressure is 12-15

Front 111

Pulmonary Hypertension mimics what disorder?

Back 111

right sided heart (right ventricular) failure

Front 112

Upon cardiac assessment, what might the RN hear in a pt with pulmonary hypertension?

Back 112

the RN detects an S4 gallop,

Front 113

pt presents with white fingertips which turn blue and then red with tingling and burning. What does the RN suspect?

Back 113

Raynauds syndrome, which could be associated with pulmonary hypertension

Front 114

during a status asthmaticus attack, what might the nurse request to add to the treatment regimen of bronchodilators?

Back 114

Lorazepam

Front 115

Normal Cardiac output.

Back 115

4-8 L/min

Front 116

general cardiac symptoms

Back 116

SOB, dyspea, rales, wt gain, nocturnal diuresi, generalized fatigue.

Front 117

Arterioles are resistance vessels that change diameter under what stimulation

Back 117

Autonomic nervous system (ANS

Front 118

pulse pressure is what?

what is normal

Back 118

systolic - distolic

30-40 mmHG

Front 119

your patient's pulse pressure is 20 mmHG, what does this indicated

Back 119

90/70 pp = 20mmHg (patient is vasoconstricted b/c of BP; trying to compensate)

Front 120

blunted baroreceptor response is a clinical implication of what?

Back 120

normal aging in the CV system

Front 121

preload definition

Back 121

The volume blood in the ventricles at end diastole before the next contraction begins.
↑preload: more fluid is left in the ventricle so, the harder the heart has to pump, to move it forward (↑ O2 consumption)

If preload stretches the myocardium beyond its physiological limits, contractile force ↓, SV is reduced, therefore cardiac output is reduced

Front 122

afterload definition

Back 122

The resistance against which the left ventricle must pump against to eject the volume. (open the aortic valve)

Front 123

what is a physical change that occurs in the heart r/t increased afterload?

Back 123

left ventricular hypertrophy

Front 124

LDL is considered "_____? and should be at what level?

Back 124

BAD
less than 130

Front 125

HDL is considered "__? and should be at what level?

Back 125

GOOD
35-85

Front 126

triglycerides should be at what level?

homosysteines?

Back 126

less than 150

4-15

Front 127

what is MAP?

Back 127

mean arterial pressure:(SBP+2DBP)÷3 (avg BP in arterial system felt by organs

adequate arterial pressure is needed for cap perfusion

Front 128

describe the two theories of HTN cause:
hemodynamic
vasoconstrictor

Back 128

Hemodynamic hypothesis: ↑SNS activity, inappropriate renin-angiotension-aldosterone system (RAAS) stimulation
Vasoconstrictor hypothesis: inappropriate Ca+2 in smooth muscles

Front 129

the sympathetic nervous system stimulates the renin angiotensi system to do what

Back 129

increase Na and increase h2o, which increase preload and cardiac output.

Front 130

baroreceptors sense low BP and cause the secreation of what hormone?

Back 130

ADH

Front 131

vasoconstriction does what?

Back 131

increases preload AND afterlowad, which increases o2 consumption and stresses heart muscle/

Front 132

what is the single biggest problem resulting from HTN>

Back 132

end organ damage
heart: lv hypertrophy
kidneys: increased RAAS stim perpetuates HN
Brain: increased risk of hemorrhage
Retinas: hemorrhage
Aorta: aneurysm and rupture

Front 133

the RN knows to question orders for what type of diuretic for a heart pt with renal failure?

Back 133

potassium sparing duretics

Front 134

what nursing concern should you monitor for for anyone on any type of diuretic?

Back 134

hypostatic hyptension and electrolyte imbalances

Front 135

you pt presents with obesity, triglycerides over 150, HDL less than 40, fasting BG over 100, and HTN. What do you expect his diagnosis will be? What is needed to prevent a cardiovascular event?

Back 135

Metabolic syndrome
Heart Healthy Life Style Education
Exercise
Tight BG management
Management with medications
antihypertensives, statins, insulin,

Front 136

a pt with a HR of 180 bpm, what is your concern and why?

Back 136

coronoary arteries receive o2 during diastole, which is not happening with that high of a HR. Concern is MI

Front 137

what is number one modifiable risk factor for all CAD/MI pts?

Back 137

smoking cessation

Front 138

If chest pain occurs with activity, lasts 3-5 min but is relieved by rest and/or nitrates, what might the dx be?

Back 138

chronic stable angina

Front 139

a diabetic pt presents with increased blood glucose and fatigue - what would the nurse be concerned about?

Back 139

angina - neuropathies may be present, lowering sensitivity to pain.

Front 140

your female pt has been diagnosed with panic/anxiety disorder and complains of an aching jaw/choking sensation, what would the RN be concerned about?

Back 140

angina

Front 141

over the age of 70, chest pain does not aloways occur. what might you see instead?

Back 141

dyspnea and indigestion, confusion or disorientation

Front 142

in your pt with chronic stable angina, what medications would you expect?

Back 142

Nitrates, sublingual nitroglycerin
Beta blockers
Low dose ASA
Calcium channel blockers

Front 143

how does nitroglycerin help in angina or ischemic events?

Back 143

Vasodilates coronary veins and arteries
Relaxes systemic arteriolar bed, decreasing SVR

Front 144

your pt is on nitroglycerin what must you monitor for?

Back 144

orthostatilc hypotension
and
tolerance over long term

Front 145

how do beta blockers work?

Back 145

block the excitation of beta receptors which lowers o2 consumption, lowers HR, lowers BP, lowers contractility. This all increases stroke volume and increase o2 to myocardial tissues by slowing the heart down (more blood to coronary arteries during diastole)

Front 146

your pt is on beta blockers, what must you watch for?

Back 146

Hypotension
Hyperglycemia (drug specific)
Bronchoconstriction
Hyperlipidemia

Front 147

calcium channel blockers work how?

Back 147

block mvment of Ca into cells, causing vasodilation, decreased HR, decr contractility and systemic vascular resistance . Reduces O2 demand by the heart.

Front 148

Your pt is on Ca channel blockers, what must you watch for?

Back 148

Cardiac arrhythmias
Hypotension
Constipation
Gastric distress

Front 149

ACE inhibitors work how?

Back 149

ACE is in blood vessel lumens and converts angiotensin I IIpreload andBP
ACE inhibitors BLOCK this mechanism
decreases BP
decreases SVR
decrease myocardial work during systole
Causes Diuresis

Front 150

your pt has been admitted to the ER with anxiety, increased HR, increase RR, diaphorsis and fever, arrhythmias, n/v and
FEELINGS OF DOOM
What is the probable diagnosis?

Back 150

Acute Coronary Syndrome

Front 151

your pt who has had a h/o chronic stable angina complains that his chest pain has "changed". What are you thinking?

Back 151

Unstable angina: acute coronary syndrome

Front 152

your pt has just had a cardia catheterization procedure. What are you doing and watching for?

Back 152

Assess circulation in extremity used for catheter insertion
Observe insertion site for hematoma and bleeding
Place compression device over catheter insertion site
Monitor VS and cardiac rhythm
Monitor for s/s of PE
Affected leg should remain straight

Front 153

Pt presents in the ER with severe CP unrelieved by rest, pressure, tightness radiation to jaw, neck, down arms, weakness, SOB
what is probable diagnosis

Back 153

myocardial infarction

Front 154

what labs would you expect to see rising 3-12 hours and peak 24 hours after an MI?

Back 154

Creatine kinase myocardial bands (Ck-MB)

Front 155

it has been 4 days since your pt says he experienced chest pain but didn't come in for it. What labs are you interested in seeing?

Back 155

cardiac-specific tronponin I (cTni) because they rise 3 hours after an MI but don't return to baseline until 5-14 days after. Ck-MB would not be a good lab for indicating MI this far after because it returns to normal after 48 hours

Front 156

your pt has a Ck-MB level of 1.0 - what is your expectation of dx?

Back 156

that an MI has not occurred. Levels of more than 2.5–3 are more indicative of an MI.

Front 157

What cTni levels are you looking for to indicated an MI has occurred?

Back 157

over five or any detection at all really

Front 158

in a pt with a 40 year history of diabetes with newly diagnosed angina, how will an MI most likely present?

Back 158

Malaise, hyperglycemia, nausea and vomiting

Front 159

you have a pt in your ER who has suffered a non-STEMI. The nurse would question orders for what?

Back 159

Clot buster medications such as:

tissue plasminogen activator
recominant plasminogen activator
streptokinase
ONLY USED IN STEMI

Front 160

What would you see as a sign that the clot buster is working when given to a pt with STEMI/

Back 160

reduced ST elevation and improved cardiac enzyme level

Front 161

you would monitor the effectiveness of Heparin with what lab?

Back 161

therapeutic PTT value should be 65 to 95 seconds, but this varies by the hospital.
If the PTT shortens to below the therapeutic range, danger of having a second heart attack. Often second attacks are fatal. PTT results that are longer than the high limit indicate a risk of bleeding.

Front 162

how would you monitor the effectiveness of coumadin?

Back 162

Most people taking Coumadin should have an INR between 2 and 3. An (PT) INR below 2 signals the danger of a new clot, whereas an INR over 4 means a risk of dangerous bleeding.

Front 163

what does the RN do post-op for a pt who has just had an artery bypass surgery?

Back 163

Ambulation
Sternal precautions
Pain control
IS/deep breathing
Incision care
Manage chest tubes/pacer wires.
Monitor hemodynamics, urine output, heart rhythm, fluid & e-lytes

Front 164

your pt's ejection fraction has just been determined to be 30%. what might your patient's diagnosis be? Define it.

Back 164

Low Output Heart Failure (systolic dysfunction): LV is unable to eject normal blood volume with each beat
Normal EF = 60-75%

Front 165

what are some causes of low output HF

Back 165

LV or RV failure
PHTN (pulmonary hypertension)
Valve stenosis

Front 166

define high output heart failure and list some causes

Back 166

Too much blood for the LV to eject
Excessive volume leads to LV dilatation and fluid backup into the Pul vasculature
Causes; valve regurgitation, hyperthyroidism, anemia, hypervolemia, lack of inotropic ventricular force

Front 167

what are some compensatory mechanisms with HF?

Back 167

increased HR to increase CO
increased rennin to cause vasocxn and volume retention to increase stroke volume
vasopressin released to increase vasocxn
when sv is adequate BNP/ANP are relased to stop these processes and decrease bp.

Front 168

describe dilated cardiomyopathy

Back 168

most common
increased dilated ventricle= decreased contraction & decreased SV, increased diastolic volume in V= increased stretch (dilate)

Front 169

describe hypertrophic cardiomyopathy

Back 169

size, mass, esp septum
incrase mass = decreased ventricle size = longer diastole, poor passive fill, increased septal mass = increased O2 consumption

Front 170

restrictive cardiomyopathy

Back 170

least common
ventricle can’t stretch
Amyloidosis (F>M

Front 171

in HF that results in poor forward flow, what doess the RN assess for and what are the treatment goals?

Back 171

Assess for cause of poor CO and treatment goals are:
Maximize CO
Improve tissue perfusion
Minimize symptoms

Front 172

what are some s/sx of decreased cardiac output?

Back 172

increased HR
****decrease Urine output/decreased renal function******
arrhythmias, ppor nutrition
****increased Diastolic BP (chronic vasoconstriction)*****
POOR ACTIVITY TOLERANCE

Front 173

your pt has SOB, rales/crackles, wet cough, nocturnal dyspnea, confusion/restlessness
WHAT DO YOU SUSPECT?

Back 173

left sided HF

Front 174

your pt has systemic edema, weight gain, hepatomegaly, ascites, peripheral edema, JVD, anorexia
What do you suspect?

Back 174

Right sided HF

Front 175

what is the goal of Nursing and collaborative care for Heart Failure?

Back 175

TO MAXIMIZE CO

Front 176

what are the ways we maximize CO in HF?

Back 176

Diuretics
ACE inhibitors (ARBs if ACE intolerant)
Beta and Ca channel blockers
Digoxin
Nitrates
Synthetic BNP (Natrecor)
Manage dyspnea
Monitor labs and treat electrolytes
Renal function tests, BNP, K, Ca, Mg, Na
Exercise programs; manage fatigue
Diet mgmt
Cardiac transplantation

Front 177

In a pt with HF, the nurse knows to establish what in order to track progress.

Back 177

establish baselines

Front 178

frequently, actue heart failure presents what?

Back 178

acute pulmonary edema, usually associated with LV failure

Front 179

your pt presents with SOB, increased RR, decreased spO2, agitation/anxiety, wheezing, wet cough, and rales. What do you suspect and what is your priority?

Back 179

Left sided heart failure causing pulmonary edema.

Priority is to improve O2, and move the fluid out of the lungs with diuretics.

Front 180

How does the nurse assess for Peripheral vascular disease?

Back 180

CMS checks: Circulation, Motion, Sensation.
Peripheral pulses
Motor function
Numbness? Tingling? Pain? Loss of sensation?
Color, tempreture, swelling, hair loss?
Skin integrety
Ankle-brachial index (ABI)
Doppler probe

Front 181

your pt presents with severe pain in lower extremities, especially with activity, intermittent claudication (impairment in walking, or a "painful, aching, cramping, uncomfortable, or tired feeling in the legs that occurs during walking and is relieved by rest)
decreased to absent pedal pulses, and deep ulcers on toes and heels. No edema
WHat do you suspect?

Back 181

Peripheral Arterial Disease

Front 182

your pt presents with dull aching craming pain in lower extremities. Pulses are +1, and there is uneven pigmentation with a blue hue in the toughened skin. Moderate edema with medial and lateral ulcers are present.

What do you suspect?

Back 182

Peripheral Venous Disease

Front 183

what are your nursing interventions in PVD?

Back 183

pain relief with meds,
position pt to relieve pressure and edema in Lower extremities
Wound healing
Keep kin clean, dry, moisturized
ENCOURAGE Mobility
antiplatelet agents

Front 184

your pt has venous stasis, immobility, hypercoagulability and is dehydrated. What is he at risk for?

Back 184

Deep vein thrombosis

Front 185

your pt has dull aching pain in his leg. you pull back the covers to reveal erythema and incrased temperature in the leg. He has a + Homan's sign.
What do you suspect?

Back 185

Deep vein thrombosis

Front 186

interventions once a DVT develops

Back 186

Bed Rest
Elevate extremity
Heparin or Warfarin
Monitor for s/sx clot migration

Front 187

what are aortic aneurysms caused by?

Back 187

CAD leading to atherosclerosis: plaques lead to degeneration of vessel walls  weaken and dilate
HTN
Genetics
Congenital abnormalities
Trauma
Infxn

Front 188

in a pt with thoracic aortic aneurysm, (TAA) what is your sign and what is your priority when diagnosed?

Back 188

embolic showers may be first s/sx in brain and fingers.
back pain, SOB, hoarsenes, difficulty swallowing

control BP (HTN)
control pain

Front 189

what is the usual primary s/sx of abdominal aoritic aneurysms?

Back 189

Renal compromise

Front 190

your pt states that it feels like her heart is in her abdomen, what do you suspect?

Back 190

abdominal aortic aneurysm

Front 191

renal and Lower extremity embolic showers could be indicative of what

Back 191

abdominal aortic aneurysm

Front 192

what do elevated levels of homocystine tell you? What 's elevated?

Back 192

+ for presence of CV disease
15-30 micromoles per liter as moderate


30-100 micromoles per liter as intermediate


Greater than 100 micromoles per liter as severe