Med Surg 2 Exam

definition of ejection fraction

% of end diastolic blood volume ejected from Left ventricle with each heartbeat Normal EF is 50-65%

lymphoscintigraphy

(sentinel lymph node mapping) is an imaging technique used to identify the lymph drainage basin, determine number of sentinel nodes, differentiate sentinel nodes from subsequent nodes, locate the sentinel node in an unexpected location, and/or mark the sentinel node over the skin for biopsy.

3rd degree heart block

*

v fib

*

v tach without pulse

*

sclice interventions for exposure to poisonous venoms

- Save it, Locate help, Ice it, Compress it, Elevate it.

definition of CO

- calculation of SV X HR to estimate amount of blood ejected in Liters per minute

IgE

.004% appears in serum, active in defending against allergic and hypersensitivity reactions, combats parasitic infections

IgD

.2% role unclear

how to measure r to r interval

1 minute strip contains 300 large boxes and 1500 small boxes. Easy to count number of small boxes from R to R, divide by 1500. Another less accurate method, still acceptable, count R waves in a 6 second strip and multiply by 10.

nasal cannula or catheter L and %

1-6 L/min 23-42% 02 delivery

IgM

10% appears in intravascular serum, is first response in bacterial/viral infections

5. During cardiopulmonary resuscitation, the chest is compressed 2 inches at a rate of at least ________ compressions per minute.

100

non-rebreather L and %

12 L/min 80-100% high concentration, not high flow

1. Hypertension is defined by the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) as a systolic BP greater than ________ mm Hg.

140

IgA

15% appears in body fluids, protects agains resp, GI and GU infections, Passes to infants in breastmilk

5. A hypertensive emergency is a situation in which the BP systolic is above _____ mm Hg and must be lowered immediately

180

normal V/Q is

1:1 - ventilation matches perfusion

3. Although the incubation period for chickenpox is about 21 days, it is during the _____ days before the rash develops that the newly infected host is capable of transmitting the virus to other susceptible contacts.

2

venturi mask L and %

4-8 L/min 24-40% 02 delivery

simple mask L and %

6-8 L/min 40-60% piped in = wall access concentrator - home

IgG

75% appears in serum and tissues, assumes a major role in bloodborne and tissue infections to enhance immune system defenses. Crosses placenta

partial rebreather L and %

8-11 L/min 50-75% high concentration, not high flow

According to the gate control theory of pain transmission, passage of pain impulses may be naturally blocked: a) At the synapse by entry of other sensory impulses b) By the stress response c) By administration of morphine directly into the spinal cord d) By referring the pain to other parts of the body

A

Neutrophils: a) Are phagocytic b) Produce histamine c) Produce antibodies d) Are elevated during an allergic response

A

The nurse understands that teaching was effective when the client with rheumatoid arthritis states: a) It will get better and it will get worse again b) Once it clears up the disease will be gone c) I am glad that I will be cured d) It will never get any better than what it is right now

A

Which client, diagnosed with pneumonia, is most likely to have community-acquired pneumonia? A client newly admitted to a long term care facility. A client who recently traveled on a cruise ship A client who has had multiple family visitors A client whose spouse recently died

A

what is digitalis

A cardiac glycoside this acts on cardiac muscle to increase contractility. Not prescribed as often due to larger selection of other more target specific meds. When used, digoxin is preferred due to more bioavailability, digitoxin not used due to low bioavailability

asthma

A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production Inflammation leads to cough, chest tightness, wheezing, dyspnea The most common chronic disease of childhood Can occur at any age Allergy is the strongest predisposing factor Usually reversible

Describe cardiogenic shock and how the intra aortic balloon pump assists with ventricular ejection

A life-threatening condition, high mortality rate Decreased cardiac output leads to inadequate tissue perfusion and initiation of shock syndrome S/S Restlessness, confusion, agitation Low BP Rapid and weak pulse Cold and clammy skin Tachypnea Low urinary output - oliguria, then anuria IABP Inserted via femoral artery Rests in the thoracic aorta Inflates during rest (diastole) Deflates when heart pumps (systole)

describe bacterial endocarditis

A microbial infection of the endothelial surface of the heart Vegetative growths occur and may embolize to body tissues Usually develops in people with prosthetic heart valves or structural cardiac defects Also occurs in IV drug abusers and in those with debilitating diseases, indwelling catheters, or prolonged IV therapy

common cause for shigella

A type of food poisoning associated with poor sanitation Causes severe bloody diarrhea High virulence Fecal-oral contamination More common in children

Do NOT stop these medications suddenly- there is also more risk for orthostatic hypotension

ACE, ARBs, Beta blockers, Alpha blockers, calcium channel blockers, diuretics, digitalis

Acute Respiratory Distress Syndrome (ARDS)

ARDS: Adult Respiratory Distress Syndrome Severe condition Alveolar collapse, ↓ airway diameter, ↑ lung stiffness pulmonary hypertension and hypoperfusion r/t acute lung injury Mortality rate of 50-60% Sepsis Multiple system organ failure

acute respiratory failure (ARF)

ARF is sudden onset; life-threatening Various causes - treat underlying cause while supporting respirations Decreased respiratory drive Dysfunction of the chest wall Dysfunction of lung parenchyma Postoperative period

emphysema

Abnormal distention of air spaces with destruction of the walls of the alveoli Decreased alveolar surface area causes an increase in "dead space" Reduction of the pulmonary capillary bed increases pulmonary vascular resistance and pressures Hypoxemia is the result of these changes Increased pulmonary artery pressure may cause right-sided heart failure (cor pulmonale)

two main types of lung cancer

About 85% to 90% of lung cancers are non-small cell lung cancer (NSCLC) About 10% to 15% are small cell lung cancer (SCLC)

pulmonary edema

Accumulation of fluid in the lung tissue or alveolar space Life-threatening condition Congestive heart failure Fluid overload Flash pulmonary edema

empyema s/s, med mgmt, nursing mgmt

Accumulation of thick, purulent fluid in the pleural space - person is acutely ill S/S: fever, pleural pain, cough, dyspnea, night sweats, weight loss Medical Management Drain the pleural cavity and begin antibiotics Thoracentesis Chest tube Nursing Management (prolonged process) Supportive, assess for changes

describe gout

Acute arthritis Onset often occurs at night Pain, redness, and swelling of the affected joint Most attacks will subside over 3-10 days Attacks come and go Attacks tend to occur more frequently, in more places, and last longer *Defect of purine metabolism Crystals of monosodium urate deposit in joints and other tissues Hyperuricemia occurs (excess uric acid) in blood) Risk factors Age, BMI Genetic predisposition Severe dieting or starvation High intake of purine rich foods

Buerger's disease

Aka thromboangiitis obliterans Recurring inflammatory process of the small/ intermediate vessels of (usually) the lower extremities Probably an autoimmune disorder Most often occurs in men ages 20-35 Risk or aggravating factor: Tobacco use Progressive occlusion of vessels results in pain, ischemic changes, ulcerations, and gangrene

identify allergic rhinitis

Also called hay fever and seasonal allergic rhinitis Common respiratory allergy Affects 10% to 25% of the population Symptoms sneezing and nasal congestion clear, watery discharge nasal itching itching of throat and soft palate dry cough and hoarseness, headache

huff coughing

Also known as directive coughing Take a full, slow, maximum inspiration Hold breath 2-3 "huffs" when exhaling

stages of hiv stage 1

Antibodies in the blood indicate that the patient is infected with HIV The window period can last 3 weeks to 6 months after exposure From infection to development of antibodies High viral replication and then CD4 T lymphocyte destruction Virus replicates quickly throughout the body Usually present with flu-like symptoms Window period variable Person tests negative for at least 2-3 weeks up to 6 months

s/s of laryngitis

Aphonia / hoarseness Severe cough Sore throat Symptoms worsen in morning and at night

nursing interventions for bowel pattern in hiv

Assess bowel pattern and factors that may exacerbate diarrhea Avoid foods that act as bowel irritants Small, frequent meals Administer medications as prescribed Assess and promote self-care strategies to control diarrhea

Effective Airway Clearance: Intervention

Assess lung sounds at least every 2 to 4 hours. Measures to clear airway: suctioning, CPT, position changes, promote mobility Humidification Medications

nursing interventions for maintaining thought processes in hiv

Assess mental and neurologic status Use clear, simple language Establish and maintain a daily routine Use orientation techniques Ensure patient safety and protect from injury Implement strategies to maintain and improve functional ability Instruct and involve family

A specific defense for the body is: a) Phagocytosis b) Sensitized T lymphocytes c) The inflammatory response d) Intact skin and mucus membranes

B

Tears are considered to be part which line of defense? a) First line of defense, specific b) First line of defense, nonspecific c) Third line of defense, specific d) Second line of defense, nonspecific

B

The client asks the nurse for a definition of a nociceptor. How does the nurse reply? a) A nociceptor is a painful response to a stimulus b) Nociceptors are pain receptors that are stimulated by chemical, thermal or physical means c) Nociceptors are specialized tissues that selectively transmit impulses d) A nociceptor is a stimulus applied to any body tissue

B

The impulses related to acute pain are usually transmitted by: a) Nociceptors b) Myelinated A delta fibers c) Unmyelinated C fibers d) Any sensory fiber with a low pain threshold

B

The presence of the bacterial capsule: a) Aids in the release of endotoxins b) Protects the microbe from phagocytosis c) Increases the release of toxins and enzymes d) Prevents replication of the bacterium

B

perfusion

Blood flow through arteries and capillaries, delivering nutrients and oxygen to cells, removing cellular waste products. Cellular survival requires consistent supply and removal

chest trauma

Blunt trauma Sternal and rib fractures, dislocations Flail chest - see diagram Pulmonary contusion - tissue bruising, hemorrhage and edema (up to 50% mortality) Penetrating trauma Stab wounds, GSW - hemorrhage along with actual tissue damage Pneumothorax Spontaneous or simple (bleb, usually healthy person) Traumatic (open wound-apply pressure) Tension pneumothorax (lung wound, progressive)

pharmacologic therapy for COPD

Bronchodilators Beta adrenergic agonist agents (albuterol) Anticholinergic agents (spiriva) Combo beta 2 adrenergic agonist and anticholinergic (combivent, duovent) Methylaxanthins (theo-dur or slo bid) Corticosteroids Inhaled - budesonide (pulmicaort), Fluticasone (flovent) Oral - methylprednisolone, prednisolone Long acting Beta2 agonists Salmeterol (Serevent diskus) Formoterol (Foradil)

Bacteria that form an irregular cluster of spheres are called: a) Bacilli b) Diplococci c) Staphylococci d) Streptococci

C

Humoral immunity is mediated by: a) Natural killer cells b) T lymphocytes c) B lymphocytes d) Neutrophils

C

In which structure do pain impulses ascend the spinal cord? a) Reticular formation b) Corticospinal tract c) Spinothalamic tract d) Relevant dermatome

C

When the client complains of persistent pain that was triggered by an electrical explosion, this pain is both a) Nociceptive and Somatic b) Neuropathic and Visceral c) Nociceptive and Neuropathic d) Neuropathic and Phantom

C

laboratory indicators for myocardial injury

CK : Elevated in 3-6 hours; Peaks in 24-36 hours; Returns to normal in 3 days MB : Elevated in 2-8 hours; Peaks in 10-24 hours; Returns to normal in 3-4 days Myoglobin : Elevated in 1-3 hours; Peaks in 4-12 hours; Returns to normal in 24 hours Troponin : Elevated in 3-4 hours; Peaks in 4-24 hours; Remains elevated for 1-3 weeks; Most important lab test for an MI The lipid profile reveals status and risk for CAD. ALSO: BNP, CRP, homocysteine

ventilator settings (CMV, A/C, IMV, SIMV)

CMV is continuous mandatory ventilation A/C is assist control setting will trigger automatically but defer if the patient initiates own breath by supplementing pt's own breath - every breath achieves the preset volume. IMV - intermittent mandatory ventilation - combines mechanical ventilation with pt breaths, the mechanical ventilation mode is set for a certain interval. SIMV - synchronized so that as the patient breathes more on their own, the machine backs off. ASSESS THE EQUIPMUNK

describe sle

Can be acute (episodic flares) or more chronic (stable) Skin manifestations: butterfly rash w erythematous papules and plaques Musculoskeletal: joints Pericarditis, myocarditis Nephron damage CNS: psychoses, and neuroses

typical alpha blockers

Carvedilol. These meds the alpha1-receptors of vascular smooth muscle, thus preventing the uptake of catecholamines by the smooth muscle cells. This causes vasodilation and allows blood to flow more easily

DVT causes and s/s

Causes: Venous stasis Vessel wall injury Altered blood coagulation S/S Nonspecific Edema Leg pain Positive Homan's sign

imaging studies for the respiratory system

Chest X-Ray CT MRI V/Q lung scan

bronchiectasis

Chronic irreversible dilation of the bronchi and bronchioles - muscle and elastic connective tissue destruction Often caused by repeated pulmonary infections or obstruction r/t congenital disorders Thick sputum permanently distends and distorts the bronchial wall More common in the lower lobes Atelectasis occurs

COPD

Chronic obstructive pulmonary disease: a disease state characterized by airflow limitation that is not fully reversible COPD - 4th leading cause of death, affecting est. 27 million Americans, 1 in 12 COPD includes diseases that cause airflow obstruction Emphysema & Chronic Bronchitis Asthma is considered a separate disorder but can coexist with COPD

what is and hypertensive urgency

Client requires close monitoring of blood pressure and cardiovascular status Client is at high risk for BP emergency Assess for potential evidence of target organ damage Medications Fast-acting oral agents

describe ehler danlos

Condition of hypermobile connective tissue where skin is fragile and stretchy, Impaired healing

nursing interventions for skin integrity in hiv

Conduct frequent routine assessment Encourage patient to maintain balance between rest and activity Reposition at least every two hours and as needed Use pressure reduction devices Instruct patient to avoid scratching Use gentle, nondrying soaps or cleansers Avoid adhesive tape Provide perianal skin care

s/s of atelectasis

Cough Sputum production Low-grade fever Respiratory distress Anxiety Symptoms of hypoxia occur if large areas of the lung are affected

1.1 An anerobic organism requires which type of specific environment? a) A dry environment b) An acidic medium c) Air at a temperature less than 610 F/160 C d) The absence of oxygen

D

Which cells are required to process and present antigens from foreign material as the initial step in the immune response? a) T helper cells b) Eosinophils c) Monocytes d) Macrophages

D

discuss cardioversion

Delivery of electric current is timed with the client's heartbeat Press the "synch" button on the defibrillator NPO 4 hours before procedure Sedation Lower amount of energy (50-100 Joules)

care and education of someone with AICD

Device function ECG Cardiac output and hemodynamic stability Incision site Coping Patient and family knowledge (BCLS)

diagnosis of pneumonia

Diagnosis Sputum result WBC Chest X-ray S/S Either bronchopneumonia or lobar pneumonia depending on location - minor distinction

anaphylaxis symptoms

Difficult/noisy breathing Swelling of tongue Swelling/tightness in throat Difficulty talking and/or hoarse voice Wheeze or persistent cough Persistent dizziness or collapse Pale and floppy (young children) Vomiting and/or abdominal pain for insect stings/bites

diuretics

Diuretics are categorized as loop, thiazide, and potassium sparing. Take regularly in am to avoid sleep issues. Loops are powerful, forcing more elimination of sodium, potassium and water. Furosemide, bumetanide (bumex), toresemide (Demadex) Thiazide are a little less powerful, forcing elimination of sodium, potassium and water more distally in the nephron loop. Long acting - will have nocturia even with morning administration. Chlorthiazide (Diuril), hydrochlorothiazide (Microzide) Potassium sparing force excretion of sodium and water but not potassium. Spironolactone (Aldactone), triamterene (Dyrenium)

anaphylaxis is a rapid release of Ig?

E

ARF s/s - early

Early S/S Restlessness Fatigue HA Dyspnea Tachycardia Elevated BP

The nurse is preparing an education plan for a patient newly diagnosed with hypertension. What should be included in the education plan? Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week) Eliminate alcoholic beverages from the diet. Reduce sodium intake to no more than 200 mmol/day Maintain a normal body weight with BMI between 18 and 30 kg/m2

Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week). Rationale: Exercise is recommended as above. Alcoholic beverages can be consumed in moderation. Sodium should be reduced to no more than 100 mmol/day, and the patient should maintain a normal body weight with a BMI between 18.5 and 24.9 kg/m2.

signs and symptoms of infection

Fever Cough SOB Dyspnea Dysphagia Swollen lymph nodes Nausea Diarrhea Dysuria Lesions

s/s of bacterial endocarditis

Fever Heart murmur Osler nodes - red, tender spots under the skin of your fingers Janeway lesions - non tender small hemorrhagic lesions under skin Roth spots - retinal hemorrhages Splinter hemorrhages HA

pharyngitis s/s

Fiery-red pharyngeal membrane and tonsils White/purple exudate Difficulty swallowing Sore throat No cough

ecg of myocardial ishemia and infarction

Focus on the ST segment. Elevation means infarction, irreversible damage, scar. Depression means ischemia, potentially reversible damage. When the ST segment "flips", this is representation of myocardial damage.

what is EPS and when is it used

For severe & symptomatic dysrhythmias Electrical impulses delivered to the heart to try to elicit a dysrhythmia Various medications are tested May include catheter ablation Nursing interventions NPO 8 hours In general, hold anti-dysrhythmic meds Bed rest 4-6 hours post procedure Keep leg straight

aspiration

Foreign material into lungs Leads to pneumonia, potentially fatal In health, protective airway reflexes get rid of any foreign particles

nursing mgmt of atelactesis

Frequent turning Early mobilization Deep-breathing exercises at least every 2 hours Incentive spirometer Coughing exercises Suctioning Chest physiotherapy

Arteriosclerosis and Atherosclerosis

Hardening of arteries vs Accumulation of lipids S/S Intermittent claudication Elevated cholesterol levels Medical Management Prevention, Exercise program Surgery, Angioplasty, Stents

nursing management of chronic venous insufficiency

Have patient lie down 2-3 times per day Reduce venous stasis Prevent venous ulcers

assessments for vascular disorders

Health history Intermittent claudication, "rest pain," location of the pain Physical assessment Skin (cool, pale, pallor, rubor, loss of hair, brittle nails, dry or scaling skin, atrophy, and ulcerations) Pulses Diagnostic evaluation

Pulmomnary HTN

High pulmonary arterial pressure Right heart ventricular failure Not clinically evident until late in disease Dyspnea is main sx and will eventually occur at rest along with hemoptysis and other signs of Rt heart failure Peripheral edema Ascites, liver engorgement JVD Heart murmer, adventitious lung sounds

s/s of cancer of the larynx

Hoarseness (bolded) Persistent cough Sore throat Lump in the neck Dysphagia Dyspnea Weight loss Radiation of pain to the ear

hypertensive emergency v hypertensive urgency

Hypertensive emergency Blood pressure >180/120 Must be lowered immediately to prevent damage to target organs Hypertensive urgency Blood pressure is very high but no evidence of immediate or progressive target organ damage

what is hemodynamic monitoring and when is it needed

ICU setting CVP (central venous pressure is indirect) Pulmonary artery pressure - swan ganz for pressures in RA, RV, PA Intra-arterial BP monitoring - art line

What should we do when a client exhibits S/S of TB?

Immediately place them on airborne isolation/precautions Anticipate sputum cultures to confirm diagnosis Notify MD Educate patient and family YOU MUST TAKE MEDICATION, YOU WILL BE INCARCERATED IF YOU REFUSE

commom nursing diagnoses for mechanical ventilation

Impaired gas exchange r/t underlying illness, vent setting adjustments, weaning Ineffective airway clearance r/t mucus production, presence of tube in airway, or continued positive pressure ventilation Risk for trauma and infection r/t ET or trach Impaired physical mobility r/t vent dependency Defensive coping and powerlessness r/t vent dependency Risk for associated alterations in function r/t cardiac and renal disease

nursing interventions for hiv

Improving airway clearance Position Pulmonary therapy Ensure adequate rest Pain management Administer medications as prescribed Provide skin and perianal care Topical anesthetics Soft cushions or foam pads Avoid bowel irritants

describe angina pectoris and explain any changes in the EKG that might indicate myocardial injury

In unstable angina, the plaque ruptures but the artery is not completely occluded. Unstable angina and acute myocardial infarction are considered the same process but at different point on the continuum. The term "acute coronary syndrome" includes unstable angina and myocardial infarction. Chest pain or pressure Radiation to left arm, neck, jaw, shoulders Weakness Numbness N/V Diaphoresis "Impending doom" Q wave Present with an MI indicates that all muscle layers are affected - not just superficial layer Not present with an MI indicates that not all muscle layers are affected

circulatory hypoxia

Inadequate capillary circulation caused by decreased cardiac output, local vascular obstruction, shock, cardiac arrest

why do nurses need to understand HIV/AIDS

Increased survival time Worldwide problem Huge economic impact Largely preventable

pre-exposure guidelines for hiv

Indicated for those at known high risk for exposure Daily Truvada™ (tenofovir and emtricitabine) HIV infection assessed every 3 months Also monitor renal and liver function

Raynaud's disease

Intermittent arterial vaso-occlusion, usually of the fingertips or toes brought on by a trigger such as cold or stress Occurs most frequently in young women Manifestations Color changes Numbness Tingling, Pain Management Protect from cold/other triggers Avoid injury to hands/fingers

identify angioneurotic edema

Involves deeper layers of the skin (into the dermis) Diffuse swelling, no pitting Swelling can occur quickly or slowly Usually last 2-3 days Regions involved Lips, Eyelids, Cheeks, Hands and feet Genitalia, Tongue, Mucus membranes GI tract

late s/s of ARF

Late S/S Confusion Lethargy Tachycardia Tachypnea Central cyanosis Diaphoresis Use of accessory muscles Diminishing breath sounds Respiratory arrest

lung cancer

Leading cancer killer in the US Incidence in men and women Often metastasized upon diagnosis Poor prognosis Causes Smoking Occupational / Environmental agents

neutropenic precaution

Low neutrophil count If less than 500, can be life-threatening Reverse isolation Protective isolation Cancer patients Especially after chemotherapy

Identify the three signs of Beck's triad that lead to cardiac tamponade

Low, falling BP JVD, rising pressure Distant, muffled heart sounds

nursing interventions for activity intolerance in hiv

Maintain balance between activity and rest Instruction regarding energy conservation techniques Relaxation measures Collaboration with other members of the health care team

medical mgmt of pulmonary embolism

Measures to improve respiratory and CV status Anticoagulation and thrombolytic therapy Surgery Greenfield filter

medical and nursing management of pericarditis

Medical Management Analgesics NSAIDs Pericardiocentesis Nursing Management Pain management Monitor and manage potential complications Cardiac tamponade; Pericardial effusion

medical mgmt of pneumonia and complications

Medical Management Antibiotics (bacterial, chemical) Supportive (viral, chemical) Complications Respiratory failure Shock Atelectasis - collapse of alveoli Pleural effusion - fluid in pleural space Superinfection - 2nd infection superimposed on 1st

med and nursing mgmt of bronchiectasis

Medical Management Clear secretions Prevent / Control infection Smoking cessation Surgery Nursing Management Chest physiotherapy Postural drainage Teach smoking cessation Adhere to antibiotic therapy Vaccinations

med mgmt and nursing mgmt of epistaxis

Medical Management Direct pressure Packing of the nasal cavity or balloon catheter Nursing Management Avoid nasal trauma, nose picking, and nose blowing Air humidification Pressure on the nose to stop bleeding If bleeding does not stop in 15 minutes, seek medical attention

nursing and medical management of degenerative joint disease

Medical Management Goal is to slow the progress of the disease Heat therapy Weight reduction Joint rest, Orthotic devices Exercises Massage TENS OT and PT Surgery up to and including joint replacement Nursing Management Pain management Patient education Encourage weight loss PT and OT, encourage participation Assistive devices

med mgmt of pulmonary tb

Medical Management Initial treatment phase 8 weeks Multiple medications INH Rifampin Pyrazinamide Ethambutol Continuation phase 4 to 7 months INH and Rifampin (RIF) or INH and Rifapentine (RPT)

medical and nursing mangement of systemic lupus erythematosus

Medical Management Medications Corticosteroids Antimalarials NSAIDs Immunosuppressants Nursing Management Fatigue, pain, mobility issues Impaired skin integrity Body image disturbance Knowledge deficit r/t self care

status asthmaticus med and nursing mgmt

Medical Management Medications IV fluids Mechanical ventilation Nursing Management Monitor the client's respiratory status Monitor for s/s of dehydration Eliminate irritants Maintain a calm environment

nursing and med mgmt for dvt

Medical Management Medications Surgery Nursing Management Assess and monitor anticoagulant therapy Monitor and manage potential complications Providing comfort Compression therapy Positioning the body Promote exercise

med and nursing mgmt for asthma

Medical Management Medications - add cromyln sodium (Cromolyn) and leukotriene modifer (singulair) Management of exacerbations Peak flow monitoring Nursing Management Monitor severity of symptoms Monitor respiratory status Patient and family teaching

nursing and medical management for fibromyalgia

Medical Management NSAIDs Antidepressants SSRI's (duloxetine) Exercise (low impact) Nursing Management Support and encouragement Advocate for pain management options and promote self care

medical management of cardiomyopathy

Medical Management Pacemaker and/or AICD Limit fluid intake Ablation therapy Surgery Heart transplant Artificial heart

med mgmt and nursing mgmt of cancer of the larynx

Medical Management Radiation Chemotherapy Surgery Speech therapy Nursing Management Loss of voice Anxiety and depression Patent airway management Communication

med mgmt and nursing mgmt of laryngitis

Medical Management Resting the voice Avoidance of irritants Inhaling steam Nursing Management Instruct the patient to rest their voice Humidified environment Report hoarseness that lasts longer than 2 weeks to physician

med mgmt of COPD

Medical Management Risk reduction Medications - combine long acting beta2 agonist with corticosteroid Management of exacerbations Nebulizers, corticosteroids, antibiotics Oxygen therapy Surgery Pulmonary rehabilitation Stop Smoking

med mgmt and nursing mgmt of sleep apnea

Medical Management Sleeping position ETOH CPAP BiPAP Surgery Medications Nursing Management Treatments Potential consequences

med and nursing mgmt of tonsillitis and adenoiditis

Medical Management Supportive measures Tonsillectomy Adenoidectomy Nursing Management Prone position with head to the side Ice collar to neck Monitor for hemorrhaging When to call the physician Vomiting Rise in temperature and/or pulse Restlessness

med mgmt of pharyngitis and nursing mgmt

Medical Management Supportive therapy Nutritional therapy Nursing Management Management of symptoms Limit exposure to irritants When to call the doctor

medical and nursing mgmt of lung cancer

Medical Management Surgery Radiation Chemotherapy Palliative therapy Nursing Management Manage symptoms Relieve breathing problems Reduce fatigue Provide education and psychological support

nursing and med mgmt for ARF

Medical Management Treat the underlying cause Mechanical ventilation Nursing Management Manage mechanical ventilation Monitor respiratory status Prevent complications Turning / skin care Mouth care ROM exercises

med mgmt and nursing mgmt of cor pulmonae

Medical Management Treat underlying lung disease Treat S/S of heart disease Nursing Management Manage ventilator Monitor respiratory status Monitor cardiovascular status Oxygen therapy

definition of colonization

Microorganisms are present without any interference or reaction by the host; no symptoms no s/s are present yet - this is an important definition to know!

enhancing gas exchange interventions

Monitor ABGs and other indicators of hypoxia. Note trends Auscultate lung sounds frequently Judicious use of analgesics Monitor fluid balance A complex diagnosis that requires a collaborative approach

care for a pt after a CABG

Monitor for dysrhythmias Monitor for ineffective cardiac output Regulate fluids and electrolytes Monitor for any acute changes including CVA Monitor for mood, psychosocial concerns, signs of delirium Offer adequate pain management

nursing manamgement for immunodeficiencies

Monitor for signs and symptoms of infection Symptoms of inflammatory response may be blunted Monitor lab values, Promote good nutrition Teach client to control or avoid factors that contribute to immunosuppression Address anxiety, stress, and coping Pain management **Nurses need to prevent exposure through education and intervention

obstructive sleep apnea and the s/s

More prevalent in men Older Overweight Smoking Obstructive -structural Central - pons and medulla oblongata Mixed - interrelated s/s Frequent and loud snoring Cessation of breathing Abrupt awakening Excessive daytime sleepiness Frequent nocturnal awakening Insomnia Morning HA that slowly resolves during day Intellectual deterioration Irritability

leg ulcer nursing and medical mgmt

Most are r/t chronic venous insufficiency, but some r/t arterial insufficiency Decreased blood supply Decreased tissue perfusion Death of tissue Arterial ulcers Venous ulcers Complications Infection, Gangrene Medical Management Anti-infective therapy Compression therapy Débridement of wound Dressings Hyperbaric Oxygenation - HBO Nursing Management Skin integrity Mobility Nutrition

pneumonia

Most common cause of death from an infectious disease in the US 7th leading cause of death in the US 66,000 deaths each year Community acquired (CAP) Health-care associated (HCAP) Hospital acquired (HAP) Ventilator associated (VAP) Differentiate viral, chemical, bacterial

common cause for campylobacter infections

Most frequent cause of diarrhea Found in poultry, beef and pork Person-to-person contact is not very likely Complication is Guillain-Barre syndrome Food should be cooked and stored appropriately Keep utensils used in meat preparation away from other food

s/s of adenoiditis

Mouth breathing Earache Draining ears Voice impairment

ventilation

Movement of the walls of the thoracic cage and diaphragm to facilitate inspiration and expiration

airborne precautions

Must keep the room as neg pressure (don't open door or window) even if the client indicates claustrophobia For patients with airborne pathogens Negative air pressure room Private room Anteroom between pt room and hallway Keep door, window closed N-95 respirator (mask)

S/S of viral rhinitis

Nasal congestion Rhinorrhea Nasal discharge Tearing Sore throat Malaise Low-grade fever Chills Head and muscle aches Cough Herpes simplex

What should the nurse palpate when assessing for an upper respiratory tract infection? Neck lymph nodes Nasal mucosa Tracheal mucosa All of the above

Neck lymph nodes Rationale: The nurse should palpate the neck lymph nodes along with the trachea and the frontal and maxillary sinuses when assessing for an upper respiratory tract infection. The nurse should inspect the nasal and tracheal mucosa when assessing for an upper respiratory tract infection.

oxygenation

Neurons within the medulla and hypothalamus control breathing. Chemoreceptors in the blood and brain and mechanoreceptors of the airways autoregulate respiratory efforts and patterns. Regulatory mechanisms also function to maintain homeostasis of arterial blood gas and acid-base balance. Within the lungs, breathing occurs as a result of pressure dynamics and the activation of pulmonary stretch receptors.

rotating tourniquets

Not used often - evidence does not support Apply BP cuffs to 3 extremities Inflate slightly above DBP Inflate for 45 minutes Release for 45 minutes Goal is to pool blood in the extremities and away from the client's lungs Also used for clients with heart failure

nursing interventions for bronchoscopy

Nursing Interventions Consent form NPO Patient education Dentures Sedation Return of gag reflex Assess respiratory status

nursing management of CHF

Nursing Management Normalize preload and afterload Address and reduce symptoms Stabilize patient condition, delay deterioration Promote lifestyle consistent with cardiac status and symptoms for activity intolerance: Recline with HOP up for acute exacerbations Encourage regular physical activity Exercise training Pacing of activities Wait 2 hours after eating before doing physical activity Avoid activities in extremely hot, cold, or humid weather

nursing mgmt of tb

Nursing Management Airway clearance Adherence to treatment regimen Activity and Nutrition Potential Complications Malnutrition Medication side effects Drug resistance Spread of TB Home care teaching

chronic sinusitis nursing mgmt

Nursing Management Blow nose gently Humidity therapy Increase fluid intake Apply heat Elevate HOB

nursing mgmt of COPD

Nursing Management Breathing exercises Inspiratory muscle training Activity pacing Self-care activities Physical conditioning Oxygen therapy Nutritional therapy Coping measures

nursing mgmt of aspiration

Nursing Management Compensate for absent reflexes Assess feeding tube placement Identify delayed stomach emptying Manage effects of prolonged intubation Elevate HOB - sit upright at 900 Place client on side when vomiting Rehabilitation therapy for swallowing

nursing management of mechanical ventilation

Nursing Management Enhancing gas exchange Promoting effective airway clearance Preventing trauma and infection Promoting mobility Communication Coping Monitor and manage potential complications

nursing management of arteriosclerossi and atherosclerosis

Nursing Management Improve peripheral arterial circulation Promote vasodilation Prevent vascular compression, spasm Relieving pain Maintaining tissue integrity Promote lifestyle modifications

nursing mgmt of pneumonia

Nursing Management Improving airway patency Promote rest Promote fluid intake Maintain nutrition Patient education Assess for pleural effusion pneumonia in immunocomprimised - HAI: S. aureus, S. pneumoniae, H influenzae, P aeruginosa, M. tuberculsis.

nrusign mgmt of pulmonary embolism

Nursing Management Minimize risk Monitor thrombolytic therapy Manage pain Manage oxygen therapy Relieve anxiety Monitor for complications Cardiogenic shock Right heart failure

ARDS nursing mgmt

Nursing Management Monitor client's condition closely Proning Reduce anxiety Enforce the PEEP on the ventilator Utilize drug induced paralysis Inspect ventilator connections Respond quickly to ventilator alarms Provide eye care Provide pain medication Educate patient and family

nursing mgmt aneurysm

Nursing Management Monitor for back pain Monitor vitals and labs BLOOD PRESSURE HGB and HCT Monitor patients' blood pressure closely Arterial line monitoring Monitor for bleeding Assess peripheral pulses

nursing management of htn

Nursing Management Patient teaching Support adherence to the treatment regimen Consultation/collaboration Follow-up care Emphasize control rather than cure Reinforce and support lifestyle changes A lifelong process

care for a person with MI

Nursing Management Relieving pain Managing ischemia Improving respiratory function Promote adequate tissue perfusion Reduce anxiety Monitor and manage complications Patient teaching Modifications in lifestyle Cardiac rehabilitation MONA Morphine Oxygen Nitroglycerin (NTG) Aspirin

nursing management of gout

Nursing Management Restrict foods high in purines Organ meats, beer, sardines, mushrooms, asparagus Limit intake of ETOH Maintain normal body weight Educate on medications to relieve pain and decrease uric acid (cochicine)

oxygen toxicity

Oxygen concentrations of greater than 50% for extended periods of time (longer than 48 hours) can cause an overproduction of free radicals, which can severely damage cells. Symptoms include substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates on x-ray.

pulmonary embolism

PE The obstruction of a pulmonary artery or branch by a clot. Most thrombi are blood clots from the veins of the legs. The obstructed area has diminished or absent blood flow. High fatality rate - sudden death is the first symptom for 25% (CDC, 2015)

venous thromboembolism

Pathophysiology: clot or thrombus formation Risk factors: anything that alters flow, damages the vessel, predisposes coagulation (Virchow's Triad) Endothelial damage Venous stasis, Altered coagulation status Manifestations Deep veins, Superficial veins

pt teaching for asthma

Patient Teaching The nature of asthma as a chronic inflammatory disease Definition of inflammation and bronchoconstriction Purpose and action of each medication Identification of triggers and how to avoid them Proper inhalation techniques How to perform peak flow monitoring How to implement an action plan When and how to seek assistance

identify dermatitis

Photoallergic requires light exposure in addition to allergen contact from direct contact with chemicals or allergens Type IV delayed hypersensitivity reaction atopic dermatitis - inflammation of the skin - type I immediate hypersensitivity reaction dermatitis medicamentosa - skin rash associated with medications

potential problems with heart failure

Potential Problems Cardiogenic shock Dysrhythmias Thromboembolism Pericardial effusion Cardiac tamponade

common cause for salmonella

Prevalent in animal food sources Chicken Eggs Raw milk Beef 40% of deaths occur in nursing homes

nursing management of viral rhinitis

Prevent infection Practice good health habits Manage symptoms When to call the doctor

prevention of chronic venous insufficiency

Prevention Elastic hose Pneumatic compression devices Medications Positioning, Exercises, Early ambulation Avoid sitting/standing for prolonged periods

nursing interventions for decreasing isolation in hiv

Promote an atmosphere of acceptance and understanding Assess social interactions and monitor behaviors Allow patient to express feelings Address psychosocial issues Provide information related to the spread of infection Educate ancillary personnel, family, and partners

nursing management of rhinosinusitis

Promote drainage Activities to avoid Rebound congestion When to contact the doctor

what is hypertensive emergency

Reduce BP 25% in first hour Reduce to 160/100 over 6 hours Then gradual reduction to normal over a period of days Exceptions are ischemic stroke and aortic dissection Medications: IV vasodilators Need very frequent monitoring of BP and cardiovascular status nitroglycerin sodium nitroprusside nesiritide

care of a client with anaphylaxis

Remove allergen and call rescue Epinephrine IM with adrenaline infusion Oxygen Positioning - lying or fowlers IV access Vital signs Monitor for return of anaphylactic symptoms

What is gas exchange between the lungs and blood and between the blood and tissues? Diffusion Perfusion Respiration Ventilation

Respiration Respiration is gas exchange between the lungs and blood and blood and tissues Diffusion is exchange of O2 and CO2 at the alveolar-capillary membrane Perfusion is arterial/venous circulation filling pulmonary capillaries with blood Ventilation is flow of air in and out of the lungs

cor pulmonale and s/s

Results from PH Enlargement of the right ventricle Caused by lung conditions COPD S/S Edema lower extremities JVD Enlarged liver Ascites Heart murmurs

describe djd (degenerative joint disease) OA, RA

Risk Factors Increased age Obesity Previous joint damage Repetitive use of joint S/S Pain Stiffness Functional impairment

risk factors of aspiration

Risk Factors Seizures Decreased LOC N/V (gastric juices pH is 1-2, very acidic) CVA Dysphagia Cardiac arrest Supine positioning

risk factors of lung cancer

Risk Factors Smoking Secondhand smoke Environmental and Occupational exposure Genetics Dietary factors

risk factors for pulmonary embolism

Risk Factors Venous stasis Hypercoagulabilty: genetic or acquired Venous endothelial disease Certain disease states Other conditions Previous history of thrombophlebitis

s/s off bronchiectasis

S/S Chronic cough Purulent sputum Hemoptysis Clubbing of the fingers Repeated pulmonary infections

s/s of COPD and risk factors

S/S Chronic cough Sputum DOE (dyspnea on exertion) Respiratory failure Risk Factors Smoking Passive smoking Occupational exposure Ambient air pollution Genetics - alpha1 antitrypsin deficiency

s/s of asthma

S/S Cough Dyspnea Wheezing Tightness in the chest More frequent at night or early in the morning Episode usually develops over time Rarely life-threatening, but seems so to individual and family

s/s chronic sinusitis

S/S Cough Hoarseness HA Facial pain Breathing through mouth Snoring Sore throat Periorbital edema Fatigue Nasal congestion

s/s of rhinosinusitis

S/S Facial pain/pressure Nasal obstruction / discharge Fatigue Fever HA Ear pain / dental pain Decreased ability to smell Sore throat Periorbital edema Cough

s/s of pneumonia

S/S Fever: bacterial and chemical - rapid rise, 101-105; viral - gradual rise, 100-102 Chills Chest pain Tachypnea & SOB Orthopnea Poor appetite Fatigue Sputum Crackles

s/s, meg mgmt, and nursing mgmt of pulmonary edema

S/S Increasing respiratory distress Anxiety and agitation Crackles upon auscultation Pink frothy sputum Medical management Treat underlying cause Rotating tourniquets (evidence does not support) Nursing management Monitor respiratory status Monitor fluid status

s/s of left sided CHF

S/S Left-sided failure Backs up in lungs CRACKLES ! Pulmonary congestion Dyspnea Cough Low O2 sats Orthopnea Paroxysmal noctural dypsnea (PND) (how many pillows do you need when you sleep at night) S3 heart sound

s/s of tuberculosis

S/S Low grade fever Especially in the afternoon Chronic cough Night sweats Fatigue Weight loss Bloody sputum Hemoptysis

ayneurysm s/s and med mgmt

S/S Most are asymptomatic Pain, Pulsatile abdomen, Dyspnea, Cough, Hoarseness, Dysphagia Severe back pain with dissection Medical Management Control HTN and monitor CT for definitive dx Surgery AAA (5.5 cm) and thoracic (7 cm)

s/s of lung cancer

S/S Often asymptomatic until late in its course Changing cough Dyspnea Hemoptysis Pain Recurring fever Weakness Weight loss Hoarseness

s/s for ARDS and med mgmt

S/S Rapid onset of severe dyspnea Hypoxemia that does not respond to supplemental oxygen Intercostal retractions Crackles upon auscultation Medical Management Aggressive treatment of the underlying condition Positive end-expiratory pressure (PEEP)

s/s of right sided CHF

S/S Right-sided failure JVD Peripheral edema Hepatomegaly and ascites Anorexia Nausea Weakness Weight gain backs up in body

s/s of pulmonary embolism

S/S Variable, depends on size and location of affected lung tissue Dyspnea, Tachypnea Chest pain, Diaphoresis Anxiety Fever Tachycardia Hemoptysis Death

Intrinsic rhythm rates for SA, AV, Purkinje

SA node: 60 - 100 AV node: 40-60 Right bundle branch: 30-40 Purkinje fibers: 30-40

status asthmaticus and s/s

Severe and persistent asthma Nonresponsive to therapy Often occur acutely Rapid progression S/S Labored breathing Prolonged exhalation JVD Wheezing Cessation of wheezing

shift to the right on oxyhemoglobin dissociation curve

Shift to the right: The curve shifts to the right when hgb has a decreased affinity for oxygen, and has a "harder" time making the bond with oxygen. Less O2 picked up in lungs but more released in tissues as long as adequate arterial oxygenation. This is an temporary advantage to those with heavy exercise, fever, acidic because tissues won't suffer as much hypoxia. Lower SpO2 for a given PO2 Requires a higher PO2 to achieve the desired SpO2 Hemoglobin more likely to dump oxygen into tissues (active muscles need more oxygen) Think Heat. Anything that creates heat will move curve to right. Acidosis with high CO2 or low pH (heat); exercise, increased 2.3. DPG

s/s of tonsillitis

Sore throat Fever Snoring Difficulty swallowing

contact precautions

Spread by skin-to-skin contact Private room Gowns Masks not needed Doors do not need to be closed Organism is easily transmitted from patient to health care worker Patient assignment

s/s of aspiration

Stomach contents into lungs S/S Tachycardia Dyspnea Central cyanosis HTN Hypotension Death Silent aspiration

structural valve changes in endocarditis

Structural valve changes include thickening of the leaflets which causes them to shorten and thicken preventing them from closing completely. As a result, blood flows backward through the valve.

Nursing Management: After Endovascular Repair

Supine for 6 hours; HOB elevated up to 45 degrees after 2 hours VS and Doppler assessment of peripheral pulses every 15 minutes and then at progressively longer intervals if the patient's status remains stable Access site (usually the femoral or iliac artery) is assessed when vital signs and pulses are monitored Assess for bleeding, pulsation, swelling, pain, hematoma formation, or skin changes of the lower extremities Temperature every 4 hours; any signs of post implantation syndrome should be reported

tracheostomy

Surgical procedure Bypasses the upper airway Temporary or permanent Frequently seen in critical care settings Managed by respiratory therapy and nursing - together Cuff pressure usually 15 -25 mm Hg

TB and risk factors

TB - worldwide public health problem Rising mortality rates Once thought that TB would be eliminated Occurrences are on the rise - latent TB Transmission - airborne droplets Risk Factors Poverty / Malnutrition Overcrowding Inadequate health care HIV

Where is the innominate artery?

The brachiocephalic artery (labeled innominate) ... the brachiocephalic artery divides into the right common carotid artery and the right subclavian artery. ...

shift to the left on oxyhemoglobin dissociation curve

The curve shifts to the left when hemoglobin has an increased affinity for oxygen, and has an "easier" time making the bond with oxygen. More O2 picked up in lungs but less released in tissues as long as adequate arterial oxygenation. This is an advantage for those with gradually worsening heart and lung diseases, resting, or very cold because tissues won't suffer as much hypoxia. Higher SpO2 for a given PO2 Hemoglobin is more likely to cling to O2 and not let go (activity is minimal) Think Cold. The colder your body, the slower activity will be. Hypothermia (cold tissues), Rest (minimal exertion), low CO2, hypocarbia, alkalosis, decreased 2.3. DPG , Fetal Hemoglobin (fetus needs less oxygen and can live off lower PO2s)

describe rheumatoid arthritis

This autoimmune condition seems to originate in synovial fluid ->breaks down collagen and bony structures Elevated Rheumatoid Factor (RF) Confirms that there is an autoimmune process Bilateral and symmetric Joint pain and swelling, limited function Joint stiffness, especially in the morning Warmth, Erythema Deformities of hands and feet

describe why a person experiencing an MI might be offered tPA

Tissue Plasminogen Activator (tPA) Protein involved in the breakdown of blood clots Risk for injury is #1 priority for patients on thrombolytic therapy

droplet precautions

Transmission by close contact Face mask Private room Door can remain open

med management of rhinosinusitis

Treat infection Decrease swelling Relieve pain Avoid life-threatening complications

medical management of viral rhinitis

Treat the symptoms OTC medications

treatment for hiv

Treatment and protocols are continually evolving - CDC committed to sharing Antiretroviral agents Nucleoside reverse transcriptase inhibitors (NRTIs) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Protease inhibitors (PIs) Fusion inhibitors Integrase Strand Inhibitors and CCR5 Antagonists Use of combination therapy

Why 2 step TB?

Two-step testing is useful for the initial skin testing of adults who are going to be retested periodically, such as health care workers or nursing home residents. This two-step approach can reduce the likelihood that a boosted reaction to a subsequent TST will be misinterpreted as a recent infection.

identify urticaria

Type l hypersensitivity allergic reaction Itching and hives with pinkish, edematous elevations on skin and mucus membranes Lesions come and go May progress into angioedema If it persists for longer than 6 weeks Chronic urticaria

prevention of oxygen toxicity

Use lowest effective concentrations of oxygen. PEEP or CPAP prevents or reverses atelectasis and allows lower oxygen percentages to be used.

incentive spirometry

Used to prevent or treat atelectasis Applies to all postoperative patients Teach patient and family Set realistic goals Encourage use Document frequency of use and progression for some, this is aggravates asthma

Identify clinical manifestations and nursing considerations for HTN

Usually NO symptoms other than elevated blood pressure Symptoms seen related to organ damage are seen late and are serious Retinal and other eye changes Renal damage Myocardial infarction Cardiac hypertrophy Stroke

pulmonary embolism diagnosis

V/Q scan Widely used method - Compares ventilation with perfusion Spiral CT More accurate visualization D-Dimer Elevation may indicate a clot formation Pulmonary angiography Visualization of the pulmonary artery Most accurate method

chronic venous insufficiency s/s

Valves are not working correctly Faulty "incompetent" valves Blood return is not pushed up toward the heart Blood pools and further stretches the vein This makes the situation even worse and causes more pooling of blood Edema Pain Brownish discoloration of skin Dry skin with cracks

venous disorders

Venous Thromboembolism Chronic venous insufficiency/post-thrombotic syndrome Varicose veins Leg ulcers

SARS s/s

Viral illness - Droplet precautions Negative pressure room S/S Fever HA Aching Diarrhea Cough

stages of hiv stage 3

Viral load high < 200 CD4 cells - not enough to fight off infection As levels drop below 100 cells/mm3, the immune system is significantly impaired Person may qualify for entitlements Disability benefits Housing Food stamps

stages of hiv stage 2

Viral replication and CD4 destruction Before a major HIV-related complication develops Patients generally feel well CD4 = 200-499 cells per microliter of blood HIV is initially asymptomatic - the "honeymoon" before the gathering storm

describe virchow's triad

Virchow's triad are: venous stasis, vessel wall injury and altered blood coagulation Another triad! V is for Venous; Beck's is about impending tamponade (low arterial BP, distended neck veins, and distant, muffled heart)

3 stages of weaning from mechanical ventilation

Wean from vent Wean from the tube Wean from oxygen

20.4 The serous membrane enclosing both lungs is called a. Pleura b. Fascia c. Pericardium d. Bronchial membrane

a

21.5 The nurse is admitting someone with COPD. A decrease in what substance in the blood gas analysis would indicate that the patient is experiencing hypoxemia? a. PaO2 b. pH c. PCO2 d. HCO3

a

21.9 The nurse is educating a patient with COPD about the technique for performing pursed lip breathing. What does the nurse indicate about the importance of using this technique? a. It prolongs exhalation. b. It increases the respiratory rate to improve oxygenation. c. It will assist with widening the airway. d. It will prevent the alveoli from overexpanding.

a

22.1 A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection? a. An antiviral agent such as acyclovir b. An antibiotic such as amoxicillin c. An antihistamine such as diphenhydramine d. An ointment such as bacitracin

a

23.2 When a poorly functioning nasogastric tube allows gastric contents to accumulate in the stomach, a condition known as ________ may result. a. Silent aspiration b. Dysphagia c. Aphonia d. Pericarditis

a

23.5 The nurse is auscultating lungs on someone with pulmonary edema. What adventitious lungs sounds are significant for pulmonary edema? a. Crackles in the lung bases b. Low pitched rhonchi during expiration c. Pleural friction rub d. Sibilant wheezes

a

24.1 The single most effective intervention to reduce risk for developing COPD or slow its progression is: a. Cessation of smoking b. Avoid air pollution c. Only use menthol cigarettes d. Avoid use of perfume

a

24.8 A positive Mantoux test indicates: a. Exposure to tuberculosis b. Active tuberculosis c. Recent tuberculosis d. Latent tuberculosis

a

A client was infected with tuberculosis bacillus 10 years ago but never developed the disease. This client is now being treated for cancer, and begins to develop signs of TB. The nurse suspects that this client is exhibiting Active infection. Latent infection Superinfection Tertiary infection

a

A client with COPD asks the nurse why he is receiving diuretic therapy. What is the nurse's best response? To reduce fluid volume and reduce oxygen demand. To reduce fluid volume and improve your mobility To reduce fluid volume and reduce sputum production To reduce fluid volume and improve respiratory function

a

Which treatment goal is the nurse's priority for a client with status asthmaticus? Avoiding intubation. Determining the cause of the attack Improving exercise tolerance Reducing secretions

a

Which patient is at highest risk for venous thromboembolism? A 50-year-old postoperative patient A 25-year-old patient with a central venous catheter in place to treat septicemia A 71-year-old otherwise healthy older adult A pregnant 30-year-old woman due in 2 weeks

a 25 year old patient with a central venous catheter in place to treat septicemia

22.5 Nancy was diagnosed two weeks ago with acute pharyngitis, but now contacts the clinic stating that her throat got better for a couple of days and ow is back along with an earache. What complications should the nurse be aware of related to acute pharyngitis? Select all that apply. a. Mastoiditis b. Otitis media c. Peritonsillar abscess (quinsy) d. Pericarditis e. Encephalitis

a,b,c

24.5 Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. a. Compromised gas exchange b. Decreased airflow c. Wheezes d. Jugular vein distention e. Ascites

a,b,c

5. ________ therapy is a treatment that destroys specific cells that are the cause or central conduction route of a tachydysrhythmia that did not respond to medications and is not suitable for anti-tachycardia pacing.

ablation

changes with emphysema

air dfoesnt leave alveoli barrel chest posture is hunched over a bit

3. Human valves, obtained from cadaver tissue donations and used for aortic and pulmonic valve replacement, are called homografts or ________.

allografts

Which of the following best defines stroke volume? The amount of blood ejected with each heartbeat. Amount of blood pumped by the ventricle in liters per minute Degree of stretch of the cardiac muscle fibers at the end of diastole Ability of the cardiac muscle to shorten in response to an electrical impulse

amount of blood ejected with each heartbeat

definition of afterload

amount of resistance to ejection of blood from the ventricle

for any vascular problem the best test is an

angiogram

5. A key strategy in preventing bacterial endocarditis in those patients at high risk who have prosthetic heart valves is prophylactic drug therapy with ________.

antibiotics

2. __________, the most common disease of the arteries, is a process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles become thickened and stiff

arteriosclerosis

1. The most common cause of cardiovascular disease in the U.S. is _________, an abnormal accumulation of lipid, or fatty substances and fibrous tissue in the lining of arterial blood vessel walls.

atherosclerosis

what is an AED

automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm.

Understand that you do not cardiovert someone who is _________ (sedate for elective cardioversion); do not defibrillate someone with a ______

awake, pulse

20.12 Which of the following individuals have a the greatest risk potential for an alteration in respiration? a. A 15 year old young man with a migraine headache b. A 44 year old woman with anemia c. A 29 year old female with diarrhea d. A 42 year old man with an earache

b

20.2 The maximum volume of air that can be inhaled after a normal inhalation is known as a. Inspiratory total volume b. Inspiratory reserve volume c. Expiratory reserve volume d. Expiratory tidal volume

b

20.7 The nurse is assessing a person in respiratory distress. What is a late indicator of hypoxia? a. Clubbing of fingers b. Cyanosis c. Crackles d. Restlessness

b

21.6 A patient has been receiving 100% oxygen therapy by way of a nonrebreather mask for several days. Now the patient is complaining of tingling in the fingers and shortness of breath, is extremely restless, and describes pain beneath the breastbone. What should the nurse suspect? a. Oxygen induced hypoventilation b. Oxygen toxicity c. Oxygen induced atelectasis d. Hypoxia

b

21.7 A nurse is admitting a client diagnosed with pulmonary embolism. The client seems hypoxic. The nurse knows that the best way to correct this condition is: a. Administer supplemental oxygen therapy by mask or nasal cannula b. Assess for possible t-PA therapy c. Implement measures to increase BP and HR d. Prepare for endotracheal intubation

b

22.2 Those most common cause of laryngitis is ______. Symptoms include hoarseness, cough and _________. a. Bacterial; aphonia b. Viral; aphonia c. Bacterial; earache d. Viral; earache

b

22.6 Following surgical removal of tonsils and adenoids, what optimal position should be maintained in both the recovery room and then later on that day to promote drainage? a. HOB elevated at 30 degrees b. Prone position with head turned to the side c. HOB elevated at 90 degrees d. Supine position with head turned to side

b

23.1 According to the textbook, the overall five year survival rate for those with lung cancer is approximately: a. 40% b. 16% c. 20% d. 45%

b

23.7 The nurse observes paradoxical chest movement in a patient who has just been involved in a car accident. What does the nurse know that this finding indicates? a. Pneumothorax b. Flail chest c. ARDS d. Tension pneumothorax

b

23.8 Joe is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient? a. Ascites b. Dyspnea c. Hypertension d. Syncope

b

24.4 A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic alkalosis d. Metabolic acidosis

b

24.6 The purpose of pursed lip breathing is: a. Prolonged inhalation b. Prolonged exhalation c. Movement of secretions d. Increases respiratory rate

b

20.6 The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation? a. PaO2 b. PaCO2 c. pH d. SaO2

b Alveolar ventilation is measured as the volume of air breathed in per minute that (1) reaches the alveoli and (2) takes part in gas exchange. PaCO2 is the only blood gas measurement that provides information on alveolar ventilation, reflecting the amount of dead space in alveoli. So if the CO2 levels are up, then there is a poor exchange of O2 and CO2 at the alveolar level. The person may be breathing (ventilating) but the alveoli are unable to facilitate the exchange of gasses.

define regurgitation

backward flow of blood into chamber

what are the primary nursing considerations for arterial disorders?

blood pressure?*** (idk)

2. Sinus ______ occurs when the SA node creates an impulse at a rate less than 60 beats per minute in an adult.

bradycardia

20.3 The two centers in the brain that are responsible for the neurologic control of ventilation are _____ and ___________. a. Temporal region of the cerebrum, hypothalamus b. Hypothalamus and medulla oblongata c. Apneustic center in the lower pons, pneumotaxic center in the upper pons d. The lower pons and the 10th cranial nerve

c

20.5 The nurse is interviewing a person who has a constant "dry cough", meaning that the cough is non-productive. About what medication or drug category should the nurse question this person? a. Aspirin b. Bronchodilators c. Angiotensin converting enzyme (ACE) inhibitors d. Vitamins B and C

c

20.9 The nurse is caring for a person with a pulmonary embolism. The nurse understands that a high ventilation-perfusion ratio may exist. What does this mean for the patient? a. Perfusion exceeds ventilation b. There is an absence of perfusion and ventilation c. Ventilation exceeds perfusion d. Ventilation matches perfusion

c

21.1 Hypoxemia usually leads to ____, a decrease in oxygen supply to the tissues. a. Acidosis b. VQ mismatch c. Hypoxia d. Sibilant breath sounds

c

21.2 Oxygen toxicity may occur when oxygen concentration at greater than ____% is administered for _________(length of time). a. 80, >72 hours b. 50, > 24 hours c. 50, >48 hours d. 60, > 72 hours

c

21.3 What type of mask will the patient require when precise oxygen concentration is required? a. Partial rebreather b. Nonrebreather c. Venturi d. Nasal cannula

c

21.8 A client who underwent a lobectomy and has a water-seal chest drainage system is breathing with a little more effort and at a faster rate than 1 hour ago. The client's pulse rate is also increased. Which action should the nurse implement first? a. Ensure that the chest tube is clamped in two places to prevent air leaks. b. Remove the chest tube immediately to promote lung expansion. c. Check the tubing to make sure that the client is not lying on it or kinking it. d. Call the physician immediately.

c

22.3 When Carly had a severe episode of epistaxis, her nose was packed with gauze. How long can the packing safely stay in her nose before it must be removed? a. Two days b. One week c. Three to four days d. One day

c

23.3 Jamie has pneumonia. What intervention can the nurse provide to decrease the viscosity of secretions? a. Encourage consumption of sports drinks b. Encourage consumption of dairy products c. Encourage at least 1.5 liters of oral fluids daily d. Encourage consumption of caffeinated beverages

c

23.4 Caroline asks how long she will need to continue taking her anti-tubercular medications? Your answer will be an estimate of: a. 3 months b. 3-5 months c. 6-12 months d. 13-18 months

c

24.2 The nurse observes that Lois has a barrel shaped chest. What does the nurse understand causes the shape of Lois' chest? a. Accumulation of mucopurulent drainage b. Overuse of nebulizers c. "Air trapping" in the lungs d. Accumulation of dried mucus in bronchioles

c

24.3 The nurse is education Andrew about prevewntive measures to avoid having an asthma attack. What does the nurse inform Andrew about that would be apriority intervention to prevent an asthma attack? a. Quickly use your long-acting steroid inhaler when an attack is coming b. Avoid any exercise or strenuous activity c. Prepare a written action plan d. Stay in the house when it is really hot and humid outside

c

24.7 The purpose of huff coughing is: a. Prolonged inhalation b. Prolonged exhalation c. Movement of secretions d. Increases respiratory rate

c

The nurse is reviewing the chart of a 68 year old client with community acquired pneumonia. Which bacteria are the most likely causative microorganisms? Haemophilus influenza Klebsiella penumoniae Steptococcus pneumoniae. Staphylococcus aureus

c

21.10 The client is being mechanically ventilated with an oral endotracheal tube in place. The nurse observes the cuff pressure at 25-30 mm Hg. The nurse is aware of what complications that can be caused by this pressure? SATA a. Tracheal aspiration b. Hypoxia c. Tracheal ischemia d. Tracheal bleeding e. Pressure necrosis

c,d,e

4. _______________, also referred to as Norovirus, is the most common cause of foodborne illness and gastroenteritis in the United States.

calicivirus

4. The delivery of an electrical current to treat a tachydysrhythmia that is timed so that it is synchronized with the electrical events of myocardial cells is __________.

cardioversion

differentiate between cardioversion and defibrillation

cardioversion Delivery of electric current is timed with the client's heartbeat Press the "synch" button on the defibrillator NPO 4 hours before procedure Sedation Lower amount of energy (50-100 Joules) defib paddles on the chest and a shock

5. A _____________ is a painless lesion at the site of primary syphilis infection which usually resolves spontaneously within 3 to 12 weeks.

chancre

describe fibromyalgia

chronic fatigue is number 1 problem and concern Myofascial pain syndrome: Hyperactive muscle response to nervous stimulation Generalized muscle and joint aching Overwhelming fatigue, stiffness 18 tender points 2-5% of US population, more common in women Unknown cause Controversial diagnosis

3. The hallmark symptom of peripheral arterial occlusive disease of the lower extremities is intermittent ___________.

claudication

what is a duplex ultrasound

combines traditional ultrasound with Doppler ultrasound. Traditional ultrasound uses sound waves that bounce off blood vessels to create pictures.

2. The most common valvuloplasty procedure is a ____________.

commissurotomy

how do you get giardi lamblia

contaminated food or drink

On October 5, 2012, the National Select Agent Registry Program published a final rule declaring SARS

coronavirus a select agent

20.1 The alveoli begin to lose elasticity at about ____ years. This loss of elasticity results in __________. a. 65 years, decreased affinity for RBCs b. 65 years, decreased surfactant c. 50 years, decreased hemoglobin d. 50 years, decreased gas diffusion

d

20.10 A nurse understands that a safe but low level of oxygen saturation provides for adequate tissue saturation while allowing no reserve for situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient? a. 40 mm Hg b. 75 mm Hg c. 80 mm Hg d. 95 mm Hg

d

20.11 Which of the following would indicate LATE hypoxia? a. Restlessness b. Anxiety c. Eupnea d. Cyanosis

d

20.8 The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high-pitched, sibilant, musical sounds that are heard? a. Rales b. Crackles c. Rhonchi d. Wheezes

d

21.4 Oxygen flow rate for a nasal cannula should not exceed ____ liters/minute. a. 4 b. 3 c. 5 d. 6

d

22.4 Jerome is scheduled for a total laryngectomy. What education and preparation is needed before the surgery? a. Emphasis on early mobility and ambulation b. Focus on coughing and deep breathing c. Targeted information to prevent depression d. Emphasis on communication strategies without using voice

d

22.7 What does medication therapy focus on when addressing symptoms related to allergic and nonallergic rhinitis? a. Sinus drainage b. Resolution of infection c. Clearing nasal obstruction d. Whatever is needed for symptom relief

d

23.6 The nurse assesses a client for possible PE. What frequent sign does the nurse anticipate finding? a. Cough b. Hemoptysis c. Syncope d. Tachypnea

d

23.9 The nurse Is caring for Sue with pleurisy. What symptoms does the nurse recognize are significant for this patient? a. Dullness or flatness on percussion over areas of collected fluid b. Dyspnea and coughings c. Fever and chills d. Stabbing pain during respiratory movement

d

24.9 Tom is in the ED after blunt trauma to his chest wall area. What sign or symptom most likely suggests presence of a pneumothorax? a. Low respiratory rate b. Diminished breath sounds c. Presence of a barrel chest d. Sucking sound at the site of injury

d

Hypoxemic hypoxia

decreased O2 level in blood from decreased O2 diffusion - might be caused by hypoventilation, high altitude, ventilation/perfusion mismatch such as seen in PE, shunting from alveolar collapse such as atelectasis

hypoxia

decreased O2 supply to tissues and cells. Might be caused by decreased cardiac output, local vascular obstruction, shock, cardiac arrest

hypoxemia

decreased arterial O2 tension in blood - lower partial pressures. Might be caused by hypoventilation, high altitude, high V/Q (ventilation exceeds perfusion), alveolar collapse such as in atelectasis

anemia hypoxia

decreased hemoglobin concentration causing decreased oxygen carrying capacity. Rare to have hypoxemia, but yes to hypoxia. CO2 poisoning will do this because hgb OK yet hypoxia. Also of course the anemias

3. _________ is the treatment of choice for the patient in ventricular fibrillation

defibrillation

definition of preload

degree of stretch of the cardiac muscle fibers at the end of diastole (how much blood can fill before ejection)

2. The four primary modifiable risk factors for coronary artery disease and its complications are as follows: cholesterol abnormalities, tobacco use, hypertension, and

diabetes

1. During ______, the relaxation phase of the pumping action of the heart, all four heart chambers relax simultaneously allowing the ventricles to fill in preparation for contraction.

diastole

modifiable v non modifiable risk factors of CVD

diet and lifestyle vs genetics etc

3. Lifestyle modifications for someone with hypertension will include changes in______ and changes in ________.

diet/ activity

define cardiomyopathy

disease of the heart muscle

huff coughing is for

emphysema

typical calcium channel blockers

end in ipine Amlodipine (Norvasc), nifedipine (Procardia), felodipine (Plendil) Calcium channel blockers limit calcium entering myocardial muscle cells to decrease HR and widen arteries, thus decreasing heart workload.

betablockers

end in lol Atenolol (Tenormin), Betaxolol hydrochloride (Kerlone), Carvedilol (Coreg) Esmolol hydrochloride (Brevibloc), Labetalol hydrochloride (Normodyne, Trandate), Metoprolol (Lopressor, Toprol XL) Nadolol (Corgard), Penbutolol (Levatol), Propranolol hydrochloride (Betachron E-R, Inderal, Inderal LA) Sotalol (Betapace), Timolol maleate (Blocadren) All the olols - Beta blockers limit the activity of epinephrine to accomplish reduction in heart rate and force of contraction - this reduces myocardial consumption of oxygen

ACE inhibitors

end in pril Enalapril, ramapril, captopril, fosinopril, lisinopril All the ils - ACE inhibitors block enzymes that trigger blood vessel constriction

ARBs

end in sartan Losartan, valsartan, irbesartan, telmisartan All the tans - ARBS block conversion of angiotensin 1 to angiotensin 11, thus minimizing vasconstriction

Monoclonal gammopathy is commonly associated with

excess amount of one single type of b lymphocyte

2. Prolonged BP elevation gradually damages blood vessels throughout the body, particularly I target organs such as the heart, brain, kidneys, and ________.

eyes

Is the following statement true or false? A patient with hypoxemia will have an increase in the PaO2 level.

false

Is the following statement true or false? For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of tachypnea and tachycardia.

false

Is the following statement true or false? Cellulitis cannot be differentiated from lymphangitis.

false

T/ F Mitral stenosis is an obstruction to blood flowing from the right atrium into the right ventricle.

false

T/ F People who have Raynaud's Disease are extremely sensitive to heat exposure.

false

T/ F Recent research evidence indicates that cigarette smoking causes high blood pressure, especially in men

false

T/ F The most characteristic clinical manifestation of pericarditis is a creaky or scratchy friction rub that can be clearly heard during auscultation at the left lower sternal border.

false

T/F 3. The person who is adjusting to reduced salt intake should be advised that it takes up to 1 year for the taste buds to adapt to changes in salt intake.

false

T/F Digitalis (digoxin) is considered the most essential and most frequently prescribed pharmacologic agent for the treatment of heart failure.

false

T/F Right-sided heart failure causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output.

false

T/F The most common type of heart failure is an alteration in ventricular contraction called diastolic heart failure, which is characterized by a weakened heart muscle.

false

T/F beta blocker medications such as lopressor and trprol are the standard treatment for angina pectoris

false

T/F myocardial dysfunction occurs when irreversibly damaged heart muscle is replaced by adipose tissue

false

T/F: Afterload refers to the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole.

false

T/F: The patient undergoing nuclear imaging techniques with stress testing should be instructed not to eat or drink anything for at least 12 hours before the test.

false

T/F: Vancomycin-resistant Enterococcus (VRE) is the most frequently isolated source of health care-associated infections in the United States.

false

T/F: the p wave represents atrial depolarization and atrial repolarization

false

Is the following statement true or false? The primary oxygen administration method for a patient with COPD is a nasal cannula.

false The primary oxygen administration method for a patient with COPD is a Venturi mask, not a nasal cannula. Why? Because venturi offers the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means. (p. 497). Use with COPD people because you can optimize supplemental oxygen without as a great a risk for suppressing hypoxic drive. Recall that in COPD, the stimulus for respirations become a decrease in blood oxygen rather than an elevation of carbon dioxide.

T/F: a patient with a permanent pacemaker should be instructed not to use a cell phone

false lol

2. The apical impulse, formerly called the point of maximal impulse (PMI), is normally palpable at the intersection of the mid-clavicular line of the left chest and at the _________ intercostal space

fifth

Where does the nurse auscultate the apex of the heart? Erb's point Fifth intercostal space. Pulmonic area Tricuspid area

fifth intercostal space

diffusion

gas exchange across alveolar-capillary membrane without difficulty because of high to low concentrations. Recall diffusion is a passive process - going high to low.

define allograft/autograft

heart valve replacement made from human heart valve, made from patient's own valve

Polyclonal gammopathy reflects the presence of a diffuse

hypergammaglobulinemia in which all immunoglobulin classes are proportionally increased

percentage of O2 SAT depends on

influences of CO2, hydrogen ion concentration (acid-base balance), body temperature, and 2,3-diphosphoglycerate (chemical that binds O2 to hgb).

1. _____________ causes myocardial dysfunction in heart failure because it deprives heart cells of oxygen and causes cellular damage.

ischemia

3. Angina pectoris is chest pain resulting from myocardial ________ of the heart muscle.

ischemia

purpose of ekg

it is an aid for diagnoses

know the structures of the heart

it will be on the test

The nurse is teaching a patient diagnosed with peripheral arterial disease (PAD). What should be included in the teaching plan? Elevate lower extremities Discourage exercise Keep lower extremities in a neutral or slightly dependent position. PAD should not cause pain

keep lower extremities in a neutral or slightly dependent position

4. Pulmonary edema is an acute event that results from _____ ventricular failure

left

which coronary artery places the individual at greatest risk for massive heart attack

left coronary artery

for a mechanical replacement valve you need

life long anticoagulation therapy

flail chest is

life-threatening, a segment of the rib cage breaks under extreme stress and becomes detached from the rest of the chest wall. There becomes paradoxical movement of the lungs since there is no stabilizing architecture.

med mgmt of chronic sinusitis

like acute sinusitis

tension ptx

lung injury, progressive build up of air in pleural space

define ventricular assist device

mechanical device used to aid a failing right or left ventricle, not designed to be long term

1. Small cell or oat cell cancer of the lung has a poor prognosis and is likely to ______ before symptoms develop

metastasize

3. The S1 heart sound results from closure of the _____ and tricuspid valves.

mitral

modifiable v nonmodifiable

modifiable Nicotine, diet Hypertension Diabetes Obesity Stress Sedentary lifestyle C-reactive protein Hyperhomocysteinemia nonmodifiable Age Gender Familial predisposition and genetics

4. Turbulent blood flow caused by a narrowed or malfunctioning valve is called a _____, which can be heard during auscultation of the heart.

murmur

post-exposure prophylaxis (PEP) (needlestick, splash) hiv

needs to start within 72 hours following exposure Wash the area with soap and water Alert your supervisor Identify the source patient Report quickly to employee health Consent for baseline testing Postexposure medications Follow-up testing Document

baroreceptors

nerve fibers located in aortic arch and carotid arteries that are responsible for BP control - sending messages afferently to medulla oblongata and sympathetic n.s.

define chordae tendinae

nondistensible fibrous strands connecting papillary muscle to atrioventricular valves

Identify criteria for normal BP, prehypertension, and actual hypertension (classified as stage 1 in slide #40

normal <120 <80 pre htn 120- 139 80-89 stage 1 140-159 90-99 stage 2 >160 >100

silent v/q (no ventilation and perfusion)

nothing is going on. Limited to no ventilation or perfusion. Seen with pneumothorax or severe acute respiratory distress syndrome.

nursing management of rhinitis and med mgmt

nursing mgmt Avoid causative agents Administration of nasal medications Hand hygiene med mgmt Identify the cause Antihistamines

you would need what type of dressing for a person with a chest tube(like if the tube were to come out)?

occlusive dressing

1. The three usual modes of transmission for the human immunodeficiency virus are sexual, _________________, and perinatal.

percutaneous

low v/q shunt

perfusion exceeds ventilation, meaning that blood bypasses the alveoli without gas exchange occurring. This is seen with obstruction of distal airways such as with pneumonia, atelectasis, tumor, or mucus plug.

define u wave

present with hypokalemia, it represents repolarization of purkinje fivers

3. Left-sided heart failure refers to failure of the left ventricle, which results in ________ congestion.

pulmonary

4. Patients need to be informed that _________ hypertension can occur if antihypertensive medications are stopped suddenly.

rebound

define pr interval

reflects rate of conduction

1. When a heart valve fails to close completely, blood flows backward through the valve in a process called _____________.

regurgitation

define annuloplasty

repair of circular valve outer ring

define t wave

repolarization of the ventricles

define p wave

represents atrial contraction

PVR: pulmonary vascular resistance

resistance to blood flow out of the right ventricle created by the pulmonary circulatory sysem

tacheostomy is managed by

respiratory therapy and nursing TOGETHER

angina typically responds to

rest or NTG

2. The three major types or classifications of cardiomyopathy, a disease of the myocardium, are as follows: dilated, hypertrophic, and ____________

restrictive

4. A _____ aneurysm is a localized sac or dilation formed at a weak point in the wall of the artery that projects from only one side of the vessel.

saccular

5. Blood vessels commonly used to bypass occluded coronary arteries include the _______ veins of the leg.

saphenous

Which of the following is the primary pacemaker for the myocardium? Atrioventricular junction Bundle of His Purkinje fibers Sinoatrial node.

sinotrial node

define commissurotomy

splitting or separating a fused cardiac valve leaflet

2. The first tier of isolation guidelines, called __________ precautions, is designed for the care of all patients in the hospital and is the primary strategy for preventing health care-associated infections.

standard

4. A ____ provides structural support to a coronary artery following angioplasty to minimize the risk of vessel stenosis.

stent

open ptx

sucking chest wound, air enters lung but can't leave

the clinical manifestations of rheumatic diseases can be

systemic or localized the symptom of pain is usually the reason why the individual seeks medical attention Pain - both aching & sharp, nociceptive and neuropathic Joint swelling - tenderness, warmth, acute vs chronic Limited movement - limited ROM Stiffness - often will loosen with paced activity Weakness - limited strength Fatigue - pain and accommodations sap energy

1. The electrical stimulation of the cardiac muscle cells is called depolarization; the mechanical contraction is called _________.

systole

the pace maker rule

the fastest rate controls the heart

define stenosis of the valve

the valve does not open completely, restricted flow through the valve

why is HTN known as a silent killer

there are usually no symptoms until much later

For patients with uncomplicated hypertension and no specific indications for another medication, what is the initial medication? Thiazide diuretic Calcium channel blockers Vasodilators Angiotensin-converting enzyme inhibitors

thiazide diuretic

Why would someone undergo a thoracotomy?

to get to the chest wall or heart

in an endotrachial tube we don't want it to be

too tight or too loose. too tight could cause skin break down and ulceration, too loose and they could cough it out.

5. Low-density lipoproteins (LDLs) are the primary transporters of cholesterol and _____ into the cell.

triglycerides

T/F for a person to be considered a candidate for a coronary artery bypass graft (CABG) the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if the affected artery is the left main coronary artery)

tru

Is the following statement true or false? In acute care setting, the patient should be encouraged to use an incentive spirometer approximately 10 breaths per hour between treatments while awake

true

Is the following statement true or false? The patient should be encouraged to use an incentive spirometer approximately 10 breaths per hour between treatments while awake

true

Is the following statement true or false? Wheezes are considered an adventitious breath sound.

true

Is the following statement true or false? An early sign of cancer of the larynx includes changes in speech, the voice may sound harsh, raspy, and lower in pitch.

true

Is the following statement true or false? An initial characteristic symptom of a simple pneumothorax is sudden onset of chest pain.

true

T/ F A decreased amount of blood is ejected from the ventricle in systolic heart failure

true

T/ F A hypertensive urgency describes a situation in which BP is very elevated but no evidence is seen of impending or progressive target organ damage.

true

T/ F A patient with pulmonary edema should be positioned upright, preferably with the legs dangling over the side of the bed, if possible.

true

T/ F The most common pathogens involved in myocarditis tend to be viral, whereas in endocarditis, the pathogens tend to be bacterial.

true

T/F Aldactone, an aldosterone receptor blocker that is prescribed for hypertension, is contraindicated in people with hyperkalemia and impaired renal function.

true

T/F Mitral valve prolapse is a deformity that often produces no symptoms.

true

T/F Nicotine from tobacco products causes vasospasm and can thereby dramatically reduce circulation to the extremities.

true

T/F Right-sided heart failure. Failure of the right ventricle, results in congestion in the peripheral tissues and viscera.

true

T/F Studies report that the average venous ulcer requires as long as 6-12 months to heal completely .

true

T/F The Dietary Approaches to Stop Hypertension (DASH) diet recommends 4-5 servings of fruit and vegetables a day (based on a 2,000 calorie diet.

true

T/F The most common cause of an abdominal aortic aneurysm is atherosclerosis.

true

T/F The pathophysiology of all cardiomyopathies is a series of events that culminate in impaired cardiac output.

true

T/F the pathophysiology of atherosclerosis involves an inflammatory response to arterial wall injury

true

T/F the total cholestrol level (normal is <200mg/dL) is a clear predictor of coronary events

true

T/F: A nurse should wear a face mask within 3 to 6 feet of a hospitalized patient receiving droplet precautions for an infection.

true

T/F: An elevated blood level of the amino acid homocysteine is believed to indicate a high risk for coronary artery disease

true

T/F: Currently, there is no treatment for West Nile virus infection.

true

T/F: Hypertension is defined as a systolic BP that is consistently greater than 140 mm Hg or a diastolic BP greater4 than 90 mm Hg.

true

T/F: Penicillin G benzathine is the medication of choice for early syphilis or early latent syphilis of less than 1-year's duration.

true

T/F: The sinoatrial (SA) node, with an inherent firing rate of 60-100 impulses per minute, is considered the primary pacemaker of the heart

true

T/F: a patient with a fib is at high risk for thrombus formation

true

T/F: the most common dysrhythmia in patieent with cardiac arrest is v fib

true

T/F: ventricular tach is considered and emergency situation because the patint is usually (but not alays) unresponsive

true

T/F:The varicella zoster organism is responsible for the chickenpox infection.

true

4. Typical candidates for a heart transplant have severe symptoms uncontrolled by medical therapy, no other surgical options, and a prognosis of less than _______ year(s) to live.

two

describe scleroderma

two major catagories: localized and systemic Raynaud's phenomenon Edema in the hands Loss of wrinkles and lines in the skin as skin and connective tissue harden Dry skin Stiffening of extremities, ↓mobility Masklike face Rigid mouth

define st segment

up or down reflects myocardial tissue changes

describe why interventions are directed at correcting various dysrhythmias

v tach needs a shock if the patient is unconscious and without a pulse v fib needs a shock asystole needs CPR

high v/q (dead space)

ventilation exceeds perfusion, meaning that alveoli do not have an adequate blood supply for gas exchange to occur. This is characteristic in many disorders such as pulmonary emboli, pulmonary infarction, cardiogenic shock

define qrs

ventricular contraction

5. ________ is a vitamin K antagonist that is indicated for extended anticoagulant therapy

warfarin (coumadin)

What is the primary clinical symptom of emphysema? Chest pain Productive cough Sputum Wheezing

wheezing

histotaxic hypoxia

when a toxin such as cyanide interferes with ability of tissues to use available O2.

define prolapse of valve

when atrioventricular valve leaflet stretches and flops into atrium during systole making an incomplete closure

when is active shingles most contagious

when the person is blistering

what qualifies someone for a pacemaker?

when you have a ventricular rate of 30 or 40 because there is complete heart block