MedSurg Exam 2
Pharmacologic Therapy for PAD Antiplatelet and Vasodilator Cilostazol
prevents platelet aggregation and HTN
Risk Factors for Sickle Cell Crisis
stress, excessive temps, dehydration, infection, environments with O2 tension (mountains, airplane)
Acute limb ischemia
sudden decrease in blood flow to an extremity that threatens tissue viability.
critical/chronic limb ischemia
sustained, severe decrease of arterial blood flow to the affected extremity, which leads to chronic ischemia, rest pain, ulceration, gangrene, and limb loss if untreated.
4 Types of Sickle Cell Crises
vaso-occlusive, aplastic crisis, sequestration crisis, hemolytic crisis.
Pharmacologic Therapy for PAD Lipid lowering Statins
Successfully reduce total cholesterol in most pts when used for extended period
Ankle-Brachial Index (ABI)
Diagnostic for PAD/PVD. Ratio of the ankle systolic pressure to the brachial systolic pressure; an objective measurement of arterial disease that provides quantification of the degree of stenosis
What heart meds are inotropes that increase contractility?
Digoxin ***this is toxic if pt is hypokalemic.
Which heart meds reduce preload?
Diuretics: HCTZ, furosemide, spironolactone
Hypertensive urgency
-Blood pressure is very elevated but no evidence of immediate or progressive target organ damage -Oral agents can be administered with the goal of normalizing BP within 24-48 hours -Fast-acting oral agents: labetalol (BB), captopril (ACE-I), clonidine (Alpha agonist)
Primary Interventions for HF
-Elevate head of bed and provide fan for dyspnea -Oxygenation -Meds to improve cardiac function -Fluid and sodium restriction -Self-care teaching
Hypertensive emergency
-Blood pressure >180/120 mm Hg and must be lowered immediately to prevent damage to target organs -Reduce BP 20-25% in first hour -Reduce to 160/100 over 6 hours -Exceptions are ischemic stroke and aortic dissection -Meds: IV vasodilators: nitropress, nicardipine, nitroglycerin
Iron Deficiency Anemia - clinical manifestations
(a result of insufficient hemoglobin to carry adequate oxygen to the tissues): Hypoxia, fatigue, pallor, tachycardia, tachypnea, glossitis (smooth, shiny, swollen tongue), koilonychias (spoon-shaped nails)
Nursing Interventions Thrombocytopenia
- Implement bleeding precautions - Minimize blood loss - Avoid intramuscular injections - Avoid rectal temperatures - Provide safe environment - Use minimal inflation with blood pressure - Minimize blood draws - Instruct patient/family on bleeding precautions - Avoid sexual intercourse when platelet count is < 50,000 - Necessity of frequent laboratory tests
Folic Acid Deficiency Anemia
- Necessary for DNA synthesis and formation of heme. - Lack of folate during pregnancy can result in neural tube defects for bebe. - Typically a result of inadequate dietary intake - Decreases in folate levels delay erythrocyte maturation, thus lowering HGB levels, causing anemia. - Absorbed in the jejunum of the small intestine
HIV/AIDS manifestations indicating deterioration that require IMMEDIATE attention:
- New cough = pneumonia, TB - Increased fatigue = anemia, infection - Fever less than 97°F (36°C) or greater than 102°F (39°C) = infection - Night sweats = mycobacterial infection - New onset of headache = meningitis - New onset of visual blurring - Recent change in mental status = CNS infection, tumor - New skin lesions - New onset of diarrhea - Weight loss greater than 10% of previously recorded weight
Risks of Chemo
- Potential chemo complications include extravasation, hypersensitivity reactions, reversible alopecia, emesis, weight loss, fatigue, kidney damage - Admin considerations: prepared under vent hood, 2RN check, chemo gloves, dispose in special chemo bin.
Clinical Manifestations of PAD
- intermittent claudication described as aching, cramping, or inducing fatigue or weakness. It occurs with some degree of exercise or activity and is relieved with rest. - Pain associated with limb ischemia of the distal extremity and is described as persistent, aching, or boring (rest pain)--ischemic rest pain is usually worse at night and often wakes the patient.
Diuretics; HCTZ, furosemide, spironolactone
-Act on the kidneys to help the body eliminate sodium and water, reducing blood volume. -Diuretics are often the first but not the only choice in high BP meds.
Treatments for DVT
-Anticoagulants; -thrombolytic therapy: dissolves clots that have already developed. Trt must be started w/in 5 days of clot formation. Nurse should monitor for bleeding. -Inferior vena cava filter can also be inserted when a pt is unresponsive to medical therapy or when anticoagulation is contraindicated. -Can also use thromboletry, balloon angioplasty, and stent placement.
Common Sites of Metastasis
Breast Cancer → Bone*, Lung*, Liver & Brain Prostate Cancer → Bone* (especially spine & legs) Lung Cancer → Brain*, Bone, Liver & Pancreas Melanoma → GI Tract, Lung & Brain Colorectal Cancer → Liver*
Hypercalcemia associated with cancer treatment- what should the nurse monitor?
-nausea and constipation -muscle weakness -assess urine output -monitor HR fr bradycardia -monitor for symptoms of delirium The nurse should monitor calcium, phosphorous, and renal function. Assess for symptoms of hypercalcemia such as delirium, somnolence, muscle weakness, fatigue, polyuria, bradycardia, nausea, and constipation. Blood pressure and perfusion are not impacted.
Virchow's Triad
1. Decreased flow rate or stasis of blood flow 2. Damage to the blood vessel wall/endothelial injury 3. An increased tendency for the blood to clot (hypercoagulability)
HIV treatment
A decreased viral load indicates a positive response to prescribed HIV treatment, because viral load testing measures the presence of HIV viral genetic material
SIADH s/s
Decreased urinary output Edema/weight gain Serum hyponatremia PT should be fluid restricted
Clinical Manifestations of Anemia (all types)
Depends on severity/concurrent problems/etc: Fatigue, weakness, malaise Pallor or jaundice Cardiac and respiratory symptoms Tongue changes Nail changes Angular cheilitis Pica
D-Dimer testing
Diagnostic for DVT D-dimers are markers of coagulation activation by measuring fibrin degradation products produced from fibrinolysis
PTP Testing
Diagnostic for DVT The pretest probability score, also called a Wells Score. It is calculated from clinical and historical data to stratify patients into low, moderate, and high risk of DVT.
What does a serum d-dimer measure?
A serum D-dimer measures the byproducts of a clot breaking down. A negative D-dimer lab test excludes a DVT without the need for compression ultrasonography. An elevated D-dimer can result from other medical conditions than a DVT, so more testing would be required to confirm diagnosis.
Intrinsic Factor
A substance produced by the mucosa of the stomach and intestines that is essential for the absorption of vitamin B12. B12 is only absorbed in the last 60cm of the intestine
A nurse is assessing a client who has a history of deep-vein thrombosis and is receiving warfarin. The nurse should identify that which of the following findings indicates the medication is effective? A. INR 2.0 B. Decreased blood pressure C. Hemoglobin 14 g/dL D. Minimal bruising of extremities
A. INR 2.0 The nurse should identify that an INR of 2.0 is within the desired reference range of 2.0 to 3.0 for a client who has a deep-vein thrombosis and is receiving warfarin to reduce the risk of new clot formation and a stroke.
What heart meds reduce afterload?
ACE-Is: -pril ARBs: -sartan Vasodilators: nitropress
CD4 Counts; what does a count of at less than 200 cells/uL indicate?
Acquired Immune Deficiency Syndrome (AIDS)
Primary Nursing Interventions for Sickle Cell Crisis:
Administer oxygen Aggressive hydration Pain management
Ultrasonography
Diagnostic for DVT allows for rapid and clean visualization of the thrombi
A patient with lung cancer is diagnosed with superior vena cava syndrome. Which action is most appropriate for this patient? Assessing for signs of fluid overload Assessing for unsteady gait Assessing for signs of renal dysfunction Assessing for signs of respiratory distress
Assessing for signs of fluid overload Rationale: The nurse should assess for fluid overload in patients with cancer-associated syndrome of inappropriate antidiuretic hormone. Assessing for unsteady gait Rationale: The nurse should assess for signs of unsteady gait in patients with spinal cord compression. Assessing for signs of renal dysfunction Rationale: The nurse should assess for signs of renal dysfunction in patients with cancer-associated tumor lysis syndrome. Assessing for signs of respiratory distress Rationale: Dyspnea is the most common clinical system of superior vena cava syndrome. Therefore, the nurse should assess for signs of respiratory distress. Chapter:Chapter 13, Overview of Cancer Care Page Reference:p. 235
A nurse is monitoring a client's ECG monitor and notes the client's rhythm has changed from normal sinus rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following interventions? A. Defibrillation B. Vagal stimulation C. Administration of atropine IV D. Initiate chest compressions
B. Vagal stimulation The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole.
The nurse is caring for a patient with spinal cord compression. Which symptoms demonstrate late stages? Back pain Weakness, numbness, and tingling Inability to distinguish between hot and cold Constipation or incontinence
Back pain Rationale: Back pain is one of the first signs. Weakness, numbness, and tingling Rationale: Weakness, numbness, and tingling is an early sign of cord compression Inability to distinguish between hot and cold Rationale: Inability to distinguish between hot and cold sensation is lost with early compression. Constipation or incontinence Rationale: Constipation or incontinence is a late finding of cord compression. Chapter:Chapter 13, Overview of Cancer Care Page Reference:p. 235
Which heart meds decrease HR and myocardial workload?
Beta Blocker: -olol
DIC s/s
Bleeding Ecchymosis Petechiae Thrombosis Ischemia Patchy cyanosis to necrosis and gangrene ID cause, ensure adequate O2 and ventilation. Maintain tissue perfusion PRBCs, fresh frozen plasma, cryoprecipitate, platelets Heparin or LMWH (BUT DO NOT USE WITH TRAUMA, GI, OR CRANIAL BLEEDS)
A patient has hematuria, abdominal discomfort, and a distended abdomen. Which condition does the patient most likely have, according to these symptoms? Brain tumor Bladder cancer Cervical cancer Esophageal cancer
Brain tumor Rationale: Headaches, personality changes, somnolence or hyperactivity, memory deficits, and visual disturbances are clinical manifestations of brain tumors. Bladder cancer Rationale: Hematuria, abdominal discomfort, and a distended abdomen are clinical manifestations of bladder cancer. Cervical cancer Rationale: Vaginal bleeding, postcoital vaginal discomfort, malodorous vaginal discharge, and tumorous lesions on the cervix are clinical manifestations of cervical cancer. Esophageal cancer Rationale: Dysphagia, indigestion, and chest discomfort are clinical manifestations of esophageal cancer. Chapter:Chapter 13, Overview of Cancer Care Page Reference:p. 229
Labs - Folic Acid Deficiency
CBC, fasting blood test, serum folate levels, MMA and homocysteine. Homocysteine will be elevated w/ FA deficiency.
HemolyticAnemia : excess destruction of RBCs
Caused by altered erythropoiesis (sickle cell disease), or other causes such as hypersplenism, drug-induced or autoimmune processes, mechanical heart valve
Hypoproliferative: defect in production of RBCs
Caused by iron, vitamin B12, or folate deficiency, decreased erythropoietin production, cancer, aplastic anemia
What does CAUTION stand for?
Change in bowel or bladder Any sore that does not heal Unusual bleeding/ discharge Thickening in breast Indigestion Obvious change in wart Nagging cough or hoarseness
Clinical Manifestations: CAUTION
Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or dysphagia Obvious change in wart or mole Nagging cough or hoarseness
CD4 Counts; what does a count of 200-499 cells/uL indicate?
Chronic infection either asymptomatic or symptomatic
what are the common, general signs of most types of anemia?
Common general signs and symptoms of most types of anemia include fatigue, pallor, tachycardia, tachypnea, and shortness of breath. The oxygen-carrying capacity of the blood is impacted by the decreased hemoglobin and lack of red blood cells. It is uncommon for a client with anemia to have hypokalemia, constipation, or dehydration directly related to the anemia.
Superior Vena Cava Syndrome
Compression or invasion of the superior vena cava resulting impaired venous drainage of the head, neck, and arms.
What are constitutional signs of cancer?
Constitutional signs are vaguer than CAUTION symptoms and may include fatigue, unexplained weight loss, fever, and night sweats. They accompany B-cell lymphoma, and are often referred to as "B symptoms."
Central Agonists
Decrease blood vessels' ability to contract and cause vasoconstriction
Pharmacologic Therapy for PAD Hemorheological Agents Pentoxifylline
Decrease blood viscosity by inhibiting platelet aggregation; increase blood flow to the affected extremity
Dromotropic
Drugs that affect conduction of electrical impulses through the heart Positive Dromotropic: speeds up conduction of electric impulses through the heart Ex: epinephrine Negative Dromotropic: slows down conduction of electrical impulse through the heart Ex: CCBs such as verapamil, adenosine, vagal stimulation
Chronotropic
Drugs that change the heart rate and rhythm Positive Chronotropic: accelerates the heart rate Ex: Adrenergic agonists: dopamine, atropine, epinephrine Negative Chronotropic: slows the heart rate Ex: Beta blockers and digoxin
In HIV and AIDS, during the acute viral infection and seroconversion stage, what does the patient experience?
During the acute viral infection and seroconversion, the CD4+ lymphocyte count rapidly decreases and the viral load rapidly increases as the HIV virus spreads. The individual may experience flu-like symptoms during this time including low-grade fever, generalized aches and pains, swollen lymph nodes, and generally feeling ill. After several weeks, the person's immune system develops antibodies to HIV, seroconversion occurs, and the person tests positive for HIV. Next
In HIV and AIDS, during the asymptomatic chronic infection stage, what does the patient experience?
During the asymptomatic chronic infection stage, the body's immune system is able to maintain control over the invading virus by increasing the CD4+ count as the viral load drops to a set point. Total elimination of the virus is not possible, but the patient is asymptomatic. It is important to recognize that the virus can still be transmitted during the phase.
Risks for B12 deficiency anemia
Elderly, GI resections, Autoimmune, Chron's, Celiac disease, long term meds that decrease acid
Syndrome of Inappropriate Secretion of Antidiuretic hormone (SIADH)
Excessive secretion of antidiuretic hormone (ADH) as a result of certain tumors.
SVC Syndrome s/s
Facial swelling, edema of neck/arms/hands Stoke's sign (swelling) Progressive dyspnea Epistaxis Cyanosis Changes in mental status Give O2, Corticosteroids, Radiation, Chemo, Sx
Treatment for thrombocytopenia
Glucocorticoids, resolution of underlying condition, replacement of clotting factors, discontinue heparin. Possible transfusions
What should pt report immediately in folic acid deficiency?
Have pt immediately report signs of fatigue, SOB, dizziness, confusion, bleeding
Angiotensin II Receptor Blockers (ARBs) Losartan
Help relax/dilate blood vessels by blocking the action-not the formation-of angiotensin II, a vasoconstrictor. Sometimes used in pts intolerant of ACE-Is
Angiotensin-Converting Enzyme Inhibitors (ACE-Is) Enalapril, Lisinopril
Help relax/dilate blood vessels by blocking the formation of angiotensin II, a vasoconstrictor, thus reducing BP
Pharmacologic Therapy for PAD Vasodilators ACEi
Help relax/dilate blood vessels by blocking the formation of angiotensin II, a vasoconstrictor. ACE-I therapy reduces the risk of MI, stroke, or vascular morbidity
Calcium Channel Blockers Amlodipine, Diltiazem, Nifedipine, Verapamil
Help relax/dilate the muscles of the blood vessels. Diltiazem and verapamil (non-DHPs) can also slow HR. African American patients respond better to CCBs due to the amount of circulating renin in their systems, therefore African American adults with HTN but without HF or CKD, including those with DM, initial antihypertensive trt should include a thiazide diuretic or a CCB.
ITP
Idiopathic thrombocytopenic purpura; a type of thrombocytopenia
If a d-dimer indicates a probable thrombus, what is the next diagnostic that would be used?
If the D-dimer indicates a probable thrombus, the next step is to perform compression ultrasonography.
Disseminated Intravascular Coagulation (DIC)
In the cancer patient most often caused by sepsis, blood transfusions, or from the cancer itself. Results in extensively impaired blood clotting processes that primarily affecting small blood vessels throughout the body. Blood clotting uses platelets and clotting factors; they become used up and then widespread bleeding occurs.
tumor lysis syndrome s/s
Increased uric acid Increased potassium Increased phosphate Decreased calcium Ensure adequate hydration! Give allopurinol for increased uric acid levels Give kayexalate to decrease serum potassium
Pharmacologic Therapy for PAD Antiplatelet Aspirin, Clopidogrel
Inhibit platelet aggregation; therefore decreasing the probability of vascular events
What is true regarding bowel obstruction in a patient with colon cancer? It can happen due to masses in bowel lumen. It can happen due to internal compression. It can happen due to excess antidiuretic hormone. It can happen due to excessive immature white blood cells.
It can happen due to masses in bowel lumen. Rationale: Masses in bowel lumen may obstruct the normal flow of enteral contents, gastrointestinal (GI) fluids and wastes, and may result in bowel obstruction. Bowel obstruction is an oncological emergency that is most commonly seen in patients with colon cancer. It can happen due to internal compression. Rationale: External compression may cause bowel obstruction that can be partial or complete and involve the small or large bowel. This may be seen in an oncological emergency such as bowel obstruction, which is most commonly seen in patients with colon cancer. It can happen due to excess antidiuretic hormone. Rationale: Excess antidiuretic hormone may cause fluid volume retention and vasoconstriction. This may be seen in an oncological emergency such as syndrome of inappropriate antidiuretic hormone (SIADH), which is most commonly found in patients who have primary or metastatic brain or lung cancer. However, this does not cause bowel obstruction. It can happen due to excessive immature white blood cells. Rationale: Excessive immature white blood cells may cause capillary sludging, thrombosis, and rupture of vessels. This may be seen in an oncological emergency such as leukostasis, which is most commonly found in acute myelocytic leukemia. However, this does not cause bowel obstruction. Test Taking Tips:Bowel obstruction occurs when the small intestine or colon is partially or completely congested.
Spinal Cord Compression
Nerve root compression from an expanding tumor or a collapsed vertebra. Most commonly occurs in the thoracic region; It can cause irreversible neurologic impairment (sensory and/or motor function).
What will MCH and MCV look like with iron deficiency anemia?
MCV will be small, MCH will be pale. dont forget to pull lab for TIBC (remember: more open seats, less iron filling them --> this is BAD and indicates a deficiency)
Vit B12 Deficiency Anemia
Macrocytic Absorption problem, not nutritional deficiency B12 and folate deficiency often coexist **Screen for both** More sensitive measure is methylmalonic (MMA) and homocysteine levels B12 levels are often normal, if they are, do MMA and HC levels
Inotropic
Medications that alter the force or energy of the heart's contraction Positive Inotropic: strengthens the force of cardiac contraction Ex: digoxin Negative Inotropic: weakens the force of cardiac contraction Ex: beta blockers, CCBs, antiarrhythmics
A nurse is caring for a patient with acute myelocytic leukemia who has been admitted to the oncology department due to leukostasis. What are the most important nursing interventions for this patient? Select all that apply. Monitor white blood cell count. Assess for signs of occluded microcirculation. Monitor calcium, phosphorous, and renal function. Assess for edema of the face and eyes. Assess for signs of bleeding.
Monitor white blood cell count. Rationale: When caring for a patient with acute myelocytic leukemia who has developed leukostasis, the nurse should continue monitoring white blood cell count. Assess for signs of occluded microcirculation. Rationale: When caring for a patient with acute myelocytic leukemia who has developed leukostasis, the nurse should assess for signs of occluded microcirculation such as blurred vision, headache, transient ischemic attacks, cerebrovascular accidents, dyspnea, and poor peripheral perfusion. Monitor calcium, phosphorous, and renal function. Rationale: When caring for a patient with renal cancer who has developed hypercalcemia, the nurse should monitor calcium, phosphorous, and renal function. Assess for edema of the face and eyes. Rationale: When caring for a patient with lung cancer who has developed superior vena cava syndrome, the nurse should perform early assessment for edema of the face and eyes. Assess for signs of bleeding. Rationale: When caring for a patient with acute myelocytic leukemia who has developed leukostasis, the nurse should assess for signs of bleeding. Test-Taking Tip Consider bleeding, clotting, and infection. Page Reference:p. 234 Question 7 of 9
Risk Factors for Folic Acid Deficiency Anemia
Most often affects elderly, alcohol abusers, people with chronic illnesses, and extreme dieters. Gastric bypass and Whipple.
Tumor Lysis Syndrome
Occurs when large number of cancer cells are quickly destroyed releasing intercellular contents such as potassium, phosphate and purines (uric acid). TLS may be severe and if untreated result in death
BNP (brain natriuretic peptide)
One diagnostic for HF; it is a hormone produced by the ventricular cardiac muscle, it is released in reaction to over-stretching of the ventricle in response to increased pressure and volume. The result is natural diuresis and arterial and venous dilation. It decreases both preload and afterload.
Which are warning signs of cancer? Select all that apply. Oral mucositis Alopecia Change in bowel habits Nagging cough or hoarseness Obvious change in a wart or mole
Oral mucositis Rationale: Oral mucositis is a common adverse effect of antineoplastic medications. Alopecia Rationale: Alopecia is a common adverse effect of chemotherapy. Change in bowel habits Rationale: A change in bowel habits is a warning sign of cancer. Nagging cough or hoarseness Rationale: A nagging cough or hoarseness is a symptom of cancer. Obvious change in a wart or mole Rationale: An obvious change in a wart or mole is caused by the metastasis of cells and is a warning sign of cancer. Chapter:Chapter 13, Overview of Cancer Care Page Reference:p. 229
6 P's of ischemia
Pain Pallor Pulselessness Paresthesia Paralysis Poikilothermic (coolness)
HIV treatment options
Prophylaxis of OIs, immunizations: pneumonia, prevnar, influenza, tDAP, herpes zoster. Live virus vaccines are contraindicated in pts w/ CD4 <200.
HIV diagnotics
Pt needs to have +antibody and +antigen to have dx of HIV. HIV rapid test, HIV lab screening, CD4+ lymphocyte count, Viral load, genetic resistance testing/genotype. After getting a positive rapid test, a patient will need to get lab confirmation. It is then important to assess CD4 and viral load.
complications of HF
Pulmonary edema: SOB, low O2 sat, pink/frothy sputum, orthopnea, tachycardia, chest pain, and anxiety/fear; give diuretics and vasodilators to treat. Renal failure, Hypotension, poor perfusion, cardiogenic shock, dysrhythmias, thromboembolism, Pericardial effusion: accumulation of fluid in pericardial sack, and cardiac tamponade: restriction of heart function bc of fluid, resulting in decreased venous return and decreased CO. Cardiogenic shock: HF symptoms, shock state, hypoxia
The nurse monitors fluid overload in a patient with cancer-associated syndrome of inappropriate antidiuretic hormone (SIADH). Which condition is the nurse aiming to prevent in this intervention? Dyspnea Heart block Leukostasis Hypertension
Rationale: The nurse should assess for dyspnea in patients with cancer-associated pleural effusion. Heart block Rationale: The nurse should assess for electrocardiogram changes to prevent heart block in patients with cancer-associated tumor lysis syndrome. Leukostasis Rationale: The nurse should monitor white blood cell count to prevent leukostasis in patients with cancer. Hypertension Rationale: Fluid overload can result in hypertension and subsequent heart failure. Therefore, the nurse monitors fluid overload in a patient with cancer-associated SIADH. Antidiuretic hormone imbalance causes fluid volume retention. Chapter:Chapter 13, Overview of Cancer Care Page Reference:p. 235
Combined Alpha and Beta Blockers
Reduce nerve impulses that promote vasoconstriction and at the same time slow the HR and reduce afterload.
Beta Blockers Metoprolol, Propranolol
Reduce the afterload on the heart and dilate blood vessels, causing the heart to beat more slowly and with less force.
Vasodilators Nitroglycerin, Nitroprusside
Relax the muscle tissue in the blood vessel walls and, in turn, lower the BP
Stages of PAD
Stage 1 = Reduced Pulses Stage 2 = Intermittent Claudication Stage 3 = Pain even when resting Stage 4 = Ulcers
True or False: The contrast medium used for coronary angiography is iodine-based. Clients who have a history of allergic reaction to shellfish often react to iodine and might need a steroid or antihistamine prior to the procedure.
TRUE
TRUE OR FALSE: Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart.
TRUE Also: The heart transplant client will remain on immunosuppressants for the remainder of their life to help prevent rejection of the heart. The client's activity tolerance should gradually improve as the healing process progresses. The client will remain on immunosuppressants for the remainder of their life to help prevent rejection of the heart. The client will need to permanently maintain a diet that is restricted in sodium and fat.
Do pts with folic acid deficiency anemia have to take an iron supplement?
The client with folic acid deficiency anemia will not have to take an iron supplement. Many people with folic acid deficiency anemia can take oral supplements, but with the client taking both metformin and oral contraceptives, oral or parenteral folic acid supplements may be necessary.
What should the nurse assess for when a patient is suspected of having leukostasis?
The nurse needs to be aware of infection, sludging of blood, and thrombosis. This includes monitoring the white blood cell count; and assessing for signs of occluded microcirculation such as blurred vision, headache, transient ischemic attacks, cerebrovascular accidents, dyspnea, poor peripheral perfusion, and oliguria. The nurse should also assess for signs of bleeding.
In HIV, during the symptomatic chronic HIV infection stage, what does the patient experience?
The symptomatic chronic HIV infection phase is when the body begins to lose its fight against the virus. During this phase, the CD4+ count will fall and the viral load begins to take over, making it more difficult for the person to fight off infections. Symptoms begin to develop, such as frequent respiratory infections, enlarged lymph nodes, and skin rashes and disorders. Once a person with HIV becomes symptomatic, the average time to the development of AIDS is 2 years.
CD4 Counts; what does a count of at least 500cells/uL indicate?
Viral transmission, acute viral infection, and seroconversion
The provider has seen John and stated that he will be started on medication for Peripheral Arterial Disease. The nurse anticipates John could be started on which of the following medications to improve this condition. Select all that apply. a) Aspirin 325mg daily b) Acetaminophen 500mg every 2 to 4 hours PRN c) Clopidogrel 75mg daily d) Cilostazol 100mg daily
a) Aspirin 325mg daily c) Clopidogrel 75mg daily d) Cilostazol 100mg daily
a nurse is caring for a client following the insertion of a permanent pacemaker. Which of the following pt statements indicates a potential complication of the inseriton procedure? a. I can't get rid of these hiccups b. i feel dizzy when i stand c. my incision site stings d. i have a headache
a. I can't get rid of these hiccups Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation. Dizziness is not a complication of the insertion procedure and is expected initially as the client adjusts to the pacemaker. Pain or stinging at the incision site is not a complication of the insertion procedure. However, the client should monitor the pacemaker insertion site for manifestations of infection. Headache is not a complication of the insertion procedure. However, it might be related to other disease processes.
A nurse in an emergency department is assessing a client who has bradydysrhythmia. Which of the following should the nurse monitor for? a. confusion b. friction rub c. hypertension d. dry skin
a. confusion Bradydysrhythmia can cause decreased systemic perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status. The nurse should monitor a client who has a bradydysrhythmia for hypotension. The nurse should monitor a client who has a bradydysrhythmia for diaphoresis.
a nurse is assessing a pt who has dilated cardiomyopathy. which of the following findings should the nurse expect? a. dyspnea on exertion b. tracheal deviation c. pericardial rub d. weight loss
a. dyspnea on exertion The nurse should identify dyspnea on exertion as an expected manifestation of dilated cardiomyopathy. Dyspnea on exertion is due to ventricular compromise and reduced cardiac output. The nurse should identify that weight GAIN is an expected manifestation of dilated cardiomyopathy. Weight gain is due to ventricular compromise and fluid retention.
A nurse is caring for a pt who has heart failure and is experiencing afib. which of the following findings should the nurse plan to monitor for and report to the provider immediately? a. slurred speech b. irregular pulse c. dependent edema d. persistent fatigue
a. slurred speech The greatest risk to this client is injury from an embolus caused by the pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. Therefore, the nurse should report this finding to the provider immediately. An irregular pulse is an expected finding for a client who has atrial fibrillation and indicates the client is at risk for inadequate cardiac output. However, another finding is the priority. Dependent edema is an expected finding for a client who has heart failure and indicates the client is at risk for inadequate circulation. However, another finding is the priority. Fatigue is an expected finding for a client who has heart failure and indicates the client is at risk for inadequate cardiac output. However, another finding is the priority.
Pernicious anemia
autoimmune disease that leads to a vit B12 deficiency d/t inability to absorb B12 w/o intrinsic factor.
The nurse is preparing John for his ABI test. Which of the following statements are true with regards to his procedure? Select all that apply. a) "This test is an invasive procedure where a probe is inserted in the femoral artery and will test your lower leg pressure." b) "A blood pressure will be taken on both arms and both legs." c) "A reading of greater than 0.9 will indicate peripheral arterial disease." d) "A reading of less than 0.9 will indicate peripheral arterial disease."
b) "A blood pressure will be taken on both arms and both legs." d) "A reading of less than 0.9 will indicate peripheral arterial disease."
The nurse entered the room to round on Elizabeth and complete her Q4 assessment. Elizabeth has muscle weakness and bradycardia (HR 55). The nurse suspects these clinical findings are related to hypercalcemia given recent bloodwork results. Which of the following are priority interventions? Select all that apply. a) Polystyrene sulfonate (Kayexalate) b) 0.9% Normal Saline Solution c) IV of calcium gluconate d) Oral Bisphosphonates
b) 0.9% Normal Saline Solution d) Oral Bisphosphonates
The nurse is explaining to the nursing student the concept of Virchow's triad, the three mechanisms that can create a venous thrombosis. The nurse explains that which of the following is not a mechanism included in Virchow's triad? a. Increased tendency of the blood to clot b. Decreased number of platelets c. Decreased blood flow rate d. Damage to the blood vessel wall
b. Decreased number of platelets
Kaitlyn, a teenage female client with sickle cell disease, has been admitted to the nursing unit with a diagnosis of sickle cell crisis. She is experiencing severe pain in her joints and shortness of breath, and has a temperature of 101.2°F. Kaitlyn's oxygen saturation on admission was 92%. She rates her pain at a 9 on a 0-10 scale.What explanation should the nurse give to Kaitlyn when she asks what causes the pain she is feeling? a. Inflammation of nerve endings related to fever b. Lack of blood circulation and oxygen into part of the body c. Presence of lactic acid in the muscle tissue d. Physical activity related to disease process
b. Lack of blood circulation and oxygen into part of the body When sickle cells clump together and block capillaries, blood circulation to certain parts of the body is blocked. This decreased blood flow causes pain.
A nurse is caring for a pt who was admitted for treatment with left-sided HF and is receiving IV loop diuretics and digitalis therapy. The pt is experiencing weakness and an irregular HR. Which of the following actions should the nurse take first? a. obtain the patient's current weight b. review serum electrolyte values c. determine the time of the last digoxin dose d. check the pt's urine output
b. review serum electrolyte values Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level, because the client is at risk for dysrhythmias from hypokalemia.
You enter the room of a 75-year-old male client, Bob, admitted with a diagnosis of left femur fracture who is in skeletal traction. Bob fell off a ladder at his home. He is going into surgery in 12 hours for an open reduction internal fixation of the fracture. The nurse considers Virchow's triad of risk factors for the development of a venous thrombosis. Which factors does Bob have? Select all that apply. a. impaired neuro status b. stasis of blood flow c. damage to blood vessel walls d. skeletal traction e. increased tendency for the blood to clot
b. stasis of blood flow c. damage to blood vessel walls The Virchow's triad includes a decreased flow of blood, endothelial injury, and hypercoagulability. This client has blood stasis from immobility (decreased blood flow) and blood vessel injury from the fracture (endothelial injury). No history indicates that he is at risk for hypercoagulability (increased tendency for blood clotting).
What should pt report in iron deficiency anemia?
bleeding, increasing fatigue, or SOB
A nurse is caring for a client who is scheduled for a coronary artery bypass graft in 2 hr. Which of the following client statements indicates a need for further testing by the nurse? a. my arthritis is really bothering me because I haven't taken my aspirin in a week b. my blood pressure shouldn't be high because I took my BP med this morning c. I took my warfarin last night according to my usual schedule d. I will check my blood sugar because I took a reduced dose of insulin this morning
c. I took my warfarin last night according to my usual schedule pts who are scheduled for a CABG should not take anticoagulants, such as warfarin, for several days prior to the surgery to prevent excessive bleeding.
The nurse is explaining the diagnosis of aplastic anemia to the client. The nurse would include which of these statements in the explanation? a. The client has a decreased number of red blood cells in the bloodstream. b. The client has a decrease in red blood cell production. c. The client is deficient in red blood cells, white blood cells, and platelets. d. The client has a lack of vitamin B12, known as extrinsic factor.
c. The client is deficient in red blood cells, white blood cells, and platelets.
A nurse is caring for. pt who had an onset of chest pain 24 hours ago. The nurse should identify that an increase in which of the following values is diagnostic of a MI? a. myoglobin b. c-reactive protein c. creatinine kinase-MB d. homocystine
c. creatinine kinase-MB Creatine kinase-MB is the isoenzyme specific to the myocardium. Elevated creatine kinase-MB indicates myocardial muscle injury. Myoglobin is elevated following an MI, and with skeletal muscle injury. However, it is not specific to the cardiac muscle. C-reactive protein increases soon after the beginning of an inflammatory process, such as rheumatoid arthritis, and is not specific to cardiac muscle. Homocysteine is always present in the blood. An increased level might indicate a risk factor for the development of cardiovascular disease.
a nurse is caring for a client who is 1 hr post-op following an aortic aneurysm repair. which of the following findings can indicate shock and should be reported to the provider? a. serosanguineous drainage on dressing b. severe pain when coughing c. urine output of 20mL/hr d. increase in temp from 98.2F to 99.5F
c. urine output of 20mL/hr Urine output less than 30 mL/hr is a manifestation of shock. Urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture.
Graft-versus-host
complication that occurs following a stem cell or bone marrow transplant in which the transplant produces antibodies against recipient's organs that can be severe enough to cause death. To prevent this, pts receive immunosuppressive drugs like cyclosproine
a nurse in an emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals that they are 1 week postop following an open cholecystectomy. Which of the following interventions is contraindicated? a. Administering IV morphine sulfate b. administering 2L/min O2 via nasal cannula c. helping to patient to the bedside commode d. assisting with thrombolytic therapy
d. assisting with thrombolytic therapy The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy.
Tumor Staging
determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis (TNM- tumor, nodes, metastasis)
Thrombocytopenia- complications
hemorrhage, spontaneous bleeding
Iron Deficiency Anemia - risk factors
inadequate iron in the diet, hemorrhage, chronic blood loss, GI problems, cancer, elderly, gastric bypass sx, CHF, CKD
Folic Acid Deficiency Anemia - clinical manifestations
increased bleeding risk, pancytopenia, pallor, tachycardia, tachypnea, SOB, fatigue, dizziness.
Hypercalcemia - cancer
ncreased serum calcium levels as a result cancerous cells invading bone or some tumors secrete parathyroid hormones
Does nonionizing radiation cause cancer?
no. nonionizing radiation is radio waves, visible light, and lasers
Clinical manifestations for B12 deficiency anemia
often delayed; neurological and psychiatric dysfunctions. Spinal cord degeneration, peripheral neuropathy, depression, visual disturbances, tachycardia, tachypnea, dizziness, SOB, fatigue, paresthesias, confusion, mood swings, impaired taste, dementia resembling Alzheimer's, tinnitus.
Clinical Manifestations for sickle cell crisis
pain, swelling, fatigue, pallor, SOB, fever, delayed wound healing
Clinical manifestations of DVT
pain, swelling, tenderness, discoloration, or redness or warmth in the affected area. s/s depend on size, location, degree of vessel occlusion, and adequacy of collateral circulation. Homan's sign may indicate.
Tumor Grading
pathologic classification of tumor cells: I-IV. How closely they resemble normal cells in morphology and differentiation (function): Grading (I to IV) Grade X (GX ): Grade Can Not be Determined Grade I (G1): More Similar; Least Aggressive Grade IV (G4): Least Similar; Most Aggressive