Health Alterations Exam 2
X-ray
This test is routinely obtained to determine the size (cardiac enlargement), silhouette, and position of the heart.
D-dimer test (An elevated result indicates a positive DVT)
This test is used for the diagnosis of DVT when the patient has few clinical signs and stratifies patients into a high-risk category for recurrence. This is a useful noninvasive test that can exclude a DVT without an ultrasound.
Low-risk individuals High risk individuals (e.g., IV drug users, immunocompromised, healthcare workers, homeless, poverty, poor access to healthcare, foreign-born persons).
> 15 mm induration is considered positive PPD in which population? > 5 mm induration is considered positive PPD in which population?
B, C, E, F A and D are symptoms of right-sided HF (I.e., blockage to the right ventricle = peripheral buildup)
A client is diagnosed with left-sided HF. Which client assessment findings will the nurse anticipate? Select all the apply. A. Peripheral edema B. Crackles in both lungs C. Tachycardia D. Ascites E. Tachypnea F. S3 gallop
Glucagon
A hormone that prevents hypoglycemia by triggering the release of glucose from storage sites in the liver and skeletal muscle. It is sometimes called the "hormone of starvation" because it is secreted when food intake is low to release glucose from the liver to keep glucose levels in the normal range.
Status Asthmaticus
A severe, life-threatening acute episode of airway obstruction that intensifies once it begins and often does not respond to usual therapy.
Encourage the patient to go beyond the point of pain to build collateral circulation.
A supervised exercise program is recommenced for patients with PAD. What is important to teach your patients when exercising with PAD?
Pursed lip breathing Remember to use pursed-lip breathing during any physical activity. Always inhale before beginning the activity and exhale while performing it. Never hold your breath.
This breathing technique delays airway compression and reduces air trapping by prolonging exhalation. Promotes expiration of CO2.
Coronary angiography
This diagnostic test is used to identify coronary blockages.
Unaffected side
After a thoracentesis what side must the patient lay on?
Coronary Artery Disease (CAD)
An elevation of cholesterol, triglycerides, and LDL, places a patient at an increased risk for what?
Emphysema (COPD)
An increased synthesis of proteases triggered by cigarette smoking, these enzymes damage alveoli causing them to lose their elasticity becoming large and flabby. This causes an increased amount of air to get trapped in the lungs (AP 1:1). Which destructive problem am I describing?
If the patinet has high serum lipids, lipid-lowering drugs such as Statins are used to reduce LDL and increase HDL ACE inhibitors to promote vasodilation (decreases BP) Antiplatelet agents, such as aspirin to reduce MI, stroke, and vascular death **Exercise is the best treatment. Instruct the patient to walk until the point of claudication, stop and rest, and then walk a little further. Eventually, he/she can walk longer distances as collateral circulation develops. Smoking cessation Proper DM management
As the nurse, you understand that the best treatment for peripheral artery disease (PAD) may include which three medications and what lifestyle modifications?
Decreased perfusion to the extremities Diminished or absent pedal, popliteal, or femoral pulses Thin, shiny skin **Delayed wound healing, tissue necrosis, arterial ulcers,and amputation are common complications of PAD
Aside from intermittent claudication, what are other clinical manifestations of PAD?
Infective Endocarditis (IE)
This disease occurs primarily in patients with injection drug use (IDU) and those ho have had valve replacements, have experienced systemic alterations in immunity, or have structural cardiac defects.
Obtain blood cultures
Before treatment for infective endocarditis is started what MUST first be done?
chronic stable angina
Chest discomfort that occurs with moderate-to-prolonged exertion in a pattern that is familiar to the patient. Usually relieved by nitroglycerin or rest and often is managed with drug therapy.
What is chronic stable angina?
Chest pain that is familiar to the patient that is relieved with nitroglycerin and rest
Cardiac Angiography
Cardiac catheterization used to identity coronary blockages
Know the levels of cholesterol, triglycerides, HDL, LDL
Cholesterol >200 is bad Triglycerides 35 - 135 (females) 40 - 160 (males) HDL > 55 (females) > 45 (males) LDL < 130
Echocardiography
Considered the best tool in diagnosing heart failure.
Chest tube insertion
This invasive procedure is performed to alleviate a collapsed lung (pneumothorax)?
SOB Chest pain Acute confusion (A PE is blockage to the lungs which wold cause hypoxia symptoms and blood flow would also become obstructed to the heart which would cause pain)
Monitor all patients with DVTs for signs and symptoms of a PE, these symptoms include what?
Potassium Hypokalemia can result from diuretic therapy
Monitor for deficiency of this electrolyte during diuretic therapy.
Left anterior descending artery (LAD)
Obstruction of this artery causes anterior or septal MIs because it perfuses the anterior wall and most of the septum of the left ventricle? Known as the "Window Markers heart attack."
Q5mins x3 (call 911 if unrelieved after first dose) Patients should allow medication to dissolve under their tongue. This route allows immediate absorption into the circulation and avoids first-pass metabolism by the liver. Patients may take up to one tablet every 5 minutes, up to 3 sublingual tablets within 15 minutes to relieve chest pain. If chest pain is not relieved after the first dose, 911 should be called.
How would you educate a patient on Nitroglycerin Use?
Mild to moderate: 15 g of carbohydrates in 15 minutes (15:15 rule) Repeat until blood glucose is > 70 mg/dL Severe: dextrose (D50) gel
How would you treat mild to moderate hypoglycemia? How would you treat severe hypoglycemia?
Monitor patient until sedation effects have resolved and a gag reflex has returned. Assess VS Assess breath sounds Q15mins for the first 2 hours Assess for bleeding, infection, or hypoxemia
Explain the follow-up care for a thoracentesis.
A person had a positive TB test who was previously negative. What does the positive test result indicate?
Exposure to TB
90 minutes
During an acute MI, the goal is to perform Percutaneous Coronary Intervention to open the area of blockage within how many minutes?
Unstable angina
ECG changes without changes in troponin levels and poorly relieved by rest or nitroglycerin is describing what manifestation?
HDL (High Density Lipoprotein)
Elevation of this serum lipid lab protects a person against CAD
Eosinophils Normal range: 50 - 500
Elevations of this differential WBC count indicates possible COPD, asthma, or allergies
The priority is assessing the patients ABCs (Maintain O2 SAT > 90%) Once ABCs are maintained: ECG monitoring VS IV access Prescribed drugs
Emergency care for the patient with chest pain includes what?
Deoxygenated blood is brought into the right atrium through the superior and inferior vena cavas. Is then passed through the tricuspid valve and into the right ventricle. Then passes though the pulmonary artery (pulmonic valve) into the lungs. The now oxygenated blood flows into the left atrium. Then through the mitral valve and into the left ventricle where it is pushed out through the aortic valve out the aorta and into the body. Valve mnemonic use Tissue Paper My Ass (tricuspid, pulmonic, mitral, aortic) Veins transport deoxygenated blood to the heart Arteries transport oxygenated blood to the body EXCEPT the pulmonary artery which brings deoxygenated blood to the lungs.
Explain the blood flow through the heart and the correct order of the valves the deoxygenated and oxygenated blood flows through.
Type 1: - Usually younger than 30 years old - Abrupt onset - Developed due to a viral infection or autoimmune response - Destruction of Beta cells (insulin producing cells) - No endogenous insulin - Insulin dependent - Usually non-obese - DKA Type 2: - May occur at any age in adults (usually > 30 years old) - Gradual onset - Genetic predisposition (obesity leading cause) - Insulin resistance (can supplement with oral hypoglycemic medication) - 60 - 80% are obese - Treated with diet and exercise - HHS
Explain the differences between Type 1 and Type 2 Diabetes.
Bedrest orders and keep the insertion site extremely straight. Current practice is for patients to remain in bed for 2 to 6 hours after the procedure. Supine position is ideal, however the HOB may be raised up to 30 degrees
Following a cardiac catheterization what activity orders would you expect the provider to order?
Intermittent claudication
This is a classic symptom of PAD. Refers to ischemic muscle pain which is caused by a constant level of exercise. It resolves within 10 or less with rest. Severe cases even experience this at rest. O2 demand > O2 supply = ischemic pain
History and physical exam DIagnosis confirmed by spirometry, FEV (forced expiratory volume) test shows increased residual volume. ALSO Chest x-ray - shows if lungs are hyperinflated or diaphragm is flattened Pulmonary function test (PFT) ABGs (respiratory acidosis (pH low, PaCO2 high) Sputum for culture and sensitivity
How is COPD diagnosed?
4 L
How many liters of oxygen do you need before you can add humidification?
Forehead
If a person has peripheral artery disease (PAD), with impaired circulation to the upper and lower extremities, which site could be used to assess the SPO2?
Understand how to read an ABG, use the ROME method: Respiratory Opposite Metabolic Equal
If the pH is low the PaCO2 will be high (opposite the pH) If the pH is low the HCO3 will also be low (metabolic equal) If the pH is HIGH the PaCO2 will be LOW (opposite)
Echocardiography (It measures ejection fracture of the heart)
Is considered the best diagnostic tool in diagnosing HF And is a noninvasive diagnostic procedure of choice to visualize the structure and movement of the heart. The test is painless and takes 30 - 60 minutes to complete, the patient lays on their left side.
NO! Teach them to avoid raising their legs above the heart level because extreme elevation slows arterial blood flow to the feet. (Arteries bring oxygenated blood throughout the body (i.e., arteries travels down the legs). Instead incorporate an individualized exercise plan which may improve arterial blood flow to the affected leg through buildup of the collateral circulation.
Is leg elevation above the heart recommended for PAD?
Generalized weakness Depressed reflexes Irregular heart rate
What are common signs and symptoms of hypokalemia?
10 - 20 mg/dL
Normal BUN range
0.6 - 1.2 mg/dL
Normal creatinine range
Insulin
Prevents hyperglycemia by allowing body cells to take up, use, and store carbohydrate, fat, and protein. It is sometimes called the "hormone of plenty" because it is secreted when food intake is high and works to move glucose from the blood into cells to keep blood glucose levels in the normal range.
B-type natriuretic peptide (BNP) An absence of elevation in BNP, in conjunction with history and physical, rules out HF as the cause of acute dyspnea and points to a primary lung dysfunction.
This lab is used for diagnosing HF, in patients with acute dyspnea. It is part of the body's response to decreased CO from either left or right ventricular dysfunction.
Troponin Troponin T and I are not found in healthy patients, so any rise in values indicates cardiac necrosis or acute MI
This myocardial muscle protein is released into the bloodstream due to injury to myocardial muscle. Blood test used to diagnose an MI
Chest x-ray
Test used to diagnose heart enlargement (cardiomegaly)
Total Lung Capacity (TLC) Increased TLC indicates air trapping from obstructive pulmonary disease. Because the alveoli are stretched
The amount of air in the lungs at the end of maximum inhalation.
Functional Residual Capacity (FRC) Increased FRC indicates hyperinflation or air trapping, often from obstructive pulmonary disease. AP 1:1 "barrel chest" commonly seen in COPD patient's
The amount of air remaining in the lungs after normal expiration.
Residual Volume (RV) RV is increased in obstructive pulmonary disease such as emphysema. RV is increased because the alveoli become stretched and saggy due to the over production of proteases resulting in retained CO2 because the body can not effectively exhale. The alveoli are stretched and cannot compress and squeeze the CO2 out.
The amount of air remaining in the lungs at the end of a full, forced exhalation.
Stroke volume (SV)
The amount of blood ejected by the left ventricle during each contraction
chronic obstructive pulmonary disease (COPD)
These clinical manifestations describe which disease? (1) Alveoli that lose their elasticity an shape making it hard to breath (alveoli become stretched). Because the alveoli are stretched the body cannot blow off CO2, leading to hypercapnia (excess CO2), resulting in respiratory acidosis (low pH, high PaCO2) (2) Air gets trapped in the lungs (resulting in AP ratio 1:1 "barrel chest") (3) Bronchial tubes become inflamed and narrowed (bronchoconstriction) (4) Thick mucus forms causing a chronic cough
Myocardial cell death or necrosis AKA Myocardial Infarction (MI)
The combination of changes on the ECG and elevation in cardiac troponin indicates what?
Preload
The degree of myocardial fiber stretch at the end of diastole and just before contraction
60 - 70 mmHg
The mean arterial pressure (MAP) must be between what mmHg to maintain perfusion of major body organs, such as the kidneys and brain?
Positive blood cultures - prime diagnostic test New regurgitate murmur Evidence of endocardial involvement by echocardiography - improved the ability to diagnose IE accurately
The most reliable criteria for diagnosing endocarditis include what 3 things?
C. Weight increase of 9 lb in the past weak A daily weight is the best indicator of fluid balance or excess
The nurse is assessing a client with HF. Which assessment data are the best indicator of fluid balance? A. Blood pressure 144/79 mmHg B. Urine output 200 mL in the last 4 hours C. Weight increase of 9 lb in the past week D. Generalized edema in the lower extremities
D. "I'll start to exercise gradually, stopping when I have pain." Instruct the patient to walk until the point of claudication, stop and rest, and then walk a little further. Eventually, he/she can walk longer distances as collateral circulation develops. A. The patient must completely quit smoking B. Educate the patient to avoid raising their legs above the heart level because extreme elevation slows arterial blood flow to the feet (arteries go with gravity, veins go against gravity). C. Caution the patient to avoid the application of direct heat to the limb with heating pads or extremely hot water. Sensitivity is decreased in the affected limb. Burns may result. **Instead encourage the patient to maintain a warm environment at home and to wear socks or insulated shoes at all times.
The nurse is caring for a client with intermittent claudication due to PAD. Which patient statement indicates understanding of proper self-management? A. "I need to reduce the number of cigarettes that I smoke each day." B. "I'll elevate my legs above the level of my heart." C. "I'll use a heating pad to promote circulation." D. "I'll start to exercise gradually, stopping when I have pain."
A, C, D, E (B) Troponin elevation is only found in patients who are experiencing an MI (A) ECG changes are seen in unable angina, as well as (C) pain lasting longer than 15 minutes, with (D) more frequent attacks (unlike stable angina where "attacks" are familiar), and the (E) chest pain increases and is most often unrelieved with nitroglycerin (unlike stable angina that is always relieved with nitroglycerin).
The nurse is caring for a patient with chest pain. What assessment data would cause the nurse to suspect unstable angina? Select all that apply. A. ST changes (ECG changes) B. Troponin T 0.6 mg/mL C. Pain lasts 15-25 minutes D. Increased number of angina attacks E. The intensity of the chest pain has increased
D. The patient has prediabetes An A1C level of 5.7% - 6.4% indicates prediabetes and an increased risk for development of diabetes. A. A normal A1C is between 4 - 6% B and D: An A1C > 6.5% indicates diabetes
The nurse reviewing the preadmission testing laboratory values for a 62 year old patient scheduled for a total knee replacement finds an A1C value of 6.2%. How will the nurse interpret this finding? A. The patient's A1C is completely normal B. The patient has type 1 diabetes C. The patient has type 2 diabetes D. The patient has prediabetes
A. A person who is in late stage COPD will have an elevated PaCO2 and a decreased PaO2. There pH is going to be on the acidic side due to the excess CO2 (CO2 breaks down into H+ which are acidic). You will also note the elevated HCO3 because the kidneys are attempting to compensate for the lungs, increasing the HCO3. You can eliminate B because the kidneys are not compensating, HCO3 is low You can eliminate C and D because the pH is alkalosis which is seen in hyperventilating patients who breathe off excess CO2, while COPD patients retain CO2.
The nurse reviews the arterial blood gases of a patient. Which result would indicate the patient has later stage COPD? A. pH 7.32, PaCO2 58 mm Hg, PaO2 60 mm Hg, HCO3 30 mEq/L B. pH 7.30, PaCO2 45 mm Hg, PaO2 55 mm Hg, HCO3 18 mEq/L C. pH 7.40, PaCO2 40 mm Hg, PaO2 70 mm Hg, HCO3 25 mEq/L D. pH 7.52, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 35 mEq/L
D. 4 - 12 hours
The nurse teaches an adolescent with type 1 diabetes about peak action of NPH insulin and the risk for hypoglycemia. The nurse determines teaching has been effective when the adolescent identifies insulin peak action within which time frame? A. 1 - 2 hours B. 2 - 4 hours C. 5 - 10 hours D. 4 - 12 hours
C. Confusion Due to hypoxia
The nurse understands that which of the following is the most common symptom of pneumonia in the older adult patient? A.Fever B.Cough C.Confusion D.Weakness
Status Asthmaticus
The patient arrives in the ER with extremely labored breathing and wheezing. Use of accessory muscles for breathing and distention of neck veins are observed. If this condition is not reversed, the patient may develop pneumothorax and cardiac or respiratory arrest. What life-threatening event is the patient suffering from?
Palpitations, cough, and a feeling of heat or a hot flash Tell the patient about the sensations that he or she may experience during the procedure, such as palpitations (as the catheter is passed up to the left ventricle), and a desire to cough (as the medium is injected into the right side of the heart). A feeling of heat or a hot flash (as the medium is injected into either side of the heart) is an expected sensation felt during the procedure.
The patient will undergo a cardiac catheterization to determine the location and severity of the blockage. Then an angioplasty is performed, usually with a stent placed. What are normal symptoms would you educate the patient about that may occur during the procedure?
D. Leukoesterase (Note: think WBCs are leukocytes which are elevated with an infection, UTI is an infection). A. Glucose - present if serum glucose exceeds threshold B. Protein - present with glomerular or tubular damage C. Nitrates - presence suggests E. Coli
The presence of what in a urinalysis suggests a UTI? A. Glucose B. Protein C. Nitrates D. Leukoesterase
Afterload
The pressure or resistance that the ventricles must overcome to open the aortic valve to eject blood through the semilunar valves and into the peripheral blood system.
Cardiac Output (CO)
The volume of blood ejected by the heart each minute
Venturi mask This high-flow oxygen device allows a precise delivery of oxygen to the patient to prevent oxygen toxicity. Low-flow is typically used as a daily management to relieve and improve quality of life for patients with COPD.
What O2 device is used for a patient who is experiencing a COPD exacerbation?
Polyuria Polydipsia Polyphagia Ketone bodies - "ketones" are abnormal acidic breakdown products that collect in the blood when insulin is not available, leading to metabolic acidosis Kussmaul respiration's - the body's attempt to "blow off" excess CO2 and acid by increasing the depth and rate of respiration's Rotting citrus odor breath - acetone is exhaled, giving the breath this distinct odor
What are clinical manifestations of insulin deficiency in the body (hyperglycemia)?
Persistent cough Small mass on lung (may have been developing over 8-10 years)
What are clinical manifestations or symptoms of lung cancer?
HTN, DM, smoking, Family history, obesity, Sleep apnea HF is caused by systemic HTN in most cases
What are common causes and risks factors for HF?
Auscultation of fine/ coarse crackles (indicates fluid buildup) Cough Fever, chills Dyspnea, tachypnea Pleuritic chest pain Green, yellow, or rust-colored sputum Changes in mentation (seen in older adults or debilitated patients)
What are common clinical manifestations of pneumonia?
Family history of HTN African-American ethnicity Smoking Excessive sodium and caffeine intake Overweight/ obesity Physical inactivity Excessive alcohol intake Excessive and continuous stress Table 33.2, page 700
What are common risk factors for developing hypertension?
Audible wheeze Increased respiratory rate (tachypnea) When inflammation occurs with asthma, coughing may increase Use of accessory muscles A patient with long-standing, severe asthma may have a "barrel chest" Prolonged exhalation Hypoxemia (decreased O2 levels) S/sx of hypoxia include: decreased LOC, tachycardia, cyanosis (oral mucosa and nail beds)
What are common symptoms noted on a physical assessment for a patient who is experiencing an acute asthma attack?
Exercise helps control blood glucose levels Wear appropriate footwear and examine feet daily and after exercise Stay well hydrated and avoid exercising in extreme temperatures DO NOT EXERCISE unless blood glucose level is at least 80 and less than 250 mg/dL DO NOT EXERCISE within 1 hour of insulin injection or near time of peak insulin action Eat a carbohydrate snack prior to exercising if last meal was over 1 hour ago Carry a simple sugar snack and identification information with you
What are important factors to educate, for a patient with diabetes, about exercising?
Smoking Sedentary lifestyle Obesity Psychological factors, such as stress, anger, depression, and hostility HTN Cholesterol > 200 mg/dL
What are major modifiable risk factors for Coronary Artery Disease (CAD)?
Atelectasis (collapse of alveoli) Bacteremia (bacteria in the blood) Pneumothorax (collapsed lung) Sepsis/ septic shock Lung abscess
What are possible complications that may develop from an pneumonia?
Atherosclerosis is the most common cause of chronic arterial obstruction; therefore, the risk factors for atherosclerosis apply to PAD as well. o Low HDL/ high LDL o Diabetes mellitus o Obesity o HTN o Sedentary lifestyle o Smoking o Stress
What are risk factors associated with developing PAD?
Onset is sudden Caused from inadequate insulin dose (remember insulin is the key that allows glucose to enter the cells and leave the body) Symptoms include: Kussmaul respirations, "rotting fruit" breath, polyuria, polydipsia, polyphagia Lab findings: Serum ketones present (remember without insulin the body cannot breakdown glucose and instead breaks down fat stores) pH < 7.35 and HCO3- < 15 (metabolic acidosis - ketones are acidic) Glucose > 300 mg/dL DKA is present in Type 1 diabetics because their body lacks the ability to produce insulin, autoimmune, destroys b cells (i.e., insulin producing cells).
What are specific characteristics of Diabetic Ketoacidosis (DKA)?
Gradual onset Caused from infection, poor fluid intake Symptoms include: altered CNS function and neurologic symptoms Lab findings: Glucose > 600 mg/dL pH > 7.4 and HCO3- > 20 (metabolic alkalosis)
What are specific characteristics of HHS?
Skin: Warm, dry Respiration's: Kussmaul, "fruity" odor breath Mental status: alert to near-unconsciousness (stuporous) Symptoms: abdominal cramps, nausea, vomiting Glucose: > 250 mg/dL (Table 59.12, page 1292)
What are symptoms of hyperglycemia?
Skin: Cool, clammy Mental status: Anxious, nervous, confusion Symptoms: Weakness, blurred vision, hunger, tachycardia Glucose: < 70 mg/dL (Table 59.12, page 1292)
What are symptoms of hypoglycemia?
Prolonged expiratory phase Wheezing Decreased breath sounds AP 1:1 (barrel chest) Tripod position (orthopneic) Pursed lip breathing Anorexia, weight loss (due to increased metabolic rate and lack of appetite)
What are the clinical manifestations of COPD?
pH: 7.35 - 7.45 PaCO2: 35 - 45 HCO3: 22 - 26 PaO2: 80 - 100
What are the normal range values of an ABG? pH PaCO2 HCO3 PaO2
Hgb: 14 - 18 Hct: 42 - 52% WBC: 5,000 - 10,000 Platelet: 150,000 - 400,000 INR: 0.8 - 1.1 (2 - 3 for warfarin therapy) PT: 11 - 12.5 seconds
What are the normal ranges for these lab values? Hgb Hct WBC Platelet INR PT
#1 priority action is to increase O2 SATs to > 93% (airway is always the priority) position patient in high-fowlers ECG IV access Nitroglycerin (IV) Statin Morphine
What are the priority actions the nurse should perform when a patient is having a myocardial infarction (MI)?
Risk factors include: Smoking/ tobacco use Poor diet Physical inactivity DM HTN > 140/90 mmHg Obesity Cholesterol > 200 mg/dL Lifestyle Alterations include: Completely quitting smoking Limit Na and cholesterol intake Moderate exercise (3-4 days a week) or walk daily. Exercise will increase your HDL and decrease your LDL decreasing cholesterol. Manage DM Monitor BP Eat better
What are the risk factors for CAD? As the RN what would you educate your patient, who has one or more of these risk factors, on how to lower or prevent the development of CAD?
Dysfunction of the left ventricle causing back up to the lungs, manifesting these symptoms: (LUNGS) Hacking cough, dyspnea, crackles or wheezes, frothy, pink-tinged sputum, tachypnea (HYPOXIA) fatigue, weakness, confusion, tachycardia, cool extremities, pallor CO is diminished, leading to impaired tissue perfusion and unusual fatigue
What are the signs and symptoms of left-sided HF?
Dysfunction of the right ventricle causing back up to the peripherals JVD, Edema in lower extremities (dependent edema), swollen hands and feet, weight gain, increased BP
What are the signs and symptoms of right-sided HF?
Priority - assess airway patency and LOC Give IV bolus of insulin followed by titration of insulin IV fluids NS Assess blood glucose Q15mins Monitor electrolytes, especially potassium Monitor urine output, must be at least > 30mL/ hour
What are the steps taken for the treatment of DKA?
Stasis of blood flow endothelial injury hypercoagulability These three categories are associated with thrombus formation
What are the three categories of Virchow's triad?
Persistent cough or change in cough Blood-streaked sputum Rust-colored or purulent sputum Recurring episodes of pleural effusion, pneumonia, or bronchitis Fever associated with one or two other signs Clubbing of the fingers (Table 27.5, page 557)
What are the warning signals associated with lung cancer?
A1C > 6.5% (Normal non-diabetic person will have an A1C of 4 - 6%) AND Fasting blood glucose > 126 mg/dL (Normal non-diabetic person will have a fasting glucose of < 100 mg/dL) OR Two-hour blood glucose OR casual/ random blood glucose > 200 mg/dL (Casual means a blood glucose taken any time of day without regard to time of last meal) (Table 59.6, page 1273)
What are two lab test values that meet the criteria for the diagnosis of diabetes?
Chest x-ray (to assess for fluid in the lungs) Blood work (i.e., WBC to rule out infection) Pulse oximetry Sputum sample if patient has a productive cough BNP (rule out if the issue is related to HF or a respiratory issue, if BNP is normal the issue is caused by a respiratory problem)
What diagnostic tests would you expect the provider to order for a patient with suspected pneumonia?
High calorie, high protein diet
What diet is recommended for a COPD patient?
3 g sodium restriction diet for mild-to-moderate HF 2 g sodium restriction diet for severe HF
What diet is recommended for mild to moderate heart failure? Severe heart failure?
Secrete glucagon **Remember there's an A in glucAgon and Alpha
What do alpha (A) cells secrete?
Insulin
What do beta (B) cells produce?
This test measures the amount of glycosylation (glucose) that accumulates (permanently attaches) to hemoglobin over the course of the life of the hemoglobin. The higher the blood glucose the more glycosylated the hemoglobin becomes.
What does A1C measure?
May indicate liver or kidney disease, dehydration, or decreased kidney perfusion (Remember that when this level is elevated it means there is damage to the kidneys, because the kidneys are stressed and compensating "working harder" which is going to result in an increase). (Think when your heart works harder your pulse and BP go up)
What does an increased BUN level indicate?
Kidney impairment
What does an increased creatinine indicate?
Long-acting insulin glargine (Lantus)
What insulin cannot be mixed?
IV fluids Potent systemic bronchodilators Steroids Epinephrine O2
What is given immediately to reverse the condition status asthmaticus?
**Chest x-ray ABGs are also done Symptoms include: Asymmetrical chest wall expansion Absent breath sounds on affected side Dyspnea Cyanosis Tachycardia Pleural pain
What is the best way to diagnose a pneumothorax? What symptoms may be noted upon assessment of a patient experiencing a pneumothorax?
Angina is chest pain caused by a temporary imbalance between the coronary arteries ability to supply oxygen and the cardiac muscles demand for oxygen. Myocardial infarction (MI) occurs when myocardial tissue is abruptly and severely deprived of oxygen.
What is the difference between Angina and an MI?
Anticoagulants The conventional treatment has been IV unfractionated heparin followed by oral anticoagulation with warfarin (Coumadin).
What is the drug of choice for actual DVT and for patients at risk for DVT?
Cigarette smoking The incidence and severity of COPD would be greatly reduced by smoking cessation. Urge all adults who smoke to quit smoking or vaping.
What is the greatest risk factor for COPD?
Keep O2 SATs > 90% during rest, sleep, and exertion OR PaO2 > 60 mmHg (Normal range is 80 - 100) Administering to much oxygen can cause a COPD patient to become oxygen toxic (excessive oxygen in body) and cause them to lose their drive to breathe.
What is the ideal O2 SAT and PaO2 level for a COPD patient?
Inflammation of the mucous membranes lining the airway General irritants such as cold air, dry air, fine airborne particles, microorganisms, or NSAIDs.
What is the key event in triggering an asthma attack? An asthma attack occurs in response to the presence of specific allergens, what are these?
Atheroscerosis
What is the leading cause of peripheral artery disease (PAD)?
Antimicrobials are the main treatment Antimicrobials are usually given IV, with the course of treatment lasting 4 to 6 weeks. For most bacterial cases, the ideal antibiotic is one of the penicillins or cephalosporins.
What is the major component of treatment for endocarditis?
pulmonary embolism (PE)
What is the most common complication of a DVT?
New or worsening heart Failure (HF) and regurgitation murmur
What is the most common complication of infective endocarditis (IE)?
Females: > 55 mg/dL Males: > 45 mg/dL HDLs are you (H)appy cholesterol
What is the normal range for HDL for females and males?
< 130 mg/dL LDLs are your (L)ousy cholesterol
What is the normal range for LDL?
< 200 mg/dL
What is the normal range for cholesterol
Females: 35 - 135 mg/dL Males: 40 - 160 mg/dL
What is the normal range for triglycerides for Females? Males?
Onset: 1 - 2 hours Peak: 4 - 12 hours Duration: up to 24 hours NPH (Humulin N, Nonolin N)
What is the onset, peak, and duration of intermediate-acting insulin? What is the intermediate-acting prototype?
Onset: 3 - 4 hours Peak: NO peak Duration: > 24 hours Glargine (Lantus) (Note: a primanTUS bug is long)
What is the onset, peak, and duration of long-acting insulin? What is the long-acting insulin prototype?
Onset: 15 - 30 minutes (given 15 minutes before a meal) Peak: 1 - 3 hours Duration: 3 - 5 hours (Remember your meals are spread out about every 3 - 5 hours, breakfast at 8, lunch at 12, dinner at 5) Prototypes: lispro (Humalog) and aspart (Novolog) (I remember this by thinking of logs moving RAPIDLY down a river, like white water rafting)
What is the onset, peak, and duration of rapid-acting insulin? Which prototypes are rapid-acting insulin's?
Onset: 30 minutes Peak: 3 hours Duration: 8 hours Regular insulin (Humulin R, Novolin R)
What is the onset, peak, and duration of short-acting insulin? What is the short-acting prototype?
Venous duplex ultrasonography
What is the preferred diagnostic test for DVT?
Collateral circulation
What is this a picture of?
Consecutive sputum samples must be obtained on 3 different days (samples are taken in the morning)
What must be obtained for the diagnosis of TB?
Sitting bent forward with arms crossed resting on their bedside table (Figure 24.13, page 493) This is the best position for a thoracentesis, which widens the spaces between the ribs and permits easy access to the pleural fluid. Stand in front of the patient to prevent the table from moving and the patient from falling.
What position is the patient placed in for a thoracentesis procedure?
Oral Glucose Tolerance Test (OGTT)
What test is often used to diagnose gestational diabetes mellitus (GDM) during pregnancy and is not routinely used for general diagnosis of diabetes?
Assess pedal pulses before and after procedure Assess color, movement, and temperature of extremity Assess for DVT formation (i.e., heat, swelling, pain in calf or groin, and unilateral leg swelling)
What would a nurse assess post op following a cardiac catheterization?
D. These symptoms indicate the presence of subcutaneous emphysema (a complication from a thoracentesis) and may indicate a persistent air leak caused by a puncture or tears in the pleura.
When assessing the patient 2 hours after a thoracentesis, the nurse notes the skin around the puncture site is swollen and a crackling is felt and heard when pressure is applied to the area. What is the nurse's best action? A. Assess the patients SpO2 levels at two separate sites B. Obtain a prescription to culture the site C. Document the finding as the only action D. Notify the respiratory HCP
Left anterior descending artery
Which artery feeds the main pump of our heart (left ventricle) and is referred to as the "widow maker."
Potassium
Which electrolyte is affected by insulin causing it to move into the cells?
Statins
Which medication is given to inhibit cholesterol synthesis, decrease LDL, and to a certain extent increase HDL?
D. Albuterol Teach patients to carry this drug with them at all times because it can stop or reduce life-threatening bronchoconstriction. When taking any Beta-2 Agonist drugs with other inhaled drugs, teach patients to use the beta-2 agonist (bronchodilator) drug at least 5 minutes before the other inhaled drugs to allow the bronchodilation effect to increase the penetration of other inhaled drugs.
Which medication would a patient use who is having an acute asthma attack? A. Fluticasone B. Montelukast C. Prednisone D. Albuterol
Diuretics (e.g., Furosemide, spironolactone (K sparing), hydrochlorothiazide) - 1st line management for HF Low Na+ diet (< 2 g/day), DASH diet Fluid restriction (< 2 L/day) Monitor potassium (unless patient is prescribed spironolactone) Daily weight (report weight gain > 2lbs/day or > 5 lbs/week)
You are a nurse working on a Med-Surg unit who receives an admission. The patient was admitted from the ER with worsening heart failure. What orders do you anticipate the doctor will prescribe to alleviate the patients HF symptoms?