AH 3 final exam
Oxygen toxicity symptoms
-Substernal discomfort -Paresthesias -Dyspnea -Restlessness -Fatigue -Malaise -Progressive respiratory difficulty -Refractory hypoxemia -Alveolar atelectasis -Alveolar infiltrates on x-ray
A heart failure patient has had previous adverse reactions to ACE-Inhibitors. Which combination of drugs would the nurse expect the provider to order?
: Combination of hydralazine and isosorbide dinitrate
Normal BNP level
<100 pg/mL
COPD testing
ABGs: high CO2 (needs bipap) Pulmonary function tests, spirometry (eval airflow obst), Chest X-ray, Alpha-1 Antitrypsin screening (<45 & fam hx of COPD)
Chronic heart failure medications
ACE inhibitors, ARBS, Hydralazine and isosorbide dinitrate, beta blockers, diuretics, digitals Inotropes, Milrinone, Dobutamine
posterior pituitary hormones
ADH and oxytocin
Your patient is experiencing septic shock. As the nurse, you expect the medical management for this patient to include all the following except
Administration of colloids
Which statement made by the patient who just received an internal cardiac defibrillator (ICD) would prompt the nurse to provide further discharge teaching?
Answer: "I can play golf with my son in about 2 or 3 weeks", Rationale: activity restriction for 6 weeks
Prioritize the following cardiac rhythms in order of the one needing medical attention most urgently to the one needing medical attention least.
Answer: (most) Ventricular Fibrillation, Supraventricular Tachycardia with a HR of 255, Sinus Bradycardia, Atrial flutter 3:1(least attention)
The nurse is caring for a client who is to have a lumbar puncture. What are the lowest vertebrae that contain the spinal cord?
Answer: 2nd lumbar vertebrae
The nurse is caring for a patient with dilated cardiomyopathy. The echocardiography testing is likely to reveal what pathophysiological funding?
Answer: Decreased ejection fraction
A client being treated for bacterial pneumonia initially experienced dyspnea and a high fever but now claims to be feeling better and is afebrile. The client is most likely in which stage of the immune response?
Answer: Effector stage (when antibodies destroy invading microorganisms)
When reviewing the most recent lab results of a patient diagnosed with cardiomyopathy, the nurse should prioritize which of the following?
Answer: Sodium
A client with a spinal cord injury (SCI) reports severe headache. The nurse notes profuse diaphoresis of the client's forehead & scalp and suspects autonomic dysreflexia. The nurse knows that autonomic dysreflexia can occur when a spinal cord injury occurs at ___ or above
Answer: T6
Discharge teaching to a patient receiving a beta-agonist bronchodilator, such as Albuterol (Proventil) or Levalbuterol (Xopenex), should emphasize reporting which side effect?
Answer: Tachycardia
The nurse instructs a patient with a pulmonary embolism about administering enoxaparin (Lovenox) after discharge. Which statement by the patient indicates and understanding about the instructions?
Answer: The medicine will be prescribed for 10 days
Compensatory Stage of shock
BP within normal limits, vasoconstriction, increased HR, increased contractility, to maintain cardiac output. Stimulation of SNS, release of catecholamines (epinephrine & norepinephrine. Body shunts blood from kidneys/skin/GI to brain/heart/lungs, skin=cool & pale, hypoactive bowel sounds, low urine output
antiarrhythmic meds
Brady: 0.5mg Atropine IV q 3-5 mins to a total of 3mg, Transcutaneous pacing Tachy: Adenosine
auto immune disease diagnosis
CRP, Sed Rate (markers of inflammation), ANA
TB Prevalence
Closely associated w/poverty, malnutrition, overcrowding, substandard housing, & inadequate healthcare, Leading cause of death from infectious disease in the world, Spreads by airborne transmission. Immune system responds by initiating inflammatory responses. airborne precaution (negative pressure room, N95 along with other PPEs)
presents itself with weight gain (especially in the trunk of the body), high blood pressure, "moon face," hyperglycemia, a fat pad on the back referred to as a "buffalo hump" as a result of elevated cortisol levels
Cushing's Disease
While providing d/c teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the pt about which side effect?
Drowsiness
Which statement made by the client receiving education about Tuberculosis (TB) indicates the need for further instruction?
I will stay in isolation for six weeks
TB education
Initial infection typically occurs 2-10 weeks after exposure, Treated with anti-TB agents for 6-12 months)
Hypothyroidism medications
Levothyroxine (Synthroid) Liothyronien (cytomel) Liotrix (thyrolar) Thyroid (thyroid USP)
Non-Hodgkin Lymphoma (NHL):
Lymphoid tissues become infiltrated with malignant cells; spread is unpredictable and localized disease is rare, Increases with age, with average age being 66 years, Increased in autoimmune, prior treatment for cancer, organ transplant, viral infections, exposure to pesticides
hyperthyroidism mediations
Medications Radioactive iodine (Raiod), PTU, tapazole, Na or K iodide sol, beta blockers, dexamethasone, sx (thyroidectomy)
Lymphoma
Neoplasm of lymphoid origin, Usually start in lymph nodes but can involve lymphoid tissue in the spleen, GI tract, liver, or bone marrow
ICD/pacemaker education
No airport hand wand screening-must be hand-screened, wear med ID cannot do activity for 6 weeks
Progressive Stage of shock
No longer regulating blood pressure and the MAP falls below normal limits. Clinically HYPOtensive (< 90 or a decrease in systolic number more than 40 pts from baseline, lack of consciences and mental status. Shock syndrome as HR increases and BP drops.
Zone of coagulation
The area of the burn that received the most severe injury with irreversible cell damage
zone of hyperemia
The area surrounding the zone of stasis that presents with inflammation, but will fully recover without any intervention or permanent damage
The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse?
The client has convert4ed from HIV to AIDS
treatment for anemia
Treat the cause, transfusion of packed RBC's, dietary therapy (iron), bone marrow transplant, stem cell transplant, immunosuppressive therapy
Physiologic responses to all types of shock include the following except:
Vasoconstriction
Neurogenic Shock
a condition in which you have trouble keeping your heart rate, blood pressure and temperature stable because of damage to your nervous system after a spinal cord injury. Like other types of shock, this is a serious condition that can be fatal because your blood flow is too low. Fluid resuscitation will be given IV in shock patients. monitor the CVP and Pulmonary artery wedge pressure related to hypotension as you resuscitate with fluid.
Septic shock
a life-threatening condition that happens when your blood pressure drops to a dangerously low level after an infection. Any type of bacteria can cause the infection. Fungi such as candida and viruses can also be a cause, although this is rare.
A patient complaining of chest discomfort is discovered to have left lower lobe (LLL) pneumonia. Which strategy would the nurse instruct the patient to use to alleviate the discomfort? Answer: Lay on the client's right side Aclient with COPD has been receiving oxygen therapy for an extended period. What symptoms would be indicators that the client is experiencing oxygen toxicity?
a) Fatigue b) Substernal Chest Pain c) Dyspnea
Refractory Stage of shock
aka irreversible stage. Organ damage is so severe the pt does not respond to treatment and cannot survive. BP remains low, metabolic acidosis, worsening lactic acidosis, poor ventilation, low MAP, death is imminent. Multiple organ dysfunction
Colloids
albumin, dextran, gelatin, hydroxyethyl starches
Hydralazine and isosorbide dinitrate:
alternative to ACE inhibitors
zone of stasis
area in a burn surrounding the zone of coagulation that is characterized by decreased blood flow
acute respiratory distress syndrome (ARDS) risk factors
can be from direct injury to lungs (smoke inhalation), indirect insult to lungs (shock). Associated with mortality ranging from 26% to 58%. The major cause of death in ARDS is non-pulmonary MODS (multiple-organ dysfunction syndrome), often with sepsis; drug ingestion and overdose, trauma
Diuretics:
decreases fluid volume, monitor serum electrolytes
Milrinone
decreases preload and afterload; causes hypotension and increased risk of dysrhythmias
Burns are classified by
depth of the burn.
treatment of Hodgkin's Lymphoma
determined by stage of the disease and may include chemotherapy, radiation therapy, or both, and HSCT for advanced disease
iron foods
rgan meats, beans, leafy greens, raisins and molasses taken w good sources of vitamin C,
albuterol, levalbuterol
short acting beta 2 agonist
IV iron replacement can cause
stools to turn black - this is normal
postive Inotropes
strengthen the force of the heart: Digoxin, berberine, calcium, calcium sensitizers (levosimendan), catecholamines (dopamine, dobutamine, dopexamine, epi, isoprenaline), angiotension II, eicosanoids (prostaglandins), phosphodiesterase inhibitors (enoximone, milrinone, amrinone, theophylline)
albuterol, levalbuterol major side effect
tachycardia
hypothyroidism risk factors
thyroid atrophy, Treatment of Hyperthyroid w/iodine or thyroidectomy, Lithium, antithyroid meds, radiation to head/neck, Iodine deficiency or excess, infiltrative diseases (amyloidosis, scleroderma, lymphoma) genetic, usually women 30-50
Dobutamine
used for patients with left ventricular dysfunction; increases cardiac contractility and renal perfusion
Addison's Disease
usually caused by an autoimmune disease that damages the adrenal gland
Angiotensin-converting enzyme (ACE) inhibitors
vasodilation; diuresis; decreases afterload; monitor for hypotension, hyperkalemia, and altered renal function; cough
CT scan with contrast for a patient with end stage renal disease - what should we do
we should hydrate them before the CT with normal saline
negative Inotropes
weaken the force of the heart (ex: beta's block the effects of adrenaline on the body's beta receptors slowing the nerve impulses that travel through the heart): Beta-blockers, calcium channel blockers, & antiarrhythmic First line vasopressors (pressors): dopamine, epi, norepi (all 3 catecholamines: stimulate sympathetic alpha & beta receptors)
hyperthyroidism risk factors
women, genetic, age 20-40, increased iodine intake
The nurse is reviewing the medication administration record of a client diagnosed with systolic heart failure. What medication should the nurse anticipate administering to the client?
A beta-adrenergic blocker
A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess?
A leukocyte count >100,000/mm3
A client comes to the walk-in clinic reporting weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses and notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?
Aplastic Anemia
cardiomyopathy labs
BNP sodium IS BAD
cardiomyopathy diagnosis
ECG, echo, chest X-ray, nuclear studies, endomyocardial biopsy
A client's injury has initiated an immune response that involves urticaria and angioedema. What are the first cells to arrive at this client's site of inflammation?
Eosinophils (increase during an allergic reaction & stress)
anterior pituitary hormones
FSH, LH, TSH, STH, ACTH, and prolactin
Which of the following would the nurse expect to hear when auscultating the lungs of a patient experiencing an exacerbation of emphysema symptoms?
Faint breathing sounds with prolonged expiration
The nurse is caring for a client who has developed diabetes insipidus. The cause is unknown, and the physician has ordered a diagnostic test to determine if the cause is nephrogenic or neurogenic. What test will the nurse prepare the client for?
Fluid deprivation test
Sickle Cell Anemia Treatment
Hematopoietic stem cell transplant Hydroxyurea pneumococcal and influenza vaccines likely folic acid, PRBC transfusions, supportive therapy
A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?
Hemoglobin S
A patient undergoing a CT scan with contrast has a baseline serum creatinine level of 3 mg/dL. Which of the following interventions is MOST likely to reduce the risk of developing radiocontrast-induced nephropathy (CIN) in this patient who is high risk for developing kidney failure?
Hydrating the client with IV saline before the test
The nurse identifies which finding to be the most consistent prior to the onset of acute respiratory distress?
Normal lung function
Primary immunodeficiency syndrome (PIDD) Risks factors:
Occasionally, adults may present with persistent, recurrent, or resistant infections: Prevent body from developing normal immune responses, May affect phagocytic function, B cells or T cells, or the complement system,
Glasgow Coma Scale
On slide, be able to identify ranges by category How would you document an assessment on a patient with eyes that only open to painful stimuli/pressure, Is able to make sounds but no comprehensible words, and exhibits abnormal flexion of the extremities? 3= brain dead, 7 or less= comatose, Highest possible is 15
What discharge instructions should the nurse review with a patient who just had a permanent pacemaker placed yesterday? (Select all that apply)
Refrain from walking through anti-theft devices, Avoid hand-held screening devices in airports, Wear a medical alert bracelet or necklace noting the presence of pacemaker
Hodgkin's Lymphoma
Relatively rare malignancy that has a high cure rate, Suspected viral etiology, familial pattern, incidence in early 20s and again after the age of 50 years; more common in men, Unicentric; initiates in a single node, Reed--Sternberg cell
The nurse is caring for a client 48 hours after their burn injury. Which treatment will the nurse anticipate to reduce the client's risk of mortality?
Remove burned tissue, Rationale on slide: remove non-viable tissue w/in 48 hrs to decrease mortality
A client has meningitis & cultures are being done to determine the cause. Which of the following is most likely to be identified as the causative factor
Streptococcus Pneumoniae
treatment of Non-Hodgkin Lymphoma (NHL):
determined by type and stage of disease and may include interferon, chemotherapy, radiation therapy, and HSCT
cardiomyopathy
disease of the heart muscle that leads to generalized deterioration of the muscle and its pumping ability
Signs and symptoms of HIV
dramatic weight loss, Gum and mouth infections, Kapsoi's syndrome, Pneumocystis carnii
thyrotoxic storm
fever >101.3, tachycardia >130, AMS, exaggerated S/S of hyperthyroidism TX - reduce body temp, humidified O2, IVF, PTU or methimazole, hydrocortisone, iodine avoid sexual contact, sharing beds, close contact with children/pregnancy women, sharing drinks/utensils
Live vaccines are contraindicated in a patient who:
has PIDD
Digitalis:
improves contractility, monitor for digitalis toxicity especially if patient is hypokalemic
complications of ICD
infections, bleeding or hematoma formation, Dislocation of lead, Skeletal muscle or phrenic nerve stimulation, Cardiac tamponade- compression of heart by surrounding fluid (prevents filling. Severe drop on BP). Can be fatal, Pacemaker malfunction
acute respiratory distress syndrome (ARDS) signs and symptoms
intercostal retractions & crackles sudden, progressive pulmonary edema, increase bilateral infiltrates visible on chest x ray, absence of a increase L atrial pressure, Rapid onset of severe dyspnea <72 hrs after initial event, Hypoxemia that doesn't respond to O2, "Stiff lungs" (hard to ventilate) w/fibrosing alveolitis w/persistent, decreased lung compliance.
Cardiogenic Shock
is a life-threatening condition in which your heart suddenly can't pump enough blood to meet your body's needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock. Cardiogenic shock is rare. Exhibits decreased cardiac output, decreased tissue perfusion, presence of pulmonary edema
Anaphylactic Shock
is a rare but severe allergic reaction that can be deadly if you don't treat it right away. It's most often caused by a histamine reaction: allergy to food, insect bites, or certain medications. Quick onset, severe (often respiratory) symptoms. May need airway support (ETT). Often treated with IM Epinephrine (Epi-Pen ©). Shock in general will receive colloids, crystalloids, and blood products depending on the type of shock.
Hypovolemic Shock
is an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working. low cardiac output due to decrease in cardiac preload, 15% of the patient's blood supply must be lost to enter
Myxedema coma
life-threatening, severe hypothyroidism with hypothermia and unconsciousness caused by infection, sedatives, opioids, noncompliance to thyroid medicine TX - synthroid, glucocorticoids Q8-12H for 24 hrs followed by lower dose, T4 administered IV until pt can take PO
signs and symptoms of Non-Hodgkin Lymphoma (NHL):
lymphadenopathy, B symptoms, and symptoms associated with lymphomatous masses
Chest PT
manual percussion, vibration, squeezing, cough & forceful expiration
Crystalloids
normal saline, 5% dextrose, lactated ringers
COPD ABGs
pH ↓ PaO2 ↓ PaCO2⬆ HCO3 ⬆ resp acidosis
Hodgkin's Lymphoma signs and symptoms
painless lymph node enlargement; pruritus; B symptoms: fever, sweats, weight loss
PIDD diagnosis
patients present with infectious diseases that are beyond the scope of normal immunocompetence - atypical pathogens that are resistant to normal treatment
The client in the ED has had a diagnostic lumbar puncture. To reduce incidence of a post-lumbar puncture headache, what is the nurse's most appropriate action?
position the client prone
Angiotensin II Receptor Blockers (ARBs)
prescribed as an alternative to ACE inhibitors; work similarly
Beta-blockers:
prescribed in addition to ACE inhibitors; may be several weeks before effects seen; use with caution in patients with asthma
auto immune disease risk factors
reproductive age female, Women 20-40 at highest risk