FINAL EXAM 114
Tuberculosis drug therapy. 2 examples: _________________________________________ Two phases of treatment for active disease ________________________________ _________________________________
-Isoniazid and Rifampin (Rifadin) -Initial (8 weeks) -Continuation (18 weeks)
The following nursing measures should be instituted for a patient experiencing angina: 1. 2. 3. 4. 5.
(1) position patient upright unless contraindicated and administer supplemental oxygen (2) assess vital signs (3) obtain a 12-lead ECG (4) provide prompt pain relief first with a nitrate followed by an opioid analgesic if needed (5) auscultate heart and breath sounds
Venous Thromboembolism (VTE) Clinical Manifestations (5)
(Lower Extremity) •Unilateral edema •Pain •Tenderness with palpation •Erythema •Febrile
ANEMIA manifestations Mild (Hgb=_______________ g/dL): __________,exertional ________________, and __________________ fatigue Moderate (Hgb=_______________ g/dL): increased ________________________(_________________ pulse), dyspnea, _______________________ ears, fatigue Severe (Hgb=_______________ g/dL) skin: __________________, eyes: __________________ mouth: _______________________________, cardiovascular: _______________, _____________________, _________________ failure neuro: headache, irritability, depression, impaired ___________________________
-10-12 -palpitations -dyspnea -none or mild -6-10 -palpitations -bounding -roaring in ears -less than 6 -pallor -blurred vision -glossitis, smooth tongue -tachycardia -murmurs -heart -thought process
For any classification of asthma, in a "rescue plan" patients are instructed to take _______________ of _____________________ every ________________, for a maximum of ___________ times to gain rapid control of symptoms.
-2 to 4 puffs -albuterol -20 minutes -3
Fluticasone an inhaled corticosteroids can take up to __________________ to see effects. Can cause __________________
-2 weeks -oral fungal infections
Pulmonary TB clinical manifestations-Takes ___________________________ to develop symptoms. Initial ____________________ that becomes ____________________. -Constitutional symptoms (fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats) -Dyspnea and hemoptysis late symptoms People with latent TB may be asymptomatic and not contagious but will test ___________________________. Treatment for Latent TB is important because 5-10% of people may develop TB later on.
-2-3 weeks -dry cough -productive -positive on a Tuberculin skin test.
HIV AIDS: CD4+ T cell count falls below _____________________/uL. Opportunistic infections (OIs) are usually present at this time.
-200 cells
CVAD dressing changed MUST be done _____________________ after insertion and then EVERY _______________ or sooner if needed.
-24 hours -7 days
The whole process of asthma is called early phase response which occurs ____________________ after exposure to an allergen or irritant Late phase response occurs in up to 50% of pts which occurs _________________ after initial attack and can be more severe and last for ____________ or longer
-30-60 min -4-6 hours -24 hours
The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should be instructed to activate the emergency medical services (EMS) system. If symptoms are improved, repeat the nitroglycerin every ____________________ for a maximum of __________________ and contact EMS if symptoms have not resolved completely.
-5 minutes -three doses
A complete lipid profile is recommended every ___________________ beginning at age ________. Persons with a serum cholesterol level greater than_________________are at high risk for CAD.
-5 years -20 - 200 mg/dl
An aPTT must be obtained _____________ after a rate change for any Heparin Protocol. Normal range __________________ Therapeutic range __________________ Prior to initiating any Heparin protocol make sure you have at least _____________________ IV accesses. Any______________________________________________ should be performed prior to initiation of any Heparin drip.
-6 hours -25-35 secs -46-70 secs -2 patent - invasion procedures such as venipuncture, IV starts, and urinary catheter insertion
diagnosis of diabetes mellitus can be diagnosed using The following diagnostic levels: -a Hemoglobin A1C level: ________________ -Fasting plasma glucose level: _________________ -Two-hour plasma glucose level during OGTT: __________________________ -Classic symptoms of hyperglycemia with random plasma glucose level of___________________________________
-6.5% or higher -higher than 126 mg/dL -200 mg/dL (with glucose load of 75 g) -200 mg/dL or higher
Acute Ascending Aortic dissection signs/symptoms: •____________________________ pain and/or __________________ radiating to _________________________ •Murmur
-Abrupt, excruciating chest -back pain -shoulders
Complications of CVADS: Clinical manifestations of pneumothorax: _______________, _________________, ______________________ This can be caused by Perforation during insertion Nursing Management: Administer _______________ __________________ position Prepare for ____________________________
-Absent/decreased breath sounds -SOB -Chest pain -oxygen -Semi-Fowlers -emergent chest-tube insertion
______________________________________ develops when ischemia is prolonged and not immediately reversible. _____________________________ is chest pain that is new in onset, occurs at rest, or has a worsening pattern. It is __________________and represents _____________________________ ________________________________________ occurs as a result of sustained ischemia, causing irreversible myocardial cell death. Contractile function of the heart stops in the infarcted area(s). _________________________ not relieved by ______________,__________________, or _____________________________ is the hallmark of a Myocardial infarction (MI). The pain is usually described as a heaviness, pressure, tightness, burning, constriction, or crushing.
-Acute coronary syndrome (ACS) -Unstable angina (UA) -unpredictable -an emergency. -Myocardial infarction (MI) --Severe, immobilizing chest pain -rest, position change, or nitrate administration
TB patients will be placed on _____________________ isolation Single-occupancy room with 6-12 airflow exchanges/hour Health care workers wear ________________________________ PT teaching for TB -_________________________ when coughing, sneezing, or producing sputum -_________________________ after handling sputum-soiled tissues -Patient _____________________ if outside of negative-pressure room -Identify and _________________ close contacts
-Airborne -high-efficiency particulate air (HEPA) masks -Cover nose and mouth with tissue -Hand washing -wears mask -screen
Collab care for pneumonia -appropriate _________________ therapy -Repeat chest xray in __________________ -_________ for hypoxemia -Analgesics for chest pain -Antipyretics -Individualize rest and activity -Increase __________________ which helps loosen secretions -____________, ___________, and ______________ meals (monitor weight loss) -PTs should avoid _______________ and people with ______________________ -PTs at risk should obtain both ___________________________________
-Antibiotic -6-8 weeks -Oxygen -fluid intake -high calorie -small -frequent -cigarette smoke -upper respiratory infections -influenza and pnuemoccal vaccines
Collaborative care for Pericarditis includes the following: - _______________________________ -Pain and inflammation are usually treated with __________________________________ or high-dose salicylates. Cortiocosteroids may be an option in some patients. -Colchicine, an antiinflammatory agent used for gout, may be considered for patients who have recurrent pericarditis.
-Antibiotics -nonsteroidal antiinflammatory drugs (NSAIDs)
Pharmacologic Therapies for PAD (2) Surgical Therapy for PAD
-Antiplatelet agents such as Aspirin, clopidogrel (Plavix), and cilostazol (Pletal) -Peripheral Artery Bypass Graft (Fem-Pop)
_____________________ in combination with ____________________ and ____________________ have improved survival of patients with HF.
-Beta blockers -ACE inhibitors -diuretics
Complications of CVADS: Clinical manifestations of Embolism: ___________________, _________________, ________________, ___________________ Caused by:Catheter has broken; Thrombus has dislodged, Air Nursing Management: -Administer _________________ -_________________ Catheter -Place pt on _____________________________ -Notify Physician—This is a LIFE-Threatening emergency
-Chest pain -respiratory distress -Tachycardia -Hypotension -Oxygen -Clamp -left side with head down
Megaloblastic Anemia Deficiency in either ______________________ or _______________________
-Cobalamin (Vitamin B12) -Folic Acid
___________________________________ is a type of blood vessel disorder included in the general category of atherosclerosis. Atherosclerosis is characterized by the deposit of _____________________________________ within the intimal wall of an artery.
-Coronary artery disease (CAD) -cholesterol and lipids
Clinical manifestations of pneumonia Most common: -Breathing: ______________, ________________, _____________________ -systemic: __________,____________ -________________ chest pain -____________________________ sputum -Change in __________________ for older or debilitated patients Physical examination findings: -Lung sounds: ________________________________, ____________________________ -______________________ on percussion
-Cough, Dyspnea, tachypnea -fever, chills -Pleuritic -Green, yellow, or rust-colored -mentation -Fine or coarse crackles, Bronchial breath sounds -Dullness
Complications of PAD (3)
-Delayed wound healing -Arterial ulcers (occur over bony prominences) -Gangrene
Rheumatoid Arthritis TREATMENT -Drug therapy often involves _________________________________________________(example: ___________________________) therapy (monitor ____________________________) -Antimalarial drug ______________________________ can be effective (monitor____________________________... can take _________________________ to work) -_____________________ (like celecoxib) and ___________________ (Aspirin) -corticosteroids (__________________) NON DRUG THERAPIES -non drug therapy Heat & Cold Therapy _____________________________ during exacerbation/_______________________ for chronic stiffness Ice no longer than _______________________ Heat no longer than _______________________ -Rest, relaxation and gentle_____________________ -Joint protection (_________________)
-Disease-modifying antirheumatic drugs (DMARD) -methotrexate -liver and kidney function -hydroxychloroquine - liver and kidneys -6 months -NSAIDS -salicylates -Prednisone -Ice application -moist heat -10-15 minutes -20 minutes - ROM exercises -splints
Classes of drugs Used for hypertension: (5)
-Diuretics -Adrenergic inhibitors -Vasodilators -ACE Inhibitors and ARBs -Calcium Channel Blockers
_______________________ is the infiltration, of vesicant solutions or medications that cause cellular death and tissue damage. If suspected or present, _________________________ immediately and follow your facility's policy and procedure for the treatment of any extravasation. Immediate intervention is required to prevent serious complications.
-Extravasation -stop the infusion
Complications of CVADS: Clinical manifestations of Central line associated blood stream (systemic) infection: _________________ , ________________________ Caused by: Contamination during insertion/use Nursing Management: -________________Cultures -drug therapy: _____________________ and _________________________ -monitor ________________ status -Catheter Removal per physician instructions
-Fever -Elevated WBC -Blood -antibiotics -antipyretics -Fluid
Droplet Precautions -Used for patients with disease transmitted through respiratory droplets like ____________ or _______________________ -Must be placed in _________________ room -Don __________________ before entering room -______________________ must be placed on patient for transport
-Flu or pertussis -private -mask -Surgical mask
Cause of Hyperthyroidism -_________________ disease (80% of cases) -increased release of _______________________ & low _____________ Manifestations of Hyperthyroidism (8) ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ Drug therapy of Hyperthyroidism ____________________ ____________________ ____________________ Radioactive Iodine Therapy used for hyperthyroidism considerations ____________________ ____________________ Nursing care of Hyperthyroidism -educate PT to include __________________________________ and to avoid _____________________ -after thyroidectomy, assess for _____________________________ due to inadvertant parathyroid removal
-Grave's -thyroid hormone (T3 & T4) -TSH -increased HR -palpitations -weight loss -increased appetite -thin/brittle nails -hair loss patchy -clubbing of fingers -warm skin -antithyroid drugs (methimazole) -iodine -beta blockers -pregnancy test -limit radiation exposure to others -high calorie diet (4-5000 calories/day) -caffeine -hypocalcemia
Collab care aortic dissection __________ admission •HR and BP control (________________, ____________________, ____________________) •_______________________ repair—descending problems •__________________________ repair—acute ascending (emergency) *The aorta is FRAGILE. *High mortality rate with __________________________ Discharge Teaching following surgical repair of aortic dissection •Lifelong __________________________ •Regular ________________ •Pain returns call 911
-ICU -Beta Blockers -ACE Inhibitors -Calcium Channel Blockers -Endovascular -Surgical (open) -surgical intervention. -antihypertensive treatment -follow-up
Drug therapy for endocarditis consists of long-term treatment with _________________________________________ with subsequent ____________________________ to evaluate the effectiveness.
-IV antibiotic therapy -blood cultures
•__________________________________ is an infection of the endocardial surface of the heart that affects the cardiac valves. •The most common causative organisms of IE are ____________________________________ and ___________________________________
-Infective endocarditis (IE) -Staph and Strep
Complications of CVADS: Clinical manifestations of Catheter Occlusion: _____________________________ Caused by: Kinked, Tip against vessel wall, Thrombosis, Occlusion Nursing Management: Have pt ______________________________ Assess for _______________________ Flush with ___________________. Do NOT _______________ flush. Notify Physician.
-Infusion or Aspiration is sluggish -change position, raise arm, and cough. -clamping/kinking -10 mL NS -force
Long-acting (basal) Examples: _______________________ and ___________________ -Released steadily and continuously with no _________________ Administered ___________________ a day -Do not ____________________________
-Insulin glargine (Lantus) and detemir (Levemir) -peak action -once or twice -mix with any other insulin or solution
_________________________, the primary lesion of IE, adheres to the valve surface or endocardium and can ___________________ to various organs and to the extremities, causing ischemia and infarction.
-Vegetation - embolize
Signs and Symptoms of Right sided HF (5)
-Jugular venous distention -Edema -Ascites -Weight gain -Anorexia and GI bloating
Contact Precautions Used for patients with infections with risk of transmitting through contact like ______________ -Must be placed in private room -Healthcare personnel must wear _____________________________ for all interactions with contact isolation patient; don upon room entry, discard before exiting room -Infected area must be covered/contained prior to _________________________ -Use______________________ and __________________________ equipment
-MRSA -gown and gloves -transport -disposable and dedicated patient-care
Hypertension Meds Diuretics Promote ______________________ thereby reducing plasma volume Thiazide Diuretics—(ex. ___________________________ and _____________________________________) •Inhibit NaCl reabsorption, increase excretion of Na+ and Cl- -Monitor for ______________________ and ___________________________ -Monitor closely with concomitant _____________________ therapy Loop Diuretics—(ex. _________________________ and _______________________) -Inhibit NaCl reabsorption within the Loop of Henle (More potent than Thiazides) -Monitor _________ level closely -Monitor for ____________________________________ -May cause _____________________ Potassium-sparing—(ex. ____________________________) -Reduced excretion of K+, H+, Ca+, and Mg+ -Not used with ___________________ -Avoid _________________ supplements and foods -May cause _________________ Aldosterone Receptor Blockers—(ex. ____________________________) -Inhibits Na+ retention and K+ excretion effects of aldosterone -Use cautiously with ____________________ -Side Effects may include ________________________ -Avoid potassium supplements
-Na+/H2O excretion -chlorothiazide (Diuril) -hydrochlorothiazide (HydroDIURIL) -hypotension and hypokalemia -Digoxin -bumetanide (Bumex) -furosemide (Lasix) -K+ -orthostatic hypotension -ototoxicity -triamterene (Dyrenium) -renal failure -potassium -photosensitivity -spironolactone (Aldactone) -ACE Inhibitors -ED and gynecomastia
Low-flow oxygen delivery systems—deliver O2 in concentrations that VARY with the individual's respiratory pattern. (Due to mixture with Room Air) _______________ Cannula __________________ Mask Partial ___________________ Non-_________________________ ____________________________ Cannulas Nasal Cannula -Allows freedom of ____________________ -Tolerated easy for _______________ use -Can become easily ____________________ and can cause dryness and irritation so ___________________ should be considered Simple Face Mask -Provides ___________________ O2 -Long-term use________________________ -COVERS mouth/nose and can cause _____________________ -mask must be _________________ Partial rebreather -Allows rebreathing -COVERS mouth and nose and can cause ________________________ -Bag must be __________________ -Mask must be ______________________ Non-rebreather -Exhaled air released via valve from mask -COVERS mouth/ nose which can cause ______________________ -Bag must be _________________ -Mask must be ________________________ Oxygen conserving cannula -Requires ______________________ to determine correct flow -Change cannula ______________
-Nasal -Simple Face -Rebreather -rebreathers -Oxygen Conserving -movement -long term -dislodged -humidification -Humidified -not tolerated -Skin breakdown -"snug" -Skin breakdown - kept FULL -"snug" -Skin breakdown -kept FULL -"snug" -ABG/oximetry -weekly
Collaborative Care Venous Thromboembolism (VTE) _________________________ is paramount. •Early/aggressive ___________________ •Position change __________________ •Flex/extend feet/knees/hips q2-4h •Ambulation •PT will wear _______________________ or ___________________ but never place ___________________ on a PT with active VTE
-Prevention/Prophylaxis -mobilization -every 2 hours -compression socks(TED hose) -SCDs -SCDs
___________________________ is a rare form of angina that often occurs at rest, usually in response to _________________________________________. When spasms occur, the patient experiences angina and transient ST segment elevation ____________,_______________, and __________________ use may precipitate coronary artery spasms; Prinzmetal's angina may also be seen in patients with a history of __________________________ and __________________________________ The pain from Prinzmetal's angina may be relieved by ________________________________ or it may disappear spontaneously. ______________________________ and/or _________________________ are drugs used to control the angina.
-Prinzmetal's angina -spasm of a major coronary artery -Tobacco, alcohol, and cocaine -migraine headaches and Raynaud's phenomenon. -moderate exercise -Calcium channel blockers and/or nitrates
Complications of CVADS: Clinical manifestations of Central line associated local infection: ____________________, _________________, ________________, __________________ ? Caused by:Contamination during insertion/use Nursing Management: Culture of ____________________ _________________ compress Catheter removal
-Redness -tenderness -edema -warmth -purulent drainage (all at the site) -exudate -Warm
Severe asthma -Respiratory rate __________________ -Dyspnea at rest, feeling of _________________ -Pulse _______________ -peak expiratory flow rate is ____________ at best - the patient speaks in _______________________ because of the difficulty breathing -Usually seen in ED or hospitalized Life-threatening asthma -Too dyspneic to _______________ -Perspiring ______________ -Drowsy and _________________ -peak expiratory flow rate ________________
-Require hospital care and often admitted to ICU -greater than 30/min -suffocation -greater than 120/min -40% -words, not sentences -speak -profusely -confused -less than 25%
_______________________________ are first-line therapy for the treatment of angina. Nitrates __________________ peripheral blood vessels, coronary arteries, and collateral vessels.
-Short-acting nitrates -dilate
Lifestyle modifications for patients with PAD (3)
-Smoking cessation -Diabetes, Lipids, Hypertension management -Physical Activity (Walking is the most effective)
Airborne Precautions -Patients with infections transmitted airborne like ______________, _____________________ and ____________________ -Must be placed in a _______________________________ room (Airborne Infection Isolation Room) -Health care personnel MUST use ____________________________ when entering the room -Surgical mask must be placed on the patient for _________________________
-TB measles and chickenpox -negative pressure -fit-tested N95 mask -transport
High-flow oxygen delivery systems—deliver FIXED concentrations of O2 independent of the individual's respiratory pattern. _____________________ Mask _____________________ Nasal Cannula Mechanical Ventilation Venti Mask Precise high-flow Can be uncomfortable and cause skin irritation. Change cannula _____________________ High Flow Nasal Cannula No strong clinical evidence ________________ needed to prevent irritation
-Venturi (Venti) -High-Flow -weekly -humidification
Lifestyle Modifications for hypertension -_______________ reduction -Dietary control (_______________ Restriction, ______________ Diet) -Reducing ________________ consumption (Men 2, Women 1) -Increasing Physical Activity -___________________ Cessation -___________________Reduction
-Weight -Na+ -(DASH) -alcohol -Smoking -Stress
Pericarditis in the acute MI patient may be described as two distinct syndromes: (1) _____________________________ (occurs within the initial 48 to 72 hours after an MI) and (2) _________________________________ (late pericarditis that appears 4 to 6 weeks after an MI).
-acute pericarditis -Dressler syndrome
Treatments for SVT Drug of choice: alternative treatment if adenosine doesn't work: Treatment if asymptomatic:
-adenosine (drug of choice) -cardioversion
The ____________________ is the largest artery in the body—it supplies the LARGEST amount of blood to ALL vital organs. ____________________________ are the most common problem affecting the aorta - higher prevalence in ______________ -increased incidence with _____________ -majority of aneurysms occur in the ___________________ -occurs mostly with which ethnicity group? ___________________ Clinical Manifestations of Thoracic aortic aneurysms—generally asymptomatic ________________________, ___________________, _____________________, and _________________________ Clinical manifestations of Abdominal Aortic Aneurysms—mostly asymptomatic -Pulsatile perumbilical ______________ -Abdominal ________________ -Generalized __________________________________ pain -________________________ syndrome—mottling of feet/toes with palpable pedal pulses
-aorta -aneurysms -males -age -abdomen -caucasian -chest pain -dysphagia -Jugular venous distention (JVD) -Facial/Neck edema -mass -bruit -abdominal/epigastric/back -Blue toe
Patients with thrombocytopenia should Avoid _______________ and other medications that affect ____________________ or production.
-aspirin -platelet function
Manifestation of atrial Fibrillation (Afib) = IF ventricular rate less than 100, the patient may be ____________________. If the ventricular rate is over 100 or a new onset, the patient can have ________________, _______________, or ____________________. The goal is to keep the ventricular rate less than 100, to convert to a sinus rhythm, and prevent _____________________ Treatments: -administer __________________ -drug therapy: ______________________ and _________________________
-asymptomatic -Chest Pain, Shortness Of Breath, or weakness -stroke -oxygen -antidysrhythmic (digoxin (lanoxin)); anticoagulants (warfarin (Coumadin)....bleeding precautions
Intermediate-acting insulin (NPH) is also used as a _________________. Its action has a duration of ____________________. The disadvantage of NPH is that its peak of action ranges from ______________________, which can result in ________________________. NPH is the only basal insulin that can be mixed with _________________________________ NPH is a cloudy insulin that must be ______________________ before administration.
-basal insulin -12 to 18 hours -4 to 12 hours -hypoglycemia -short- and rapid-acting insulins -gently agitated
The management of the patient's pain and anxiety during acute pericarditis is a primary nursing consideration. Pain relief measures include maintaining ______________ with the head of the bed _____________________________, providing an overbed table for support, and _________________________ medications.
-bed rest -elevated to 45 degrees -anti-inflammatory
Manifestations of Hyperparathyroidism -high serum ____________________ -bowel function equals: _________________ -muscle ____________________ -________________________ -________________ failure and ____________________________ Treatment of Hyperparathyroidism -______________________ is most effective -_______________________ to improve bone density -Pts with kidney disease ______________________
-calcium -constipation -weakness -osteoporosis -renal -kidney stones -surgical removal -alendronate -cinacalcet
CHEST TUBES Tidaling- Reflects __________________________ Gradual reduction and eventual cessation of tidaling is expected as the lung ________________________ Investigate any sudden cessation of tidaling, as this may signify an ________________________ Bubbling in water-seal chamber indicates ___________________ Intermittent bubbling during ________________, ________________, or __________________ (when the patient's intrathoracic pressure is increased) may be observed as long as air is in the pleural space. Eventually _________________ Water suction control Amount of water in chamber controls suction to lungs Excess suction from source vented Chamber is typically filled to ________________________ Adjust suction until _________________________ in third chamber
-changes in pressure -reexpands -occluded chest tube. -air leak -exhalation, coughing, or sneezing -disappears -20 cm of water -gentle bubbling
Teach patients with sickle cell disease to: (3) -Avoid ________________ -Maintain adequate________________ -Treat ____________________
-high altitudes -fluid intake -infections promptly
Clinical manifestations of pericarditis include the following: Progressive, frequently severe _____________________ that is ____________________ and __________________ in nature and worse with _________________________________ and when _____________________. The pain is relieved by _________________________________________. It can be referred to the ______________________________________. The hallmark finding in acute pericarditis is a ________________________________________
-chest pain -sharp -pleuritic -deep inspiration -lying supine -sitting up and leaning forward -shoulder and upper back -pericardial friction rub
Blue bloaters=_____________________________ Pink puffers=_____________________________ complication of COPD _____________________________ Drug therapy for COPD -4 classes used: ___________, _______________, ____________, _________________ -oral _________________ can be used for severe COPD -two agents such as __________________ and ___________________ can be nebulized together known as _____________ PT teaching for COPD ___________________ vaccine ___________________ vaccine __________________ cessation Modify ADLs to ______________________ _________ during activities of hygiene Walk ___________________________ at least 3 times a week with gradual increases
-chronic bronchitis -emphysema -cor pulmonale -Short-acting bronchodilators (albuterol) -Oral systemic corticosteroids -Antibiotics -Supplemental oxygen therapy -Daliresp -albuterol -ipratropium -DuoNeb -Influenza virus -Pneumococcal -Smoking -conserve energy -O2 -15 to 20 minutes a day
Hypertension Meds Adrenergic blockers Lowers SNS effect on BP Central-Acting α-Adrenergic Antagonists— Example: ________________________ -Sudden discontinuation= _____________________ symptoms -_________________ can be a side effect -________________________ increases risk of sedation α1-Adrenergic Blockers— Example: ______________________ -Peripheral __________________________ -Take at bedtime to reduce risk of __________________________ β-Adrenergic Blockers—Examples : ______________________ and ____________________________ -Decrease ______ -Monitor ________ -Cautioned use with _______________________ Mixed α-/β- Adrenergic Blockers— Examples: ________________________, ____________________ -Peripheral vasodilation and ___________________ HR -May be given IV, pts kept _____________________ during administration d/t risk of severe ______________________________
-clonidine (Catapres) -WITHDRAWAL -dry mouth -alcohol -doxasoin (Cardura) -vasodilation -Orthostatic Hypotension -atenolol (Tenormin) -metoprolol (Lopressor) -CO -HR -Diabetes mellitus -carvedilol (Coreg), labetolol(Normodyne) -decreased -supine -orthostatic hypotension
Collab care Cobalamin (Vitamin b12) deficiency -Parenteral or intranasal administration of _________________________ is the treatment of choice. -Patients will die in ___________________ without treatment. -This anemia can be reversed with ongoing treatment but long-standing ______________________________ may not be reversible.
-cobalamin B12 -1-3 years -neuromuscular complications
-Anaphylactic Reaction -May be localized or systemic -Localized: wheal-and-flare reaction -Systemic: LIFE-THREATENING due to bronchial ______________________, airway _____________________, and vascular collapse -Shock occurs RAPIDLY—______________, _________________, ___________________ -dyspneic, cyanotic; bronchial edema/angioedema -EMERGENT treatment is paramount -SSx: Feeling of ___________________, pruritus, hoarseness, wheezing, hypotension... -Maintain __________________ airway -__________ administration (NON-rebreather) -IV access -_______________________ IM into mid-anterior lateral thigh, may repeat __________________ Other IV meds: ____________________________ and _____________________________ •Recumbent with legs elevated for hypotension •CONTINUOUS monitoring: VS, Resp. effort, LOC •Anticipate intubation with Resp. distress
-constriction -obstruction -tachycardia -weak pulse -hypotensive -impending doom -PATENT -O2 -Epinephrine -q5-15 mins -Diphenhydramine (Benadryl) IM or IV Methylprednisolone (Solu-Medrol) IV
Cause of Cushings -Excess ___________________________________ -May be caused by exogenous _______________ or _____________ Manifestations of Cushings -weight ____________ -poor _____________________ -_________________ on abdomen -"____________________" -androgen excess which can cause _______________ and ______________ Diagnostics of Cushings ___________________________________ Treatment of Cushings -____________________________ -____________________________ post op surgery
-corticosteroids (esp. glucocorticoids) -steroids -tumor -gain -wound healing -purple/red striae -moon face -acne -hirsutism -24 hour urine cortisol (high) -adrenalectomy -corticosteroids
Clinical manifestations of pulmonary edema (caused by left sided HF) -_________________ and __________________________ -_______________________ skin -Respiration Rate _______________________________ -breath sounds: ________________________________ -______________________________ sputum
-dyspnea -orthopnea (SOB when lying down) -pale, clammy, cold -greater than 30 breaths/min -wheezing/coughing/crackles -frothy pink tinged
The ACE inhibitor Captopril (Capoten) can lead to ______________, ____________________ and _________________(which can be life threatening)
-excessive hypotension -hyperkalemia -angioedema
Clinical Manifestations of PAD •Gradual •Most commonly occurs in the ______________________ region •*Commonly below the knee in patients with _______________________ -___________________________ is the characteristic presentation -ischemic muscle pain 2° exercise (results from lactic acid buildup.....resolves following rest) -Most common in the calves, but can be higher -older women experience it less often than men -Paresthesia—which causes _____________________ in the lower extremities (nerve tissue ischemia) -Rest pain—occurs in the absence of physical activity( More common during the ___________.....Relieved by placing limbs in dependent position) -Critical Limb Ischemia (results from chronic rest pain, ulceration, gangrene and if left untreated leads to _________________________)
-femoral/popliteal -Diabetes mellitus -Intermittent claudication -numbness/tingling -PM -amputation
Hypertension Meds Direct Vasodilators Stimulates direct arterial vasodilation Examples: ___________________________, ____________________, _________________________ -Reduce SVR -IV use for ______________________ -Apresoline is NOT used among individuals with _________________ -Tridil/Nipride may be continuous infusion. These are ______________________ drips. ___________________ continuously!!! -Nipride drip must be protected from _______________
-hydralazine (Apresoline) -nitroglycerin (Tridil) -sodium nitroprusside (Nipride) -Hypertensive Crisis -CAD -CRITICAL -MONITOR -light
The most common form of HF is ____________________ from _____________________________ dysfunction. In Left sided HF, Blood backs up into the ________________ and into the _______________________, causing ______________________________________________
-left-sided HF -left ventricular -left atrium -pulmonary veins -pulmonary congestion and edema.
Hypertension Meds Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors) Examples: _______________________, ________________________ ,____________________________________ -Inhibit conversion of angiotensin I to angiotensin II. Inhibits angiotensin II-mediated vasoconstriction -______________________________ may decrease efficacy §Diuretics _________________ efficacy -NOT used with ____________________ drugs -Vasotec IV is given over 5 mins, must monitor ___________ closely -May cause _______________________________________ -Risk of _____________________ and ________________________________ Angiotensin II Receptor Blockers (ARBs) Examples: ________________________, _____________________________, _____________________________ -Produces vasodilation and increased Na+ and water excretion -Takes time to work- about ___________________ -May be given to those who develop dry cough while on _____________________________
-lisinopril (Prinivil, Zestril) -ramipril (Altace) -enalapril (Vasotec or Vasotec IV) -Aspirin and NSAIDS -increases -K+ sparing -BP -a "dry" or "hacking" cough -Angioedema -Acute Renal Failure -losartan (Cozaar) -olmesartan (Benicar) -valsartan (Diovan) -3-6 weeks -ACE Inhibitors
Rapid-acting (bolus) Examples: ___________________, and __________________ -Have an onset of action of approximately __________________ -Sould be injected within ____________________ of mealtime -Peak is _________________ -Most closely mimic natural insulin secretion in response to a meal
-lispro (Humalog) -aspart (NovoLog) -15 minutes -15 minutes -30 min to 3 hours
Cause of Addison's -Deficient adrenal corticosteroids -most common cause is autoimmune Manifestations of Addison's -more subtle, progressive fatigue -weight _______________ -_________________ skin -_________________________ (emergency) Diagnostics: ________________________ test Treatment of Addison's ________________________________________
-loss -bronze -addisonian crisis -ACTH stimulation -lifelong hormone therapy (hydrocortisone)
Presentation/Manifestation of bradycardia if symptomatic (4) Treatment: -___________________________ is the medication used to increase the HR -then we look for WHY was the HR low. -Also appropriate to give IV fluids, teach slow position changes, head of bed ________________; withhold any medication with the side effect of _______________________
-low blood pressure, pale, cool skin, dizzy - atropine IVP -down -lowering HR
Manifestations of Hypoparathyroidism -low serum _______________________ -___________________________ -___________________________ -___________________________ Nursing care of Hypoparathyroidism -___________________________ supplements, -___________________________________, BUT avoid oxalic acid found in ___________________ which inhibits absorption of Calcium
-low serum calcium -hyperreflexes -tetany -lethargy -oral calcium -Vit. D, dark green vegetables -spinach
Antiplatelet therapy with ___________________________ is recommended for people at risk for _____________. For people who are aspirin intolerant, alternatives (__________________________________) are considered.
-low-dose aspirin -CAD -clopidogrel [Plavix]
Systemic Lupus Erythematosus -exacerbation sometimes occurs: after ____________________, use of ___________________________, during and after ___________________________________________ SIGNS AND SYMPTOMS -Dermatologic problems: butterfly rash, __________________ lesions, ______________________ rash -musculoskeletal problems: arthritis -cardiopulmonary: tachypnea, _______________, pleurisy, endo/peri/myocarditis, ______________ phenomenon -renal problems: lupus nephritis can lead to ____________________________________________ -nervous system: seizures, peripheral neuropathy -hematologic: anemia, thrombocytopenia -increased risk of _____________________ NURSING MANAGEMENT -Pain management -Compliance with therapy regimens -Avoid exacerbation -Use of __________________________ outdoors -energy conservation... avoid physical and emotional stress
-menarche -oral contraceptives -pregnancy (worsens in postpartum) -discoid -erythema -cough -raynaud's -end-stage kidney disease -infection -sunscreen(and other sun protection)
-HHS constitutes a medical emergency and has a high _________________________ -The management of DKA and that of HHS are similar and includes immediate IV administration ________________ and either ____________________________________ -HHS usually necessitates greater volumes of fluid replacement. This should be accomplished _____________________________________ -When blood glucose levels fall to approximately 250 mg/dL (13.9 mmol/L), IV fluids containing _____________________ are administered to prevent hypoglycemia. -______________________ are monitored and replaced as needed.
-mortality rate -insulin -0.9% or 0.45% NaCl -slowly and carefully. -glucose -Electrolytes
Asthma triad: some pts will have asthma along with __________________, and ________________________ Some patients may also have a reaction to which two meds: ___________________ and ____________________
-nasal polyps -sensitivities to aspirins and NSAIDS -β-Adrenergic blockers -ACE inhibitors
-Patients should know that drugs used for erectile dysfunction should not be used with _______________ as severe hypotension may occur. -Typically, it is safe to resume sexual activity _______________________ after an uncomplicated Myocardial Infarction (MI).
-nitrates -7 to 10 days
Chemo and radiation side effects: mucositis: assess ________________ daily, encourage frequent ___________________ with ___________________. discourage use of irritants like __________________ and _____________________ Nausea and vomiting: antiemetic and antianxiety prophylactally ___________________ before start of chemo Diarrhea foods low in ____________ and _____________ before treatment including food high in roughage like_____________________________. _________________________ and _________________ balance are important. Radiation: dry/wet desquamation skin protocals: do not use _____________ or _______ avoid _________________ garments, harsh chemicals or ____________ if dequamation becomes wet, skin care includes ________________ compresses and _____________ gauze as protection
-oral mucosa -oral rinses -saline -tabacco -alcohol -1 hour -fiber -residue -fresh fruits and veggies -hydration -electrolyte -ice packs -heating pads -consticting -deodorants -normal saline -vaseline petroleum
Aplastic Anemia Nursing & Collaborative Management -Identify and remove causative agent (when possible). -Provide supportive care until ___________________ reverses. -Prevent complications from _______________ -Prevent _________________ -_________________________ and _________________________ can be curative.
-pancytopenia -infection. -hemorrhage -Immune therapies -bone marrow transplantation
The classic symptoms of diabetes type 1-________________, _________________, _______________________- are caused by hyperglycemia. Some other symptoms include: __________________, __________________, and ____________________.
-polyuria (frequent urination) -polydipsia (excessive thirst) -polyphagia (excessive hunger) -Weight loss -Weakness -Fatigue
Patients taking spironolactone should have their ________________ levels closely monitored and avoid foods high in _____________________ because it is a _______________________ diuretic. They should also use with caution when taking _________________ because ______________________ may reduce the effects of _________________________.
-potassium (K+) -potassium (K+) -potassium (K+) sparing -digoxin -hyperkalemia -digoxin
Hyperosmolar hyperglycemic syndrome (HHS)is a life-threatening syndrome that can occur in the patient with diabetes who is able to _________________________________________________ but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion. The main difference between HHS and DKA is that the patient with HHS usually has enough circulating insulin so that __________________ does not occur. Because HHS produces fewer symptoms in the earlier stages, ______________________ levels can climb quite high before the problem is recognized. (as much as _________________) More severe ________________________ manifestations because of ↑ serum osmolality Ketones are ______________________ in blood and urine
-produce enough insulin to prevent DKA -ketoacidosis -blood glucose -over 600 -neurologic -absent or minimal
In type 2 diabetes, the pancreas usually continues to ____________________________. However, it is either ________________ for the needs of the body and/or is poorly used by the tissues. Diabetes type 2 is controlled with __________________ and ________________
-produce some insulin - insufficient -oral medications (ex. Metformin) -diet
carvedilol(Coreg) can produce _______________, _________________, ______________, and __________________________. Obtain ________________________ 1 hour after administration to assess tolerance. Abrupt withdrawal will lead to ________________________
-profound bradycardia -hypotension -bronchospasm -cardiogenic shock -withdrawal effects
Flushing is the best way to keep a line patent. The ____________________ method is recommended. If you feel any resistance then ____________________
-push/pause -STOP
One test for occlusion is to ____________________. If there is no increase in the flow rate when the container is raised there is probably an occlusion. Another sign can be visible ___________________ in the line. First examine all the equipment for any obvious problems, such as __________________, or the ____________________. Check the time strip on the container to see if infusion has been proceeding at the correct rate. Intervention is to use a ______________________, but not force it. If any resistance is felt, stop immediately.
-raise the bag -blood backup -kinked lines -patient lying on a line -very low-pressure flush
-All insulin pumps are programmed to deliver a continuous infusion of _______________________________ 24 hours a day, known as the "basal rate." -Insulin can be temporarily increased or decreased on the basis of ____________________, _____________________, or _________________________ -At mealtime, the user programs the pump to deliver a _________________________________ appropriate to the amount of carbohydrate ingested and an additional amount, if needed to bring down high premeal blood glucose levels. -Insulin pump users must check their blood glucose level at least ___________________ per day. Testing __________________ or more per day is common.
-rapid-acting insulin -carbohydrate intake -activity changes -illness -bolus infusion of insulin -four times -eight times
Short-acting _______________ insulin -Onset of action is ____________________, and preparation should be injected __________________________ before a meal to ensure that the onset of action coincides with meal absorption. -Peak is ______________________ -Because it is difficult to schedule meals, the flexibility that ______________________________ offer is preferred by those taking insulin with their meals. -Short-acting insulin is also more likely to cause __________________________ because of a longer duration of action.
-regular -30 to 60 minutes -30 to 45 minutes -2-5 hours -rapid-acting insulins -hypoglycemia
Collab care for Iron-Deficiency Anemia -Goal is to treat the underlying disease causing reduced intake or absorption of iron. -Efforts are aimed at _________________________ -__________________ therapy -_____________ or occasional _________________ iron supplements -Transfusion of ______________________
-replacing iron. -Nutritional -oral -parenteral -packed RBCs
Preventer and controller meds for asthma -Long acting B2-adrenergic agonists (LABAs) like _________________________________ -leukotriene receptor blockers like _________________________ -inhaled cortiocosteroids like____________________
-salmeterol a dry powder inhaler -montelukast (Singulair) oral tablets - fluticasone
Differences between a metered dose inhaler and dry powder inhaler. shake? inpiration rate? spacer? hold breath?
-shake mdi and don't shake dpi -slow mdi, rapid dpi -yes w/ corticosteroid in mdi, none for dpi -hold with mdi, don't with dpi
Angina with chronic stable angina is rarely ___________________ or _____________________, and it usually does not change with __________________ or ______________________. Pain usually lasts __________________________ and commonly subsides when the precipitating factor is relieved. Pain at rest is ________________.
-sharp or stabbing -position or breathing -for only a few minutes -unusual
Nursing care of Post op thyroidectomy Assess for:
-signs of low calcium (hypocalcemia) -tetany -airway obstruction
Some signs of infiltration are ______________________ in the area, and even along the entire arm. A patient may complain of ________________________ at the site and there will be ________________ and _____________________ of the skin. Intervention is to __________________________ and prepare to restart the infusion in another vein. Apply____________________ to aid absorption of the fluid and ____________________ the limb. If the infiltration was severe, notify the physician after taking the interventions.
-swelling -burning or pain -coolness -blanching -remove the catheter -warm soaks -elevate
Right sided HF occurs when...? This causes what? Venous congestion from Right sided heart failure present as...? The primary cause of right sided heart failure is what?
-the right ventricle fails to contract effectively -a backup of blood in the right atrium and venous circulation -jugular venous distention and peripheral edema -left sided heart failure
COPD clinical manifestations -The patient may need to breathe louder than normal for auscultated breath sounds to be heard. -The patient may sit _______________________________________ -The patient may naturally _____________________ on expiration and may use _____________________ to aid with inspiration. -Over time, __________________________ may develop with hypercapnia which is _________________________________ COPD diagnostics -______________________ are not diagnostic but may show a flat diaphragm due to the hyperinflated lungs. -Patients often have _________________-induced hypoxemia, and thus a ___________________________ should be done by physical or respiratory therapy, with pulse oximetry readings taken when the patient is walking and at rest. -If values of oxygen saturation are _______________________ when at rest and the patient is breathing room air, they qualify for supplemental oxygen.
-upright with arms supported on a fixed surface such as an overbed table (tripod position). - purse lips -accessory muscles, such as those in the neck -hypoxemia (PaO2 <60 mm Hg or O2 saturation <88%) -(PaCO2 >45 mm Hg). -Chest x-rays -exercise -6-minute walk test -88% or lower
Hypertension Meds Calcium Channel Blockers Inhibits intake of extracellular calcium across the cell membrane, resulting in __________________ (Ex. _______________________, ________________________, ________________________) -Use with caution in ___________________ -Avoid _______________________ *Cardizem is cardiac selective and can decrease HR by slowing AV conduction. Used for individuals with ____________________________. This is a _______________________ drip
-vasodilation -diltiazem extended release (Cardizem ER) -amlodipine (Norvasc) -nifedipine (Procardia) -Heart failure -grapefruit juice -supraventricular tachycardia -CRITICAL
Definitive diagnosis of IE exists if two of the following major criteria are present:
-vegetation noted on echocardiography. -positive blood cultures -new or changed cardiac murmur -intracardiac mass
Monitoring for signs of blood while on heparin therapy Bruising Coffee ground-like _____________ Bleeding ___________ Blood in _______________ and ________________
-vomitus -gums -urine -stool
Pharmacologic Therapies Venous Thromboembolism (VTE) Includes 3 major anticoagulant classes: Vitamin K Antagonists Thrombin Inhibitors Factor Xa Inhibitors Vitamin K Antagonists: example: ________________________ •Inhibits Vit K-dependent coag factors II, VII, IX, and X. •Takes ______________________ to reach therapeutic levels •Monitored through ___________________ (Daily) •Monitor for SSx of ________________ •Do NOT give ___________________ •Dietary consideration (____________________) Thrombin Inhibitors: Heparin and Lovenox •___________________________ is the reversal agent for Heparin. Dabigatran (Pradaxa) •Effects are not reversible •Monitor ______________ •Monitor SSx of bleeding
-warfarin (Coumadin) -several days -Pt/INR -bleeding -NSAIDS/ASA -leafy greens -Protamine Sulfate -aPTT
Common signs of phlebitis are ____________________ at the site, _________________ along the vein, or the vein feeling _______________________ on palpation. Intervention is to ____________________________ and prepare to restart the infusion in another vein . Apply a ________________________ to soothe the affected site
-warmth and tenderness -redness -hard and cordlike -withdraw the catheter -warm moist compress
Collaborative Therapy for HF includes: -Daily ________________ -__________________ and possibly ______________ restricted diets -____________________ position -__________ by mask or nasal cannula -Continuous ECG and pulse ox -Hemodynamic monitoring -Drug therapy
-weights -sodium and fluid -High Fowler's -Oxygen -BP
At a clinic visit, the nurse provides dietary teaching for a patient recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? A. "I will limit the amount of milk and cheese in my diet." B. "I can add salt when cooking foods but not at the table." C. "I will take an extra diuretic pill when I eat a lot of salt." D. "I can have unlimited amounts of foods labeled as reduced sodium."
A note:Milk products should be limited to 2 cups per day for a 2500-mg sodium-restricted diet. Salt should not be added during food preparation or at the table. Diuretics should be taken as prescribed (usually daily) and not based on sodium intake. Foods labeled as reduced sodium contain at least 25% less sodium than regular.
Which factor should be considered when caring for a woman with suspected coronary artery disease? A. Fatigue may be the first symptom. B. Classic signs and symptoms are expected. C. Increased risk is present before menopause. D. Women are more likely to develop collateral circulation.
A. Fatigue may be the first symptom. note: Fatigue, rather than pain or shortness of breath, may be the first symptom of impaired cardiac circulation. Women may not exhibit the classic signs and symptoms of ischemia such as chest pain which radiates down the left arm. Neck, throat, or back pain may be symptoms experienced by women. Risk for coronary artery disease increases four times after menopause. Men are more likely to develop collateral circulation.
_____________________ are the primary drug of choice for blocking the RAAS system in HF patients with systolic failure
ACE inhibitors
_________________________________ is necessary for patients with endocarditis undergoing certain invasive procedures (e.g., dental work that perforates the oral mucosa).
Antibiotic prophylaxis
The nurse prepares a discharge teaching plan for a 44-yr-old male patient who has recently been diagnosed with coronary artery disease (CAD). Which risk factor should the nurse plan to focus on during the teaching session? A. Type A personality B. Elevated serum lipids C. Family cardiac history D. Hyperhomocysteinemia
B. Elevated serum lipids Correct notes:Dyslipidemia is one of the four major modifiable risk factors for CAD. The other major modifiable risk factors are hypertension, tobacco use, and physical inactivity. Research findings related to psychologic states (i.e., type A personality) as a risk factor for coronary artery disease have been inconsistent. Family history is a nonmodifiable risk factor. High homocysteine levels have been linked to an increased risk for CAD.
A 74-yr-old man with a history of prostate cancer and hypertension is admitted to the emergency department with substernal chest pain. Which action will the nurse complete before administering sublingual nitroglycerin? A. Administer morphine sulfate IV. B. Auscultate heart and lung sounds. C. Obtain a 12-lead electrocardiogram (ECG). D. Assess for coronary artery disease risk factors.
C. Obtain a 12-lead electrocardiogram (ECG). notes: If a patient has chest pain, the nurse should institute the following measures: (1) administer supplemental oxygen and position the patient in upright position unless contraindicated, (2) assess vital signs, (3) obtain a 12-lead ECG, (4) provide prompt pain relief first with a nitrate followed by an opioid analgesic if needed, and (5) auscultate heart sounds. Obtaining a 12-lead ECG during chest pain aids in the diagnosis.
A patient admitted to the emergency department 24 hours ago with complaints of chest pain was diagnosed with a ST-segment-elevation myocardial infarction (STEMI). What complication of myocardial infarction should the nurse anticipate?
Cardiac dysrhythmias NOTE:Dysrhythmias are present in 80% to 90% of patients after myocardial infarction (MI)
___________________________________ refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms.
Chronic stable angina
What is one of the most firmly established risk factors for CAD?
Elevated serum lipid levels
FACES acronym to help teach patients to identify HF symptoms
F-Fatigue A-limitations of Activities C-Congestion/Cough E-Edema S-Shortness of Breath
Many risk factors have been associated with CAD. Nonmodifiable risk factors include......? Modifiable risk factors include.......?
Nonmodifiable: age, gender, ethnicity, and genetic inheritance. Modifiable: elevated serum lipids, elevated blood pressure, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states, and homocysteine level.
Vasular Manifistations of Infective Endocarditis
Splinter hemorrhages - black longitudinal streaks Petechia - conjunctivae, mouth, ankles, feet, AC areas, and popliteal areas Osler's Nodes - painful/tender, red or purple pea-size lesions (fingertips & toes) Janeway's lesions - flat, painless, small red spots (palms and soles) Roth's spots - hemorrhagic retinal lesion
Classification of Infective Endocarditis
Subacute: -Preexisting Valve Disease -Course may extend over months Acute: -Healthy Valves -Rapid progression of illness
Actions/Care for symptomatic sinus tachycardia =
Symptomatic = treat the cause (stress, fever, pain...reassurance, anti-anxiety medication, motrin, Tylenol, pain medication, repositioning)
A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time?
Troponin result and when the next troponin level is due to be collected
Implanted infusion ports can only be accessed using __________________
a Huber needle
Chronic stable angina can progress or develop into ________________________ or ______________________Therefore any change in the usual pattern of angina should be evaluated.
a myocardial infarction (MI) or unstable angina.
A clinical manifestation of myocardial infarction is skin that is ____________________________________________.
ashen, clammy, and/or cool to touch
Primary diagnostic studies used to determine whether a person has unstable angina (UA) or an MI include
an ECG and serum cardiac markers.
Aortic Dissection •NOT an aneurysm •Results from development of a false lumen between the intima/media layers •2/3 involve _______________________ and are acute
ascending aorta
Elevated low-density lipoprotein (LDL) levels correlate most closely with an increased incidence of ____________________________ and ______________________________
atherosclerosis and CAD.
In cardiac catheterization and coronary angiography, _____________________________ and __________________________ are used to obtain information about the coronary arteries, heart chambers and valves, ventricular function, intracardiac pressures, O2 levels in various parts of the heart, CO, and EF.
contrast media and fluoroscopy
B-type natriuretic peptide (BNP) has emerged as the marker of choice for_____________________________________________________________
differentiating a cardiac or respiratory cause of dyspnea.
Any peripherally inserted or centrally inserted vascular access device MUST _____________________________ before you can use the device
have placement verified via x-ray
With Infective endocarditis there is likely an onset of a new or changing __________________
murmur
No ______________________ or ____________________ in the arm with a picc line
needlesticks BP
The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of ___________,______________,_______________, and _________________. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation.
oxygen, nitroglycerin, aspirin, and morphine
Complications of pericarditis include:
pericardial effusion and cardiac tamponade.
A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from?
pericarditis
Foods high in sodium that should be avoided on the DASH diet
processed meats, cheese, bread, cereals, canned soups, and canned vegetables
Acute decompensated HF can manifest as _____________________________ (most commonly caused by left sided HF)
pulmonary edema
Manifestations of Hypothyroidism ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ Treatment of Hypothyroidism -Drug of choice for life long hormone replacement is Levothyroxine (monitor heart rate) Nursing care of Hypothyroidism -treat _______________________ -stress importance of _______________________________
slowing of body processes leads to: -fatigue/lethargy -impaired memory -weight gain -SOB -exercise intolerance -Myxedema (medical emergency) -cold skin -sparse hair -thick/brittle nails -Levothyroxine (monitor heart rate) -constipation -lifelong hormone replacement
If lipoprotein levels remain elevated despite lifestyle changes, drug therapy is considered. -The _____________ are the most widely used drugs.
statins
Patients and caregivers must be taught to recognize signs and symptoms of life-threatening complications of Infectious Endocarditis(IE), such as ____________, _________________, and _____________________________.
stroke, pulmonary edema, and heart failure(HF).
A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that _____________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by providers.
troponin
