MED SURG EXAM 3

Risk Factors for Diabetes - Related Complications

Smoking Overweight and obesity Physical inactivity A1C High BP High cholesterol

The nurse is teaching a class on risk factors for cardiovascular disease. Which risk factors will the nurse include?

Smoking history Family history of heart disease Elevated C-reactive protein levels Diabetes Mellitus

The nurse is assessing a client with a cardiac infection. Which nursing assessment data causes the nurse to suspect infective endocarditis instead of pericarditis or rheumatic carditis?

Splinter hemorrhages Splinter hemorrhages are indicative of infective endocarditis. Splinter hemorrhages appear as black longitudinal lines or small red streaks along the distal third of the nail bed.

A client with hypertension is started on verapamil. What teaching will the nurse provide for this client?

"Avoid grapefruit juice." The nurse teaches the client who is taking verapamil to avoid grapefruit juice. Grapefruit juice must be avoided with calcium channel blockers, such as verapamil, because it can enhance the action of the drug.

What is the nurse's best first response when a client with a suspected endocrine disorder says, "I can't, you know, satisfy my wife anymore."?

"Can you please tell me more?" An open-ended question such as, "Can you please tell me more?," is a best first response because it allows the nurse to explore the client's feelings more thoroughly. Clients with endocrine disorders may report issues with infertility, impotence, and changes in sexual function.

Which question asked by a 48-year-old client with sleep apnea whose blood glucose level is elevated suggests to the nurse the possibility of a growth hormone excess?

"Does everyone's feet get bigger during menopause?" Growth hormone is secreted and is needed throughout the life span. When it is secreted in excess in adults, organs can enlarge and bones containing desmoid bone type increase in size, including the facial bones, hands, and feet.

The nurse is teaching a client the precautions to take while on warfarin therapy. Which client statement demonstrates that teaching has been effective?

"Eating foods like green beans won't interfere with my warfarin therapy." Teaching about the precautions of warfarin has been effective when the client says "that eating foods like green beans won't interfere with my Coumadin therapy." Vitamin K is not found in foods such as green beans, so these foods will not interfere with the anticoagulant effects of Coumadin.

Which question is most relevant to ask a male client suspected to have a gonadotropin deficiency?

"How often do you need to shave your face?" A gonadotropin deficiency reduces the expression of secondary sexual characteristics and leads to decreased libido and fertility in both male and female clients. Male clients lose facial fair and need to shave less frequently. This change may be the first problem noticed by the client

Which statement made by the client alerts the nurse to the possibility of hypothyroidism?

"I am always tired, even when I get 10 or 12 hours of sleep."

The nurse is caring for a client who experienced a recent cardiac event. Which client statement indicates maladaptive denial?

"I don't need to change. It hasn't killed me yet."

When caring for a client with an abdominal aortic aneurysm (AAA), the nurse suspects dissection of the aneurysm when the client makes which statement?

"I just started to feel a pain in my belly and low back." The nurse suspects dissection of an AAA when the client says that "I just started to feel a tearing pain in my belly." Severe pain of sudden onset in the back or lower abdomen, which may radiate to the groin, buttocks, or legs, is indicative of impending rupture of AAA.

The nurse discusses the importance of restricting sodium in the diet for a client with heart failure. Which client statement indicates the need for further teaching?

"I need to avoid eating hamburgers." Further teaching about restricting sodium in the diet for a client with heart failure is needed when the client says, "I need to avoid eating hamburgers." Cutting out beef or hamburgers made at home is not necessary, but fast-food hamburgers are to be avoided owing to higher sodium content. Bacon, canned foods, lunchmeats, and processed foods are high in sodium, which promotes fluid retention, and must be avoided. The client correctly understands that adding salt to food must be avoided

Which nursing statement reflects appropriate cardiac physical assessment technique?

"I will auscultate the aortic valve in the second intercostal space at the right sternal border."

The nurse is providing discharge teaching to a client with heart failure, focusing on when to seek medical attention. Which client statement indicates understanding of the teaching?

"I will call the provider if I have a cough lasting 3 or more days." Cough, a symptom of heart failure, is indicative of intra-alveolar edema; it is important to notify the provider if this occurs.

After instructing a client about the correct procedure for a 24-hour urine test, which client statement indicates to the nurse a need for further teaching?

"I will not eat any fatty foods when I am collecting urine for this test." A need for further teaching is needed when the client says that he/she will not eat any fatty foods while collecting urine for a 24-hour urine test to evaluate a hormone level.

Which statement made by the client who is going home after a transsphenoidal hypophysectomy indicates to the nurse correct understanding of actions to prevent complications from this treatment?

"I will keep the cat food bowl on my counter so that I do not have to bend over." After this surgery, the client must take care to avoid activities that can increase intracranial pressure. They should avoid bending from the waste and should not bear down, cough, or lay flat.

A client who is to undergo cardiac catheterization must be taught which essential information by the nurse?

"Keep your affected leg straight for 2 to 6 hours."

The nurse is caring for a client who is scheduled for a percutaneous transluminal angioplasty (PTCA). Which client statement indicates a need for further teaching?

"My angina will be gone for good." In this situation, further teaching is needed when the client states that angina will be gone after the PTCA. The client's angina may not be eliminated. Reocclusion is possible after PTCA.

What is the nurse's best response when a client, who has been taking high-dose corticosteroid therapy for a month for a problem that has now resolved, asks you why she needs to continue taking the corticosteroid?

"The drug suppressed your own adrenal gland secretion of corticosteroids. Slowly decreasing the dose over time allows your adrenal glands to start adequate secretion again." One of the most frequent causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of ACTH and adrenal production of cortisol.

Cardiovascular Changes Associated With Aging

Cardiac valves Conduction system Left ventricle Aorta and other large arteries Baroreceptors

A client undergoing coronary artery bypass grafting asks why the surgeon has chosen to use the internal mammary artery for the surgery. Which nursing response is appropriate?

"These arteries remain open longer." The correct response by the nurse is that mammary arteries remain open and patent much longer than other grafts.

A client with angina has received education about acute coronary syndrome. Which client statement indicates understanding?

"This is a warning sign and I need to change my lifestyle to prevent a heart attack." The statement by the client that angina is a warning sign and needing to alter lifestyle shows that the client understands the teaching. Health promotion efforts are directed toward controlling or altering modifiable risk factors for CAD, which will then lower the risk of progression in unstable angina and/or MI.

The nurse is caring a college athlete who collapsed during soccer practice. The client has been diagnosed with hypertrophic cardiomyopathy and states, "This can't be. I am in great shape. I eat right and exercise." Which nursing response is appropriate?

"This may be caused by a genetic trait." Hypertrophic cardiomyopathy is often transmitted as a single gene autosomal dominant trait.

The nurse is teaching a client about the purpose of electrophysiology studies (EPS). Which teaching will the nurse include?

"This test evaluates you for potentially fatal cardiac rhythms."

The nurse is teaching a client with peripheral arterial disease. What teaching will the nurse include?

"Walk to the point of leg pain, then rest, resuming when pain stops." the teaching point the nurse include for a client with PAD is walk to the point of leg pain, rest, and then resume when pain stops. Exercise may improve arterial blood flow by building collateral circulation. Instruct the client to walk until the point of claudication, stop and rest, and then walk a little farther.

During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." Which nursing response is appropriate?

"Where might you be able to walk?" In this situation, the best response by the nurse is to ask the client where he or she might be able to walk. This calls for cooperation and participation from the client. Increased activity is imperative for this client.

What is the nurse's best response when a client with Cushing syndrome screams at her husband, bursts into tears, throws her water pitcher against the wall, and then says "I feel like I am going crazy"?

"You feel this way because of your high hormone levels. Your health care provider can prescribe an antianxiety drug for you." Changes in blood cortisol levels can cause the client to show neurotic or psychotic behaviors. The client's need to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and more steady blood cortisol levels. Drug therapy to reduce these feelings and behaviors may be appropriate.

For which client will the nurse question the prescription for long-term androgen therapy?

A 52 year old with a history of prostate cancer treatment. Androgen therapy can make any residual prostate cancer cells proliferate and cause a recurrence of the disease.This therapy is often prescribed for impotence.

Normal troponin would be less than

0.03 ng/mL (0.03 mcg/L).

Syringe Selection for Insulin Admin

1 mL 0.5 mL 0.3 mL Obtain a new syringe for each injection Discard syringes after use

Concentration of insulin

100 units/mL (U-100) 500 units/mL (U-500)

A normal magnesium level is

1.7 to 2.4 mEq/L (0.85 to 1.2 mmol/L)

For which change reported by a client taking bromocriptine therapy to manage hyperpituitarism will the nurse notify the primary health care provider immediately to prevent harm?

Chest pain Bromocriptine can cause serious cardiac dysrhythmias and coronary artery spasms.

he client would call the provider for weight gain of

3 lb (1.4 kg) in a week or 1-2 lb (0.45 to 0.9 kg) overnight.

In adults, the cardiac output ranges from .

3 to 6 L/min

A client who is suffering from dyspnea on exertion and heart failure (HF) will most likely report which symptom during the health history?

Fatigue

The nurse is caring for a client with heart failure. What assessment data will the nurse anticipate?

Fatigue Chest discomfort or pain Tachycardia

Our body secretes ____ units of insulin daily

30-50

Normal potassium is

3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L).

Normal triglycerides would be

35 to 135 mg/dL (0.40 to 1.50 mmol/L) for females and 40 to 160 mg/dL (0.45 to 1.81 mmol/L) for males.

Mechanisms that Influence Blood Pressure

4 control systems play a major role in maintain BP: The arterial baroreceptor system Regulation of body fluid volume The renin-angiotensin-aldosterone system Vascular autoregulation

Which client has a risk for hypovolemic shock?

A client with esophageal varices The client with esophageal varices is at risk for hypovolemic shock. Esophageal varices are caused by portal hypertension where the portal vessels are under high pressure. With this high pressure, the portal vessels are prone to rupture, causing massive upper gastrointestinal tract bleeding and hypovolemic shock.

Hematologic Disorders/WBC and Lymphatic: Lymphoma

A group of cancers of the lymphoid tissues throughout the body, resulting from an abnormal overgrowth of one type of leukocyte, the lymphocyte, starting in a single lymph node or a single chain of nodes

Long-acting

Glargine (Lantus), detemir (Levemir) Clear, colorless solution Usually dosed once daily Referred to as basal insulin Peak less

Glucose-Elevating Drugs

50% dextrose in water (D50W) (IV push) Glucagon (IM or IV push) Given when pts have very low blood glucose and are unable to swallow

normal calcium level is

8.5 to 10.5 mEq/L (4.25 to 5 mmol/L).

The nurse has just received report on a group of clients. Which client is the nurse's first priority?

A 28 year old with acute adrenal insufficiency who has a blood glucose of 36 mg/dL (2.0 mmol/L). The nurse first attends to the client with adrenal insufficiency who has a blood glucose level of 36 mg/dL (2.0 mmol/L). The client's condition is considered a medical emergency and must be assessed and treated immediately.

Based on the assessment data, which client will the nurse identify as having a higher risk for development of sepsis and septic shock?

A 40-year-old female with a history of a double lung transplant 4 years ago. A 38-year-old male with HIV who has a low viral load. A 54-year-old female with breast cancer who is receiving chemotherapy. A 44-year-old male client who has a history of alcoholism and diabetes mellitus. An 86-year-old male with acute onset confusion.

After receiving change-of-shift report about these four clients, which client would the nurse assess first?

A 46 year old with aortic stenosis who takes digoxin and has new-onset frequent premature ventricular contractions. The nurse would first assess the 46 year old with aortic stenosis on digoxin and now has new-onset frequent PVCs. The PVCs may be indicative of digoxin toxicity. Further assessment for clinical signs and symptoms of digoxin toxicity must be done and the primary health care provider notified about the dysrhythmia.

An LPN/LVN is scheduled to work on the stepdown cardiac unit. Which client will the charge nurse assign to the LPN/LVN?

A 66 year old who has a prescription for a nitroglycerin patch and is scheduled for discharge to a long-term care later today The nurse will assign the 66-year-old client with a prescription for a nitroglycerin patch to the LPN/LVN. The LPN/LVN scope of practice includes administration of medications to stable clients.

Which client who has just arrived in the emergency department does the nurse assess as emergent and in need of immediate medical evaluation?

A 70 year old with a history of diabetes who has "tearing" back pain and is diaphoretic. The client who just arrived in the ED and needs immediate medical evaluation is the 70 year old with a history of diabetes who has "tearing" back pain and is diaphoretic. This client's history and clinical signs and symptoms suggest possible aortic dissection. The nurse will immediately assess the client's blood pressure and plan for IV antihypertensive therapy, rapid diagnostic testing, and possible transfer to surgery.

Therapeutic Lifestyle Changes (TLC) for High Cholesterol

A program the can help you lower cholesterol Lifestyle changes include diet, exercise, wt loss, and not smoking Diets main focus is to reduce amount of saturated fat you eat Choose fruits, veggies, whole grains, low-fat or nonfat dairy products, fish, poultry w/o the skin, and in mod amounts, lean meats

Type 2 (T2DM)

A progressive disorder in which the person initially has insulin resistance that progresses to decreased beta cell secretion of insulin Insulin resistance - (a reduced cell receptor response to insulin) develops from obesity and physical inactivity in a genetically susceptible adult and progresses to a deficiency of insulin production because of the impaired beta cells Heredity plays a major role

Hematologic disorders/RBC and Platelets: Thrombocytopenia

A reduction in platelets Can occur as a result of treatments that suppress general bone marrow activity Limited platelet formation or an increased rate of platelet destruction in the spleen Patient is at great risk of excessive bleeding if platelet count falls below 50,000/mm3

Treatment Outcomes for Glycosylated Hemoglobin (A1C) and Blood Glucose Levels

A1C levels are maintained at 7.0% or below Majority of premeal blood glucose levels are 70 - 130 mg/dL Peak after meal blood glucose levels are less than 180 mg/dL

Beta Blockers (OLOL)

ACTION: Lower HR Lower force of contraction Lower rate of A-V conduction S/E: Lethargy GI Disturbance CHF Low BP Depression Carvedilol (Coreg) Effect: treatment of hypertension, CHF, L ventricular dysfunction after an MI S/E: hyperglycemia, diarrhea, fatigue Nursing Imp: take w/ food Metoprolol tartrate (Lopressor) Effect: treatment of hypertension, MI (IV use), prophylaxis of angina S/E: insomnia, depression Nursing Imp: check pulse, hold if <50 and contact HCP, take on empty stomach, before meals, or bedtime, do not use decongestants Propranolol (Inderal) Effect: treat stable angina, hypertension, dysthymias, prophylaxis MI, AF S/E: depression, bronchospasm Nursing Imp: check pulse, hold if <50 and contact HCP, do not use aluminum-containing antacid S/E ALL: brady, hypotension, hypoglycemia in diabetics, do not stop abruptly taper after 2 weeks Alpha adrenergic blockers Effect: treatment of hypertension

Endocrine Changes Associated With Aging

Decreased antidiuretic hormone (ADH) production - pt at greater risk for dehydration

Hematologic Disorders/WBC and Lymphatic: Agranulocytosis

Acute disease deficit or absence of granulocytic WBC (Neutrophils, basophils, and eosinophils) Causes: leukemia, certain meds, radiation

Which characteristics place women at high risk for myocardial infarction (MI)?

Abdominal obesity Family history Increasing age Increasing age is a risk factor, especially after 70 years. Family history is a significant risk factor in both men and women. Also, a large waist size and/or abdominal obesity are risk factors for both metabolic syndrome and MI.

Renin-angiotensin-aldosterone system (RAAS) inhibitors: ACE inhibitors (Angiotensin-converting enzyme) inhibitors - "pril"

Action: Decreased peripheral vascular resistance w/o: Increased cardiac output Increased cardiac rate Increased cardiac contractility S/E: Dizziness Orthostatic hypotension GI distress Cough HA Lisinopril (Prinivil, Zestril) Effect: treatment of mild to mod hypertension, CHF, acute MI Captopril (Capoten) Effect: treatment of hypertension, CHF, L ventricular dysfunction, diabetic neuropathy Enalapril (Vasotec) Effect: treatment of hypertension, CHF, L ventricular dysfunction S/E: HA, cough, tachycardia, dizziness Nursing Imp: contact HCP if fever, rash, swelling, monitor for hypotension, avoid high K foods and supplements (can cause hyperkalemia

Adrenal Gland Hypofunction

Acute adrenal insufficiency, or Addisonian crisis, is a life-threatening event in which the need for cortisol and aldosterone is greater than the available supply Often occurs in response to a stressful event

The nurse is caring for a client with dark-colored toe ulcers and blood pressure (BP) of 190/100 mm Hg. Which nursing action does the nurse delegate to the LPN/LVN?

Administer a clonidine patch for hypertension. The action the nurse delegates to the LPN/LVN caring for a client with dark-colored toe ulcers and a BP of 190/100 mm Hg is to administer a clonidine patch for hypertension. Administering medication is within the scope of practice for the LPN/LVN.

Adrenal Glands - tent shaped organs on top of each kidney

Adrenal Cortex (Outer) secretes: Mineralocorticoids - help control body fluids and electrolytes Aldosterone causes kidney to reabsorb Na+ and water to bring plasma volume and osmolarity back to normal Maintains ECF volume If K+ increases, aldosterone enhances kidneys to excrete K+ Glucocorticoids (Cortisol) are essential for life Adrenal Medulla (Inner) secretes Catecholamines in small amounts at all times to maintain homeostasis Stress triggers increased secretion of these hormones, resulting in the fight or flight response, a state of heightened physical and emotional awareness Catecholamines (norepinephrine and epinephrine) - increased pulse and fight or flight response

Clients who have deficiencies of which hormones will the nurse assess for increased risk of life-threatening consequences?

Adrenocorticotrophicn hormone (ACTH) and thyroid-stimulating hormone (TSH) Deficiencies of (ACTH) or TSH are the most life threatening because they cause a decrease in the secretion of vital hormones from the adrenal and thyroid glands.

Thrombolytic agents

Alteplase and Reteplase- Effect: use to break up blood clots, give within 6 hrs of infarction S/E: bleeding Nursing Imp: administer streptokinase slowly to prevent hypotension

The nurse is teaching a class on diagnostic cardiovascular testing. Which teaching will the nurse include?

An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography.

Disorders of Endocrine System Usually Related To

An excess of a specific hormone A deficiency of a specific hormone Poor hormone-receptor interactions resulting in decreased responsiveness of the target tissue

Metabolism consists of:

Anabolism Catabolism

The nurse caring for a client with heart failure who is taking digoxin. What assessment data requires that nurse notify the health care provider?

Anorexia Blurred vision Fatigue

The nurse is assessing a client with right-sided heart failure. What assessment findings will the nurse anticipate?

Ascites Peripheral edema

A client is exhibiting signs and symptoms of early shock. Which nursing actions support the psychosocial integrity of the client?

Ask family members to stay with the client. Remain with the client Reassure the client that everything is being done for him or her.

Antiplatelet

Aspirin (Ecotrin) Effect: inhibits both platelet aggregation and vasoconstriction, decreasing the likelihood of thrombosis

Pack years

Pack per day x years smoked

Defibrillation

Asynchronous countershock that depolarizes a critical mass of myocardium simultaneously to stop the re-entry circuit, allowing the sinus node to regain control of heart

Antiarrhythmic

Atropine Effect: increases HR, decreased GI and respiratory secretions

The home health nurse visits a client with heart failure who has gained 5 lb (2.3 kg) in the past 3 days. The client states, "I feel so tired and short of breath." Which action does the nurse take first?

Auscultate the client's posterior breath sounds. The action the home care nurse takes first is to auscultate the heart failure client's posterior breath sounds. Because the client is at risk for pulmonary edema and hypoxemia, the breath sounds must be assessed.

Acute Coronary Syndrome: Incidence and Prevalence

Avg age for first MO 65 yrs old - men 72 yrs old - women Family history is a risk Women w/ abdominal obesity and metabolic syndrome are at risk Analysis: Analyze Cues & Prioritize Hypotheses Acute pain due to an imbalance between myocardial oxygen supply and demand Decreased myocardial tissue perfusion due to interruption of arterial blood flow Potential for dysrhythmias due to ischemia and ventricular irritability Potential for HF due to left ventricular dysfunction

Six P's of Arterial Insufficiency

Pain Pallor Pulselessness Paresthesia Paralysis Poikilothermia (coolness)

venous System

Primary function is complete circulation of blood by returning blood from capillaries to the right side of the heart

The nurse is assessing a 54-year-old male client for risk of atherosclerosis. What assessment data is associated with an increase in risk?

BMI is 32 History of type 2 diabetes mellitus. LDL of 160 mg/dL. Current smoking history. Risk factors that contribute to atherosclerosis include: an increase in LDL (160 mg/dL is high), obesity (as indicated by a BMI is 32), smoking, and type 2 diabetes.

Which action immediately after a hypophysectomy will the nurse instruct a client to avoid to prevent harm?

Bending at the waist Coughing Coughing early after surgery both increases intracranial pressure (ICP) and also increases pressure in the incision area and may lead to a leak of cerebrospinal fluid. Bending at the waist also increases ICP.

For a client with an 8-cm abdominal aortic aneurysm, which assessment data must be addressed immediately?

Blood pressure (BP) 192/102 mm Hg The problem that must be addressed immediately in a client with an 8-cm abdominal aneurysm is a BP of 192/102 mm Hg. Elevated blood pressure can increase the rate of aneurysmal enlargement and risk for early rupture.

Glucose is the main fuel for central nervous system cells

Brain needs continuous supply from the blood to prevent neuron dysfunction and cell death

Cardiac Output (CO)

CO = HR x stroke volume

Insulin allows Cells to use & store

COH Fat Protein

Chronic Stable Angina (CSA) Pectoris

CSA - chest discomfort that occurs w/ moderate to prolonged exertion in familiar pattern

High-Output Failure

Cardiac output remains normal or above normal Caused by increased metabolic needs or hyperkinetic conditions Septicemia High fever Anemia Hyperthyroidism

Acute Cardiac Tamponade

Cardiac tamponade is an EXTREME EMERGENCY Fluid accumulation in pericardium; sudden decreases in cardiac output Pericardiocentesis

Diabetic Autonomic Neuropathy

Cardiovascular autonomic neuropathy (CAN) affects sympathetic and parasympathetic nerves of the heart and blood vessels Contributes to left ventricular dysfunction, painless myocardial infarction, and exercise intolerance Leads to orthostatic (postural) hypotension and syncope (Brief loss of consciousness on standing) and increases the risk for falls Teach pt to change positions slowly, when moving from sitting to standing Can affect entire GI system Gastroesophageal reflux, delayed gastric emptying and gastric retention, early satiety (feeling completely full), heartburn, nausea, vomiting, and anorexia Sluggish movement of the small intestine can lead to bacterial overgrowth, which causes bloating, gas, and diarrhea Gastroparesis (delay in gastric emptying) Urinary problems - incomplete emptying and urine retention, urinary infection and kidney problems, frequency, urgency, inability to sense bladder fullness and incontinence

Diabetic ketoacidosis (DKA)

Caused by an absence of insulin Acidosis caused by an accumulation of ketone bodies from rapid fat breakdown BLOOD SUGAR READINGS >300 MG/DL Sudden onset Symptoms Kussmaul's respirations/hyperventilation - increased rate and depth of respirations in an attempt to excrete more acids by exhalation Rotting fruit breath Nausea/abdominal pain Polyuria/polydipsia Wt loss Dry skin/sunken eyes Lethargy/coma

Type 1 (T1DM)

Caused by autoimmune destruction of the insulin-secreting beta cells of the pancreas in a genetically susceptible person No insulin is present and w/o an outside source of insulin Type 1 is rapidly FATAL

Valvular Heart Disease: Mitral regurgitation

Caused by mitral valve prolapse, rheumatic heart disease, infective endocarditis, MI, connective tissue diseases, dilated cardiomyopathy Progresses slowly; pt may be symptom free for decades Symptoms include: fatigue, chronic weakness, anxiety afib, respiration changes

Right-Sided Heart Failure

Causes Left ventricular failure Right ventricular MI Pulmonary hypertension Right ventricle cannot empty completely Increased volume and pressure in venous system and peripheral edema JVD Increased abdominal girth Dependent edema Hepatomegaly Hepatojugular reflux Ascites Wt most reliable indicator of fluid gain/loss

A-fib

Chaotic rhythm No clear P wave Irregular ventricular response Associated w/ atrial fibrosis and loss of muscle mass Common in heart disease Up to 30 genetic mutations Most common dysrhythmias Incidence increases w/ age Risk factors include hypertension, previous ischemic stroke, TIA or other thromboembolic events

When caring for a client who is obtunded and admitted with shock of unknown origin, which action will the nurse take first?

Check the airway and respiratory status. The nurse's first action when caring for an obtunded client admitted with shock is to check the client's airway and respiratory status. When caring for any client, determining airway and respiratory status is the priority.

Which action in the plan of care for a client who is hospitalized for pituitary function testing would be most appropriate for the nurse to delegate to an experienced assistive personnel (AP)?

Checking the client's blood glucose levels every 4 hours Monitoring blood glucose is within the nursing assistant's scope of practice if the nursing assistant has received education and evaluation in the skill.

A client has just returned from coronary artery bypass graft surgery. Which assessment data requires immediate nursing action?

Chest tube drainage 175 mL last hour The nurse needs to report chest drainage over 150 mL/hr to the surgeon. Although some bleeding is expected after surgery, 175 mL/hr is excessive. This requires immediate nursing action to notify the health care provider.

Coronary Artery Disease (CAD)

Chronic stable angina, acute coronary syndromes Ischemia Insufficient oxygen supplies to meet requirements of myocardium Infarction Necrosis or cell death that occurs when severe ischemia is prolonged and decreased perfusion causes damage to tissue

The client asks the nurse about modifiable risk factors for heart disease. What nursing response is appropriate?

Cigarette smoking is one of the most significant modifiable risk factors. Increasing physical exercise is a method to modify your risk.

Anticoagulants

Coumarins - warfarin (Coumadin) Effect: management of pulmonary emboli, DVT, MI, atrial dysrhythmias, post cardiac valve replacement Nursing Imp: avoid foods high in Vit. K Heparin Effect: prophylaxis and treatment of thromboembolic disorders Nursing Imp: give deep sub-q

For which assessment finding in a client who had a transsphenoidal hypophysectomy yesterday will the nurse notify the primary health care provider immediately?

Client report of a headache and stiff neck Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care. The finding requires the nurse to immediately notify the primary health care provideR

Which assessment finding in a client with hyperaldosteronism indicates to the nurse that the condition is becoming more severe?

Client reports numbness and tingling around the mouth

The nurse is caring for a client with heart failure in a cardiac clinic. What assessment data indicates that the client has demonstrated a positive outcome related to the addition of metoprolol to the medication regimen?

Client states, "I can sleep on one pillow." Improvement in activity tolerance, less orthopnea, and improved symptoms represents a positive response to beta blockers such as metoprolol.

Centrally Acting Alpha Agents: Antihypertensive

Clonidine (Catapres) Effect: treatment of hypertension, severe cancer pain (in combo w/ opiates) S/E: severe rebound hypertension, drowsiness Nursing Imp: avoid high sodium foods, avoid use w/ alcohol, CNS depressants

Which client is best to assign to an LPN/LVN working on the telemetry unit?

Client with dilated cardiomyopathy who uses oxygen for exertional dyspnea. The best client to assign to the LPN/LVN working on the telemetry unit is the client with dilated cardiomyopathy who uses oxygen for exertional dyspnea. This client is the most stable. Administration of oxygen to a stable client is within the scope of LPN/LVN practice.

Which client demonstrates the highest risk for hypovolemic shock?

Client with severe ascites A client with severe ascites best demonstrates the problem with the highest risk for hypovolemic shock. Fluid shifts from vascular to intra-abdominal may cause decreased circulating blood volume and poor tissue perfusion.

The nurse in the coronary care unit is caring for a group of clients who have had a myocardial infarction. Which client will the nurse see first?

Client with third-degree heart block on the monitor The client with the third-degree heart block needs to be seen first. Third-degree heart block is a serious complication that indicates that a large portion of the left ventricle and conduction system are involved. This type of block usually requires pacemaker insertion.

Platelet Aggregation Inhibitor

Clopidogrel (Plavix) Effect: used to reduce risk of stroke, MI, peripheral artery disease, ACS S/E: bleeding, N/V Nursing Imp: take w/ meals to decrease gastric symptoms

Which factor or condition does the nurse expect to result in an increase in a client's production of thyroid hormones (TH)?

Cold environmental temperatures Cold and stress are two factors that cause the hypothalamus to secrete thyrotropin-releasing hormone (TRH), which then stimulates the anterior pituitary to secrete thyroid-stimulating hormone (TSH) to increase production of the two major thyroid hormones.

Addison's Disease - Chronic Insufficiency

Common cause of adrenal insufficiency is the sudden cessation of long-term high-dose glucocorticoid therapy Glucocorticoid drugs must be withdrawn gradually to allow for increasing pituitary production of (ACTH) and activation of adrenal cells to produce cortisol Potassium excretion is decreased leading to hyperkalemia Sodium and water secretion is increased causing hyponatremia and hypovolemia Assess for electrolyte and fluid imbalances, and hypoglycemia Diet High cal High sodium Low potassium

The assistive personnel (AP) is concerned about a postoperative client with blood pressure (BP) of 90/60 mm Hg, heart rate of 80 beats/min, and respirations of 22 breaths/min. What is the appropriate nursing action?

Compare these vital signs with the last several readings. The nurse will take the vital sign trends into consideration. A BP of 90/60 mm Hg may be normal for this client.

Left-Sided Heart Failure

Congestive heart failure Typical causes Hypertension Coronary artery disease Valvular disease 2 types Systolic Diastolic Dyspnea Fatigue Weakness Arm heaviness Chest pain or palpitations, skipped beats, fast rate Tachycardia and Tachypnea S3 gallop

Thyroid Gland

Control of metabolism Calcium and phosphorus balance

Which assessment data cause the nurse to suspect that a client who had a myocardial infarction (MI) is developing cardiogenic shock?

Cool, diaphoretic skin Crackles in the lung fields Anxiety and restlessness The client with shock has cool, moist skin. Because of extensive tissue necrosis, the left ventricle cannot forward blood adequately, resulting in pulmonary congestion and crackles in the lung fields due to poor tissue perfusion. A change in mental status, anxiety, and restlessness are also expected.

The client in the cardiac care unit has had a large myocardial infarction. What assessment data indicates to the nurse the onset of left ventricular failure?

Crackles in the lung fields Signs and symptoms of left ventricular failure and pulmonary edema are noted by listening for crackles and identifying their locations in the lung fields.

Varicose Veins

Distended, protruding veins that appear darkened and tortuous Treatment includes the 3 E's Elastic compression hose Exercise Elevation

A client with heart failure reports a 7.6-lb (3.4 kg) weight gain in the past week. What intervention does the nurse anticipate from the primary health care provider?

Daily weight monitoring

Hypothyroidism

Decreased metabolism from low levels of thyroid hormones and be from: Thyroid cells may fail to produce sufficient levels of thyroid hormones Sometimes cells themselves are damaged and no longer function normally adult does not ingest enough of substances needed to make thyroid hormones occur as a result of thyroid surgery and radioactive iodine (RAI) treatment of hyperthyroidism When production of thyroid hormones is too low or absent, blood levels of TH are very low, and pt has a decreased metabolic rate Symptoms Slow metabolism leading to decreased appetite and weight gain GI system slowed resulting in constipation Cold intolerance Cardiac output decreases leading to hypotension Priority collaborative problems: Decreased gas exchange and oxygenation due to decreased energy, obesity, muscle weakness, and fatigue Hypotension and reduced perfusion due to decreased heart rate from decreased myocardial metabolism Reduced cognition due to reduced brain metabolism and formation of edema Potential for complication of myxedema coma Focused Assessment Assess cardiovascular status, cognition and mental status, condition of skin and mucous membranes, neuromuscular status Ask about: sleep, body temp, 24 hr diet recall and activity recall, OTC meds, Last BM Assess pts understanding of illness and adherence w/ therapy: Symptoms to report to PHCP Drug therapy plan Self-Management Ed Most important educational need for the pt w/ hypothyroidism is about hormone replacement therapy and its S/E Emphasize the need for lifelong drugs and review the symptoms of both hyperthyroidism and hypothyroidism

For which symptoms will the nurse instruct the family and client who is being treated for diabetes insipidus (DI) to call 911 or go to the nearest emergency department?

Decreased urine output Weigh gain of more than 2.2 lb (1 kg) in 24 hours Persistent headache Acute confusion Drug therapy for DI can cause a greatly increased kidney reabsorption of water and lead to life-threatening water toxicity. Indications of water toxicity are a relatively rapid onset of acute confusion, rapid weight gain, decreased urine output, persistent headache, and nausea and vomiting.

Antidiuretic Hormones

Desmopressin acetate (DDAVP); Vasopressin (Pitressin) Primary action is enhanced reabsorption of water in the kidneys, promoting antidiuretic effect, regulating fluid balance S/E: Flushing, HA, water intoxication, HTN Used for treatment of DI Administered intranasal, oral, SQ, IV The parenteral form of desmopressin is 10 times stronger than the oral form, and dosage must be reduced

Polyphagia

Despite eating, person remains in cellular starvation until insulin is available to move glucose into the cells

Acute Complications of Diabetes

Diabetic ketoacidosis (DKA) Hyperglycemic - hyperosmolar state (HHS) Hypoglycemia (low blood glucose level)

The nurse is caring for a client in the refractory stage shock. Which intervention does the nurse consider?

Discussion with family and provider regarding palliative care When caring for a client in the refractory stage of shock, the nurse considers discussing palliative care with the family and provider. In this irreversible phase, therapy is not effective in saving the client's life, even if the cause of shock is corrected and mean arterial pressure temporarily returns to normal. A discussion on palliative care would be considered.

The nurse is teaching a group of teens about prevention of heart disease. Which point is mostimportant for the nurse to emphasize?

Do not smoke or chew tobacco. The most important point for the nurse to emphasize when teaching a group of teens about heart disease prevention is not to smoke or chew tobacco. Tobacco exposure, including secondhand smoke, reduces coronary blood flow, causing vasoconstriction, endothelial dysfunction, and thickening of the vessel walls. Smoking also increases carbon monoxide and decreases oxygen. Because it is highly addicting, beginning smoking in the teen years may lead to decades of exposure.

The nurse is caring for a client who is being treated for hypertensive crisis. Which prescribed medication would the nurse question?

Dopamine Dopamine is used for its inotropic and vasoconstrictive properties to raise blood pressure, and would not be used in hypertensive crisis.

Which atypical symptoms may be present in a female client experiencing myocardial infarction (MI)?

Dyspnea Extreme fatigue Dizziness Many women who experience an MI present with dyspnea, light-headedness and dizziness, and fatigue.

Premature atrial complexes

Ectopic focus of atrial tissue fires an impulse before next sinus impulse is due Caused by stress, fatigue, anxiety, inflammation, infection, caffeine, nicotine, alcohol, certain drugs

Renin-angiotensin-aldosterone system (RAAS) inhibitors: ARBs (angiotensin receptor blockers) - "sartan"

Effect: prevent the development of HF Valsartan (Diovan) Effect: treatment of hypertension, HF in pts who cannot take an ACE inhibitor, reduction of cardiovascular mortality in pts w/ L ventricular failure, or L ventricular dysfunction after an MI Losartan (Cozaar) Effect: decrease BP, decrease the progression of diabetic nephropathy, decrease incidence of stroke in pts w/ HTN and L ventricular hypertrophy

Acute Peripheral Arterial Occlusion

Embolus May have severe pain below the level of occlusion

Which action is most important for the nurse to perform when caring for an older client decreased antidiuretic hormone (ADH) production?

Encouraging fluids every 2 hours A decrease in ADH production in the older adult causes urine to be more dilute. In this instance, urine might not concentrate when fluid intake is low, allowing for excess water loss. Encouraging fluid intake every 2 hours, even during the night, is important to prevent dehydration.

Antithrombotic, low molecular weight heparins

Enoxaparin (Lovenox) Effect: used to prevent clots from becoming larger or other clots from forming S/E: hemorrhage Nursing Imp: avoid ASA, monitor for signs of hemorrhage: bleeding gums, nosebleed, black tarry stools

The nurse plans to administer an antibiotic to a client newly admitted with septic shock. What action will the nurse take first?

Ensure that blood cultures were drawn. The nurse's first action when planning to administer an antibiotic to a newly admitted patent in septic shock is to ensure that blood cultures were drawn. Cultures must be taken to identify the organism for more targeted antibiotic treatment before antibiotics are administered.

What is the nurse's best action when noticing that the phlebotomist, who plans to draw blood from the client with severe hypercortisolism, displays symptoms of a cold?

Ensuring the phlebotomist wears a facemask while in the client's room The nurse needs to make sure the phlebotomist wears a facemask because the client is immunosuppressed and at higher risk for respiratory infection. Anyone with a suspected upper respiratory infection who must enter the client's room needs to wear a mask to prevent the spread of infection.

Hypercortisolism (Cushing's Disease)

Excess secretion of cortisol from adrenal cortex Leads to problems w/ fluid and electrolyte balance Moon face appearance, truncal obesity, thinner arms and legs, buffalo hump, abdominal striae, high BP, fatigue, muscle weakness, bruising, dependent edema, wt gain Pituitary adenoma is the most common cause of Cushing's disease Assessment Skin changes Cardiac changes Musculoskeletal changes Glucose metabolism Immune changes Psychosocial assessment Mood swings Irritability Confusion Depression Lab tests Blood salivary Urine cortisol levels Imaging assessment CT scans MRI Arteriography Priority collaborative problems Fluid overload due to hormone-induced water and sodium retention Potential for injury due to skin thinning, poor wound healing, and bone density loss Potential for infection due to hormone-induced reduced immunity Potential for acute adrenal insufficiency

Hyperthyroidism

Excessive thyroid hormone secretion from thyroid gland Stimulate most body systems causing hypermetabolism and increased sympathetic nervous system activity Symptoms are called thyrotoxicosis Thyroid hormones increase metabolism in all body organs, producing many diff symptoms Can bet temporary or permanent Most common form of disease is Graves' disease, also called toxic diffuse goiter Graves' disease is an autoimmune disorder resulting from Hashimoto's thyroiditis Associated w/ several gene mutations, other autoimmune disorders Physical Assessment & S/S Exophthalmos (abnormal protrusion of eyes) Photophobia - sensitivity to light Physical Assessment exophthalmos Pretibial myxedema (dry, waxy swelling of front surfaces of lower legs the resembles benign tumors or keloids Increased systolic BP, tachy, thinning hair, tremors Psychosocial assessment - wide mood swings, restless, irritable, fatigue, not sleeping, "full speed ahead" History - heat intolerance Lab Tests T3, T4, T3RU, TSH, TSH-Rab Thyroid scan - evaluates position, size, and function of thyroid Ultrasonography - determine size, masses, or nodules Electrocardiography (ECG) - SVT, A-Fib, Dysrhythmias, PVC Drug therapy Antithyroid drugs Block thyroid hormone production by preventing iodide binding in thyroid gland Thyroidectomy Post Op complications Hypocalcemia and tetany - tingling around mouth or toes and fingers Assess for muscle twitching as a sign of calcium deficiency Laryngeal nerve damage Thyroid storm or thyroid crisis - fever, tachy, and systolic HTN, anxiety, tremors As crisis progresses pt may become restless, confused, or psychotic and may have seizures, leading to coma

Minerals

Ferrous Sulfate Effect: treatment of iron deficiency anemia, prophylaxis for iron deficiency in pregnancy

Vitamins

Folic Acid Effect: treatment of anemia, liver disease, alcoholism, intestinal obstruction, pregnancy due to folic acid deficiency Vitamin B12 Necessary to convert folic acid to active form Give orally (due to inadequate dietary intake), or parenterally or intranasally (malabsorption syndrome) to be absorbed

Insulins

Function as a substitute for the endogenous hormone Effects are the same as normal endogenous insulin Restores the diabetic pts ability to: Metabolize carbs, fats, and proteins Store glucose in liver Convert glycogen to fat stores

Hyperglycemia (elevated blood glucose level) resulting from problems with

GLUCOSE REGULATION that include reduced insulin secretion or reduced insulin action of both

Alpha cells produce glucagon

Glucagon is a hormone that has balancing actions opposite those of insulin Prevents hypoglycemia by triggering the release of glucose from storage sites in the liver and skeletal muscle When blood glucose levels fall, insulin secretion stops and glucagon is released, triggering the release of glucose from storage sites in the liver and skeletal muscle

Insulin allows

Glucose in blood move into cells for energy

Gestational (GDM)

Glucose intolerance w/ onset or first recognition during pregnancy All pregnant women should be screened

Criteria for Diagnosis of Diabetes

Glycosylated Hemoglobin Assays (Hgb A1C) >6.5% Fasting plasma glucose test >126 mg/gL Oral glucose tolerance test equal to or >200 mg/dL Pt w/ classic manifestations of hypoglycemia or hyperglycemic crisis, a random blood glucose concentration >200 mg/dL

Which laboratory findings will the nurse use to validate the statement of a client with diabetes that therapy instructions for glucose control "have been followed to the letter" for the past 2 months?

Glycosylated hemoglobin (HbA1c) The glycosylated hemoglobin (HbA1c) evaluates the average blood glucose level for 2 to 3 months; this is the best indicator of overall blood glucose control.

Beta cells produce insulin when blood sugars are

HIGH

Identify health care education and safety needs for adults who have an alteration and metabolism

Health Promotion and Maintenance Control of diabetes and its complications is major focus for health promotion activities Prevent Complications Interventions Teach control hyperglycemia (target range) Teach healthy lifestyle Low calorie diet Increase physical activity Wt loss Decrease HTN Decrease triglycerides Smoking/drinking cessation Yearly physical exam w/ eye/vision checks and urine albumin levels Daily foot inspections and report ulcers/open areas Exercise Blood glucose monitoring Foot care Nutrition Self-injection of insulin Insulin therapy

The nurse is caring for a postoperative client at risk for hypovolemic shock. Which assessment indicates an early sign of shock?

Heart rate 120 beats/min Tachycardia is an early symptom of shock. Heart and respiratory rates increased from the client's baseline level or a slight increase in diastolic blood pressure may be the only objective manifestation of this early stage of shock.

Describe the role of the nurse in providing quality care to adults who have an alteration in regulation and metabolism

Help manage weight, teach about diets and exercise Teach cardiovascular and kidney disease prevention Teach healthy sleep habits Social factors (food, employment) Access to technology

Heart Failure: Assessment

History Lab assessment Serum electrolyte BUN, creatinine Hgb and Hct BNP Urinalysis ABGs Imaging assessment CXR Echocardiography Radionuclide studies MUGA ECG Hemodynamic monitoring

Peripheral Venous Disease Assessment

History Physical Assessment/S&S Calf or groin pain Sudden onset of unilateral leg swelling Diagnostic assessment Venous duplex ultrasonography Doppler flow studies Impedance plethysmography MRI D-dimer

Acute Coronary Syndrome: Assessment

History Physical assessment Psychosocial assessment Lab assessment Troponin T and I Imaging assessment CXR Thallium scans, CMR, echocardiography, CTCA Other diagnostic assessment 12-lead electrocardiograms Exercise tolerance (stress test) Cardiac catheterization

Hypertension Assessment:

History Physical assessment/ S&S Psychosocial assessment Diagnostic assessment Urinalysis for protein, RBC, BUN, creatinine CXR ECG shows degree of cardiac involvement

The nurse is preparing to administer digoxin as prescribed to a client with heart failure and notes: Temperature: 99.8° F (37.7° C), Pulse: 48 beats/min and irregular, Respirations: 20 breaths/min, Potassium level: 3.2 mEq/L (3.2 mmol/L). What action will the nurse take?

Hold the digoxin, and obtain a prescription for a potassium supplement. The nurse needs to hold the digoxin and gets a prescription for a potassium supplement. Digoxin causes bradycardia and hypokalemia potentiates digoxin toxicity.

Hypothalamus

Hormones of posterior pituitary gland are vasopressin (antidiuretic hormone ADH) & oxytocin Antidiuretic hormone (ADH) targets tissue in kidney and promotes water reabsorption HELPS MAINTAIN FLUID AND ELECTROLYTE BALANCE Pt often needs lifelong hormone replacement therapy, and physical and emotional support is critical Diabetes insipidus (DI) is a disorder of the posterior pituitary gland Water loss is caused by either ADH deficiency or an inability of kidneys to respond to ADH ADH deficiency results in excretion of large volumes of dilute urine Key symptoms are increase in urination and excessive thirst First step in diagnosis is measure 24 hr fluid I & O and analyze specific gravity and osmolarity

Diuretics

Hydrochlorothiazide Effect: inhibit water and sodium reabsorption, and increase potassium excretion Furosemide (Lasix) Effect: decrease sodium reabsorption and increase potassium excretion Spironolactone Effect: affects the distal tubule and prevent reabsorption of sodium in exchange for potassium

Which changes in laboratory values will the nurse expect to see in a client who has tumor causing excess secretion of aldosterone?

Hypokalemia Hypernatremia Aldosterone is the mineralocorticoid that maintains extracellular fluid volume and electrolyte composition. It promotes sodium and water reabsorption and potassium excretion in the kidney. Excessive amounts of this hormone result in hypernatremia and hypokalemia.

Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem?

Increased facial hair and absent menses in a 28-year-old nonpregnant woman Absence of menses when pregnancy is not present is considered abnormal, especially when accompanied by hirsutism. Possible endocrine problems associated with these changes include ovarian, adrenal gland, hypothalamic, or anterior pituitary dysfunction.

What effect on circulating levels of sodium and glucose does the nurse expect in a client who has been taking an oral cortisol preparation for 2 years because of a respiratory problem?

Increased sodium; increased glucose Any of the glucocorticoids have some mineralocorticoid activity and increase the reabsorption of sodium from the kidney tubules, thus increasing the serum sodium level.

Infection Concept Exemplar: Sepsis and Septic Shock

Infection that causes tissue damage, organ failure, and death if not treated promptly Septic shock is a subset of sepsis SIRS

Pericarditis

Inflammation or alteration of the pericardium Associated w/ Infective organisms (bacteria, viruses, or fungi) Post-myocardial infarction (MI) syndrome (Dressler's syndrome) Postpericardiotomy syndrome Acute exacerbations of systemic connective tissue disease

Which primary health care provider order will the nurse perform first for a client with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 105 mEq/L (105 mmol/L)?

Inserting an indwelling catheter and monitoring urine output The first intervention the nurse performs is to administer an infusion of 150 mL hypertonic saline over 3 hours. When the serum sodium level is below 115 mEq/L (115 mmol/L), the client is at increased risk for seizures and coma.

Hyperglycemic - hyperosmolar state (HHS)

Insulin deficiency Characterized by profound dehydration BLOOD SUGAR READINGS >600 MG/DL Gradual onset S/S Altered CNS function w/ neurological symptoms Dehydration & electrolyte loss

Intermediate-acting

Insulin isophane suspension (NPH) Cloudy appearance Slower in onset and more prolonged in duration than endogenous insulin

Treatment for DM Type 1

Insulin therapy

How does the nurse caring for a client with septic shock recognize that severe tissue hypoxia is present?

Lactate 81 mg/dL (9.0 mmol/L) The client with septic shock and a lactate level of 81 mg/dL (0.9 mmoL/L) indicates that severe tissue hypoxia is present. Poor tissue oxygenation at the cellular level causes anaerobic metabolism, with the by-product of lactic acid.

Macrovascular

Large blood vessels Coronary heart disease Cerebrovascular disease Peripheral vascular disease

Treatment for DM Type 2

Lifestyle changes Oral drug therapy Insulin when the above no longer provide glycemic control

The nurse is teaching the client dietary methods to reduce LDL levels. What teaching will the nurse include?

Limit trans-fat intake. Emphasize the intake of whole grains. Nuts are a good snack food. Try to purchase skinless chicken to cook with.

In collaboration with the registered dietitian nutritionist, which dietary alterations will the nurse instruct a client with Cushing disease to make?

Low carbohydrate, high calorie, and low sodium The client with Cushing disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. The sodium retention causes water retention and hypertension. Clients are encouraged to moderately restrict sodium intake.

Which client has the highest risk for cardiovascular disease?

Man who smokes and whose father died at 49 of myocardial infarction (MI).

Which clinical symptoms in a postoperative client indicate early sepsis with an excellent recovery rate if treated?

Low-grade fever and mild hypotension Low-grade fever and mild hypotension in a postoperative client can indicate very early sepsis. With treatment, the probability of recovery is high.

Peripheral Arterial Disease (PAD) Assessment:

MRA Segmental systolic BP measurement Ankle-brachial index (ABI) Exercise tolerance training Plethysmography

Chronic Complications of Diabetes

Macrovascular Microvascular

Identify priority actions for adults who have an alteration in regulation and metabolism

Major focus of management is to identify the presence of DM to help the adult manage the disorder and maintain glycemic control for prevention of complications The desired outcome is to help patients maintain blood glucose levels in the normal range (euglycemia) w/o causing either hyperglycemia (higher than normal blood glucose level) or hypoglycemia (lower than normal blood glucose level) Ensure that no pt suspected of having DI is deprived of fluids for more than 4 hrs because he or she cannot reduce urine output and severe dehydration can result

A postoperative client is admitted to the intensive care unit (ICU) with hypovolemic shock. Which nursing action will the nurse delegate to an experienced assistive personnel (AP)?

Measure hourly urine output. The nurse delegates to an experienced ICU AP the measurement of hourly urine output for a client with hypovolemic shock. Monitoring hourly urine output is included in nursing assistant education and does not require special clinical judgment. The nurse will evaluate the results.

The nurse is teaching a class on the management of sepsis. What teaching will the nurse include regarding the Hour-1 sepsis management bundle?

Measure lactate levels Administer broad spectrum antibiotics. Begin rapid administration of crystalloids for hypotension. A bundle is a group of two or more interventions that has been shown to be effective when applied in a sequence.

Metabolic Syndrome

Metabolic syndrome is the simultaneous presence of metabolic factors known to increase risk for developing type 2 DM and cardiovascular disease Abnormal obesity: waist circumference Hyperglycemia: fasting blood glucose level of 100 mg/dL or more or on drug treatment Hypertension: systolic BP of 130/85 mg Hg or more or on drug treatment Hyperlipidemia: triglyceride level of 150 mg/dL or more or on drug treatment Genetic defects of beta cell function Genetic defects in insulin actions Pancreatic disease (pancreatitis, trauma, cancer, cystic fibrosis) Endocrinopathies (acromegaly, Cushing's disease, hyperthyroidism, aldosteronism) Drugs or chemical induced (steroids, TPN, tube feedings) Infections/illness/stress/immune related Genetic syndromes (down syndrome and others)

Infective Endocarditis

Microbial infection of the endocardium Often occur in those who use IV drugs

Essential Hypertension

Most common type of hypertension Results in damage to vital organs Causes medial hyperplasia (thickening) of arterioles Common risk factors: Obesity Smoking Stress Family history

Valvular Heart Disease: aortic stenosis

Most common valve dysfunction Disease of "wear and tear" Right-sided HF can occur late in the disease When surface area of the valve is 1 cm or less, surgery is indicated urgently

Rapid-acting

Most rapid onset of action (5 - 15 min) Shorter duration Pt must eat a meal after injection Insulin lispro (Humalog) Similar action to endogenous insulin Insulin aspart (NovoLog) Insulin glulisine (Apidra) May be given SC or via continuous SC infusion pump (but not IV)

The nurse is assessing a client with arterial insufficiency. What assessment data would cause the nurse to suspect an acute arterial occlusion of the right lower extremity?

Mottling of right foot and lower leg Numbness and tingling of right foot Cold right foot Signs/symptoms of acute arterial occlusion of the right lower extremity include cold right foot, numbness and tingling of the right foot, and mottling and tingling of the right foot. Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (cool limb), and mottled color are characteristics of acute arterial occlusion.

Mixing insulins

NPH w/ short-acting insulins Short-acting insulin drawn first (regular) CLEAR TO CLOUDY

If pt is __, contact provider before giving insulin

NPO

Diabetic Nephropathy

Nephropathy is a pathologic change in the kidney that reduces kidney function and leads to kidney failure Diabetes is the leading cause of end-stage kidney disease (ESKD) and kidney failure in the US Kidney disease causes progressive albumin excretion and declining glomerular filtration rate (GFR) Annual testing for urine albumin is recommended for pts Psychosocial Integrity encourage pt to express concerns about a change in appearance, sexual function, or fertility as a result of a possible endocrine problem Ask family members about changes in pts personality or behavior Be aware that the onset of endocrine problems can be slow and insidious or abrupt and life threatening The endocrine system working w/ the nervous system controls overall body function and regulation including: Metabolism Nutrition Elimination Temp Fluid and electrolyte balance Growth Reproduction

Unstable angina

New-onset angina Vasospastic angina Preinfarction angina Myocardial infarction NSTEMI STEMI

Organic Nitrates

Nitroglycerin (Nitro-dur, Transderm-Nitro/Nitrostat) Effect: relief or prevention of angina attacks, increased cardiac output S/E: transient HA, postural hypotension, flushing Nursing Imp: sublingual-pt sitting/lying let tab dissolve under tongue, onset 1-3 min, duration 30 min Isosorbide dinitrate (Isordil) and isosorbide mononitrate (Imdur) Effect: to prevent angina episodes S/E: dizziness, potential hypotension, flushing, drowsiness, nausea Nursing Imp: PO - 1 hr before food or 2 hrs after meals, SL - dissolve under tongue, do not eat, drink, talk, or smoke during use

Which client symptom appearing after a head injury suffered in a car crash is most relevant for the nurse to consider the possibility of diabetes insipidus (DI)?

No change in urine output with minimal fluid intake. DI results from absent or insufficient secretion of antidiuretic hormone (ADH, vasopressin) from the posterior pituitary and can result from a head injury that damages this endocrine gland.

Which action will the nurse delegate to experienced assistive personnel (AP) working in the cardiac catheterization laboratory?

Obtain client vital signs and a resting electrocardiogram (ECG).

Which nursing action may be delegated to assistive personnel (AP) working on the medical unit?

Obtain daily weights for several clients with class IV heart failure.

A client comes to the emergency department with chest discomfort. Which action does the nurse perform first?

Obtains the client's description of the chest discomfort. A description of the chest discomfort must be obtained first, before further action can be taken.

polydipsia

Occurs and cell starvation triggers

Hormone-receptor work in a lock and key manner

Only the correct hormone (key) can bind to and activate the receptor site (lock)

Recognize components of a focused assessment that should be included when collecting data on adults who have an alteration in cardiac output and tissue perfusion: Diagnostic Assessment

PA and lateral CXR Angiography (arteriography) Cardiac catheterization ECG EPS Exercise echocardiography Echocardiography Transesophageal echocardiography (TEE) Myocardial nuclear perfusion imaging (MNPI) CT, MRI Stress test

the 3 p's

POLYURIA - frequent and excessive urination POLYDIPSIA - excessive thirst POLYPHAGIA - increased eating

Acute Coronary Syndrome

Pain Management Nitroglycerin Morphine sulfate Oxygen Position of comfort; semi-Fowler's position Quiet and calm environment Increase Tissue Perfusion Drug therapy Antiplatelet Beta blockers (BBs) Angiotensin converting enzyme inhibitors (ACEIs) Angiotensin receptor blockers (ARBs) Calcium Channel Blockers Statins Thrombolytic therapy Anticoagulants

Recognize components of a focused assessment that should be included when collecting data on adults who have an alteration in cardiac output and tissue perfusion: current health problems

Pain, discomfort Dyspnea, DOE, orthopnea, PND Fatigue Palpitations Wt-edema - sudden wt increases of 2.2 lbs over a few days is best indicator Syncope Extremity pain

A client with peripheral arterial disease (PAD) has a percutaneous vascular intervention. What is the priority nursing assessment?

Pedal pulses After a client with PAD has had a percutaneous vascular intervention, it is essential for the nurse to assess for pedal pulses. Priority nursing care focuses on assessment for bleeding at the arterial puncture site and monitoring distal pulses to ensure adequate perfusion. Pulse checks must be assessed postprocedure to detect improvement (stronger pulses) or complications (diminished or absent pulses).

A client recovering from cardiac angiography develops slurred speech. What will the nurse do first?

Perform a neurologic assessment and notify the primary care provider.

Peripheral Arterial Disease (PAD)

Peripheral vascular disease Alters natural flow of blood thru arteries and veins of peripheral circulation Results of systemic atherosclerosis Stage I: asymptomatic Stage II: claudication Stage III: rest pain Stage IV: necrosis/gangrene Hair loss and dry, scaly, pale, or mottled skin, thickened toenails Severe arterial disease Extremity is cold and gray-blue or darkened Pallor may occur w/ extremity elevation Dependent rubor Muscle atrophy

Infective Endocarditis Assessment

Physical Assessment/S/S Development of HF Evidence of systemic embolization Petechiae Splinter hemorrhages Osler nodes (on palms or hands and soles of feet) Janeway lesions (flat, reddened maculae on hands and feet) Roth spots (hemorrhagic lesions that appear as round or oval spots on the retina) Positive blood cultures

Which intervention best assists the client with acute pulmonary edema in reducing anxiety and dyspnea?

Place the client in high-Fowler position with the legs down. The best intervention to help the client with acute pulmonary edema to reduce anxiety and dyspnea is to place the client in high-Fowler position with the legs down. High-Fowler position and placing the legs in a dependent position will decrease venous return to the heart, thus decreasing pulmonary venous congestion.

The nurse is caring for a client in phase 1 cardiac rehabilitation. Which activity does the nurse suggest?

Placing a chair in the shower for independent hygiene Placing a chair in the shower is an activity performed in phase 1 cardiac rehabilitation. It begins with the acute illness and ends with discharge from the hospital. Phase 1 focuses on promoting rest and allowing clients to improve their activities of daily living based on their abilities.Phase 2 begins after discharge and continues through convalescence at home, including consultation with a social worker for long-term planning. It consists of achieving and maintaining a vital and productive life while remaining within the limits of the heart's ability to respond to increases in activity and stress. Phase 3 refers to long-term conditioning, such as a walking program.

A client is receiving unfractionated heparin (UFH) by infusion. What laboratory data will the nurse report to the primary health care provider (PCP)?

Platelets 32,000/mm3 (32 × 109/L) When caring for a client receiving UFH, the nurse notifies the PCP of a platelet level of 32,000/mm3 (32 × 109/L). UFH can decrease platelet counts. The PCP must be notified if the platelet count is below 100,000 to 120,000/mm3 (100 to 120 × 109/L).

Hyperglycemia disturbs fluid and electrolyte balance leading to the classic symptoms of diabetes:

Polyuria Polydipsia Polyphagia

The nurse is caring for a client with heart failure in the coronary care unit. The client is exhibiting signs of air hunger and anxiety. Which nursing intervention will the nurse perform first for this client?

Position the client to alleviate dyspnea. The nurse's first action is to position the client to alleviate dyspnea. This action will help ease air hunger and anxiety.

Coronary Artery Bypass Graft Surgery

Post Op care: Manage F&E balance Complications Hypotension Hypothermia Hypertension Bleeding Cardiac tamponade Change in LOC

Which problem places a client at highest risk for sepsis?

Post kidney transplant A client with post kidney transplant is the highest risk for sepsis. This client will need to take lifelong immune suppressant therapy and is at risk for infection from internal and external organisms.

The nurse is reviewing the medical record of a client admitted with heart failure. Which laboratory result warrants a call to the primary health care provider by the nurse for further instructions?

Potassium 3.0 mEq/L (3.0 mmol/L) The nurse needs to contact the primary health care provider when a potassium level of 3.0 mEq/L (3.0 mmol/L) is noticed on a client admitted with heart failure. Normal potassium is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Hypokalemia may predispose to the client to dysrhythmia, especially if the client is taking medications that deplete potassium (such as furosemide).

____ insulin (insulin secreted after a meal) secreted at HIGH levels after EATING

Prandial

The nurse is teaching a class about mechanical properties of the heart. What teaching will the nurse include?

Preload is the degree of stretch in the myocardial fibers

atrial Dysrhythmias

Premature atrial complexes Supraventricular tachycardia A-fib

Common Dysrhythmias

Premature complexes Bigeminy Trigeminy Quadrigeminy Bradydysrhythmias Tachydysrhythmias

Ventricular Dysrhythmias

Premature ventricular complexes (PCVs) Ventricular tachycardia (VT) Ventricular fibrillation (VF) Ventricular asystole (ventricular standstill) OR Left ventricle pumps oxygenated blood thru the body to perfuse vital organs and other tissues

Ketone bodies are by products of fat breakdown and they accumulate in the blood and urine

Produced by liver from fatty acids during periods of low food intake (fasting), carb restricted diets, starvations, prolonged intense exercise, or untreated (or inadequately treated) type 1 DM

Thyroid Hormone

Promote sufficient pituitary secretion of growth hormone and gonadotropins Regulate protein, carbs, and fat metabolism Exert effects on heart rate and contractility Increase red blood cell production Affect respiratory rate and drive Increase bone formation and decrease bone resorption of calcium Acts as insulin antagonists

Classification and Staging of Heart Failure

Pts at high risk for developing HF (Class I NYHA) Pts w/ cardiac structural abnormalities or remodeling who have not developed HF symptoms (Class I NYHA) Pts w/ current or prior symptoms of HF (Class II or III NYHA) Pts w/ refractory end-stage HF (Class IV NYHA)

Cardiac Valves: semilunar valves

Pulmonic valve Aortic valve

Arterial System

Purpose Delivers oxygen and nutrients to various body tissues

Vascular System

Purposes Provides a route for blood to travel from the heart to nourish the various tissues of the body Carries cellular wastes to the excretory organs Allows lymphatic flow to drain tissue fluid back into circulation Returns blood to heart for recirculation

Supraventricular tachycardia

Rapid stimulation of atrial tissue occurs at rate of 100-280 beat/min w/ mean of 170 beats/min PSVT (paroxysmal supraventricular tachycardia) rhythm is intermittent, terminated suddenly w/ or w/o intervention Often occurs in healthy young people, especially women

Normal Sinus Rhythm

Rate: 60-100 beats/min Rhythm: regular P waves: present, consistent, configuration, 1 P wave before each QRS complex PR interval: 0.12-0.20 sec and constant QRS duration: 0.04-0.10 sec and constant

Sinus Arrhythmia

Rate: atrial and ventricular rates between 60-100 beats/min Rhythm: atrial and ventricular rhythms irregular, w/ shortest PP or RR interval varying at least 0.12 sec from longest PP or RR interval P waves: 1 P wave before each QRS complex; consistent configuration PR interval: normal, constant QRS duration: normal, constant

Insulin Storage

Refrigeration Maintain potency Prevent exposure to sunlight Inhibit bacterial growth Keep a spare bottle Pre-filled syringes Stable for 3 wks Store in upright position (needle up)

Short-acting

Regular insulin (Humulin R) Onset 30 - 60 min The only insulin product that can be given by IV bolus, IV infusion, or even IM

Parathyroid Hormone

Regulates calcium and phosphorus metabolism by acting on bones, kidneys, and GI tract Bone is main storage site of calcium Increase bone resorption Works w/ calcitonin to maintain normal calcium levels in blood and ECF

QT interval

Represents the total time required for ventricular depolarization and repolarization and is measured from the beginning of the QRD complex to end of T wave

QRS complex

Represents ventricular depolarization and is measured from the beginning of the Q (or R) wave to the end of the S wave

T wave

Represents ventricular repolarization

Which client assessment data is most consistent with cardiac pain requiring the nurse to notify the primary health care provider?

Reports of pressure in the upper abdomen and sternum and diaphoresis

P wave

Represents atrial depolarization

ST segment

Represents early ventricular repolarization

U wave

Represents late ventricular repolarization

QRS duration

Represents the junction where the QRS complex ends and the ST segment begins

PR interval

Represents the time required for atrial depolarization as well as impulse travel thru the conduction system and Purkinje fiber network, inclusive of the P wave and PR segment Measure from beginning of P wave to end of PR segment

PR segment

Represents the time required for the impulse to travel thru the AV node, where it is delayed, and thru the bundle of His, bundle branches, and Purkinjean fiber network, just before ventricular depolarization

The nurse is caring for a client with peripheral arterial disease (PAD). Which symptom will the nurse anticipate?

Reproducible leg pain with exercise The symptom the nurse assesses the client with PAD is reproducible leg pain with exercise. Claudication (leg pain with ambulation due to ischemia) is reproducible in similar circumstances.

The nurse is caring for a client 36 hours after coronary artery bypass grafting. Which assessment causes the nurse to terminate an activity and return the client to bed?

Respiratory rate 28 breaths/min The activity should be terminated when the nurse assesses the client's respiration rate of 28 breaths/min. This indicates activity intolerance.

Valvular Heart Disease: Aortic regurgitation (Insufficiency)

Results from nonrheumatic conditions May be asymptomatic for years Symptoms include exertional dyspnea, palpitations (Severe disease)

polyuria

Results from osmotic diuretics caused by glucose in the urine

Premature ventricular complexes (PCVs)

Results of increased irritability of ventricular cells Seen as early ventricular complexes followed by a pause

Venous Insufficiency

Results of prolonged hypertension that stretches veins and damages valves Leg edema, stasis dermatitis, stasis ulcers Nonsurgical management unless complicated by stasis ulcer Surgical management

Valvular Heart Disease: Mitral stenosis

Rheumatic fever is most common cause Pulmonary congestion and right-sided HF occurs first Later, preload decreases and cardiac output falls People w/ mild mitral stenosis may be asymptomatic Symptoms may include dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, palpitations, dry cough

HOT & DRY =

SUGAR HIGH

Hormones

Secreted by endocrine glands and travel thru the body to reach their target tissues

Sinus Dysrhythmias

Sinus tachycardia Sinus bradycardia

Recognize components of a focused assessment that should be included when collecting data on adults who have an alteration in cardiac output and tissue perfusion: Laboratory assessment

Serum cardiac enzymes Troponin T and I - elevated = cardiac condition or acute MI Normal = less than 0.03 ng T - Detectable a few hours after chest pain begins up to 7 days Serum lipids Total cholesterol Normal = fasting less than 200 Triglycerides Normal = 40-160 men 35-145 women HDL Normal = greater than 55 for men Greater than 45 for women LDL Normal = less than 130 Others Homocysteine - elevated = risk High-sensitive C-reactive protein - help to determine treatment outcomes CAD Microalbuminuria - protein in urine Blood coagulation studies - ability of blood to clots PT/INR PTT ABG F&E (fluid & Electrolyte) Erythrocyte count H&H Leukocyte count

A client with heart failure is prescribed furosemide. Which assessment data concerns the nurse with this new prescription?

Serum potassium level of 2.8 mEq/L (2.8 mmol/L) The nurse is concerned with the serum potassium level of 2.8 mEq/L (2.8 mmol/L) in a heart failure client taking furosemide. Furosemide is a loop diuretic and clients taking this drug must be monitored for potassium deficiency from diuretic therapy.

Which laboratory finding in a client with a possible pituitary disorder will the nurse report to the health care provider immediately?

Serum sodium 110 mEq/L (110 mmol/L) The normal range for serum sodium is 135 to 145 mEq/L (135 to 145 mmol/L). A result of 110 mEq/L (110 mmol/L) represents severe hyponatremia, requiring immediate action to prevent increased intracranial pressure, seizures, and death as the intravascular fluid shifts into brain tissue. The most likely cause of the problem is an increased vasopressin level that is increasing water reabsorption and diluting the serum sodium level.

Which change in serum electrolyte values in the past 12 hours for a client with syndrome of inappropriate antidiuretic hormone (SIADH) being treated with tolvaptan will the nurse report immediately to the health care provider?

Serum sodium increases from 122 mEq/L to 140 mEq/L The purpose of tolvaptan is to restore a normal sodium concentration to the blood and other extracellular fluid. In the case of syndrome of inappropriate antidiuretic hormone, excessive amounts of antidiuretic hormone have caused more water to be absorbed, causing the serum sodium to be diluted. When tolvaptan therapy brings the serum sodium level to normal levels, it must be discontinued to prevent hypernatremia. A serum sodium of 140 mEq/L is within the normal range

Which assessment by a new nurse requires the charge nurse to intervene?

Simultaneously palpating bilateral carotids The vascular assessment by the new nurse that requires intervention by the charge nurse is simultaneously palpating bilateral carotids.Carotid arteries are palpated separately because of the risk for inadequate cerebral perfusion and the risk for causing the client to faint.

Cardiac Conduction System

Sinoatrial node Electrical impulses 60-100 beats/min P wave on ECG Atrioventricular junction PR segment on ECG Contraction known as "atrial kick" Bundle of His Right bundle branch system Left bundle branch system

Other Antidiabetic Drugs

Sitagliptin (Januvia) Canagliflozin (Invokana) Farxiga Ozempic Non-insulin injectable: Extentide (Byetta) Liraglutide (Victoza) Precose Metformin Discontinue if pt needs a contrast dye for a test Sulfonylurea Glipizide (Glucotrol) Glyburide (Micronase) Actos

Recognize components of a focused assessment that should be included when collecting data on adults who have an alteration in cardiac output and tissue perfusion: Physical assessment

Skin color and temp BP

Which client report of changes in appearance indicates to the nurse that a client's adrenal insufficiency is related to direct malfunction of the adrenal glands?

Skin darkening Clients whose adrenal insufficiency is caused by adrenal glands that cannot produce appropriate levels of adrenal hormones have overall skin darkening. When the problem is in the adrenal gland and not either the hypothalamus or pituitary, plasma ACTH and melanocyte-stimulating hormone (MSH) levels are elevated in response to the adrenal-hypothalamic-pituitary feedback system. (Both ACTH and MSH are made from the same prehormone molecule.) Anything that stimulates increased production of ACTH also leads to increased production of MSH. Elevated MSH levels result in areas of increased pigmentation. Skin darkening does not occur when adrenal insufficiency is caused by hypofunction of the hypothalamus or pituitary gland.

A1C test

Standardized test that measures how much glucose permanently attaches to the hemoglobin molecule

Antilipemic (lipid lowering)

Statins-atorvastatin (Lipitor), (simvastatin) Zocor Effect: used to lower cholesterol levels, digitalis toxicity, biliary obstruction pruritus and diarrhea, decrease risk of MT, stroke in pt w/ diabetes type 2

Things that can affect diabetics blood sugar

Stress Infection Illness Trauma Pregnant/lactating

Cardiomyopathy

Subacute or chronic diseases of cardiac muscle Types: Dilated cardiomyopathy (DCM) Hypertrophic cardiomyopathy (HCM) Restrictive cardiomyopathy Arrhythmogenic right ventricular cardiomyopathy (dysplasia)

The nurse is assessing a client with chest pain to evaluate whether the client is experiencing angina or myocardial infarction (MI). Which assessment is indicative of an MI?

Substernal chest pressure relieved only by opioids Substernal chest pressure relieved only by opioids is typically indicative of MI.

Aortic Regurgitation Assessment

Sudden illness or slowly developing symptoms over many yrs Ask about attacks of rheumatic fever, infective endocarditis, IV drug use Echo, CXR, ECG

Which assessment data will the nurse associate with suspected pericarditis?

Sudden-onset chest pain relieved by anti-inflammatory agents. Chest pain relieved by sitting upright. Pain in the chest described as sharp or stabbing.

Hypertensive Crisis (Malignant Hypertension)

Symptoms include morning Has, blurred vision, dyspnea, uremia Systolic may be > 200 mm Hg Diastolic may be > 150 mm Hg

Which assessment data is most important for the nurse to report to the primary care provider prior to a coronary arteriogram?

The client develops wheezes and dyspnea after eating crab or lobster. The client with a shellfish allergy is likely to have an allergic reaction to the contrast and must be medicated with an antihistamine or a steroid before the procedure.

DASH Diet: Dietary Approaches to Stop Hypertension

The DASH diet eating plan has been proven to lower BP Based on an eating plan rich in fruits and veggies, beans, nuts, and whole grain, and low-fat or non-fat dairy High fiber, low to mod fat diet, rich in potassium, calcium, and magnesium Fish Legumes Nontropical veggie oils Limit intake of sweets, sugar-sweetened beverages, and red meats Lower sodium intake to no more than 2400 mg per day; limit of 1500 mg of sodium per day is preferred Engage in aerobic physical activity 3 or 4 times a week Should last 40 min on avg and involve mod to vigorous physical activity

Which nurse would be assigned to care for a client who is intubated with septic shock due to a methicillin-resistant Staphylococcus aureus (MRSA) infection?

The RN with 2 years of experience in intensive care unit (ICU). The RN with 2 years ICU experience would be assigned to care for an intubated client with septic shock due to a MRSA infection.

The nurse is assigned to all of these clients. Which client would the nurse assess first?

The client who had percutaneous vascular intervention of the right femoral artery 30 minutes ago. The client who would be assessed first is the client who had a percutaneous vascular intervention of the right femoral artery 30 minutes ago. This client must have checks of vascular status and vital signs every 15 minutes in the first hour after the procedure.

After receiving change-of-shift report in the coronary care unit, which client will the nurse assess first?

The client with acute coronary syndrome who has a 3-lb (1.4-kg) weight gain and dyspnea. The nurse needs to first assess the client with acute coronary syndrome with dyspnea and weight gain. These are symptoms of left ventricular failure and pulmonary edema. This client needs prompt intervention.

A new nurse is caring for four clients. Which client is at risk for secondary hypertension?

The client with kidney disease. The client who is most at risk for secondary hypertension is the client with kidney disease. Kidney disease is one of the most common causes of secondary hypertension.

A client admitted for heart failure has a priority problem of hypervolemia related to compromised regulatory mechanisms. Which nursing assessment data, obtained the day after admission, is the best indicator that the treatment has been effective?

The client's weight decreases by 2.5 kg. The best indicator that treatment is effective on a client with heart failure and problems of hypervolemia is the client's weight decreased by 5.5 lb (2.5 kg) in 1 day. The best indicator of fluid volume gain or loss is daily weight. Because each kilogram represents approximately 1 L, this client has lost approximately 2500 mL of fluid.

Hematologic disorders/RBC and Platelets Polycythemia:

The number of RBCs in the blood is greater than normal The blood of a patient w/ polycythemia is hyperviscous (thicker than normal) Increased levels indicate possible chronic hypoxia or polycythemia vera (a cancer of the RBC) Can be temporary (because of other conditions) or chronic

Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy?

The nurse obtains a bedside commode before administering furosemide.

Illness, infections, stress, or when receiving certain meds increase the need for insulin!

The pt may require admin of EXTRA insulin per a correction dose scale Insulin doses should NOT be withheld during illness, infections, or stress!

A client begins therapy with lisinopril. What does the nurse consider at the start of therapy with this medication?

The risk for hypotension At the start of therapy with lisinopril, the nurse needs to consider the risk for hypotension. Angiotensin-converting enzyme (ACE) inhibitors like lisinopril are associated with first-dose hypotension and orthostatic hypotension, which are more likely in those older than 75 years.

Cardiac Valves: AV Valves

Tricuspid valve Mitral valve

Venous Thromboembolism

Thrombus Phlebothrombosis Thrombophlebitis DVT

Peripheral Venous Disease

Thrombus formation Defective valves Skeletal muscles that do not contact to help pump blood in veins Virchow's triad -Blood flow stasis -Endothelial injury -Hypercoagulability

Hypovolemic Shock: Etiology

Too little blood volume causes MAP decrease that prevents total body perfusion and gas exchange

Hypoglycemia (low blood glucose level)

Triggers a surge in activity of the autonomic nervous system Body's way of telling the liver to release glucose stores Neuroglycopenic Symptoms (Gradual) Weakness Fatigue Difficulty thinking Confusion Behavior changes Emotional instability Seizures LOC Brain damage Death Neurogenic Symptoms (Rapid) Adrenergic Shaky/tremulous Heart pounding Nervous/anxious Cholinergic Sweaty Hungry Tingling Management Caused by Too much insulin or too little glucose Too little food Excessive activity Mild hypoglycemia - BS less than 60 mg/dL Treat w/ 10 - 15 g of Carbs (one-half C of fruit juice) Moderate hypoglycemia - BS less than 40 mg/dL CNS function impairment Treat w/ 15 - 30 g of Carbs Severe hypoglycemia - BS less than 20 mg/dL Severely impaired CNS function Inability to swallow/unconscious (pt will need assistance w/ treatment) Treat w/ 1 mg of glucagon (converts liver glycogen to glucose) IM or SQ per order Repeat dose in 10 min if pt remains unconscious If still unconscious transport to ED

To assess if a client has had a myocardial infarction (MI), which lab value will the nurse assess?

Troponin Positive findings for troponin are the most specific cardiac marker used to determine whether an MI has occurred.

Which laboratory finding is consistent with acute coronary syndrome (ACS)?

Troponin 3.2 ng/mL (3.2 mcg/L)

A client has been admitted to the hospital with chest pain radiating down the left arm. Which test result best confirms that the client sustained a myocardial infarction (MI)?

Troponin of 5.2 ng/mL (5.2 mcg/L) The presence of elevated troponin indicates myocardial damage.

The nurse is preparing to teach a client that metabolic syndrome can increase the risk for myocardial infarction (MI). Which signs of metabolic syndrome will the nurse include?

Truncal obesity Client taking losartan Glucose intolerance Hypercholesterolemia Truncal obesity related to large waist size (excessive abdominal fat causing central obesity)—40 inches (102 cm) or greater for men, 35 inches (89 cm) or greater for women—is a sign of metabolic syndrome. Decreased high-density lipoprotein cholesterol (HDL-C) (usually with high low-density lipoprotein cholesterol)—HDL-C less than 45 mg/dL (1.17 mmol/L) for men or less than 55 mg/dL (1.42 mmol/L) for women—or taking an anticholesterol drug is a sign of metabolic syndrome. Increased fasting blood glucose (caused by diabetes, glucose intolerance, or insulin resistance) is included in the constellation of metabolic syndrome. Blood pressure greater than 130/85 mm Hg or taking antihypertensive medication indicates metabolic syndrome.

The nurse is caring for a client who had abdominal aortic aneurysm (AAA) repair. Which assessment data is most concerning to the nurse?

Urine output of 20 mL over 2 hours The nurse caring for a client who had an AAA repair would be most alarmed with the client's urine output of 20 mL over 2 hours. Complications post AAA stent repair include bleeding, which may manifest as signs of hypovolemia and oliguria.

Which assessment finding in a client with diagnosis of diabetes insipidus (DI) indicates to the nurse that desmopressin therapy is effective?

Urine output of 30 to 50 mL/hr With DI, insufficient amounts of vasopressin (antidiuretic hormone [ADH]) prevent reabsorption of water, leading to profound diuresis that can result in dehydration.

Thyroid Replacement - Levothyroxine

Used for replacement in hypothyroidism to restore normal hormonal balance, and for suppression of thyroid cancer Control metabolic rate of tissues Accelerate heat production Oxygen consumption Given PO, IM, IV - Labs: monitor thyroid function studies S/E - N/V, anorexia, diarrhea, cramps, tremors, irritability, insomnia, HA, wt loss Contra: MI, severe renal disease, adrenal insufficiency Pt ed: daily on empty stomach w/ full glass of water, 30-60 min before breakfast (to prevent insomnia), teach pt that taking thyroid med is lifelong replacement and thyroid function tests need to be completed yearly, teach all brands are not interchangeable dosages, teach to report symptoms of hyperthyroidism (tachy, chest pain, palpitations, diaphoresis)

Oral Antidiabetic Drugs

Used for type 2 DM Effective treatment involves several elements Careful monitoring of blood glucose levels Therapy w/ one or more drugs Treatment of associated comorbid conditions such as high cholesterol and high BP

Ventricular fibrillation (VF)

V fib Result of electrical chaos in ventricles LIFE THREATENING

Ventricular tachycardia (VT)

V tach Repetitive firing of irritable ventricular ectopic focus, usually at 140-180 beats/min or more

Calcium Channel Blockers

VND Very - verapamil Nice - nifedipine Drugs - diltiazem ACTION: Blocks calcium access to cells causing: Decreased contractility Decreased conductivity of heart Decreased demand for oxygen S/E: Low BP Bradycardia May precipitate AV block HA Abdominal discomfort (constipation, nausea) Peripheral edema Nifedipine (Procardia XL) Effects: used in treatment of hypertension and angina Nursing Imp: do not drink grapefruit juice Diltiazem HCL (Cardizem) Effect: management of angina, hypertension, vasospasm, AF, flutter Nursing Imp: do not crush, chew, or break S/E ALL: hypotension, fatigue, edema Nursing Imp: take on an empty stomach w/ full glass of water

The nurse is assessing a client with mitral stenosis who is to undergo a transesophageal echocardiogram (TEE) today. Which nursing action is essential?

Validate that the client has remained NPO.

Valvular Heart Disease: Mitral valve prolapse (MVP)

Valvular leaflets enlarge and prolapse into the left atrium during systole Etiology varies; has family tendency Most people are asymptomatic Some may report chest pain, palpitations, exercise intolerance May have mid systolic click and late systolic murmur at apex

Ventricular asystole

Ventricular standstill

Hematologic Disorders/WBC and Lymphatic: Multiple myeloma

WBC cancer that secretes antibodies Increase cancer cell growth and destroy bone w/o treatment, progressive bone destruction, bleeding problems, kidney failure, immunosuppression and death can occur

The nurse in the cardiology clinic is reviewing teaching provided at the client's last appointment regarding hypertension management. Which actions by the client indicate that teaching has been effective?

Weight loss of 3 lb (1.4 kg) since last seen in the clinic. Reports eating a low-sodium diet. Reports drinking one less cup of coffee daily.

Insulin lack initially causes potassium depletion

With increased fluid loss from hyperglycemia, excessive potassium is excreted in the urine, leading to low serum potassium levels High serum potassium levels may occur in acidosis because of the shift of potassium from inside the cells to the blood

The nurse is educating a group of women about the differences in symptoms of myocardial infarction (MI) in men versus women. Which teaching will the nurse include?

Women may experience extreme fatigue and dizziness as sole symptoms. The differences in symptoms of MI in men versus women are that women may experience extreme fatigue and dizziness as sole symptoms. Women may have atypical symptoms, including absence of chest pain. Women often present with a "triad" of symptoms. In addition to indigestion or a feeling of abdominal fullness, chronic fatigue despite adequate rest and feeling an inability to "catch the breath" (dyspnea) are also common in heart disease. The client may also describe the sensation as aching, choking, strangling, tingling, squeezing, constricting, or vise-like.Men do report chest pain. Women have higher mortality from MI than men. Because of differences in symptoms, denial may occur more often in women.

Hematologic Disorders/WBC and Lymphatic: lymphedema

an abnormal collection of tissue fluid in the interstitial spaces risk factors include injury or infection of an extremity, obesity, presence of extensive axillary disease, and radiation treatment lifelong measures must be taken to prevent it symptoms: sensation of heaviness or swelling Aching, numbness, tingling Fatigue

_____insulin (insulin that our body is continuously or presently producing) secreted at LOW levels during FASTING

basal

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

body makes too much antidiuretic hormone (ADH) Causes body to retain too much water A problem in which Vasopressin is secreted even when plasma osmolarity is low or normal leading to disturbances of fluid and electrolyte balance Results in water retention and fluid overload Lab results hyponatremia Findings Recent head trauma Cerebrovascular disease TB or other pulmonary disease Cancer All past and current drug use Decrease in serum sodium levels Interventions Fluid restriction Drug therapy (diuretics) Monitor for fluid overload Safe environment Neurologic assessment

Catabolism

breakdown of substance

Anabolism

build of substance

The ACTION of insulin (decreasing blood glucose levels) is the opposite of or

negative to the condition that stimulated insulin secretion (elevated blood glucose levels)

Insulin increases glucose uptake by the cells, causing a

decrease in blood glucose levels

American Indians/Alaskan Natives have the HIGHEST prevalence of

diabetes

Polyuria Polydipsia Polyphagia

frequent and excessive urination excessive thirst excessive eating

Hgb A1C is the derivative of the interaction of

glucose w/ hemoglobin in RBCs Level reflects avg glucose level for up to 3 months

Avoid applying pressure on or palpating the thyroid in a pt who has or is suspected to have____ because these actions cans stimulate a sudden release of thyroid hormones and cause a thyroid storm

hyperthyroidism

Metabolic acidosis

increased acidity of blood due to an accumulation of acids ABGs will show decreased pH of the body as a result of the retention of acids

Right-sided heart failure is associated with

increased systemic venous pressure and congestion; producing signs such as peripheral edema, ascites, liver enlargement, and neck vein distension

With ___ ___, fats break down, releasing fatty acids, converting fatty acids to ketone bodies, and causing metabolic acidosis

insulin deficiency

hormone control

is maintained via neg. feedback

Stroke volume

is the amount of blood ejected by the left ventricle during each contraction (not each minute).

Cardiac output

is the amount of blood pumped from the left ventricle each minute (not with each contraction)

Chronic___ disease and heart disease connect w/ diabetes

kidney

COLD & CLAMMY =

need some candy

Respiratory alkalosis

occurs when the levels of carbon dioxide and oxygen in the blood are not balanced

Major intracellular cation is ___, major extracellular cation is __

potassium sodium

left-sided heart failure is associated with

pulmonary congestion and can produce shortness of breath, weakness, fatigue, oliguria, and a third heart sound (S3 gallop).

Preload

refers to the degree of myocardia fiber stretch at the end of diastole and just before contraction.

Serum potassium levels in DM may be low (hypokalemia) or high (hyperkalemia) or normal depending on hydration, the ___of acidosis and the patient's response to treatment

severity

Microvascular

small blood vessels Nephropathy - kidney dysfunction Neuropathy - nerve dysfunction Retinopathy - vision problems Sexual dysfunction/male erectile dysfunction Cognitive dysfunction

Negative Feedback

when blood glucose levels start to rise above normal, the hormone insulin is secreted