Med-Surg Test #2

What is Cor Pulmonale and what should you assess for if it is suspected?

Hypertrophy of right side of heart due to vascular changes in the lungs w/ COPD (pulmonary hypertension) causing back-up of blood into the heart. (Eventually causing Rt sided HF); Should assess for JVD

How is Cellulitis treated?

IV antibiotics

How to Chemical sunscreens (light creams) work?

They absorb or filter UV light

What are the classifications of nasal fractures and what do each entail?

1) Unilateral--little or no displacement 2) Bilateral--most common "Flattened nose" 3) Complex--damage to adjacent facial structures

What is the normal ABI range?

1-1.1; anything below 1 is abnormal

1. What are examples of loop diuretics? 2. What would you teach a pt taking a loop diuretic?

1. Bumex, Lasix, Demadex 2. Dietary intake of K+

What blood pressure is ideal in the Diabetic pt?

130/80

What meal regimen should a COPD patient be on and why?

5 to 6 small meals/day; b/c pressure on the diaphragm from a full stomach causes dyspnea and difficulty breathing while eating leads to inadequate consumption (malnutrition)

What is considered a "good" peak flow range and what tx is required w/ a "good" peak flow in someone w/ asthma?

80-100% of personal best is good; continue taking long acting Beta 2 agonist Salmeterol (Servent) for prophylaxis

What indicates a positive reaction in a PPD test?

>15mm for low risk people >10mm for people w/ DM, renal disease, prolonged corticosteroid use, etc. >5mm for severely immunocompromised (HIV/AIDS, etc.)

What is Status Asthmaticus and how is it treated?

A severe, life-threatening attack unresponsive to usual tx; tx with IV Solumedrol (corticosteroid) and IV Mag. Sulfate (bronchodilator)

What is Basal cell carcinoma?

A slowly enlarging papule, "pearly", erosion, ulceration and depression of center. (Dx w/ tissue biopsy)

What is intermittent claudication? How is it treated?

A symptom of PAD. Ischemic muscle pain w/ exercises; resolves w/ rest; tx w/ Trental or Pletal

What should be observed when assessing for melanoma?

A-Asymmetry of shape B-Border irregularity C-Color variation within 1 lesion D-Diameter greater than 5mm E-Evolving or enlargement (2 out of the 5 usually indicates melanoma)

What are furuncles?

Boils; staph infection in the deeper portion of the follicle

What are signs of consolidation in a pneumonia patient?

Dullness to percussion Increased fremitus Bronchial breath sounds Crackles

What are risk factors for venous stasis?

Dysfunctional valves Obesity Pregnancy Smoking A-fib

What should be monitored post-op in an aortic aneurysm repair?

EVERY HOUR: Monitor BP! (Avoid severe fluctuation) Peripheral pulses Peripheral perfusion (color, temp, cap refill, sensation, and movement of extremities)

Which of the following drugs would you expect to administer to a hypertensive pt? a) Mexiletine (Mexitil) b) Hydrochlorothiazide (Diuril) c) Digoxin (Lanoxin) d) Warfarin (Coumadin)

b) Hydrochlorothiazide or HCTZ (Diuril)

What should you encourage in a patient with Herpes Zoster (shingles)?

To avoid secondary bacterial infections

What are nursing interventions for fungal infections?

Topical antifungal agents Systemic agents (Ketoconazole) for widespread/resistant

What does Digoxin do?

It is a positive inotropic drug; therefore it increases the contractility of the heart

How does Nitroglycerine work?

It is a vasodilator; therefore it decreases venous return and preload

What is the benefit of salt water gargles?

It pulls the water out and decreases swelling

What complications will be seen w/ right sided heart failure?

JVD, splenomegaly, hepatomegaly

What is Squamous cell carcinoma?

Keratinizing epidermal cells, thin scaly erythematosus plaque

What happens in a latent TB infection (LTBI)?

Pt will be asymptomatic The bacteria is dormant Will have a + PPD

Who should avoid taking Amphotericin B and why?

Pt's w/ liver problems; b/c it is very toxic to the liver

What complication occurs w/ left sided heart failure?

Pulmonary congestion

How is secondary hypertension differentiated from primary hypertension?

Secondary hypertension has a specific cause (Ex: renal disease)

What is Ejection Fraction? What is the normal?

The amount of blood pumped out of the ventricle w/ each heart beat (left and right); Normal = >55% of ventricular volume (Stroke volume/ end diastolic volume)

If the patient is on a bronchodilator (Albuterol) and also a glucocorticoid inhaler (beclomethasone), which should the patient take first in an asthma attack?

The bronchodilator (Albuterol)

Direct Arterial Vasodilators: 1) Give examples? 2) Is orthostatic hypotension a concern?

1) Apresoline, loniten, nitropress 2) No, b/c no significant dilation of veins

What are the three ways that blood pressure is regulated?

1) Baroreceptors in the vascular system 2) Renin-Angiotensin system 3) Renal Regulation (the kidneys)

What 3 chemical mediators are involved w/ Allergic Rhinitis and what do each cause?

1) Histamine 1--allergy symptoms 2) Leukotrienes--bronchoconstriction, mucus production, and airway edema 3) Prostaglandins--increased cap. permeability, vasodilation, fever and pain

Who should receive the pneumococcal vaccine?

All people 65 or older who have not received the vaccine within 5 years and the Immunosuppressed

What are clinical manifestations of pneumonia?

Fever/chills (temp. set point raises) Tachypnea/Dyspnea Tachycardia Productive cough (HUGE want them to cough it out!) Chest pain Hypoxemia Confusion (in elderly)

What foods should people on Warfarin (Coumadin) take caution w/ and why?

Foods high in Vitamin K: Green leafy vegetables B/c they alter the therapeutic action

What are carbuncles?

Multiple boils

What isolation is required for someone with a Pulmonary fungal infection?

No isolation required

What are the most common skin cancers?

Non-melanoma

What Calcium Channel Blockers must be used cautiously in heart patients?

Non-selective CCBs (Verapamil, Diltiazem)

What is the drug of choice in Fungal Pharyngitis?

Nystatin (Mycostatin)-- an antifungal agent

If a patient comes in with acute pharyngitis and is experiencing fever and severe sore throat and presents with a reddened throat w/ yellow exudate, what is the priority action by the health care provider?

Obtain a throat culture

What is cellulitis?

Staph or strep involving deeper connective tissue

What is a sign of pneumococcal pneumonia?

Increased fremitus

What is used to treat Psoriasis?

**Steroids**, emollient cream, and antihistamines (for urticaria, pruritus, and angioedema); **Cover w/ occlusive dressing after steroid administration.**

What is the DASH diet and what does it include?

"Dietary Approaches to Stop Hypertension" Several servings of fish/ week Plenty of fruits and **vegetables (3-4 servings/day)** Increasing Fiber Drink lots of water Decreasing red meat intake (This significantly lowers BP)

What is folliculitis?

A Staph infection of the upper portion of the hair follicle

In what patient may pulse oximetry not be a reliable indicator of oxygen sats?

A hypovolemic patient

What is the recommended initial treatment for Pneumonia?

A macrolide (or broad spectrum antibiotic)

What is Emphysema?

Abnormal permanent enlargement of the air space distal to the terminal bronchioles; destroying the bronchial walls; Air becomes trapped (hyperinflation) causing a barrel-chest look (Two types: Centrilobular and Panlobular)

What happens with an active TB infection and how is it **diagnosed**?

Active bacteria is spreading and multiplying Pt will have *night sweats*, low fever, fatigue, wt loss, cough Hemoptysis (coughing up blood) is a late sign **Dx w/ acid fast bacillus sputum culture**

What is the tx of choice for a pt w/ a serious, systemic fungal infection?

Amphotericin B

What is beclomethasone?

An Intranasal glucocorticoid (commonly used in Allergic Rhinitis)

How is heart failure classified?

As diastolic or systolic

What is an airway complication to worry about with Pneumonia?

Aspiration

What are nursing interventions for a viral infection?

Astringent compresses (Burow's solution) to relieve pain ***Acyclovir within 72 hours (at first sign of symptoms)***

Why is hypertension sometime's referred to as the "silent killer"?

B/c it is mostly asymptomatic until target organ disease occurs

Why does B-Type Natriuretic Peptide (BNP) increase in Heart Failure? Where is it produced?

B/c it promotes venous and arterial vasodilation; produced in the ventricles

Why would you not want to over oxygenate a pt w/ Emphysema?

B/c the air stays in the lungs and may cause hyperinflation and loss of elastic recoil

What is the difference between Bacterial and Viral Pharyngitis?

Bacterial typically appears more beefy red w/ exudate pockets and fever is usually higher in bacterial. May also have an odor to their breath with bacterial.

Why is malignant melanoma dangerous?

Because it can metastasize to any organ

What drug group is given to block the reflex tachycardia of some drugs?

Beta Blockers

If a COPD patient asks about sexual activity, what should the nurse advise him?

Breathe deeply into the nose, and slowly out of the mouth with pursed lips (do this before and after) it will decrease anxiety.

What is the treatment of choice for severe sleep apnea?

CPAP mask (continuous positive airway pressure mask)

What are secondary lesions?

Changes in appearance of primary lesions (scales, ulcers, crusts, scars, etc.)

What should you report to the doctor in someone with Influenza?

Crackles (b/c they are signs of pulmonary complications)

What are nursing interventions for a bacterial infection?

Daily bath w/ antibacterial soap Remove pustules or crusts gently Warm compresses to furuncles and cellulitis Incision and drainage (I&D) and packing Topical and systemic antibiotics

How do Ace-inhibitors work in Heart Failure?

Decrease BP by blocking influx of Ca+ and relaxing vascular smooth muscle

How is stroke volume determined?

End diastolic -- End systolic

How should melanoma be diagnosed?

Excisional biopsy. Never by a shave-biopsy!

What are risk factors for Malignant Skin Neoplasms?

Fair skin type Hx of chronic sun exposure Family hx Exposure to tar/systemic arsenals Living near equator Outdoor occupation Immunosuppression caused by smoking Indoor/Outdoor tanning

What food should be avoided when taking Calcium Channel Blockers and why?

Grapefruit; b/c it inhibits metabolism of the drug; therefore creating greater than expected effects

What position would you place a person w/ Heart Failure in and why?

High Fowler's to decrease preload

What is a manifestation heard in the throat of someone with a Thoracic aorta aneurysm?

Hoarseness

What may hypokalemia indicate?

Hyperaldosteronism (which may lead to hypertension)

What are side effects of Ace-inhibitors?

Hyperkalemia Angioedema Cough

What is the Tx for Latent TB and in whom is it contraindicated?

INH alone for prophylaxis (ppl in close contact w/ active TB or +TB test); Tx for 6 months to 1 year **Contraindicated in ppl w/ poor liver function (Need LFT to check liver enzymes); Substitute Rifampin for 4 months in liver failure patients

What is the nursing management of an Aortic Aneurysm?

If <4cm pt should decrease BP and monitor Q 6 months If >5.5cm it needs repaired

When is it safe for a person with Influenza to get back out and around other people?

If they have been self isolated for 24 hours w/o medication and no fever persists

What NANDA nursing diagnosis would be priority for a client with pneumonia?

Impaired Gas Exchange

What is Diastolic failure and what happens?

Impaired ability of the ventricles to relax and fill during diastole; blood "backs up" into organs, results in decreased stroke volume/CO; Normal Ejection Fraction **Diagnosis is based on: presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy and the normal ejection fraction**

When and how should Nitropress (Nitroprusside or Nipride) be administered and what are important things to consider about the solution?

In life-threatening hypertension Administered IV w/ D5W only. Wrapped in opaque substance d/t light sensitivity Reconstituted solution will be brown

When is blood pressure the highest?

In the morning

What should the nurse do if a patient comes into the hospital and pneumonia is suspected?

Initiate the "Door to Dose" protocol; Start an antibiotic within 4 hours of arrival to the hospital

What is the most effective drug in the treatment of Allergic Rhinitis?

Intranasal Glucocorticoids b/c of their anti-inflammatory actions

What is a Nevi characterized by?

Irregular borders, various shades of color, and >5mm

What precautions should be taken with a TB patient?

Isolated in their own room w/ negative airflow, wear HEPA mask; Airborne precautions

What is characteristic of Systolic Heart Failure?

Low Cardiac Output Poor renal perfusion Increased BNP Decrease in LV ejection fraction (<50)

What is Superficial spreading melanoma?

Melanoma that frequently arises from a preexisting mole; it is the most common and most curable

Who should avoid taking Nitrates?

Men who are currently taking erectile dysfunction medications

What precautions should a patient take when taking sympathomimetics such as Afrin?

Only use up to 5 days b/c of rebound congestion

What do the mucous membranes look like in someone with Allergic Rhinitis?

Pale and Boggy

What is the drug of choice for Bacterial Pharyngitis?

Penicillin (Erythromycin if allergic)

Who is at greater risk for developing a Pulmonary fungal infection?

People on immunosuppressive therapy

What would you want to monitor w/ the use of diuretics?

Potassium levels

In what are ARBS and Ace-inhibitors contraindicated?

Pregnancy

What is Actinic Keratosis?

Premalignant form of squamous cell carcinoma; hyperkeratotic papules and plaques

What is Chronic Bronchitis?

Presence of chronic productive cough for 3 or more months in each of 2 successive years

How does the Renin-Angiotensin system work?

Renin is released due to low BP and stimulates the production of Angiotensin I which is converted to Angiotensin II which then stimulates **aldosterone release which promotes sodium and water retention**

What is Directly observed therapy (DOT) and why is it used in people w/ TB?

Requires watching the pt swallow the drugs; Preferred to ensure adherence b/c non-compliance is a major factor in multi-drug resistance and tx failure

What acid base imbalance will COPD cause and what causes this imbalance?

Respiratory Acidosis; COPD pts build a tolerance to CO2 which usually stimulates a person to breathe.

What is Stage I hypertension? Stage II?

Stage I = BP of 140/90 Stage II = BP of 160/100

What Calcium Channel Blockers are okay to use in heart patients? Give examples.

Selective CCBs (for blood vessels) are okay. Procardia, Norvasc

What are signs of a ruptured aneurysm?

Severe pain in the back, flank, groin, abdomen or periumbilical region

In what position should a pt be in if they have a nose bleed (epistaxis)?

Sitting, leaning forward, and pinching the soft part of the nose

What is the biggest risk factor for developing COPD?

Smoking (80-90% of COPD deaths)

What is an endarterectomy?

Surgical removal of plaque from an artery

For people over age 50, which BP (diastolic or systolic) is a greater CVD risk factor?

Systolic BP

How is the mean arterial pressure determined?

Systolic BP + 2(Diastolic BP) / 3

How is pulse pressure or cardiac output determined?

Systolic BP -- Diastolic BP (S-D)

What is the primary nursing responsibility after obtaining a blood specimen for ABGs?

Take the specimen to the lab in an iced container

What should the nurse do if clear drainage is noted with a nasal fracture?

Test the drainage to indicate if the fluid is CSF (check for the presence of glucose)

When nasal packing, what should the nurse observe?

The patient's Oxygen sats

What is most important to note in a hypertensive crisis?

The rate of increase in BP rather than the absolute value

What is End-Systolic Volume?

The volume of blood within a ventricle at the end of a contraction

What is End-Diastolic Volume?

The volume of blood within a ventricle immediately before a contraction

In a heart failure patient, what would you want to assess aside from their heart?

Their lungs! Assess for cough, dyspnea, and tachypnea

What is the concern when oxygenating a COPD patient?

There is a concern of over oxygenating the patient because it can wipe out their drive to breath. (Want O2 sats at 90-92% not 98-100%)

How do ARBS work?

They block Angiotensin II receptors, preventing the release of Aldosterone

How do Ace-inhibitors work?

They block the release of Aldosterone by preventing the Angiotensin-converting enzymes from forming

How do Physical sunscreens (thick, opaque creams) work?

They reflect UV radiation

If a person is on anti-hypertensive meds, when should they take them and how should they stop taking them?

They should take them everyday; When stopping the medication they should taper off d/t rebound HTN

What is the benefit of fluids when caring for someone with Acute Viral Rhinitis?

They will loosen and moisten secretions making it easier to cough them up. (water is the best expectorant)

What is the first line agent used to tx hypertension?

Thiazide Diuretics (K+ wasting) (Diuril, HCTZ, Hygroton)

What is often prescribed w/ INH to prevent neuropathy?

Vitamin B6 (especially in malnourished pt)

What is the antidote for Warfarin (Coumadin)?

Vitamin K+

What is Paroxysmal Nocturnal Dyspnea?

Waking up at night feeling suffocated. Occurs w/ CHF.

What are ways to tx the underlying cause of pruritis?

Warm or cool therapeutic baths Cool cloth Monitor antihistamine effect

What should a heart failure pt do regarding weight?

Weigh themselves everyday, same time, same clothes. Report weight gain of 3 Ibs in 2 days or 3-5Ibs in one week to the doctor!

What should the nurse encourage for an obese patient experiencing sleep apnea?

Weight loss!

When are antihistamines most effective when treating Allergic Rhinitis?

When taken prophylactically

When does asthma become an emergency situation? Is asthma reversible?

When you don't hear any wheezing; means there is a lack of air movement in the lungs. Yes, Asthma can be reversible depending on Pulmonary function tests (PFT)

What should you worry about w/ impetigo?

it is highly contagious!

What does a white hair shaft indicate?

lice (pediculosis)

In what patients are non-selective Beta Blockers (Propranolol) contraindicated in and why?

pts w/ asthma and heart failure; because of it's bronchoconstriction and cardiac effects

What would you find upon assessing a patient if they are experiencing hypoxemia?

tachycardia and tachypnea