NURS1220 Perfusion

Atrial Fibrillation

Multiple rapid impulses from many foci depolarize in the atria in a totally disorganized manner at a rate of 350-600x per minute. NO DEFINITE P-WAVE (usually) The atria quiver, which can lead to the formation of thrombi

Surgical Interventions for DVT

-thrombectomy -Inferior vena cava Interruption -Ligation (removal of veins ("stripping") -External Clips

COPD Manifestations

Chester hyperinflated - per X-RAY Decreased oxygen saturation with mild exercise

Blunt closed-chest injury

Diminished breath sounds

Diogxin toxicity

Measure serum magnesium level

backward failure

Blood backs up behind the affected ventricle, causing increased pressure in the atrium behind the affected ventricle

Complications of A. fib

Blood clots Heart failure Heart attack Stroke Sudden cardiac arrest Cognitive impairment/ Dementia

Low out-put failure

Not enough cardiac output is available to meet the demands of the body

Acute pulmonary edema

A medical emergency, results from left ventricular failure

Causes of Hypertension

Aging Family Hx African American Obesity Smoking Excessive alcohol Hyperlipidemia Excess salt or caffeine

s/s of pulmonary embolism

Apprenhension/ restlessness Blood-tinged sputum Chest pain & cough Crackles and wheezes on auscultation Cyanosis Distended neck veins Dyspnea: anginal/pleuritic pain Impending doom Shallow respirations Tachypnea/Tachycard Hypotension Petechiae: chest/axilla area

Side of effects of medications -lol

Bradypnea Palpitations Difficulty breathing Irregular heartbeat Signs of HF Cold hands/feet

Medications for hypertension

Diuretics - "Aldactone (spironolactone) Bumex (bumetanide) Demadex (torsemide) Esidrix (hydrochlorothiazide) Lasix (furosemide) Zaroxolyn (metolazone)" Central alpha antagonist Adrenergic beta blockers - "LOL" ACE inhibitors (stops RAA) - "Prils" Calcium Channel blockers - "Pines" Angiotensin II receptors antagonist - "Tans" Angiotensin-converting enzyme inhibitors

S/S Stable Angina

Dyspnea Pallor Sweating Palpitations and tachycardia Dizziness and syncope Hypertension Digestive disturbance

Stable angina

Extertional angina Occurs with activities that involve exertion or emotional stress, relieved with rest or nitroglycerin Usually has a stable pattern of onset, duration, severity, and relieving factors

Diastolic heart failure

Heart failure preserved EF, leads to problems with heart relaxing and filling with blood

systolic heart failure

Heart failure with reduced EF, leads to problems with contraction and ejection of blood

Right sided heart failure

Jungular Vein Distention Ascending Dependent Edema Weight Gain Hepatomegaly (Liver Enlargement) Splenomegaly Anorexia/ nausea Nocturnal diuresis Swelling *fingers and hands* Increased BP

Hypertension

May be asymptomatic Headache Visual disturbances Dizziness Chest pain Tinnitus Plushed face Epistaxis

Priority Nursing Action: P.E

Notify RRT and PHCP Reassure client and elevate the head of the bed Prepare to administer oxygen Obtain vital signs and check lung sounds Prepare to obtain ABG Prepare for administration of heparin therapy or other therapies Document the event, interventions taken, and the client's response to treatment

Atrial rate

Number of p.waves in 6 seconds x 10

High out-put failure

Occurs when a condition causes the heart to work harder to meet the demands of the body

Respiratory failure

PaO2 greater than 60mm/Hg

Pain with Stable Angina

Pain Pain can be described as mild or moderate Develops quickly or slowly Substernal, crushing, squeezing pain may occur Pain may radiate to the shoulders, arms, jaw, neck, or back Unaffected by inspiration/expiration Lasts less than 5 minutes however, can last up to 15-20 minutes Relieved by nitroglycerin or rest

Causes of P.E

Prolonged immobility Obesity Surgery Pregnancy Heart failure Advanced age History of thromboembolism

Risks factors for DVT

Prolonged immobility Surgery Active cancer Previous VTE Thrombophilic condition Recent trauma Older adult *+70* Cardiac respiratory failure Acute MI/ Ischemic stroke Acute infection Obesity Hormonal treatments

Types of heart failure

Right Ventricle/ Left Ventricle Forward failure/ Backward failure Low output, high output Systolic failure, Diastolic failure

Early signs of exacerbation

Shortness of breath

Left sided heart failure

Signs of pulmonary congestion Dyspnea Tachypnea Crackles in the lungs Dry, hacking cough Paroxysmal nocturnal dyspnea Increased BP (excess fluid) Decreased BP (pump failure)

Deep Vein Thrombosis

blood clot forms in a large vein, usually in a lower limb S/S calf-groin pain sudden unilateral swelling of leg edema redness pain with dorisflexion

Secondary hypertension

high blood pressure caused by the effects of another disease high blood pressure caused by kidney disease (presence of protein, RBC in urine) Increased BUN Increased creatinine

Forward failure

inadequate cardiac output - decreased perfusion to vital organs

A client with chronic kidney disease being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious, and the nurse suspects air embolism. What are the priority nursing actions?

A. Administer oxygen to the client B. Continue dialysis at a slower rate after checking the lines for air. C. Notify the PHCP and Rapid Response Team D. Stop dialysis and turn the client on the left side with head lower than feet. A., C., D.

A client receiving TPN experiences sudden development of chest pain, dyspnea, tachycardia, cyanosis, and a decreased level of consciousness. What should the nurse suspect as a complication of the TPN?

A. Air embolism B. Hyperglycemia C. Catheter-related sepsis D. Allergy reaction the catheter A.

A client is admitted to the hospital 24 hours following an aspirin (acetysalicyclic acid) overdose. The nurse assesses the client for which signs/symptoms indicating the acid-base disturbance that could occur in the client?

A. Bradypnea, dizziness, and parasethesias B. Headache, nausea, vomiting, and diarrhea C. Bradycardia, listlessness, and hyperactivity D. Restlessness, confusion, and a positive Trousseau's sign B.

A client is brought to the emergency department complaining of substernal chest pain. To distinguish between angina and myocardial infarction, the nurse assesses for which characteristics of angina?

A. Chest pain that resolves with rest B. Chest pain requiring an opioid for relief C. Chest pain that is relieved by nitroglycerin D. Chest pain that lasts longer than 30 minutes E. Chest pain that is usually precipitated by exertion A., C., E.

The nurse is monitoring chest tube drainage system in a client with a chest tube. The nurse notes constant bubbling in the water seal chamber. Which is the most appropriate initial nursing action?

A. Continue to monitor B. Document the findings C. Change the chest tube drainage system D. Perform a focused respiratory assessment.

The nurse is caring for a client with diabetes ketoacidosis whose respirations are abnormally deep, regular, and increased in rate. What is the purpose of this type of respiration?

A. Correct bradypnea B. Blow off carbon dioxide C. Correct metabolic acidosis D. Correct an acid-base imbalance E. Cause respiratory compensation F. Stimulate Cheyne-Stokes respirations B., C., D., E.

The nurse is assessing the functioning of a chest tube drainage system in a client with chest injury who has just returned from the recovery room following a thoracotomy with wedge resection. Which are the expected assessment findings?

A. Excessive bubbling in the water seal chamber B. Vigorous bubbling in the suction control chamber C. Drainage system maintained below the client's chest D. 50ml of drainage in the drainage collection chamber E. Occlusive dressing is placed over the chest tube insertion site F. Fluctuation of water in the tube in the water seal chamber during inhalation and exhalation C., D., E., F.

A child with B-thalassemia is receiving long-term blood transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusion. Which medication should the nurse anticipate to be prescribed?

A. Fragmin B. Metaprolol C. Meropenem D. Deferoxamine D.

A client is newly admitted to the hospital with a diagnosis of stroke (brain attack) manifested by complete hemiplegia. Which item in the medical history of the client should the nurse be most concerned about?

A. Glaucoma B. Emphysema C. Hypertension D. Diabetes mellitus B.

A client is determined by blood gas analysis to be in a respiratory alkalosis. Which electrolyte disorder should the nurse monitor for that could accompany the acid-base imbalance?

A. Hypokalemia B. Hypercalcemia C. Hypochloremia D. Hypernatremia A.

The nurse is caring for a client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate and notes that the client is receiving 2L/min. The client's spo2 level is 86%. Based on the assessment, which action is appropriate?

A. Increase to 3L/min and titrate until the spo2 is 95%. B. Increase to 3L/min and titrate until the spo2 is 88% C. Place the client on a non-rebreather mask on 100% fio2. D. Maintain a 2L/min and call respiratory therapy for a breathing treatment.

The ambulatory care nurse is reviewing an adult client's laboratory test results and notes that the hematocrit level is 60% The nurse recognizes that this level is most likely to be found in clients with which diagnosis?

A. Leukemia B. Hemolytic anemia C. Pernicious anemia D. Iron deficiency anemia C.

The nurse Is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe?

A. Respirations that are shallow B. Respirations that are increased in rate C. Respirations that are abnormally slow D. Respirations that are abnormally deep E. Respirations that cease for several seconds B., D.

A clinic nurse is reviewing the record of a client with suspected diagnosis of pernicious anemia. The nurse anticipates that which diagostic test will be prescribed by the client's primary health care provider?

A. Schilling test B. Clotting time C. Bone marrow biopsy D. White blood cell differential

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease with TB. The nurse should monitor for which side/adverse effects of the medication? (SATA)

A. Signs of hepatitis B. Flu-like syndrome C. Low neutrophil count D. Vitamin B6 deficiency E. Ocular pain or blurred vision F. Tinging and number of the fingers A., B., C., E.

A client receiving total parenteral nutrition (TPN) demonstrating signs and symptoms of an air embolism. What is the first action by the nurse?

A. Stop the TPN solution B. Place the client in the high-fowler's position C. Notify the PHCP D. Place the client on the life side in the Trendelenburg's position. D.

The nurse is caring for a client immediately after removal of the endotracheal tube. The nurse should report which sing immediately if experienced by the client?

A. Stridor B. Occasional pink-tinged sputum C. Respiratory rate of 24 breaths/min D. A few basilar lung crackles on the right A.

The nurse is caring for a client whose arterial blood gas results reveal alkalosis. What client reactions would the nurse expect to see?

A. Tetany B. Lethargy C. Confusion D. Tingling E. Numbness F. Restlessness A., C., E., F.

The nurse is monitoring a client with heart failure who is taking digoxin. Which findings are characteristic of digoxin toxicity?

A. Tremors B. Diarrhea C. Irritability D. Blurred vision E. Nausea and vomiting B., D., E

IV heparin therapy is prescribed for a client with a fib. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?

A. Vitamin K B. Protamine sulfate C. Potassium chloride D. Aminocaproic acid B.

medications ending in "pril"

ACE inhibitors - hypertension Side effect: nagging dry cough