Download NSG 430 Exam 2 Practice Test – Community Nursing Focus. and more Exams Nursing in PDF only on Docsity!
NSG 430 Exam 2 Practice Test –
Community Nursing Focus.
What it acute decompensated heart failure
Exacerbation of chronic heart failure
What are the clinical manifestations of acute decompensated heart failure
Fluid overload, SOB, fatigue
Symptoms of acute decompensated heart failure
Jugular Vein Distension (JVD)
edema
dyspnea
orthopnea
paroxysmal nocturnal dyspnea
N/V
weight gain or loss
hepamegaly
pulmonary rales
cardiac gallops S3 or S
pleural effusion
What can acute decompensated heart failure lead to
pulmonary edema
What is acute kidney injury (AKI)?
- Abrupt reduction in renal function with elevated BUN and creatinine and Cystatin C levels (biomarker of kidney function).
- Usually associated with oliguria (<30 mL/hr or <400 mL/day)
- GFR decreases
- Can be reversed if diagnosed and treated early
Types of AKI
Prerenal
Intrarenal
Postrenal
Labs to diagnose AKI
GFR
creatinine
electrolytes (particularly potassium)
Symptoms of AKI
Fatigue, dizziness, swelling, decreased urine output
oliguria (<500 ml urine), azotemia (increased urea in blood)
Interventions for AKI
treat underlying cause of AKI
fluid restrictions
nutrition
-enteral nutrition (low sodium, low potassium, high calcium)
-total parental nutrition (TPN)
medications
Other treatment of bradycardia
transcutaneous pacemaker if acute
Types of cardiomyopathy
dilated, hypertrophic, restrictive
dilated cardiomyopathy
disease of the heart muscle that causes the heart to become enlarged and to pump less strongly
mostly in elderly population
hypertrophic cardiomyopathy
heart muscle becomes enlarged and blocks blood flow
Affects young athletes
restrictive cardiomyopathy
heart muscle hardens, restricting the expansion of the heart, thus limiting the amount of blood it can pump to the rest of the body
most rare
Symptoms of cardiomyopathy
Breathlessness with exertion even at rest, swelling of the legs, ankles and feet, bloating of the abdomen due to fluid buildup, fatigue, irregular heartbeat, dizziness, lightheadedness and fainting.
cardiomyopathy medications
BP meds like beta blockers, ACE inhibitors and ARBS
Digoxin to improve heart contraction effectiveness
Diuretics -- to reduce BP
Blood thinners to prevent clots
acute coronary syndrome (angina)
-- stable resolves with rest
-- unstable does not resolve with rest
Treatment for acute coronary syndrome (angina)
nitroglycerine x 3 before 911
-- MONA
-- Morphine
-- Oxygen
-- Nitro
-- Aspirin 324 or 325 mg
Continuous Renal Replacement Therapy (CRRT)
method used to replace normal kidney function in patients who are hemodynamically unstable by circulating the patient's blood through a hemofilter and returning it to the patient
ICU 1:
endocarditis
inflammation of the inner lining of the heart
Kidney cancer surgery what to watch
-- no urine output -- strict I&O
-- infection -- temperature
kidney stones
renal calculi
Symptoms of kidney stones
colicky flank pain
hematuria
decreased urine output
nausea and vomiting
fever and chills
burning on urination
Priority intervention for kidney stones
pain management
Potassium lab values normal
3.5-5.0 mEq/L
BUN lab values normal
10-20 mg/dL
Creatinine lab values
0.6-1.2 mg/dL
ABG lab values
pH 7.35-7.
PaCO2 32-48mm Hg
HCO3- (bicarb) 22-26 mEq/L
PaOs 80-100 mm Hg
SaO2>95% (seen at 90%)
Base excess +2.0mEq/L
creatinine clearance lab values
Male: 97 to 137 mL/min (1.65 to 2.33 mL/s)
Female: 88 to 128 mL/min (14.96 to 2.18 mL/s).
GFR lab value
More than 90
mitral valve stenosis
narrowing of the mitral valve from scarring, usually caused by episodes of rheumatic fever
Symptoms of mitral stenosis
dyspnea, orthopnea, paroxysmal nocturnal dyspnea, dry cough, hemoptysis as pulmonary edema begins to occur, symptoms of RHF
treatment for mitral stenosis
patient education new pacemaker
--Keep their arm down for the first month
--follow up with cardiology closely,
--take your medications
--keep the site dry and clean
when to seek care if you have a pacemaker
· Dizzy or lightheaded
· Alarm or feel buzzing from pacemaker
· It heart rhythm is not at the paced level
pericarditis
-- bacterial
-- viral
-- fungal
Pericarditis S/S
chest pain worse when lying down, cough, fever, anxiety, FRICTION RUB
PVC (Premature Ventricular Contraction)
Big wide QRS
looks bizarre with what appears to be an extra QRS
Can lead to VTach can be dangerous
Causes of PVCs
--Digoxin toxicity, hypoxia, hypokalemia, fever, acidosis, exercise
--can be caused by caffeine, alcohol, hypertension and thyroid disease
-- check electrolytes especially potassium
PVC symptoms
palpitations or skipped heart beat
PVCs treatment
-None is asymptomatic
-If symptomatic: beta blockers or ablation
-- lifestyle changes
renal transplant
surgical implantation of a donor kidney into a patient with inadequate renal function
Signs of renal transplant rejection
Temperature higher than 100
Pain or tenderness over grafted kidney
2-3 lb wt gain in 24 hours
Edema
HTN
Malaise
Elevated BUN and creatinine
Deceased creatinine clearance
Elevated WBC
Rejection indicated by ultrasound or biopsy
R-region and radiation (where is it, where does it go?)
S-signs and symptoms (SOB, diaphoresis)
T-timing and responses to treatment (when start; better/worse)
Treatment for STEMI
--known as MONA (morphine, oxygen, nitroglycerin, and aspirin).
-- Remember in right ventricular infarctions do not use
nitroglycerin as it decreases preload.
-- anticoagulation such as heparin or enoxaparin.
-- antiplatelet therapy the standard of care is dual platelet therapy; such as, aspirin and clopidogrel.
-- reperfusion therapy
--The goal is door to balloon time within 90 minutes.
STEMI patient education
exercise, no alcohol, no tobacco, no stress
STEMI prescription
Niroglycerine
No ED drugs like Viagra or Cialis
Sinus Tachacardia
rate is above 100
SVT (supraventricular tachycardia)
Increased heart rhythm caused by impulses originating above the ventricles, as in the AV node
-- No discernible P wave
-- Rate 150 +
SVT treatment
-- vagal maneuver
-- Adenosine
SVT causes
-overexertion, emotional stress, deep inspiration, caffeine, tobacco, stimulants
-rheumatic heart disease, dig toxicity, CAD
tachycardia examples
o Patient in sinus tach HR of 120 came in because they are a visitor from out of town and it is June and they went hiking
-- DEHYDRATED
o Patient comes in with a heart rate of 140 who just did coke
-- Tachycardia is from the coke
Vascular access for renal replacement therapy
o AV fistula, temporary dialysis catheter, AV graft
AV fistula assessment
LISTEN to the bruit using a stethoscope to assess blood flow
-A continuous low-pitched bruit should be present.
-If it has disappeared or changed in tone, Notify physician.
unstable or pulseless
CPR
Amiodarone
Defib
Amiodarone (Cordarone)
--Antidysrhythmic agent.
--Prolongs repolarization
--relaxes smooth muscles
--decreases vascular resistance
--prevents conduction of unwanted electrical activity by
decreasing excitability of the heart tissue
IV / PO
For ventricular fibrillation and unstable ventricular tachycardia.
Amiodarone (Cordarone) nursing interventions
--Assess before admin pulmonary toxicity, hyper and
hypo thyroidism
--Monitor electrolytes: potassium, sodium, chloride
--Monitor chest x-ray, PFTs with diffusion capacity,
thyroid function tests
-- Monitor liver function studies: AST, ALT, bilirubin,
alkaline phosphatase
Amiodarone side effects
P eripheral neuropathy
P hotosensitivity
P ulmonary alveolitis
P igmentation of skin
P eripheral conversion of T4 to T3 inhibited (hypothyroid)
Atenolol (Tenormin)
o Beta blocker
o IV
o Evaluate blood pressure and heart rate before and after
o Side effects: hypotension, bradycardia
o Heart rate and blood pressure will decrease
Atropine
o Antidysrhythmic / anticholinergic
o Route IV / IM
o Assess before admin apical pulse, above 60
o Monitor for tachycardia and palpitations urinary retention
o Used to treat VFIB / SVT
o increased heart rate
Atropine side effects
Increased heart rate
hot as a hare
dry as a bone
--Drowsiness
Cardizem
o Calcium channel blocker
o Route PO IV
o Assess before admin
--blood pressure, heart rate, and cardiac monitor
--Assess BUN, Cr and AST, ALT
--Monitor for signs of heart failure, pulmonary
edema, weakness, dyspnea
o Side effects
--Dysrhythmia, edema, HF, bradycardia, hypotension,
palpitations, heart block
-- Decreased angina pectoris, dysrhythmias, B/P
Digoxin
o antidysrhythmic, cardiac glycoside
o Route PO IV
o Assess before admin monitor apical pulse 1 minute before admin > 60
o Side effects
--Dysrhythmias, hypotension, bradycardia, AV block,
Visual changes Headache, drowsiness, apathy,
confusion, disorientation, fatigue, depression,
hallucinations
o Decreased edema, pulse, respiration, crackles, improved contractility
Dobutamine
Beta 1 agonist
o Route IV
o Assess before admin BP and cardiac rhythm, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, CVP, and urinary output continuously during the administration
o Side effects
--Hypo and hyper tension
--Tachycardia
--Rash / Fever / Anaphylaxis
o Cardiac output increased contractility with decreased
fatigue and dyspnea
Epinephrine
o cardiac stimulant, vasopressor
o Route IV IM
o Assess before admin
--heart rate, cardiac rhythm, and blood pressure
o Side effects
--Palpitations
--Tachycardia & arrhythmias
--HTN
--Headache
--Tremor / weakness
--Pallor Sweating
--N/V
--Nervousness and Anxiety
--Tissue necrosis if it gets on skin
o Vasoconstrictor, cardiac stimulator, bronchodilator
Furosemide (Lasix)
o Loop diuretic
o Route PO, IM, IV
o Assess before admin BP and electrolytes, renal functions
