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Med/Surg II Nursing
Exam 1 K.Parsons red flags
| Question | Answer |
|---|---|
| What is the Hallmark sign for respiratory failure? | Dyspnea (always subjective. Pt says, "I can't breath") |
| where should the nurse mark for ET tube placement? | Tape tube, makr level where it touches the incisor |
| FIO2 (fraction of inspired oxygen). What is the goal to get the FIO2 at to prevent O2 toxicity? | below 40% |
| Vent controls & settings: Modes-AC (assist control). What is the Pt always going to get with this setting? | Will always get a preset tidal volume and rate. |
| Vent controls and settins: SIMV synchronoized intermittent mandatory ventilation. What does this do for the Pt? | tidal volume(Vt)and rate preset allows spontaneous breathing w/Pts own rate and Vt between vent breaths |
| Vent controls & settings: Modes: Pressure Support Ventilation (PSV). What does this do for the Pt? | Assists SIMV by applying pressure to airway throughout pt triggered breath. Decreases resistance w/in trach tube and vent tubing. |
| Explain Positive End Expiratory Pressure (PEEP). | + pressure exerted during expiratory phase. Increases O2 & gas exchange - prevents atelectasis. |
| Largest problem with PEEP is? | pressure on venacave causes HYPOtension!!!! |
| Explain Coninuous Positive Airway Pressure (CPAP). | Continuous pressure throughout resp cycle. Increases O2 & gas exchange, requires spontaneously breathing. |
| Sedation with MV. Diprivan(Propofol) give Mechanism and SE and Nursing activities. | Mechanism: decrased anxiety - produc amnesia SE: cardiac depression Nursing activities: Monitor level of sedation (modified ramsey scale) |
| Neuromusclular block agents for MV. Pavulon (pancuronium) give Mechanism, SE, and Nursing activities. | Mechanism: produces prolonged paralysis to prevent "bucking" the vent. Pt Needs concomitant sedation and analgesia!! SE: Prolonged Skeletal muscle weakness. Nursing activities: Protect Pt from environ, evaluate level of paralysis q4h with "Train of Four |
| Inhaled corticosteroids for MV. Beclomethasone. Give mechanism, SE, and nursing activities | Mechanism: suppresses inflammatory response SE: increased risk for infection! NA: monitor SE, TE, and prevent complications |
| What is a nursing activity performed every day for a Pt with an ET? | reposition and re-tape ET daily |
| When a nurse is documenting for a Pt on a vent what is one thing thy document? | Perform & document ventilator checks. Write down settings! |
| What is a cardiac complication for a Pt on a MV? | Hypotension due to + pressure in thoracic cavity which inhibits blood return to the heart which decreases CO and creates fluid retention. |
| If a Pt is on plavix (antiplatlet)what should I give him/her instead of protonix due to a interaction? | zantac |
| #1 cause of infection in MV Pts is? | Increased permeability of gastric mucosea due to it stop working and permebility changes, E. coli from gut gives Pt sepsis. |
| How to prevent ventilator associated pneumonia? | oral care and pulm hygiene (brush teeth 2xd with chlorhexiden rinse), hand washing, antibiotic control, semi fowlers, glucose 80-110, enteral feeding, circuit changes 48=72 hrs. |
| Extubation of pt on MV | monitor VS and vent pattern q1h, monitor for signs of Resp distress, stridor, |
| Pt w/chest drainage system. when would you notify the physican about the drainage/ | if the amount of fluid is >100ml/hr after first 3 hrs, color change from serous to bright red. |
| When wall vacuum is turned off for drainage system what should the nurse do ? | the drainage system must be open to the atmosphere so that intrpleural air can escape from the system. detach tubing from suction port to provide a vent. |
| What are important things to remember about sedation agents such as Versed (Midazolam) and Diprivan (propofol)? | IV continous drip, decrease anxiety, produce amnesia but NO PAIN RELIEF, side effects are cardiac dpression. |
| Pavulon (Pancuronium is a neuromuscular blocking agent. What does it do? | It produces prolonged paralysis to prevent "bucking" the vent. Nedd to give sedation and analgesia. A side effect is prolonged skeletal muscle weakness. #1 nursing activity is protect Pt from enviroment. |
| Albuterol...what is the SE and Mechanism? | Relaxes smooth muscle and its side effects are tachycardia, and increased BP |
| Atrovent (lprtropium). Whats the mechanism and SE? | Blocks constriction of smooth muscle and it has few side effects |
| Mucomyst Mechanism and SE? | Liquifies secretion. SE : bronchospasm (usually given w/ bronchodilator. |
| Inhaled corticosteroids such as Beclomethason ...what is the mechanism and SE? | Suppresses inflammatory response and causes a increased risk for infection. |
| What would be the primary nursing diagnosis for an MV Pt? | Imapried gas exchange |
| clinical manifestations of a pneumothorax | respiratory distree, reduced breath sounds, pleuritic pain, tachypnea, subcutaneous emphysema |
| What are the three risks for Virchow's Triad? | Venous stasis Hypercoagulable states Vascular wall damage. If you have 1 your at risk for DVT, 2Increased Risk for DVT, all 3 you have a DVT! |
| Clincial presentation for a PE is? | Sudden severe chest pain (increased w/inspiration), Tachypnea, Dyspnea, Cough hemoptysis, Cardiac s/s tacycardia, arrhythmias |
| PE diagnostics are? | ABS, D-dimer, CXR, VQ mismatch, Pulmonary arteriogram (blocked arteries. |
| PE Medical Management would be? | Anticoagulant therapy, Thrombolytic therapy (TPA), O2, MV, Surgical management. |
| What are clincial s/s of pulmonary edema? | dyspnea at rest, crackles, diorientation and confusion, anxiety & panic, tachycardia, moist cough (blood tinged frothy sputum), cool, clammy, cyanotic skin |
| What are the diffences between cardiogenic and non-cardiogenic pulmonary edema? | Cardiogenic would include Failure of LV, increase in hydrostatic pressure in pulmonary capillary. Non-Cardiogenic Hypo-oncotic, Permeability |
| How to treat non cardiogenic pulmonary edema? | treat underlying cause - hypo=oncotic give transfusion PRC, plasma, albumin, parenteral nutrtion. Permeability - treat & manage spepsis, burn neurogenic problems |
| Pulmonary edema diagnostics would be? | CXR, CT, ABG, Hemodynamic monitoring w/pulmonary artery catheter, PCWP (pulmonary capillary wedge pressure >25mmHg. If over 25mmHg problem is cardiac |
| What position would you want to put a Pt in with cardiogenic Pulmonary edema? | High Fowlers with legs dngling |
| What is the goal of PCWP (pulmonary capillary wedge pressure? | 15-18 mmHg |
| What kind of medication would you want to give a Pt with Pulmonary Edema? | morphine 2-4mg IV q2h vasodilating (decreases afterload, decreases anxiety. Vasodilators decrease preload & afterload (Nitroglycerine (venous vasodilator, Nitroprusside (arterial & venous vasodilator). |
| ARDS s/s are? | Grunting, Nasal flaring, cyanosis, sternal retractions, tachypnea. |
| How do you diagnose ARDS? | PCWP <18mmHg, refractory hypoxemia most significant (<50-60mmHg w/ supp O2), ABS resp alk then resp acid, CXR diffuse bilateral pulmonary infiltrates, WHITE OUT! |
| Pulmonary Hypertension leads to Right ventricular failure and premature death. What are the risk factors? | Primary - idiopathic, Secondary - pulmonary diseases, congenital heart disease, HIV, collagen vascular disease (lupus) |
| Clinical presentation of ARDS looks like? | Dyspnea, weakness/fatigue, s/s of RVF (cor Pulmonale). Diagenositics would be right heart catherization. |
| Pharmacological Management of PAH is? | sildenafil (revatio aka viagra) Epoprostenol (flolan) Bosentan (tracleer) Nitric Oxide |
| What is the medical management for PAH? | treat underlying cause and lung transplantation |
| Explain PQRST | P-position, Provocation Q-Quality R-Radiation, Relief S-Severity, Symptoms T-Timing |
| Symptoms of MI are? | SOB, "indigestion" nausea, anxiety, elevated HR, RR, BP,signs of decreased CO: cool, clammy skin, decreased peripheral pulses decreased, urinary output, mental status changes |
| What enzymes are assesed for an MI? | Ck-MB (0-5 ng/ml) specific to cardiac muscle, elevates w/in 4hr; normal in 3days. Troponin (0-0.2 ng/ml)specific to cardiac muscle, elevates w/in 4hr; normal in 3 weeks. Myoglobin (30-90 ng/ml) not specific to cardiac muscle, good to rule out MI if - |
| name some interventions to increase myocardial O2 supply. | O2, ASA & antiplatelet and anticoagulants, NTG, thrombolytics, PCI, CABG(coronary artery bypass graft) |
| Name some interventions to decrease myocardial O2 demand. | Morphine, NTG, Beta blockers, Ace inhibitors, Ca channel blockers, balance rest/activity |
| Name contraindications for thrombolytics (alteplase, reteplase) | recent trauma, gi bleeding, surgery, hemorrhagic CVA, bleeding disorder, uncontrolled HTN |
| Percutaneous Coronary Intervention (PCI) | Superior to thrombolytics, not always available, PTCA percutaneous transluminal coronary angioplasty, stent, atherectomy, brachytherapy |
| What is pre-PCI care? | NPO, baseline pedal pulse assessment, labs, bun, cr, h&h, Plt, coag studies, electrolytes, allergies to IODINE, IV line and hydratio, mucomyst w/ renal insufficiency, informed consent, assess ability to lay flat for @ least 4hrs |
| Post PCI complications | abrupt closure, vascular complications groin or retroperitoneal bleed, PSAarterial throbus/distal embolization, acute renal failure |
| Post PCI care | bedrest w/ leg sraight, hob <30, bedrest w/leg straigh X hrs after sheath removal, during sheath removal hr/bp drop give saline bolus & atropine, manual pressure to groin X5min, assess 4-8hr for bleeding, hematoma bruit |
| Post PCI care continued VS/Extremity check | Q15min X 4, Q30min X2, Q1hr X2: check VS, groin and pedal pulses, color and temp, ECG & w/chest pain, Labs: H&H, creatinine sever hrs post procedure, I&O, supervise resumption of activity prior to d/c |
| Pre CABG care | baseline labs, EXR, ECG, TXM (type and cross match), allergies, IV line & hydration, informed consent, teaching |
| Post CABG care | Specialized ICU care, decreased CO, Impaired gas exchange, Pain, Infectio, Renal failure |
| Post CABG care discharge teaching | anxiety,infection (sternal and vein sites), activity, pulm care, medications, cognitive fx and sleep changes |
| MI cardiac rehabilitation Phase 1 -3 | Phase 1 - hospital (walking, diet, exercise) Phase 2- community (PT, BP, activity) Phase 3- 6-8 wks after follow up high risk behavior |
| M.Fey says All people w/MI have? | 1. dysrhythmias 2. L sided Heart Failure |
| Where does BNP live and what does it do? | It lives in the Left ventricle....as LV starts to stretch it is released ...kind of like a diurectic for the heart :) |
| Left sided heart failure looks like ... | pulmonary edema, dypnea, orthopnea (trouble breathing when laying flat), activity intolerance, decreased bowel sounds, urine output, eleveated creatinine, decreased perfusion to CNS: confusion. |
| What does Right sided Heart failure look like? | jugular venous distention, enlarged liver and spleen, engorged gut; anorexia, ascities, peripheral edema |
| 1 k of water weight is = to how much water gain? | 1 L |
| pharmacologic management of Heart faliure | ACe inhibitors = "prils" Beta Blcokers = "lols" Diuretics Vasodilators: hydralazine, Nitrates Digitalis: positive inotroup (contractibility) |
| If giving ACE inhibitors for the first time what does the nurse want to do? | Be back in the room in 20 mins due to "first dose effect" |
| A Pt is in Heart Failure...what does the nurse want to do to the heart to make it easier to pump? | Maximize pre load and after load |
| Milrinone, Dobutamine are ? | used for Pts with Heart failure...positive inotropic agents |
| Why would morphine be given to a pt with ehart failure? | to manage pulmonary edema (vasodiolator), decrease anxiety |
| A. Fib | no true p wave (loss of atrial kick) 2 problems: decreased CO and clotting |
| Nursing care: A.Fib | clotting: asses for evidence of embolization, admin anticoags. Decreased CO: manage symptoms Assist w/cardioversion: chemica, electrical, if duration unknow or >48hrs, TEE first (echo in esophagus for clots) |
| Cardioversion chemical: meds that are givien | Amiodarone: bolus and IV infusion Flecanide, Propafenone: oral Calicum Channel Blcokers: verapamil, diltiazem Precautionsall antiarrythmics (on monitor, VS q5-10 min, |
| Sinus Tachycardia is a prob or symp? | usually asymptom. Hr less than 150 probably from a node. pain, anxiety, dehydration, SV goes down. |
| Atrial Tachycardia (Hr>150)is usually a prob or symp? | usually a problem. Atrial tachy grater tahn 150 ..somethings wrong! |
| Nursing care of Tachys...If ST (<150, P-waves) | Assess for and treat causes: pain, anxiety, fever, dehydration, compensatory mechanism for decreased SV. some drugs. |
| Nursing care of Atrial tachy (HR 150-250) | Vagal maneuvers - carotid massage, valsalva Adenosine - given rapidly w/ rapid flus causes asystole Beta Blcokers Ca Channel blockers |
| Bradydysrhythmias... | sinus brady - not always a problem (athletic) Heart Balcok - always a problem (s/s hypotension, leight headed, got more p waves than QRST |
| Nursing care for Bradydysrhythmias.. | sinus brady: Asses for symptoms -ONLY treated if sysmptomatic. Heart Blcoks: treatment aimed at increasing HR to maintain CO, Atropine IV, Pacemaker exteral in emergency, permanent may be necessary |
| Nursing care for Pacemakers | assess for bleeding, infection at insertion site or site of generator, Hemo/pneumothorax psot procedure, ventricular dysrhytmias, phrenic nerve stimuation(hiccups), dislocation of lead(arm sling), monitor for proper Fx of pacemaker loss of capture sensin |
| What does loss of capture mean? | pacemaker fired but don't beat |
| What does loss of sensing mean? | Pacemaker won't stop firing even when Pt tries to have its own beat |
| On EKG failure to capture looks like? | pacemaker spike isn't followed by QRS complex |
| on EKG Failure to sense looks like? | pacemaker doesn't sence pts own beat and fires when it shouldn't |
| Pt teaching: pacemakers | s/s infection, carry ID/medic alert, electromagnetic interference, security procedures, move awary from electrical or magnetic device, talk pulse, battery lasts 10 yrs |
| What dysrhythmias are the "Killers"? | Ventriular: PVCs, Vent tachycardia |
| What is a PVC? | myocardial ischemia, MI, or decreased K, MG, O2 |
| V tach is what? | 3 or more PVCs |
| Nursing care of PVCs | may be normal, pathological causes: hypoxia, myocaridal ischemia,hypokalemia, hypomagnesemia, acidosis. Initally correct the cause; rarely need meds for PVCs |
| Nursing care for V tachy | Pt may bepulseless or stable, but it needs to be fixed Meds: Amiodarone, sotolol, lidocaine. May be cardioverted if stable, defibrillated if pulseless |
| ADPGE means? | All Dead People Get Epi |
| Lidocane make old people? | CRAZY!! if they get confused give them something else |
| If asystole the nurse does what? | CPR, ambu, defib |
| Nursing care: VF (disorganized electrial activity) | Always pulseless. Call code #1 priority is defib, cpr ACLS protocol meds. Epinephrine (ADPGE), vasopressin (vasoconstricotr) |
| Nursing care: asystole | No electrial activity call code, cpr,ACLS protocol meds (Epi, vasopressin, atropine) |
Created by:
ashleydc1987
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