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NSG220 Final
| Question | Answer |
|---|---|
| Movement of air in and out of the lungs through the conducting passages | Ventilation |
| Furnishing O2 to the cells of the body and removal of Co2 | Respiration |
| Oxygen delivered to the tissues via the cardio system | Transport |
| After O2 is diffused into erythrocytes, it binds to ______. O2 is carried in the blood bound to ___ or dissolved in plasma. | Hgb, Hgb |
| Peripheral and central chemoreceptors in the brain can trigger ventilation, they are sensitive to high levels of ____ | C02 |
| Normal levels of CO2 is | 35-45 mm Hg |
| Tendency for lungs to relax after being stretched. | Recoil |
| Measure of elasticity of lungs/thorax; the ease of which lungs are inflated. | Compliance |
| person can breathe comfortably only when standing or sitting erect; associated with asthma and emphysema... | orthopnea |
| abnormal respiration in which periods of shallow and deep breathing alternate. | Cheyne-stokes |
| Rapid deep breathing pattern | Kussmauls |
| Measures partial pressure of CO2 in arterial blood. Normal range______ | PaCO2, 35-45 |
| PaO2 measures? Range? Geriatrics? | Measures partial pressure of oxygen in arterial blood. Norm 80-100, Geriatrics can be lower naturally. Due to decreased lung function second to aging. |
| Measures the amount of bicarb in the arterial blood. Normal range? | HCO3, 22-26 |
| Respiratory function indicator is, | PaCO2 |
| Metabolic function indicator is. | HC03 |
| Rome | Respiratory if opposite Metabolic if equal |
| ABG interpretation: PH 7.23, CO2 32, HCO3 14 | Met acid, partial comp |
| PH 7.51, PACo2 28, HCO3 25 | Resp acid, uncomp |
| What measurement indicates the percentage of O2 bound to Hgb? | Pulse ox Good indicator as long as sats are above 70. |
| When collecting a sputum sample, the patient cannot cough but can produce saliva. Will this be an adequate test? | No, sputum is needed. If they cannot expectorate by deep cough, suctioning may be necessary . |
| The best time for a sputum collection is? After meals? Before bed? Early in the am? Directly following exercise? | In the AM. |
| Patient is suspected to have TB, a sputum sample has been sent, what does the nurse need to do before the sample results are read? a.Wait, nothing can be done. b. Put them in a room alone. C. move them to ICU D. Encourage use of mask | B. They need to be in isolation until results arrive, 48-72 hours. |
| What information do Pulmonary function tests provide? | Provides info r/t lung volume, mechanics. Diffusion capability of lungs. The progression of disease. |
| What should the nurse teach the patient preparing for a pulmonary function test? | They may be SOA during procedure. No smoking or bronchodilator use It will be performed in a pulmonary function lab. |
| If a CT test is ordered, what labs or assessments need to be done prior to test? | BUN/Creatinine levels, contrast dye MAY be used. Allergies to Iodine/Shellfish |
| Teaching for person undergoing an MRI? A. Earrings can be left in place during test. B. Contrast medium will be used, assess allergies. C. Remove all body piercings or metal implements | C |
| T/F? Pet Scan First line test to distinguish between benign and malignant pulmonary nodules? | False, too expensive, other tests must be performed first. CXR, PFT, CT, MRI, then a PET scan if needed. |
| Angiography is used to | determine vascular defects in the pulmonary system. **Spiral CT's are mainly used now** |
| Most common type of Lung scan is.... | V/Q, ventilation perfusion |
| Ventilation/perfusion is. | A lung scan used to R/O pe's, uses radioactive isotopes |
| Visualized the lung structure by use of a bronchoscopy | Bronchoscopy |
| What other procedures can be done along with a bronchoscope? | Obtain lung tissue, wash out mucus plug from COPD client, bronchial wash/brushing. |
| Preop care for pt undergoing bronchoscopy? | Permit, NPO 6-8 hours, Inform them that they may have a sore throat afterward. |
| Postop for bronchoscopy? | VS/breath sounds/ assess gag reflex, NPO till returns/ monitor for respiratory depression, aspiration, frank bleed. |
| You are assigned a patient who had undergone a bronchoscopy this am. They are now expectorating blood streaked sputum. What should you do? | Nothing, this is normal |
| Lung biopsy/pleural biop assess patient for? | Pneumothorax, respiratory distress. Any procedure that uses puncture has the potential to cause the above. |
| What does this patient have? Decrease in elastic recoil Decrease in chest wall compliance A-P diameter increased Decrease in functioning alveoli Small airways in lung base may be closed Resp defense mech less effective | They are a geriatric patient. These are normal findings of the respiratory system with age. |
| The dividing sections between the nares isn't straight | Deviated septum |
| Tx of nosebleed? | Pinch nose 10-15 minutes. Ice compress, small gauze pad into nostril |
| Tx of continuous bleed? | Anterior packing by HCP After bleed stops, may cauterize or use silver nitrate. |
| Tx. of severe bleed? | Posterior nasal packing, will be inpatient Monitor respiratory status Monitor for s/s of aspiration |
| Sore throat | acute pharyngitis |
| develops from chronic exposure to enviro pollutants, or smoking | Chronic pharyngitis |
| most common complication of the flu? | pneumonia |
| laryngospasm may occur as a result of what>?? | Repeated attempt at intubation, gen anesthesia, hypocalcemia |
| Benadryl and drixoral. What classification and what do they do? SE? | Antitussive works on CNS, cough suppressant TX nonproductive cough SE: sedation, dry mouth, constipation |
| Neo-Synephrine and sudafed? Class? Action? SE? | Decongestant Stim alpha 1 receptors on sm. muscle= shrinkage of vessels/shrinkage of swollen membranes. rebound congestion if used often |
| Nasocort? Class? Action? SE? | Corticosteriod Inhibs inflammatory response. TX seasonal allergic rhinitis, relieves inflammation after nasal polyp removal Local burning/stinging |
| Claritin Benadryl Class? Generation? Action SE? | Antihistamine Claritin 2nd gen (no drowsy) Benadryl 1st Blocks histamine at H1 receptor sites. relief of sneezing, rhinorrhea, nasal itching. Drowsy, dried resp/gi membranes |
| Mucinex class? Action? SE? | Expectorant reduces adhesiveness/surface tension promotes removal of mucus. Reduces viscosity, assists with Headache/nausea/anorexia |
| Mucomyst Class? Action? SE? | Mucolytics, Decreases viscosity of mucus, secretions are less thick. **Water also good tx** Nausea, bronchospasm, rash |
| Most common type of head and neck cancer | Laryngeal cancer. Highest in men. |
| Etiology of laryngeal cancer | Tobacco smoke, alcohol, asbestos, wood dust, textile industry |
| Laryngeal cancer, pathophys | 95% are squamous cell carcinomas, grow slowly and remains superficial for a long time. |
| S/S of laryngeal cancer | hoarseness, pain in throat, feeling of foreign body in throat, neck mass, pain that radiates from ear to ear. |
| DX. of laryngeal cancer | laryngoscopy. Stage based on tumor size, number and location of lymph nodes, extent of mets. Classed stages I-IV. |
| Laryngeal cancer TX. | radiation for early vocal cord lesions. Chemo usually not effective in advanced laryngeal cancer. Surgical therapy |
| What surgery? One true vocal cord involved. Removal of 1/2 or more of the larynx. Temporary trach in place after. | Hemi or Partial laryngectomy |
| What surgery? Removal of structures above true cords; false cords and epiglottis. Temp trach | Supraglottic laryngectomy |
| What surgery? removal of large glottic tumors, metastasis w/fixation of vocal cords. Permanent trach. No sense of smell, cannot speak. | Total laryngectomy |
| The patient with a total laryngectomy are they at risk for aspiration? | No, unless a fistula develops |
| 3-4 days postop, device is held alongside neck, or tube in mouth. Voice pitch is low, robot like. | artificial larynx |
| Speaking with air held in esophagus. | Esophageal speech. Much like supraglottic swallow. |
| Surgical technique used to restore speech. Fistula created between esophagus and trachea. allows air from lungs to enter esophagus. Speech is due to air vibrating against esophagus. | Tracheoesophageal puncture (TEP) |
| Inflammation of mucous membranes of trachea and bronchial tree. | Acute bronchitis |
| Cause of acute bronchitis? | Associated with upper respiratory infection. Bacterial or viral. also caused by cigarette smoke, vigorus suctioning. |
| Persistent cough lasting 6-10 days after URI. Sternal soreness from cough. clear or purulent sputum. fever, headache, malaise, Soa on exertion | acute bronchitis |
| Inflammation of lower airways, cough that lasts several months, worsens at night. Low immunity is cause | Pertussis |
| patient has epistaxis, controlled by anterior nasal packing. What discharge teaching? A. use aspirin for pain B. remove packing later in day C. Skip antihypertensive med D. avoid vigorous nose blowing | D |
| What are the symptoms of a primary TB infection? | Usually asymptomatic, if present, fever, malaise, anorexia, wt. loss, low fever, night sweat. |
| How is TB diagnosed? | sputum cultures, smears |
| PPD significance of test ratings 1-4mm >5mm >10mm | 1-4 not significant >5 significant >10 definitely significant (if immigrant) >15 significant for all if no known risk factors |
| TX for TB, ____ first line drug for 9 months. | INH SE: hepatitis |
| Drug given for TB that Vitamin B6 would be given with during high dose therapy | INH also, monitor liver function tests SE: hepatitis |
| Suppresses effect of oral contraceptives and many other drugs, may see orange urine. Most commonly used with ___. | Rifampin used with INH hepatitis SE: |
| Hyperuricemia treated only if symptomatic, monitor LFT's. | Pyrazinamide SE: hepatis, arthralgias, hyperuricemia |
| Optic neuritis may be unilateral, baseline and monthly tests of visual acquity and color vision | Ethambutol SE: ocular toxicity |
| TB meds, INH, Rifampin, PZA and Ethambutol Which are given entire length of tx? | INH, Rifampin. |
| localized necrotic lesion of lung tissue | lung abscess |
| Sucking wound, atmospheric air has entry to lung interior | Open pneumothorax will may also see hemothorax with this |
| Air is entering pleura secondary to rib fracture | Closed pneumothorax |
| air is in pleural space but cannot be removed. Pt. C/O increased pressure, heart sounds are noted to the right of the sternum. | Tension pneumothorax. Most threatening |
| Tx for tension pneumothorax? | Large bore needle or chest tube hooked up to water seal drainage. |
| Chest drainage system Which chamber? A. Drains from chest B. filled to 2cm. prevents flow of material back into lung C. Controls speed of drainage evacuation | A. collection B. water-seal C. suction control |
| collection of fluid within the pleural space | Pleural effusion |
| Tx for pleural effusion | Lasiks, short term thoracentesis |
| Sharp stabbing pain on inspiration. May hear pleural friction rub Mgmt? | Pleurisy Manage with analgesics, splinting |
| Pt has atelectasis, presents with shallow breathing, decreased sounds in lower lobes. What types of nsg manaagement should you anticipate? | TCDB, Incentive spirometer, ambulation, supplemental O2 |
| enlargement of right ventricle secondary to disease of lung, thorax, pulm. NSG? | Cor pulmonale Long term, low flow O2, diruretics, R/F embolis. |
| Pt. presents with dyspnea, crackles present on auscultation +3 pitting edema in lower extemities, organomegaly, distended neck veins. | cor pulmonale |
| Acute respiratory failure | PaO2<60, PaCO2 >45 |
| <3 Widow maker | Left anterior descending artery |
| <3 Progressive disease, displays plaque formation, affects intimal and medial layers of the large/midsized arteries | Atherosclerosis |
| <3 Level should be below 200, high in cholesterol, used in cells for energy production | Lowdensity lipoproteins, LDL |
| <3 Large molecules made up of trigs and cholesterol. | VLDL |
| <3 Attracts cholesterol, returns from peripheral to liver. Levels should remain above 60 | HDL |
| <3 Manifestations of atherosclerosis don't appear until __% of the arterial lumen has been occluded | 75 |
| <3 A. Meds that restrict lipoprotein prod B. "" that increase lipoprotein removal C. Decreases cholesterol absorption D. Anti-Platelet therapy | A. statins, niacin, tricor, lopid B. Bile acid sequest; questran, welchol C. zetia D. low dose aspirin, plavix, heparin |
| <3 pain that only occurs while lying down, relieved when standing | decubitus angina |
| <3 Prinzmetals angina, occurs in response to? | occurs at rest, in re: spasm of a major coronary artery |
| <3 Drug therapy for angina Dilates periph blood vessels decreases preload, oxygen demand. Dilates coronary arteries/increases flow to ischemic areas of heart | FIRST LINE THERAPY for Angina Short acting nitrates |
| <3 Drugs for chronic stable angina Isordil, imdur topical nitro may cause headache r/f orthostatic hypotension. | Long acting nitrate |
| <3 Drugs for chronic angina Decreases myocardial contraction; HR, BP. Decreased morbidity/mortality with CAD pts Avoid in asthma Do not d/c abruptly | Beta blockers |
| <3 Used if beta blockers are contraindicated/ineffective. Used for Prinzmetals cause smooth muscle relaxation | Ca Channel blockers **potentiates the action of dig by increasing serum dig levels.** |
| <3 Drug class used for chronic stable angina considered high risk for a cardiac even such as ejection fraction less and 40% or diabetes. | ACE inhibitors. Pril |
| <3 D/O seen after rupture of a previously stable plaque. | ACS |
| <3 Acute MI process takes time, cardiac cells can withstand ischemic conditions for __ minutes before cellular death begins | 20 |
| <3 Earliest tissue to become ischemic during an MI is the ____________, after 4-6 hours the entire thickness of the heart muscle becomes necrotic | subendocardium *may take up to 12 hours if thrombus does not completely occlude the artery* |
| <3 Infarct causes _______ on EKG | Q waves |
| <3 Injury causes _________ on EKG | ST elevation |
| <3 Ischemia causes ___________ on EKG | T wave inversion |
| <3 If crackles are present in the lungs with an MI this is an indication of _____ ventricular dysfunction | Left |
| <3 With an MI jugular venous distention and peripheral edema is present in ___sided ventricular dysfunction | Right |
| <3 with an MI, fever may increase/decrease during the first ___ hours and may last up to a week | increase, 24 |
| <3 T/F After an infarction, catecholamine-mediated lipolysis and glycogenolysis occur, increasing serum glucose. | True, pt may appear to be diabetic. |
| <3 Within the first 24 hours of an MI, _________ infiltrate the dead cardiac tissue and the necrotic tissue release enzymes that are important dx indications of an MI | leukocytes |
| <3 T/F? Following an MI, the patient is free to resume intense physical exercise between 10-14 days, the scar tissue is strong and at this point myocardium is healthy. | False Scar tissue is new and weak, myocardium is vulnerable |
| <3 CK elevation is indicative of an infarction. | Nope, CK-MB elevation is indicative of <3, CK is muscle injury anywhere in the body |
| <3 First levels to rise following an MI? *CK *CK-MB *Troponin T *Troponin I | Troponins rise within 2-4 hours last (T) 10-14 days, (I) 7-10 days. followed by CK (3-6) lasts 24-48hrs and last CK-MB, 4-8 hours. (72 hours) |
| <3 Other dx for MI aside from serum cardiac markers? | EKG, Coronary angiography, Stress test |
| <3 Reduces anginal pain, improves coronary blood flow. Decreases preload/afterload while increasing myocardial oxygen supply | Nitro |
| <3 Drug of choice for chest pain unrelieved by nitro. Vasodilator that decreases cardiac workload by lowering myocard o2 consumption. reduces contractions, decreases bp/hr | Morphine |
| <3 Decreases myocardial oxygen demand by decreased HR, BP and contractions. Reduces risk of reinfarction, v-fib if not at r/f cardiogenic shock | Beta blockers |
| <3 Given if ejection fraction is less than 40% and not contraindicated. Prevents ventricular remodeling, prevents/slows progression of HF | Ace inhibitors |
| <3 Stool softeners would be given to an MI patient because??? | prevents vagal stimulation |
| <3 Interventions with an MI? | admin supplemental O2, position upright! Assess meds, nitrates, viagra? VS |
| <3 MOAN? | Morphine, oxygen, aspirin, nitroglycerin |
| <3 Sudden cardiac death, med to tx with???? | cordarone |
| <3 Progressive plaque formation that occurs in the arteries | atherosclerosis |
| <3 angina that occurs at night only | nocturnal |
| <3 serum cardiac marker that can have a duration of up to 14 days. | Troponin |
| <3 Group of irregular heart rhythyms (sinus, atrial, ventricular) | dysrrhytmias |
| <3 angina that is new in onset | unstable |
| <3 Inflammation commonly seen after an acute MI | pericarditis |
| <3 Natural pacemaker of the heart Initial impulses begin here. Rate is __ to __bpm | SA node 60-100 |
| <3 Rate is 40-60 bpm controls speed and number of impulses that reach the ventricles Impulses pause here __ to __ seconds which is the PR interval | AV junction 0.12-0.2 |
| <3 After leaving AV junction, impulses come here | Bundle Branches |
| <3 Causes almost instant depolarization of both ventricles Inherent rate is less than 40 bpm | Purkinje fibers |
| <3 Represents atrial depolarization Associated with impulse from SA node and passage through atria. | Pwave |
| <3 Represents time required to depolarize the atria, travels thru AV node and into the bundle of His Norm rate is 0.12-0.2 | PR interval |
| <3 Represents ventricular depolarization Normal measurement is less than 0.12 | QRS complex |
| <3 Synchronized cardioversion, used for? | For unstable vtach, svt, afib |
| <3 When performing synchronized cardioversion, what wave do you synchronize with before delivering shock? | R waves |
| <3 Synchronized Cardioversion Starting levels range from ___ to ___ joules | 50-100 NOT higher than 100 |
| <3 Impaired cardiac pumping or filling | Heart Failure |
| <3 Contributing factor to HF? | Hypertension major factor, CAD, diabetes, smoking, obesity, high serum cholesterol contribute. |
| <3 Inability of the heart to pump effectively | Systolic heart failure |
| <3 Systolic Heart failure, cause? | impaired contractile function (MI) increased afterload (HTN) cardiomyopathy and mechanical abnorms |
| <3 Inability of the ventricles to relax and fill during diastole | Diastolic HF Noncompliant ventricles = venous engorgement in pulm and vasc systems. |
| <3 Form of HF that prevents normal blood flow, causes blood to back up into the _____________, and into the pulmonary veins | L sided HF, Left atrium |
| <3 Backup of blood, causing jugular vein distention, vascular congestion, periph edema | Right sided HF |
| <3 Right sided HF is usually a result of?? | Left sided HF |
| <3 What is a result of right ventricular dilation and hypertrohphy? | cor pulmonale |
| <3 1st mechanism triggered by low cardiac output in which catecholamines are released that results in increased HR, increased myocard contractility and periph vasoconstriction | SNS activation |
| <3 Decreased cardiac output causes the kidneys to release renin which converts angiotens 1 to 2. What response? | Neurohormonal |
| <3 Enlargement of the chambers of the heart. Initial adaptive response to cope with increased blood volume. | Dilation |
| <3 ?? Degree of stretch related to the force of the contraction. | Frank-Starling law |
| <3 increase in muscle mass and cardiac wall thickness. | Hypertrophy occurs over time |
| <3 Hypertrophic heart muscle has less/more contractility, tissues become _______ easily and prone to ____________ | Less contractility easily ischemic prone to dysrhythmias |
| <3 FACES | Fatigue Activity limits congestion/cough edema shortness of breath |
| <3 increase in pulmonary venous pressure caused by decreased efficiency of the lung volume. | Pulmonary edema ABGs show lower pao2 and increased co2. |
| <3 What are the following S/S related to? Cold, clammy skin Severe dyspnea Accessory muscle use RR greater than 30 breaths pm Orthopnea Production of frothy blood tinged sputum | Pulmonary edema |
| <3 CHF earliest symptom? | Fatigue r/t decreased co and perfusion |
| <3 CHF Other manifestations? | anemia dyspnea orthopnea paroxysma nocturnal dyspnea tachycard edema nocturia skin changes (color) behavior changes chest pain wt gain or loss |
| <3 causes client to awaken during sleep due to reabsorption of fluid from dependent body areas when lying down. | Paroxysma nocturnal dyspnea **ask them how many pillows they use to sleep** |
| <3 Client is receiving Nitroprusside (Nipride) why and what procedures should you expect? | Reduces preload/aftterload, increases Co and reduces pulmonary congestion. Generally client requires ICU admit and arterial line to monitor bp q 5-10 minutes. |
| <3 Med causes arterial and venous dilation, increases Co without increasing myocardial oxygen consumption *Nsg intervention? | Nesiritide (Natrecor) Given as a bolus (depending on PT. wt.) and continuous infusion over 2 days. no titration required. **Monitor for Hypotension, if severe drip may be d/c'd. |
| <3 New admit with med dx of HF has been prescribed Nesiritide (Natrecor) 50 mg/10ML bolus. What do you do? | Don't admin the bolus all at once on a patient with heart failure. Give in small doses. |
| <3 Why would lanoxin (digoxin) be prescribed to a patient with HF? | It increases contractility but also increases myocardial oxygen consumption. **Loading dose required** |
| <3 Nsg implications for lanoxin/digoxin? | Monitor for decreased HR, N&V, vision changes, and seeing halo's. |
| <3 Normal digoxin level? | 0.5-2 |
| <3 Diuretics What drug causes excretion of sodium and fluid in the distal tubule? | Thiazide (hydrochlorthiazide) |
| <3 Loop Diuretics Works in the loop of Henle to promote ___,___, and ____ excretion. Also causes _____excretion. Examples? | Na, Chloride, water, potassium Lasix, Bumex |
| <3 DRUG alert Captopril (capoten) | Monitor for 1st dose hypotension (syncope) teach not to skip doses excess hypotension, hyperk can occur |
| <3 DRUG alert Spironolactone (aldactone) | Monitor K levels, use caution in clients taking digoxin, hyperK may reduce the effects of digoxin Teach foods to avoid |
| <3 Erectile agents are contraindicated in clients taking nitrates as together they can cause _____________ due to excess dilation. | Hypotension Nitrate: apresoline |
| <3 Drug alert Carvedilol (Coreg) | OD can cause profound bradycardia, hypotension, and cardiogenic shock. Obtain BP 1 hour after dose to assess medication tolerance. |
| <3 Antidote to digoxin?? | digoxin immune fab (digibind) given IV |
| <3 Meds used to decrease r/f rejection of transplant? | CellCept, Sandimmune |
| <3 Infection of the innermost lining of the heart | Infective endocarditis |
| <3 Acute or subacute? Infective endocarditis **affects those with pre-existing valve disease, course of infection spans over months. | Subacute |
| <3 Subacute/acute Infective endocarditis Affects those with healthy valves, manifests as rapid illness. Often seen with drug abuse | Acute |
| <3 Common cause of Infective endocarditis (organisms) | Staphylococcus aures, streptococcus viridans |
| <3 Primary lesions of infective endocarditis are called...... consist of fibrin, leukocytes, platelets, microbes of organism that has adhered to the valve surface or endocardium | Vegetations |
| <3 Vegetation lesions can mobilize from the _______-side of the heart causing systemic injury to organs, extremities causing limb infarct. _____-sided lesions can enter the lungs causing pulmonary emboli | Left Right |
| <3 Painful, tender, red or purple pea-sized lesions on fingertips or toes. | Osler's nodes assoc with infective endocarditis |
| <3 Flat, painless, red spots found on palms and soles | Janeways lesions assoc with infective endocarditis |
| <3 S/S of infective endocarditis? | Low grade fever, chills, weakness, mailaise, fatigue, anorexia New onset of murmurs, aortic and mitral valves most often Blockage to a body organ |
| <3 Subacute infective endocarditis S/S | If subacute, low back pain, abd discomf, wt loss, headache, clubbed fingers |
| <3 Infective endocarditis S/S of vascular form | Vascular- splinter hemorrhage,veg lesions on conjunctiva, lips, buccal mucosa, palate. Over ankles, feet, antecubital and popliteal areas |
| <3 teaching for client with infective endocarditis? | Avoid people with URI report cold, flu, cough symptoms Avoid excessive fatigue(hot showers) Good oral hygiene, inform HCP prior to invasive dental or surgical procedures of hx of infect endocarditis- **antibio before dental work** |
| <3 inflammation of the pericardial sac | Acute pericarditis |
| <3 Common cause of acute pericarditis? | Viral, bacterial, tb, histoplasmosis, Lyme disease, acute MI,trauma, Dressler syndrome, Rheumatic fever, drug reactions |
| <3 KEY POINT Acute pericarditis can occur within the initial __to__hrs post MI | 48-72 |
| <3 KEY POINT Acute pericarditis Dressler syndrome (late pericarditis) can appear _- to __ weeks post MI | 4-6 |
| <3 Pt c/o Frequent severe chest pain that is building in intensity. States it is worse when they take deep breaths or lying down. Sitting up and leaning forward makes the pain go away. What does the nurse anticipate the problem may be? | Acute pericarditis On auscultation a pericardial friction rub would be anticipated |
| <3 Develops as a pericardial effusion that increases in volume resulting in an increase of intrapericardial pressure which causes heart compression | Cardiac tamponade |
| <3 During assessment, the nurse notes the patient has distended jugular veins, has a HR124, RR 26. Heart sounds are muffled. What is it likely to be? | Cardiac tamponade |
| <3 D/O that is a result from scar tissue formation, caused by a loss of elasticity of the pericardial sace. Prevents the atria and ventricles to stretch adequately. | Chronic constrictive pericarditis |
| <3 S/S of chronic constrictive pericarditis | Dyspnea Periph edema ascites fatigue anorexia weight loss Pericardial knock may be heard |
| <3 Myocarditis is caused by | viruses bacteria, fungi radiation or pharmacological factors |
| <3 S/S of myocarditis | Fever fatigue malaise pharyngitis dyspnea lymphadenopathy N&V all the above are early symptoms (7-10days) cardiac signs: pleuritis chest pain, pericardial rub, Late- HF, crackles, periph edema, angina |
| <3 Nsg interventions for myocarditis | Digoxin ace inhibs, beta blockers diuretics steroids oxygen bed rest limited activity and rest periods semi fowlers position |
| <3 Why should digoxin be used with caution in client with myocarditis? | Predisposes client to drug related dysrhythmias and toxicity |
| <3 What is rheumatic fever caused by? | Group A streptococcol pharyngitis |
| <3 What is rheumatic fever? | acute inflammatory disease of the heart potentially involves all layers |
| <3 Rheumatic heart disease | Chronic condition resulting from Rheumatic fever that caused deformity of the heart valves |
| <3 Rheumatic fever affects ? | heart (results in valve stenosis) joints skin CNS |
| <3 Which valves are most affected by rheumatic heart disease? | Mitral and aortic |
| <3 Clinical manifestations of Rheumatic heart disease? | Carditis (heart murmur, enlargement and pericarditis) Pericarditis can cause cardiac tamponade can also have mono or polyarthritis (inflammation of synovial membranes of joints) |
| <3 A client discharged with rheumatic fever, what type of home care might they need? | Will need Monthly PNC injections. And if they have carditis or heart disease, antibiotics for 10 years |
| <3 What form of Mitral valve regurgitation causes a poorly tolerated new systolic murmur with pulmonary edema and cardiogenic shock | Acute |
| <3 What form of mitral valve regurgitation causes weakness, fatigue, exertional dyspnea, palpitation and S3 gallop? | Chronic |
| <3 Abnormality of mitral valve and papillary muscles that allows the valve to prolapse into left atrium during systole | Mitral valve prolapse |
| <3 S/S of mitral valve prolapse? | Asymptomatic (majority) could have palpitations, dyspnea, chest pain, activity intoler. syncope. |
| <3 Aortic valve stenosis is a result of? | Rheumatic fever |
| <3 DRUG alert for Nitroglycerin and aortic stenosis? | Use with caution in client with aortic stenosis, can cause significant reduction in BP Chest pain can worsen due to drop in BP |
| <3 What will a patient with a mechanical valve require? | anticoagulants throughout their lifetime? |
| <3 What are the 3 types of cardiomyopathy? | Dilated Hypertrophic and Restrictive |
| <3 Which type of cardiomyopathy is asymmetric left ventrical hypertrophy without dilation? | Hypertrophic |
| <3 Which type of cardiomyopathy is a disease of the myocardium that impairs diastolic filling and stretch? | Restrictive (least common form) |
| <3 Which type of cardiomyopathy is a high r/f clot formation due to stasis of blood? | Dilated |
| <3 What is dilated cardiomyopathy? | Inflammation and degeneration of myocardial fibers that creates ventricular dilation impairment of systolic function, atrial enlargement and stasis of blood in left ventricle. |
| <3 cardiomyopathy... Dilated affects the ______ function | systolic **may require heart transplant*** |
| <3 CARDIOMYOPATHY Restrictive affects the ______ function | diastolic |
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purpleapple87
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