Exam 1 Flashcards
1
Q
Ischemic chest pain becomes unpredictable, more intense, and more difficult to review; can awaken patient from sleep
A
Acute Coronary Syndrome: Unstable Angina
2
Q
EKG & Lab results: Unstable Angina
A
All negative/no notable findings
3
Q
Ischemic chest pain that
EKG: ST depression or T wave changes
Labs: positive cardiac biomarkers
A
Acute Coronary Syndrome: Non-stemi
4
Q
Associated with complete occlusion of a coronary artery by a thrombus superimposed on ruptured plaque
A
Acute Coronary Syndrome: Stemi
5
Q
EKG & Lab results: Stemi
A
EKG: 1mm or more ST elevation two or more contiguous leads
Labs: positive cardiac biomarkers
6
Q
2 important Cardiac Biomarkers with MI
A
Troponin
CKMB
7
Q
RV Triad
A
Systemic hypotension
Absence of pulmonary congestion
Increased CVP and jugular venous distention
8
Q
S/S Acute Coronary Syndrome (4)
A
Chest pain/discomfort unrelieved by rest
Sense of impending doom
-Bradycardia: inferior MI
-Tachycardia: sympathetic stimulation
9
Q
Tx: acute coronary syndrome (6)
A
-oxygen
-325 aspirin (have them chew; so no enteric coating)
-nitroglycerin (every 5min up to 3x)
-Morphine
-Beta Blocker
-ACE inhibitor
10
Q
treatment of stemi
A
heart cath within 90-120 minutes
11
Q
Parameters for administering nitroglycerin
A
SBP > 90 mmHg
Pulse > 50
12
Q
_________ decrease myocardial oxygen demand by decreasing heart rate, contractibility, and BP
A
Beta-blockers
13
Q
___________ are generally given after repercussion therapy because they reduce infarct size and improve ventricular remodeling
A
ACE inhibitors
14
Q
A
Normal Sinus
15
Q
A
Sinus Brady
16
Q
A
Sinus Tachycardia
17
Q
A
Sinus Dysrhythmia (arrhythmia)
18
Q
A
Premature Atrial Contraction (PAC)
19
Q
A
Premature ventricular contraction (PVC)
20
Q
A
Atrial Fibrillation
21
Q
A
Atrial Flutter
22
Q
A
Ventricular Fibrilation
23
Q
A
Ventricular Tachycardia
24
Q
A
Supraventricular Tachycardia (SVT)
25
1st degree heart block
26
3rd degree heart block
27
therapeutic interventions for SVT (4)
-vagal maneuver
-adenosine (drug of choice)
-diltiazem or beta blocker
-cardioversion
28
what should be ready when administering adenosine and why?
crash cart, asystole occurs after administration
29
collection of air in the pleural space
pneumothorax
30
occurs when air accumulates in the pleural space to the point of causing a mediastinal shift pushing the heart, great vessels, trachea, and lungs toward the unaffected side of the thoracic cavity
tention pneumothorax
31
collection of blood in the pleural cavity
hemothorax
32
excessive fluid in the pleura cavity
pleural effusion
33
collection of purulent material from an infection like pneumonia
empyema
34
4 common causes of air/fluid in the pleural space (need for a chest tube)
trauma
medical/surgical complications
infectious disease
cardiovascular problems
35
risk associated w/ chest tubes (5)
risk for infection
subcutaneous emphysema
lung trauma/perforation of diaphragm
bronchopleural fistula
malposition
36
what do you do when the chest tube becomes disconnected from the patient
Cover the whole with jellied gauze, taping 3 sides
If in the field, cover with cleanest thing nearby
37
what do you do when the chest tube becomes disconnected from the drainage system?
place tube end in sterile water until new system can be obtained
38
Which information would the nurse educator include in a presentation on how to care for clients with a chest tube drainage system? Select all that apply. One, some, or all responses may be correct.
* Ensure that chest tube dressing is tight and intact.
* Palpate the skin to detect subcutaneous emphysema.
* Place the chest tube drainage system below the chest.
* Quickly attempt to reinsert the chest tube if it falls out.
* stripped the chest tube with long strokes to promote drainage
Ensure that chest tube dressing is tight and intact.
Palpate the skin to detect subcutaneous emphysema.
Place the chest tube drainage system below the chest
39
Which actions will the nurse take when caring for a client with a chest tube in place after thoracotomy, select all that apply. One, some, or all responses may be correct.
* Administer prescribed analgesic medications.
* Check around chest tube insertion site for crepitus.
* Clamp the chest tube before the client ambulates.
* Add fluid to the suction control chamber as needed.
* Milk the tubing toward the collection chamber.
* Check for air bubbling in the water seal chamber.
Administer prescribed analgesic medications.
Check around chest tube insertion site for crepitus.
Add fluid to the suction control chamber as needed.
Check for air bubbling in the water seal chamber
40
Which finding in a client who has had a chest tube removed would be of most concern to the nurse ?
* poor cough effort.
* Pain at the chest tube site.
* Crepitus at the chest tube site.
* 2 centimeters of pink drainage on dressing
Crepitus at the chest tube site
41
A client with a chest tube is to be transported via a stretcher.When transporting the client, what would the nurse do?
* Keep collection device attached to mechanical suction.
* Keep chest tube clamped distal to the water seal chamber.
* Keep collection device below the level of the client's chest.
* Keep the chest tube and covered with sterile gauze pads taped to theclient
Keep collection device below the level of the client's chest
42
When a client has a chest tube placed in the second intercostal space, how will the nurse evaluate for the effectiveness of the chest tube?
* Check for bubbling in the suction control chamber.
* Measure the amount of drainage in the collection chamber.
* Inspect the amount of bubbling in the water seal chamber.
* Observe for the presence of clots in the tubing
Inspect the amount of bubbling in the water seal chamber
43
When caring for a client after a thoracotomy, which action would the nurse take to keep the chest tube and closed chest drainage system patent?
* Position the drainage system below the level of the client's heart.
* Empty the collection chamber and measure contents every 12 hours.
* Assure that a daily chest X-ray is done to check chest tube position.
* Keep the client on bed rest until the chest tube is disconnected.
Position the drainage system below the level of the client'sheart.
44
A client anticipates removal of his or her chest tube with angst. Which diagnostic procedure does the nurse discuss when determining when to remove a client's chest tube?
* The client tolerates disconnection from the chest tubes drainage system for 24 hours.
* A chest X-ray examination occurs before removal to determine lung re-expansion.
* A required arterial blood gas occurs to determine sustained oxygen status.
* The nurse will sedate the client 30 minutes before the scheduled procedure.
A chest X-ray examination occurs before removal to determine lung re-expansion
45
The client has a closed chest tube drainage systemconnected to section. Which assessment findingrequires additional evaluation by the nurse?
* A column of water 20cm high in the suction control chamber.
* 75 mL a bright red blood in the drainage collection chamber.
* An intact occlusive dressing at the insertion site.
* Constant bubbling in the water-seal chamber
Constant bubbling in the water-seal chamber
46
Which action would the nurse take to determine patency of the chest tube and closed chest drainage system in a client after left lower lobectomy?
* milk the chest tube toward the drainage unit.
* Check the amount of bubbling in the section control chamber.
* Observe for fluctuations of the fluid in the water seal chamber.
* Assess for extent of chest expansion in relation to breast sounds.
Observe for fluctuation of the fluid in the water seal chamber
47
After being notified that a client with a sucking chest wound Is being transported to the emergency department, the nurse will anticipate which initial collaborative intervention?
* Obtaining a chest X-ray.
* Notifying the on call surgeon.
* Preparing for chest tube insertion.
* Drawing blood for laboratory studies
Prepare for chest tube inertion
48
Which nursing action is of the highest priority when aclient's chest tube has accidentally dislodged?
* place the client in a left side lying position.
* Apply oxygen via non rebreather mask.
* Apply a petroleum gauze dressing over the site.
* Prepare to insert a new chest tube.
Apply a petroleum gauze dressing over the site
49
When caring for a client who has a hemopneumothorax and a chest tube, which prescribed action by the health care provider would the nurse question?
* Auto transfuse the blood in the collection chamber after six hours
* Disconnect the drainage system from the suction to ambulate the client.
* Add sterile water to the suction control chamber to maintain the 20cm Of suction.
* Use a dressing impregnated with a petroleum Jelly around the chest tube insertion site.
Auto transfuse the blood in the collection chamber after six hours
50
A nurse is caring for a client with a pneumothorax who has a chest tube attached to a closed chest drainage system. If the chest tube and the closed chest drainage system are affective, which type of pressure will be reestablished?
* Neutral pressure in the pleural space.
* Negative pressure in the pleural space.
* Atmospheric pressure in the thoracic cavity.
* Intrapulmonary pressure in the thoracic cavity.
Negative pressure in the pleural space
51
While walking in a hallway, a client with a chest tube becomes confused and pulls the chest tube out. Which action would the nurse take?
* Place the client in the supine position.
* Spread a clamp in the insertion site to hold the site open.
* Obtain a sterile Vaseline gauze to cover the opening.
* Cover the opening with the cleanest material available.
Cover the opening with the cleanest material available.
52
After a change of shift report, which client would the nurse assess first?
* Client with possible lung cancer who has just returned from the nursing unit after mediastinoscopy
* Client with cough whose chest X-ray shows possible active tuberculosis and needs sputum testing.
* Client who has pneumococcal pneumonia and very decreased breath sounds in the right lung base.
* Client who has a chest tube with rapid bubbling in the suction controlChamber of the drainage system.
Client with possible lung cancer who has just returnedfrom the nursing unit after mediastinoscopy
53
Ventilator mode that allows for a minimum # of preset mandatory breaths delivered by the vent but does NOT allow for spontaneous breaths
Assist/Control mode
54
Complication from A/C mode
hyperventilation -> respiratory alkalosis
55
Ventilator mode that allows for preset minimum # of breaths and ALLOWS patient to initiate spontaneous breaths in-between mandatory ones
Synchronous Intermittent Mandatory Ventilation (SIMV) mode
56
When should A/C vs SIMV mode be used
-A/C should be used for pts who need full ventilatory support
-SIMV should be used for pts who need partial ventilatory support or are weaning off vent
57
advantages of SIMV mode (3)
-helps maintain respiratory muscle strength avoiding atrophy of respiratory muscles
-distributes tidal volume throughout the lung fields evenly
-helps to decrease mean airway pressure
58
vent mode that allows pressure above atmospheric pressure to be maintained throughout the breath cycle
CPAP
59
vent mode that allows spontaneous breaths supported by the vent during inspiratory breathing phase
Pressure Support Ventilation (PSV)
60
vent mode that delivers a supported breath to reach a set tidal volume
volume support
61
FiO2 > __________ for a prolonged time increase risk of oxygen toxicity
60%
62
Flow rate too low can cause: (2)
-patient-ventilator dyssnchrony
-increase work of breathing
63
Side effects of PEEP (5)
decreased systolic blood pressure
decreased cardiac output
decreased venous return to heart
barotrauma
increased ICP
64
Nursing care during intubation (5)
-assist with set-up
-administer medications
-monitor vs
-documentation
-family/patient education
65
what is needed in intubation set-up (3)
intubation box/cart
suction
Ambu-bag
66
intervention measures to clear airway (4)
suctioning
CPT
position changes
promote mobility
67
how to prevent ventilation association pneumonia (VAP) (5)
-HOB up 30-45 degrees
-oral care every 2 hours
-Closed suction device
-humidified oxygen
-in-line metered dose inhaler administration
68
Ventilator bundle (6)
-oral care every 2 hours
-HOB elevated at least 30 degrees
-daily sedation holiday/interruption
-daily assessment for extubation/weaning
-GI prophylaxis
-DVT prophylaxis
69
Vent bundle GI prophylaxis includes (2)
H2 blocker (Pepcid)
PPI (Protonix, Prilosec, or Nexium)
70
Vent bundle DVT prophylaxis inlcludes (2)
-anticoagulation (heparin, lovenox)
-SCDs
71
Complications of mechanical ventilation (6)
-barotrauma/volutrauma
-hemodynamic instability
-Ventilator associated pneumonia (VAP)
-aspiration
-immobilization
-anxiety/pain/delirium
72
Post extubation nursing bedside swallow screening procedures (4)
-patient must be alert and able to sit upright
-position patient at 90 deg with head in neutral position
-instruct patient to drink 3ox water w/o interruption
-watch for s/s of aspiration up to 1 min after water drank
73
if patient fails swallow screen: (2)
NPO
Speech consult
74
consequences of pain (8)
-inadequate sleep
-anxiety
-increases stress response
-prevents and slows rest/healing
-tachycardia
-hypertension
-hypoxia
-linked to patient death
75
Scales to assess pain (3)
-self report
-behavioral pain scale (BPS)
-Critical Care Pain Observation Tool (CPOT)
76
non-pharmacological interventions for pain (7)
-ET section/repositioning
-Reposition patient in bed
-Oral care
-Reassurance/family presence
-heat/cold therapy
-massage, acupuncture, relaxation
-muscle, low lights, room temp
77
Pharmacological pain management (2)
-continuous pain management
-breakthrough pain management
78
Most common medications for pain management (6)
-hydromorphone
-morphine
-fentanyl
-methadone
-oxycodone
-hydrocodone
79
scales to assess agitation
RASS
Ramsay SAS
Riker SAS
80
goal is to reach a quality of sedation where patients are:
cooperative
comfortable
accepting of care
81
Sedative medications (5)
Dexmedetomidine (presidex)
Lorazepam
Propofol
Midazolam
Barbituates
82
Role of RN with sedation management (6)
Daily sedation holiday
educate family
skin management
DVT prophylaxis
pain control
assessment
83
Equipment needed for conscious sedation (7)
intravenous access
monitoring equipment (pulse, BP, rhythm)
Emergency cart w/ defibrillator & medications
Suction equipment
Ambu bag
Supplemental oxygen
appropriate artificial airways
84
monitor that measures and displays end tidal carbon dioxide
capnograph monitor
85
daily planned discontinuation of paralytics and/or sedation in order to do neurological assessment of paient
Sedation holiday
86
syndrome characterized by the acute onset of cerebral dysfunction with a change or fluctuation in baseline mental status, inattention, and either disorganized thinking or an altered level of consciousness
delirium
87
impact of delirium (4)
-increased mortality
-increased length of stay
-increased cost of care
-long-term cognition impairment
88
assessment tools for delirium (2)
Confusion assessment method of the ICU (CAM-ICU)
Intensive Care Delirium Screening Checklist (ICDSC)
89
3 subtypes of delirium
-Hyperactive
-Hypoactive
-Mixed
90
characteristics of hyperactive delirium (3)
Combative
Agitated
Restless
91
characteristics of hypoactive delirium (3)
-lethargic
-Sedated
-Stupor
92
Management of delirium (6)
-treat the cause of the delirium
-mobilize the patient if possible
-provide sleep enhancement
-antipsychotic such as haloperidol
-manage withdrawal symptoms
-family involvement
93
Goal of neuromuscular blockage (4)
decrease:
-oxygen consumption
-total body work
-pain and anxiety
-temeprature
94
golden rule of sedation/paralytic
never start a neuromuscular blockade without sedation
95
Common paralytics (3)
Norcuron (vecuronium)
Pavulon (pancuronium)
Rocuronium
96
classification of post complications (3)
immediate: within 24 hrs of procedure
early: occurs as inpatient or within 30 days of procedure
late: occurs following discharge of >30 days of procedure
97
amount of blood pumped by ventricle in liters per minute
cardiac output
98
percent of end diastolic volume ejected with each heart beat (left ventricle)
ejection fraction
99
amount of blood ejected with each heartbeat
stroke volume
100
3 components of stroke volume
preload
afterload
contractility
101
degree of stretch of cardiac muscle fibers at end of diastole
preload
102
resistance to ejection of blood from ventricles
afterload
103
ability of cardiac muscle to shorten in response to electrical impulse
contractility
104
cardiac output formula
heart rate x stroke volume = cardiac output
105
normal cardiac output:
4-8 L/min
106
cardiac output correction method accounting for body surface area (CO/BSA)
cardiac index
107
normal cardiac index
2.5-4 L/min/m2
108
direct measurement of blood pressure in the right atrium and vena cava
central venous pressure
109
normal central venous pressure
2-6 mmHg
110
indications for central venous access (7)
-need to rapid fluid infusion
-IV fluid requiring CVC
-Frequent blood draws
-Chronically ill/unable to obtain peripheral access
-CVP monitoring
-SvO2 monitoring
-Administration of several IV medications/vasoactive/incompatible meds
111
contraindications for central line (2)
recurrent sepsis
hypercoagulable state
112
normal MAP ranges from
70-90 mm
113
MAP formula
(Systolic + (2x diastolic)) / 3
114
isotonic fluids given to
increase intravascular volume
115
isotonic fluids (3)
0.9% sodium chloride (normal saline)
Lactated ringers (LR)
Dextrose 5% in water (DSW)
116
Hypotonic Fluids (3)
Quarter (0.225%) normal saline
Half (0.45%) normal saline
Dextrose 5% in water (D5W)
117
hypotonic fluid indications
hyper- states (hypernatremia, DKA)
118
hypertonic fluid indications
Hypo-states (hypovolemia, hyponatremia)
119
Dexmedetomidine (presidex) side effects (4)
hypotension
bradycardia
sinus arest
AFib
120
Dexmedetomidine (presidex) nursing implications (2)
continuous vital sign, telemetry, & fluid balance monitoring
assess sedation w/ sedation scale
121
Dexmedetomidine (presidex) expected outcomes
sedation & decreased need for additional analgesia medication
122
Dexmedetomidine (presidex) teaching (5)
report agitation, confusion, weakness, abdominal pain, & changes in bowel movements
123
Digoxin expected outcomes (2)
slow heart rate
increase cardiac output
124
Digoxin side effects (5)
dizziness
fatigue
headache
weakness
blurred vision
125
Digoxin nursing implications (4)
monitor apical pulse and hold if <60 bpm
Monitor BP and heart rhythm
Monitor I&O, edema, lung sounds for fluid overload
Monitor potassium, calcium, and magnesium
126
Digoxin teaching (3)
How to take pulse and hold if <60bpm
Don't double dose
Report s/s of toxicity
127
Digoxin toxicity s/s (3)
-GI distress
-visual disturbances
-arrhythmais
128
Fentynal expected outcome
decrease moderate-severe pain
129
Fentynal s/s (5)
confusion/sedation
weakness
constipation
apnea
respiratory depression
130
Fentanyl nursing implications (3)
-baseline assessment of vitals, pain, and respiratory status before and after giving
-remove old patches before placing new ones
-if overdose occurs, removing patch will not immediately reverse effects
131
Fentanyl education (3)
-avoid alcohol consumption
-constipation, over sedation, and dependency risks
-change positions carefully & avoid driving
132
Heparin action/expected outcome
prevention/treatment of thrombi emboli and DIC
133
Heparin side effects (4)
hematuria
hemorrhage
prolonged coagulation time
tarry stools
134
heparin nursing indications (3)
-obtain PTT and anti-Xa labs prior to & designated interbals
-assess for s/s of bleeding
-rotate subq sites
135
heparin antidote
protamine sulfate
136
heparin teaching (4)
-report s/s of bleeding
-n/v of blood
-dark tary stools
-report bruising or bleeding from gums
137
Ipratropium action
maintenance therapy of reversible airway obstruction through bronchodilator or reduction in rhinorrhea
138
ipratropium side effects (6)
dizziness
nervousness
blurred vision
bronchospasm
cough
hypotension
139
Ipratropium nursing indications (4)
assess respiratory status before & at peak
have patient rinse mouth after use
assess oral cavity for stomatitis
intranasal: avoid inhalation during administration
140
Ipratropium education (2)
rinse mouth after use (inhalation)
don't inhale medication (intranasal)
141
Lorazepam action (3)
CNS depressant decreases anxiety, improves sleep, and decreases seizure activity
142
Lorazepam side effects (5)
dizziness
drowsiness/lethargy
confusion
hepatic dysfunction
respiratory depression
143
Lorazepam nursing interventions (5)
-Assess geriatric patients carefully for CNS reaction
-Assess fall risk
-Monitor renal, hepatic, and hematologic function
-Monitor VS for hypotension
-Verify patient is not pregnant
144
Lorazepam education (3)
-Used for short-term therapy
-Avoid driving until response to medication is known
-Taper off when stopping
145
Morphine/Dilaudid action
relief of moderate to sever pain
146
Morphine is the analgesic of choice for (2)
MI pain
Acute pulmonary edema associated w/ left ventricle failure
147
Morphine/Dilaudid side effects (5)
respiratory depression
anxiety
bradycardia
constipation
urinary retention
148
Morphine/Dilaudid nursing implications (2)
Frequent VS & pain assessment before and after
Have oxygen, respiratory equipment, and antidote available
149
dilaudid/morphine teaching (3)
avoid alcohol
educate about constipation, over sedation, and dependency risks
change positions carefully and avoid driving
150
Nitroglycerin action
increases coronary blood flow to relieve or prevent angina pain and reduce BP
151
Nitroglycerin side effects (5)
Dizziness
headache
hypotention
tachycardia
nausea
152
Nitrolgycerin nursing interventions (3)
-Monitor BP, HR, & telemetry
-have patient sit or lie down before giving med
-notify PCP if patient is taking erectile
dysfunction medication
153
Nitroglycerin education (3)
sit down before taking
avoid alcohol
change positions slowly
154
propanolol action
decreases heart rate & BP
arrhythmia suppression
MI prevention
155
propranolol side effects (6)
fatigue/weakness
bradycardia
pulmonary edema
hyper/hypoglycemia
bronchospasm
orthostatic hypotension
156
propranolol nursing implications (4)
hold if SBP <100
Monitor telemetry, I/O, edema, & lung sounds
monitor renal function and potassium levels
monitor blood glucose
157
propranolol education (3)
check pulse daily & BP bi-weekly
take at same time each day
taper off medication when stopping
158
Vecuronium Bromide action
paralysis
159
Vecuronium Bromide side effects (6)
muscle weakness
respiratory insufficiency
apnea
bronchospams
hypotension
tachycardia
160
Vecuronium Bromide nursing implications (3)
assess patient response using nerve stimulator
monitor vital signs
promote frequent ROM & repositioning
161
Vecuronium Bromide education
use of paralytic during ET intubation and mechanical ventilation
162
normal pH
7.35
163
normal PaCo2
35-45
164
normal HCO2
22-26
165
pH high; PCO2 is low
respiratory alkalosis
166
pH low; PCO2 is high
Respiratory acidosis
167
pH high; HCO3 high
metabolic alkalosis
168
pH low; HCO3 low
metabolic acidosis
169
ABG: uncompensated
if respiratory: HCO3 is normal
if metabolic: PCO2 is normal
170
ABG: partially compensated
nothing is normal
171
ABG: compensated
pH is normal
