Upper Respiratory
Pt with History of Epstein-Barr virus, egg allergy or Guillian-Barre virus should NOT get this vaccine
influenza
A parent comes in and asks how long their child’s whooping cough contagious?
Day 5 of antibiotic therapy
While rounding on a patient the nurse notes a SP02 level of 82% while laying supine. What action should the nurse take first?
Raise the HOB to 30-45 degrees (semi-fowlers)
A patient with a diagnosis of pneumonia is on supplemental oxygen (2l/min nasal canula). Their ABG results show PaO2 of 52 mm Hg and a PC02 of 46 mm Hg.
The nurse should expect a dx of which type of acute respiratory failure?
hypoxemic respiratory failure.
Which cardiac dysrhythmias would indicate defibrillation?
v-tach and v-fib (must be pulseless)
What are specific manifestations of PAD ?
- intermittent claudication
( muscle pain thats induced by standing or walking, it gets better with rest)
- Maker for advanced systemic atherosclerosis
What are normal lab values for kidney function ?
- GFR: >65
- Creatinine: 0.5-1.2
- BUN: 10-20
Crackles, dyspnea, coughing, fluid retention are manifestations related to:
left sided heart failure
These two complications develop from Coronary Artery Disease and make up Acute Coronary Artery Syndrome
Unstable Angina, Acute Myocardial Infarction
What are the parameters of Prehypertension?
120 - 139/80 – 89
What medications can you NOT give to a patient with Hypertrophic Cardiomyopathy?
Vasodilators, Digoxin, Diuretics
Tachycardia, bounding pulses, restlessness, agitation, and pale, cool, clammy skin are all what?
Early signs of Shock
Pt is presenting with less than 400 ml/day, metabolic acidosis, increased BUN/Creatine levels, hyponatremia/hyperkalemia
Initiation (Oliguric) phase
A patient who is receiving radiation for neck cancer is reporting pain in their mouth, after inspection you notice that their saliva glands are inflamed and red. What complication of radiation is this?
xerostoma
A patient who was previously diagnosed with HIV comes in with a fever of 102.4 and a productive cough, what diagnosis would the nurse expect to see?
Pneumocystis Jirovecii
A patient presents to the emergency room with increased dyspnea, sputum volume, & sputum purulence. What diagnosis would the nurse expect?
COPD exacerbation
The nurse rounds on patient and sees they are sitting tripod position and breathing rapid and shallow.
What is the nurse’s priority?
Maintain a patent airway.
What are the nursing interventions for patients with a pacemaker?
ECG monitoring, early ambulation once able, limit arm and shoulder movement on the operative side, observe insertion site (bleeding, intact, temperature, elevation, pain), anticipate discharge the next day
What type of ulcer appears dry, rounded, punched out, & may become necrotic?
arterial
What type of incontinence do you expect a pt with Alzheimer’s disease to have?
JVD, murmurs, ascites, anasarca, hepatomegaly are manifestations of:
right sided heart failure
Nonspecific marker of inflammation, increased in many patients with CAD
CRP
Most concerning organ affected by HTN?
Eyes -- Retinal Damage
Blurred, hemorrhage, vision loss
With Atrial Valve Stenosis, this medication should NOT be given due to causing severe hypotension, chest pain, and worsening of preload
Nitroglycerin
A patient is experiencing bounding pulses with a fever, and 15 min later they have weak thready pulses, confusion, and Hypotension, which phase of shock are they in now?
Progressive
Irreversible, present with altered levels of consciousness, hyperkalemia, hyperglycemia
Chronic Kidney Disease
A patient comes in with raccoon eyes and nasal drainage, what sign should the nurse check for?
Halo sign
How is a diagnosis of flail chest made?
fracture of 3 or more consecutive ribs or of 2 breaks in more than one rib
Which diagnostic results indicates a diagnosis of cystic fibrosis?
Sweat chloride test
What stage of acute respiratory distress syndrome is characterized by alveolar sacs initially filling with fluid ?
injury/ exudative phase
Education/safety regarding AED use
Never place pads over pacemaker and/or defibrillating device, synchronizer set to "off" for DEFIB, synchronizer set to "on" to cardiovert, door must be open, no one touching patient and must verbalize "CLEAR!"
What type of ulcer appears dry around the wound but the wound bed itself is moist, irregular shape, will have stasis dermatitis.
venous
What diseasr process is associated with costovertebral angle tenderness?
Acute pyelonephritis
Heart muscle is weak and unable to pump hard enough; presents with decreased ejection fraction
systolic heart failure
Gender most at risk over age 65
Female
5 labs for HTN assessment
· BMP
i. Creatinine/BUN
· CBC
· Serum Lipid Profile
i. Atherosclerosis check
· Electrolytes
i. Uric acid, Na, Mag, K
ii. Heart muscle damage risk
· TSH
What kind of murmur can you hear with Mitral Valve Stenosis?
Diastolic murmur
What are the six sepsis goals of care?
Oxygen, blood cultures, IV antibiotics, fluid challenge (large bore IV), lactate level (>2), urine output (<30 mL/hr)
Output is 1-3L or more a day, hyponatremia/hypokalemia, labs will begin to normalize, hypovolemia, hypotension and kidneys will NOT be able to concentrate urine yet
Maintenance (diuretic) phase
A patient is concerned about nasal polyps, stating that they are scared they have cancer after hearing they have polyps. What education should the nurse provide about nasal polyps?
benign growths
A patient has reported night sweats, low grade fever, cough and weight loss. The nurse suspects TB, after a positive bleb, the patient gets chest X-ray, what confirms this diagnosis?
Gohns lesions
A patient with cystic fibrosis complains of hemoptysis, thick, tenacious, purulent sputum, and pleuritic chest pain. What complication would the nurse suspect?
Bronchiectasis
What 5 things would a nurse include in a vent bundle for a patient experiencing acute respiratory distress syndrome?
What is the treatment for asymptomatic atrial flutter?
VTE prophylaxis (Heparin, Warfarin, Coumadin, Xarelto), Beta Blockers to slow HR (metoprolol), conversion with antidysrhythmic drugs (ibutilide) or a calcium channel blocker (Cardizem drip), maintain normal sinus rhythm with amiodarone (Cordaron), flecainide (Tambocor), dronedarone, NO MULTAQ WITH HF
Management of venous ulcer: (avoid what)
What disease presents as hematuria , proteinuria, lowered GFR, edema, and hypertension?
Glomerulonephritis
Inability of the heart's ventricles to relax and fill during diastole; presents with normal ejection fraction
diastolic heart failure
Patho cause of CAD, referred to as “hardening of arteries”
atherosclerosis
5 Antihypertensive drug classes in order of importance
· Thiazide Diuretics
· Ace Inhibitors
· Arbs
· Calcium Channel Blockers
· Beta Blockers
Which valve replacement requires anticoagulants for life?
Mechanical
When do we Zero an arterial line and where is it placed?
At the beginning of every shift, every position change, significant changes in hemodynamic status; must be placed at the Phlebostatic axis (4th intercostal)
Recovery phase takes _______ for kidney function to stabilize
Up to 12 months
A pt with a history of HTN comes to the ED with a nosebleed that has not stopped despite leaning forward and applying pressure. Epistaxis in this case is likely compensating for?
chronic hypertension
A patient presents to the ED with dyspnea, hypoxemia and tachypnea. After being diagnosed with a pulmonary embolism, what orders should the nurse implement first?
Low molecular weight heparin (Enoxaparin)
Oxygen
A couple who both carry the autosomal recessive gene for cystic fibrosis are planning to conceive. What patient education should be provided?
Patient education regarding genetic counseling
How would a nurse position a patient experiencing acute respiratory distress syndrome to promote optimal lung expansion?
Prone positioning
How do we perform CPR?
First assess for a pulse and absence of breathing! If no pulse, start compressions at 100-120 bpm, 2" depth, over the breastbone at nipple line, 30 compressions at a time, with 2 breaths in between sets, assess for pulse every 2 minutes.
Management of arterial ulcers...
To promote perfusion.....
To alleviate pain....
To promote perfusion..... dangle legs
To alleviate pain.... elevate legs
What is the first line of meds used for polycystic kidney disease?
Ace inhibitors
mnemonic for patient education for early identification of heart failure
FACES
Fatigue, activity intolerance, cough/chest congestion, edema, shortness of breath
ACS can be caused by
coronary artery ruptures
Patient has Severe headache, oliguria, dyspnea, excruciating chest and back pain that feels like “tearing”. What type of HTN is this?
HTN Emergency
Which Mitral Valvular problem will not allow the valve to close and allow back flow of blood?
Regurgitation
What is the difference in causes of obstructive vs. cardiogenic shock?
Obstructive =Cardiac tamponade, pulmonary embolism, tension pneumothorax (a physical blockage); cardiogenic = MI, dissected coronary artery (heart pump failure)
Uremia manifestations
Metallic taste in the mouth, anorexia, muscle cramps, itching, fatigue, lethargy, hiccups, edema, dyspnea, paresthesia and more common one GFR is less than 15