Nursing Considerations
What medications need to be held before a pulmonary function test?
Hold Bronchodilators and oral corticosteroids.
What four things does cardiac output depend on? And describe what each is responsible for.
Preload (volume), Afterload (resistance), Heart Rate, Contractility (squeezing of the heart)
What ABG imbalance is typically associated with Asthma?
Respiratory Alkalosis
Patient takes Budesonide what teachings should you include about administration?
Add a spacer and rinse after use to prevent oral thrush
What medication is used for longterm treatment and maintenance of persistent asthma? What do you want to teach the patient for this?
Montelukast; can take 1-2 weeks to feel any relief.
What are the side effects of ACE Inhibitors?
A: angioedema
C: cough
E: hyperkalemia
A patient is diagnosed with heart failure. The patient has ineffective pumping of their ventricles and has an increased afterload. The patient has an ejection fraction of 40%. What type of HF does this patient have?
Systolic HF.
Follow up question :) What is normal ejection fraction? What percentage does HF start at?
A patient is having a COPD exacerbation they are on 2L NC and their O2 stat is at 89% You get notified about their O2... What do you do?
A. Increase to 3L NC B. Notify Doc C.Continue to monitor D.Add humidity
C; You will continue to monitor the patient; A COPD pt will not have a high oxygen stat a lot of the time... you also do not want to add more unless necessary because you do not want them to get used to the increased oxygen demand.
How do you teach the patient to use an IS vs. a Peak Flow Meter?
IS -- Breathe IN and watch the ball go up! (I=IN); Peak flow -- deep breath and place lips on mouthpiece then exhales FAST and HARD and watch to see what color you are in!
FOLLOWUP QUESTION :) What are the zones of peak flow? When do you need to intervene?
A patient with Asthma is taking albuterol and experiences awful tremors and insomnia. The patient comes in and asks if there is anything else they can take in order to help their asthma, but not have these side effects. What will the PCP probably prescribe?
Anticholinergics! (ipratropium)
What is really important to ask a male patient if they come into the ED with chest pain when doing a med rec? Why?
if they are on any erectile dysfunction medications! it can cause life threatening hypotension.
Followup question: If a patient has an order for nitro ointment to be put on their chest. What is important todo before administering and why?
A patient had an Xray that showed congestion in the pleural cavity caused by a backup of blood from the left ventricle to the left atrium. The patient is presenting with cough, SOB, orthopnea, and crackles. What is going on with the patient?
Left sided heart failure!
Followup Question: What is the difference between Orthopnea and paroxysmal nocturnal dyspnea?
A patient comes into the ED with SOB, cough, tight chest. You start to assess the patient in triage and you hear wheezing, the RR is 26. The patient had used her inhaler before coming into the ED with no relief. The nurse admits her into the unit and the new nurse for the patient goes into the room for a second assessment and the wheezing has suddenly diminished... What is happening?
If you do not hear anything.. EMERGENCY Intervention.. OPEN AIRWAY ASAP! Could be leading to a severe acute attack or even a life threatening attack. Open airway and ask for help!
How do you teach a patient to do pursed lip breathing? What is the benefit of pursed lip breathing?
“Breathe in the roses, blow out the candles” helps blow out CO2
Helps patients prolong expiration time and decreases air trapping, strengthens and conditions respiratory muscles
Three counts in, seven counts out
A patient taking Lisinopril came into the PCP complaining of a persistent cough since taking the medication. All tests for illness have came back negative. What is this from? What is the next step?
This is a s/e of ACE inhibitors; They will begin to use ARBS (sartans)
A patient with HF with edema is ordered furosemide. What is a nursing consideration for administration?
What is Collateral Circulation and what are some contributing factors?
Allows for the heart tissue to receive in some cases adequate amounts of blood and O2
Contributing factors
Inherited: some individuals are predisposed to develop new blood vessels
Occurs over time more likely to have the time to be able to develop connections
Chronic Ischemia
Plaque blocks normal blood flow which in long term leads to ischemia
What main s/s will be included for a patient with COPD?
Cough, increase in sputum production, dyspnea (+exposure to risk factors)
What education will you provide for a patient with heart failure concerning nutrition?
Low sodium diet (2g/d), DASH diet, fluid restriction in advanced cases: if required <2L/d ( ice chips, gum, hard candy can help with dry mouth) Whole grains, lean meats, fruits and veggies. Fluid loves salt, that is why it is restricted! Teach about food labels, how to take BP and HR
Raymund is reviewing cardiovascular drugs for his upcoming exam. For a well-prepared student, he should know that vasodilators are agents that:
A. Relax smooth muscles.
B. Are used to treat hypotension.
C. Stimulate the adrenergic receptors of peripheral sympathetic nerves.
D. Cause respiratory depression.
A. Relax smooth muscle; vasodilators dilate or prevent constriction of the blood vessels, which allow greater blood flow to various organs in the body.
A patient is prescribed digoxin for HF. What must the nurse assess for before giving this to the patient?
Assess the apical pulse for a full minute. HOLD if it is <60
Followup: What do you want to watch for with digoxin?
The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient?
a. Low dietary fiber intake
b. No regular aerobic exercise
c. Weight 5 pounds above ideal weight
d. Drinks wine with dinner once a week
ANS: B
The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake will not increase the hypertension risk.
A patient is admitted on the medsurg unit. During the assessment, the nurse notes JVD, upper quadrant tenderness, and peripheral edema. Looking at the history, the patient has COPD and has had gradual weight gain for the last couple of months. What is the nurse expecting is happening as a complication of COPD and what do you need to look out for?
Cor pulmonale! Pulmonary hypertension; hypertrophy of the right side of the heart; Can cause right sided HF
What is important to report to the provider when taking loop diuretics concerning weight? Also, what f/e imbalances are associated with loop diuretics?
Report weight gain greater than 2lb in 24 hrs to the provider or 5lb in a week; Hyponatremia/ hypokalemia
A client with congestive heart failure is being treated with torsemide (Demadex). The nurse obtains the following vital signs: Blood pressure of 100/65 mm hg; pulse rate of 91 beats per minute; and respiration of 25 breaths per minute? Which of the following will be the priority assessment of the nurse after the initiation of the dose?
A. Urine output
B. Serum potassium and calcium
C. Blood pressure
D. Weight
C. Blood pressure; Loop diuretic s/e: f/e imbalances, ototoxicity, HYPOTENSION, diuresis.