CHF
What lab value is elevated in HF?
Double points if you know the normal value!
BNP
Normal < 100
The most common cause of rheumatic heart disease is ____________.
Untreated strep throat
Why would a client receiving a heparin drip for a diagnosis of a DVT also be ordered warfarin?
Double points if you can identify the target INR goal for a client on warfarin AND the antidote for warfarin.
Warfarin acts as a bridge from heparin, the drip continues until the warfarin becomes therapeutic (3-5 days).
Target: 2-3, antidote Vitamin K/plasma transfusions
What types of tasks CANNOT be delegated to unlicensed personnel?
Assessments, medications, teaching, evaluations.
Identify signs of digoxin toxicity.
Double points if you know the normal therapeutic range for digoxin levels!
Yellow vision, confusion, anorexia, N/V/D, palpitations.
0.5-2 ng/mL
A client with CHF should contact their provider for a weight gain of ___________.
2-3 lbs in 1 day or 5 lbs in 1 week
Identify 3 signs of infectious endocarditis.
SOB, fever, elevated WBC/ESR, malaise, anorexia, positive blood cultures, murmurs, embolic complications (thrombi, petechiae, splinter hemorrhages, Roth's spots, Janeway lesions, Osler's nodes)
Describe patient education for anticoagulant use.
Clippers (no straight razors), fall prevention, identify signs/symptoms of bleeding, importance of taking medication, lab monitoring if needed.
What heart sound would you expect to hear in a client with pericarditis?
Identify patient education related to warfarin interactions.
Avoid foods rich in Vitamin K (green leafy vegetables), avoid garlic.
Identify 3 nursing interventions for a client with CHF and a nursing diagnosis of Decreased Cardiac Output.
Apply O2 as ordered, High Fowler's, balance exercise with rest, Monitor VS, Monitor I/O, Monitor daily weight.
Identify a situation when prophylactic antibiotics would be recommended.
High risk pt (recurrent endocarditis, valve replacement, heart transplant) undergoing extensive dental procedure.
Describe the signs and symptoms of a client who is diagnosed with chronic venous insufficiency.
Edema, ruddy/cyanotic color, pain improved with elevation, scaly skin, brawny changes, normal pulses, moist ulcers.
Identify 3 signs of pulmonary edema.
Pink frothy sputum, crackles, cough, decreased UOP, tachypnea, shock-like symptoms.
What should the nurse do prior to administering digoxin?
Check the apical pulse for 1 full minute - hold if <60.
Describe patient education for diuretic therapy.
Potassium-rich foods, may need oral KCL, combined loop + potassium sparing to avoid drop in K, take in the AM, change positions slowly.
Describe cardiac tamponade and symptoms of it.
Fluid in the pericardial sac putting pressure on the heart causing decreased cardiac output.
Sx - tachycardia, hypotension, JVD, panic/restlessness, paradoxical pulse
Describe the signs and symptoms of a client who is diagnosed with chronic arterial insufficiency.
Pain at rest, diminished hair growth, diminished pulses, elevation pallor, dependent rubor, thickened nails, intermittent claudication.
Identify nursing measures aimed at preventing the #1 most preventable complication during hospitalization.
VTE!
SCDs or TED hose, ambulation/ROM/exercises, SQ heparin or Lovenox
Which medication can be given in heart failure to improve cardiac output by increasing the BP?
Dopamine
Identify 3 symptoms of RIGHT sided HF and 3 symptoms of LEFT sided HF
Right - JVD, elevated CVP, peripheral edema, ascites, hepatomegaly
Left - dyspnea, crackles, nocturnal dyspnea, orthopnea
DAILY DOUBLE
Place your bet (must be an increment of 500)!
You are caring for a client weighing 225 lbs who is ordered a Heparin infusion for a DVT. The order reads 15 units/kg/hr. The pharmacy dispenses a bag containing 25,000 units / 250 mL. At what rate will you set the pump in mL/hr? Round to the nearest tenth.
Differentiate the nursing interventions of arterial insufficiency versus venous insufficiency.
Arterial - warm environment, no direct heat, flat/dependent legs, no tight clothing, don't cross legs
Venous - elevate legs, ambulation, compression stockings, protein, good skin care/dressing changes as needed.
DAILY DOUBLE
Place your bet (must be an increment of 500)!
Rotate sites, look for signs of bleeding, leave the bubble in the syringe, don't massage the site.