Acid-Base Balance
Normal pH, CO2, and HCO3 values
What is pH 7.35-7.45, CO2 35-45, and HCO3 22-26?
Pt presents to ED with vision changes, intense headache, SOB, fatigue, and chest pain; pt has BP of 200/124. What is the dx?
What is hypertensive crisis?
Bonus: Diff between hypertensive urgency & emergency (DBP > 120 without TOD vs w TOD)
A patient with HF has an EF of 43%. What is the dx?
What is heart failure with reduced ejection fraction (HFrEF)?
>50% is HF w preserved EF (HFpEF)
Normal EF is 55-70%
Describe Virchow's triad
What is endothelial injury, hypercoagulability, and decreased flow rate of blood or stasis?
Common sites of gangrene
What is toes, fingers, hands, and feet?
What is partially compensated?
Treatment goal for patient taking HMG-CoA reductase inhibitors?
Bonus: Nurse should monitor for what S/S?
What is lowering LDL below 100 and HDL above 40?
What is muscle pain, cramping, weakness, liver function, urine output & quality, and myoglobin levels? -- rhabdomyolysis
Dx tests for CAD
What is ECG (initial test; ST depression or inverted T waves -- ischemia), exercise stress test, and coronary angiography (determines occlusion)?
Nonobstructive CAD: coronary CT angiography (CCTA), cardiographic magnetic resonance, stress echocardiograms
Risk factors for DVT
What is age, active cancer w/o chemotherapy, varicose veins, prior venous thrombosis, pregnancy, postpartum period, oral contraceptives, hormone therapy, surgery, trauma, & immobility?
A patient has an ABI of 0.3. What level of severity of PAD does the patient have?
What is severe peripheral arterial disease?
A patient with COPD has suffered a recent exacerbation and has begun exhibiting signs of dyspnea, restlessness, and confusion. When ABGs were assessed, it revealed pH 7.22, PaCO2 67, and HCO3 24. What is the acid-base imbalance and interventions?
What is respiratory acidosis?
What is bronchodilators, supplemental O2, chest physiotherapy, or intubation for mechanical ventilation?
Other interventions: medications to treat hyperkalemia, abx, removal of foreign body from airway, or chest tube insertion.
Describe the pathophysiology of atherosclerosis and arteriosclerosis
What is injury to endothelium, inflammatory response, and plaque accumulation (LDL) within the tunica intima?
What is thickening/hardening of the arterial wall d/t aging?
Risk factors for heart failure
What is CAD, HTN, DM, metabolic syndrome, obesity, smoking, high sodium dietary intake, cor pulmonale, and sleep apnea?
A patient with PAD reports feeling pain at rest that often awakens them at night? What is the stage of their disorder?
What is Stage 3?
Complications of percutaneous coronary intervention (PCI)
Bonus: Common vessels for coronary artery bypass grafting (CABG)
What is hemorrhage, abrupt vessel closure, dysrhythmias, and ruptured arteries?
What is internal thoracic (mammary), radial artery, saphenous vein?
The patient presented to the ER complaining of nausea, vomiting, and severe diarrhea. What are treatments used to address this issue?
Bonus: Is pH acidic or alkalotic?
What is fluid replacement (IV fluid therapy), insulin (DKA), dialysis, and antidiarrheal medication?
What is acidic pH?
Describe the diet & dietary changes for a pt w HTN
What is DASH diet and <1,600 mg sodium/day?
Grains (6-8 servings/day), fruits (4-5), veggies (4-5), low/nonfat dairy foods (2-3), lean meats, fish & poultry (<6), nuts, seeds, & legumes (4-5/week), fats & oils (2-3/day), sweets (<5/week)
Describe the types of angina
What is stable angina (caused by physical activity, relieved by rest and NTG), unstable angina (chest pain at rest, prolonged & not relieved w rest or meds, precursor to MI), and Prinzmetal's/variant angina (coronary artery spasm, occurs at night)?
A patient with DVT taking warfarin comes in for routine labs. The results show an INR of 4. What is the appropriate nursing action?
What is notify healthcare provider to adjust + lower dose of warfarin?
Patient teaching for a patient dx with PAD
What is proper positioning (avoid crossing legs), inspect feet daily (especially between toes), report chest pain or neurological changes (angina, MI, stroke), and lifestyle modifications (DASH diet, cessation of alcohol and smoking, and exercise)?
A patient admitted to the unit has an NG tube in place but has been vomiting excessively. He's dizzy, has muscle twitching and cramps, and has a respiratory rate of 10. What acid-base imbalance does the patient have, and how is it treated?
What is metabolic alkalosis?
What is d/c the NG tube, discontinue potassium wasting diuretics, potassium supplementation, antiemetics, or IV therapy?
Pt teaching for managing HTN
What is DASH diet, sodium restriction, moderate exercise, limit alcohol (1 drink/day for women, 2 drinks/day for men), stress reduction, smoking cessation, monitoring BP at home, know S/S of TOD, stroke, and aneurysm, & medication compliance (rebound hypertension)?
Drugs that reduce preload
Bonus points: Drugs that reduce afterload
What is spironolactone, furosemide, and dapagliflozin?
What is ACE inhibitors, ARBs, ARNIs, & vasodilators (hydralazine)?
Key points: do not give ARNI w/in 36 hrs of an ACE inhibitor, caution with spironolactone w/ pts who have renal insufficiency, & Lasix can cause hypokalemia (last dose around 1400)
Complications for PAD and descriptions
What is critical limb ischemia? (sustained decrease in arterial blood flow, chronic ischemia, pain at rest, ulcerations, gangrene, infection & tissue breakdown)
What is acute limb ischemia? (sudden decrease in blood flow, caused by embolus, cool, 6Ps - pain, pulselessness, pallor, paralysis, paresthesia, poikilothermia)
Left vs. right-sided S/S of heart failure
What is SOB, dyspnea, orthopnea, pink, frothy sputum, crackles, pale, cool skin, cold extremities, capillary refill > 3 seconds, fatigue, weakness for left-sided HF?
What is JVD, dependent edema, hepatomegaly (organ enlargement), and ascites for right-sided HF?