Heart Failure
What is the difference between left and right sided HF?
Left = fluid backup in lungs
Right = fluid backup in body
What medication is given in angina?
Nitroglycerin (NTG)
Preterm
Smoking
Allergens
Genetic
Obesity
Teach pursed lip breathing
Breathe in through the nose
Exhale out through the mouth with lips pursed
smell the roses, blow out the candle
Tachycardia
Hypotension
Respiratory Arrest
All of the above
None of the above
Tachycardia
Jebbediah is an Amish 47 year old male that presents to the hospital for shortness of breath, suddenly waking up breathless in the middle of the night, and has a "bulging vein in his neck" according to his wife. What is Jebbediah suffering from?
Right sided HF
A patient who has atrial fibrillation is likely on which of the following medications?
apixaban
furosemide
albuterol/atrovent combination inhaler
lisinopril
Apixaban
What type of disease is asthma?
Reactive
Inactive
Obstructive
None of the above
Reactive airway disease
Veronica is a 67 year old female with a 40 year h/o 1/2ppd. She has COPD and is getting ready to discharge home. What education would be beneficial for Veronica when discharging her?
Smoking cessation
When giving amlodipine or diltiazem, what is a common side effect?
Dependent edema
Sheila has heart failure with a 35% EF. What type of HF is present?
Systolic Heart Failure
Chad is a 56 year old male that has a consistent blood pressure of 150's/90's. He does not smoke, eats lean meat, exercises regularly, has low stress, and is otherwise healthy. What lifestyle modification should be educated on?
Reduction in sodium intake
You are the nurse in a PCP office when you receive a call for a patient that report 47% of normal peak flow when using their IS. What should you inform the patient?
To receive care at an emergency department
OR
Activate emergency services (9-1-1 system)
What is most important when teaching a COPD patient that is getting discharged with oxygen for the first time?
Do not smoke or be near an open flame with oxygen
Why is methylprednisolone given in asthma?
Nitroglycerin (NTG)
You have just educated Susan on nitroglycerin administration. She has COPD and chronic CAD with a history of a coronary artery bypass graft, bilateral BKAs, and poly substance use disorder. During teach-back Susan says that she is to take 1 nitro 5 times every 3 minutes and that if the pain doesn't stop after the third dose, she is to call 9-1-1. Does Susan understand the use of this medication and what is your rationale?
She requires further education. She is to take 1 SL NTG q5m x3. If no relief after 3rd dose she is to call 9-1-1
Shannon is a 43 year old female admitted to the ICU for status asthmaticus. She was given "numerous breathing treatments at 2200" per the nightshift nurse. Upon assessing your patient you find her in a tripod position, cyanotic, hypoxemic on the SpO2 monitor, and unable to speak. You urgently assess her lung sounds while a coworker requests the intensivist STAT to the bedside. You are not able to auscultate any lung sounds. The intensivist verbally orders 1mg ipratropium and 5mg albuterol nebulized STAT with a reassessment in 15 minutes. What is the expected outcome upon lung reassessment?
Wheezing in all lobes
What is the pathophysiology of both chronic bronchitis and emphysema
Chronic Bronchitis: productive cough for at least 3 months for 2 consecutive years with increase mucus production
Emphysema: permeant enlargement of air space w. CO2 retention & w/o fibrosis
Explain how both ACEIs and ARBs work
ACEI- prevents angiotensin I from converting to angiotensin II
ARB- blocks receptor site of angiotensin II
Nichole is a 63 year old female admitted to the hospital for heart failure requiring emergent intubation. She is now on your medical surgical unit wearing 2 liters of oxygen via nasal cannula. Before being admitted to the hospital she smoked 3ppd of Marlboro Reds. She is A&Ox3 and makes her own medical decisions. HF is a new diagnosis for her. What is most important to discuss with Nichole?
Advanced Directives
Stable angina
You are eating lunch at the Atrium when you see a frantic mom struggling to get something out of her purse as her daughter appears to be leaning over a chair obvious respiratory distress. You approach the mom and she explains that Brittany, her daughter, was recently diagnosed with asthma and believes her daughter is having an asthma attack. You can hear audible wheezing from Brittany. The mom is frantic and unsure of how to assist her child as she pulls out an albuterol/ipratropium rescue MDI. You explain to her how to use as you administer a dose to Brittany. This is not a new inhaler. What are the steps that you teach Brittany's mom?
IN ORDER:
Shake inhaler
Tell Brittany to breath out
Tell Brittany enclose her lips around the MDI
Inform Brittany to inhale as the MDI is depressed
Inform Brittany to hold her breath for 5-10 seconds
Inform Brittany to exhale
Jessica presents to the ED with dyspnea with and without exertion. She is normally on 2L o2 via NC and is currently on 4L and is still dyspenic. She states she has "late stage COPD." The doctor has ordered an arterial blood gas. What are the expected findings for pH, HCO3-, & CO2?
Low pH
High CO2
near normal HCO3-
Elevated PaCO2
Chronic respiratory acidosis with failure to compensate (failure to compensate is not needed info)
Jacob is a 76 year old male from a local assisted living unit. After taking an EKG the doctor states Jacob is having a heart attack with 100% occlusion and orders "0.4mg nitroglycerin SL q5m x3 for CP". When you ask what medications he is on and he states "amlodipine, sildenafil, furosemide, and something that thins my blood." What two assessments are imperative before administering the medication?
Assessing Blood Pressure
Assessing last use of sildenafil