Acute Coronary Syndrome/Hemodynamics
Describe preload and its effect on cardiac output
In a properly functioning heart, increased preload will increase cardiac output
What are two medication-related teachings for patients after heart valve replacements?
Prophylactic antibiotics and anti-coagulation
Mechanical valves: life-long anti-coagulation
Bioprosthetic valves: 3 months anti-coagulation
Name early presentation signs of cardiogenic shock (name at least 2)
Tachycardia, hypotension, narrowed pulse pressure, increased SVR, increased oxygen demand
What is he oxygen saturation goal for COPD exacerbation patients?
88-90% with or without oxygen therapy
True/False: Small-cell lung cancer is more common and has a poorer prognosis
False: small cell lung cancer is less common (most commonly seen in heavy smokers) and is very aggressive
What is the hallmark assessment finding of ARDS?
Refractory hypoxia
What are the systemic findings that indicates that a patient's cardiogenic shock has progressed into MODs?
Organ dysfunction: kidneys (decreased urine output, elevated creatinine), liver (elevated AST/ALT, decreased liver function)
Compare and contrast stable angina vs ACS
Stable: Precipitated by exertion, less than 15 minutes in duration, relieved with nitroglycerin, few associated symptoms
ACS: Not precipitated by exertion, greater than 20 minutes in duration, not relieved with nitroglycerin, many associated symptoms
Explain assessment findings present with mitral valve regurgitation
Pulmonary edema (crackles on auscultation, frothy bloody sputum, SOB)
Thready pulses, cool/clammy extremities, low cardiac output that could lead to cardiogenic shock
Name manifestations of acute decompensated heart failure (name at least 3)
Tachypnea, SOB, dyspnea, orthopnea, wheezing/crackles/rhonchi, productive cough with frothy, blood-tinged sputum, edema, hypertension, anxious, pale, clammy/cold skin, decreased oxygen saturations
What are three educational topics to include for an asthma patient?
Inhaler knowledge and usage, identify and avoid triggers, developed action plan, compliance with medication, weight loss prevention, vaccinations
What are two of the three types of non-small cell lung cancer?
Squamous, adenocarcinoma, large cell
What are two of the predisposing factors for the development of ARDS?
Sepsis, pneumonia, trauma, aspiration
What are the effects of afterload on cardiac output and workload/oxygen demand?
Increased afterload will cause decreased cardiac output and increased workload/oxygen demand
Explain the complications of aortic stenosis as it pertains to hemodynamics and pathophysiology of the heart
Decreased cardiac output, increased workload/oxygen demand, left ventricular hypertrophy which causes decreased contractility
Describe at least 3 patient teaching items for a patient with a pacemaker/ICD
Routine follow-up checks, s/s of infection, avoid lifting arm above shoulder, avoid driving until cleared, avoid contact sports, call if HR is below set rate, avoid large magnetic fields/MRI, call MD if ICD fires, call 911 if ICD fires more than once, wear medical alert ID, carry device card
What are 2 medications used in asthma exacerbations?
Long acting (steroid) inhalers, short acting inhaler (bronchodilator), antihistamines, anti-emetics
Moderate exacerbation: IV corticosteroids
Severe exacerbation: magnesium, stacked nebulizers
What is one of the screening diagnostics used for lung cancer?
Sputum cytology or CT scan in patients 55-74 years of age with at least a 30-pack year history, and having quit <15 years ago
A high-pressure ventilator alarm is caused from: (minimum of one)
Kinked tubing, patient coughing, patient gagging, patient agitation, water in circuit tubing, patient secretions, patient lung compliance issues
What are nursing assessments and interventions after a PCI? (Name at least 3)
Site assessment for hematoma/bleeding, CMS of extremity, chest pain, EKG, hemodynamics
What are the manifestations of an aortic dissection?
Type A (ascending)Type B (descending)
A: abrupt, excruciating chest pain
B: abrupt, excruciating back, abdomen, leg pain, absent pulses
Describe the function of an intraaortic balloon pump (IABP)
The balloon is inflated during diastole to help augment pressure and deflates during systole to decrease afterload
What are 2 long-term outcomes of patients with COPD?
What are three potential assessment findings of acute rejection in a lung transplant patient?
What are at least 3 nursing interventions implemented to prevent ventilator-associated pneumonia (VAP)?
Elevate HOB, oral care with chlorhexidine, regular oral suctioniong, stress ulcer prophylaxis, sedation vacation, maintain water-free circuit tubing, maintain ventialtor circuit tubing connection, early patient mobility
Name the three signs/symptoms of cardiac tamponade
JVD, hypotension, faint heart sounds
Name 3 post-operative nursing assessments post-throacic aneurysm repair
Surgical site, hemodynamics, EKG, neurological exam, CMS checks, urine output, bowel sounds
Describe normal assessment findings of a patient with an LVAD
Percutaneous line at abdomen with dressing, mechanical interference on auscultation, no SBP/DBP only MAP, no palpable pulses
What acid-base imbalance would the nurse suspect in a patient with a COPD exacerbation?
Respiratory acidosis
(decreased pH, elevated CO2, elevated bicarbonateWhat are three nursing interventions for the post-operative lung cancer resection patient?
Pain control with a PCA, epidural or nerve bock, incisional splinting, incentive spirometer, assessment of respiratory rate, effort, lung sounds, oxygen saturation, sputum characteristics, incisional assessments for crepitus, drainage, and healing, chest tube assessment for tidlaing and drainage
What are the four P's of nursing care for a patient with ARDS?
Perfusion, positioning, protocol, protection