Podcast
Questions and Answers
A client with chronic stable angina reports chest pain rated 5/10. The client is sitting upright, alert, and oriented. Which intervention would the nurse implement first?
A client with chronic stable angina reports chest pain rated 5/10. The client is sitting upright, alert, and oriented. Which intervention would the nurse implement first?
- Encourage the client to lie down and take deep breaths.
- Apply oxygen via nasal cannula at 2 L/min.
- Administer sublingual nitroglycerin as prescribed. (correct)
- Call the healthcare provider for new antianginal medication orders.
A client with acute decompensated heart failure presents with dyspnea, orthopnea, bilateral crackles, and an oxygen saturation of 88% on room air. What should the nurse do first?
A client with acute decompensated heart failure presents with dyspnea, orthopnea, bilateral crackles, and an oxygen saturation of 88% on room air. What should the nurse do first?
- Administer IV furosemide (Lasix) as prescribed.
- Notify the healthcare provider of worsening symptoms.
- Place the client in high Fowler's position and apply supplemental oxygen. (correct)
- Restrict the client's fluid intake to 1,500 mL per day.
A nurse is teaching a client with severe aortic stenosis about activity restrictions. Which statement by the client needs further teaching?
A nurse is teaching a client with severe aortic stenosis about activity restrictions. Which statement by the client needs further teaching?
- If I start feeling dizzy or lightheaded when standing, I should sit down right away.
- It's important to watch for symptoms like shortness of breath and swelling in my legs.
- I should avoid strenuous activities, but I can continue my daily walks at a slow pace.
- I can take my daily nitroglycerin before exercise to prevent chest pain. (correct)
A client with newly diagnosed heart failure with reduced ejection fraction is being discharged. Which statement demonstrates a correct understanding of daily weight monitoring?
A client with newly diagnosed heart failure with reduced ejection fraction is being discharged. Which statement demonstrates a correct understanding of daily weight monitoring?
The nurse is caring for a client who had surgery 2 hours ago due to Crohn's disease complications. The client's vital signs are: T 98.6F (37C); HR 142; RR 18; BP 92/60; SpO2 94%. The client reports pain of 4 out of 10. Which post-operative order should be implemented with highest priority?
The nurse is caring for a client who had surgery 2 hours ago due to Crohn's disease complications. The client's vital signs are: T 98.6F (37C); HR 142; RR 18; BP 92/60; SpO2 94%. The client reports pain of 4 out of 10. Which post-operative order should be implemented with highest priority?
A nurse is caring for a client with ulcerative colitis experiencing severe abdominal cramping and frequent bloody diarrhea (10 stools/day). Vital signs: BP 88/54 mmHg, HR 120 bpm, RR 22, Temp 99.1°F (37.3°C). What is the priority nursing intervention?
A nurse is caring for a client with ulcerative colitis experiencing severe abdominal cramping and frequent bloody diarrhea (10 stools/day). Vital signs: BP 88/54 mmHg, HR 120 bpm, RR 22, Temp 99.1°F (37.3°C). What is the priority nursing intervention?
A client with acute hepatitis B is admitted with jaundice, nausea, dark urine, and right upper quadrant pain. The nurse notes confusion, lethargy, and asterixis. What is the priority nursing action?
A client with acute hepatitis B is admitted with jaundice, nausea, dark urine, and right upper quadrant pain. The nurse notes confusion, lethargy, and asterixis. What is the priority nursing action?
A patient newly diagnosed with Crohn's disease asks the nurse how to manage symptoms at home. Which statement indicates correct understanding?
A patient newly diagnosed with Crohn's disease asks the nurse how to manage symptoms at home. Which statement indicates correct understanding?
A nurse is teaching a pregnant woman diagnosed with hepatitis C about disease transmission. Which statement by the patient requires further teaching?
A nurse is teaching a pregnant woman diagnosed with hepatitis C about disease transmission. Which statement by the patient requires further teaching?
A client is receiving discharge education for CAD/Chronic Angina. What type of fat intake would require further teaching?
A client is receiving discharge education for CAD/Chronic Angina. What type of fat intake would require further teaching?
When teaching a client about taking nitroglycerin sublingually for angina, which instruction should the nurse include?
When teaching a client about taking nitroglycerin sublingually for angina, which instruction should the nurse include?
A client with heart failure is prescribed a potassium-wasting diuretic. Which food should the nurse recommend the client include in their diet?
A client with heart failure is prescribed a potassium-wasting diuretic. Which food should the nurse recommend the client include in their diet?
What should the nurse emphasize when educating a client about the need to decrease their salt intake?
What should the nurse emphasize when educating a client about the need to decrease their salt intake?
What finding in a client with valvular heart disease should the nurse report to the healthcare provider?
What finding in a client with valvular heart disease should the nurse report to the healthcare provider?
What type of valve replacement needs long-term anticoagulation?
What type of valve replacement needs long-term anticoagulation?
A client with heart failure is prescribed a diuretic. Which of the following should the nurse educate the client to monitor?
A client with heart failure is prescribed a diuretic. Which of the following should the nurse educate the client to monitor?
A client with diverticulitis is being discharged. What dietary instruction is most important for the nurse to provide?
A client with diverticulitis is being discharged. What dietary instruction is most important for the nurse to provide?
What finding should the nurse instruct the client with diverticulitis to report when they are discharged?
What finding should the nurse instruct the client with diverticulitis to report when they are discharged?
A nurse is teaching a client with colorectal cancer about screening guidelines. What should be included?
A nurse is teaching a client with colorectal cancer about screening guidelines. What should be included?
When providing dietary education to a client with hepatitis, what should the nurse recommend?
When providing dietary education to a client with hepatitis, what should the nurse recommend?
The nurse is providing education to a client regarding hepatitis prevention. Which of the following statements indicates a need for further teaching?
The nurse is providing education to a client regarding hepatitis prevention. Which of the following statements indicates a need for further teaching?
A nurse assessing a client with cholecystitis notes pain in the right upper quadrant that radiates to the back. Which term best describes this type of pain?
A nurse assessing a client with cholecystitis notes pain in the right upper quadrant that radiates to the back. Which term best describes this type of pain?
A client with cholecystitis is prescribed a low-fat diet. Which meal choice indicates that the client understands this dietary restriction?
A client with cholecystitis is prescribed a low-fat diet. Which meal choice indicates that the client understands this dietary restriction?
A client with Crohn's Disease reports that they need to take ibuprofen in order to manage the pain associated with the condition. What should the nurse advise them?
A client with Crohn's Disease reports that they need to take ibuprofen in order to manage the pain associated with the condition. What should the nurse advise them?
A nurse is reviewing discharge instructions with a client post-angiography. Which statement indicates that the client understands the teaching?
A nurse is reviewing discharge instructions with a client post-angiography. Which statement indicates that the client understands the teaching?
A nurse is caring for a client post cardiac stress test. Which assessment finding requires immediate attention?
A nurse is caring for a client post cardiac stress test. Which assessment finding requires immediate attention?
Which of the following should the nurse educate the client to consume at low amounts with valvular disease?
Which of the following should the nurse educate the client to consume at low amounts with valvular disease?
What education is required to provide to a client on statins, in treating CAD and Angina?
What education is required to provide to a client on statins, in treating CAD and Angina?
Which clinical manifestation distinguishes chronic angina from a myocardial infarction?
Which clinical manifestation distinguishes chronic angina from a myocardial infarction?
Which diagnostic test is least invasive for evaluating coronary artery disease?
Which diagnostic test is least invasive for evaluating coronary artery disease?
When teaching a client on Valsalva maneuver after heart surgery, which action indicates understanding? (Select all that apply)
When teaching a client on Valsalva maneuver after heart surgery, which action indicates understanding? (Select all that apply)
What medication is used as first-line treatment for HFrEF, with an ejection fraction of 40%?
What medication is used as first-line treatment for HFrEF, with an ejection fraction of 40%?
A nurse is to administer sublingual nitroglycerin to a client that has chronic angina. What should the education consist of?
A nurse is to administer sublingual nitroglycerin to a client that has chronic angina. What should the education consist of?
What diet is recommended for clients with Hepatitis?
What diet is recommended for clients with Hepatitis?
What type of diet change may clients with diverticulitis be taught in managing their condition?
What type of diet change may clients with diverticulitis be taught in managing their condition?
A client presents with a fever, cramping, and abdominal pain with diverticulitis. What further assessment is necessary?
A client presents with a fever, cramping, and abdominal pain with diverticulitis. What further assessment is necessary?
A client recently diagnosed with Crohn's Disease asks 'So what should i be looking out for with this diagnosis?'. What is the best answer?
A client recently diagnosed with Crohn's Disease asks 'So what should i be looking out for with this diagnosis?'. What is the best answer?
What may clients with Hepatitis present with?
What may clients with Hepatitis present with?
A nurse is teaching a client about modifiable risk factors for coronary artery disease. Which factor should the nurse emphasize?
A nurse is teaching a client about modifiable risk factors for coronary artery disease. Which factor should the nurse emphasize?
When assessing a client with chronic angina, which manifestation would the nurse expect to differentiate it from a myocardial infarction?
When assessing a client with chronic angina, which manifestation would the nurse expect to differentiate it from a myocardial infarction?
A client with heart failure who is prescribed a potassium-wasting diuretic should be taught to recognize signs and symptoms of hypokalemia. Which of the following should be included?
A client with heart failure who is prescribed a potassium-wasting diuretic should be taught to recognize signs and symptoms of hypokalemia. Which of the following should be included?
A client with endocarditis suddenly reports right flank pain radiating to the groin. Which complication should the nurse suspect?
A client with endocarditis suddenly reports right flank pain radiating to the groin. Which complication should the nurse suspect?
In planning care for a client with Crohn's disease, what assessment finding would prompt the nurse to urgently communicate with the provider?
In planning care for a client with Crohn's disease, what assessment finding would prompt the nurse to urgently communicate with the provider?
After a colonoscopy, a client reports severe abdominal pain and notes rectal bleeding. Which action should the nurse take first?
After a colonoscopy, a client reports severe abdominal pain and notes rectal bleeding. Which action should the nurse take first?
A client with hepatitis reports clay-colored stools and dark urine. Which pathophysiological process explains these findings?
A client with hepatitis reports clay-colored stools and dark urine. Which pathophysiological process explains these findings?
The nurse is providing discharge teaching to a client status post angiography. What statement indicates the client needs further teaching?
The nurse is providing discharge teaching to a client status post angiography. What statement indicates the client needs further teaching?
Which of the following diets is recommended for clients with Hepatitis, to promote hepatic healing?
Which of the following diets is recommended for clients with Hepatitis, to promote hepatic healing?
What type of valve replacement requires long-term anticoagulation therapy post-operatively?
What type of valve replacement requires long-term anticoagulation therapy post-operatively?
When planning dietary teaching for the client following the diagnosis of diverticulitis, what is the most appropriate teaching?
When planning dietary teaching for the client following the diagnosis of diverticulitis, what is the most appropriate teaching?
A client with chronic angina is prescribed sublingual nitroglycerin. Which instruction should the nurse prioritize to ensure safe and effective medication use?
A client with chronic angina is prescribed sublingual nitroglycerin. Which instruction should the nurse prioritize to ensure safe and effective medication use?
A client with heart failure is prescribed Amlodipine. What is the primary reason for using this specific calcium channel blocker in heart failure management?
A client with heart failure is prescribed Amlodipine. What is the primary reason for using this specific calcium channel blocker in heart failure management?
Which statement best describes how beta-blockers improve outcomes in heart failure with reduced ejection fraction (HFrEF)?
Which statement best describes how beta-blockers improve outcomes in heart failure with reduced ejection fraction (HFrEF)?
A nurse is teaching a client with chronic angina about lifestyle modifications. Which dietary recommendation is most appropriate for minimizing the risk of anginal episodes?
A nurse is teaching a client with chronic angina about lifestyle modifications. Which dietary recommendation is most appropriate for minimizing the risk of anginal episodes?
A client with valvular heart disease is being evaluated for potential complications. Which assessment finding is most indicative of a thromboembolic event?
A client with valvular heart disease is being evaluated for potential complications. Which assessment finding is most indicative of a thromboembolic event?
Following a mechanical valve replacement, a client asks why long-term anticoagulation is necessary. Which response by the nurse is most accurate?
Following a mechanical valve replacement, a client asks why long-term anticoagulation is necessary. Which response by the nurse is most accurate?
A client with heart failure is prescribed a potassium-wasting diuretic. Which electrolyte imbalance should the nurse prioritize monitoring for, recognizing its potential to cause life-threatening arrhythmias?
A client with heart failure is prescribed a potassium-wasting diuretic. Which electrolyte imbalance should the nurse prioritize monitoring for, recognizing its potential to cause life-threatening arrhythmias?
What is the rationale for instructing clients to avoid the Valsalva maneuver after heart surgery?
What is the rationale for instructing clients to avoid the Valsalva maneuver after heart surgery?
Which of the following is the primary goal of medical management for clients diagnosed with Coronary Artery Disease (CAD) and angina?
Which of the following is the primary goal of medical management for clients diagnosed with Coronary Artery Disease (CAD) and angina?
A client is scheduled for a cardiac stress test. What should the nurse emphasize when educating the client?
A client is scheduled for a cardiac stress test. What should the nurse emphasize when educating the client?
A client is being discharged post-angiography. Which statement, if made by the client, would indicate a need for further teaching?
A client is being discharged post-angiography. Which statement, if made by the client, would indicate a need for further teaching?
A client with chronic angina, who has been managing well with medication, reports a recent increase in the frequency and intensity of chest pain. Which intervention should the nurse implement?
A client with chronic angina, who has been managing well with medication, reports a recent increase in the frequency and intensity of chest pain. Which intervention should the nurse implement?
A patient with Crohn's disease develops a high fever, experiences sudden and severe abdominal pain, and shows signs of dehydration. What immediate action should the nurse advise?
A patient with Crohn's disease develops a high fever, experiences sudden and severe abdominal pain, and shows signs of dehydration. What immediate action should the nurse advise?
For a patient experiencing an exacerbation of ulcerative colitis, which dietary adjustment is most appropriate to advise?
For a patient experiencing an exacerbation of ulcerative colitis, which dietary adjustment is most appropriate to advise?
A hospital client is diagnosed with Hepatitis B. What actions should a nurse implement?
A hospital client is diagnosed with Hepatitis B. What actions should a nurse implement?
A patient with hepatitis reports that their stools are consistently clay-colored. Which physiological process explains this?
A patient with hepatitis reports that their stools are consistently clay-colored. Which physiological process explains this?
In a client with acute hepatitis, what signs/symptoms would prompt the nurse to contact a provider?
In a client with acute hepatitis, what signs/symptoms would prompt the nurse to contact a provider?
A client with acute hepatitis asks the nurse the best way to manage symptoms. Which instruction is most appropriate for the nurse to include when answering?
A client with acute hepatitis asks the nurse the best way to manage symptoms. Which instruction is most appropriate for the nurse to include when answering?
Which vaccination should the nurse encourage, in order to promote Hepatitis prevention?
Which vaccination should the nurse encourage, in order to promote Hepatitis prevention?
A patient with cholecystitis reports a sharp abdominal pain. What assessment would be best to perform by the nurse?
A patient with cholecystitis reports a sharp abdominal pain. What assessment would be best to perform by the nurse?
A nurse is teaching a client with cholecystitis about dietary modifications to control symptoms. Which meal choice indicates that the client may require further discharge teaching?
A nurse is teaching a client with cholecystitis about dietary modifications to control symptoms. Which meal choice indicates that the client may require further discharge teaching?
What is the recommendation for when a patient with diverticulitis should call 911?
What is the recommendation for when a patient with diverticulitis should call 911?
What is the specific recommendation for following a diet with diverticulitis?
What is the specific recommendation for following a diet with diverticulitis?
A client recovering from a severe diverticulitis flare-up is receiving discharge instructions. Which statement indicates that the client needs further clarification on managing their condition?
A client recovering from a severe diverticulitis flare-up is receiving discharge instructions. Which statement indicates that the client needs further clarification on managing their condition?
When teaching a client about recommended health screenings, what should a nurse say about testing for colorectal cancer?
When teaching a client about recommended health screenings, what should a nurse say about testing for colorectal cancer?
A nurse is creating a plan of care for a client diagnosed with Crohn's disease, who presents with repeated episodes of abdominal pain, diarrhea, and weight loss. A key collaborative intervention would be:
A nurse is creating a plan of care for a client diagnosed with Crohn's disease, who presents with repeated episodes of abdominal pain, diarrhea, and weight loss. A key collaborative intervention would be:
What is the best recommendation to give a client about maintaining their BMI with a diagnosis of diverticulitis?
What is the best recommendation to give a client about maintaining their BMI with a diagnosis of diverticulitis?
A 55 year old client with no known family history of any GI disorders asks if they should be screened for any colorectal cancers. What is the best answer?
A 55 year old client with no known family history of any GI disorders asks if they should be screened for any colorectal cancers. What is the best answer?
Explain the pathophysiology of Crohn's disease and how it differs from ulcerative colitis.
Explain the pathophysiology of Crohn's disease and how it differs from ulcerative colitis.
Match the following: Crohn's Disease
Match the following: Crohn's Disease
Match the following: Ulcerative Colitis
Match the following: Ulcerative Colitis
A nurse is developing a discharge teaching plan for a client with Hepatitis. Which of the following should be included?
A nurse is developing a discharge teaching plan for a client with Hepatitis. Which of the following should be included?
The doctor orders a test to see if the Hepatitis B Virus has antibodies in their system. What is the difference between the Hepatitis B surface antibody (anti-HBs) and Hepatitis B core antibody (anti-HBc)?
The doctor orders a test to see if the Hepatitis B Virus has antibodies in their system. What is the difference between the Hepatitis B surface antibody (anti-HBs) and Hepatitis B core antibody (anti-HBc)?
What should the healthcare provider assess a newly diagnosed client with Crohn's Disease for?
What should the healthcare provider assess a newly diagnosed client with Crohn's Disease for?
A nurse working in an endoscopy center is providing care for a client undergoing a colonoscopy for colorectal cancer screening. After the procedure, the client reports severe abdominal pain and significant rectal bleeding. What is the nurse's priority action?
A nurse working in an endoscopy center is providing care for a client undergoing a colonoscopy for colorectal cancer screening. After the procedure, the client reports severe abdominal pain and significant rectal bleeding. What is the nurse's priority action?
How might social determinants of health (SDOH) (e.g., lack of healthcare access and low socioeconomic status) impact the management of chronic hepatitis?
How might social determinants of health (SDOH) (e.g., lack of healthcare access and low socioeconomic status) impact the management of chronic hepatitis?
A nurse is to administer lactulose to a client with liver failure. What is the best anticipated therapeutic affect of lactulose?
A nurse is to administer lactulose to a client with liver failure. What is the best anticipated therapeutic affect of lactulose?
A client with a history of stable angina reports experiencing chest pain. After administering sublingual nitroglycerin, the client continues to have chest pain with no relief. What should the nurse do next?
A client with a history of stable angina reports experiencing chest pain. After administering sublingual nitroglycerin, the client continues to have chest pain with no relief. What should the nurse do next?
A nurse is caring for a client with acute decompensated heart failure. After placing the patient in High Fowler's position and applying supplemental oxygen, which assessment finding would indicate the interventions have been effective?
A nurse is caring for a client with acute decompensated heart failure. After placing the patient in High Fowler's position and applying supplemental oxygen, which assessment finding would indicate the interventions have been effective?
A client with aortic stenosis is being discharged. The nurse is providing education on activity restrictions. Which statement by the patient would require the nurse to follow up with additional teaching/clarification?
A client with aortic stenosis is being discharged. The nurse is providing education on activity restrictions. Which statement by the patient would require the nurse to follow up with additional teaching/clarification?
A patient with newly diagnosed heart failure with reduced ejection fraction (HFrEF) is receiving education on how to monitor daily weights at home. Which statement, if made by the client, would indicate a need for further instruction?
A patient with newly diagnosed heart failure with reduced ejection fraction (HFrEF) is receiving education on how to monitor daily weights at home. Which statement, if made by the client, would indicate a need for further instruction?
A client with ulcerative colitis is experiencing severe abdominal cramping, frequent bloody diarrhea, and weakness. The nurse anticipates which order from the healthcare provider?
A client with ulcerative colitis is experiencing severe abdominal cramping, frequent bloody diarrhea, and weakness. The nurse anticipates which order from the healthcare provider?
A client with acute hepatitis B exhibits signs of hepatic encephalopathy, including confusion and asterixis. Which dietary modification prescribed by the provider should the nurse question?
A client with acute hepatitis B exhibits signs of hepatic encephalopathy, including confusion and asterixis. Which dietary modification prescribed by the provider should the nurse question?
A patient with newly diagnosed Crohn's disease is being educated by the nurse on how to best manage symptoms at home. Which statement by the patient would indicate a need for clarification?
A patient with newly diagnosed Crohn's disease is being educated by the nurse on how to best manage symptoms at home. Which statement by the patient would indicate a need for clarification?
Which statement made by a pregnant woman, who has been diagnosed with hepatitis C, would require the nurse to clarify information about disease transmission?
Which statement made by a pregnant woman, who has been diagnosed with hepatitis C, would require the nurse to clarify information about disease transmission?
A client who has endocarditis suddenly reports flank pain. What should the nurse do first?
A client who has endocarditis suddenly reports flank pain. What should the nurse do first?
If a client with a history of stable angina states the chest pain they are experiencing is a 9/10, what diagnostic is appropriate?
If a client with a history of stable angina states the chest pain they are experiencing is a 9/10, what diagnostic is appropriate?
Flashcards
Atherosclerosis
Atherosclerosis
Hardening and stiffening of the arteries.
Cardiac Labs
Cardiac Labs
CBC, cardiac enzymes, coagulation studies, lipid panel. These help assess cardiac function and risk factors.
Cardiac Diagnostics Approach
Cardiac Diagnostics Approach
Least invasive to most invasive. Start with the simplest tests first.
Cardiac Stress Test
Cardiac Stress Test
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Angiography Nursing Management
Angiography Nursing Management
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Medical Management Goals for CAD and Angina
Medical Management Goals for CAD and Angina
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Why use Beta Blockers for Cardiac Issues?
Why use Beta Blockers for Cardiac Issues?
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Calcium Channel Blockers
Calcium Channel Blockers
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ACE Inhibitors & ARBs
ACE Inhibitors & ARBs
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Nutrition Recommendations for CAD/Chronic Angina
Nutrition Recommendations for CAD/Chronic Angina
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Lifestyle Modifications for CAD/Chronic Angina
Lifestyle Modifications for CAD/Chronic Angina
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Early Signs of Valvular Heart Disease
Early Signs of Valvular Heart Disease
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Goals of Medication Regimen (Valvular Heart Disease)
Goals of Medication Regimen (Valvular Heart Disease)
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Mechanical Heart Valves
Mechanical Heart Valves
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Biologic Heart Valves
Biologic Heart Valves
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Lab Monitoring for Valvular Heart Disease
Lab Monitoring for Valvular Heart Disease
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Heart Failure Symptoms
Heart Failure Symptoms
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Diagnostic tests for Heart Failure
Diagnostic tests for Heart Failure
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First-line medication goals (Heart Failure)
First-line medication goals (Heart Failure)
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Crohn's vs. Ulcerative Colitis
Crohn's vs. Ulcerative Colitis
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Diverticulitis
Diverticulitis
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Clinical Manifestations of Diverticulitis
Clinical Manifestations of Diverticulitis
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Risk Factors for Colorectal Cancer
Risk Factors for Colorectal Cancer
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Diet & Lifestyle recommendations for Hepatitis
Diet & Lifestyle recommendations for Hepatitis
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Cholecystitis Assessment
Cholecystitis Assessment
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Hepatitis Clinical Manifestations
Hepatitis Clinical Manifestations
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Rapid chest pain relief
Rapid chest pain relief
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Avoid anti-diarrheal.
Avoid anti-diarrheal.
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Spread of Hepatitis C.
Spread of Hepatitis C.
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Coronary Artery Disease Risk Factors
Coronary Artery Disease Risk Factors
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Positive vs negative query
Positive vs negative query
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Diuretics
Diuretics
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Pulmonary Congestion
Pulmonary Congestion
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Patients with aortic stenosis need to avoid Nitroglycerin
Patients with aortic stenosis need to avoid Nitroglycerin
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Hypovolemia symptoms after surgery
Hypovolemia symptoms after surgery
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Hepatic encephalopathy
Hepatic encephalopathy
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NSAIDS
NSAIDS
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Fever and rebound test.
Fever and rebound test.
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Rest Up
Rest Up
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Sudden generalized abdominal pain.
Sudden generalized abdominal pain.
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Intake and Output
Intake and Output
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Valvular Heart Disease
Valvular Heart Disease
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Broken down in the body and can only indicate one!
Broken down in the body and can only indicate one!
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Education with K+ wasting diuretics
Education with K+ wasting diuretics
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Study Notes
- The notes are for Exam 2 and cover chronic health alterations, including cardiac conditions (Parts 1 and 2) and GI & Hepatitis.
Coronary Artery Disease (CAD) and Angina
- Key considerations include differentiating between modifiable and non-modifiable risk factors
- Atherosclerosis involves the hardening and stiffening of arteries, impacting how the disease manifests
- Chronic angina needs to be distinguished from myocardial infarction (MI) based on clinical manifestations
- Diagnostic labs to consider: CBC, cardiac enzymes, coagulation studies, and lipid panel, noting that cardiac patients will have different ranges than average
- Diagnostic approach: Start with the least invasive methods and progress to more invasive ones
- The cardiac stress test can be performed via treadmill or chemical stress
- Angiography is a diagnostic option
- Nursing management includes pre- and post-angiography care, focusing on client education and care management
Gender Differences in Heart Attack Manifestations
- Heart attack symptoms can vary significantly between men and women
Medications for CAD and Angina
- Medical management aims to reduce the risk and incidence of clots and decrease the workload on the heart
- Statins are used
- Anti-platelet aggregates are utilized
- Vasodilators like Nitro are administered sublingually every 5 minutes, up to 3 doses; 911 must be called if pain persists after the first dose
- Beta Blockers, Calcium Channel Blockers, ACE inhibitors, or ARBs are also used
- Education should include the mechanism of action, when to notify the provider, and what labs to monitor
Why Cardiac Medications are Used
- Beta Blockers reduce excessive sympathetic stimulation and prevent cardiac remodeling, which is vital in heart failure with reduced ejection fraction (HFrEF)
- Calcium Channel Blockers: Dihydropyridines like Amlodipine are preferred in heart failure because others can worsen HFrEF; these reduce afterload
- ACE Inhibitors & ARBs: Considered first-line treatments for HFrEF with an ejection fraction ≤40%; reduce both preload and afterload, prevent cardiac hypertrophy and fibrosis, and reduce fluid overload by promoting sodium excretion
Discharge Education for CAD/Chronic Angina
- Nutrition: Review recommendations for fats, cholesterol, red meat, salt intake, omega-3s, and complex carbs/fiber
- Lifestyle: Consider exercise and smoking cessation
Valvular Heart Disease
- Clinical manifestations resemble heart failure
- Risk factors are important
- Patients can be asymptomatic for years; fatigue and a possible murmur may be the first signs
- Dysfunction must be assessed: Mitral vs. Aortic Valve
- Diagnostics: EKG, CXR, Echocardiogram
- Medication goals: Reduce the workload of the heart and fluid volume
- Surgical Management: Involves types of valve replacements
- Mechanical valves last longer but pose a thromboembolism risk, necessitating long-term anticoagulation
- Biologic valves do not necessitate long-term anticoagulation but don't last as long
- Lab monitoring: Coags (PT/PTT/INR)
- Assessment is the same as with heart failure
Heart Failure
- Risk factors should be analyzed
- Right- vs. Left-Side HF considerations, with Left-Side HF causing Pulmonary Congestion and Right-Side HF causing Venous back-up
- Diagnostics: Echo, CXR, Stress Test, Angiography, BNP
- First-line medication goals: Reduce heart workload and increase contractility
- Education: K+ wasting diuretics and the implications of quickly removing fluid, also what to watch for
- Education: Low sodium food options, slowly increase exercise tolerance, and manage fluid restriction
GI Conditions & Hepatitis
- The section covers Crohn’s Disease, Ulcerative Colitis, Diverticulitis/Diverticulosis, Colon CA, and Hepatitis
GI Conditions: Inflammatory Bowel Disease (IBD)
- Crohn's Disease:
- Affects from mouth to anus, all bowel layers, with skip lesions and deep ulcerations
- Induces 5-6 loose stools per day
- Causes malabsorption of nutrients
- Ulcerative Colitis:
- Affects the large intestine, specifically the mucosa and submucosa
- Spreads uniformly
- Induces diarrhea (>20 stools/day), liquid, watery, bloody, with mucus
- Diagnostics: Colonoscopy, barium enema, labs
- Medical Management: Includes medications, nutrition, and supplementation
- Surgery: Curative for UC but not for Crohn's
- Nursing Management:
- Teaching about when to call 911
- Emergent situations include high fever, sudden abdominal pain, and dehydration
- Education: Small frequent meals and rest periods
- Teaching about when to call 911
GI Conditions: Diverticulitis
- Involves outpouching due to decreased fiber, slow stool transit time, and pressure from straining
- Manifests with fever, LLQ or mid-abdominal pain, cramping
- Complication: Perforation, necessitating concern for immediate pain relief
- Diagnostics: Abdominal XR, CT
- Nursing Management: Fluids, NPO, NG tube, pain control
- Discharge and At-Home Management tips:
- Diet: manage high and low fiber intake, avoid nuts and seeds during flare-ups
- Maintain a healthy BMI
- When to call 911: high fever, abdominal pain >3 days, GI bleed
GI Conditions: Colorectal Cancer
- Risk factors: High BMI, alcohol and tobacco use, T2DM, IBD > 10 years
- Clinical Manifestations:
- General: Fatigue, unexpected weight loss
- Specific: Abdominal pain/distention, changes in bowel regularity/appearance, red or black stool
- Screening (Age 45-75):
- FOBT: Annually
- Sigmoidoscopy: Every 5 years
- Colonoscopy: Every 10 years
- Start screening before 45 if high risk
- Medical Management: Chemo, radiation, surgery
- Nursing: Intake/output, pain management, diet/fluid status, NGT, promote activity
Hepatitis
- Differentiate between hepatitis types: how it’s spread, causes, risk factors, acute or chronic
- Clinical Manifestations: Abdominal pain, irritability, pruritis, fever, N/V, jaundice
- Diet: Small, frequent meals with supplements
- Diet modifications include:
- Low fat and moderate protein intake
- Encourage activity
- Education: When to call 911: change in mental status, weight loss, high fever for several days
- Nutrition:
- Small frequent meals
- Limit fats
- Diet should include:
- Moderate protein
- Adequate hydration
- Avoidance of items known to be hepatotoxic
- Consider hygiene, vaccination, water source, and risk-taking behaviours
Cholecystitis
- Remembering that "Itis" indicates infection
- Clinical Manifestations:
- RUQ "colicky" intermittent pain that can radiate to the back, rebound tenderness & guarding
- Pain/complaints often occur after eating a large meal
- Possible N/V and jaundice
- Management includes being NPO
- Focus on pain management and medications
- IV antibiotics
- Medications to dissolve gallstones.
- Consider surgery
- Education: Promote bed rest in Semi-Fowlers, avoiding lying flat
- Diet: Avoid fatty foods and heavy alcohol use while encouraging bland foods with probiotics, whole grains, fruit and lean meats.
- Check VS, skin turgor, pain and do abdmonial assessments
- Check daily weight and monitor nutritional intake/output
- Interventions might include inserting a NG tube to allow GI to rest
- Indications to call 911 would be sudden generalized abdominal pain and high fever
Test-Taking Strategies
- Focus on data provided and not personal assumptions
- Base answers on the information provided
- Watch out for strategic words like "immediate"
- Identify if the question is positive or negative query
- Use the process of elimination and reread the question before finalizing
Clinical Judgement
- When answering questions, the NCSBN Clinical Judgement Model components are:
- Recognizing Cues.
- Analyzing Cues.
- Prioritizing Hypotheses.
- Generating Solutions.
- Taking Action. -Evaluating Outcomes.
Managing a Complex Question (Example):
- A client who had surgery 2 hours earlier, that arrives from PACU with elevated vitals.
- Implement the order for a type and crossmatch, preparing for possible blood transfusion as the priority
Cardiac Question #1:
- With a 65- year old client with chronic angina that reports chest pain while watching television, administer sublingual nitroglycerin and reassess in 5 minutes
- Administer nitroglycerin as a priority as prescribed
- Option C is appropriate for unstable angina or MI
Cardiac Question #2:
- A client with acute decompensated heart failure presents with dyspnea, orthopnea, and bilateral crackles to optimize oxygen apply supplemental oxygen, placing the patient in high fowlers.
Cardiac Question #3:
- Clients with aortic stenosis should avoid nitroglycerin, due to symptom management and sudden drops in blood pressure that can lead to syncope.
Cardiac Question #4:
- A client with newly diagnosed heart failure should be discharged with instructions on daily weight monitioring
- They should know that 5 pounds in a week of fluid could mean they are retaining fluid
GI Question #1:
- A client that has ulcerative colitis reports severe abdominal cramping with bloody diarrhea, the priority is to start to prevent dehydration with normal saline.
GI Question #2:
- A client that has hepatitis B admitted with jaundice and right quadrant pain, also with confusion and lethargy with flapping hand tremors is priority to administer as prescribe lactulose and monitor their mental health
GI Question #3:
- A client with newly undiagnosed chrons disease and is talking to a nurse should know to avoid high-fat foods that can cause inflammation
GI Question #4:
- A pregnant women teaching nurse being digonised with hepatitis C is saying she needs to use a sepereate bathroom. You should interveen and tell her it is not spread in casual contact
Study Material for Exam Includes:
- Review PDFs, Study Guides, and Homework Assignments
- Pay attention to Dosage information, unit/liquid conversions, and calculations
- Review the Risk Factors & Clinical Manifestations
- See what is normal for new baselines and what is of concern
Additional Information:
- Exam 2 takes place on Wednesday, March 26 at 10:00 am ET for both sections.
- The Exam consists of 50 questions
- The exam is 75 minutes
- The Exam download will be available by Tuesday, March 25.
- You will receive an announcement regarding the room location prior to the exam.
- Scrap paper will be provided.
- Covers Modules 6, 7, & 8.
- Cardiac conditions parts 1 and 2 and GI conditions.
- Post-exam review will follow at 1:00 pm on March 26.
- Notes about your upcoming Community Health Challenges Assignment Leverage AI to explore how social determinants of health (SDOH) impact chronic disease outcomes in communities.
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