Med Surg II Exam 1 Information PDF

lOMoARcPSD|22876375 Med Surg II exam 1 - information Medical-Surgical Nursing II (Herzing University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by S. Elissa ([email protected]) ...

lOMoARcPSD|22876375 Med Surg II exam 1 - information Medical-Surgical Nursing II (Herzing University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 Thrombolytic therapy is aimed at “busting up clots.” Receiving this therapy puts patients at risk for bleeding. For a small amount of bleeding from an IV site, apply pressure to the site first. A large amount of oozing would require physician intervention and the stopping of the therapy. Heparin therapy is common intravenously for A-Fib in the hospital. What lab value do we monitor when adjusting the IV dose? We monitor the aPTT value (activated partial thromboplastin time). Normal value is between 25-35 seconds. If a value came back as 35, we would need to increase the heparin rate to be therapeutic. We do not want a normal clotÝng time in this case. What teaching is needed when sending clients home after a mitral valve replacement? Report any bleeding or bruising immediately because they will be on warfarin therapy for three months. Their INR value should be 2-3.5 to be therapeutic. It is not necessary to obtain antibiotics prior to dental procedures unless they have had a mechanical valve replacement. What is the window for getÝng a patient to a percutaneous coronary intervention after an MI? The goal is within 90 minutes of arriving to the hospital. When would a cardiac stress test be performed? A cardiac stress test is performed as part of a workup for cardiac intervention. They are not to be performed on a patient who has had an MI within the last 48 hours. Which noninvasive test is the basic “first” for cardiac diagnostics? Echocardiogram is non-invasive A TEE, CT, or MRI are considered invasive. Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 Teaching for Beta-Blockers Change position slowly, beta-blockers reduce HR and BP. Report any dizziness or difÏculty breathing. Never stop abruptly unless having an allergic reaction. Cyclosporine after a heart transplant Common side effects: edema, vomiting, tremors, abdominal pain, decreases in the body’s ability to fight infections, high BP, and kidney damage. Signs and symptoms of endocarditis Fever, chills, fatigue, night sweats, heart murmurs. Endocarditis is inflammation of the heart valves. What exhibits pain in the legs while walking, but goes away when resting? Arterial insufÏciency. Check basic labs and serum cholesterol levels. The legs would be pale, cool, and have reduced pulses. Myocarditis and causes Myocarditis symptoms include chest pain, abnormal HR and shortness of breath. The causes can be viral, fungal, or bacterial, but viral is the most common cause. A person with atrial fibrillation is at risk for which complications? Forming clots or thrombi can lead to 20% of all strokes. Thrombolytic therapy is aimed at “busting up clots.” Receiving this therapy puts patients at risk for bleeding. For a small amount of bleeding from an IV site, apply pressure to the site first. A large amount of oozing would require physician intervention and the stopping of the therapy. Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 Which labs are elevated with an acute MI? Elevated creatin-kinase-MB (CK-MB) and Troponin levels. Your patient is exhibiting signs of angina and feels a heaviness in their chest while ambulating. What steps do you take first? Have the patient sit down immediately. Apply oxygen and get vital signs. Follow the protocol for nitroglycerin administration. Remain calm and stay with your patient. What are the characteristics of normal sinus rhythm? Regular rhythm, a p-wave before every QRS complex, heart rate between 60-100 beats per minute. How does smoking affect cardiac function? Smoking or nicotine causes vasoconstriction and spasms of the arteries that lead to reduced cardiac output and coronary artery constriction which can cause heart attacks. Myocardial infarction first aid: MONA: morphine to reduce pain, oxygen to prevent ischemia, aspirin for anti-platelet, nitroglycerin to vasodilate. Preparing male clients for an ECG: Apply electrodes to skin with slight pressure, connect electrodes to lead wires, do not shave excess hair with a razor, and trim hair with scissors. Amiodarone administration nursing actions: Amiodarone can cause induced pulmonary toxicity if patients have poor pulmonary function. Baseline testing should include pulmonary function studies with compromised patient populations such as the elderly. Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 What are two medications that can decrease the heart rate in atrial fibrillation? Diltiazem (Cardizem) and beta-blockers such as metoprolol can reduce the heart rate in atrial fibrillation. Your patient has chronic atrial fibrillation and is admitted to your unit and placed on telemetry. What action would be appropriate to take? The telemetry alarm will sound with atrial fibrillation, so turn off the irregular heart rate rhythm. The telemetry alarms for lethal heart rates, such as VFIB & VT, are unable to be turned off and are safety measures. What part of the rhythm strip represents ventricular depolarization? The QRS complex represents the depolarization of the ventricles. What are risk factors for developing AFIB? Age, high BP, obesity, family history, sleep apnea, previous heart disease, ETOH, diabetes, asthma, white race. Your patient weighs 250 pounds. You are to administer medication dosed at 0.25mg/kg. How many mg do you give? Round to the nearest tenth. 250 pounds divided by 2.2 = 113.63 kg 113.63 kg x 0.25 mg = 28.40 28.4 mg will be given What instructions are given before a stress test? Do not eat or drink anything 3 hours prior, do not smoke before the test, report any chest pain during the test, and wear comfortable clothes. Do not hold your regular medications. Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 List the modifiable risk factors for developing atherosclerosis. This is usually a SATA question We can’t modify our race, age, or family history, but we can modify our hypertension, Type II Diabetes, stop smoking, and diets. What type of angina occurs only at night? What kind occurs only at rest? Variant angina occurs only at night, while prinzmetal angina occurs only during rest. Which lab values are monitored before administering ezetimibe to a client with atherosclerosis? Ezetimibe (Zetia) lowers high cholesterol. A contraindication would be patients with liver disease, or pregnant and nursing mothers. Which assessments would be included when performing a baseline assessment for a client with cardiomyopathy? SATA type question Take vital signs, weight, heart and lung auscultation, and pulse pressures. Teaching topics for taking/storing nitroglycerin tablets. Take a maximum of 3 doses five minutes apart. If pain is not gone, go to the ER…might be a heart attack. Side effects are dizziness and headaches. Tablets are sensitive to the environment so keep in the original bottle and store out of the light. Replace every 6 months. Cholesterol lowing medications (Statins) teaching cues: Limit high-cholesterol foods, take pills at the same time every day, and do not drink grapefruit juice. Side effects are leg and muscle cramps. Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 Teaching a client with atherosclerosis and peripheral artery disease how to lessen leg pain. When walking is painful, limit activity and rest. Do not elevate legs higher than your heart. You can use a heating pad on your abdomen to increase blood flow to your legs. Applying cold compresses to your legs after exercise makes the pain and circulation worse. Angina or an MI? ANGINA: usually brought on by exertion or stress, pain lasts under 15 minutes and is relieved by nitroglycerin, no nausea and vomiting, anxiety, or diaphoresis. MI: can occur anytime, the pain lasts over 15 minutes and is relieved with morphine or opioids, patients are anxious, restless, short of breath, can have nausea and vomiting, and have diaphoresis. Which positioning helps to reduce pain in pericarditis? Supine, lateral, and prone to do relieve pain in pericarditis, but orthopneic has been shown to be helpful. Orthopneic positioning is also referred to as the tripod position. Endocarditis, myocarditis, or pericarditis? Endocarditis: inflammation of the heart valves Myocarditis: inflammation of the innermost layer of heart muscle Pericarditis: inflammation of the thin membrane surrounding the heart Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 Risk factors for atrial fibrillation: Risk factors include high blood pressure, family history, history of heart failure, and diabetes. Atrial fibrillation is the most common and controllable heart arrhythmia and can even be seen in children from early age upwards. Downloaded by S. Elissa ([email protected])