Test Review Exam 1 S4 PDF

# Topics : assessment of CV system dysonythmias · · hypertension deep vein thrombosis...

# Topics : assessment of CV system dysonythmias · · hypertension deep vein thrombosis · · hypertensive disorders in pregnancy pulmonary embolism · · - Chapters : 18 : Perfusion 35 : Assessment : ev system 36 : Hypertension 39 : Dysrhythmias QUIZLETS: https://quizlet.com/Salmeron_12/folders/ah2-exam-1?i=1l2jpv&x=1xqY NURSING INTERVENTION FOR PE : BED REST check OXYGEN & give if needed Pain management Meds: Heparin &warfarin MONITOR ARTERIAL PRESSURE HIGH FOWLERS ABG level CAP REFILL PULSE HEART-SOUNDS AND RHYTHM check for JVD: 30-45 degrees CT SCAN OF LUNGS W/CONTRAST: GOLD STANDARD SUDDEN SOB = PE ; SUDDEN CONFUSION = STROKE CLINICAL MANIFESTATIONS for PE: Dyspnea AND PLURATIC CHEST PAIN = MOST COMMON SYMPTOMS Feeling of impending doom, anxiety Mild to moderate hypoxemia (low level of oxygen in the blood) Tachypnea; cough; chest pain; hemoptysis (coughing up blood); crackles; wheezing; fever; accentuation of pulmonic heart sound; tachycardia; syncope (loss of consciousness) Peticahe in chest and arms: late symptoms Massive pe may cause a sudden change in mental status, hypotension, and feelings of impending doom FOCUSED CARDIAC ASSESSMENT : HEART AND LUNG SOUNDS PULSES - PERIPHERAL, DORSALES PEDIS , POSTERIOR TIBIALIS (feet) CAP REFILL: 2-3 seconds VITAL SIGNS : BP, TEMP, RR, O2, HR LOCATION OF HEART SOUNDS - AORTIC, PULMONIC, ERBS POINT, TRICUSPID, MITRAL ( APE To Man”) A: 2ND R ICS, P:2ND L ICS, E.P:3RD L ICS S1&S2) ,T: 4TH L ICS , M: 5TH L ICS, POINT OF MAX IMPULSE - 5TH INTERCOSTAL SPACE AT MIDCLAVICULAR LINE, AKA APICAL PULSE 6TH ICS- ENLARGED HEART - VENTRICULAR HYPERTROPHY (HTN) S1: LUB - first heart sound - low pitched S2: DUB - second heart sound - high pitched S3 : low intensity - use bell IN LEFT LATERAL POSITION NOT LEANING FORWARD!! — low pitched sounds (heart murmurs). Heard during diastole. — normal finding in children, pregnant women, and well trained athletes S4: almost always abnormal Don’t want to hear S3&S4 ** LISTEN TO APICAL PULSE 1 FULL MIN JVD: 30-45 DEGREES LAYING POSITION, ASSESS BOTH, ONE AT A TIME* TEMP AND COLOR - warm PRESENCE OF EDEMA : check extremities, clubbing fingers CARDIAC CATHETERIZATION: CAN BE USED AS A TX AND AN EMERGENCY PROCEDURE** PASSED INTO HEART THROUGH PERIPHERAL VEIN OR ARTERY (FEMORAL VEIN IS BIG & EASY) TEACHING BEFORE: TAKING METFORMIN? CONSENT FORM BASELINE VITALS AWAKE NO ANESTHESIA FLUSHED FEELING, WARM SENSATION - DYE (CONTRAST) SHELLFISH OR IODINE ALLERGIES CHECK URINE OUTPUT NPO FOR 4-6 HRS TEACHING AFTER: CANT CROSS LEGS FOR 4-6HR CHECK FOR BLEEDING COMPRESSION DEVICES: SCDS KEEP LEG STRAIGHT / ADEQUATE BED REST CHECK FOR CARDIAC PERFUSION ASK FOR SENSATION/ WIGGLE TOES HOLTER MONITOR HEART MONITOR TAKEN HOME 24- 48HRS DIARIES - JOURNALING ACTIVITIES SYMPTOMS FEELING IN ACTIVITY WIRED SO NO SHOWERING/BATHING CARDIAC STRESS TEST NO CAFFEINE NO SMOKING TREADMILL (AKA EXERCISE) STRESS TEST LEADS CONNECTED TO THEM MONITOR VITALS : HR, O2, BP, RR ONLY STOP IF DYSRHYTHMIAS APPEAR !!! SOB, HIGH HR, HIGH BP : NORMAL CAN ONLY DO IF PT IS STABLE ECHOCARDIOGRAM: EJECTION FRACTION TEE: TRANSESOPHAGEAL ECHOCARDIOGRAM INVASIVE IV SEDATION/ANESTHESIA NPO 6 HOURS REMOVE DENTURES BEFORE MAY HAVE SORE THROAT AFTER CANT EAT OR DRINK UNTIL THEY HAVE A GAG REFLEX CNA/UAP DELEGATION VITALS, ASSIST PTS, CAN PUT ON TELLY MONITOR, CAN DO ECG, CANT GIVE EDUCATION OR DISCHARGE, CANT GIVE INSULIN OR PT ASSESSMENT, ONLY ASSESS CAROTID PULSE ONE AT A TIME PRE-HYPERTENSION RF: PRE- ROUTINELY HIGH BP OBESITY HIGH SODIUM DIABETES SMOKING DRUGS HISTORY STAGES OF HTN: LOW: 90/60 or less STAGE 1: S:>130-139 / D: >80-89 STAGE 2: S: >140/ D: >90 HTN URGENCY: >180/120 : stroke risk or CVA - doesn’t require hospitalization HTN EMERGENCY: >220/140 - requires hospitalization MAP: DBP + 1/3 (SBP-DBP) OR SYSTOLIC + (2xDIASTOLIC) / 3 MAP RANGE: 70-110 MMHG CO- SV X HR BETA BLOCKERS: - LOLS ANTIHYPERTENSIVES — ARBS/ACES INHIBITORS/ MEDICATION ADHERENCE SLOW POS CHANGE MONITOR BP (LOWERS BP) PRIMARY HTN: HAS NO KNOWN CAUSE, DEV OVER TIME, MOST COMMON SECONDARY HTN: CAUSED BY ANOTHER MED CONDITION OR MED, LESS COMMON V-TACH: CODE BLUE (CHECK CAROTID PULSE) 150-250 BPM ISCHEMIC HEART DISEASE MOST COMMON NO P WAVE NO DEFINE QRS COMPLEX : WIDE LOOKS LIKE TOMBSTONES DEADLY!!! OFTEN LEADS TO V-VIB= DEATH HALLMARK SIGN: WIDE QRS STABLE: procainamide, lidocaine or amniodarone UNSTABLE: CRP & SHOCK CPR, EPI 1MG, 300 AMNIODARONE, DEFIBR, REPEAT CAUSES: MI, CAD, E IMBALANCE, DRUG TOXICITY A-FIB 350 - 600 BPM IRREG & CHAOTIC RHYTHM NO P WAVE !!! TREATMENT: RATE CONTROL CARDIOVERISION (SHOCK) IF UNCONTROLLED AMIODARONE : CORRECTS RHYTHM ANTICOAGULANT CATHETER ABLATION THERAPY, AMIODERONE MED FIRST, DIGOXIN V - FIB MOST SERIOUS COMPLICATION: SUDDED