NURS 222 Study Guide Exam #1 PDF

NURS 222 Study Guide Exam #1 Chapter 28 Dysrhythmias (AKA arrhythmia) 1. Signs and symptoms Palpitations Pounding in the chest/ chest discomfort/ tightness* Shortness of breath Dizziness Weakness or fatigue Anxiety/ Sweating Confusion 2...

NURS 222 Study Guide Exam #1 Chapter 28 Dysrhythmias (AKA arrhythmia) 1. Signs and symptoms Palpitations Pounding in the chest/ chest discomfort/ tightness* Shortness of breath Dizziness Weakness or fatigue Anxiety/ Sweating Confusion 2. Nursing intervention Monitor patients vitals Administer meds Provide oxygen therapy if needed ○ (From book) apply oxygen if oxygen saturation is below 94% or the patient is short of air Putting patient on 12-lead ECG (From book) If the heart rate does not increase sufficiently, prepare for transcutaneous or transvenous pacing to increase the heart rate. If treatment of the underlying cause does not restore normal sinus rhythm, the patient will require permanent pacemaker implantation. Sinus tachycardia *A heart rhythm arising from the SA node that is fast but regular Rate: The heart rate is greater than 100 beats per minute but usually will not exceed 180 bpm Rhythm: The rhythm is regular, with P waves and QRS complexes marching out P waves: The P waves are present and normal and are upright in front of every QRS complex. At very fast rates, the P waves may merge with T waves creating a camel hump appearance PR interval: This is normal and constant, between 0.12 and 0.20 seconds QRS complex: This is normal and less than 0.12 seconds after every P wave. Each QRS complex is preceded by a P wave Sinus Bradycardia *A heart rhythm arising from the SA node that is slow but regular A normal sinus rhythm with a rate of less than 60 bpm in adults  A normal upright P wave in lead II before every QRS complex Upright, consistent P waves that are normal in morphology and duration The PR interval between 0.12 and 0.20 seconds in duration Chapter 29 Cardiac Conditions 1. Heart Failure a. Signs and symptoms Left = lungs: pulmonary edema, dyspnea, fatigue, weakness, arm heaviness chest pain Right = rest of body: JVD, ascites, edema, wt increase, hepatomegaly RV cannot empty completely There is increased volume and pressure in venous system and peripheral edema b. Nursing teaching Lifestyle modifications Medication education/adherence When to seek help/contact provider Common s/s c. Nursing interventions Monitor RR Q1-4hrs Auscultate breath sounds Q4-8hrs High fowlers for dyspneic pt Improve gas exchange + output Meds - ACE, diuretics, beta-blockers Monitor wt daily d. Priority of care Decreased gas exchange Decreased perfusion Pulmonary edema 2. Mitral valve prolapse: valvular leaflets enlarge + prolapse into the left atrium during systole a. Signs and symptoms Most asymptomatic Chest pain Palpitations/dizziness/syncope Exercise intolerance Midsystolic click or late systolic murmur may be heard at apex  b. Nursing intervention Assess VS Auscultate Assess for s/s 3. Chronic obstructive pulmonary disease: an umbrella term for chronic bronchitis and emphysema a. Signs and symptoms Dyspnea Productive cough Hypoxemia Tachypnea Use of accessory muscles Barrel chest Clubbing of the nails Edema Cyanosis b. Laboratory as s/s and outcome evaluation Hematocrit = increase b/c low O2 levels Sputum cultures + WBC count used to diagnose acute respiratory infections ABGs Hypoxemia PaO2 < 80 Hypercapnia PaCO2 > 45 Blood electrolytes PFTs Chest x-ray Alpha 1 antitrypsin levels COPD Assessment Test c. Pathophysiology Chronic bronchitis: overproduction of mucus (hard to get air in) Emphysema: over distended alveoli (air trapping) d. Risk factors Smoking Long-term exposure to air pollution/secondhand smoke Alpha 1 deficiency-related emphysema Hx of childhood respiratory infection Older adults 4. Chest tube management a. Priority of care  Monitor vitals (O2, RR Frequent position changes Assess site for leakage b. Drainage system and nursing responsibility 3 chamber drainage system most common First chamber: drainage collection / Second chamber: water seal / Third chamber: suction control (wet or dry) Nurse responsibility Keep tubing kink + occlusion free Monitor for signs of respiratory distress Monitor chest tube drainage system + maintain documentation of output Keep these items within reach for an emergency ○ Two guarded clamps ○ Sterile water ○ Vaseline gauze ○ 4x4 sterile dressing ○ Waterproof tape Chapter 17 Human immunodeficiency virus ABOUT HIV: - Virus that attacks body’s immune system, progressively destroys certain white blood cells - AIDS is the most severe form of HIV infection (3 stages: acute, chronic, aids) - HIV enters CD4 T helper cells, becomes virus factory - Transition occurs mainly through blood, semen, vaginal fluid, and breast milk - HIV-1 and HIV-2 subtypes, 1 is the most common 1. Laboratory & signs and symptoms Laboratory: a. Serologic tests: Detect the body’s immune response to HIV, looking for antibodies or antigens  i. HIV antibody tests (ELISA, Western Blot): Detects antibodies to HIV in blood or saliva. Usually positive between 3-12 weeks after exposure ii. HIV Antigen/Antibody test (4th generation tests): Detects both antibodies and proteins of the virus. Early as 2-6 week detection b. Virologic tests: Directly detect the presence of the virus in the body. Focusing on RNA or viral particles i. HIV RNA Test (Viral Load Test): Measures amount of HIV RNA in blood. Can detect 1-2 weeks after exposure ii. HIV DNA Test: Used in certain causes (Newborns of HIV mothers) Signs/Symptoms: Stage I and II (Acute and Chronic) - Patients in stage I or II may be asymptomatic or have minor symptoms - Presence of flu-like symptoms (swollen lymph nodes, sore throat, fever) - Assess for opportunistic pathogens since their immune system is affected, common ones: candidiasis, cryptococcus, cytomegalovirus, TB) Stage III (AIDS) - Significant immune suppression, CD4 count below 200 cells/mm^3, severe weight loss, cancers (sarcoma, lymphoma) 2. Sexual history - Assessment for HIV risk - Partners: Number of current and past sexual partners - Practices: Types of sexual activity (vaginal, anal, oral) and frequency - Protection: Use of condoms or other barrier methods - Past History of STIs - Prevention of Pregnancy (if applicable) 3. Occupational needlestick protocol - Wash the wound, report the incident, risk assessment - Initiate PEP: ideally within 1-2 hours, a 28-day course of antiretroviral drugs - Baseline testing (HIV, Hep B, Hep C) - Follow-up testing (HIV testing at 6 weeks, 3 months, 6 months) Chapter 34 Hematology conditions  1. Anemia A reduction in either the number of RBCs, hemoglobin, or hematocrit. A clinical indicator (not specific disease); occurs with many health problems Causes: Dietary problems, genetic disorders, bone marrow disease, and excessive bleeding. a. Nutritional type Iron deficiency anemia, Vitamin B12 deficiency anemia, and Folic acid deficiency anemia b. Teaching Iron deficiency anemia ○ Increase oral intake of iron red meat, organ meat, egg yolks, kidney beans, leafy green vegetables, and raisins ○ Iron supplements iron losses are mild, oral iron supplements may be started until the hemoglobin level returns to normal If anemia is severe, iron solutions can be given parenterally Vitamin B12 anemia ○ Increase intake of foods rich in B12 animal proteins, fish, eggs, nuts, dairy products, dried beans, citrus fruits, and leafy green vegetables ○ Injections, oral preparations, nasal spray, sublingual cobalamin Folic acid anemia ○ Prevent deficiency with diet rich in folic acid AND vitamin B12 2. Sickle cell disease Genetic hemoglobin disorder Formation of abnormal hemoglobin chains ○ Normal: is hemo. A ○ Sickle cell is hemo. S Cells are then distorted into sickle shapes which clump together Clumps block blood flow; tissue becomes hypoxic a. Laboratory HPLC Sickle cell screen Hemoglobin S b. Pain management Drug therapy (ex: opioids) ○ Administration of IV analgesics (Morphine and hydromorphone) either scheduled or by (PCA). ○ Once relief is obtained, the IV dose can be tapered and the drug can be given orally. ○ Avoid “as needed” (PRN) schedules because they do not provide adequate relief. ○ Moderate pain may be managed with oral doses of opioids or NSAIDs. Hydration via IV or oral  Integrative therapies (warm room, comfort, etc) c. Sickle cell crisis Teach pt how to prevent crisis and complications ○ Drink at least 3 to 4 L of liquids every day. ○ Practice deep breathing to facilitate gas exchange. ○ Wear socks, hats, gloves, and a coat when going outside on cold days to avoid getting too cold. ○ Avoid consuming alcoholic beverages and illicit substances, cigarettes or using tobacco or nicotine in any form, strenuous physical exercise, exposure to hot and cold temperature extremes, getting overheated and overexposure to the sun, airplanes with unpressurized passenger cabins, and traveling to areas of high altitudes. ○ When you are not in crisis, engage in mild, low-impact exercise three times a week. ○ See your primary health care provider for regular checkups. ○ Get an influenza immunization and a COVID-19 immunization every year. ○ Ask your primary health care provider about receiving the pneumonia vaccine. ○ Contact your primary health provider at the first sign of illness or infection. ○ Notify all health care providers that you have sickle cell disease, especially the anesthesia provider and radiologist. d. Reporting to the provider Report pain to be maintained at an acceptable level If priapism is present, report this finding to the health care provider 3. Blood transfusion a. Emergency management 4. Thrombocytopenia Thrombocytopenic purpura is the destructive reduction of circulating platelets after normal platelet production. Three common types are immune thrombocytopenic purpura (ITP), (formerly called idiopathic thrombocytopenic purpura), thrombotic thrombocytopenia purpura (TTP), and heparin-induced thrombocytopenia (HIT). a. Signs and symptoms ITP- easy bruising and purpura TTP– purpura, pallor, weakness, fever, RBC’s in urine HIT- mild, spontaneous resolving reaction; sudden onset of pain, redness, extreme swelling b. Nursing intervention Interventions include protection from bleeding episodes and therapy for the different underlying condition ITP- Corticosteroids, drug therapy, splenectomy TTP- Plasma exchange, drug therapy HIT- D/C of heparin, administer alternate non heparin anticoagulant Chapter 18 Cancer 1. Palliative care  2. Chemotherapy a. Assessment Primary: identified by the tissue from which it arose (parent tissue) Secondary: cancer cells move from primary location by breaking off and establishing remote colonies Classification: ○ Grading ○ Ploidy (look at disruption of cancer cells by chromosomes and their appearance) ○ staging (clinical, surgical, pathologic) (seeing if it spreaded) ○ TNM-tumor, node, metastasis (how big is the cancer) ○ Doubling time and mitotic index Impact of cancer on physical function: ○ Immunity and clotting ○ GI function ○ Peripheral nerve sensory perception ○ Central motor and sensory deficits ○ Respiratory and cardiac function ○ Cancer pain and quality of life b. Nursing intervention c. Teaching Primary prevention ○ Avoidance of known or potential carcinogens ○ Modifying associated risk ○ Removal of “at risk” tissue ○ Chemoprevention ○ Vaccination (HPV) Secondary prevention ○ Regular screening d. Medications e. Neuropathy f. “Nadir” of bone marrow activity g. Complications 3. Radiation Uses high-energy radiation to kill cancer cells Usually given in divided doses over a set time Delivery methods: ○ external beam- outside source ○ Brachytherapy- internal radiation therapy a. Side effects Acute and long-term Vary according to radiation site Radiation dermatitis Altered taste  Fatigue Bone marrow suppression Chemotherapy- Temporary and permanent damage can occur to normal tissues CTCAE- standardized grading scale to evaluate and document common side effects: ○ Neutropenia ○ Thrombocytopenia ○ Alopecia ○ Mucositis ○ Skin changes ○ anxiety b. Skin care c. Teaching Bone marrow suppression: ○ Protect patient from infection ○ Teach AP, patient and family how to reduce infection in the home ○ Report signs of infection ○ Good handwashing ○ Bleeding precautions ○ Electric shaver ○ Mouth care ○ Avoid contact sports, activities involving bumping, scraping, scratching