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nrb 132 exam 1 - mostly cardiac
mostly cardiac content (few meds) some perioperative, behavioral health content
Terms in this set (96)
T or F: perioperative is for during and after surgery
T or F: leg exercises are good for venous return
T or F: the nurse is responsible for explaining risk of surgery to the patient
false; that is the surgeon's job
T or F: time out refers to taking the time to check the correct patient for the correct surgery and body part
why is it important to encourage deep breathing after surgery?
to expel anesthesia gases, keep alveoli from collapsing, manage pain and overall maintain airway patency
T or F: regional anesthesia puts the patient to sleep and cannot respond to verbal stimuli
false - it is the opposite
The patient is NPO the morning of surgery should the nurse administer oral medications that are due?
no- the nurse should check with the HCP before administering
who is propofol contraindicated in?
patients who are allergic to eggs
how is cardiovascular stability monitored post-op?
vital signs and levels of consciousness
what are prophylactic antibiotics good for perioperatively?
preventing infection post-op
T or F: the best active listening approach is sitting with arms and legs uncrossed, leaning forward and establishing eye contact
what are some assessment findings of moderate anxiety?
selectively attentive, narrowed perceptions and irritability
what is Lorazepam effective for?
what kind of opening is best in therapeutic communication?
broad such as "what would you like to discuss"
what is the assessment tool used to diagnose and assess mental health?
what kind of boundaries are broken when a patient asks for your cell phone number?
what best describes the phrase "you have a capable physician I'm sure he has your best interests in mind."
non-therapeutic communication- defending
what neurotransmitter imbalance results in anxiety?
GABA is hypoactive
A nurse is caring for a patient who smokes and has lung cancer but claims the cough is from a cold. What defense mechanism does this represent?
T or F: the word veracity implies the duty to always be truthful
what are some psychotic disorders?
major depressive disorder, schizophrenia, bipolar
what are some neurotic conditions?
anxiety, phobias, PTSD, panic disorders
how is psychosis best treated?
medication, therapy also beneficial since it is chronic
how is neurosis best treated?
therapy but could benefit from medication. can be chronic or temporary
what is the difference between benzos and non-benzos?
benzos cause sedation while non-benzos do not
T or F: some common symptoms in a person having cardiovascular problems include dizziness and pain in jaw
what are some non-modifiable risk factors for cardiovascular disease?
gender, age, race, genetics (family hx)
what is hypertension defined by?
130/80 BP or higher on at least 3 readings
T or F: physical activity 30 minutes a week is adequate for someone with CV disease
false- it should be 30 minutes everyday
how is stable angina characterized?
pain relief from nitroglycerin and rest
what is a critical marker for myocardial injury?
elevated troponin levels and elevated CK-MB levels, not lipid profile
name all the medications for hypertension
2. beta blockers
3. calcium channel blockers
4. ACE inhibitors
7. Central Alpha Agonists
8. Alpha blockers
how can you recognize diuretics?
how can you recognize beta blockers?
how can you recognize calcium channel blockers?
ends in -pine
how do you recognize ACE inhibitors?
ends in -pril
how do you recognize statins?
ends in -statin
how do you recognize ARBs
ends in -tan
what does the nurse assess during a cardiac health history?
anything related to cardiac, if they have a cardiologist, lifestyle (exercise, diet, sleep, stress/mental health) family history, pacemaker, any symptoms or changes in past year, medication history, social history and risk factors (smoking, drinking, illicit drugs), elimination habits
what are some common symptoms of CVD?
-pain in chest or arm, jaw, neck, stomach, back
-SOB or dyspnea
-peripheral edema and weight gain
-palpitations and tachycardia
-fatigue, dizziness and syncope
what is SDB/OSA?
sleep-disordered breathing and obstructive sleep apnea- abnormal breathing in sleep stresses the heart untreated and can lead to HTN, HF, CAD
what are the important cardiac enzymes/biomarkers and how would they be tested?
-troponin T & I would be elevated
-CK (MB) elevated - creatine kinase
in increments, like 3x once q8hours
what do elevated cardiac enzyme results suggest?
how long can troponin levels be elevated from a MI?
within a few hours of MI up to 14 days
how long would CK-MB be elevated after MI?
within a few hours, peaking at 24 hours and finished by 48. (about 2 days)
how soon after reported chest pain would myoglobin levels be up?
within 24 hours
what is a lipid profile test?
other cardiac lab test that measures cholesterol HDL/LDL and triglycerides
what is a BNP test?
B-type natriuretic peptide, neurohormone that regulates BP and fluid volume. measured periodically for a decrease in HF
what is a C-reactive protein test?
measures inflammation and high levels indicate risk for CVD
what is a homocysteine test?
amino acid linked to development of atherosclerosis, damage to vessel walls and formation of thrombus. elevated levels indicate CVD, stroke, or PVD.
what do elevated BUN and creatinine levels indicate?
decreased kidney function possible result of CVD
how does CBC relate to cardiac alterations?
low levels mean higher risk for MI, or angina and medications may interact.
how may CVD impact coagulation studies?
a lot of CVD medication alters coagulation like blood thinners so these need to be monitored
how are chest X-rays and fluoroscopies used for the cardiovascular system?
measure size, contour and position of heart. fluoroscopy more clear image both used for potential positioning of pacemaker or other catheters
electrocardiography detects cardiac irregularities like in
, can detect
ischemia or infarction
, electrolyte disturbances like calcium or potassium
pick up symptoms like chest pain or SOB, those need to be reported
what is an important nursing implication for cardiac telemetry electrodes?
making sure there is no skin irritation or breakdown under electrodes if used for long period of time
what is a holter monitor?
continuous, ambulatory cardiac monitor for at least 24 hours that detects arrhythmias or ischemia or reason behind syncope, needs to log any symptoms
describe the cardiac exercise stress test
-stress out cardiovascular system to see response and potential CVD
-test chest pain, CV function, medications, issues during exercise, like dizziness
-exercises to increase heart rate and is continuously monitored during and 15 mn after
what are some implications of the stress test
-avoid stimulants before
-needs to fast
-doctor may stop beta-blocker medications prior
-need clothes and sneakers for exercise
-may have IV line
-report symptoms during test
-if contraindicated like disability, pharmacologic stress test (dilating agents adenosine and dipyridamole)
describe transthoracic echocardiography
noninvasive ultrasound that shows size, shape and motion which can diagnose murmurs, effusion, heart valve and wall function
describe the TEE test
-6 hour fast prior
-informed consent for moderate sedation and anesthetic, pt asked to swallow
-assess any dysphagia or radiation therapy and gag reflex afterwards
describe radionuclide tests
-check for allergies due to agents used
very little radioactivity
-assess function of ventricles, accurate perfusion, ischemia, assessed after rest/exercise
-MUGA, SPECT, PET, cardiac CT, MRA
describe SPECT test and some nursing implications
-determines if CAD is cause of chest pain or other s/s, done after MI
-patients put hands over head and get IV isotope
describe PET test and nursing implications
-evaluate severity of CAD and perfusion, damage from MI, circulation
-refrain from tobacco or caffeine 24 hours before
-lie still with arms over head, may need medications if claustrophobic
-glucose needs to be in range
-fasting/NPO status depends on facility
describe cardiac CT test
-evaluates images of four chambers, valves, pericardium, arteries and veins and any masses
-not for pregnant women or renal issues
what are some nursing implications for cardiac CT test?
-IV hydration may be needed due to dye
-may need beta-blockers before test to slow HR, if too fast imaging is not clear
-must remain still for test
-may experience transient flushing, bradycardia, metallic taste or nausea are possible symptoms
assess kidney function before and after test
describe MRA test and implications
-magnetic field to examine heart and vessels like diagnosing aorta, heart muscle and other abnormalities
-may not be that clear cannot visualize coronary arteries
-screen for any metals like pacemaker, metallic implants, transdermal patches with aluminum or jewelry
-warn pt about noises and in motionless supine position
describe cardiac catheterization
-invasive procedure where catheters go into selected blood vessels in each side of the heart
-diagnose CAD and determine patency and structural effects of valves
-guided by fluoroscopy
-done in either groin or wrist
what are the nursing implications for cardiac catheterization
-must fast 8-12 hours prior, varies from institution
-lay on table for 2 hours may need IV medication
-using dye need to
assess for iodine allergy
-pt may feel pounding in chest or flushed
-check kidney/cardiac function prior and after, needs to be stable
-coagulation studies and CBC so they do not bleed out
what are some nursing interventions after the cardiac catheterization?
assess for bleeding on dressing
-HOB no higher than 30 degrees
assess peripheral pulses q15mn for 1 hour, q1-2hrs until stable
-check temp, cap refill, color, any tingling or numbness
-check for dysrhythmias
-check for nephropathy
what is blood pressure?
product of cardiac output (HR x SV) x peripheral resistance
how does blood pressure occur physiologically?
increase in CO or increase in peripheral resistance
what is the difference between primary and secondary HTN?
primary: unidentifiable cause, most cases like 90-95% of cases
secondary: identified cause like pregnancy, certain medications, narrowed arteries, renal disease
what is normal BP?
120/80 mmHg and below
the nurse is educating a patient about the long term effects of hypertension left untreated. what are some of the things they mention?
can damage heart, kidneys, eyes, brain and cause stroke, MI, kidney failure, impaired vision, CHF
what are some parts of a HTN assessment?
health/family history, physical assessment (vitals more specifically BP), routine labs, and risk factors (smoking, drinking, stress etc)
what is SWADE?
-lifestyle changes for HTN
Sodium restriction (less than 2.4g)
Weight reduction (18.5-24.9 BMI)
Alcohol consumption limits
Dash diet (reduced fat and saturated fat, low dairy, high fruits and veg,
Exercise (at least 30mn/day)
a patient is interested in alternative therapies to treat HTN, what may the nurse discuss with the patient?
-stress management (yoga, meditation, acupuncture)
-herbals (evidence based sources)
-supplements (evidence based like omega 3 fatty acids and vitamins)
what are some of the roles nurses play in patient's HTN?
-assess their knowledge of the disease/treatment (follow up's too)
-assess their self care/medication administration abilities
-assess complications, side effects or symptoms
-promoting BP management in community
-support and teach
what is a hypertensive crisis?
-Used to indicate either hypertensive urgency or emergency. (more than 180/120)
-Determined by the degree of target organ damage and how quickly the BP must be lowered
what is atherosclerosis?
The build-up of fats, cholesterol, and other substances in and on the artery walls. block and narrow vessels and reduces blood flow
-leading cause of death
what is CAD?
coronary artery disease
-produces symptoms/complications based on how narrow the lumen of the coronary artery is and the location of it.
-thrombus formation, and obstruction to myocardium
what is ischemia?
inadequate blood flow leading to decreased blood supply to the heart, may cause chest pain/angina, HF, death of myocardial cells, death
what symptoms of CAD should the nurse look out for in a patient?
chest pain, SOB, atypical symptoms like other pain
how can we prevent CAD?
-control cholesterol abnormalities
-promote smoking cessation
what does a lipid profile measure?
a nurse is evaluating a patient's lipid profile, what are normal values?
total cholesterol: less than 200mg/dl
LDL: less than 100mg/dl
HDL: greater than 40mg/dl for men, greater than 50mg/dl for women
triglycerides: less than 150mg/dl
what are some of the ways someone can control their lipid levels?
what kind of diet is recommended for someone with high lipid levels?
diet low in saturated fat and high in fiber (total lifestyle changes diet, in conjunction with DASH)
what are the two lipid medications that are most important?
-statins (HMG CoA)
-omega 3 ethyl esters
what is angina pectoris?
chest pain possibly caused by inadequate blood flow to heart in stress or non-stress and thus low oxygenation, can result if CAD is left untreated
a patient is experiencing chest pain, what symptoms regarding the pain would point to angina?
-can feel like indigestion in upper chest
-apprehension and impending death
-pain radiating to neck, jaw, shoulder and upper arm
-SOB, diaphoresis, dizziness, pallor, N/V
if a patient is experiencing chest pain, what should you do?
-EKG may be performed to show ischemia
-medication (nitroglycerin) administered
-lab tests like troponin and CK-MB
how is angina medicated?
-medication administration (chew an aspirin if home or nitroglycerin)
-oxygen therapy to reduce need for oxygen
what types of medications are used to treat angina?
-calcium channel blockers
-anti-platelet and anticoagulants
-nitrate that is a vasodilator
-cab be SL, oral, IV
-improves blood flow and reduces chest pain
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