Test one (cardio,respiratory,renal/urinary)

Helpfulness: 0
Set Details Share
created 7 years ago by jnewman21
286 views
updated 7 years ago by jnewman21
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

rythyms of SA, AV nodes and ventricles

SA 60-100
AV 40-60
ventricular 30-40

2

depolarization

electrical activation of cell caused by influx of sodium into cell while potassium exits cell

3

repolarization

return of cell to resting state caused by re-entry of potassium into cell while sodium exits

4

effective refractory period

phase in which cells are incapable of depolarizing

5

relative refractory period

phase in which cells require stronger-than-normal stimulus to depolarize

6

why is the myocardium thicker on left ventricle?

provides for systemic blood flow therefore requires more muscle for force

7

define following:
Stroke volume: amount of blood ejected with each heartbeat
Cardiac output: amount of blood pumped by ventricle in liters per minute
Preload: degree of stretch of cardiac muscle fibers at end of diastole
Contractility: ability of cardiac muscle to shorten in response to electrical impulse
After load: resistance to ejection of blood from ventricle
Ejection fraction: percent of end diastolic volume ejected with each heart beat

...

8

formula for cardiac output

CO=HR x stroke volume

9

preload is increased in what conditions?

hypervolemia and regurgitation of cardiac valves

10

afterload is increased in what conditions?

what is the effect of this?

hypertension and vasoconstriction

cardiac workload

11

Which of the following is the normal pacemaker for the myocardium?

Atrioventricular junction
Bundle of His
Purkinje fibers
Sinoatrial node

sinoatrial node

Rationale: The sinoatrial node is the normal pacemaker for the myocardium

12

Which of the following best defines stroke volume?

The amount of blood ejected with each heartbeat

Amount of blood pumped by the ventricle in liters per minute

Degree of stretch of the cardiac muscle fibers at the end of diastole

Ability of the cardiac muscle to shorten in response to an electrical impulse

The amount of blood ejected with each heartbeat

Rationale: Stroke volume is the amount of blood ejected with each heartbeat. Cardiac output is the amount of blood pumped by the ventricle in liters per minute. Preload is the degree of stretch of the cardiac muscle fibers at the end of diastole. Contractility is the ability of the cardiac muscle to shorten in response to an electrical impulse.

13

Name some things that take place in regard to the cardiovascular system and aging

Atherosclerosis
Blood Pressure Increases
Vein Valves More Incompetent (Murmurs)
Heart Muscle Less Efficient
Dysrhythmias Common

14

what are most common manifestations of heart disease/disorders

Chest pain
Dyspnea
Peripheral edema, weight gain
Fatigue
Dizziness, syncope, changes in level of consciousness

15

name the valves that of each side of the heart

Pulmonic and tricuspid (right)

bicuspid (or mitral) and aortic (left)

16

things to inspect for cardiac function

oxygenation, skin color
extremities: hair,skin,nails,edema, color
JVD
capillary refill
clubbing

17

things to check when palpitating for cardiac signs

Point of Maximum Impulse
Extremity Temperature
Edema
Homans’ Sign

18

how do you perform percussion for cardiac issues?

the advanced practitioner does that along the cardiac border

19

What are the heart sounds?

S1 and S2 are the normal lub and dub sounds from valves closing

20

S1 is the sound of _________

AV valves closing

21

S2 is the sound of ___________

semilunar valves closing

22

Describe the abdominal assessment for cardiac issues

Inspection – abdominal distention
Auscultation – aortic & renal bruits
Palpitation – ascites (fluid accumulation in the peritoneal cavity). Enlarged liver

23

Where does the nurse auscultate the apex of the heart?
Erb’s point
Fifth intercoastal space
Pulmonic area
Tricuspid area

B. Fifth intercoastal space
Rationale: The nurse auscultates the apex of the heart at the fifth intercoastal space.

24

what do we use echocardiogram for?

to look at the structures of heart

25

what is done before cardiac cath?

look at labs

26

what is cardiac catherization?

invasive procedure study used to measure cardiac chamber pressures, assess patency of coronary arteries

27

what things would you assess prior to cardiac cath?

allergies (dyes) and blood work

28

when do you perform patient education for cardiac cath?

pre and post procedure

29

when performing ECG which lead reveals the most common problems?

2

30

what is dysrhythmia?

disorders of formation or conduction or both of electrical impulses within heart

31

what can dysrhythmias cause disturbances in?

rate
rhythm
or both
can also alter blood flow, causing hemodynamic changes

32

What is point of maximum impulse?

at 5th intercostal space (apical area)

33

homan's sign

check for deep vein thrombosis (DVT)
uses dorsiflexion to check for pain

34

what is JVD and how do you check for it?

Jugular venous distention
patient is lying back at 45 degrees...can see pulse in side of neck
it is seen with right ventricular heart failure and congestive heart failure

35

what is heart murmur caused by?

valves not closing properly

36

What is S4 heart sound?

gallop rythm
la da da, la da da

37

what lab test indicates cardio infarction

Tropinin T and I

38

when patient is scheduled for lipid profile what should you instruct them to do

fasting for 12 hours

39

what does C-reactive protein level disclose?

degree of inflammation with in cardiac wall

40

What is Tropinin T and I?

highly sensitive proteins in cardiac muscle

41

where does the nurse ascultate the apex of the heart?

fifth intercostal space

42

P wave

first wave
is atrial depolarization

43

P-R interval

beginning of P to beginning of QRS complex

normal size: 0.12-0.20 seconds

44

QRS Complex

3 waves (Q,R, and S)
Q wave- first downward deflection
R Wave- first upward deflection
S Wave- Second negative deflection if Q wave or first negative deflection after R Wave

represents ventricular depolarization
normal is 0.04- 0.12 seconds

45

T wave

represents ventricular repolarization

46

an inverted T wave is seen with _______

a peaked T wave on ECG is indicative of ________

myocardial ischemia

hyperkalemia

47

myocardial ischemia

blood flow to your heart muscle is decreased by a partial or complete blockage of your heart's arteries (coronary arteries). The decrease in blood flow reduces your heart's oxygen supply.

48

U wave is only seen with ___________

hypokalemia

49

what is the 5 steps of interpreting cardiac rhythms on ECG

1. regularity of rhythm
2. heart rate
3. P wave (missing any?)
4. P-R interval
5. QRS complex

50

Normal sinus rhythm rules

rhythm regular
rate 60-100 bpm
P wave- rounded before each QRS
PR interval- 0.12-0.20 seconds
QRS interval- 0.04-0.12 seconds

51

Sinoatrial Node dysrhythmias include

sinus bradycardia and sinus tachycardia

52

what is defining characteristic of Sinus Bradycardia

heart rate is less than 60

53

what is defining characteristic of sinus tachycardia

heart rate is 101-180 bpm

54

sinus tachycardia causes

physical activity, shock, hyper and hypovolemia (fluid volume), fever, electrolyte imbalance, MI, anxiety, meds (stimulants)

55

defining characteristics of atrial fibrillation

irregular heart rate...atrial rate not measurable, ventricular rate < 100 usually but greater the 100 if rapid ventricular response

no identifiable P waves
P-R interval is not measurable

56

causes of A fib

aging, rheumatic heart diseases, HTN, heart failure, meds, post-op CABG

57

A fib patients have increased risk of _____

thrombus formation

58

Ventricular tachycardia is marked by

HR 150-250 ventricular bpm
P waves: none
P-R interval: none
QRS interval: > 0.11 seconds

59

pt's in ventricular tachycardia need:

immediate d-fib

60

ventricular tachycardia can be caused by

hypokalemia

61

signs and symptoms of tachycardia

dyspnea, palpitations, light-headedness, angina

62

ventricular fibrillation is marked by

extremely irregular rhythm, non measurable HR, no P waves, No P-R or QRS intervals

63

patients in ventricular fibrillation need

immediate D fib

64

signs and symptoms of ventricular fibrillation

unconscious, no heart sounds, peripheral pulses or BP
cyanosis
pupil dilation

65

ACLS protocols for ventricular fibrillaiton therapeutic interventions

immediate D fib
CPR
endotracheal intubation
epinephrine, vasopressin, magnesium, etc

66

asystole

flat line- can't shock them

67

CPR rules

15 compressions
2 breaths every 5 seconds

68

ACLS protocols include

endotracheal intubation
transcutaneous pacin
epinephrine, atropine

69

In assessing patients with a dysrythmia the nurse should assess indicatore of

cardiac output and oxygenation, especially changes in level of consciousness
fluid retention

70

bradycardia patients usually need

pacemakers

71

implantable cardioverter defibrillator (ICD)

detects, terminates life-threatening episodes of bradycardia or fibrillation

72

what must a patient with an automatic implantable cardioverter defibrillator (ICD) do?

document events that trigger a shock sensation

73

atherosclerosis

abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen
this reduces blood flow to myocardium

74

CAD (coronary artery disease)

most prevalent cardiovascular disease in adults

75

clinical manifestations of artherosclerosis

due to myocardial ischemia
are related to location and degree of vessel obstruction
angina pectoris
myocardial infarction
heart failure
sudden cardiac death

76

desired cholesterol levels

< 100 (LDL)
> 60 (HDL)

77

triglycerides

fat sugars we eat
correlates with diabetes

78

test for C-reactive proteins

tests for inflammation

79

most common symptom of myocardial ischemia

angina
some may be asymptomatic or have atypical symptoms such as weakness, dyspnea and nausea

80

angina

charactewrized by episodes or paroxysmal pain or pressure in anterior chest by insufficient coronary blood flow

81

physical exertion or emotional stress increases

myocardial oxygen demand and coronary vessels are unable to supply sufficient blood flow to meet O2 demand

82

stable angina

chronic

83

unstable angina

acute onset usually requiring immediate tx

84

chronic stable angina may be described as

tightness, choking, or a heavy sensation
radiating retrosternal to neck, jaw,shoulders, back or arms (usually left sided)
usually resides with rest or nitroglycerin

85

Acute coronary syndromes are caused by

lack of O2 to heart muscle and includes:
unstable angina
non-Q wave MI (damage already done)
ST segment elevation MI

86

Post MI and ____ __ ____

myocardium is permanently destroyed

87

MI usually caused by

reduced blood flow in coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus

88

Unstable angina the plaque ruptures but the artery is not completely

occluded

89

The term acute coronary syndrome includes

unstable angina and MI

90

MI's are classified by

area of heart affected
depth of involvement
ECG changes that are observed

91

When pt is diagnosed with acute MI what is protocol

EKG within 10 minutes of arrival to ER
chest Xray
Labs: Tropinin I (every 90 min or series in 8 hrs)
Myoglobin
CK-MB

92

CABG (coronary artery bypass grafts) use

greater and lesser saphenous veins

93

regurgitation

the valve doesnt close properly and blood backflows through it

94

stenosis

valve doesn't open completely and blood flow through is reduced

95

valve prolapse

stretching of an AV valve leaflet into the atrium during diastole

96

mitral regurgitation

back flow of blood to left atrium
leads to pulmoary congestion
chordae tendineae dysfunction

97

mitral stenosis

mitral valve thickening/chordae tendineae shortening
backward pressure occurs until left ventricle dilates/fails
CO reduced

98

signs and symptoms of mitral stenosis

murmur-low pitched
exertional dyspnea, cough, hemoptysis
fatigue
palpitations
a fib
chest pain

99

aortic regurgitation

aortic valve doesn't close
blood leaks back into left ventricle
causes decreased Cardiac output and pulmonary edema

100

signs and symptoms of aortic regurgitation

none early on
exertional dyspnea, fatigue
CORRIGAN's pulse: palpitated pulse forceful, quickly collapses (done at radial pulse)

101

Aortic and mitral valvular heart disease results in

left heart failure

102

Aortic stenosis

Aortic valve narrowed and sticky- not all blood can make it out
Left ventricle contracts more forcefully and eventually hypertrophies

can be caused by calcification with aging or birth defects or rare rheumatic heart disease

103

aortic stenosis signs and symptoms

mumur- loud and rough- S4 sound
orthopnea-need to sit up
pulmonary edema- blood not being able to exit left atrium

104

tests for Aortic stenosis

ECG
chest Xray:enlarged left ventricle
doppler echocardiography
cardiac cath

105

types of replacement valves

mechanical valves- are thrombogenic and require life-long anticoagulation therapy

tissue valves-xenograft, homograft, autograft (usually use pulmonic valve or artery)

106

pericarditis

inflammation of pericardium- causes restriction
ventricular filling reduced
decreased cardiac output and BP

107

acute pericaditis

lasts 6 weeks or less and resolves

108

chronic pericaditis

results in fibrous tissue- scar tissue

109

potential complications of pericarditis

pericardial effusion
cardiac tamponade

110

pericarditis can be caused by

infections like lyme disease
drug reactions
CT disorders
post MI
renal disease or uremia

111

pericarditis pain increases

with deep inspiration

112

classic sign of pericarditis

friction rub

113

complications of pericarditis

pericardial effusion (fluid accum. rapidly in sac)

cardiac tamponade (life threatening compression-blood builds up in heart)

immediate pericardiocentesis- done to pull fluid off heart

114

small cell lung cancer

grows rapidly

115

large cell carcinoma (lung)

grows rapidly

116

adenocarcinoma

slow growing

117

squamous cell carcinoma

near bronchi...slow growing

118

what is most common surgery for a small apparently curable tumor of the lung?

lobectomy

119

sleeve resection

look up

120

chest trauma symptoms

blunt trauma
sternal rib fractures
flail chest
pulmonary contusion
penetrating trauma
pneumothorax - air enters chest (spontaneous or simple, traumatic (air enters pleural space), tension pneumothorax

121

tension pneumothorax

considered emergency

122

flail chest

multiple rib fractions can be sucked inward
constricts lung inspiration and don't get enough air
on expiration it goes back to midline

123

open pneumothorax

air enters chest during inspiration
then exits during expiration (into pleural space)

124

tension pneumothorax

thin frail people typically seen in
air enters but cant leave...continues to build up pressure
can enter A Fib if no intervention
need intubation

125

signs and symptoms of pneumothorax

shallow rapid respirations
asymmetrical chest expansion
dyspnea
chest pain
absent breath sounds over affected area
tracheal deviation
cyanosis
tachycardia
pleural pain
shock and death if left untreated

126

biggest sign of pneumothorax

tracheal deviation to unaffected side

127

T or F...initial characteristic symptom of a simple pneumothorax is sudden onset of chest pain

True...pressure continues to build up

128

COPD

characterized by airflow limitation that is not fully reversible.
4th leading cause of death

includes emphysema and chronic bronchitis or both
asthma is seperate but can coexist with COPD

129

inflammatory response in COPD

occurs throughout the airways, lung parenchyma, and pulmonary vasculature
scar tissue and narrowing occurs in airways
leads to damage to the parenchyma
and causes changes in pulmonary vasculature

130

classic sign of COPD

barrel chest
and CO2 increased
often have respiratory acidosis

131

chronic bronchitis

have cough and sputum production for at least 3 months in each of 2 consecutive years

132

mucous secreting glands and goblet cells increase in number when

there is chronic bronchitis

133

chronic bronchitis signs and symptoms

wheezing, crackles
chronic cough
dyspnea
thick tenacious sputum
increased susceptibility to infection
mucous plugs
color dusky to cyanotic (called blue bloaters)
hypoxia
hypercapnea
respiratory acidosis

134

T or F... For patients with chronic bronchitis the nurse expects to see major clinical symptoms of tachypnea and tachycardia

True

135

emphysema

abnormals distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli
barrel chest from air trapping
hypoxemia
drive to breath for them is O2...have to be careful not to give too much O2 because CO2 build up is normal drive to breath

136

signs and symptoms of emphysema

cough KNow all of these!!
sputum production
dyspnea
prolonged expiration
barrel chest
activity intolerance
diminished breat sounds

137

Emphysema patients referred to as pink puffer

minimum cyanosis
orthopneic
prolonged expiratory time
speaks in short jerky sentences
use of accessory muscles to breathe

138

distinctions between COPD disorders

bronchitis...productive cough
emphysema...wheezing

139

risk factors for COPD

tobacco smoke causes 80-90%
passive smoking
occupational exposure
ambient air pollution
genetic abnormalities (alpha1-antitrypsin)

140

Diagnostic tests for COPD

PFT
spirometry
ABGs
Oximetry

141

collaborative problems accompanying COPD

respiratory insuff. or failur
atelectasis
pulmary infection
pneumonia
pneumothorax
pulmonary hyptertension

142

meds and therapies to help with COPD

corticosteroids and bronchodialtors
breathing exercises to reduce air trapping...diaphragmatic breathing...pursed lip breathing
supplemental O2

143

other interventions for COPD pts

set realistic goals
avoid extreme temps
enhance coping strategies
monitor and manage potential complications

144

T or F....a commonly prescribed methylxantine is theophylline

True

145

allergies is the strongest

predisposition for asthma

146

common triggers to asthma

smoking, allergens, infection, sinusitis, stress, GERD

147

signs and symptoms of asthma

dyspnea, wheezing, cough, sputum, use of accessory muscles, may worsen at night

148

status asthmaticus

exteme sustained asthma...worsening hypoxemia....respiratory alkalosis progresses to acidosis
can be life threatening

149

meds for asthma

beta2-adrenergic agonists...albuterol
anticholinergics....atrovent

long acting....corticosteroids
long acting bet2-adrenergic agonists...advair
leukotriene modifiers...singulair

150

important for inhaler users to use

spacer...helps deliver med to lungs and not allow it to get trapped in mouth/throat

151

peak flow meter

red, green, yellow zones based on symptoms for patient to know plan of action

152

acid base balance is desired outcome for

asthma

153

cystic fibrosis

most common fatal autosomal recessive disease among caucasian population

mutation of gene causes changes in chloride transport which leads to thick viscous secretions (SPUTUM) in lungs, pancreas, liver, intestines and reproductive tract

bronchoscopy used to remove mucus plug

154

symptoms of cystic fibrosis

thick tenacious sputum
airway clearance issues
CF related diabetes (CFRD)
reduced absorption of degestive nezymes and vitamins
growth retardation
rectal prolapse
fatty stolls

155

know anatomy and physiology of urinary system parts

...

156

urine formation 3 step process

formation, reabsorption, excretion

157

normal blood flow to kidneys

1200 ml/24 hours

158

normal urine output specific gravity, and pH

1000-2000 ml/24 hrs
1.010-1.025 spec gravity
4.6-8.0 pH

159

specific gravity of urine tells us

kidneys ability to filter blood

160

anything less than 30 ml/hr of urine

report to Doctor immediately

161

aging effects on urinary system

decreased tulubular function
renal flow decreased 50%
GFR decreases
decreased sense of thirst...leads to hypernatremia and fluid volume deficit
renal mass smaller

162

percentage of water in urine

95%

163

adult bladder holds...

normal amount voiding per day

300-500 mls

8-10

164

flanked pain if

infection resides in ureters

165

prostate pain felt in

peritinium area

166

bladder pain felt in

suprapubic area

167

hematuria

blood in urine

168

polynuria

frequent voiding

169

anurea

not voiding...decreased urine output...common with disease process as body shunts blood from kidneys to organs

170

what is considered urinary retention

>100 ml left in bladder post voiding

171

noturia

voiding at night

172

dysnuria

painful voiding

173

urinalysis requires how much urine

10 ml

174

orthostatic hypotenstion

drastic drop in BP upon standing

175

adventitious lung sounds with crackles may be heard with

fluid volume overload

hypervolemia

176

chronic renal failure often presents with

edema

177

daily weight is most accurate way to determine

fluid volume

178

bladder mus be distended in order to:

palpate it

179

renal functions tests for:

serum creatinine, blood urea nitrogen (BUN), uric acid, creatinine clearance test (24 hour urine), specific gravity, urine osmolality

180

most important indicator of renal function

serum creatinine

181

urea nitrogen is indicative of _________and can also be indicator of ___________

renal function

liver function

182

uric acid often elevated with

gout

183

radiological studies reveal what

kidneys-ureter-bladder (KUB)

show tumors, swollen kidneys, stones

184

24 hour urine collection

throw first void out
add urine for 24 hour consistently thereafter
start over if one is missed

185

intravenous pyelogram

dye injected that outlines renal structures

need to check for allergies pre-procedure
ALSO check creatinine and BUN...if elevated dye can cause further damage

after dye...increase fluid

186

renal ultrasound

non invasive way to see tumors, kidney enlargement, kidney stones, chronic infection.

187

cystoscopy

inserted into bladder through urethra

antibiotic often pre-emptively ordered

188

T or F...Urea is abnormal component of urine?

False...is waste product of urine...don't want high concentration of it though

189

normal adult bladder capacity

300-500 ml

190

hydronephrosis

water on kidney

obstruction in urinary tract...kidney enlarges as urine pools
caused by: calculus, tumor,scar tissue, congenital defects and kink in ureter

191

oligurea

less than normal voiding..<400-500 ml

192

hydronephritis can lead to

polynephritis

193

polycystic kidney disease

multiple cysts in kidney
dull heaviness in flank/back
hematuria
hypertension
UTI...most common complication

194

oliguria...what is it

reduced urine formation due to renal failure

associated with hydronephrosis

195

polycystic kidney disease etiology

genetic, progressive, no tx for it

often presents after childbearing years

196

cancer of kidney risk factors

smoking
obesity
hypertension
exposure to lead, cadmium and phosphates

197

85% of renal tumors are

malignant

198

acute renal failure marked by

Azotemia (waste products accumulating)
GFR decreases
BUN (blood urea nitrogen increases
Oliguric- output of less than 400 ml/day
May recover

199

causes of acute renal failure

prerenal failure (decreased blood supply to kidneys)

intrarenal failure (damage to nephrons)
postrenal failure (obstruction)

200

chronic renal failure

gradual decrease in kidney function

endstage renal failure

large portion of nephrons are damaged- 90% lost

urea in blood

201

assess and monitor effects of chronic renal failure

fluid accumulation
electrolyte imbalances
waste products retained
acid-base imbalances
anemia (inadequate production of erythropoeitin)

202

make card of slide at end of ch. 44 ppt

(lady on it with symptoms)

...

203

urinary stasis can cause:

UTI from holding in urine

204

urethrovesical reflux

coughing or sneezing forces urine back into bladder amounting to retention

205

uretherovesical reflux

urine forced back into ureters

206

cystitis

inflammation of bladder wall

207

urethritis

inflammation of urethra

208

pyelonephritis

infection of kidneys ...usually result of lower UTI...can be severe and cause sepsis

209

dysuria

burning pain on urination

210

stress incontinence

involuntary urine loss from increasing abdominal pressure

211

urge incontinence

involuntary urine loss with abrupt/stong desire to void

212

Nursing diagnosis for UTI can be risk for injury...why?

can lead to confusion especially in elderly

213

overflow incontinence

incontinence for distention of bladder
commonly assoc. with obstruction of outlet or BPH

214

functional incontinence

from impairment of physical/mental function

215

acute urinary retention

due to aneshesia, meds, local trauma to urinary structures

216

anything over ____ mls in bladder considered

urinary retention and indicates need for intervention

217

chronic urinary retention

due to enlarged prostate, meds,strictures, tumors

218

reasons for indwelling caths

shock,urinary tract obstruction, neurogenic bladder

219

suprapubic catheter

indwelling cath inserted through incision in lower abdomen into bladder

220

back of urine will

destroy kidney

221

urethral strictures

urethra lumen narrowing due to scar tissue

caused by STIs, trauma to urethra during surgery/caths

222

nephrolithiasis

kidney stones (calculi) formed primarily in kidneys

223

renal calculi

hard generally small stones

224

calcium is found in _____ of kidney stones

90%

225

etiology of kidney stones

heredity, chronic dehydration, infection, immobility

occur more in men than women

226

complications of renal calculi

UTIs, hydronephrosis, pain, spasm or colic from peristalis movement of ureter contacting with stone, tissue trauma

227

cancer of bladder is most common

urinary tract cancer

228

most common etiology of bladder cancer

smoking

also caused by industrial pollution

229

diagnostic tests for bladder cancer

urinalysis
cytology, culture
cystoscopy and transurethral biopsy
IVP - intravenous pyelogram