NUR 325 Final Exam 2024

The degree of stretch at the end of diastole (how much blood is in the ventricles) is known as - Preload An increase in fluids will preload, and a decrease in fluids will preload - An increase in fluids will increase preload, and a decrease in fluids will decrease preload The resistance to eject blood from the ventricles is known as - Afterload Hypertension and vasoconstriction have what effect on Afterload? - HTN and vasoconstriction will INCREASE afterload (increased afterload raises cardiac workload as well) How effectively the heart can squeeze out blood is also known as - Contractility How are preload and contractility related? - Optimal filling allows for maximum stretching What could the nurse give a patient to increase their contractility? - Epinephrine, Digoxin, Dopamine What could the nurse give a patient to decrease their contractility? - Beta-blocker (the "lol" meds) What are the life-threatening dysrhythmias? - V Tach, V Fib, and Asystole What is the first thing the nurse should do if they see a life threatening rhythm on a patient's EKG? - Assess the patient (Did a lead fall off? Does the patient show signs of decreased CO? Are they responsive? Pulses?) The patient is in V Tach but has a pulse, how can we treat this? - We give amiodarone and use cardioversion (because they have a pulse) The patient is in V Tach but does NOT have a pulse, how do we treat this? - CPR and Defibrillation The patient is in V Fib, what do we do? - CPR/ACLS, Defibrillate, Drug therapy What drugs can we give to a patient in V Fib? - Epinephrine, Amiodarone I can defibrillate the patient if they have what dysrhythmias? - Pulseless V Tach, and V Fib The patient is a candidate for Synchronized Cardioversion if they have what dysrhythmias? - V Tach (WITH A PULSE), SVT, A Fib, and A Flutter The patient is asystolic, what do you do? - CPR/ACLS, drug therapy, intubate What drugs do we give if the patient is in asystole? - Epinephrine and/or vasopressin The patient shows activity on their EKG but has no pulse, this is known as - Pulseless Electrical Activity (PEA) The patient has a normal heart rate, but the PR interval is longer than normal. What dysrhythmia do you suspect the patient has? - 1st Degree AV Block You notice a gradual lengthening in the patient's PR intervals and a missing QRS wave. What dysrhythmia do you suspect the patient has? - 2nd Degree AV Block Type 1 (Mobitz I // Wenckebach) The patient has constant elongated PR intervals and P waves at a regular rate, but missing QRS complexes. What dysrhythmia do you suspect? - 2nd Degree AV Block Type 2 (Mobitz II) You notice the patient has consistent P waves and QRS complexes, but the rates between the two are different (Some P waves do not have a QRS after). What dysrhythmia do you suspect? - 3rd Degree AV Heart Block (Complete Heart Block) The main cause of CAD, characterized by fat deposits in the arteries - Atherosclerosis What are some modifiable risk factors for CAD? - Lipid levels, HTN, smoking, obesity, inactivity This cholesterol transports lipids to the liver for removal, known as the "good cholesterol" - High Density Lipoprotein (HDL) This cholesterol transports lipids to the arterial vessels, known as the "bad cholesterol" - Low Density Lipoprotein (LDL) A serum cholesterol of indicates a risk factor for CAD - >200 A total triglyceride level of indicates a risk factor for CAD - >150 What drugs can we give to lower lipid levels and manage CAD? - Statins: Decrease cholesterol and LDL's, increase HDL's Niacin: Lowers LDL's and Triglycerides, increases HDL's The physician places an order for cardiac enzymes to be drawn. The nurse knows this order will consist of what lab values? - Myoglobin, BNP, CK-MB, Troponin I, and Troponin T The normal range for Troponin I is ? The normal range for Troponin T is ? - Troponin I: < 0.03 Troponin T: < 0.1 Inadequate cardiac pumping/filling leading to insufficient blood & oxygen supply to tissues - Heart Failure (HF) The nurse knows that the backflow of blood from the left atrium to the pulmonary veins is the cause of ? - Left-Sided HF What symptoms might you expect in a patient with Left-Sided HF? - Paroxysmal Nocturnal Dyspnea, restlessness, fatigue, orthopnea Pulmonary Congestion (Cough, crackles, wheezing, blood-tinged sputum, and tachypnea) The nurse knows that backflow of blood into the right atrium and venous circulation is the cause of ? - Right-Sided HF Right-Sided HF is most commonly caused by what? - Left-Sided HF What symptoms might the nurse expect in a patient with Right-Sided HF? - Dependent Edema, Ascites, Splenomegaly, Hepatomegaly, JVD, GI distress The normal ejection fraction ranges from? - 55-65% This lab value indicates ventricular wall stretching: - BNP The normal range for BNP is: Increased risk for mortality is associated with what BNP level? - Normal: < 100 Risk for mortality: > 500 The nurse expects to give which diuretics to the patient with HF? - Furosemide The nurse expects to give which medications when caring for a patient with HF (not including diuretics)? - Lisinopril, Metoprolol, Digoxin, Nitroglycerin What is a key nursing intervention for patients with HF? - Fluid and sodium restriction (Usually 2L/day and 2g/day) What amount of HF weight gain in 2 days should be reported? What amount of HF weight gain in a week should be reported - 3 pounds over 2 days 3-5 pounds in a week What are the normal ABG values? - pH: 7.35-7.45 PaCO2: 35-45 HCO3: 22-26 How does a decreased PaCO2 affect pH levels? - A decreased PaCO2 will increase pH (Respiratory Alkalosis) How does an increased PaCO2 affect pH? - An increased PaCO2 will decrease pH (Respiratory Acidosis) How does an increase in HCO3 affect the pH? - An increased HCO3 will increase the pH (Metabolic Alkalosis) How does a decreased HCO3 affect pH? - A decreased HCO3 will result in a decreased pH level (Metabolic Acidosis) Your patient's airway is obstructed resulting in hypoventilation, how might this affect their ABG's? - Hypoventilation results in elevated PaCO2 levels, which will decrease pH levels (Respiratory Acidosis) You notice your patient has become anxious after hearing their COPD diagnosis. They begin taking rapid deep breaths, how might this affect their ABG's? - Hyperventilation results in decreased PaCO2 and increased pH (Respiratory Alkalosis) ABG Interpretation: pH: 7.37, PaCO2: 55, HCO3: 31 - Fully Compensated Respiratory Acidosis Rationale: HCO3 compensating for elevated PaCO2 to keep pH at normal level ABG Interpretation: pH: 7.48, PaCO2: 48, HCO3: 32 - Partially Compensated Metabolic Alkalosis Rationale: pH is elevated due to increased HCO3. Only partial compensation since PaCO2 is also elevated, but pH is not in the normal range This is a state of altered gas exchange resulting in a failure to oxygenate and/or remove CO2 from the body - Respiratory Failure When large amounts of unoxygenated blood arrive at the left side of heart, this is known as: - Intrapulmonary Shunting How might low cardiac output lead to respiratory failure? - Cardiac output is the main mechanism for delivering O2 to the tissues, a decrease in CO will lead to resulting in less oxygenated blood perfusing the tissues How can we use ABG's to differentiate failure of oxygenation and failure of ventilation in respiratory failure? - Failure of Oxygenation will result in a PaO2 <60 Failure of Ventilation will result in a PaCO2 >50 (on room air) Flip This Card - You've earned a break, gee whiz! What is the proper cuff inflation level of an ETT? - 20-25 cm H2O What medications should the nurse expect to give to the patient requiring intubation? - Sedative (Midazolam) and a paralytic agent (Succinylcholine) How often should we suction the ETT? - Only as indicated (visible secretions, frequent cough, coarse crackles, desatting, etc.) How can we prevent Ventilator-Associated Pneumonia? - HOB elevation, oral care (with chlorhexidine), hand hygiene, controlled cuff pressure This mode of noninvasive ventilation gives oxygen, along with a high inspiratory pressure and low expiratory pressure - BiPAP What is the main difference between Volume-Controlled Modes and Pressure- Controlled Modes - Volume-Controlled Modes deliver a preset tidal volume with each breath Pressure-Controlled Modes fill the lungs until a preset inspiratory pressure is reached (tidal volume varies based on lung compliance and resistance) This Vent mode delivers a preset # of breaths and also aids the patient during spontaneous breaths by ensuring an adequate tidal volume is met - Assist/Control Ventilation This vent mode uses positive inspiratory pressure to increase a patient's spontaneous respiratory activity - Pressure Support This vent mode delivers a set respiratory rate and helps each breath with inspiratory pressure - Pressure-Assist Control Ventilation Why might pressure-controlled modes be better than volume-controlled modes? - If a patient's PIP level is elevated during volume-controlled ventilation, pressure- controlled modes can reduce the risk of barotrauma (Pressure modes are used for stiff, noncompliant lungs) What is the tidal volume setting of a vent? What is the normal range? - Tidal Volume: The amount of air with each breath Normal Range: 4-8 mL/kg What values can we look at to ensure patient doesn't experience barotrauma? - PIP: Should be BELOW 40 cm H2O Plateau Pressure: Should be below 30 cm H2O What is the function of the PEEP setting? What is the normal range for PEEP? - PEEP adds positive pressure during exhalation to keep alveoli open and help with oxygenation. Physiological PEEP is 3-5 cm H2O but can range anywhere from 5-20 cm H2O How are PEEP and FiO2 related? - PEEP allows us to use a lower FiO2 since we're increasing the area for exchange Assign points to each possible finding while assessing eyes during a GCS: Patient opens eyes to pain: Patient opens eyes to voice: Patient doesn't open eyes Patient opens eyes spontaneously: - Patient opens eyes to pain: 2 Patient opens eyes to voice: 3 Patient doesn't open eyes: 1 Patient opens eyes spontaneously: 4 Assign points to each possible finding while assessing motor response during a GCS: Flexion is observed: Patient withdraws from pain: Extension is observed: Patient localizes pain Patient obeys commands: No response observed: - Flexion is observed: 3 Patient withdraws from pain: 4 Extension is observed: 2 Patient localizes pain: 5 Patient obeys commands: 6 No response observed: 1 Assign points to each possible finding while assessing verbal response during a GCS: Patient is confused but converses: Patient says random words: Patient makes random sounds: Patient is oriented and converses: No response: - Patient is confused but converses: 4 Patient says random words: 3 Patient makes random sounds: 2 Patient is oriented and converses: 5 No response: 1 The patient is very drowsy, falls asleep in between care, and responds to voice. What is the patient's LOC? - Lethargic The patient is difficult to arouse, and responds to pain. What is the patient's LOC? - Obtunded The patient is difficult to arouse, with little response to rigorous stimulation and pain. What is the patient's LOC? - Stuporous