Appropriate intervention for COPD exacerbation addressing impaired perfusion -
ANSWER Administer O2
Appropriate intervention for heart failure exacerbation addressing impaired gas
exchange - ANSWER Position patient in semi-fowlers
Sign of impaired electrolyte the imbalance in a patient with both COPD and HF -
ANSWER irregular heart beat
Sign of impaired fluid imbalance in a patient with both COPD and HF - ANSWER
Peripheral edema
Physical assessment to distinguish R vs L sided heart failure - ANSWER jugular
vein distension (indicates right)
According to the oxygen supply and demand framework, oxygen supply depends
on... - ANSWER Cardiac output and arterial oxygen content
Cardiac output depends on... - ANSWER Heart rate and stroke volume (after load is
affected by vascular resistance and aortic impedance, contractility is affected by
Ca2+, ATP, and contractile proteins, and preload is affected by filling time and
venous return)
Arterial oxygen content depends on... - ANSWER Oxygen bound to hemoglobin
(affected by hgb levels and # of RBCs), oxygen dissolved in plasma (PaO2), and $
saturation of Hgb (SaO2)
Alveolar gas exchange, which determines PaCO2 and PaO2, is affected by... -
ANSWER composition of inspired air, ventilation (lung compliance, airway
resistance, neuromuscular function), pulmonary perfusion (blood vessel latency,
central perfusion), and alveolar capillary diffusion (surface area, pressure gradient,
diffusion distance)
According to the oxygen supply and demand framework, oxygen demand depends
on... - ANSWER metabolic demand (determined by temperature, stress, and
physical activity)
Clinical manifestations of acute HF and COPD exacerbation - ANSWER decreased
O2 sats, increased CO2, irregular HR (due to electrolyte balance and salbutamol),
low HgB, lactic acid buildup, low diastolic BP, edema (peripheral and pulmonary),
poor CWMS, dizziness, low EF, increase RR
,Pharmacological management of clients experiencing exacerbation of COPD and HF
- ANSWER Salbutamol: bronchodilator, used as long term agent in COPD
Atrovent: controlling symptoms of COPD by relaxing airway muscles
Steroids (anti-inflammatories): help reduce inflammation in lungs, however can
increase fluid retention in HF
Furosemide: prevent fluid retention, helps peripheral and pulmonary edema (may
cause dehydration or electrolyte imbalance)
Definition of delirium - ANSWER Acute confusional state
Risks of delirium - ANSWER Infection, multiple medications, change in environment,
dehydration, surgery, injury, constipation, pain
Outcomes of delirium + treatment - ANSWER changes in mood, alertness, agitation,
drowsiness, hallucinations, delusions, disturbed sleep, disorganized thinking.
Treated by addressing cause, occasionally by antipsychotics (haloperidol)
Definition of dementia - ANSWER a general term for the impaired ability to
remember, think, or make decisions that interferes with doing everyday activities
Outcomes of dementia - ANSWER decline in communication, learning,
remembering, and problem solving
Treatment of dementia - ANSWER anticholinesterase inhibitors to slow the
progression. Symptomatic treatment with environmental & staff approaches.
Maintain and enhance remaining abilities.
Definition of depression - ANSWER Mood disorder that causes persistent feelings of
sadness or loss of interest
Outcomes of depression - ANSWER selective memory, highlighting negativity,
feeling of physical illness, withdrawing, often answering questions with "I dont know"
Treatment of depression - ANSWER antidepressants, ECT, cognitive therapy, assist
person to improve confidence and self-esteem through conversation and activity
, Alcohol withdrawal timeline - ANSWER stage 1 - 8 hours: anxiety, insomnia,
nausea, abdominal pain
stage 2 - 1-3 days: high blood pressure, increased body temp
stage 3 - 1 week, up to weeks if not treated: hallucinations, fever, seizures, agitation
Characteristics of ECG wave - ANSWER ECG waves measure electrical activity, not
contractions or pumping.
P: atrial depolarization, SA node firing
PR segment: atrial systole, "Pause": atrial construction needs to finish prior to
ventricular contraction
QRS complex: ventricular depolarization, AV node firing
ST segment: ventricular systole
T: repolarization, ("undo-ing") electrical firing
What causes upward and downward deflections - ANSWER electrical activity is
going in the same direction as lead, electrical activity away from a lead causes a
downward deflection (depolarization and repolarization deflections occur in opposite
directions.)
What causes an increase in amplitude (on ECG) - ANSWER synchronicity, mass
(ex. Ventricle vs. atria)
What does a peaked T wave indicate - ANSWER hyperkalemia
What is heart rate controlled by? - ANSWER the autonomic nervous system →
extrinsic factors impact HR through the sympathetic (increases HR) and
parasympathetic (decreases HR)
Intrinsic rates - ANSWER SA node is 60-100, AV node is 40-60, Purkinje fibers are
20-40
Sympathetic receptors - ANSWER Epinephrine and norepinephrine
alpha 1: arterial vasoconstriction
beta 1: increase HR and contractility
beta 2: bronchodilation
ANSWER Administer O2
Appropriate intervention for heart failure exacerbation addressing impaired gas
exchange - ANSWER Position patient in semi-fowlers
Sign of impaired electrolyte the imbalance in a patient with both COPD and HF -
ANSWER irregular heart beat
Sign of impaired fluid imbalance in a patient with both COPD and HF - ANSWER
Peripheral edema
Physical assessment to distinguish R vs L sided heart failure - ANSWER jugular
vein distension (indicates right)
According to the oxygen supply and demand framework, oxygen supply depends
on... - ANSWER Cardiac output and arterial oxygen content
Cardiac output depends on... - ANSWER Heart rate and stroke volume (after load is
affected by vascular resistance and aortic impedance, contractility is affected by
Ca2+, ATP, and contractile proteins, and preload is affected by filling time and
venous return)
Arterial oxygen content depends on... - ANSWER Oxygen bound to hemoglobin
(affected by hgb levels and # of RBCs), oxygen dissolved in plasma (PaO2), and $
saturation of Hgb (SaO2)
Alveolar gas exchange, which determines PaCO2 and PaO2, is affected by... -
ANSWER composition of inspired air, ventilation (lung compliance, airway
resistance, neuromuscular function), pulmonary perfusion (blood vessel latency,
central perfusion), and alveolar capillary diffusion (surface area, pressure gradient,
diffusion distance)
According to the oxygen supply and demand framework, oxygen demand depends
on... - ANSWER metabolic demand (determined by temperature, stress, and
physical activity)
Clinical manifestations of acute HF and COPD exacerbation - ANSWER decreased
O2 sats, increased CO2, irregular HR (due to electrolyte balance and salbutamol),
low HgB, lactic acid buildup, low diastolic BP, edema (peripheral and pulmonary),
poor CWMS, dizziness, low EF, increase RR
,Pharmacological management of clients experiencing exacerbation of COPD and HF
- ANSWER Salbutamol: bronchodilator, used as long term agent in COPD
Atrovent: controlling symptoms of COPD by relaxing airway muscles
Steroids (anti-inflammatories): help reduce inflammation in lungs, however can
increase fluid retention in HF
Furosemide: prevent fluid retention, helps peripheral and pulmonary edema (may
cause dehydration or electrolyte imbalance)
Definition of delirium - ANSWER Acute confusional state
Risks of delirium - ANSWER Infection, multiple medications, change in environment,
dehydration, surgery, injury, constipation, pain
Outcomes of delirium + treatment - ANSWER changes in mood, alertness, agitation,
drowsiness, hallucinations, delusions, disturbed sleep, disorganized thinking.
Treated by addressing cause, occasionally by antipsychotics (haloperidol)
Definition of dementia - ANSWER a general term for the impaired ability to
remember, think, or make decisions that interferes with doing everyday activities
Outcomes of dementia - ANSWER decline in communication, learning,
remembering, and problem solving
Treatment of dementia - ANSWER anticholinesterase inhibitors to slow the
progression. Symptomatic treatment with environmental & staff approaches.
Maintain and enhance remaining abilities.
Definition of depression - ANSWER Mood disorder that causes persistent feelings of
sadness or loss of interest
Outcomes of depression - ANSWER selective memory, highlighting negativity,
feeling of physical illness, withdrawing, often answering questions with "I dont know"
Treatment of depression - ANSWER antidepressants, ECT, cognitive therapy, assist
person to improve confidence and self-esteem through conversation and activity
, Alcohol withdrawal timeline - ANSWER stage 1 - 8 hours: anxiety, insomnia,
nausea, abdominal pain
stage 2 - 1-3 days: high blood pressure, increased body temp
stage 3 - 1 week, up to weeks if not treated: hallucinations, fever, seizures, agitation
Characteristics of ECG wave - ANSWER ECG waves measure electrical activity, not
contractions or pumping.
P: atrial depolarization, SA node firing
PR segment: atrial systole, "Pause": atrial construction needs to finish prior to
ventricular contraction
QRS complex: ventricular depolarization, AV node firing
ST segment: ventricular systole
T: repolarization, ("undo-ing") electrical firing
What causes upward and downward deflections - ANSWER electrical activity is
going in the same direction as lead, electrical activity away from a lead causes a
downward deflection (depolarization and repolarization deflections occur in opposite
directions.)
What causes an increase in amplitude (on ECG) - ANSWER synchronicity, mass
(ex. Ventricle vs. atria)
What does a peaked T wave indicate - ANSWER hyperkalemia
What is heart rate controlled by? - ANSWER the autonomic nervous system →
extrinsic factors impact HR through the sympathetic (increases HR) and
parasympathetic (decreases HR)
Intrinsic rates - ANSWER SA node is 60-100, AV node is 40-60, Purkinje fibers are
20-40
Sympathetic receptors - ANSWER Epinephrine and norepinephrine
alpha 1: arterial vasoconstriction
beta 1: increase HR and contractility
beta 2: bronchodilation
