Nurs 5463 Test 1, question and answer latest updated

Nurs 5463 Test 1, question and answer latest updated Atypical s/s of AMI in older adults diaphoresis, SOB, N/V, AMS, syncope What differential diagnoses are most important when presenting with chest pain? AMI, PE, PTX, aortic dissection, esophageal rupture What is considered ST elevation in men and women? Men = 2mm Women = 1.5mm OR new LBBB in 2 leads Which troponin is more specific? I or T? Troponin I is more specific How often to check troponins? Q6h What 2 things can exclude PE? Negative DDIMER & low Wells score Paradoxical abd movement during inspiration indicates... impending respiratory failure...indicates fatigue If a pt c/o dyspnea, it's always important to determine if... they have a problem with gas exchange Hypoxia Reduced level of tissue oxygenation Hypoxemia decrease in partial pressure of oxygen in the blood Causes of hypoventilation? Treatment? CNS dep, narcs, obesity, A-a gradient, elevated CO2.....corrects with oxygen Most common cause of hypoxia VQ mismatch Causes of VQ mismatch COPD, asthma, ILD, PNA, increased A-a gradient Does VQ mismatch improve with O2? Yes Causes of right to left shunt? anatomic (heart problems), physiologic (PNA, ARDs, atelectasis) Does right to left shunt respond to oxygen? difficult to correct with O2 Causes of diffusion impairment PF, PCP, emphysema Does diffusion impairment correct with O2? What makes it worse? Worsens with activity, corrects with oxygen What is the cause of reduced inspired oxygen tension? Does it correct with O2? High altitude, yes VQ mismatch causes _____ A-a gradient High Hypoventilation causes a ____ A-a gradient normal Type of abd pain that is caused by stretching, distention, or contraction of organs Visceral pain Type of abd pain that is caused from peritoneal irritation Parietal pain Causes of RUQ pain Gallbladder, liver, perforated ulcer, pancreatitis Causes of RLQ pain App, IBD, hernia, gastroenteritis, ischemic colitis, kidney stone, ectopic pregnancy, diverticulitis (but esp LLQ) Causes of LUQ pain Gastritis, PUD, pancreatitis, splenic enlargement/rupture, LLL PNA, AMI, pyelonephritis Causes of LLQ pain Diverticulitis**, IBD, GE, ischemic colitis, hernia, kid stone, ectopic Causes of epigastric pain PUD, pancreatitis, biliary colic, gallbladder, esophagitis, GERD, cholangitis, MI, aortic dissection, mesenteric ischemia Causes of periumbilical pain SBO, GE, early appendicitis, aortic dissection, mesenteric ischemia Causes of diffuse abd pain GE, peritonitis, perf, GI bleed, obstruction, mesenteric ischemia What radiology scan is good for unexplained abd pain? CT abd What test do you need if you suspect mesenteric ischemia? CTA abd What does free air under the diaphragm on a KUB indicate? Bowel perf What is a HIDA scan good for? Liver, bile ducts, gallbladder What do high-pitched bowel sounds indicate? Possible bowel obstruction How long do you have to listen if bowel sounds are absent? 4 minutes What does rebound tenderness indicate? Peritoneal irritation What does dullness indicate on an abd exam? Ascites Most common cause of syncope vagal response "The worst headache of my life" subarachnoid hemorrhage Work-up if presenting with HA and known hx of HA? No w/u needed unless new/worsening s/s What labs do you need for HA with scalp tenderness or suspected arteritis? ESR or CRP Labs for suspected vasculitis ANA, ANCA Onset of migraines after age 50 need MRI brain primary team goes off duty and on-call team comes on shift change stays on same service, but transferred to another hospitalist team service change transferred to an entirely different service (ex. hospitalist to critical care team) service transfer Who is at highest risk for 30-day readmission rate? elderly and heart failure patients Requirements for rehab tolerate 3h of rehab per day Requirements for SNF placement qualifying event that precedes a 3-night hospital admission Requirements for home health must be home bound Anticipated LOS for obs patients 48h What to document if need to transition from obs to inpatient "anticipated LOS is greater than 48 hours" Electrolyte abnormalities that warrant admission K 3 w/o clear etiology Na 120 w neuro s/s Ca 10 w AMS Phos 2.5 Willingness of hospital staff to openly communicate concerns about patient care on their units Safety culture Respond, report, investigate, communicate, performance improvement, follow-up Principles approach to patient harm Order of surrogacy 1. Spouse or domestic partner 2. Adult child, parent, or sibling 3. Close friend Pts complete this with their MD when they have a 1 yr life expectancy Physician Orders for Life-Sustaining Treatment (POLST) Sedation that is for relief of heightened anxiety and does not reduce consciousness Ordinary sedation Sedation that reduces awareness of distressing symptoms, but is a minimum dose so they can still interact with people Proportionate sedation Using a medication where potential outcome is good (relief of a symptom) but there can also be an undesired second effect (death) Doctrine of double effect What are the 3 types of medical ineffectiveness? Physiologic futility Qualitative futility Quantitative futility Medically certain that is impossible to achieve a physiologic effect Physiologic futility Patient's physiology may improve, but there is no patient-centered benefit Qualitative futility Intervention has not worked in similar patients Quantitative futility