NR 324 Exam 1 2023 with verified questions and answers

What is wrong with the body during DKA? It is too acidic Do people with COPD and other chronic respiratory illnesses hyper or hypoventilate? HYPOventilate What organs are the two regulators of acid in our body? Lungs and kidneys When will a patient display Kussmaul breathing in relation to acid-base balance? During acidosis / Normal pH range of blood 7.35-7.45 normal PaCo2 35-45 mm Hg PaO2 normal levels 80-100 Normal HCO3 levels 22-26mEq/L Ratio of carbonic acid to bicarbonate in a healthy state 1:20 Three regulatory mechanisms of acid-base regulation Buffer system respiratory system renal system Which regulatory system responds immediately? The buffer system. It is your natural neutral reaction process Which system responds in minutes and reaches its maximum effort within hours? Respiratory system Which regulatory system takes 2-3 days to respond? Renal system What type of acid-base imbalance would someone who took too much Aspirin have? Respiratory acidosis Why is a brown bag helpful for someone with respiratory alkalosis to breathe into? Because they can help return the CO2 back to their body that they lost from hyperventilating What type of meds are useful for someone in Respiratory alkalosis? Minor tranquilizers and anti-anxiety meds such as Ativan because they are hyperventilating and need help relaxing What are two common causes for metabolic acidosis? Aspirin overdose and prolonged diarrhea Common cause for metabolic alkalosis: prolonged vomiting or gastric suction ---you are eliminating acid from the body for a prolonged period of time. The kidneys compensate by dumping...lungs hypoventilate to keep CO2 When you auscultate cardiac sounds what are you hearing? The valves opening and shutting What is the major purpose of the cardiac system? to supply the body with oxygenated blood Ejection fraction the amount of blood ejected per minutes. It is 65mL per minute. You need an effective cardiac output and ejection fraction to ensure the hear is working well. If cardiac output is insufficient, what does this mean? you do not have enough o2 in your body what are the three layers of the heart epicardium- outer layer ,myocardium-middle layer, endocardium-inner layer why is the left ventricle thicker? because it does most of the pumping of blood to the body. It is 2-3x thicker than the R ventricle. What artery supplies the heart's oxygen and nutrients? The coronary artery (right and left) What happens when blood flow to a coronary artery is obstructed? Angina Complete occlusion of coronary artery lead to ... heart attack/ myocardial infarction partial occlusion of coronary artery angina SA node where all the elecrtical activity in the heart starts. Primary pacemaker what is the direction of electric flow to heart? SA node--AV node----bundle of His----purkinje fibers What is the relationship between sodium and potassium and your heart? Sodium and potassium are positively charged and provide the "electricity" to your heart. As the move in and out of your heart, they create electricity. The heart will never contract without them. How do you measure the electricity of the heart? EKG Systole heart contracts (first sound) diastole heart relaxes (second sound) stroke volume amount of blood ejected with each heart beat Cardiac output amount of blood pumped by each ventricle each minute. 4-8L of blood per minute. Decreased CO= something is wrong with your heart. Why do you have fatigue if you have an ineffective cardiac output? Because you have a lack of oxygenated blood flowing throughout your body. preload volume of blood in the ventricle at the end of diastole afterload tissue resistance against which the left ventricle must pump blood contractility how effectively the heart is able to contract. Blood pressure is highly individualized all arteries carry oxygenated blood except the pulmonary artery all veins carry deoxygenated blood except the pulmonary vein Why is blood in arteries bright red and blood in veins ashy arteries carry oxygenated blood, veins cary deoxygenated blood arteries vs veins arteries are deeper and thicker because they carry oxygenated blood. Veins are more superficial and thinner Sympathetic nervous system decreases HR parasympathetic increases HR Baroreceptors and chemoreceptors also help regulate HR Blood pressure = CO X SYSTEMIC VASCULAR RESISTANCE When taking a BP make sure person is sitting and arm is at chest. Make sure you have the appropriate sized cuff. If you get a bad BP reading what should you do? Check other extremities first. If heart rate is high and blood pressure is low, what is most likely happening? Hypovolemic shock- the patient is losing blood somewhere in the body What do you use if you cannot auscultate a blood pressure? doppler pulse pressure the difference between systolic and diastolic What are two reasons HTN is more common in older adults? Blood vessels are less elastic, and valves become thicker and more stiff and do not work as well beta adrenergic (spelling? ) receptors responsible for vasoconstriction Orthostatic HTN in older adults very common... do not get them up too fast, let them dangle their feet on the edge of the bed first. thready pulses +1 bounding pulses +4 normal pulses +2 Troponin a cardiac enzyme that will continue to rise in a patient who is having a heart attack What lab will tell you the difference between MI and angina? Troponin level. If troponin is normal, it is angina. If troponin is high, it is a heart attack First thing they will do for a patient with chest pain in ER EKG. Then draw labs for troponin CK-MB specific to myocardial cells and will indicated myocardial damage How often will you draw Troponin level and why? Q 1 hour, because a rise in Troponin each hour indicates an impending heart attack c-reactive protein produced by the liver, it is a nonspecific marker of inflammation. Increased in many patients with CAD . Chronic elevations are associated with unstable plaques and the oxidation of LDL which further contributes to atherosclerosis homocysteine elevated levels is a risk factor for CAD BNP another cardiac marker. Increased BNP is indicative of heart failure When drawing a lipid panel pt must be NPO lipid panel/lipoprotein LDL/HDL..elevated serium lipids are risk factors for CAD. LDL bad cholesterol HDL good cholesterol echocardiogram an ultrasound of the heart. measure the pressure within the chambers Cardiac cath/angiography They insert a catheter usually in the groin that follows the coronary artery all the way to the heart. they inject a dye to see which artery is affected or blocked. IF a coronary artery is blocked they will need bypass surgery angiography nursing implications be aware of any allergy to the dye NPO must sign consent Coronary artery disease the blockage of a coronary artery by fat or plaque buildup angina a symptom of CAD, it is chest pain due to a partial blockage a coronary artery Pt teaching for CAD avoid saturated fats. Get fat from plant sources, not animal sources. Saturated fats are bad for your heart The main cause of CAD deposits of plaque/ atherosclerosis One of the first symptoms of CAD Chest pain Explain what happens during CAD There will be an initial injury of the artery. Soft plaque will break off and your body will try to form a clot to repair the injury. The clot that forms will block the artery and cause angina collateral circulation The body's way of providing blood supply(it's own bypass to a blockage) to the area around an infarction site. Someone with a long history of CAD will develop this collateral circulation which is why a young person may have a more serious first MI than an older person. modifiable risk factors for CAD smoking teach pt to lower cholesterol Hypertension physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states, elevated homocysteine level Hypertension and plaque plaque in arteries is very soft. If blood pressure is high, plaque will break off from the pressure. smoking constricts blood vessels, increases BP Diabetics have _______circulation. Why is this a problem? Slow. When circulation slows down, clots can form easily lack of oxygen to the heart will cause chest pain Angina that can be treated at home: stable and chronic stable angina angina that requires hospitalization unstable angina unstable angina does not go away with rest or with meds. You cannot tell if it is a heart attack or unstable angina until you draw blood and get an EKG P wave atrium contracts depolarization QRS ventricle contracts T wave rest after checking the airway, what is the first thing you will do for a patient with angina? EKG silent angina and who is it most common in? seen on EKG machine but presents no symptoms to patient. ST segment depression most common in diabetic women angina decubitus angina when lying down that is relieved when sitting up nocturnal angina pain only at night but not necessarily when person is in recumbent position printzmetal's angina common among drug users due to spasm of coronary artery. They may have transient ST segment elevation microvascular angina due to spasm of the tiniest capillaries related to myocardial ischemia Nitroglycerin to relieve chest pain. If there is no relief in 5 minutes, call 911. If there is some relief, repeat the dose every 5 mins no more than 3 times. sublingual, patch, spray, or ointment . brown bottle to protect from light and heat expires in 3 months causes orthostatic hypotension What should never be take with nitroglycerin (for men) viagra- it will cause them to blackout main two side effects of nitroglycerin headache and orthostatic hypotension Meds for chronic stable angina ACE inhibitors Beta-adrenergic blockers calcium channel blockers sodium current inhibitors ** these lower heart rate and lower the o2 demand of the heart can relieve angina purpose of cardiac cath/angiography to visualize the area of blockage If a cardiac cath/angiography shows that the coronary blockage can be intervened, what will occur next? a percutaneous coronary intervention (PCI) PCI a catheter with an inflatable balloon tip is inserted, when the blockage is located, the catheter is passed through it, the balloon is inflatedm and the plaque is compressed resulting in vessel dilation. A stent can then be placed and left there if indicated. After a cardiac cath a patient must: lay flat for 8-12 hours and be monitored for femoral bleeding acute coronary syndrome unstable angina or heart attack. person must get to ER quickly. Very serious condition STEMI heart attack COMPLETE OCCLUSION. ST segment elevated. Myocardial infarction. (most common) non STEMI heart attack ST segment will stay normal. PARTIAL OCCLUSION which heart attack looks similar to unstable angina non-STEMI What are some symptoms that will occur with MI and not angina? nausea, vomiting, sweating, chest pain longer than 20 minutes. In heart attack, the heart muscle is.. Dying. Damage is irreversible. Multiple heart attacks cause more areas of necrosis in the heart muscle sx of heart attack radiating pain to jaw, shoulder, and back Some women and/or diabetics may not have pain. Diaphoresis( sweating) weakness nausea/vomiting low grade fever scar tissue will form after 4 weeks heart failure will commonly occur on..... the side of heart which sustained the MI cardiogenic shock a complication of MI. Occurs when oxygen and nutrients supplied to the tissues are inadequate bc of severe left ventricular failure. all valves inside the heart will be damaged pericarditis inflammation of pericardial layers causes friction run and ECG changes. Treated with antiinflammatory agents. Results in cadiac tamponade, decreased left ventricular filling and emptying, heart failure Dressler syndrome joint pain throughout the body Why is it important to distinguish between STEMI and non STEMI heart attack? Patients with STEMI will have a more extensive MI that is associated with prolonged and complete coronary occlusion, and the development of a pathologic Q wave on the ECG. Initial interventions of Acute Coronary syndrome (unstable angina) 12 lead ECG semi-fowler's position oxygen IV access Nitroglycerin sublingual aspirin chewable (will begin chewing in the ambulance on the way to the hospital) morphine heparin, and glycoprotein inhibitor once they are stable, angiography with PCI If cardiac markers are present, what is next? emergent PCI since MI is confirmed (within 90 mins of arrival is the goal) If PCI is not available what is next? thrombolytic therapy Thrombolytic therapy offers rapid administration if PCI is not available at location or cannot be done safely. Thrombolytic therapy stops the infarction process by DISSOLVING the thrombus. Patient must arrive to hospital within 6 hours for this to work. ***THIS IS DONE VIA IV PUSH* *monitor patient for bleeding purpose of IV heparin prevents reocclusion DOES NOT dissolve current clot CABG (coronary artery bypass grafting) & post op interventions will take a saphenous vein from leg or arm and use it to bypass the occlusion. monitor pulses and circulation after procedure especially to extremities from which vein was taken. why do we give stool softeners for a patient with acute coronary syndrome? so they do not strain and put more pressure on the heart drug therapy for acute coronary syndrome *IV nitroglycerin *morphine β-adrenergic blockers Angiotensin-converting enzyme inhibitors Antidysrhythmia drugs *Cholesterol-lowering drugs **stool softeners what are the two purposes of giving morphine? it is a vasoconstrictor and pain medication interventions for chronic stable angina semi-Fowler's nitroglycerin PRN for life pain meds reassurance teaching about CAD MI interventions monitor for pain EKG cardiac rehab begins in the hospital allow patient to vent their feelings they will be very anxious PCI interventions monitor insertion site neuro assessment lay flat to prevent bleeding per protocol monitor VS monitor for angina CABG interventions ICU A- Line intubation this is a major surgery control pain---staples on sternum will be extremely painful post-op complications of CABG & interventions bleeding fluid imbalances irregular beat medicate for pain DVT prophylaxis teach about activity restrictions resume sexual activity after they can climb TWO FLIGHTS of stairs Hypertension can cause kidney problems, heart attack, stroke, and heart disease. 33% of adults in US have it COx systemic vascular resistance = BLood pressure When the BP is too low the kidneys will activate: RAAS SNS: speeds up HR. Stimulation of SNS affects BP HTN is BP than 140/90 REPEATED what body system is highly affected by HTN? The kidneys. If HTN is left untreated the kidneys will be damaged. All blood goes to the kidneys and if it is sent with high pressure over a long period of time it will cause damage. BP is highly individualized. Most important intervention for a patient with pre-HTN EDUCATION & TEACHING 3 stages. stage 1: 140-149 / 90-99 stage 2: 160/100 primary HTN most people with HTN have primary HTN. Increase in systemic vascular resistance (amount of resistance felt in the left ventricle while pumping blood of to the body)We do not know why people have primary HTN, it is idiopathic HTN risk factors tobacco use, alcohol, obesity, excess sodium in diet, increased cholesterol, diabetes, old age, common in African AMericans, family history, low social ecomonic status why are older people more prone to HTN? blood vessels are less elastic High blood pressure can rupture your.. retinas. Tiny BVs will be damaged and cause visual disturbances Diuretics give only in the daytime not at night (frequent urination) Monitor for orthostatic hypotension especially in the elderly. Do not get them up too fast Most common reason for non compliance of BP meds men do not like the side effects of erectile dysfunction. Educate them on the importance of compliance other reason: financial Pt teaching for HTN smoking cessation drug therapy stop smoking exercise lose weight medications