Advanced Med Surg Exam 1 Cardiovascular Exam 2024

- Contrast-induced nephropathy - The onset of AKI w/in 48h after admin of contrast. Risk for this is highest in pts who are older, dehydrated, have pre-existing CKD, or have comorbidities of DM, HF, or current hypotension - Metformin - should be d/c at least 24 hours before the time of a procedure and for at least 48 hours after iodinated contrast media. - Reactions - When a CT scan w/ contrast is prescribed, report the pts Hx of associated w/ the admin of contrast media to the radiologist and HCP. - Asthma - pts w/ have been shown to be at greater risk for contrast reactions than the general public. When reactions do occur, they are more likely to be severe. - Hay - Contrast reactions have been reported to be high as in pts w/ fever or food or drug allergies, especially to seafood, eggs, milk, or chocolate. - MRI - The pt w/ a metal implant is not eligible for this test: Items include pins, pacemaker, joint replacement, aneurysmal clips. - Coag - A panel is taken before a kidney biopsy d/t risk for bleeding. - Bleeding - HTN is aggressively managed before a kidney biopsy d/t this factor increasing the risk for . - Uremia - D/t high bleeding risk, dialysis may be prescribed for before a kidney biopsy. - 24 - For hours after a kidney biopsy, the RN should monitor VS, dressing site, urine output, and H&H. - Slow - Careful management of conditions such as diabetes, hypertension, and heart failure (HF) can the onset and progression of CKD. - Overload - Extracellular volume can occur in CKD because the body loses the capability to excrete sodium. The pt may have edema, pulmonary crackles, shortness of breath, and pleural or pericardial effusion (w/ symptoms of a friction rub and/or decreased breath sounds or heart sounds). - Hypernatremia - In the later stages of CKD, kidney excretion of sodium is reduced as urine production decreases. This leads to w/ only mild increases in dietary sodium intake. - Metabolic - complications from AKI include hyperkalemia, hyponatremia, hypocalcemia, hypophosphatemia, hyperlipidemia, and metabolic acidosis. - Cardiopulmonary - complications from AKI include edema, HF, PE, pericarditis, pericardial effusion, HTN, and MI. - Neurologic - complications from AKI include neuromuscular irritability or weakness, asterixis, seizures, and mental status changes. - Immune/infectious - complications from AKI include pneumonia and sepsis. - GI - complications from AKI include N/V, decreased peristalsis, enteral nutrition intolerance, malnutrition, ulcer formation, and bleeding. - Hematologic - complications from AKI include bleeding, thrombosis, and anemia. - Prerenal - causes of AKI include blood/fluid loss, BP meds, MI, heart disease, infection, liver failure, ASA, NSAIDs, anaphylaxis, burns, dehydration, renal artery stenosis, and atherosclerosis. - Intrarenal - causes of AKI include blood clots in nearby veins/arteries, cholesterol deposits, glomerulonephritis, hemolytic uremic syndrome, pyelonephritis, lupus, ABX, chemo, contrast dye, scleroderma, and TTP. - Postrenal - causes of AKI include bladder, colon, cervical, and prostate cancers, enlarged prostate, kidney stones, nerve damage, and blood clots in the urinary tract. - 30 - Report a urine output of less than mL/hr for 2 hours or dark amber urine to the primary health care provider. - Hour - If a pt has a catheter, assess urine output every after surgery until stable, during fluid resuscitation for shock or hypotension, and when the patient has a high risk for AKI following hospital admission - Drinks - Teach pts w/ kidney issues to avoid sugary, high-calorie ; they provide low-quality calories that contribute to weight gain and sugar- induced urination. - Loop diuretics - This class of drugs is used in the Tx of CKD. This class increases urine output to manage volume overload when urinary elimination is still present. They are not effective in managing ESKD. - Greater - For the pt taking loop diuretics, monitor I&O to assess effectiveness. Generally the expected outcome is for output to be than intake by 500-1000/mL/24 hr. - Loss - For the pt taking loop diuretics, monitor electrolytes because these drugs result in of potassium. - Chronic stable angina - Chest discomfort that occurs w/ moderate-to-prolonged exertion in a pattern that is familiar to the pt. - Unstable - An increase in the number of attacks and in the intensity of pressure indicates angina. - Unstable - In this type of angina, the pressure may last longer than 15 mins or may be poorly relieved by rest or NTG. - ST depression, T wave inversion - What changes may be seen on a 12-lead ekg in the pt w/ an NSTEMI? - ST elevation - What changes may be seen on a 12-lead ekg in the pt w/ a STEMI? - Remodeling - Scar tissue permanently changes the size and shape of the entire left ventricle, called ventricular . - Left - A key feature of angina and MI is substernal chest discomfort that radiates to the arm. - Jaw - A key feature of MI is pain/discomfort in the , back, shoulder, or abd. - Morning - A key feature of MI is occurring w/o a cause, usually in the . - Opioids - A key feature of MI is pain/discomfort that is only relieved by which drug class? - MI (myocardial infarction) - Key features of include N/V, diaphoresis, dyspnea, fear/anxiety, dysrhythmias, fatigue, palpitations, epigastric distress, dizziness, confusion. - Vasodilation - For NTG admin, monitor BP for hypotension because this med causes . - 3 - For NTG admin, keep in mind that SL tabs can be taken every 5 mins up to times. - Burns - For NTG patch admin, remove the patch before defibrillation to prevent . - Tolerance - For NTG patch admin, the patch should be removed every 12-14 hours each day to prevent drug . - HR, BP - The RN should assess these two things before beta blocker admin cause a decrease in these. - Bronchoconstriction - For beta blocker admin, assess for wheezing and shortness of breath because beta blocking effects in the lungs can cause . - Output - For beta blocker admin, observe for signs of HF such as cough, edema, dyspnea, and weight gain because this can occur w/ a decrease in cardiac . - Aspirin - For anti-PLT admin, the RN should teach the pt to avoid any OTC meds that contain or NSAIDs. - 50, 100 - Do not give beta blockers if the pulse is below or the SBP is below w/o notifying the provider. - Intracranial - An absolute contraindication to thrombolytic admin is any prior hemorrhage. - Lesion - An absolute contraindication to thrombolytic admin is a known structural cerebral vascular (arteriovenous malformations). - Neoplasm - An absolute contraindication to thrombolytic admin is a known malignant incracranial (primary or metastatic). - 3 - An absolute contraindication to thrombolytic admin is a known ischemic stroke w/in months except acute ischemic stroke w/in 3 hours. - Dissection - An absolute contraindication to thrombolytic admin is a suspected aortic . - Diathesis - An absolute contraindication to thrombolytic admin is active bleeding or bleeding (excluding menses). - 3 - An absolute contraindication to thrombolytic admin is significant closed- head or facial trauma w/in months. - HTN - A relative contraindication to thrombolytic admin is a Hx of chronic, severe, poorly controlled . - Renal - The pt who undergoes cardiac surgery is at risk for injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. - Decreased, increased - Renal injury is signaled by urine output and blood urea nitrogen (BUN) and creatinine levels. - Intrarenal - AKI caused by glomerulonephritis is classified as failure. This form of AKI commonly manifests with HTN, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. - Kussmaul - Clinical manifestations associated w/ AKI occur as a result of metabolic acidosis. The nurse would expect to note respirations as a result of the metabolic acidosis because the bodily response is to exhale excess carbon dioxide. - Diuretic - In the phase of AKI, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring. - Air embolus - If the pt experiences during hemodialysis, the nurse should terminate dialysis immediately, position the client so the air embolus is in the right side of the heart, notify the PHCP and Rapid Response Team, and administer oxygen as needed. - MAP - If CRRT does not require a hemodialysis machine, the pt's needs to be maintained above 60 mm Hg, and arterial and venous access sites are necessary. - Nonrebreather - The priority nursing action for pulmonary edema is to administer O2 at 5 to 12 L/min by simple face mask or at 6 to 10 L/min by mask with reservoir (which may deliver up to 100% oxygen) to promote gas exchange and perfusion. - High fowler - If the pt w/ pulmonary edema is not hypotensive, place in position with the legs down to decrease venous return to the heart. - NTG - For the pt w/ pulmonary edema, if the patient’s SBP is above 100, administer sublingual as prescribed to decrease afterload and preload every 5 minutes for 3 doses while establishing IV access for additional drug therapy. - Antibiotic - Teach patients with valve disease the importance of prophylactic therapy before any invasive dental or oral procedure. This includes patients with a previous history of endocarditis and cardiac transplant or valve recipients. - Oral - Have patients demonstrate appropriate oral hygiene because optimal health is the best intervention to prevent endocarditis. - Cirrhosis - Common causes of include alcoholic liver disease, hepatitis, steatohepatitis, drugs/chemical toxins, gallbladder disease, metabolic/genetics, and CVD. - Cirrhosis - Key features of late-stage include jaundice, icterus, pruritus, rashes, petechiae, ecchymosis, palmar erythema, spider angiomas, ascites, peripheral dependent edema, and vitamin deficiency. - High - For the pt w/ cirrhosis, will the serum liver enzyme levels be abnormally high or low? - Void - Before a paracentesis, ask the pt to before the procedure to avoid prevent injury to the bladder. - Elevated - For a paracentesis, the head of the bed should be during the procedure. - Weight - The RN should take a full set of vital signs and a before and after a paracentesis. - Hepatotoxic - One of the most important things to teach the pt w/ cirrhosis is the need to avoid substances such as tylenol, alcohol, smoking, and illicit drugs. - Pancreatitis - Some potential complications of acute include pancreatic infection, hemorrhage, kidney failure, paralytic ileus, hypovolemic shock, pleural effusion, ARDS, atelectasis, pneumonia, multiorgan system failure, DIC, and type 2 DM. - Jaundice - This complication of acute pancreatitis causes yellowing of the skin and occurs d/t swelling of the head of the pancreas, compressing the flow of bile through the bile duct. The bile duct may also be compressed by calculi or a pancreatic pseudocyst. - Intermittent hyperglycemia - This complication of acute pancreatitis occurs from the release of glucagon and the decreased release of insulin d/t damage to the pancreatic islet cells. - Pleural effusions - Left lung freq develop in pts w/ acute pancreatitis. Atelectasis and pneumonia may also occur, especially in older pts. - Organ - Multisystem failure is caused by necrotizing hemorrhagic pancreatitis (NHP). The pt is at risk for acute respiratory distress syndrome (ARDS). - Edema - A serious complication of acute pancreatitis is severe pulmonary , and is caused by the disruption of the alveolar- capillary membrane. - DIC (disseminated intravascular coagulation) - A serious complication of acute pancreatitis is , which involves hypercoagulation of the blood, w/ consumption of clotting factors and the development of microthrombi. - Shock - in acute pancreatitis results from peripheral vasodilation from the released vasoactive substances and the retroperitoneal loss of protein- rich fluid from proteolytic digestion. - Abd - A key feature of chronic pancreatitis is intense pain, a major symptom, that is continuous and burning or gnawing. - Tenderness - A key feature of chronic pancreatitis is abd and ascites. - Mass - A key feature of chronic pancreatitis is a possible in the LUQ. - Respiratory - A key feature of chronic pancreatitis is compromise manifesting w/ adventitious/diminished breath sounds, dyspnea, or orthopnea. - Steatorrhea - A key feature of chronic pancreatitis is (clay-colored stools). - Loss - A key feature of chronic pancreatitis is weight . - Dark - A key feature of chronic pancreatitis is urine. - Polyuria, polydipsia, polyphagia - A key feature of chronic pancreatitis includes the 3 p's of DM. What are they? - Caffeinated, alcoholic - To prevent exacerbation of chronic pancreatitis, teach pts to avoid drinking and drinks. - High - To prevent exacerbation of chronic pancreatitis, teach pts to eat bland, low- fat, -protein, and moderate-carb meals. - Stimulants - To prevent exacerbation of chronic pancreatitis, teach pts to avoid gastric such as spices. - Small - To prevent exacerbation of chronic pancreatitis, teach pts to eat meals and snacks high in calories. - Water - Teach the pt taking PERT to take w/ all meals and snacks and follow w/ a glass of . - After - Teach the pt taking PERT to take antacid or H2 blockers. - Chewing - Teach the pt taking PERT to swallow capsules w/o to minimize oral irritation and to allow for proper absorption. - Applesauce - Teach the pt taking PERT if they can't swallow the capsule, pierce the gelatin casing and place contents into . - Protein - Teach the pt taking PERT to not mix capsules into foods containing . - Increase - Teach the pt taking PERT to f/u on all scheduled lab testing because PERT can cause an in uric acid levels. - Pacemaker - If the pt has symptomatic bradydysrhythmias or heart block after CABG, turn on the and adjust the settings as prescribed. - Complications - from CABG include fluid and electrolyte imbalance, bleeding, hypothermia, hypotension, decreased LOC, cardiac tamponade, anginal pain and HTN. - Collapse - Hypotension (SBP 90) is a major problem because it may result in the of the coronary graft. - 96.8 - Monitor the body temperature and institute rewarming procedures if the temperature drops below °F after CABG. - Incision - Antimicrobial agents should not be applied to sites. - 200 - Maintain perioperative glucose levels mg/dL even in those patients without a history of diabetes mellitus. - HTN - Hypothermia is a significant risk for the patient after CABG because it promotes vasoconstriction and . - HTN - after CABG is dangerous because this promotes leakage from suture lines and may cause bleeding. - 150 - Measure mediastinal and pleural chest tube drainage at least hourly after CABG. Report drainage amounts over mL/hr to the surgeon. - Dependent - One effective way of promoting chest tube drainage is to prevent a loop from forming in the tubing.