Rasmussen - MDC III - Final Exam 75 Qs - 5 SATA, 3 Dose Calc, 2 ABGs

respiratory alkalosis - high pH, low CO2 pH: 7.35-7.45 acidic-basic HCO3: 21-28 acidic-basic CO2: 45-35 acidic-basic metabolic acidosis - low pH, low HCO3 pH: 7.35-7.45 acidic-basic HCO3: 21-28 acidic-basic CO2: 45-35 acidic-basic respiratory acidosis - low pH, high CO2 pH: 7.35-7.45 acidic-basic HCO3: 21-28 acidic-basic CO2: 45-35 acidic-basic metabolic alkalosis - high pH, high HCO3 pH: 7.35-7.45 acidic-basic HCO3: 21-28 acidic-basic CO2: 45-35 acidic-basic ▪ change in condition make take priority over ABCs (ex: post op bleeding is priority over an O2 Sat% of 90%) ▪ pick the patient that is going to die first - Priority questions...something to consider CPR, press the code button - You walk into your patient's room and they *don't have a pulse*, what are you going to do? bag resuscitation, press the code button - You walk into your patient's room and they are *not breathing but have a pulse*, what are you going to do? ▪ unconscious, pulseless ▪ shock them with the AED! - If you walk into a room with a patient that is in *ventricular fibrillation (v fib)* ▪ How will they present? ▪ What must we do to get them out of that state? ▪ make them bear down (valsalva maneuver) ▪ make them cough (vagal maneuver) - If you walk into a room and a patient is alert and oriented, speaking to you, has a pulse, but their cardiac monitor shows they are in *ventricular tachycardia* ▪ What are you going to do? Supraventricular Tachycardia (SVT) - Which cardiac rhythm requires the patient to take *adenosine*? ▪ they may end up with a *blood clot* because the blood is pooling in the atria - What is our priority concern for a patient in *atrial fibrillation (a-fib)*? *control RVR for patient:* ▪ give anticoagulants ▪ beta blockers, digoxin, diltiazem ▪ if meds don't work...cardioversion (synchronized shock to re-start the rhythm) ▪ if cardioversion doesn't work...ablation - Nursing Interventions: *A-fib RVR* ▪ chest pain ▪ SOB ▪ diaphoresis ▪ N/V ▪ hypertension ▪ tachycardia ▪ jaw pain, anxiety, indigestion (women) ▪ elevated troponin levels ▪ EKG changes - ST elevation - If you have a patient who comes into the ED and they are having an MI, what are the signs/symptoms? lab values to confirm this? *Oxygen* - 1st *Nitro* - given sublingual, 3 doses q 5 min (home), drip (hospital), drops BP (vasodilator) *Aspirin* - antiplatelet, stops clotting, 325 mg, chew it *Morphine* - calms the patient down, helps pain - Treatment: *Myocardial Infarction* ▪ CPK ▪ troponin ▪ CK-MB ▪ BNP - Name the cardiac enzymes angioplasty stent the artery angiogram remove clots cardiac catheterization - Procedures: *Myocardial Infarction (MI)* CABG (Coronary Artery Bypass Graft) - Procedure: Patient has an MI and extreme plaque build up pericarditis - inflammation of the membrane surrounding the heart heart can't expand and contract properly (*cardiac tamponade*) - When you have pericarditis what are you at risk for? pleural friction rub - What sounds will you hear in a patient with pericarditis? pericardial effusion - accumulation of fluid in the pericardial cavity Pericardialcentesis - Surgical treatment: *Pericardial Effusion* aneurysm - a localized weak spot or balloon-like enlargement of the wall of an artery Abdominal Aortic Aneurysm (AAA) - Which is the most common aneurysm? ▪ epigastric pain ▪ pulsating in the abdomen - do not push on it! - S/S: *Abdominal Aortic Aneurysm (AAA)* immediately go to the OR for surgery ▪ pain between the scapulas (straight across the back) - S/S: *Thoracic Aortic Aneurysm* monior BP periodically and check the size of it no anticoagulants!!! - Non-emergent thoracic aortic aneurysm interventions elevated BP 3 times in a six month period - documented by MD - How do we diagnose hypertension? ▪ lifestyle modifications (diet, exercise) ▪ record values at home - Patient Education: *Hypertension* ▪ obesity ▪ drugs ▪ alcohol ▪ age ▪ race (hispanic, african american) ▪ high cholesterol ▪ family Hx ▪ elevated LDL, decreased HDL - Risk Factors: *Hypertension* primary - because of the pressure in the arteries only, usually hereditary secondary - r/t kidney problems or other issues - What's the difference between primary and secondary hypertension? ▪ ACE inhibitors ▪ Beta Blockers ▪ ARBs ▪ Calcium Channel lockers - Pharmacological Treatment: *Hypertension* atherosclerosis - plaque builds up on the inner walls of the arteries ▪ Cholesterol ▪ Smoking ▪ Uncontrolled diabetes ▪ Uncontrolled HTN ▪ Obesity ▪ Diet ▪ Lack of exercise - Causes of plaque build up arteriosclerosis - hardening of the arteries, happens with age, normal good cholesterol, want it 60 - What is HDL? bad cholesterol, want it 150 - What is LDL? "sugary cholesterol" - What are triglycerides? peripheral arterial disease (PAD) - shiny hairless legs peripheral vascular disease (PVD) - Atherosclerosis and Arteriosclerosis can cause what conditions? ▪ cool hands and feet ▪ bad pedal pulses ▪ leg pain ▪ decreased capillary refill ▪ mottled skin - S/S: *Peripheral Vascular Disease (PVD)* lower extremity doppler - How do you diagnose Peripheral Vascular Disease (PVD)? ▪ anticoagulants ▪ cath lab to have stent placement ▪ angioplasty - Treatment: *Peripheral Vascular Disease (PVD)* ▪ no crossing legs ▪ no pressure on legs, keep them in a dependent or dangling position ▪ no constrictive clothing - Patient Education: *Peripheral Vascular Disease (PVD)* -aortic -mitral -tricuspid -pulmonic - Types of valves mitral valve due to increasing age aortic valve - Which valves most commonly have issues? valve regurgitation - backward flow of blood through a heart valve valve stenosis - when valves become narrower than normal, impeding the flow of blood. rheumatic fever - What are some reasons, besides age, patients might end up with *mitral stenosis*? decreased cardiac output which leads to heart failure - When we have any damage to our valves, whether it be regurgitation or stenosis, what are we at risk for? ▪ mitral regurgitation: High pitched holosystolic murmur - begins at S1 and continue to S2 ▪ aortic regurgitation: Blowing, decrescendo diastolic murmur - Murmur sounds associated with mitral regurgitation vs aortic regurgitation ▪ high pitched holosystolic murmur ▪ JVD ▪ SOB ▪ fatigue ▪ tachycardia - S/S: *Mitral Regurgitation* endocarditis - inflammation of the inner lining of the heart antibiotics - How do we FIRST treat endocarditis? dental work IV drugs strep - Causes of Endocarditis Transient Ischemic Attack (TIA) - why? because of microclots that get loose and travel - Complication of Endocarditis left-sided heart failure aka CHF - Heart failure where it backs up to the lungs ▪ SOB ▪ decreased O2 Sat ▪ fluid around lungs ▪ fluid in lungs ▪ crackles ▪ potential confusion ▪ fatigue ▪ weakness