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270 Cards in this Set
- Front
- Back
What is always a major consideration in the elderly and those on medications? |
vital signs especially orthostatic hypotension
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Where will I find the heart sound of the Aortic valve?
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2nd intercostal space (ICS), right sternal border
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Where will I find the heart sound of the Pulmonic valve?
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2nd ICS left sternal boarder (LSB)
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Where will I find the heart sound of the Tricuspid valve?
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4th ICS, LSB
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Where will I find the heart sound of the Mitral valve?
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5th ICS, midclavicular line
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Pnemonic to remember heart sounds in order?
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All (Aortic) Physicians (Pulmonic) Take (Tricuspid) Money (Mitral)
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What is S1?
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the closure of the MITRAL and TRICUSPID valves and heard loudest in those areas
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What is S2?
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the closure of the AORTIC and PULMONIC valves and heard loudest in those areas
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How many seconds is each small block on a rhythm strip?
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0.04 seconds, this may be used to determine intervals such as the PR interval or the duration of the QRS complex. If the complex is really small, adjust the gain or amplitude on the monitor
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What is a U wave?
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an extra bump seen after the T wave, when seen, it could mean hypokalemia or stroke
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What wave is the first part of the beat, which signifies the atria have contracted?
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P wave
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What does it mean if there is no P wave?
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there is a problem is with the SA node.
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If a question is about heart blocks where is the problem?
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AV node
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What is the PR interval?
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from the beginning of the P wave to the beginning of the QRS complex
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Normal time for the PR interval is?
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0.14 -0.20
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If the PR interval is greater then 0.20 the client has a?
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first degree block |
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What is the tallest part of a rhythm strip and signifies the ventricles have contracted?
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The QRS complex
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Wide QRS complexes are associated with what?
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Hyperkalemia along with Tall Tented T waves
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Normal QRS rhythm is ?
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0.08-0.12
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The ST segment is the point where the end of the ______ and the _____ wave join.
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QRS and the T wave join.
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What does ST segment elevation signify?
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ischemia over the area of the infarction
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What is the bump seen after the QRS complex and signifies return to resting for the heart?
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The T wave
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Tall and peaked T waves can mean?
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hyperkalemia
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If you defibrillate on the T wave what would result?
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ventricular fibrillation can result
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QT interval is from the beginning of the ____ comples until the ____ of the _____
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QRS comples until the end of the T wave.
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If the QT interval is prolonged what is happening
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bradycardia and is seen with some medications and conditions
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Describe Asystole
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lack of rhythm with no QRS compleses, it may also be called cardiac standstill (flat line)
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What do you give to a client in Asystole
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Epinephrin and Atrophine to treat the rhythm, may also give sodium bicarbonate if prolonged.
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How soon with the client die in Asystole if not corrected
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8 minutes
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Describe Atrial Flutter
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Saw tooth pattern of the P wave ^^^^^^^^^^
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What is Atrial Flutter associated with
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stokes due to turbulent blood flow through the chambers and valves
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Describe Atrial Fibrillation
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Chaotic P waves are seen,
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What is Atrial Fibrillation associated with
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turbulent blood flow through the chambers and valves.
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What do you see with Ventricular Fibrillation
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Chaotic QRS complexes
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Is V Fib a lethal rhythm
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YES, die within 8 minutes if not correctd
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How do I treat V Fib
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Defibrillate
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What is the most common cause of death immediately after an acute MI
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V Fib, or V tachcardia
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What do you see with Ventricular Tachycardia
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Wide, bizarre QRSs
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Tx for Ventricular Tachycardia
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check the pulse if none treat like V Fib and Defibrillate, tx with xylocaine (Lidocaine) diluted with D5W
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Describe Premature Ventricular Contractions (PVCs)
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Periodice wide, bizarre QRS, premature beats followed by a compensatory pause
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When do I become concerned with PVCs
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more then 6 per minute, occure in pairs, are multifocal, fall on the T wave, or more then 6 in a row.
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What do PVCs signify
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ventricular irritablity, monitor the client, no treatement needed unless risk factors such as heart disease or more then 6 per minute, occure in pairs, are multifocal, fall on the T wave, or more then 6 in a row.
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Will PVCs cause palpitations in the client
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yes, feel for a pulse deficit when the beats occur
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Describe Supraventricular Tachycardia
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A rapid rhythm coming from above the ventricles
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Treatment for Supraventricular Tachycardia
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Give adenosine (Adenocard) and beta blockers to treat
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What is Hemodynamic monitoring
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invasive procedure which tells left heart function, a Swan Ganz catheter is inserted with the tip of the catheter positioned in the pulmonary artery
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What is PCWP
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Pulmonary artery wedge pressure and it is very significant
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Where is PCWP most accurate of
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most accurate assessment of the left ventricle
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Normal PCWP
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4-12 mmHg
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What could it be if client has a higher then 12 mmHg PCWP
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fluid overload, left ventricular failure, ischemia, mitral stenosis, cardiac tamponade
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What could it be if client has a lower the 4 mmHg PCWP
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dehydration
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What is CVP
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Central Venious Pressure, tells right heart funciton, increases and decreases simular to PCWP
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What is normal CVP
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2-8 mmHg
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Inotropic agents action
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increases the force of contract and perfusion to the organs. An increase in urine output would indicate an increased perfusion to the kidneys. Advisse the client to rest during the day to decrease the demands on the heart and prevent fatigue.
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Do inotropic agents control angina
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NO
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Side effect os Inotropic agents
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slow heart rate, do not give if HR is below 60 or above 120, call Dr. 1st
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Signs of toxicity with Inotropic agents
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N&V, diarrhea, bradycardia, heart block, halos in the visual field
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What potentiates the effects of digoxin (Inotropic agent)
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Hypokalemia, the clients level could be high normal in the presence of hypokalemia and toxic rhythms and symptoms may develop
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How is Digoxin excreted
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by the kidneys dosage must be DECREASED in renal dysfunciton
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What is the antidote for digoxin toxicity
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digoxin immune fab (Digibind)
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Action of Antidysrhythmics
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treat abnormal heart rhythms which can begin in the atria or the ventricles
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Side Effects of Antidysrhythmics
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Hypotension, Dizziness, Other dysrhythmias, Confusion especially in the elderly
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Side Effect with Quinidine gluconate (Quinaglute)
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Diarrhea, N&V, Loss of appetite, Dizziness
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Xylocaine (Lidocaine) which is an Antidysrhythmic can cause
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toxicity signs of it are SAMS S= Slurred or difficult speech, Paresthesi and numbness of the tongue and lips, A= Altered CNS with drowsiness, dizziness, restlessness, confusion, Arrhythmias, M= Muscle Twitching, tremors, S= Seizures and convusions, repiratory depression, cardiac arrest remember SAMS in trouble with Lidocaine
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Additional Antidysrhythmics
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Disopyramide (Norpace), Flecainide (Tambocar), Mexiletine HCL (Mexitil), Moricizine (Ethmozine), Procainamide (Pronestyl, Procan), Propafenone HCI (Rythmol), Tocainide (Tonocard), Acebutolol (Sectral, Monitan), Esmolol (Brevibloc), Metoprolol (Lopressor), Propranolol (Inderal), Sotalol (Betapace), Amiodarone (Cordarone), Dofetilide (Tikosyn), Diltiazem (Cardizem), Verapamil (Calan, Isoptin, Verelan)
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Action of Nitrates and Vasodilators
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Relax smooth muscles in the coronary arteries to increase blood supply to the heart muscle for better perfusion and to relieve chest pain. These drugs can also relax the blood vessels in the peripheral circulation to lower blood pressure and decreased preload and afterload to impove heart function. In otherwords it DECREASES Preload and Afterload.
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Side effects of Nitrates and Vasodilators
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Headache, Hypotension, Dizziness, Lightheadedness
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What do you know about Diazoxide (Hyperstat) a Nitrate/Vasodilator
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Fast acting with in one to five minutes of administration, duration of effect form 2-12 hours
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What do you know about Nitroprusside (Nipride) a Nitrate
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Must be protected from light, becomes unstable when exposed
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Nitrates
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Isosorbide dinitrate (Isordil, Sorbitrate), Isosorbide monoitrate (Imdur), Nitroglycernine, Pentaerythritol tetranitrate (Peritrate)
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Vasodilators
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Hydralazine (Apresoline), Minoxidil (Loniten, Rogaine), Sildenafil (Viagra)
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What is the action of Beta Blockers
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Block the effects of the sympathetic nervous system and can be used to treat abnormal rhythms, chest pain and can protect the heart after an acute MI, they DECREASE HR, BP, Cardiac Output, Myocardial Oxygen Consumption.
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Side Effects of Beta Blockers
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Hypotension, Bradycardia, SOB, Impotence, Decreased Libido, also can exacerbate Heart Failure, Asthma and Depression
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Beta Blockers
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Acebutolol (Sectral), Atenolol (Tenormin), Bisprolol (Zebeta), Metoprolol (Lopressor, Toprol), Carvedilol (Coreg), Nadolol (Corgard), Pindolol (Visken), Propranolol (Inderal)
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Calcium Channel Blockers Action
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Relax the blood vessels reducing blood pressure and improving blood flow. They also slow down the electrical conduction in the heart and can be used to control rapid dysrhythmias.
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Side Effects of Calcium Channel Blockers inclued the 5 H’s
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Hypotension, HA, Hot Flashes, Heart Block, Hard Bowel Movements
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When should I give Calcium Channel Blockers
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before meals and at bedtime
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Common Calcium Channel Blockers
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VERY = Verapamil (Calan, Isoptin, Verelan), NICE= Nifedipine (Adalat, Procardia), DRUGS= Diltiazem (Cardizem, Dilacore, Tiazac) others are Amlodipine (Norvasc), Bepridil (Vascor), Nicardipine (Cardene) (tend to end ind ipine)
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Angiotensin-converting enzyme (ACE) inhibitors use
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to control high blood pressure and help the heart funciton better in those with heart failure and after a heart attack
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Lab effects of ACE inhibitors
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Increase K+ and decrease WBC
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Side Effects of ACE Inhibitors
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Frequent cough, Angioedema (large tongue), HA, Fatigue, Hyperkalemia
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Common ACE Inhibitors
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(End in Pril) Benazepril (Lotensin), Captopril (Capoten), Enalapril (Vasotec), Enalapril plus thiazide (Vaseretic, Prinzide, Zestoretic), Fosinopril (Monopril), Linsinopril (Prinivil, Zestril), Moexipril (Univasc), Perindopril (Acenon), Quinapril (Accupril), Ramipril (Altace)
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Angiotensin II receptro blockers (ARBs) action
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work like the ACE inhibitors except they allow for an additional step in the drugs conversion which decreases the incidence of the side effects of a dry annoying cough.
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Common ARBs
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(End in artan) Candesartan (Atacand), Eposartan (Teveten), Irbesartan (Avapro), Losartan (Cozaar), Telmisartan (Micardis), Valsartan (Diovan)
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Alpha-blockers use
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to treat hypertension and benigh prostatic hypertrophy in men
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How do I give the 1st dose of an Alpha Blocker
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give at night due to can get first dose effect and get hypotension.
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Methyldopa (Aldomet) (Alpha-Blocker) what do you know about it
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can cause hepatotoxicity within 2-4 weeks of beginning the drub. Hemolytic anemia occurs in 4% of the clients.
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Common Alpha-Blockers
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Clonidine (Catapress), Doxazosin (Cardura), Mecamylamine HCL (Inversine), Prazosin (Minipress), Terazonsin (Hytrin), Guanabenz acetate (Wytensin), Guanfacine HCL (Tenex)
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Coagulation Modifiers action
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Antiplatelet and anticoagulants interfere with the formation of blood clots to prevent heart attacks, strokes, and DVT. Thrombolytics dissolve blood clots
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Side effect of Coagulation Modifiers
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bleeding
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What is a mainstay of the treatment for DVT
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Heparin
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How long should aspirin, coumadin and plavix be held prior to surgery
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minimum of 48 hours but 5 days is best
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What drug helps to protect the clients artivical heart valves after surgery
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Dipyridamile (Persantine)
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Common Antiplatelets
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Abciximab (ReoPro), Anagrelide (Agrylin), Cilostazol (Pletal), Clopidogrel bisulfate (Plavix), Dipyridamole and aspirin (Aggrenox), Eptifibatide (Ticlid), Tirofiban (Aggrastate), Treprostinil (Remodulin), Deltaparin (Fragmin), Danaparoid (Orgaran), Enoxaparin (Lovenox), Tinzaparin (Innohep), Anisindione (Miradon)
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Common Thrombolytics
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Alteplase (Activase, t-PA), Reteplase (Retavase), Streptokinase (Streptase, Kabikinase), Tenecteplase (TNKase)
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Antilipemic agents action
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Decrease the amount of LDL cholesterol in the blood stream and reduce the amount of plague deposits. Some agents can increase the amount of HDL cholesterol
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SE of Antilipemic agents
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Constipation, Heartburn, Bloating, Belching, Nausea, Lowers ADEK vitamins, Muscle Pain with Statin drugs, Headache, Vertigo, UTIs, Impotence, Formation of gallstones with Fibric acid derivatives Can increase liver enzymes
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Common HMG CoA reductase inhibitor (Statin Drugs)
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Atrovastatin (Lipitor), Fluvastatin (Lescol), Lovastatin (Mevacor), Pravastatin (Pravachol), Rosuvastatin (Crestor), Simvastatin (Zocor)
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Common Fibrin acid derivatives
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Clofibrate (Atromid-S), Fenofibrate (Tricor), Gemfibrozil (Lopid), Niacin
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Bile acid Sequestrants use
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they are a powder that I mix in water, may bind to other medications so give alone, Take 1 hours before or 4-6 hours after other meds
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Common Bile acid Sequestrants
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Cholestryramine (Questran), Colestipol (Colestid), Colesevelam (Welchol)
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Common Colony Stimulating Factors
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Erythropoietin (Epogen, Procrit) makes Erythrocytes (RBCs), Filgrastin (Neupogen) and pegfilgrastim (Neulasta) makes Neutrophils (WBC)
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What form can Colony Stimulating Factors be given
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SQ and IV
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SE of Colony Stimulating Factors
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hypertension and tachycardia
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What is Coronary artery disease
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Plague buildup resulting in a reduction of blood flow to the myocardium. Affected by blood cholesterol levels
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Target levels of Triglycerides
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less than 150
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Target levels of Cholesterol
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less than 200
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Target Levels of LDL
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less than 100 LDL for those with risk factors, less than 160 LDL for all others
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Target levels of VLDL
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less than 100 LDL for those with risk factors, less than 160 LDL for all others
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Target levels of HDL
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Greater than 40 for men, greater then 50 for women, greater than 60 for cardioprotection
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What is LDL
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cholesterol and protein
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What is VLDL
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triglyceride and protein
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What is HDL
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phospholipids and protein
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What is Angina
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Lack of blood supply to the myocardium causing pain in chest
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Stable Angina
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pain with a stable pattern
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What do unstable angina clients have
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cardiac insufficiency
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What type of angina occurs at night or at rest and is due to vasospasm of the coronary arteries
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Variant Angina
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What do you call damage to the myocardium resulting from an interruption of blood flow
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Acute myocardial infarction (AMI)
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Clinical manifestation of an MI
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Chest pain, pallor, cool, clammy, increased BP, dyspnea, Heart Failure, Fatigue, Weakness, N & V, Decreased LOC, Temp elevation
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What EKG changes will I see with an area of infaction
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irreversible damage, causes a Q wave to dip down on the EKG
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What EKG changes will I see with an area of injury
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Next to the infacted tissue, increase O2 to save the tissue, ST segment elevation or depression on the EKG
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What EKG changes will I see with an area of ischemia
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ST segment depression and T wave inversion on the EKG, will be next to injury tissue, increase O2 to save tissue, circulation is able to compensate
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Treatment of an MI
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O2, Nitro, Aspirin, Morphine in order for NCLEX and give thrombolytics within 1-4 hours from and AMI, BSC for BM inituall after an AMI
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What is a major factor in clients not to seek treatment for an MI
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denial
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What is a defense mechanism after an MI
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Noncompliance
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When can sexual relations begin after an AMI
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when the client can climb a flight of stairs without fatique or discomfort
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Complications of an AMI
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Dysrhythmias, Cardiogenic shock, Heart Failure, Recurrent MI
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Where is a Coronary Artery Bypass Graft taken from
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Saphenous vein in the leg
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What does a slow heart rate after heart surgey indicate
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heart block
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Expected chest tube drainage after 1st 2 hours of placement
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100 ml
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Expected chest tube drainage in 24 hours of placement
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500 ml
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What is Angioplast (PTCA)
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Ballon therapy to open up the arteries, angioplasty may be preceded by an angiogram when contrast dye is injected.
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What will a coronary artery angiogram and angioplasty due
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improve blood flow to the mycardium
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What will a femoral angiogram and angioplasty do
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improve blood flow to the leg
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What will an illiac artery angiogram and angioplasty do
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improve blood flow to the plevis and leg, if bleeding occurs after the proceudre, it causes blood to accumulate in the retroperitoneal area.
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What is a disorder of the mycardium that impaired venous return occures
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cardiomyopathy
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What is it called when a client has damage to their valves resulting in a murmur or necessitating a valve replacement
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Valvular heart disease
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What is it when the right atrial pressure is increase and enlarged and a systolic murmur is heard
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Tricuspid Regurgitation
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What is it when the left atrial pressure is increased and enlarged and diastolic murmur is heard
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Mitral Stenosis
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What is is called when the left atrial pressure is increased and enlarged and systolic murmur
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Mitral Regurgitation
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What is ic called when the left ventricular pressure is increased and enlarged and Systolic murmur
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Aortic Stenosis
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What type of valve needs Coumadin for life
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Mechanic Valve
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What is an inflammatory disorder which may develop after a Group A beta hemolytic streptococcal infection and can involve the heart, joints, skin and brain
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Rheumatic Fever
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Clinical manifestations of Rheumatic Fever
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Fever and histry of sore throat, Erythema Marginatium (red raised skin lesions starting on the trung and spreading outward, Chorea (involuntary movements of extremities and face), Carditis, Polyarthritis, Subcutaneious Nodules, Abdominal pain in some, will have a + ASO titer and increased ESR.
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Inflammation of all parts of the hear, especially the mitral valve
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carditis
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Complication of Rheumatic Fever
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Endocarditis
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Tx for Acute Phase of Rhumatic Fever
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Treat with antibiotics and bedrest Penacilin is 1st option if allergy then Erythromicin
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Inflammation of the inner lining of the heart incluing the vlaves
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Endocarditis two types
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Acute Endocarditis
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most often affects healthy people
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Subacute Endocarditis
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Usually have a pre-existing condition such as rheumatic heart disease, mitral valve prolapse, or immunosuppression
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Tx for endocarditis
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Hospitalization for 7-10 days
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Lesions on the heart valves increase the risk of
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microthrombi, erosion, or perforation of the valve, or absecessess in the mycardial tissue, ATB therapy is needed
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Failure of the heart to act as a pump
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heart failure, the heart cant pump in relation to the bodys needs, avoid sodium to decrease the work load of the heart
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Left sided heart failure proceeds _____
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right sided except in the case of pulmonary hypertension
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Left sided HF clinical manifestation
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Paroxysmal nocturnal dyspnea, Orthopnew, Dyspnea on exertion, Cough, Blood tinged sputum, Crackles, Wheezes, Restlessness, Confusion, Cyanosis, Increased HR, BP and PCWP.
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Right sided HF clinical manifestations
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Fatigue, Distended Jugular veins, swelling in hands and fingers, dependent edema, enlarged liver and spleen from increased pulmonary pressure due to long term repiratory acidioses, ascites, anorexia and complaints of GI distress
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Treatment of HF
|
“UNLOAD FAST in heart failure” U= Upright postion, N= Nitrates, L = Lasix, O = Oxygen, A = Aminophylline, D = Digoxin F= Fluids reduced, A = Afterload reduction, S= Sodium restiction, T= tests include DIG level, ABGs, K+ level
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Fluid accumulation in the alveoli
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Pulmonary edema
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Clinical manifestations of Pulmonary Edema
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Extreme dyspnea, Suffocation feeling, Wheezing, Anxiety, Restlessness, Frothy Sputum, Diaphoresis, Pallor, Chest pain, Tachycardia, Palpitations, - put HOB 90 degrees
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Treatement for Pulmonary Edema
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“MAD DOG” M=Morphine, A=Aminophylline, D=Digitalis (Lanoxin), D=Diuretics (Lasix), O=Oxygen, G=ABGs (this is not in orde follow ABC rule for order)
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Inflammation of the pericardium
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Pericarditis
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Clinical Manifestations of Pericarditis
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Chest pain, Dyspnea when supine, low grade fever, ST segment elevation and T wave inversion, Weakness and fatigue, Dry cough, Dependent edeam
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Complcation of Pericarditis
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Pericardial Tamponade (a whole bunch fo fluid around the heart)
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Signs of Pericardial Tamponade
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Tachycardia, Hyptension, Paradoxial Pulse, Distant or muffled heart tones, Jugular vein distention
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Treatment of Pericardial Tamponade
|
Pericardiocentesis, which drains the pericardial cavity
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An electronic device used to generate electrical activity for the heart
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Permanent pacemake, stimulates a normal heart beat
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What type of pacemaker Fires as needed when the heart rate slows down
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Synchronous (demand)
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What type of pacemaker Firsts at a constant rate and not in relation to demand by the heart, may be used briefly to evaluate pacemaker function
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Asyncrhonous pacemaker
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Device used to pace or defibrillate a client our of a dangerous dysrhythmia
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Implantable cardioverter defibrillator
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Nursing teaching relating to Implantable cardioverter defribrillator
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device may discharge for a dysrhythmia, avoid magnetic fields (warning signla will beep if near a magnet field), there will be activity restrictions after the device is place, avoid strenous activity, Driving may be restricted due to possible rhythm abnormalities and discharges
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Distended vains due to incompetent valves. Usually complain of heaviness in the legs
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Vericose Veins
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Tx for Varicose Veins
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Stripping and ligation procedure removes the dilated, superfical veins, bedrest for 24 hours with ambulation for 5-10 minutes every 2 hours after the procedure. Elastic compression of the leg for one week after surgery (not TED hose, but Ace bandages or jub hose)
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Formation of a blood clot in the deep vein
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Deep Vein Thrombosis
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Most commong sign is unilateral swelling of an extremity
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DVT, ambulation best prevention for lower leg DVT
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Teachings with DVT
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Activity limitaitons, never a pillow under the knee, heat to increase blood flow to promote dissolution of the clot, Heparin, Enoxaparin (Lovenox) and Warfarin (Coumadin) for drug therapy to prevent further clot formation. Remember will not dissolve the current clot but will prevent others from forming.
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Inability of the body to return blood from the distal cirucation due to incompetent valves or obstruction
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Venous insufficiency, varicose veins common in these clients
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What will I see with venous insuffienciency
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Thick, pigmented skin, elevation relieves pain, possible cyanosis when foot dependent, venous stasis ulcers are common, ankle swelling during the day, FOB should be elevated at night to promote venous return.
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Inability of the body to supply adequate blood flow due to vessel damage
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Arterial insufficiency know they can get arterial ulcers, intermittent claudication is the pain and cramping experience with activity which is relieved by rest
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Pale, shiny skin with decreased pulses, pale when elevated, red when dependent. Need to tell client to check pulses periodically
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signs of arterial insufficiency
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What will relieve pain in arterial insufficiency
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putting legs down
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What procedure is done to supply blood flow to a compromised extremity
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femoral popliteay bypass gravt
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When do I ambulate a femoral popliteal bypass graft
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the day after surgery
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What could compromise the intra-abdominal graft after a femoral poplieteal bypass graft surgery
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Hypertension
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Ass the color of extremities and feel for pulses how often after a femoral popliteal bypass graft
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every day
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Blood pressure consistently greater than 140/90 Systolic and diastolic BP
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Hypertension
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Systolic and diastolic BP does what in the elderly population
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increase
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Risk factors for Hypertension
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Heredity, Race, Age, Obesity, Alcohol Abuse, Increased sodium intake, Oral Contraceptives
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Which side of the heart fails with Hypertension
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Left ventricular failure
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Complications of Hypertension
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CAD Coronary Artery Disease, CRF Chronic Renal Failure, CHF Congestive Heart Failure, CVA Cerebrovascular Accident “ the 4 C’s of hypertension
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A widening, Stretching, or ballooning of the aorta usually due to hypertension
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Abdominal Aortic Aneurysm AAA
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What will I see with a AAA
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Palpable pulsating mass may be felt, Dissection of the aneurysm may occur, Those at highets risk are African American Men and those with severe hypertension
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What can happen during surgical repair of a AAA
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Kidney damage, due to large arteries are clamped for a time period so monitor BUN, creatinine, and ratios
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Deficeincy of red blood cells
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Anemia (Labs will be low RBC, Hgb, Hct
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What type of Anemia has Malfuncitoning bone marrow
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Aplastic
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What type of Anemia has a genetic defect of hemoglobin S. Life span of RBC is less than 40 days
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sickle cell or speroidal anemia
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What can I give to a sickle cell pt to help
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folic acid and HOP H=Hydration, O=Oxygenation (no matter what the pulse ox states always give O2 to sickle cell), P= Pain relieve only Morphine or Hydromorphone (Dilaudid) NEVER DEMORAL WILL CAUSE SEIZURES
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What culture is prone to sickle cell
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African, Meditrainin, Will not see until 6 months old
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Labs for Sickle Cell Trait
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HbgAS
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Labs for Sickle Cell Disease
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HbSS
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Labs for Sickle Cell Disease and Trait
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NGBS
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What is Hypochromic
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Iron or vitamin deficiency
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Who gets Hypochromic
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anyone who is growing
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Red cell destruction by antibodies
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Erythroblastosis this is a type of hemolytic disease, will see low Hgb and Hct and high bilirubin due to the breakdown of the blood cells
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Secondary anemia can develop with
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persistent bleeding, leukemia, cancer, or chronic kidney disease
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What type of anemia has a lack of intrinsic factor (form of megaloblastic anemia)
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Pernicious
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What can cause Pernicious anemia
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gastritis or gastic surgery or problem with ileum where B12 is absorbed
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Signs of Pernicious anemia
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signs of malnutrition, weakness, mild diarrhea, and a SMOOTH, SORE RED TONGUE
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Treatment of Pernicious anemia
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B12 injections once a month for life
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What test is done to dx Pernicious anemia
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Schilling test, Cobalamin is injected, if it cannot be absorbed as in pernicious anemia, very little is excreted in the urine. Collect a 24 and 48 hour urine specimens
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Tx for iron deficiency anemia
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iron tablets
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How do I give iron tablets
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not with milk or antacid, take without food if possible, OJ increased absorption, Nausea and heartburn initially with use but keep taking will go away, causes constipation
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Excess red blood cells as a result of an abnormality of the bone marrow
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Polycythemia vera
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Clinical manifestation of Polycythemia vera
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Ruddy complexion, hypertension, chest pain, SOB, HA, fatigue, dizzyness, signs of heart failure, blood is think so will have increased BP due to heart has to work harder
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Lab effects of Polycythenia vera
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increased Hgb, Hct, if COPD on increased Hct
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Peticia in a Christmas tree pattern with what type of blood dyscrasias
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Thrombocytopenia and immune thrombocytopenic purpura (ITP), bone marrow shows increased number of megakaryocytes which is the precursor to platelets
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Neutrophils less than 1000
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Leukopenia
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What type of shock occurs with bleeding of any kind
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Hypovolemic
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What is treatment of hypovolemic shock
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Give fluid isotonic such as 0.9% NaCl and blood
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What type of schock occurs with damage to the spinal cord
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Neurogenic
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What is treatment of Neurogenic shock
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Give fluids and vasopressors early
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What type of shock occurs with damage to the heart muscle
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Cardiogenic shock, pulmonary edema may result
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What is treatment of Cardiogenic shock
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Give fluids, vasopressors (such as Levophed or Dopamine), vasodilators, and insert an intra-aortic balloon pump. Monitor for the development of pulmonary edema.
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What position due I put a Pulmonary Edema patient in
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High Fowlers with legs down to decrease venous returen
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What shock occurs due to histamine release
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Anaphylactic shock, will see broncial constriciton and decreased periperal resistance, leads to hyptension and flushed appearance
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What is the treatement for Anaphylactic shock
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Give fluid, antihistamines, bronchodilators, and steroids, Epinephrine 1:1000, 0.2-0.5 ml SQ for mild reaction 1:10,000, 0.5 ml for severe reaction “ remember give the $10,000 drug for a severe reaction”
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What type of shock occurs due to an infectious process
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Septic
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What is the treatment of Septic shock
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Give fluids, vasopressors, and anti-infectives. May need digitalis (Lanoxin) to increase contractility of the heart
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What type of shock is caused by vasodilation
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Distrubutive shock and ther are three, Neurogenic, Anaphylactic and Septic
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Clinical manifiestation of early shock
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increased anxiety, agitation and restlessness, normal BP, increase HR, color normal , cool and mosit, increased deep respirations, decreased urine output
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Clinical manifestations of late shock
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BP less than 90 systolic (hypotension), Weak increased heart rate, pale, cold and clammy, coma, incrased shallow respirations, NO urine output
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What stage of shock will I see Tachycardia, Cap refil more then 2 seconds, Irritable due to increasing hypoxia
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Compensated
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What stage of shock will I see Metabolic acidosis, widespread cellular injury, third spacing, multisystem organ dysfunction
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Decompensated or progressive
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What stage of shock will I see client dying
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irreversible
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A client is bleeding from everywhere what do they have
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DIC, give blood, paletlets, FFP and heparin to prevent further depletion of clotting factors
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Lab effects of DIC
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Decreased RBC, platelets, fibrinogen and increased FDP
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What is a disorder of blood vessels resulting in vasoconstriciton and decreased blood flow
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Raynauds disease and phenomena
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What is Raynauds phenomenon
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unilateral involvement
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Raynauds disease is bilateral
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extremity involvment
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What can trigger a vasospasm in Raynauds
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stress
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What is Thromboangiitis obliteran (Buergers disease)
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Similar to Raynauds, treat the same it is just the lower extremeties and more common in smokers and men.
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What blood level elevation is the earliest indicator of AMI
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Troponin and CPK-MB
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What is most predicative of CAD
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Elevated LDL and cholesterol levels
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What is the study called when wires are put into the right side (veneous) heart to stimulate abnormal rhythms
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Electrophysiology EP study
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A non invasive EP study is a
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holter monitor diary should be kept with the following info, medication times and does, chest pain episodes, and description, valsalva, sexual activity, exercise
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Do MUGA and Thallium scans involve radioisotopes injections
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YES they look at blood flow and musle function
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What does an ECG or EKG provide
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multiple vies of the electrical activity of the heart
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What is done on ALL AMI clients
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Echocardiogram
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Cardiac Catherterization Nursing Teachings
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Invasive procedure performed in the cath lab, activity restricted afterwards, Must be supine position for minimum of 4 hours and keep leg straight for 6 hours , Dye injection to visualize the vessels. Vitals will be monitored frequently to detect any bleeding
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CPR needs renewed every
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2 years
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CPR ratio
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30:2 of compressions to respirations
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How often do I reevaluate pulse and breathing during CPR
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after 5 cycles
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CPR Cycles
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15 with 100/min compressions then switch with another person for a break, when changing people begin with compressions
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Contributing factors to cardiac arrest
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Hypovolemia, Hypoxia, Hydrogen ion acidosis, Hyp/Hyperkalemia, Hypoglycemia, Hypothermia, Toxinx (overdose), Tamponade (cardiac), Tension Pneumothorax, Thrombosis (cardiac or pulmonary), Trauma
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Cardia Monitoring Nursing teachings
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May need to clip the hair on the chest, change electrodes every 24 hours due to irritation unless hypoallergenic once are used, if diaphoretic, tincture of benzoin or alcohol used to clean the skin and increased adhesiveness
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Universal donor
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O –
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Universal recipient is
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AB +
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Priority with blood administration is
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proper typing and cross matching
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What do Gas bubbles in a unit of blood indicate
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possible bacterial growth do not use
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How long do I have to give 1 unit of blood
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no longer then 4 hours
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When preparing to give a unit do in what order
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vital signs to make sure blood can be transfused and the IV is still patent, got to lab to check the integrity of the unit and compatibility, Check the blood at the bedside with 2 RNs, Prepare the solution and tubing, start the infusion, remain with the client, Use only normal saline to flush the tubing for blood. Never add medications to a blood bag.
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Febrile reaction
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Chills, fever, HA, N & V, Anxiety
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Allergic reaction
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Hives, facial fluhsing, and bronchospasm
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Hemolytic reaction
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immediate onset, low back pain, hypotension, fever, chest pain, dyspnea and HA
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Treatment for ANY transfusion reaction
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STOP the blood and turn on the saline to keep the vein open, get a new bag of saline with NEW tubing so the person does not get more of the blood, send a urine specimen to the lab to check for free hemoglobin in the urine. Red blood cells break during the transfusion reaction, hemoglobin is released into the circulation and found in the urine.
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Albumin tranfusion are given for very low albumin level, when are they contrainindicated
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sever anemia, heart failure and renal insufficiencly level
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What level do you transfuse Albumin at
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less than 2
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Steps to cardioversion and defibrillation
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call “all clear” before discharge of energy in defribrillation, lubrication on chest for discharge, TURN OFF O2 if possible before defibrillation due to combustion, need to remove nitroglycerine patch if present due to it has metal in it.
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Cardioversion is it an elective procedure
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YES, client is awake but sedated, need consent form, EKG monitor, Sychronized with heart rhythm
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What do I begin joules at for Cardioversion
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50-100 joules
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What do I begin joules at for Defibrillation
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200 joules up to 360, clinet is uncouscious, EKG monitor, no cardiac output, Must be in Ventricular Fibrillation or Tachycardia, it is an emergent procedure to safe a life.
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