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2023 UPDATE RSNG 1413 EXAM 3 QUESTIONS AND
ANSWERS 100%CORRECT/VERIFIED BEST RATED A+
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Signs and symptoms of chest pain: Nausea, diaphoresis, extreme fatigue, weakness Men: on the left side of chest and radiates to left arm Women: Less definitive, SOB, jaw/back pain, nausea, fatigue how to assess the heart and to interpret findings. Listen to the 5 areas: Aortic and pulmonic: s Tricuspid and Mitral: s Si: “LUB” Low sound where mv and tv close and is loudest at apex “Beginning of systole” S2: “Dub” Sound where AV and PV close and is Loudest at base “End of systole/Beginning of diastole” Erb’s point: They are equal. Compensatory mechanisms of hypoxia. Pulmonary vasoconstriction, hyperventilation to improve co2, increase in rbc production, acidosis related right shifting of the oxyhemoglobin dissociation curve to help 02 unloading and increase cardiac output
Priority assessment as it relates to oxygenation needs. purpose of vasodilators and diuretics as it relates to the heart Vasodilators cause smooth muscle to relax which causes vessels to dilate. It treats hypertension, heart failure, and angina. Diuretics helps kidneys get rid of unneeded water and salt making it easier for your heart to pump by decreasing pressure in the veins and overload of venous blood into the heart. treats high BP and ease swelling and water buildup caused by many medical problems including heart failure signs and symptoms of right and left sided heart failure. Right sided Heart Failure Left sided Heart Failure Increased Peripheral Venous Pressure Paroxysmal Nocturnal Dyspnea Ascites Elevated pulmonary cap Pressure Enlarged Liver and spleen (Hepatosplenomegaly) Pulmonary congestion: Cough, crackles, wheezes, May be Secondary to COPD blood tinged sputum, tachypnea Distended Jugular Veins Restlessness Anorexia Confusion Complaints of GI Distress Orthopnea Weight Gain Tachycardia Dependent Edema Exertional Dyspnea/hypoxia Fatigue Cyanosis and fatigue
up to 4 hours face Oxygen conserving cannula (oxymizer) 8LPM long term
Bag-valve mask 15+ LPM emergent situations only requires manual ventilator Venturi 4,8,12 LPM short term claustrophobic, can’t eat drink or talk while on Digoxin and the relationship with potassium. Lower the potassium: higher the digoxin toxicity. -Digoxin normally binds to atpase pump (same as potassium) and less potassium means easier to bind- effects are increased. Hold Digoxin for HR <60. Therapeutic level 0.5-2.0 ng. Potassium is 3.5-5. How ace inhibitors work and side effects. “Prils” THAT RELAX THE VIENS AND ARTERIES THUS LOWERING BP. IT DOES THIS BY PREVENTING CONVERSION FROM ANGEOTENSIN I TO ANGIOTENSIN II (VASOCONSTRICTOR) WHICH IS A SUBSTANCE THAT’S SUPPOSED TO NARROW YOUR BLOOD VESSELS. SIDE EFFECTS: HACKING COUGH, DRY MOUTH, NAUSEA, RASH, KIDNEY DYSFUNCTION, ELEVATED POTASSIUM. VERTIGO, HYPOTENSION, STROKE, PROTEINURIA. Orthostatis hypotension ACE Inhibitor side effects = "Angioedema, Cough, Elevated potassium" Lasix and nursing considerations. LASIX: LOOP DIURETIC THAT WORKS IN THE KIDNEY TO INHIBIT
the large intestine. Ascending, , descending). With palpation you are assessing for hardness, distention, etc. "the contour of the
abdomen" "bruising, wounds, bloating, prior surgeries, scar tissue". When its absent listen for 5 minutes. What are subjective questions when doing a systems assessment. lung sounds: normal and adventitious lung sounds. Vescula r Bronchi lar And Bronchovescular pitting edema and how to assess.
Potential complications for a patient with emphysema. Pneumothorax due to bullae anorexia/weight loss due to work of breathing COPD. Characterized by airflow obstruction caused by chronic bronchitis or emphysema. The obstruction is caused by inflammation which changes the structural function of the lung that makes it harder to expire CO2. The air becomes trapped causing the chest to hyper-expand and become barrel shaped. This prevents more air from being expired. Because of decreased expiration the patient will become hypercapnic and hypoxic. Increased c02 = respiratory acidosis which means they are reliant on hypoxic oxygen so be careful with oxygen supplementation.
Delegation of interventions to assistive personnel. Ineffective airway Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway Associated with airway spasms, allergies, asthma, COPD, exudate in the alveoli, hyperplasia of bronchial walls, neuromuscular
involved -lower BP and Heart rate Examples: Arthritis, fibromyalgia, multiple sclerosis, shingles, peripheral neuropathy Questions to assess pain: Do you have pain? What makes your pain better or worse? Where is your pain? How does pain limit your function or activities? When did your pain start? How do you usually react when you are in pain? What does your pain feel like? What does this pain mean to you? How much pain do you have now? how blood flows through the heart. (deoxygenated blood) from IVC/svc RA TV RV PA Lungs Blood becomes oxygenated in lung’s pulmonary capillaries (PC) Pc PV LA MV LV AV Aorta Body the conduction of the heart. Sinoatrial node (pacemaker of the heart that creates p wave) ➔ Av Node (Gatekeeper) ➔ Bundle of his ➔ Bundle branches ➔ Purkinje Fibers preload and afterload preload: Pressure from volume of blood in LV at the end of diastole before next contraction. “Stretch” (end diastolic pressure) (Increased in hypervolemia, Regurgitation of cardiac valves and heart failure) afterload: Resistance to ejection of blood from lv. “Resistance” lv must
over overcome to circulate blood. Out. (Increased in HTN and Vasoconstriction) Purpose of alveoli. small air sacs surrounded by pulmonary capillaries (blood vessel walls of the alveoli) at the end of bronchioles that provide increase surface where oxygen and carbon dioxide gas exchange take place. S1 and S2 heart sounds. Si: “LUB” Low sound where mv and tv close and is loudest at apex “Beginning of systole” S2: “Dub” Sound where AV and PV close and is Loudest at base “End of systole/Beginning of diastole” Ventilation and diffusion. Ventilation: Air Moving in and Out of Lungs Diffusion: Respiratory gas exchanges across alveoli and capillaries of body to tissues (moving from one area to another via concentration gradients) What to do if O2 sat is 88 %? What does that mean? 88%: Moderate- Severe Hypoxia (Absence of enough oxygen in tissues to sustain bodily functions). Provide oxygen therapy early sign of hypoxia and a late sign of hypoxia. Early signs: anxiety, confusion, restlessness, dizziness, behavioral changes, unable to lie flat, BP increase Late signs: cyanosis (central: tongue, soft palate, conjunctiva) (peripheral:
V- tach is a life-threatening dysrhythmia (100-300 BPM) caused by decreased CO & can turn into V-FIB (Occurs during an MI) or sudden cardiac Death A-Fib: The electrical impulse in the atria is chaotic & originates from multiple sites making The rhythm irregular due to multiple pacemaker sites unpredictable conduction to the ventricles. QRS complex is normal but occurs at irregular intervals. an “irregularly regular” rhythm. It decreases CO by altering preload and contractility Second degree heart block Type 2 Third degree heart block Idioventricular rhythm (20-40bpm) Accelerated idioventricular (40- 100bpm) Ventricular Fibrillation Asystole Interventions on how to prevent chest pain. Avoid alcohol intake and drugs Daily 30 minutes exercise and proper diet If have diabetes, bp then keep it under control Medications (Nitroglycerin), massage, thermal therapies, relaxation, guided imagery, music therapy, acupuncture, pt/ot
What is cardiac output? The amount of blood ejected from the lv/min. 4 to 8L/min in a healthy adult at rest. changes according to the oxygen and metabolic needs of the body. Increases during activity, pregnancy and fever but decreases during sleep Stroke volume (SV) x Heart rate (HR) = Cardiac output (CO) If a patient has increased cardiac afterload, what best piece of equipment do you need to assess the status of the patient. BP Cuff: the diastolic aortic pressure measures afterload carbon monoxide and relationship with hemoglobin Carbon monoxide causes decrease in 02 carrying capacity of blood. In carbon monoxide (c02) toxicity, Hemoglobin strongly binds with co creating functional anemia. This is because the bond is too strong, and hemoglobin cannot unbind to become available for oxygen transport. chemoreceptors in the aorta. These peripheral chemoreceptors in the aortic bodies regulate respiratory activity by detecting changes in blood oxygen and carbon dioxide only. (peripheral chemoreceptors in the carotid body does the same but can also detect/sensitive to ph and respond to atrial hypoxia) how medications may affect preload of the heart. They reduce the preload (amount of stretch or tension applied to a muscle prior to contraction). IV Fluids.
Assess location, characteristics, onset, duration, frequency, quality and severity of pain. Review patients’ expectations of pain relief, encourage breathing techniques and positive affirmations, use narcotics, tranquilizers and analgesics sparingly. Encourage use of nonpharmacological interventions (relaxation exercises, music therapy, massage, guided imagery, breathing techniques). Evaluate effectiveness of pain medications and ask to decrease or increase dose and frequency as needed. Administer prescribed pain relief medications. Factors that influence pain: Gender, culture/ethnicity/religion, disability, morphology--obese patients experience more pain, age, genes PCA pumps Patient controlled analgesia pump. Morphine is the main medication for PCA pumps. Allows patients to administer a small dose of pain medication as needed when the button is pressed. Anyone other than the patient should be discouraged from pushing the button. prevents overdose by
lockout amount per hour How to assess if pain affects mobility.
