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Exam 1 Med Surg 3 Study Guide:QUESTIONS AND ANSWERS LATEST UPDATE 2023 GUARANTEED SUCCESS, Exams of Nursing

Saint Francis Medical Center College of Nursing Nursing

Exam 1 Med Surg 3 Study Guide:QUESTIONS AND ANSWERS LATEST UPDATE 2023 GUARANTEED SUCCESS TOP RANKED SOLUTIONS

Typology: Exams

2022/2023

Available from 10/21/2023

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Exam 1 Med Surg 3 Study Guide:QUESTIONS AND ANSWERS LATEST

UPDATE 2023 GUARANTEED SUCCESS TOP RANKED SOLUTIONS

PP 1/ 7

The Synergy Model

•Basic Concepts

oThe needs or characteristics of clients and families influence and

drive nurse’s competencies

oSynergy results in the needs & characteristics of a client, clinical unit or

system are matched with a nurse’s competencies

oAmerican Academy of Cardiology nursing

oCritical patients- require different nurse competencies to care for patients

oLinking critical nursing practice with patient outcomes

oRN II start

oUsed for nursing staff ratio to complete nursing assignments

•Client Characteristics are unique to each care situation  8 client characteristics

o1. Resiliency

▪Capacity to return to a restorative level of functioning using

compensatory/coping mechanisms;

▪The ability to bounce back quickly after an insult

▪Level one – minimally resilient – unable to mount a response

▪Level five - highly resilient

▪Restore to original level

▪Family support/ involvement,

o2. Vulnerability

▪Susceptibility to actual or potential stressors that may adversely affect

outcomes

▪Level one – highly vulnerable

▪Level five- Minimally vulnerable

o3. Stability

▪Ability to maintain a steady-state; equilibrium

▪Level one – Minimally stable / unstable, not responding to therapies

like we would want them to

▪Level five – Highly stable, responsive to therapies, decreased risk of death

o4. Complexity

▪Entanglement of 2 or > systems

•Body, family, therapies

▪Level one – highly complex

▪Level five – minimally complex

▪Pay attention to comorbidities

o5. Resource Availibility

▪Extent of resources the client/family/community bring to situation

•Technical

•Fiscal

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Download Exam 1 Med Surg 3 Study Guide:QUESTIONS AND ANSWERS LATEST UPDATE 2023 GUARANTEED SUCCESS and more Exams Nursing in PDF only on Docsity!

Exam 1 Med Surg 3 Study Guide:QUESTIONS AND ANSWERS LATEST

UPDATE 2023 GUARANTEED SUCCESS TOP RANKED SOLUTIONS

PP 1/ 7

The Synergy Model

Basic Concepts o The needs or characteristics of clients and families influence and drive nurse’s competencies o Synergy results in the needs & characteristics of a client, clinical unit or system are matched with a nurse’s competencies o American Academy of Cardiology nursing o Critical patients- require different nurse competencies to care for patients o Linking critical nursing practice with patient outcomes o RN II start o Used for nursing staff ratio to complete nursing assignments
Client Characteristics are unique to each care situation  8 client characteristics o 1. Resiliency ▪ Capacity to return to a restorative level of functioning using compensatory/coping mechanisms; ▪ The ability to bounce back quickly after an insult ▪ Level one – minimally resilient – unable to mount a response ▪ Level five - highly resilient ▪ Restore to original level ▪ Family support/ involvement, o 2. Vulnerability ▪ Susceptibility to actual or potential stressors that may adversely affect outcomes ▪ Level one – highly vulnerable ▪ Level five- Minimally vulnerable o 3. Stability ▪ Ability to maintain a steady-state; equilibrium ▪ Level one – Minimally stable / unstable, not responding to therapies like we would want them to ▪ Level five – Highly stable, responsive to therapies, decreased risk of death o 4. Complexity ▪ Entanglement of 2 or > systems
Body, family, therapies ▪ Level one – highly complex ▪ Level five – minimally complex ▪ Pay attention to comorbidities o 5. Resource Availibility ▪ Extent of resources the client/family/community bring to situation
Technical
Fiscal

Personal
Psychological
Social ▪ Support groups, outside help available ▪ Best resource: case management ▪ Arrange for home health, meals on wheels, dialysis in outpatient setting, etc. ▪ Level one - few resources ▪ Level five – good knowledge of resources

▪ Aim of promoting comfort & healing o 4. Collaboration ▪ Working with others

Clients/families
Health care providers ▪ Promotes each individual’s contributions ▪ Involves intra- and inter-disciplinary work with colleagues & community

o 5. Systems Thinking ▪ Body of knowledge & tools that allow the nurse to manage environmental & system resources available o 6. Responsiveness to Diversity ▪ Sensitivity to recognize, appreciate, & incorporate differences into provision of care. ▪ Difference may include:

**Culture
Spiritual**
**Gender
Race**
**Ethnicity
Lifestyle**
**Socioeconomic status
Age**
Values o 7. Facilitation of Learning ▪ Ability to facilitate learning for:
Clients/families
Nursing staff
Members of health care team
Community ▪ May include both informal & formal learning o 8. Clinical Inquiry/Evaluator ▪ Ongoing process of questioning & evaluating practice ▪ Creating practice changes through research utilization & experiential learning
The goal of nursing is to restore a client to an optimal level of wellness as defined by the client.

junction impulses to the ventricles *** If the pace is originating from other areas other than the SA node, be cautious with beta blockers & calcium channel blockers.

Electrical conduction o In the normal heart: ▪ Electrical impulses cause and is followed by the mechanical contraction of the heart: - **Electrical Stimulation= Depolarization (contract) - **Mechanical Stimulation= Systole - **Electrical Relaxation= Repolarization (relax) - **Mechanical Relaxation= Diastole
Influences on HR and Contractility o Sympathetic Nervous System Stimulation ▪ Increases HR (positive chronotropy) ▪ Increases conduction through AV node (positive dromotropy) ▪ Increases force of myocardial contraction (positive inotropy) o Parasympathetic Nervous System Stimulation ▪ Reduces HR ▪ Reduces AV conduction ▪ Reduces force of myocardial contraction
The Electrocardiogram o EKG/ECG is a graph tracing of the electrical activity of the heart (Not the mechanical activity) o Information obtainable from an EKG rhythm strip analysis: ▪ Heart rate? Yes ▪ Rhythm/regularity? Yes ▪ Impulse conduction time intervals? Yes ▪ Pumping action? No ▪ Blood pressure? No ▪ Cardiac Output? No o What else does the EKG reflect? ▪ Ischemia ▪ Infarction ▪ Electrolyte disturbances ▪ Drug toxicity ▪ Enlarged cardiac chambers o ST for ischemia  depressed (ischemia) o Elevated (MI) o Old MI= look at q wave o T wave = correlates with potassium (hyperkalemia when T wave is elevated) o Prolonged QT interval can reflect enlarged cardiac chambers o EKG Waveforms/Segments/Intervals ▪ P wave ▪ PR interval ▪ QRS complex ▪ ST segment ▪ T wave o P wave ▪ Represents the electrical impulse starting in the SA node and spreading

▪ Measured from the beginning of the P wave to the beginning of the QRS complex

Represents time needed for sinus node stimulation, atrial depolarization and conduction through the AV node ▪ 0.12-0.20 seconds in length o QRS Complex ▪ Represents ventricular depolarization - 1 st^ negative deflection: Q wave - 1 st^ positive deflection: R wave
1 st^ negative deflection after the R wave: ▪ S wave ▪ <0.12 seconds in length o ST Segment ▪ Represents early ventricular repolarization ▪ Lasts from the end of the QRS complex to the beginning of the T wave ▪ Normally isoelectric
Analyzed above or below the baseline o T Wave ▪ Represents ventricular muscle repolarization ▪ Resting phase ▪ Follows the QRS complex; usually in the same direction as the QRS ▪ HR 140s because the monitor is counting the elevated Q and the T each as a beat ▪ Lead 2? o General Rules in Identifying Heart Rhythms ▪ Rapid assessment of your patient first ▪ Read every strip from left to right, starting at the beginning of the strip ▪ Apply a systematic approach ▪ Avoid shortcuts and assumptions ▪ Ask and answer each question in the five-step approach…this is important for consistency! ▪ Assess the pt if something is off on the monitor before acting on a code blue o Systematic Analysis of the ECG ▪ Identify P wave: is there a p-wave before every QRS? ▪ Identify the P wave shape: consistent? Upright? ▪ Determine each PR interval: Consistent? Irregular but with a pattern? Irregular? ▪ Identify the QRS: Duration consistent? Shape consistent? ▪ Evaluate the ST segment: Isoelectric? Depression vs. Elevation? Peaked? ▪ Identify the T wave: Upright? Inverted? ▪ Identify ventricular rate and rhythm
No p coming from somewhere other than the atrium (consider a- flutter or a- fib) ▪ 30 boxes in a 6 second strip ▪ 1500/R to R ▪ Consider the ^ second strip, ignore the extra ▪ Atrial rate – look at p to p waves ▪ Ventricular rate – look at r to r

PP 3/

Cardiac Dysrhythmia Management and Pacemakers

Normal Sinus o Answers to evaluation of rhythm will always be within normal limits
Sinus Node Dysrhythmias o Sinus Bradycardia ▪ HR<60 bpm ▪ Sinus node creates impulse at slower than normal rate ▪ Characteristics of NSR but a slower rate ▪ What can cause it?
Lower metabolic needs (sleep, athletic training, hypothyroidism)
vagal stimulation (vomiting, suctioning, severe pain)
Medications (CCBs ex: nefedipine or amiodarone, BBs ex: metoprolol
Idiopathic sinus node dysfuction (risk factors include: increased age, white race, obesity, hypertension, low HR, and history of a cardiovascular event)
Increased intracranial pressure
CAD, especially MI to inferior wall
*Unstable and symptomatic bradycardia is frequently due to hypoxemia o Other possible causes include acute altered mental status (delirious) and acute decompensated heart failure ▪ What S&S would you see?
SOB, acute alteration in mental status, angina, hypotension, ST- segment changes or premature ventricular complextes ▪ How would you treat it?
If symptomatic, 0.5 mg of atropine may be given rapidly as IV bolus and requested q 3 to 5 minutes until maximum dosage of 3 mg is given
If not responding to atropine, emergency transcutaneous pacing can be instituted, or catecholamines such as dopamine or epinephrine
If brady and asymptomatic, and you know they have a BB for example on board, wait the half life of the BB and reassess o ****IN CLASS REVIEW

o Atrial Flutter ▪ Conduction defect in the atrium ▪ Creates atrial rate between 250-400 times/minute (Ventricular rate 75-150) ▪ Not all impulses conducted to ventricle: therapeutic block at AV node ▪ 2:1, 3:1, 4: ▪ Flutters are coming at high rate ▪ Ratios: 1 are representing the QRS…. The number of flutters between determine what the first number in the ratio is ▪ Aflutter afib switching back and forth is possible ▪ ▪ Regular atrial activity ▪ P wave= “saw tooth” appearance ▪ HR > 100 bpm ▪ “uncontrolled” ▪ HR > 150 bpm ▪ “rapid ventricular rate” ▪ CAUSES:

COPD
Pulmonary HTN
Valvular disease
Thyrotoxicosis
Open heart surgery ▪ CLINICAL MANIFESTATIONS: - Clinical Manifestations:
Chest pain
Dyspnea
Hypotension ▪ Management:
Electrical Cardioversion for unstable patient
See treatment for atrial fibrillation
Medications to slow the ventricular response: o Beta blockers o Calcium channel blockers o Digitalis ▪ In the atrium, the blood is pooling causing SOB and increased risk for clotting ▪ Cardioversion- syncronize it with the heart (syncronized with the R) ▪ Try medication first before cardioversion (if pt is on long term anticoagulation therapy this increases the risk of complication of a cardioversion) ▪ Try amiodarone first, or CCC, or dig

Atrial Fibrillation o Rapid, disorganized and uncoordinated twitching of atrial muscle o Paroxysmal or chronic o Rapid ventricular response; loss of atrial kick (25-30% of cardiac output)

o Diagnosis ▪ Depends on cause and duration, patient age, symptoms and co -morbidities ▪ 12-lead EKG ▪ Echocardiogram ▪ Thyroid, renal and hepatic function labs

▪ CXR

▪ Exercise test ▪ Holter monitoring o As we age, the risk for delevopment of dysrhythmias increases o CXR could show enlarged heart or calcifications that could cause afib o Management of AFib ▪ Rhythm control vs. rate control ▪ Hemodynamically unstable?

Electrical cardioversion if < 48 hours
48 hours: TEE to confirm mural wall thrombus. o If absent: Heparin prior to cardioversion o High risk of embolization of atrial thrombi if cardioverted if AF duration 48 hours o Coumadin x 4 weeks after cardioversion o Amiodarone, Betapace, Rhythmol prior to cardioversion
Pharmacologic cardioversion o Tikosyn, Ibutelide= required patient hospitalization ▪ HR control ▪ Beta blocker
Contraindicated with bronchospasm ▪ Calcium channel blocker
Contraindicated with impaired ventricular function AV block ▪ IV amiodarone or digoxin ▪ Antithrombotic therapy indicated for all patients with A Fib ▪ Heparin therapy until INR therapeutic with Coumadin
Xarelto, Pradaxa o Premature Atrial Complex (PAC) ▪ Single, ECG complex occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node ▪ Atrial bigeminy, trigeminy ▪ Interrupts the sinus rhythm ▪ Etiology: PACs
Caffeine
Alcohol

Exam 1 Med Surg 3 Study Guide:QUESTIONS AND ANSWERS LATEST UPDATE 2023 GUARANTEED SUCCESS, Exams of Nursing

Related documents

Partial preview of the text

Download Exam 1 Med Surg 3 Study Guide:QUESTIONS AND ANSWERS LATEST UPDATE 2023 GUARANTEED SUCCESS and more Exams Nursing in PDF only on Docsity!

Exam 1 Med Surg 3 Study Guide:QUESTIONS AND ANSWERS LATEST

UPDATE 2023 GUARANTEED SUCCESS TOP RANKED SOLUTIONS

PP 1/ 7

The Synergy Model

PP 3/

Cardiac Dysrhythmia Management and Pacemakers

▪ CXR