HESI Medical Surgery, Exams of Nursing

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HESI Medical Surgery

Sodium 3.5- 5 Potassium 97 - 107 Chloride 8.6-10. Calcium 1.3-2. Magnesium

HESI Medical Surgery

Phosphorous 2.5-4. BUN 8 - 20 Creatinine 0.7-1. Glucose 60 - 100 Albumin 3.5-5. AST 10 - 40 ALT 8 - 40 WBC 4.5-11k Platelets 150 - 450k hgb (hemoglobin) 12 - 18 hct 35 - 52 2.2 lbs one kilogram 5 mL one teaspoon 15 mL one tablespoon 30 mL one ounce Automaticity cells can spontaneously initiate impulse- pacemaker cells ion shift-ability to respond to impulse and generate action Excitability potential Injured/scared cells lose excitability Conductivity able to transmit impulse Contractibility how well cell contracts after receiving a stimulus Lead 2 arrythmias, infarct V1 right 4th intercostal space-anterior/post view V6 horizontal to V5, mid-axillary line;lateral view

Pulmonary Congestion Resp-Orthopnea, PND, DOE,Cough, SOB Neuro-anxious disoriented r/t low O Skin-cool,clammy Pulse-weak,elevated Oliguria-reduced urine output Fatigue Right sided heart failure congestion of the viscera and peripheral tissues Edema-feet/legs/sacrum; weight gain JVD- Hepato-megaly-Ascites GI Weaknes Causes of carcinogenic shock *MI, cardiac tamponade, pulmonary embolism, trauma, ruptured ventricle, valve disease especially leaky Primary symptoms of infective endocarditis fever and heart murmer

• Prosthetic Valves
• Hx of bacterial endocarditis
• Congenital malformation of valve high risk for infective endocarditis - Previous cardiac surgeries
• Elderly
• IV drug use/body piercing
• Hospitalized pt-IV lines TEACHING!! Prophylactic antibx (AHA guidelines) risk for poor out- comes from endocarditis, including: those with prosthetic heart valves or repairs patients who have had endocarditis in the past congenital heart defects heart transplant with abnormal heart valve

nursing care for valve disorders Coumadin for mech. valves; INR 2-3. S+Sx of heart failure-lung congestion, SOB Weights Report: 2lbs./daily 5 lbs/week Diet and Activity AHA re-checked 2014. Short-term coumadin for an- nulplasty or tissue valves unless pt has a-fib disorder requiring long term anticoag therapy valve disorder/valve replacement Mitral Valve Prolapse-floppy valve Mitral Re-gurgitation/Insuflciency Cardiac Valve Disorders Mitral Stenosis-most common after rheumatic fever, women>men Aortic Re-gurgitation Aortic Stenosis digoxin

• increases force of contraction, slows conduction through AV node. diabetic ischemia peripheral neuropathy may interfere with neuro-recep- tors..dulling pain elderly ischemia degenerating nuero-transmitters may decrease pain re- sponse, dyspnea common symptom, bilateral arm pain woman ischemia chest pain/discomfort most common but...shortness of breath, nausea/vomiting, and back or jaw pain. Little appreciation for non-chest pain symptoms---symp- prodromal ischemia Type of angina that beings the Acute Coronary Syndrome continuum toms intermittent perhaps a month before onset. SOB, vital fatigue, fleeting CP unstable

< 6 hours of chest pain adenosine (Adenocard) Reperfusion Therapy: Thrombolytics- indications of the heart Active bleed/known bleeding disorder History of hemorrhagic stroke Contraindications for thrombolytics Complications post MI Vessels used for CABG Pregnancy Recent major surgery or trauma Uncontrolled HTN *Acute Pul. Edema *HF *Cardio-dysrhythmias/cardiac shock *Pericardial Ettusion *Myocardial Rupture

• Greater sapheneous vein
• Lesser sapheneous vein
• Right and left internal mammary arteries
• Occ. Radial arteries
• Gastro-epiploic artery MI complications post GABG Dysrhythmias-F/E imbalance, ischemia Infection Hypovolemia*—bleeding, dehydration MS changes...Pump Brain Pulmonary complications-gas exchange Renal complications r/t reduced CO Post-op concerns-pain manage, clotting, skin, isolation, education meds for cardiac stress test dipyridamole (Persantine)

AV node Digoxin increases force of contraction, slows conduction through Prevents angio 1 to 2 ends in SARTAN allow conversion of angio 1>2 but blocks at cell receptor ARB site ends in PRIL prevent conversion of angio I to angio II, inhibits aldos- terone secretion block SNS-AV conduction, reducing HR, decreases BP as it Beta-adrenergic blockers Calcium Channel Blockers reduces contractility. ends in LOL inhibit the movement of calcium across cell mem- branes-slows conduction, contractility. Diltiazem (Cardizem, Tiazac) Verapramil Amlodipine (Norvasc) degree of stretch of the cardiac muscle fibers at the end of diastole afterload amount of resistance to ejection of blood from the ventri- cle ejection fraction Percentage of the end-diastolic blood volume ejected from the ventricle with each heartbeat valve balloons into atrium at systole mitral prolapse Occurs more in women-inherited connective tissue dz Often asymptomatic or: 'click' , murmur on auscultation

ACE

ACE and ARB preload

aortic valve doesn't close during diastole, coronary artery perfusion compromised Symptoms very similar to AS Left ventricular hypertrophy Risk-pulm edema/shock Dx-similar to AS Tx-surgery mitral regurg tx diuretics vasodilators- to reduce preload ACEI- to reduce afterload reconstruct valve rather than replace mitral prolapse tx beta blocker, ccb reduce: etoh, catteine, cold medicine ph < 7.35 = Acidotic pulmonary edema labs PO2 <80 = Hypoxic PCO2 > 45 = Build up of CO Bicarb > 28 = Kidney trying to fix acidosis Pink frothy sputum pulmonary edema Amino acid peptide produced by ventricles due to stretch Increases when heart is required to work harder over long BNP- Beta Natriueretic Peptide Normal Ejection fraction period of time High BNP indicate high filling pressures ** >100 pg/mL indicates heart failure 55%-65% percentage of end-daistolic blood volume ejected from the ventricle with each heartbeat chest pain > 20 mins ST segment in at least 2 leads that face the same side of Indications for thrombolytics

dilt (CCB) Atropine the heart less than 6 hours of chest pain Blocks parasympathetic action (rest and digest); increased SA node automaticity and AV conduction Increase HR , treat bradycardia give rapidly 0.5 mg IV push up to 3 mg Tx for tachy vagal maneuvers, adenosine, amiodorone, beta blockers, normal PR interval 0.12-0.2 seconds QRS complex 0.6- 0.12 seconds QT interval less than 0.43 seconds substanced as by-products of any tissue/skeletal damage cardiac enzymes Troponin Troponin CK-MB Myoglobin Myocardial protein, helps regulate myocardial contraction process Detected within hours and remains elevated increase within a few hours, peaks at 24 of infarct isoenzyme found in cardiac muscle myoglobin increases in 1 - 3 hours, peaks within 12 falling systolic BP, narrow pulse pressure, JVD, muffled cardiac tamponade s/s tachycardia, htn, sob, drop in saturation, dry hacking cough, fatigue, crackles, restless pt looks like drowning heart sounds Cyanosis of nails, lips, restless pulmonary edema

CK-MB

bleeding precautions contra for balloon angioplasty/ percutaneous trasnlumi- nal coronary angioplasty management of risk factors for CAD put TOP 3*** hypovolemia, reduced caridac output, shock electric razor, soft tooth brush, watch for brusing, fall risk, monitor for nose/gum bleed, meds that interfere call doc, wear breacelet, follow INR occlusion of the left main weight loss stop smoking exercise diet BP control Lower cholesterol treating diabetes ****med compliance treatment of angina bring down voice, take vitals, give o2, ECG, nitro CAD - most common HTN causes of heart failure

MI

Rheumatic heart dz Valve Dz Arrythmias normal QT interval Less than 0. greater than 0.04 width greater than 25% of R wave height abnormal Q wave