NUR2571: Professional Nursing II / PN 2 Exam 2 Study Guide, Exams of Biology

Download NUR2571: Professional Nursing II / PN 2 Exam 2 Study Guide and more Exams Biology in PDF only on Docsity! 1 NUR2571: Professional Nursing II / PN 2 Exam 2 Study Guide 1. Effects of beta-blockers on heart and heart rate -Beta Blocker will decrease Heart Rate and Blood pressure. -Assess heart rate (HR) and blood pressure (BP) before administration because beta blockers cause a decrease in HR and cardiac output and suppress renin activity. • Do not administer if HR is <50-60 beats/min. • Hold for systolic <90-100 mm HG and contact the health care provider. • Monitor for orthostatic hypotension because this is a common adverse effect that can contribute to falls and confusion, especially in older adults. - Use with caution in patients with diabetes because glucose production may be affected. - Teach the patient that these agents can cause fatigue, depression, and sexual dysfunction. These adverse effects should be reported to the primary health care provider. 2. Complications of atrial fibrillation -Atrial fibrillation occurs commonly in clients with cardiac disease and is a common reoccurrence after coronary artery bypass graft surgery. -Clients are at risk for embolitic stroke. Evidence of embolitic events includes changes I mentation, speech, sensory function, and motor function. -Clients with A-fib often have a rapid ventricular response as a result. - Clients with a-fib are at risk for decreased cardiac output and fatigue when completing activities of daily living. -Nursing Intervention: schedule periods of rest and exercise during the day. -for patients with acute a-fib who have a cardioversion, the nurse should turn off any oxygen therapy to prevent fire. 3. Complications from wide QRS and bradycardia combined, what does it mean? -An HR of 40 beats/min or less with widened QRS complexes could have hemodynamic consequences. The client is at risk for inadequate cerebral perfusion. The nurse should assess for level of consciousness, lightheadedness, confusion, syncope and seizure activity. 4. What does pacer spikes without QRS complex imply and what complication can it cause? -Pacer spike without QRS complex imply “LOSS OF CAPTURE”. If there is no capture then there is no ventricular depolarization and contraction. The nurse should assess for cardiac output via vital signs and level of consciousness. 5. Precautions taken when the nurse uses a defibrillator 2 -PRIORITY: Ensure that everyone is clear of contact with the client and the bed** -Epinephrine should be administered AFTER defibrillation 6. Know what V-Tach looks like on monitor and the treatment -You MUST shock someone with ventricular tachycardia via defibrillator AND INITIATE CARDIO-PULMONARY RESUSCITATION (CPR)!!!! 7. Know what bradycardia looks like on monitor and the treatment 8. Know Signs and symptoms of left sided heart failure and right sided heart failure LEFT SIDED HEART FAILURE -Cause for left sided heart failure include mitral and aortic valve disease, coronary artery disease and hypertension. -Orthopnea, coughing, and difficulty breathing could all be results of left sided heart failure, as well as dyspnea on exertion!! -Client may report weakness and fatigue while performing activities of daily living as well as difficulty breathing and catching their breath. EX. walking up the stairs. - The presence of an S3 gallop is an early diastolic filling sound indicative of increasing left ventricular pressure and left ventricular failure. RIGHT SIDED HEART FAILURE 5 -Best Rest -Elevation of the extremities. -Perform range of motion exercises of the legs at least hourly. 21. Goals of Healthy People 2020 related to cardiovascular disease and stroke - An important goal of the HP2020 is to increase the proportion of adults who have had their blood pressure measure within the preceeding 2 years and can state whether their blood pressure was normal or high. Participating in a blood pressure screening in a public setting will best meet this goal. 22. Know side effects and purpose of ace-inhibitors -Administration of the first dose of ACE-inhibitors is often associated with hypotension, usually termed “first dose effect”. -Nursing Interventions: nurse should instruct the client to seek assistance when rising from bed to prevent injury. -Nurse should monitor for signs of hyperkalemia especially if the client has renal insufficiency secondary to hear failure. -ACE inhibiters such as enalapril inhibit the excretion of potassium. Hyperkalemia is a life-threatening side effect and clients should be taught to limit potassium intake. (SALT SUBSTITUES ARE COMPOSED OF POSTASSIUM CHLORIDE) - New onset of cough -Nursing Intervention: Assess the client lung sounds and oxygenation FIRST before assuming side effect of medication. **Always assess respiratory first! 23. Know what PAD is and what it looks like, as well as the treatment and interventions -PAD is peripheral Arterial Disease and it occurs in disorders that altar the natural flow of blood through the peripheral arteries and veins, causing decreased tissue perfusion, especially to the lower extremities. -Most patients with PAD are not diagnosed until they develop leg pain. -Skin will be cool, pale and moist in extremities because of decreased perfusion. -As PAD progresses, it takes less oxygen demand to cause pain. -Patients will experience leg pain known as intermittent claudification, causing them to be able to walk only certain distance before a cramping, burning muscle discomfort or pain forces them to stop. (Needing to cut down on activity to be pain free indicates that the disease is worsening.) -Clients with PAD should never use heating pads as skin sensitivity is diminished and burns can result*** 6 -This patient has DEPENDENT RUBOR which is a classical finding of peripheral arterial disease (PAD) ** Nurse should measure the client ankle brachial index -Ankle Brachial Index: A ratio derived by dividing the ankle blood pressure by the brachial blood pressure; this calculation is used to assess the vascular status of the lower extremities. To obtain the ABI, a blood pressure cuff is applied to the lower extremities just above the malleoli. The systolic pressure is measured by Doppler ultrasound at both the dorsalis pedis and posterior tibial pulses. The higher of these two pressures is then divided by the higher of the two brachial pulses. 7 24. What is xarelto and what does it do? - It is a direct thrombin inhibitor - It is an anticoagulant that prevents thrombolytic events - Classified as an antithrombotics - This may lower the risk of stroke, deep vein thrombosis (DVT), pulmonary embolism (PE), and similar conditions 25. What are examples of platelet inhibitors? - Clopidogrel (Plavix)* <- Most common -Ticagrelor (Brilinta aka p2y12) 26. What nursing interventions are needed for radioisotopic imaging scan, and what is it? -The nurse should ensure that teaching is done and the client understands the procedure. - An imaging technique used to visualize parts of the body by injecting a small dose of a radioactive chemical into the body. 27. Treatments for sickle cell crisis and interventions - Administer oxygen FIRST* (main problem in sickle cell crisis is tissue and organ hypoxia) - Provide pain medication* (Clients are usually in extreme pain) - Clients are often dehydrated, hydrate with a hypotonic solution such as 0.45% Normal Saline - Remove constrictive clothing - Keep Client’s lower extremities warm!! - Do not raise the knee position of the bed - Elevate the head of the bed no more than 30 degrees - Check circulation and extremities every hour. - Avoid taking blood pressure with external cuff. - *An elevated creatinine indicates kidney damage, which occurs in SCD. Normal levels is 0.6-1.2mg/dL. 28. Know types of anemia - Iron deficiency anemia is mostly caused by blood loss, often from the GI tract. Nurse should perform a Hemoccult test on the clients stools. *High protein foods may help condition. -Malabsorption syndromes such as Crohn’s disease leave a client prone to folic acid deficiency anemia 29. Know interventions and definition of polycythemia vera