Adult Health Exam 2 Study Guide 1

Adult Health I- STUDY GUIDE Exam 2 Cardio and Hematology Chapters 30, 31, 32, 33, 34, 35, 36 & 67 Anatomy and Function: o What system does this effect? o What are the three most significant things that the nurse MUST know? Pathophysiology: o Discuss the pathology of this topic as it relates to:  Etiology: Causes, Contributing Factors  Signs and Symptoms  Medical treatment modalities  Nursing considerations Nursing Care: o Identify the PRIORITY nursing diagnosis related to the topic.  Identify one long term and one short-term goal for each priority item.  To identify appropriate priorities, utilize Maslow’s hierarchy of needs. o What are the KEY nursing assessments?  What should the physical examination of the patient include?  Identify expected verses unexpected. What does each finding mean to the nurse? o What is the plan of care for this patient?  Review both independent as well as collaborative interventions.  Independent interventions/ Nursing Management  Why is the nurse doing this?  How will this assist the patient in meeting the established goal?  How will the nurse evaluate the effectiveness of the intervention?  Collaborative interventions  Medications o Classification o Action/ Administration o Side Effects o Adverse Effects o Nursing Considerations o Patient/ Family education.  Treatments o Reason? o Review steps of the procedure. o Side Effects o Adverse Effects o Nursing Considerations o Patient/ Family Education  Diagnostics o Reason? o Is this the “gold” standard diagnostic for this issue? o What results are expected related to the pathology? o What are the nursing considerations associated with this diagnostic? o Special instructions? *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 TESTING STRATEGIES TO REVIEW • • • • • • • • • • • • • • Analyze the situation described in the question. Treat each question as a NEW situation unless otherwise directed. Determine what the question is asking. ACCEPT that what is the correct nursing action/ answer for one item MAY NOT be CORRECT in another scenario. Select the answer that represents the safest nursing judgment. Identify the topic of the question. Select an answer by eliminating choices. Do not use background information unless necessary. Do not “read into” the question. Think about what the answer choices really mean THERAPEUTIC COMMUNICATION: • Open ended responses • Nonjudgmental response • ONLY use YES or No questions in a crisis situation. • “Why”.. Places people on the defensive. Delegation/ Assignment • ONLY AN RN MAY: • Assess • Teach • Perform a skill that requires “clinical judgment” POSITIONING: • Are you being asked to prevent or promote something? • Does it address the problem? PRIORITIZATION: • Select ACTUAL over Potential problems • What is the safest thing to do? • Address the MOST unstable issue first. The Center for Academic Success offers TESTING Strategies workshops routinely. All students are recommended to attend at least one per session. Please reach out to your faculty or directly to the CAS staff to obtain a schedule. *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 not be correct on another que Alternate Type Questions: Multiple Choices - Select all that Apply Medication Calculation Total Number of Questions: Exam 2: 60 questions; 4 points each Topics Dysrhythmias  Cardiopulmonary Resuscitation (See Appendix A highlights) Cardiopulmonary Resuscitation Cardiac arrest is characterized by the absence of a pulse and breathing in an unconscious victim. The current approach for CPR is the chest compressions–airway-breathing (CAB) sequence.1 The first step in CPR is to perform a pulse check by palpating the carotid pulse for at least 5 but no more than 10 seconds. While maintaining a head-tilt position with one hand on the forehead, locate the victim's trachea using two or three fingers of the other hand. Slide these fingers into the groove between the trachea and the neck muscles where the carotid pulse can be felt. The technique is more easily performed on the side nearest you. If a pulse is felt, give one rescue breath every 5 to 6 seconds (10 to 12 breaths/minute) and recheck the pulse every 2 minutes (see Fig. A-1 and Airway and Breathing below). If no pulse is felt, initiate CAB.1 FIG. A-1 The head tilt–chin lift maneuver is used to open the victim's airway to give rescue breaths. A, Rescuer places one hand on the victim's forehead and applies firm, backward pressure with the palm to tilt the head back. The chin is lifted and brought forward with the fingers of the other hand. B, Mouth-to-barrier device: Rescuer places the device tightly over the victim's mouth and nose and delivers a regular breath. C, Mouthto-mouth technique: Rescuer pinches the victim's nostrils, tightly seals mouth over victim's mouth, and delivers a regular breath. NOTE: Rescuer should observe for a rise in the victim's chest (blue arrows). Chest Compressions The proper technique for providing chest compressions is shown in Fig. A2. Chest compression technique consists of fast and deep applications of pressure on the sternum. The victim must be in the supine position when the compressions are performed. The victim must be lying on a flat, hard surface, such as a CPR board (specially designed for use in CPR), a Resourc es Lewis et al., 9th edition Cardio and Hematol ogy Chapter s 15,30, 31,32, 33, 34, 35, 36, 38 & 67 Please use the blue highligh ts from your Ebook and the notes attached to the highligh ts in order to comple ment the study guide topics for each chapter **For all your exams *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 headboard from a unit bed, or, if necessary, the floor. Position yourself close to the side of the victim's chest. Chest compressions are combined with rescue breathing for an effective resuscitation effort of the adult victim of cardiac arrest. The compressionventilation ratio for one- or two-rescuer CPR is 30 compressions to 2 breaths (Table A-1). TABLE A-1 ADULT ONE- AND TWO-RESCUER BASIC LIFE SUPPORT WITH AUTOMATIC EXTERNAL DEFIBRILLATOR (AED) you MUST know scope of practice for UAP, LPN and RN Assess • Determine unresponsiveness: tap or shake victim's shoulder; shout, “Are you all right?” • Check for no breathing or abnormal breathing (e.g., gasping). Activate Emergency Response System (ERS) • Activate ERS (e.g., call 911) and get the AED (if available) (outside of hospital). • Call a code and ask for the AED or crash cart (in hospital). Check for Pulse • Feel for carotid pulse (5-10 sec). • If victim has a pulse but is not breathing or not breathing adequately, begin rescue breathing at a rate of 1 breath every 5-6 sec (see Fig. A-1) and recheck circulation every 2 minutes. Begin High-Quality CPR • If there is no pulse, expose the victim's chest and immediately begin chest compressions (see Fig. A-2). • Deliver compressions at a rate of at least 100/minute. • Compress the chest at least 2 inches. • Allow for complete chest recoil after each compression. • Deliver a compression-ventilation ratio of 30 compressions to 2 breaths. • Minimize interruptions in compressions by delivering the 2 breaths in <10 sec. In order for CPR to be effective the depth of the compressions should be at least 2 inches, with a compression rate of at least 100 compressions/minute. “Push hard and push fast “to maintain blood flow; in order for cardiac compressions to be efficient and effective, there should be vertical pressure through the heel of the hand with each compression; only the heel of the hand should be placed on the sternum.  Normal Sinus Rhythm Normal sinus rhythm refers to a rhythm that starts in the SA node at a *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 rate of 60 to 100 times per minute and follows the normal conduction pathway (Fig. 36-8). Fig. 36-9 shows the components of a normal ECG tracing. Table 36-2 describes ECG waveforms and intervals, normal durations, and possible sources of disturbances in these features. FIG. 368 Normal sinus rhythm. NOTE: Recorded from lead II.  Sinus Bradycardia In sinus bradycardia the conduction pathway is the same as that in sinus rhythm but the SA node fires at a rate less than 60 beats/minute (Fig. 3611, A). Symptomatic bradycardia refers to an HR that is less than 60 beats/minute and is inadequate for the patient's condition, causing the patient to experience symptoms (e.g., chest pain, syncope). FIG. 36-11 A, Sinus bradycardia. B, Sinus tachycardia. o ECG interpretation In sinus bradycardia, HR is less than 60 beats/minute and the rhythm is regular. The P wave precedes each QRS complex and has a normal shape and duration. The PR interval is normal, and the QRS complex has a normal shape and duration. o Clinical Manifestations The clinical significance of sinus bradycardia depends on how the patient tolerates it. Signs of symptomatic bradycardia include pale, cool skin; hypotension; weakness; angina; dizziness or syncope; confusion or *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 disorientation; and shortness of breath. o Treatment For the patient with symptoms, treatment consists of administration of atropine (an anticholinergic drug). If atropine (AtroPen) is ineffective, transcutaneous pacing, or a dopamine (Intropin) or epinephrine (Adrenalin) infusion is considered. Permanent pacemaker therapy may be needed. If bradycardia is due to drugs, these may need to be held, discontinued, or given in reduced dosages.  Sinus Tachycardia Sinus tachycardia is associated with physiologic and psychologic stressors such as exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial ischemia, heart failure (HF), hyperthyroidism, anxiety, and fear. o ECG interpretation In sinus tachycardia, HR is 101 to 200 beats/minute and the rhythm is regular. The P wave is normal, precedes each QRS complex, and has a normal shape and duration. The PR interval is normal, and the QRS complex has a normal shape and duration. o Clinical Manifestations The clinical significance of sinus tachycardia depends on the patient's tolerance of the increased HR. The patient may have dizziness, dyspnea, and hypotension because of decreased CO. Increased myocardial oxygen consumption is associated with an increased HR. Angina or an increase in infarction size may accompany sinus tachycardia in patients with coronary artery disease (CAD) or an acute MI. o Treatment The underlying cause of tachycardia guides the treatment. For example, if the patient is experiencing tachycardia from pain, effective pain management is important to treat the tachycardia.  Atrial Fibrillation/ Flutter FIG. 36-14 A, Atrial flutter with a 4:1 conduction (four flutter [F] waves to each QRS complex). B, Atrial fibrillation with a controlled ventricular response. Note the chaotic fibrillatory (f) waves (arrows) between the RS complexes. NOTE: Recorded from lead V1. *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 Atrial fibrillation is characterized by a total disorganization of atrial electrical activity because of multiple ectopic foci, resulting in loss of effective atrial contraction (Fig. 36-14, B) Clinical Associations. Atrial fibrillation usually occurs in the patient with underlying heart disease, such as CAD, valvular heart disease, cardiomyopathy, hypertensive heart disease, HF, and pericarditis. It often develops acutely with thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte disturbances, stress, and cardiac surgery. o ECG interpretation ECG Characteristics.:During atrial fibrillation, the atrial rate may be as high as 350 to 600 beats/minute. P waves are replaced by chaotic, fibrillatory waves. Ventricular rate varies, and the rhythm is usually irregular. When the ventricular rate is between 60 and 100 beats/minute, it is atrial fibrillation with a controlled ventricular response. Atrial fibrillation with a ventricular rate greater than 100 beats/minute is atrial fibrillation with a rapid (or uncontrolled) ventricular response. The PR interval is not measurable, and the QRS complex usually has a normal shape and duration. At times, atrial flutter and atrial fibrillation may coexist.1 o Clinical Manifestations Clinical Significance: Atrial fibrillation results in a decrease in CO because of ineffective atrial contractions (loss of atrial kick) and/or a rapid ventricular response. Thrombi (clots) form in the atria because of blood stasis. An embolized clot may develop and move to the brain, causing a stroke. Atrial fibrillation accounts for as *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 many as 17% of all strokes.10 Thrombi can form and move not just to the brain but to the lungs, upper or lower extremities. The nurse has to assess for clinical manifestation of clots in the extremities such as pallor and cold skin as well as S/S of pulmonary embolism. o Treatment including medications The goals of treatment include a decrease in ventricular response (to less than 100 beats/minute), prevention of stroke, and conversion to sinus rhythm, if possible. Ventricular rate control is a priority for patients with atrial fibrillation. Drugs used for rate control include calcium channel blockers (e.g., diltiazem), β-adrenergic blockers (e.g., metoprolol), dronedarone, and digoxin (Lanoxin). For some patients, pharmacologic or electrical conversion of atrial fibrillation to a normal sinus rhythm may be considered o Complications Warfarin (Coumadin) is the drug of choice to treat patients with atrial fibrillation who have one or more high-risk factors in order to prevent stroke. Patients should avoid drastic changes in diet, especially foods high in vitamin K (interfere with the action of warfarin). o Patients’ education Green leafy vegetables contain vitamin K which is the antidote for warfarin. These foods will interfere with the action of warfarin.  Ventricular tachycardia Ventricular Tachycardia. A run of three or more PVCs defines ventricular tachycardia (VT). It occurs when an ectopic focus or foci fire repeatedly and the ventricle takes control as the pacemaker. Different forms of VT exist, depending on QRS configuration. Monomorphic VT (Fig. 36-18, A) has QRS complexes that are the same in shape, size, and direction. Polymorphic VT occurs when the QRS complexes gradually change back FIG. 36-18 Ventricular tachycardia. A, Monomorphic. B, Torsades de pointes (polymorphic). *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 o ECG interpretation ECG Characteristics. In sinus tachycardia, HR is 101 to 200 beats/minute and the rhythm is regular. The P wave is normal, precedes each QRS complex, and has a normal shape and duration. The PR interval is normal, and the QRS complex has a normal shape and duration. (Lewis, 2014, p. 794) Ventricular tachycardia Rate &rhythm: 150-250 beats/min and regular or irregular P wave:Not usually visible PR interval:Not measurable QRS Complex:Wide and distorted Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (usually greater than 0.14 second), and a rate between 100 and 250 impulses per minute. The rhythm is usually regular. o Clinical Manifestations The clinical significance of sinus tachycardia depends on the patient's *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 tolerance of the increased HR. The patient may have dizziness, dyspnea, and hypotension because of decreased CO. Increased myocardial oxygen consumption is associated with an increased HR. Angina or an increase in infarction size may accompany sinus tachycardia in patients with coronary artery disease (CAD) or an acute MI. (Lewis, 2014, p. 794) o Treatment The underlying cause of tachycardia guides the treatment. For example, if the patient is experiencing tachycardia from pain, effective pain management is important to treat the tachycardia. o Complications  Ventricular Fibrillation Ventricular fibrillation (VF) is a severe derangement of the heart rhythm characterized on ECG by irregular waveforms of varying shapes and amplitude (Fig. 36-19). This represents the firing of multiple ectopic foci in the ventricle. Mechanically the ventricle is simply “quivering,” with no effective contraction, and consequently no CO occurs. VF is a lethal dysrhythmia. o ECG interpretation HR is not measurable. Rhythm is irregular and chaotic. The P wave is not visible, and the PR interval and the QRS interval are not measurable. o Clinical Manifestations VF occurs in acute MI and myocardial ischemia and in chronic diseases such as HF and cardiomyopathy. It may occur during cardiac pacing or cardiac catheterization procedures because of catheter stimulation of the ventricle. It may also occur with coronary reperfusion after thrombolytic therapy. Other clinical associations are electric shock, hyperkalemia, hypoxemia, acidosis, and drug toxicity. FIG. 36-19 Ventricular fibrillation. *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 Clinical Significance:VF results in an unresponsive, pulseless, and apneic state. If it is not rapidly treated, the patient will not recover. o Treatment Treatment consists of immediate initiation of CPR and advanced cardiac life support (ACLS) with the use of defibrillation and definitive drug therapy (e.g., epinephrine, vasopressin [Pitressin]). There should be no delay in using a defibrillator once available. o Complications  Cardiac tamponade Cardiac tamponade develops as the pericardial effusion increases in volume. This results in compression of the heart. The speed of fluid accumulation affects the severity of clinical manifestations. Cardiac tamponade can occur acutely (e.g., rupture of heart, trauma) or subacutely (e.g., secondary to renal failure, malignancy). o Clinical Manifestations The patient with cardiac tamponade may report chest pain and is often confused, anxious, and restless. As the compression of the heart increases, there is decreased cardiac output (CO), muffled heart sounds, and narrowed pulse pressure. The patient develops tachypnea and tachycardia. Neck veins usually are markedly distended because of increased jugular venous pressure, and pulsus paradoxus is present. Pulsus paradoxus is a decrease in systolic BP during inspiration that is exaggerated in cardiac tamponade. (See Table 37-5 for the measurement technique.) In a patient with a slow onset of a cardiac tamponade, dyspnea may be the only clinical manifestation. *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. *** Adult Health I- STUDY GUIDE Exam 2 o Treatment o Complications Two major complications that may result from acute pericarditis are pericardial effusion and cardiac tamponade. Pericardial effusion is a buildup of fluid in the pericardium. It can occur rapidly (e.g., chest trauma) or slowly (e.g., tuberculosis pericarditis). Large effusions may compress nearby structures. Pulmonary tissue compression can cause cough, dyspnea, and tachypnea. Phrenic nerve compression can induce hiccups, and compression of the laryngeal nerve may result in hoarseness. Heart sounds are generally distant and muffled, although blood pressure (BP) usually is maintained.  PATIENT & CAREGIVER TEACHING GUIDE: Implantable Cardioverter-Defibrillator TABLE 36-10 PATIENT & CAREGIVER TEACHING GUIDE: Implantable Cardioverter-Defibrillator (ICD) Include the following information in the teaching plan for a patient receiving an ICD and the patient's caregiver. 1. ICD. Follow up with cardiologist for routine checks of the function of the 2. Report any signs of infection at incision site (e.g., redness, swelling, drainage) or fever immediately. 3. Keep incision dry for 4 days after insertion or as instructed. 4. Avoid lifting arm on ICD side above shoulder until approved. 5. Discuss resuming sexual activity with your cardiologist. It is usually safe to resume sexual activity once your incision is healed. 6. Avoid driving until cleared by your cardiologist. This decision is usually based on the ongoing presence of dysrhythmias, the frequency of ICD firings, your overall health, and state laws regarding drivers with ICDs. 7. Avoid direct blows to ICD site. 8. Avoid large magnets and strong electromagnetic fields because *** Please note that this is meant to serve as a study tool. Students ARE subject to be tested on any material related to readings, simulations, labs, assignments and activities within the course. ***