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If a pt has a low BP after an MI what would the nurse expected his heart rate to be and why?
Hart rate would be high to get blood flow to the heart
Describe the use of beta blockers after an MI. What it does, side effects, pt education
Improve the condition of some patients in HF. Reverses this effect, improving morbidity,mortality, and quality of life for patients in HF. Side effects dissiness or drop in BP. Beta blockers must be started slowly with a low dose. Pt should weight their self daily report any signs of worsening HF immediately.
Describe orthostatic hypotension and why it happens?
Moving from a lying to a sitting or standing position. It happens due to cardivascular drugs, blood volume decrease, prolonged bedrest, age-related changes, or disorders of the ANS.
What is a possible symptom of an MI in an older adult that may not be seen in a younger person and why?
Confusion, memory loss, and slowed verbal responses
Describe cardiac angiography, it's possible complications and interventions for those complications?
Invasive diagnostic procedure that involves fluoroscopy and the use of contrast media. Possible allergy to Iodine alternative is intravascular ultrasonography sound waves, which reflect off the plaque and the arterial wall to create an image of the blood vessel.
Describe when an exercise electrocardioghaphy(stress test) is stopped?
- -predetermined HR is reached and maintained
- -chest pain, fatigue, exteme dyspnea, vertigo, hypotension, and ventricular dysrhythmias appear
- -ST segment depression or T wave inversion occurs
- -20 minute protocal is completed
Describe reasons that a pt may not be able to have an MRI?
If they have a pacemaker or implanted defibrillators, must remove all jewlery, hair clips and clothing with metal fasteners
Describe coronary catheterization, possible complications and their interventions?
- Include studies of right or left side of the heart and coronary arteries.
- -Cardiac tamponade
- -Pulmonary edema
- -Hemayoma or blood loss at insertion site
- -Reaction yo contrast medium
Why is it important for a pt with right sided heart failure to weigh themselves every day?
Weight gain of up to 10-15 pounds commonly known as edema
What are s/s of right and left sided heart failure and what medications can a nurse anticipate to be given?
- Right side
- -Jugular (neck vein) distention
- -Enlarged liver and spleen
- -Anorexia and nausea
- -Dependent edema (legs and sacrum)
- -Distended abdomen
- -Weight gain
- -Swollen hands and fingers
- -Increased blood pressure (from excess volume) or decreased blood pressure (from failure)
- Left Side
- -Acute confusion
- -Pulmonary congestion
- -Oliguria (scant urine output)
When a pt is attending rehab, how does a nurse know the activity the pt is doing too strenuous and needs stopped?
- -Short of breath
- -Chest pain
Why does a pt with a heart valve replacement need to be on lifelong anticoagulants? What lab to be monitor for Coumadin and hearin? and what is expected lab range with a pt on coumadin?
- -Prevent blood clots
- -PT-INR 0.8-1.1 normal, 2.0-3.0 standard, 3-4.5 high dose
- -PTT 1.5-2.0 normal
Describe embolectomy and s/s of compartment syndrome and interventions?
- Removal of blood clot
- The 6 P's
- -Poikilothermy (coolness)
How does a nurse know if an abdominal aortic aneurysm(AAA)is expanding and preparing to rupture?
Pt complains of abdominal, flank, or back pain
Describe why a pt can receive both heparin and Coumadin at the same time if they are both anticoagulants?
- -Coumadin takes 3-4 days to reach theraputic anticoagulation
- -Heparin continues to provide theraputic anticoagulation until this effect is achieved
Describe pt education for a pt on anticoagulation?
- -Watch for blood in stool
- -Use electric razor to shave
- -Use soft tooth brush
- -Avoid taking NSAIDs
- -Avoid foods high-fat and Vitamin K-rich
Describe peripheral artery disease and ways to promote vasodilation?
- Lack of oxygen to legs or feet
- -No smoking
- -Elevate legs
Describe pt education regarding diet restrictions for a patient with hypertension?
- -Avoid processed food
- -Avoid salt
- -Avoid high fat lunch meats
Describe the difference between stable and unstable angina?
- -chest pain caused by a temporary imbalance between the coronary arteries' ability to supply oxygen and the cardiac muscle's demand for oxygen
- -chest pain pr discomfort that occurs at rest or with exertion and causes severe activity limitation
What labs are most specific for acute coronary syndrome? What are the normal ranges?
- -Traponin T and I <0.20
- -CKMB females 30-135
- males 55-170
Describe how to use SL nitroglycerin for chest pain, pt education, and what to do if it doesn't help?
Hold tablet under the tongue and drink 5ml of water to allow the tab to disolve. Pain relief should begin within 1-2 minutes and should be clearly evident in 3-5 minutes. After 5 minutes, recheck the patient's pain intensity and vital signs. A total of 3 times if still no relief go to the emergency room.
What are exclusions from a pt to receive thrombolytic therapy (clot buster)?
- -Stroke patient
What s/s does a nurse monitor for that shows poor organ perfusion?
- -Chest pain
- -No urine output
Describe the use of dobutamine (Dobutrex) for a pt with heart failure. What should the nurse see happen to the pt's heart rate and contractility?
Used for short-term treatment of acute episodes of HF. Heart rate will increase, Dobutamine improves cardiac contractility and thus cardiac output wnd myocardial-systemic perfusion.
What is low level of platelets called? What normal range for platelets? What are pt education points for a pt with this problem?
- -Normal range 150,000-400,000
- -Educate pt is at risk for bleeding
Describe what anemia is and why a pt would have dyspnea from it?
- Amenia is a reduction in either the number of RBCs, the amount of hemoglobin , or hematocrit.
- -Pt would have dyspnea due to lack of oxygen in the blood
Describe sickle cell anemia and what interventions a nurse can do to help with pain control?
- Is a genetic disorder that results in chronic anemia, pain, disability, organ damage, increased risk for infection.
- -Intervetions 48 hour IV opiod analgesics Morphine and Hydromorphone (Dilaudid)on a routine schedule
- -Infusion pump using patient controlled analgesia(PCA)
What does a nurse FIRST do if a pt prsents with a possible transfusion reaction?
Stop the transfusion
What lab is a nurse most concerned about when a pt is receiving multiple PRBC transfusions and why?
- -Iron level 60-180
- -Normal Potassium level 3.5-5.0
- -Low Iron level cause a increase in potassium level
What interventions does a nurse do BEFORE starting a PRBC transfusion?
- -Perscription from the health care provider is required
- -Crossmatching of donor's blood and recipient's blood for compatibility
- -Use at least a 20-guage needle
- -Both Y Tubing and straight tubing sets are used for blood component infusion
- -A blood filter to remove sediment from the stored blood products
- -Normal saline as the solution to administer with blood products
- -Must be verified by a second nurse