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NSG-430 EXAM 2 Review
Adult Health Nursing II (NSG-430)
Grand Canyon University
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CARDIAC KIDNEY
Acute Decompensated HF Basically an exacerbation of HF (emergent) S/S: Fatigue, ascites, lower extremity swelling, SOB TX: MONA + sit upright with feet dangling Risk: Recent MI LHF (causes: MI, valvular disease, dilated cardiomyopathy) o Fatigue, decreased UO, rapid/irregular HR, SOB, cough up blood, wt gain RHF o Fatigue, irregular heart rhythm, swelling in lower extremities, jugular venous distention, wt gain, ascites, increased UO especially after lying flat Congestive Heart Failure (CHF) Low CO, low BP, low UO (no perfusion to the kidneys) Energy conservation: begin walking 200 ft/day Heart transplant: avoid large crowds Stable: >95% O2, >90 SBP A-fib can lead to exacerbation of HF, check the patient’s LOC LAB: BNP (80-100) Interventions: Strict I&Os, sodium (1-3g/day) restrictions, fluid restrictions, regular physical activity (start small – walking), stop smoking, restrict milk to 2 cups/day DIGOXIN toxicity: loss of appetite (anorexia), n/v, yellow vision, dysrhythmias o Monitor potassium = increased risk for toxicity Pulmonary edema: dyspnea, bloody/frothy saliva Atenolol Cardiomyopathy Primarily used for HTN Drug choice for patients with hx of MI or HF Decreases CO and renin secretion by the kidneys Chest Pain Give nitroglycerin (3x 5 min apart), if relieved MI can be ruled out o DON’T give to patients who are taking
Acute Renal Failure/Injury AKF usually caused by hypervolemia which leads to HTN AKI care: VS (q4h), Lasix (40 mg PO/daily), assess breath sounds q2h, low salt diet Nutrition: Low potassium, salt restriction, low protein (Renal Diet: HIGH FAT, HIGH CARBS) Stages of AKI o Oliguria (not peeing enough) o Diuretic (peeing a lot) 2-6 weeks after onset – worry about hypokalemia o Recovery Pre-renal: interruption in fluid/blood flow to the kidneys o Severe burns, severe vomiting, hemorrhage, hypotension Intrarenal: o Acute tubular necrosis, strong abx (vancomycin), MRSA Post-renal o Renal calculi, injury AKI Labs: GFR <60, high creatinine, high K+ Acute Tubular Necrosis Causes: ischemia, nephrotoxins, or sepsis Risks: major surgery, shock, blood transfusion reaction, muscle injury from trauma, and prolonged hypotension Vanco to treat? CRRT (Continuous Renal Replacement Therapy) Patient need to be in ICU setting (1:1) with a special nurse 80 mL at a time For patients who are not hemodynamically stable (fragile hearts and kidneys) Done over 24 hours instead Vascular Access for RRT Hemodialysis o Patients without healthy heart cannot have this! o AV fistula – useable in 4-6 weeks after insertion (assess for thrill and bruit) o NOTHING on arm with fistula – patients
erectile dysfunction drugs Angina S/S: Chest pain < 20 min, radiates to L arm/jaw, diaphoresis, SOB o Stable: Known triggers, relieved with rest o Unstable: Occurs at rest o Prinzmetal: unrelated to exertion, ST elevation, relieved with NTG/CCB Endocarditis Infective endocarditis: standard precautions 4-6 weeks of IV abx Manifestations: chills, weakness, malaise, fatigue, and anorexia, arthralgias, myalgias, back pain, abdominal discomfort, weight loss, headache, and clubbing of fingers TX: Early valve replacement followed by abx for 4-6 weeks Mitral Valve Stenosis S/S: SOB, crackles, pulmonary HTN, alveoli hemorrhage, A-fib Echocardiogram: L atrial hypertrophy Progression: dyspnea on exertion Mitral Valve Regurgitation Fluid overload, LHF Cause: infective endocarditis S/S: holosystolic “blowing” murmur Pacemaker Education: Until incision is healed do NOT submerge in water (showers only 7 days after?), report HR lower than your pacemaker settings, do not lift your arm above shoulder for 8 wks, no pressure (including tight clothing) on it Pericarditis S/S: Friction rub left lower sternal border, sharp pain that worsens with deep inspiration and lying flat Distinction from angina: Trap muscles Complication: cardiac tamponade (chest pain + confusion) STEMI MONA (Morphine, Oxygen, Nitroglycerin, Aspirin) 90 minutes from door to cath lab Troponin – ACS protocol, very specific to cardiac Alteplase (tPA) – TIME is the biggest factor (ask when the sx/chest px started) o 3-4 hrs max for tPA
need to come in 3x a week for 3-4 hrs a week o Watch for changes in VS – n/v, headache, syncope Peritoneal o Can do at home & while sleeping o Worried about infection or leaking of the fluids (cloudy) Renal Transplant Anti-rejection medications for life Increased risk for CVD: diet and exercise Better quality of life Infection: Recognize s/s, stay away from infections Antirejection: Calcineurins and corticosteroids o Tacrolimus/cyclosporine Kidney Cancer
Renal Calculi Hurts A LOT Strain urine to collect calculi and send to the lab Urine, CT Management: *PAIN MEDS (Toradol/Morphine), fluids (treat the sx) RIFLE (Risk, Injury, Failure, Loss, ESRD) Risk (stage 1): Increase in serum creatinine to 1 times baseline Injury: Increase in serum creatinine 2x baseline Failure: Increase in serum creatinine 3x baseline Loss: Kidney replacement >4 weeks End-Stage: Kidney replacement >3 months Lab normal values to know: Potassium: 3 – 5 mmol BUN: 10-20 mg/dL (2 to 8 mmol/L) Creatinine: 0 – 1 mg/dL ABGs Creatine Clearance: Male: 107–139 mL/min or Female: 87–107 mL/min GFR: 90+ = normal (90-125 mL/min), <60 = kidney disease, <15 = kidney failure Minimum urine output: 30 mL/hr or 1-2 L/day
A-Flutter
Sawtooth, high risk for PE and strokes TX: CCB and beta-blockers
V-fib
Common causes: Acute MI and myocardial ischemia and in chronic diseases such as HF and cardiomyopathy, during cardiac pacing or cardiac catheterization procedures because of catheter stimulation of the ventricle, electric shock, hyperkalemia, hypoxemia, acidosis, and drug toxicity. TX: CPR, D-FIB, epinephrine and amiodarone V-tach
Common causes: MI, CAD, significant electrolyte imbalances, cardiomyopathy, long QT syndrome, drug toxicity, and central nervous system disorders Go to treatment is Amiodarone If unstable: cardioversion AV Paced Rhythm
Stable – assess VS
PVC
Common causes: TX: Amiodarone
Sinus rhythm with PAC
Common causes: emotional stress or physical fatigue, or from caffeine, tobacco, or alcohol use TX: Decrease or stop caffeine + B-blockers
Sinus rhythm with 1st degree AV block
Common causes: age, MI, CAD, rheumatic fever, hyperthyroidism, electrolyte imbalances (e., hypokalemia), vagal stimulation, and drugs, such as digoxin, β-blockers, calcium channel blockers, and flecainide Not usually serious TX: None, monitor the patient and treat the cause
Complete/3rd degree heart block
Transcutaneous pacing TX: Transcutaneous pacemaker + dopamine/epinephrine
Torsades de Pointes (polymorphic VT)
Common causes: alcoholics, malnourishment TX: Magnesium No pulse = CPR/D-fib + epi and amiodarone
Paroxysmal supraventricular tachycardia
Common causes: overexertion, emotional stress, deep inspiration, and stimulants, such as caffeine and tobacco. PSVT is also associated with rheumatic heart disease, digitalis toxicity, CAD, and cor pulmonale.
NSG-430 EXAM 2 Review
Course: Adult Health Nursing II (NSG-430)
University: Grand Canyon University
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