MDC III Exam 3 Questions with 100% Correct Solutions

Neurovascular checks - pain, pallor, paresthesia, paralysis, pulselessness, pociothermia Discharge on sickle cell - educate on avoiding future crisis by staying hydrated, rest, no smoking, avoid stress, extreme exercises What does stress do to the vessels when we are stressed out? - vasoconstriction what do you see with regular anemia - low hgb/hct, fatigue, pallor, anxiety, tachycardia, low O2, and intolerance to cold how to treat anemia - Iron-take with vitamin C, can cause constipation, iron rich foods what do you see with L heart failure - Crackles, wheezing, pink-frothy sputum, fatigue, orthopnea, dyspnea, coughing at night How to prevent coughing attack in HF - place pillow behind patient loop diuretics - Furosemide (Lasix) monitor K+/Na, dehydration BP give IV push slow over 1 minutes A/E: Tinnitus Thiazide diuretics - Hydrochlorothiazide (HCTZ) Potassium sparing diuretics - Spironolactone Monitor K+ intake how do we know if they are taking diuretics - check weight daily what do you see with decreased cardiac output - confusion, hypotension, tachycardia patient with heart failure what do we teach before discharge - monitor weight daily, medication adherence, diet modifications, limits activity but stay active, avoid NSAIDs patient comes in and what labs do you monitor - BNP- if elevated order diuretics. BNP - measures vasoconstriction, show that the heart is stressed and HF is worsening and have more fluid how do you know the difference between L and R - R will have fluid in the body what else can lead to HF - HTN, valve disorders, drugs, CAD, DM, Afib Mitral valve disorders - Mitral on L Can lead to L sided HF Predispose to mitral valve stenosis - Rheumatic fever what is mitral valve stenosis - thickening/hardening of the valve which causes narrowing what are you going to see in mitral valve stenosis - AFIB, turbulence, fluid back up, decreased CO fatigue, low bp, orthopnea, poor turgor, and difficulty breathing treatment for mitral valve stenosis - valve replacement or repair, anticoagulants, balloon valvuloplasty what do you educate your patient who has prosthetic mitral valve - will be on anticoagulants forever decreased cardiac output, what do the vitals look like - decreased bp, increased HR tachycardia, hypotension end stage heart failure what is their last treatment - heart transplant educate on rejection signs, med adherance, will be on immunosuppresants what will you see with mitral regurgitation - High pitched holosystolic murmur, decreased HR, r sided HF (JVD, edema) R sided HF vitals - hypertension, bounding pulses if we have tachycardia what is the best drug - beta blockers Hypertension - ACE are first responders ARBs are 2nd responders Assessing patients lung and hear crackles, what do you ask them - cough, recheck ask to cough to see if it subsides when doing assessment and hear something abnormal, and going to do an intervention... - Reassess, reassess after any changes or not enough info Aortic stenosis, what do you hear - systolic crescendo-decrescendo valvular disease best diagnostic test - ECHO endocarditis - fever, infection of lining, murmur oral cavity source of infection; IV drug use what are Janeway's lessions - maculae on hands and feet, non-painful what other condition has Oslers node - lupus how do you treat endocarditis - antimicrobials and antibiotics- always take full course pericarditis - you will hear a pericardial friction rub- muffled heart sounds what do you do for someone with pericarditis - antibiotics, steroids' and NSAIDS SE of long-term use of steroids - weight gain hyperglycemia osteoporosis insomnia immune suppression what happens if you do not treat pericarditis - cardiac tamponade- excessive fluid in pericardial cavity atherosclerosis, what is it and what causes it - hardening of blood vessels High fat diet, sedentary life, DM, smoking, hyperlipemia, HTN=modifiable what can atherosclerosis lead to - coronary artery disease what will you see in coronary artery disease - Angina, MI What do you treat for angina - nitro; monitor chest pain level, HR, BP; can take 3 tabs what can nitro cause - headaches what is a STEMI - ST elevation, MI see on EKG what do you do - MONA, then get to cath. lab for PCI within 90 minutes what do you see in PAD - the 6 P's pain, pallor, pulse, hairless legs, necrotic ulcers on feet and toes, cool to touch, intermittent claudication upon ambulation what do you treat PAD with... - ciopidogel, asprin