NUR 140: Exam #3_December 21st

Reminder: *You may be tested on the causes, diagnostic test, clinical manifestations, & and
treatment for the disorders on the blueprint*

Chapter 22: You must read the textbook and the PowerPoint slides discussed in class.

1. Normal sinus rhythm Both atrial and ventricular rhythms are essentially regular.
Rate: 60 to 100 beats/min.
Rhythm: Regular.
P waves: Present, consistent configuration, one P wave before each QRS complex.
PR interval: 0.12 to 0.20 second and constant.
QRS duration: 0.04 to 0.10 second and constant

2. Sinus tachycardia Heart rate greater than 100 beats/min.

CAUSES: physical activity, anxiety, pain, stress, fever, anemia, hypoxemia, and
hyperthyroidism.
S/S: fatigue, weakness, shortness of breath, orthopnea.
Drugs that increase HR: epinephrine, atropine, caffeine, alcohol, nicotine, cocaine,
aminophylline, and thyroid medications.
Treatment: take care of the CAUSE!

3. Sinus bradycardia Stimuli slow the heart rate and decrease the speed of conduction
through the heart.
S/S: syncope, dizziness, weakness, confusion, hypotension, diaphoresis, shortness of
breath, and chest pain.
Treatment: depends on if stable or not.
Stable: identify & treat underlying cause.
Unstable: if the patient has symptoms & inability to find the underlying cause. Atropine
0.5 mg IVP, IV fluids, & Oxygen.
4. VTach: Also called V-tach.
It is the repetitive firing of irritable ventricular ectopic focus.
Usually at 100 to 200 beats/min.
Causes: cocaine usage, low K+, low Mg, drug toxicity, heart failure, MI.
S/S: depends on whether the patient is pulseless vtach or vtach with a pulse.
q Treatment: ABC, cardioversion, & antidysrhythmic medications.

q Top: Monomorphic because ALL QRS are going in the same direction.
q Bottom: Polymorphic because the QRS complexes are different shapes and sizes.

q IMPLANTED CARDIOVERTER/DEBFIBRILLATOR (ICD) Appropriate for patients

who: Have spontaneous sustained VT.
q Are at high risk for future life-threatening dysrhythmias. And Decreases mortality

5. Vfib: Also called V-fib.

Results due to electrical chaos in ventricles.
Causes: prolonged Vtach, cardiac arrest.
S/S: unconscious, hypotensive, pulseless, apneic.
Treatment: CPR & defibrillation.

Treatment: CPR & defibrillation.

6. Asystole : Also called ventricular standstill and cardiac arrest.

Complete absence of any ventricular rhythm.
Medical EMERGENCY!
S/S: unconscious with no pulse.
Treatment: CPR and drug therapy (Ex: epinephrine).
q CPR:
Ø Maintain patent airway
Ø Ventilate with mouth-to-mask device
Ø Start chest compressions
 7. Pacemaker & Defibrillation : Treat conduction disorders that are not temporary.
Powered by a lithium battery & lasts 10-20 years.
q Post Op: cardiac rhythm, assess site for bleeding, swelling/hematoma, redness,
tenderness, infection, and lead misplacement. Must assess pacemaker for CAPTURE.
REVIEW CHART 22-7*
q Give written and verbal information about pacemaker.
q Teach the patient to report any pulse rate lower than that set on the pacemaker.
q MRIs contraindicated.
q Avoid tight clothing and belts.

Picture on top: bimanual pacing. Pacemaker spike before each p wave and before each
QRS complex.Picture on bottom: pacemaker spike before each p wave.

Chapter 26: You must read the textbook and the PowerPoint slides discussed in class.

1. DVT : DVT- DEEP VEIN THROMBOSIS

• Thrombus forms in the deep vein of the thigh or calf.

• Edema comes from release of histamine, WBC release, and vasodilation.
• Risks ;
• No movement for a long period of time (surgery, pregnancy, occupations)
• Causes pulmonary embolism in the lungs
• Clinical manifestations
• UNILATERAL EDEMA (ON THE SIDE OF DVT)
• CBC(platelet count), BMAT(kidney and liver function), PTT&INR (how fast the blood
is clotting) & Venous Duplex (ultrasound).
• GOAL is to prevent pulmonary embolism!!!!
• Medications
• Heparin - antidote= protamine sulfate
• Warfarin - antidote = Vitamin K
• Eliquis/ Xarelto - antidote = fresh frozen plasma
• When platelets are 100,000 or less (150-450 norm) initiate bleeding precautions(AVOID
SHARP OBJECTS, INVASIVE PROCEDURES). 70k platelets patient is bleeding.
• EDUCATE ON BLEEDING- caution with toothbrush and shaving
• NO GREEN LEAFY VEGETABLES
• Blood draw 3x a week with WARFARIN- Patient cannot ambulate until coagulation
therapy has started
 2. PAD: When pt walks or does activity pt will be in pain, classic symtoms, as disease gets
worse at rest pain gets worse…. AVI is the diagnostic test . treatment: Vasodilator ,
however with vasodilation we have capillary leakage / side effect perfieral edema – don’t
give to heart failure patient , anti platlet , aspirin , long term treatment :Angiogram
Check for the 5PS PAIN, PALLOR etc – inability to move limbs post op monitor for
bleeding
PAD- PERIPHERAL ARTERY DISEASE

• Intermittent claudication !!!

• Arterioscleroisis = Build up of fatty substances in the arterial wall
o Arteries become narrowed and blood flow decreases
• Clinical masnifestation
o #1= intermittent claudication (pain while doing physical activity in lower
extremities )
o Coolness of extremities
o Diminished/unequal pulses
o As disease worsens, pain will be during rest too.
• Labs =
o History (smoking & cholesterol)
o Physical exam
o ABI - ankle brachial index (TRUE DEFINITIVE DIAGNOSTIC TEST)!!
§ BP taken on ankles and arms.
• Leading cause of AMPUTATION in the USA!
• Medication
o Cilostazol = Vasodilator (blood vessel wall opens for blood flow & o2) & inhibits
platelet aggregation
o Avoid PT with HF can cause peripheral edema (volume overload)
o Dual antiplatelet agent (aspirin + plavix) to prevent
o Statin to control cholesterol (monitor muscle weakness, rnhabdomylosis & liver function
(AST & ALT), cola colored urine, clay colored stool.
o Angioplasty (stent) done to open up blood vessels (same as cardiac one).
§ Monitor vitals, pulses, capillary refill

§ High risk for bleeding and hematoma

Chapter 48: You must read the textbook and the PowerPoint slides discussed in class.
1. Acute kidney injury (AKI) Know: a lot of pts go into AKI pre or post renal / pre renal
anything that triggers stress, post renal pregnant women and V.P.H in men
Rapid loss of renal function due to damage to the kidneys.
Causes: hypovolemia, hypotension, heart failure, kidneys, and obstruction to kidneys or
urinary tract.
3 Categories of AKI:
Prerenal, intrarenal, and postrenal.
 Pre renal AKI – most common decrease in blood flow to kidney: causes hypovolemia,
hemorrhaging, vomiting diarrhea, burns, sepsis and anaphylaxis , heart failure, renal
stenosis, embolus

Intrarenal : internal structures of kidney is dmage due to ischemia, toxins or tubular

obstruction: Causes fluid back up – urine output reduced
Causes : Preneal isse , nephrotoxic (metals) , glomerulonephritis

q POST renal: obstruction after the kidney

q Initiation: starts with kidney injury and ends once the patient becomes oliguric.
q Oliguria: decreased urine output & patient may start to have signs of uremia.
q Diuresis: GFR improves, and the patient will have increased urine output.
q Recovery: improvement of renal function. It may take 3 to 12 months to resolve.

q Affects ALL systems due to the function of the kidneys.

q S/S: drowsiness, headache, muscle twitching, seizures, dry skin & mucous membranes,
and pallor.
Lab values:
Decreased urine output
q Elevated BUN/Creatinine Higher in Prerenal than in intrarenal
q Decreased GFR
q Hyperkalemia
q Hyperphosphatemia
q Hypocalcemia
q Decreased H/H
MANAGEMENT : AVOID or limit exposure to nephrotoxic medications.
q TREAT the underlying cause.
q IV fluids- 0.9% Normal Saline.
q Monitor electrolytes.
q Strict intake and output.
q Promote rest periods to prevent muscle fatigue.
q Meticulous skin care and provide emotional support.
q Severe- may need emergency dialysis.

2. Chronic kidney disease (CKD)

Development of permanent kidney that can not be reversed. Slow progression.
GFR Determines Kidney Failure:
Stage 1- GFR ≥90 mL/min
Stage 2- GFR = 60–89 mL/mi
Stage 3- GFR = 30–59 mL/min
Stage 4- GFR = 15–29 mL/min
Stage 5- GFR <15 mL/min (ESRD)
q Once the kidneys lose the ability to function- they lose the ability to excrete.
q Loss of excretion allows for the build up of products in the body. This develops into toxic
waste/uremia.
q Causes: HTN, DM, untreated or under-treated AKI.
q S/S: affects ALL body systems.
q LAB VALUES : GFR decreases due to nonfunctioning glomeruli.
q Serum creatinine and BUN levels increase.
q Serum creatinine- sensitive indicator of renal function.
Management
q Calcium Carbonate (Os-Cal) or Calcium Acetate (PhosLo)- bind phosphorus in the GI
tract.
q Sevelamer hydrochloride (Renagel)- binds phosphorus in the intestines.
q Antihypertensives (Ex: Hydralaizne) & Anticonvulsants (Ex: Valium).
q Epoetin alfa is administered IV or subcutaneously three times a week
q Diet: Renal (Low K+, Low Salt, and Low Protein). Vitamin supplements (folic acid,
vitamin B12, etc.)
q

3. Acute glomerulonephritis : Sudden onset

Onset: 10 days after an infection
Common cause: infection
Group A beta-hemolytic Streptococcus
Hepatitis B & C, and Herpes
Staphylococcal or gram-negative bacteremia.
q History: recent infection, immune disorders, exposure to the virus, recent surgery, and
illness.
q S/S: pulmonary edema, HTN, S3, neck vein distention, smoky, reddish, or cola-colored
urine.
q Labs: increase BUN/Creatinine, decrease GFR, & red blood cells & protein in the urine.
q Diagnostic: biopsy.
q Complications:
Ø Hypertensive Encephalopathy
Ø Pulmonary Edema
Ø Heart Failure
Ø Chronic Kidney Disease
q Treat symptoms:
Ø IV Corticosteroids
Ø Manage hypertension
Ø Treat underlying infection
Ø Limit protein & sodium
Ø Daily weight & IV Diuretics
Ø Home care nurse- assess BP, urinalysis, & med education.

4. Post-renal transplant management

Vital signs & head to toe assessment.
 Monitor for rejection:
Hyperacute- occurs within 24 hrs of transplant. Occurs due to immediate antibody
mediated reaction.
Acute- occurs within a few days to weeks of surgery. Tenderness at transplant site &
increase BUN/Creatinine.
q Immunosuppressive therapy for life
q Monitor for signs of rejection.
q Monitor for signs of infection & prevent it at all costs.
q Monitor urine output.
q Monitor for electrolyte changes.
q Provide opportunities for the patient & donor to express thoughts & fears.
q Provide support and refer to support groups.

5. Hemodialysis: Hemodialysis: anyone that is acutely ill or needs permanent renal

replacement therapy. 3x a week (takes 4 hours), acutely ill or needs permanent renal
replacement therapy
6.
7. Peritoneal dialysis : Peritoneal: used for patients that are unable or unwilling to undergo
hemodialysis or kidney transplantation.
Goal: remove toxic waste, metabolic waste, remove excess fluid & fix electrolyte
imbalance.

o pt who are unable to undergo hemodialysis. Port near the navel connected outside
of the abdominal cavity.
§ complication= peritonitis (cloudy fluid).
o Need to weigh pre and post, BP pre and post.
o Nephrologists order how much blood needs to be cleansed with their dialysis.

o Monitor fistula (listen for brewing of blood) once a shift)

Chapter 20: You must read the textbook and the PowerPoint slides discussed in class.
1. Chronic obstructive pulmonary disease (COPD) : Know the patho/ s/s treatment, pt
education, lifestyle adjustment
2. Asthma
Chapter 49: You must read the textbook and the PowerPoint slides discussed in class.
1. Urinary tract infection
Lower UTI’s: includes the bladder and structures below the bladder.
Upper UTI’s: includes the kidneys and ureters.
q Causes: female gender, DM, older adults or cognitive impairment, inability to empty
bladder, bladder tumors, sexual intercourse, catherization, and calculi.
q S/S: depends on location
Ø Uncomplicated- burning on urination, urinary frequency & urgency.
Ø Complicated- systemic symptoms such as shock.
q Organism: E. coli, Proteus, Klebsiella, Pseudomonas, Staphylococcus, and
Enterococcus.
q Labs & Diagnostics: elevated WBC with a “left shift”, RBC & WBC in urine.
Ø Culture: identifies organism.
Ø Analysis/Dipstick: Leukocytes Esterase, Nitrates, & Hematuria.
Ø X-ray, CT Scans, and Ultrasounds.
q Management: Medications
Ø Nitrofurantoin (Macrobid)- Renal insufficiency.
Ø Ciprofloxacin (Cipro)- Achilles tendon rupture.
Ø Trimethoprim-Sulfamethoxazole (Bactrim)– Look out for Steven Johnson Syndrome.
Ø Phenazopyridine (Pyridium)- turns urine to an orange color.
Ø Patient Education: Increase oral hydration.
Ø Daily intake of cranberry juice to prevent & control symptoms.
Ø Avoid caffeine, alcohol, and citrus fruits.
Ø Increase intake of Vitamin C.
Ø Antispasmodic agents to relieve bladder irritability and pain.

Chapter 18: You must read the textbook and the PowerPoint slides discussed in class.
1. Acute pharyngitis : sore throat
Sudden, painful inflammation of the pharynx.
Higher incidence in the winter due to poorly vented rooms & exposure to viral agents.
Causes: Step A
Complications: rhinosinusitis, otitis media, peritonsillar abscess, glomerulonephritis, &
sepsis.
q S/S: fiery-red pharyngeal tonsils, white exudate, tender cervical lymph nodes, fever,
malaise, vomiting, & rash.
v Clients with viral will NOT have exudate.
q Labs & Diagnostic: Rapid antigen detection test (RADT) and throat culture.
q Viral- support measures to treat the symptoms.
q Bacterial- PCN V potassium for 10 days orally.
q If the client has a PCN allergy or is resistant to erythromycin administer:
v Cephalosporins- Cephalexin
v Macrolides- Azithromycin or Clarithromycin
v Administer Tylenol to help manage pain.
v A liquid or soft diet depends on the client’s level of discomfort.
 v Cool beverages and ice pops are soothing to the throat.
v Warm saline gargles & mouth care.
v Avoid sharing eating utensils & food with others.

2. Cancer of the larynx : Smoking commericals

Accounts for half of head & neck cancers.
Risk Factors: smoking, alcohol, men, adults older than 65, exposure to toxins such as
asbestos (Chart 18-6).
S/S: hoarseness for more than 2 weeks, raspy voice & low pitch, persistent cough, sore
throat, lump in neck, dysphagia, & weight loss.
q Diagnostic: Fine needle aspiration (FNA) biopsy, barium swallow study, CT scan, MRI,
and PET scan.
q Treatment: Depends on the stage
v Chemotherapy & Radiation
v Surgery: Cordectomy in mild cancer & laryngectomy in severe disease
v The airway is a priority post-op! Monitor for respiratory distress.
v Explain to the client with a complete laryngectomy that the natural voice will be gone.
v NPO for 7 days, so will have enteral feeding or TPN.
v Disturbed body image and anxiety need to be addressed.
q Speech therapy: alternate methods to communicate. Utilize writing, lip-reading, and
electronic devices such as iPad or cell phones.
v Esophageal speech
v Artificial larynx
v Tracheoesophageal puncture
q Educate client & family:
v Wear a loose-fitting bib or hold your hand over your stoma when showering.
v AVOID swimming.
v Humidification is needed in the house.
v Proper care & management of tracheostomy.

Chapter 40: You must read the textbook, review the PowerPoint, & and listen to the lecture
recording.
1. PUD & complications of PUD: Complication: bleeding hemorrhage
Erosion of the mucous – gastric or Duodenal , stress curling ulcer
Curling/stress ulcer:
All ulcer patients on; Proton pump inhibitor and Histime H2 inhibitor blocker (ends ine): these
will prevent stress ulcer
Risk fact: NSAID users (motrin), Type o blood type, elderly, H-Pylori
Gastric ulcer = the stomach pt will feel pain asap
Duodenol ulcer: Pain 2-3 hrs later after they eat
q Labs & Diagnostic:
Ø CBC, BMET, Coagulation studies.
Ø Upper endoscopy & biopsy.
Ø Stool for occult blood.
Treatment: Management : Antibotics if pt has H-Pylori only , PPI, H2 Blocker, NO ASPRIN,
NO NSAIDS , NO CAFFEINE, NO ALCOHOL, no hot food, VAGOTOMY- removal of vagus
nerve , ANTRECTOMY -removal of partial stomach
q Hemorrhage- most serious complication.
Ø Clinical Manifestations: vomits bright red or coffee-ground blood, dark/tarry stool,
hypotension, tachycardia, diaphoresis, & dizziness.
Ø Treat: endoscopy, NG tube, and IV fluids, surgery

2. Dumping syndrome : Rapid Stomach emptying

Early Dumping: 10-30min
Late Dumping 1-3 hours : rapid increase in sugar absorption: Pancreas produces more
insulin, sometimes producing too much insulin, causing too low glucose- hypoglycemia –
sweating tremors

food break down in the small intestine , when pts have surgery in the GI tract stomach,
etc pt can have issues with bowel movements , pt take in food – not adoquently absorbed
in small intestine, as they eat within 20 min they poop at the same time,

Early signs: ABD PAIN bloading pain

Late signs; 60-90 min hypoglycemia, sugar rises in blood stream but gets popped out
rapidly

Treatment: Pt edu don’t eat and drink at the same – becomes full
 Avoid sugar foods , consume small meals

q Hemorrhage- monitor for bleeding at the site or vomiting blood.

q Dumping Syndrome:
q Early symptoms occur within 10-30 minutes of eating.
Ø Resolves after 1 hour from eating or after defecation.
Clinical Manifestations- cramping abdominal pain/distention, nausea, vomiting,
headache, flushing, dizziness, and diarrhea

Other topics: you will have med math questions on the exam.