Medical Surgery

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1. ABG normal ranges for: 1. pH - 7.35 to 7.45

1. pH 2. PaO2 - 80 to 100
2. PaO2 3. SaO2 - >95%
3. SaO2 4. PaCO2 - 35 to 45
4. PaCO2 5. HCO3 - 22 to 26
5. HCO3
2. ABO 1. O- doesn't have A, B, or O antigens. AB+ has A, B, and O antigens.
1. who gets what? 2. O- is universal donor. AB+ is universal recipient.
2. who's the universal
donor and recipient?
3. Allergic vs. febrile vs. A. Allergic - facial flushing, hives/rash, increased anxiety, decreased BP, dyspnea
hemolytic rxns B. Febrile - fever, chills, anxiety, headache, tachydardia, tachypnea
1. Symptoms of each C. Hemolytic - chest pain, low back back pain, fever, chills, tachycardia, apprehension, decreased BP,
increased resp. rate
4. Asthma Bronchoconstriction
- pathophysiology/what Airway hyper-responsiveness
happens? Airway edema
Increased mucus production
Airway obstruction = ↑ airway resistance, ↓ flow rates =
hypoxemia, hyperventilation (↓ PaCO2) = ↑Airway obstruction, ↑Air trapping = lungs hyper-expanded,
respiratory muscles work harder, CO2 retained = respiratory acidosis = respiratory failure
5. Asthma Genetics
- risk factors Immune response
Allergens
Exercise
Air pollutants
Nose/Sinus problems
GERD
Respiratory infections
Influenza
Rhinovirus
Drugs/Food additives
NSAIDS, ASA
β-blockers
Psychologic factors
6. Asthma Anxiety
- s/s Expiratory wheezing
- mild vs severe Dyspnea
Cough
Prolonged expiration
Tachycardia
Tachypnea
Severe attacks:
Use of accessory muscles
Wheezing during inspiration and expiration
Pulsus paradoxus
Dyspneic at rest
Speaks in words, not sentences
Sits forward
Tachypneic (> 30/min)
Tachycardic (>120/min)
PEFR < 40% of personal best or < 200 L/min
JVD
7. Asthma 300m world
- stats 22m US
Occurs at all ages
50% during childhood
33% before the age of 40
After puberty, 66% - women + higher death rate
8. Asthma treatments: (1-4 are anti infammatory)
1. corticosteroids 1. More effective than any other drugs
2. IV/oral drugs 2. acute exacerbation
3. ICS 3. few systemic effects
4. Leukotriene modifiers 4. prevent bronchoconstriction, not used in acute attacks, Singulair (montelukast), Accolate
5. monoclonal antibodies (zafirlucast)
6. bronchodilators 5. expensive, risk of anaphylaxis, Xolair (omalizumab)
6.β2-adrenergic agonists
Methylxanthines - rare
Anticholinergics - common
9. Asthma Chronic airway inflammation w/recurrent:
- what is it Wheezing
Dyspnea
Chest tightness
Cough
Obstruction
10. Blood screening checks Hep C, HIV, West Nile
for...?
11. CAD Healthy weight
- prevention Reduce sodium
Increase activity
Avoid tobacco
Limit alcohol
Diet - low chol + sat fats. high fruits/veggies/lean meats/poultry/fish
Drug therapy - restrict lipoprotein production, removal or absorption
12. CAD Unmodifiable:
- risk factors Age (>65), gender (men), race (white), genetics
unmodifiable vs modifiable Modifiable:
#1 Hyperlipedemia #1!!!!!
#2 Hypertension
#3 Tobacco
#4 Physical Inactivity
13. Care and complications of a Care: assess airway, breath sounds,warmed & humidified air via vent or trach collar, elevate HOB >30
trach tube degrees after eating or tube feeding
Complications: obstruction, dislodgement, pneumothorax, bleeding, infection
Prevention of tissue damage: cuff pressure less < 20, stabilize tube, suction only when needed
14. Causative Organisms for CAP:
pneumonia: Mycoplasma
Strep
Haemophilus
Legionella
Immunocompromised
Pneumocystis carinii
Viruses:
Influenza A
Adenovirus
Varicella-zoster
Togavirus (rubella)
Paramyxovirus
Herpes simplex
Cytomegalovirus
Ebstein-Barr
15. Cholesterol Produced in liver. Building block in estrogen, steroidal hormones.
16. Classes of pneumonia: 1. Aspiration - from↓LOC, dysphagia, NG tubes, bacteria
2. Opportunistic - from ↓immune response
ex. Pneumocystis jiroveci - HIV disease
ex. Cytomegalovirus - transplant pts
17. Compliance Compliance is a measure of lung distensibility
1. decreased compliance 1. lungs harder to inflate, seen in increased fluid (pneumonia, pulmonary edema, ARDS),
2. increased compliance decreased elasticity (fibrosis, sarcoidosis), and
restrictions (pleural effusion)
2. lungs easier to inflate, seen in COPD
18. Complications of IV therapy 1. D/C IV, document location and size of catheter, edema, temp. of skin at site, and pain; s/s =
1. infiltration and sepsis swelling and tissue leakage
2. phlebitis 2. D/C IV, vein is swollen, tender, red
3. extravasations 3. when the medication from the IV leaks into the surrounding tissue, can cause tissue necrosis
19. Complications of Tb Miliary TB - orgs invade blood and spread t/o body
Pleural effusion and empyema
Tuberculosis pneumonia
20. COPD Cor pulmonale
- complications RHF
COPD exacerbations
Acute respiratory failure
*DC bronchodilators/corticosteroids
21. COPD PFTs - to confirm diagnosis
- diagnostic studies FEV1 - obstruction
CXR
ABGs - show hypoxemia, hypercarbia, acidosis, ↑ bicarbonate
BMI -1/3 of COPD patients are underweight
22. COPD risk factors Cigarette smoking
Occupational chemicals & dust
Air pollution
Infection
Genetics
Aging
23. COPD Dyspnea
- s/s Chronic cough
Sputum production
Wheezing/chest tightness
Tripod-ing
Clubbed nails
Prolongued expiration
Barrel chest
"Pursed lip" breathing
Hypoxemia
Hypercapnia
Polycythemia
24. COPD stats 4th cause of death in US
More in women and whites
25. COPD smoking cessation
- tx vaccination
Bronchodilators
Β2 adrenergic agonists
Anticholinergic agents
Methylxanthines
Corticosteroids
ICS
O2 therapy
26. COPD Inability to expire air
What happens? Loss of elastic recoil
Air trapping
Breathing with "over-inflated" lungs
Air trapping worsens and alveoli destroyed
Hypoxia and hypercarbia
Bullae and blebs
Excess mucus production
Pulmonary hypertension
Vasoconstriction from hypoxia
Cor pulmonale
Right ventricle hypertrophy
27. Coronary Artery Disease CV is #1 cause of death in US
- stats Def: heart disease from impaired coronary blood flow by atherosclerosis
Mortality rate decreasing
28. Cryoprecipitate 1. the precipitate after FFP thaws
1. what is it? 2. factor VII, vonWillebrand, fibrinogen, factor XIII
2. what factors are in it? 3. for fibrinogen levels < 100, when there's a factor deficiency that's leading to bleeding
3. when is it given?
29. Decribe lipoproteins 1. LDL "bad"
- HDL < 130 desirable
- LDL < 100 mg/dL optimal
- Triglycerides carry cholesterol to tissue sites
2. HDL "good"
> 30 desirable- higher HDL = less CAD
> 50 mg/dL (females); > 40 mg/dL (males) optimal
carry cholesterol from arteries to the liver for removal
3. Triglycerides:
< 150 mg/dL optimal
30. Decrsibe head and neck MCC: ETOH, tobacco, HPV, chronic laryngitis, GERD
cancerM S/S: painless growth, non healing ulcer, pain later on, hoarseness, change in voice, neck mass, big
MCC nodes, tracheal deviation, ulcer, asymmetric tongue, white or red patches in mouth
S/S Increased risk >50yr and male
-Pharyngeal Pharyngeal : unilateral sore throat, ear pain
- laryngeal Laryngeal : hoarseness, "lump" in throat, change in voice. Later - pain, dysphagia, airway closes
TX TX:
Stage I & II -radiation, sx, goal of curing
Stage III and IV - poor prognosis
31. Decsribe laryngeal polyps MCC: smoking, intubation, singers
MCC S/S: hoarseness
S/S TX: voice rest, hydration, sx
TX
32. Describe a febrile 90% of all reactions; fever, chills; recipient's antibodies react to antigens in the donor's blood
nonhemolytic transfusion rxn
33. Describe cardiovascular Calcification in valves
changes associated with Pacemaker cells decrease in number
aging Conduction time lengthens
Left ventricle size increases (dilates)
Aorta and large vessels thicken and become stiffer
Baroreceptors less sensitive
34. Describe complete upper Total airway obstruction, medical emergency
airway obstruction MCC: Aspiration/choking, edema, CNS depression, allergic rxn, extubation, abscess
MCC S/S: stridor, increased WOB, intercostal retractions, wheezing, restlessness, tachycardia, cyanosis
S/S TX: Assess airway, suction, heimlich, cricothyroidotomy, intubation, tracheotomy
TX
35. Describe COPD Chronic airflow limitation, progressive, systemic effects
COPD includes:
Chronic bronchitis
Chronic cough for 3 mos in 2 consecutive yrs
Emphysema
Abnormal, permanent enlargement of air spaces
Bronchospasm
36. Describe: Sx treatments for neck cancer:
Cordectomy Cordectomy - one cord
Hemilaryngectomy Hemilaryngectomy - one vocal cord
Supraglottic laryngectomy Supraglottic laryngectomy - false cords and epiglottis
Radical neck dessection Radical neck dissection - excision of nodes, muscles, IJ vein, thyroid and parathyroids
37. Describe drug therapy Nitrates - relieves ischemic pain
treatments for angina Venodilators - reduce preload
Anti-platelets - first line of defense (ASA, Plavix)
β-adrenergic blockers
ACE-inhibitors or ARBs
Vasodilate - ↓ afterload
*Nitroglycerin: Relieves pain, can be used prophylactically. Side Effects - decreased B/P, flushing
and throbbing headaches.
38. Describe heart rate Heart muscle generates its own action potentials/impulses
conduction SA node is pacemeker, fastest
AV node conduction slows thru the Bundle of His
Delay allows the atria to completely empty w/atrial kick as they depolarize
Bundle branches depolarize in unison
Purkinje fibers depolarize ventricles in unison
39. Describe hypertension "Vascular Disease"
1 in 4 adults in US
Rsk factor for cv disease: stroke, MI, Heart Failure
Other Target Organ Damage:
-LV hypertrophy
-Nephropathy
-Vascular Disorders
-PVD
-Retinopathy
40. Describe MAP Mean Arterial Pressure (MAP)
Average systemic pressure
Need MAP > 60 mmHg to adequately perfuse major organs
MAP = [SBP + (2xDBP)] 3
41. Describe obstructive sleep Upper airway obstruction during sleep
apnea MCC: obesity, >65yrs, smoker
MCC S/S: snoring, sleep distruptions, daytime somnolence, apneic episodes
S/S TX: side sleeping, lose weight, CPAP
TX Comps: HTN, pulmonary disease, heart disease, CVA's. heart failures, and arrhythmias
Comps
42. Describe peritonsillar MCC: acute pharyngitis or tonsillitis
abcess S/S: Pus, deviation of uvula, fever, chills, drooling, severe throat pain, difficulty swallowing, stridor,
MCC resp. distress
S/S TX: Assess airway, antibiotics, aspiration
TX
43. Describe Printzmetal's Occurs at rest
angina Spasm of the coronary artery
Not always associated with documented CAD
Precipitated by a sudden increase in myocardial O2 demand due to:
Nicotine
Histamine release
Treated with Calcium-channel blockers
44. Describe s/s of silent Often is women and diabetic
atypical angina No chest pain
#1 s/s = Fatigue!!
Shortness of breath
Epigastric burning - "heartburn"
Anxiety
45. Describe stable angina Usually stable plaque that is about 75% occlusive
Chest Pain with exertion - subsides with rest or nitroglycerine
Reversible - if perfusion restored no permanent damage
Occurs intermittently with same pattern-duration-intensity of symptoms
46. Describe the chambers of a 1. Collection chamber:
"pleur-evac" Receives fluid and air
1. collection chamber Air vents to outside
2. water seal chamber 2. Water-seal chamber:
3. suction control chamber One way valve
Bubbling and tidaling
3. Suction control chamber:
Water or dry
Usually 20 cm H2O
47. Describe the clinical Early - Elevated BP, asymptomatic (silent killer)
manifestations of primary Later - Symptoms second to effects on other organs, headache, N/V, fatigue, confusion, dizziness,
HTN epistaxis, blurred vision, palpitations, angina, dyspnea, nocturia, dependent edema
48. Describe the 1. restrict lipoprotein production - "Statins" (atorvastatin/Lipitor ), niacin, nicotinic acid (severe flushing/itching
drugs used to common)
lower lipid 2. increase lipoprotein removal - Bile acid sequestrants (cholestyramine/Questran)
levels 3. decrease cholesterol absorption - ezetimibe (Zetia)
49. Describe the MCC: Smoking!
etiology of Female smokers greater risk than male smokers
lung cancer Never smokers w/ adenocarcinoma - 2.5 x more female
- mcc
50. Describe the Regulates BP and CO
RAAS system
1. In presence of low blood volume, renal perfusion decreases (↓ blood flow to kidney decreases GFR) = secretion
of renin from juxtaglomerular cells in kidney.

2. Renin converts angiotensinogen (from liver) to angiotensin I. I is converted to II by ACE = vasoconstriction and
aldosterone release.

3. Angiotensin II - ↑ SVR and aldosterone

4. ↑ Aldosterone secretion = more Na and H20 reabsorption = increased BP

5. Ultimately, the extra ECF leads to ↑ preload = ↑ energy expenditure = ↑ workload for the heart = pulmonary
congestion.
51. Describe the what is it: deposits of fat lining coronary arteries
steps involved Fatty streaks start at age 15
in the By 30, fibrous plaque appears
development 1. Inflammation or injury occurs (smoking, HTN, DM, high cholesterol) C-reactive protein will be elevtated
of 2. Immune response to injury. Platelets attach, smooth muscle cells migrate in, lipids accumulate,
artherosclerosis 3. Fibrous plaque forms, can lead to complicated lesions ( dangerous, unstable and can rupture)
Two types of plaque:
Stable - obstructs blood flow, angina when lesion >75%
Unstable - gel-like lipid rich core covered w/fibrous cap - if ruptures leads to platelet aggregation and acute MI or
unstable angina

**CAD - lipids (atheromas) and cholesterol deposit in the intimal wall of coronary arteries = localized
inflammatory response that develops into a fibrous plaque = endothelial injury as the plaque bulges into the lumen
of the artery. Ongoing growth of the fibrous plaque plus continued inflammation = plaque instability, ulceration,
and ultimately rupture. Once the endothelial layer is damaged, platelet aggregation leads to thrombus formation
from receptor binding of fibrinogen.
52. Describe Leading cause of transfusion-related deaths; chills, sudden resp. distress, resp. failure;
(TRALI)
transfusion-
related acute
lung injury
53. Diagnostic CXR
studies for lung CT scan (most effective non-invasive technique)
cancer PET (for metastases)
Sputum cytology - only 20-30% positive
Biopsy - definitive diagnosis
Fine needle aspiration
Bronchoscopy
Thoracoscopy
Thoracentesis
54. Diagnostic studies used to assess CBC, ABGs, Oximetry, IGRA
respiratory fxn: Skin Tests
Sputum
C&S/Gram stain
Acid-fast
Cytology
Most common = CXR
Pulmonary angiogram = gold standard
Bronchoscopy
Thoracentesis (tripod position)
55. Diagnostic sudies for Tb Skin test (PPD) - don't re-test if pos
Tw0-step test for health care workers
CXR - Not diagnostic alone
Acid-fast bacilli
Sputum X 3
QFT (QuantiFERON-TB Gold)
56. Diffusion rate of CO2 vs O2 CO2 diffuses 20X faster than O2
57. Dressing changes for CVAD's 1. original PICC dressing changed after 24 hrs
2. occlusive gauze changed q 24 hrs
3. transparant semiperm membrane dressing changed q week or when damp, loose, or
soiled
58. Examples of colloids dextran, albumin, mannitol; pull water toward them, can't cross membrane
59. Examples of crystalloids dextrose, NACL, lactated ringers, KCL
60. Fats saturated = bad (animal fats, coconut, palm oil, dairy products)
- saturated vs monounsaturated vs monounsaturated = ok (fish oil, advocado, almonds, penuts, pecans, olives, canola and
polyunsaturated olive oil)
polyunsaturated = good (shellfish, walnuts, pumpkin seeds, sunflower seeds, margarin,
safflower/soy/cottonseed/flaxseed oils)
61. Flushing a CVAD Always use a 10 ml syringe
Scrub port with alcohol for 15 sec. prior to accessing
Use SAS(H) technique
Use pulsating flush technique to break up fibrin
Maintain IV at KVO rate
- Central line/PICC - 10ml NACL after meds and every shift, 20ml after TPN
- Implanted port - 10ml NACL+2ml heparin after meds, 20ml+2ml heparin after TPN
62. Frozen Fresh Plasma 1. seperated via centrifuge
1. how is it seperated? 2. to restore plasma volume and treat some bleeding problems
2. when is it given? 3. no
3. are they cross matched? 4. all clotting factors, antithrombin, plasmin protein
4. what's in it? 5. short half-life means it runs over 30-60 minutes and must be stored frozen, must finish
5. how is it infused? w/in 4 hrs
63. Give examples of Loop, thiazide, and k Loop:
sparring diuretics Bumetanide (Bumex)
Furosemide (Lasix)

Thiazides:
Chlorothiazide (Diuril)
Hydrochlorothiazide (HCTZ)

K-Sparing:
Spironolactone (aldactone)
Triamterene (Dyrenium
64. How do diuretics work? Block Na+ reabsorption in nephron - Na+ follows water and
What are common side effects? increases water/urine excretion
What are some important things to watch for? Loop of henle has highest concentration of Na = loop diuretics are
the most potent

Side Effects: F&E imbalances, CNS effects, GI effects

Nursing Considerations:
Monitor for orthostatic hypotension
Dehydration
Hypokalemia

Loop & B- blockers are recommended for initial drug therapy of

uncomplicated HTN

Thiazides first and most commonly used due to more gentle

diuresis
65. How long after being brought up from the blood bank must 30 minutes
the blood be infused?
66. Implanted CVAD's implanted port
titanium or plastic resevoir
subcutaneous pocket under the skin
self-sealing septum made of silicone
67. Latent Tb vs active Tb Latent:
No active disease
Not infectious
~10% develop active TB
Dormant bacteria can persist for years and reactivate-thus treat
latent TB
Active:
Initial immune response inadequate
Bacteria multiply and cause active disease
68. Leukocyte poor RBC's 1. a blood product in which the WBC's have been removed to
1. what are they? reduce risk of reaction
2. who are they given to? 2. patients w/ known nonhemolytic transfusion reactions and
imunosuppressed ppl
69. List the two main functions of transfusions 1. increase O2 carrying capacity of the blood
2. reverse tissue hypoxia
70. Location and function of respiratory center - located in medulla, aortic arch, lungs, chest wall, diaphragm
- chemoreceptors resond to changes in PaCO2 and pH
71. Long term CVAD's 1. tunneled cathetars and impanted ports
1. types
72. Lung cancer 1. Early
1. early s/s Persistent cough with blood-tinged sputum
2. late s/s Chest pain
Dyspnea
Wheezes
2. Later
Anorexia - N&V
Fatigue
Weight loss
Diaphragm paralysis
Dysphagia
node changes in neck or axilla
73. Lung cancer Most common cancer
- stats Leading cause of cancer-related deaths in US
Decreasing in men
Leading cause of cancer death in women
74. Mixed venous blood 1. pH - 7.33 to 7.53
gases normal ranges 2. PaO2 - 38 to 42
for: 3. SaO2 - 60-80%
1. pH 4. PaCO2 - 40 to 55
2. PaO2 5. HCO3 - 22 to 26
3. SaO2
4. PaCO2
5. HCO3
75. Non-tunneled good for 7-10 days, placed at bedside, single/double/triple lumen available
percutaneous - distal (blood)
catheters - medial (TPN)
- proximal (blood components)
76. Obstructive pulmonary Increased resistance to airflow, need more force/time to exhale
disease Unifying sign/symptom - wheezing/dyspnea, ↑ work of breathing, V/Q mismatch, ↓ FEV1
1. what is it
2. most common s/s
77. Osmolarity of 1. the concentration/tonicity of a solution
parenteral solutions, 2. >375, more concentrated than cell, fluid moves out of cell and it shrinks, D10W, 3%NS
definitions: 3. <250, fluid moves into cell and it swells, treats cellular dehydration; D5W, 0.45NS
1. osmolarity 4. 250-375, no movement, treats intravascular dedydration; D5W, 0.9NS, Lactated Ringer's
2. hypertonic
3. hypotonic
4. isotonic
78. Oximetry assessed w/ vitals, non-invasive, less accurate w/ O2 < 70%; affected by low perfusion, anemia, cold
extremities
79. PaO2 values to >60 = adequate, O2 sat >90 = adaquate
remember
80. Patient lays in what low semi-fowlers and doing valsalva maneuver to prevent air embolism, remaining like this for 30 minutes
postion for the after
removal of a PICC?
81. PICC lines inserted into basilic vein at ac fossa
1. insertion location
82. Platelets 1. maintain normal coagulability of the blood, given for bleeding disorders and when bone marrow doesn't
1. when is it given? make enough
2. are they cross 2. no
matched? 3. room temp w/ agitation, expire after 5-7 days
3. how are they
stored?
83. Pneumococcal vaccine: Initial pneumococcal vaccine ≥ 65 yrs
When to vaccinate? 2-64 yrs long-term health probs
19-64 yrs smoker, asthma
2-64 yrs for decreased resistance
19-64 yrs in chronic care settings
Re-vaccinate:
≥ 65 yrs if > 5 yrs previous and < 65 yrs
84. Pneumonia: Fever, chills, crackles, rhonchi, SOB, chest pain, (productive) cough, fremitus, myalgias, sore throat, fatigue,
S/S restlessness, lethargy, splinting, tachypnea, use of accessory muscles, decreased chest movement, pleural
friction rub, mental status changes
85. Pneumonia stats: Fifth leading cause of death in hospitals
Nosocomial = 50 % mortality (20 - 30% become septic)
86. Pneumothorax Tachycardia
s/s Dyspnea
O2 desaturation
Chest pain
Cough
No breath sounds
Tracheal deviation
87. Positive lab findings for pneumonia: Chest X-ray: lobe infiltrate/atelectasis, pulmonary infiltrate or consolidation
PO2 decreased
Purulent sputum
WBC elevation
Assess: H & P, CXR, CBC, Sputum C&S/Gram stain, Blood cultures, ABGs/O2 sat
88. PRBC's 1. must be typed and cross matched
1. what must you do first? 2. Rh neg. gets Rh neg.
2. what must you do for Rh neg? 3. 1 unit increase Hgb by 1g/dL or Hct by 3%
3. how does it affect the blood? 4. 4 unit = 300-350mls
4. 1 unit = how many mls? 5. 250-300 mls given over 2-3 hrs, completed w/in 4
5. what's the infusion rate?
89. Primary HTN risk factors: Age
Alcohol use
Cigarette smoking
Diabetes
Elevated serum lipids
Excess dietary sodium
Gender (w)
Family history
Obesity
Sedentary lifestyle
Socioeconomic status
Stress
Ethnicity:
African Americans have highest incidence of HTN
90. Primary vs. piggyback solution 1. Primary - lg. volume, crystalloid
2. Piggyback - small volume med, short term, hangs higher than primary
91. Primary vs secondary hypertension 1. Primary (Essential/Idiopathic)- no known cause, 90-95%
2. Secondary- identifiable causes
renal disease, endocrine disorders, neurological disorders, sleep apnea, medications,
pregnancy
92. Pulmonary fungal infections MCC: spore inhalation
- mcc Common in seriously ill
- causative org's No isolation req'd
Org's:
Histoplasmosis ("Valley Fever")
Coccidiomycosis
Candidiasis
Pneumocystis - most common in HIV
93. Red hepatization vs gray Red - organisms, neutrophils, and RBCs
hepatization Gray -Leukocytes and fibrin consolidate
94. Removal of a PICC never pull against resistance!
x-ray if stuck
use fluid gectures
take 1-2" at a time
keeps hands close to site so end isn't flopping around
95. Respiratory changes Stiff chest wall
due to aging: ↓ elastic recoil/compliance/alveoli/macrophages
↑ V/Q mismatch
↓ response to hypoxemia and hypercapnia
↓ immunity and antibodies
↓ pharyngeal sensation/cough
96. Rh 1. blood factor made of antigens
1. what is it? 2. Rh+ gets + or - blood, Rh- gets - blood only
2. who gets + or - ?
97. Risk factors for Extended ICU stays, intubations, impaired LOC, ETOH head injury, seizures, overdose, immobility,
pneumonia: immunosuppresive therapy, smoking, corticosteroids, cancer, chemo, malnutrition, chronic illness, age, NG
feedings, coma
98. Risks of infusion disease transmission (most likely Hep B), bacterial contamination, transfusion rxn, circulatory overload
therapy
99. Short term CVAD's 1. non-tunneled percutaneous, PICC
1. types
100. Stable angine Antiplatelets, nitroglycerin, lipid-lowering agents, β-adrenergic blockers, Ca-channel blockers
- tx Manage risk factors
Re-establish blood flow
Surgery
101. Status Asthmaticus Drowsy/confused
- s/s Too dyspneic to speak
Profuse diaphoresis
PEFR < 25% of personal best
Distant breath sounds
"Silent chest"
Bradycardia
102. Steps involved in Diaphragm contracts
breathing: Intrathoracic volume ↑
Abdominal contents pushed ↓
External intercostal and scalene muscles contract
Intrathoracic pressure ↓
Air enters lungs
103. Surgical and Surgery:
radioation tx for Stage I - 5-yr survival rates ~90%
lung cancer Stage II - 5-yr survival rates ~50%
Radiation:
Used for SCLC and NSCLC
Palliative
Treat pain from bone or brain metastases
Reduce tumor mass
104. Tb No symptoms in early stages
S/S Afternoon temp elevation
Weight loss
Pleuritic chest pain
Positive skin test,
Asymptomatic in latent
Active TB:
Fatigue, malaise
Low grade fever, night sweats
Anorexia, unexplained weight loss
Cough with/without sputum production
Usually no dyspnea or hemoptysis
105. Treating pneumonia: Antibiotics
Empiric therapy
MDR organisms
O2
Analgesics
Antipyretics
Hydration - Oral/IV
106. Treatment steps for asthma step 1: SABA (albuterol)
step 2: low dose ICS (flovent 0r singulair)
step 3: combo LABA & ICS (serevent)
step 4: medium ICS & LABA
step 5: high dose ICS & LABA
step 6: high dose ICS & LABA & corticosteroid
107. Tuberculosis: Gram-positive, acid-fast bacillus
- bacteria type Spread via airborne droplets
- spread via Remains airborne for minutes to hours
- where found Not highly infectious
Once inhaled, lodges in bronchioles and alveoli
Replicates slowly
Can be found in lungs, kidneys, bone, cerebral cortex, and adrenal glands
Caused by Mycobacterium tuberculosis
World's 2nd most common cause of death
Occurs disproportionately in poor, under-served, and minorities
In US, Native Americans, health care workers with exposure high risk
Emergence of MDR strain
108. Tunneled catheters silver impregnated cuff is antimicrobial
uses Hickman or Groshong needle
109. Tx for Tb Active TB:
6 mo/4 drugs (INH, rifampin, pyrazinamide, ethambutol), side effect non-viral hepatitis!!
Latent TB infection:
6-9 mo/1 drug (INH)
BCG vaccine - causes false-positive PPD but not IGRA
110. Types of lung cancer 1. Non-small cell lung cancer (NSMCLC)
1. nsmclc Adenocarcinoma
2. sclc 30-40%) - more women
Never smokers
No symptoms til metastasis
Treat w/ sx
Squamous cell carcinoma
30% - more men
Sx resection
Better life expectancy
Large cell (undifferentiated) carcinoma
5-15%
Highly metastatic
Sx resection - chemo palliative
2. Small cell lung cancer (SCLC) - "Oat cell"
20%
Most malignant!
Early metastasis
Chemotherapy - poor prognosis
Radiation - palliative
111. Types of pneumonia: (H)CAP : Onset in community or w/in 2 days of hospitalization
CAP HAP: within 48 hrs or more after admission, common!!
HAP VAP: > 48 hrs after intubation
VAP *increased morbidity, death, all caused by different organisms
112. Ventilation 1. mechanical movement of gas into/out of lungs
1. what is it? 2. inhalation - active process, intrathoracic pressure decreases
2. inhalation vs exhalation exhalation - passive process based on elastic recoil, intrathoracic pressure
increases
113. What are complications of pneumonia? Pleurisy
Pleural effusion
Empyema - pus
Lung abscess
Atelectasis
Bacteremia
Pericarditis
Endocarditis
Meningitis
114. What are diagnostic tests used to determine cv 12 lead ECG
disease? 24-Hour Holter monitor (ambulatory ECG)
Electrophysiologic (EP) study
Exercise Stress test
Echocardiography
2D and Color Doppler
Pharmacologic echocardiogram
Transesophageal echocardiogram
Thallium imaging
115. What are modifiable cardiovascular risk factors? Tobacco Use
Substance abuse
Physical inactivity
Obesity
Psychological factors
Chronic disease
116. What are non modifiable cardiovascular #1 Age - greatest risk factor for cv disease
risk factors? Gender
Ethnicity
Family history & genetics
117. What are side effects and Hypotension
considerations ass. w/ ace inhibitors? Hyperkalemia...esp w/CHF, CKD, DM
Angioedema
Facial/laryngeal swelling

Nursing considerations
Do not use with potassium sparing diuretic!

By blocking angiotensin II ace inhibitors decrease BP, lowering peripheral resistence-

AFTERLOAD....and decreasing blood volume-PRELOAD
118. What are some lifestyle modifications Weight loss
for HTN? DASH diet - less fat, sat fat, cholesterol, salt, sugar. More fruits, vegetables, dairy, fiber,
whole grain
Increase activity
Less booze
Stress reduction
119. What are some other blood volume crystalloids, artificial crystalloids (dextran)
builders?
120. What are the 3 purposes of IV therapy? 1. Maintenance - replaces insesnible losses, given for 24 hrs, 30ml/kg water replacement
2. Replacement - given for 48 hrs, replaces F&E's lost from hemorrhage, vomiting,
diarrhea, clotting probs, and starvation
3. Restoration - ongoing, for fistulas, burns, abd wounds
121. What are the complications of primary Coronary Artery Disease
HTN? Atherosclerosis
Left Ventricular Hypertrophy
Increases cardiac workload & oxygen consumption
Heart Failure
Pump failure
Cerebral/Peripheral Vascular Disease
#1 Risk Factor for Stroke
Retinal Damage
Hemorrhage; blurring/loss of vision
Nephrosclerosis
Chronic and End-Stage Renal Disease
122. What are the components of parenteral water, glucose, amino acids, vit's, electrolytes, ph
solutions?
123. What are the provoking factors for Physical exertion
angina? Temperature extremes
Strong emotions
Heavy meal
Tobacco use
Sexual activity
Stimulants
124. What are the respiratory defense Filtration of air
mechanisms? Mucociliary clearance system
Cough reflex
Reflex bronchoconstriction
Alveolar macrophages
125. What are the rules regarding chest
tubes and clamping?
126. What are the serum markers of
myocardial damage?
127. What Beta Blockers are used to
treat HTN?
What will you see a decrease in,
post admin?
What are side effects and
considerations ass. w/ b blockers?
Don't clamp during transport or if disconnected
May be clamped: briefly to change drainage system and to check for leaks
Removal requires MD order
Troponin & Creatine kinase (CK)
B-Type Natriuretic Peptides
Serum lipids
C-reactive protein
Electrolytes
K+; Mg++
Blood coagulation
PTT; PT/INR
1. Cardioselective (β1):
Atenolol (Tenormin)
Metoprolol (Lopressor)
2. Non-cardioselective (β1, β2)
Propranolol (Inderal)
Decreased HR, BP, contractility, CO and SBP

Bradycardia
Hypotension
Fatigue
Weakness
Use with caution in heart failure, asthma, diabetics
128. What determines CVAD tip x-ray, prior to initiation of therapy
location?
129. What do ABG's measure? O2, CO2, Acid-base
130. What factors affect diffusion? membrane thickness, surface area, pressure differences, coefficient of the gas
131. What factors effect cardiac preload, afterload, myocardial contractility, and HR
output?
132. What happens during the Exudate lysed and processed by macrophages
resolution period of pneumonia? Healing occurs if no complications
133. What happens in atelactasis? The alvoeli collapse
134. What is afterload? The force of resistance that the left ventricle must overcome to open the aortic valve.
135. What is a Huber needle? a noncoring needle with a slanted tip used in implanted ports, placement is verified by blood
return
136. What is an autologous blood donation to one's self, good for one month
donation?
137. What is a pneumothorax? Air in the pleural space = partial or complete lung collapse; as air increases, lung volume
decreases
138. What is collateral circluation? Body's defense mechanism to prevent ischemia
If given enough time, vessels will grow around the blockage and blood supply will continue
139. What is pneumonia? Inflammatory alveolar spaces b/c of infection. Cearance mechanism are overwhelmed by
secretions, alveoli fill w/ exudate, tissues become ischemic or necrotic
140. What is Starlings Law of the heart? Maximum efficiency of CO is achieved when the myocardium is stretched 2 ½ X its length
Think "rubber band"
CO is decreased with too low or too high a preload
141. What is surfactant? lipoprotein
What does it do? lowers alveolar surface tension
Where is it produced? made by Type II alveolar cells
sighs promote secretion
142. What is the "door to balloon" core balloon will be in place and blown within 90 minutes of arriving at the hospital.
measure?
143. What is the first symptom most commonly Persistent pneumonia from obstructed bronchi
seen in lung cancer?
144. What is the only solution that can be used 0.9% normal saline
when giving blood?
145. WHat is the pathway of depolarization? SA node to AV node, to AV bundle to Bundle Branches to Perkinje Fibers
146. What is "type and cross matching"? It's a process used to determine blood type compatibility between donor and recipient.
Determines Rh and ABO.
147. What is whole blood given for and how is -for shock, low blood volume, low Hgb, low Hct, hemorrhage
it transfused? -500 mls over 2-4 hrs
148. What must nurse do to before giving positively ID the pt, inspect the blood, 2-nurse verification, verify donor-recipient
blood? compatibility, check expiration date, get baseline vitals, start IV w/ 18-20G needle to
avoid lysing of cells
149. What must the nurse do after starting a Infuse slowly for first 15 min and assess q 15 min, watch for vitals, and check vitals
blood infusion? regularly
150. What religion won't accept blood Jehovas Witness
transfusions?
151. When removing the transparent dressing Pull away from the insertion site
on a central port, in which direction do
you pull?
152. Why do patients get blood products? 1. anemic w/ a hgb < 8-10
2. increase their blood volume
3. they have a clotting disorder
4. surgical blood loss > 1200
5. never just b/c
153. Why is smoking so bad to heart?? Increases LDL, decreases HDL, nicotine stimulates release of catecholamines which
increases HR and BP which increases cardiac workload and demand,
When heart needs more O2 supply, O2 extraction is decreased due to carbon
monoxide in smoke, stimulates polycythemia = vessel inflammation and thrombosis