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midterm review Flashcards

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1
Q

What are signs of a stable patient?

A

Stable indicators: adequate perfusion, no confusion/lethargy, no SOB, HR may be low but asymptomatic, BP adequate, warm/dry skin. Stable patients require least invasive interventions and monitoring.

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2
Q

What are signs of an unstable patient?

A

Unstable indicators: cold/clammy skin, low BP (ex: 80/40), confusion/LOC changes, abnormal vitals. Unstable patients need aggressive interventions (electricity).

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3
Q

When do you use cardioversion vs defibrillation?

A

Cardioversion: for patients with a pulse and fast rhythm. Defibrillation: for patients with no pulse and fast rhythm. Pacemaker: for slow rhythms with a pulse.

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4
Q

What does the P-wave represent and what does it mean if abnormal?

A

P-wave = atrial depolarization (SA node). Abnormal P-waves (multiple, sawtooth, missing) indicate atrial problems (PACs, A-fib, A-flutter, SVT).

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5
Q

What does the PR interval represent and what is the normal range?

A

PR = AV node pause for ventricular filling. Normal: 0.12–0.20s. Prolonged PR = AV block.

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6
Q

What does the QRS complex represent and what if it’s wide?

A

QRS = ventricular depolarization. Normal <0.12s. Wide QRS = ventricular problem (PVCs, V-tach, V-fib).

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7
Q

What does ST elevation vs depression indicate?

A

ST elevation = active MI. ST depression = ischemia (past or present oxygen deprivation).

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8
Q

What are symptoms of sinus bradycardia and how is it managed?

A

Symptoms: hypotension, syncope, pale/cool skin, confusion, SOB, weakness. Management: asymptomatic = monitor; stable symptomatic = atropine; unstable = pacemaker.

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9
Q

What are common causes of sinus tachycardia?

A

Causes: fever, dehydration, anxiety, pain, hypoxia, electrolyte imbalance, hyperthyroidism, heart failure, meds (albuterol, atropine, cocaine, caffeine).

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10
Q

How is symptomatic sinus tachycardia managed?

A

First treat the cause (antipyretics for fever, fluids for dehydration, oxygen for hypoxia, anxiolytics for anxiety, stop stimulants). If unresolved: beta blockers (ex: metoprolol).

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11
Q

What are the signs of a stable patient?

A

Stable: good perfusion, not confused/lethargic, no SOB, no tachycardia, adequate BP (~110/65), warm/dry skin, no bothersome symptoms even if HR is low.

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12
Q

What are the signs of an unstable patient?

A

Unstable: poor perfusion signs such as cold/clammy skin, low BP (e.g., 80/40), confusion/LOC changes, abnormal vital signs.

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13
Q

What is the principle for intervention in stable patients?

A

Stable patients: use least invasive measures first (monitor, simple meds), avoid aggressive interventions.

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14
Q

What is the principle for intervention in unstable patients?

A

Unstable patients: automatically require aggressive intervention, typically electricity.

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15
Q

When is cardioversion used?

A

Cardioversion: for patients with a pulse and fast rhythm.

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16
Q

When is defibrillation used?

A

Defibrillation: for patients with no pulse and fast rhythm.

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17
Q

When is a pacemaker used?

A

Pacemaker: for patients who have a pulse but rhythm is very slow.

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18
Q

Why should you ‘treat the patient, not the monitor’?

A

Always assess the patient, not just the EKG strip. Artifact (tremors, loose leads) can mimic lethal rhythms; check the pulse first.

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19
Q

What does the P-wave represent?

A

Atrial depolarization (SA node). Abnormal P-waves (multiple, sawtooth, missing) indicate atrial problems (PACs, A-fib, A-flutter, SVT).

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20
Q

What does the PR interval represent and normal range?

A

Pause at AV node for ventricular filling. Normal: 0.12–0.20s. Prolonged PR indicates AV block.

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21
Q

What does the QRS complex represent and what does a wide QRS mean?

A

Ventricular depolarization. Normal <0.12s. Wide QRS = ventricular problem (PVCs, V-tach, V-fib).

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22
Q

What does the ST segment indicate if elevated or depressed?

A

ST elevation = active MI. ST depression = ischemia (past or present oxygen deprivation).

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23
Q

What does the T-wave represent?

A

Ventricular repolarization (recharging before next contraction).

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24
Q

Steps for analyzing an EKG rhythm strip?

A
  1. P-QRS-T relationship, 2. R-R interval regularity, 3. Rate calculation, 4. Measure PR interval and QRS duration.
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25
What defines sinus bradycardia and how is it managed?
HR < 60 bpm. Asymptomatic = monitor, Symptomatic but stable = atropine, Unstable = pacemaker.
26
What defines sinus tachycardia and how is it managed?
HR > 100 bpm and <151 bpm. Treat underlying cause (fever, dehydration, anxiety, etc). If unresolved, beta blockers like metoprolol.
27
What are premature atrial contractions (PACs)?
Early atrial beat causing irregular R-R. Often from stimulants (caffeine). Usually benign, no treatment needed.
28
What is supraventricular tachycardia (SVT) and treatment?
HR >150 bpm, P-wave often hidden in T-wave. Stable: vagal maneuvers, adenosine, calcium channel blockers. Unstable: synchronized cardioversion.
29
What is the definition of cancer?
Unregulated, uncontrolled proliferation of cells that do not die. Higher incidence in older adults and men. Second leading cause of death in the USA.
30
What are major causes/risk factors for cancer?
Obesity, smoking/vaping, alcohol, chemical exposure, hormone replacement therapy, poor diet, unprotected sun exposure, radiation, air pollution.
31
What does the CAUTION mnemonic stand for in cancer warning signs?
Change in bowel/bladder habits, A sore that doesn’t heal, Unusual bleeding/discharge, Thickening/lump, Indigestion/difficulty swallowing, Obvious change in wart/mole, Nagging cough/hoarseness.
32
What are the ABCDE criteria for skin cancer?
Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving mole changes.
33
Why is chemotherapy given via central line?
Chemo is a vesicant, damaging to veins. Administered by chemo-certified staff, usually via central line to prevent extravasation injury.
34
What are the main side effects of chemotherapy?
Hair loss (alopecia), mucositis/stomatitis, bone marrow suppression (neutropenia, anemia, thrombocytopenia).
35
What precautions are needed for neutropenic patients?
Private room, no fresh flowers/plants/pets, no raw foods, dedicated equipment, monitor temp, obtain cultures before antibiotics, reverse isolation.
36
What teaching is important for thrombocytopenia?
Use electric razors, avoid rectal temps, avoid NSAIDs, monitor for petechiae/bleeding, hold pressure ≥10 min after punctures, avoid contact sports.
37
What is brachytherapy (internal radiation)?
Implanted radioactive seeds/needles. Patient needs private room, radiation sign, limit staff exposure, no pregnant visitors, use tongs if implant dislodges.
38
What is external radiation (teletherapy) teaching?
Patient not radioactive. Do not remove tattoo marks. Use mild soap/water, pat dry. Avoid lotions/perfumes, sun exposure, swimming pools. Report skin blanching.
39
What vaccines are recommended for older adults?
Influenza, Pneumococcal, Zoster (shingles), Meningococcal polysaccharide (MPSV4).
40
What cardiovascular changes occur with aging?
Decreased cardiac output, decreased perfusion, slower capillary refill, SOB, cooler extremities.
41
What interventions help older adults with cardiovascular changes?
Low-impact exercise (walking, swimming), avoid smoking, low-sodium/low-fat diet, stress reduction activities (yoga).
42
What respiratory changes occur with aging?
Loss of lung elasticity, increased residual volume, impaired gas exchange, SOB, difficulty clearing secretions.
43
What interventions help older adults with respiratory changes?
Avoid sick contacts, increase fluid intake, use incentive spirometer, maintain regular exercise.
44
What is dementia?
Umbrella term for cognitive decline. Progressive, chronic, and irreversible in conditions like Alzheimer's.
45
What percentage of dementia cases are Alzheimer’s disease?
Alzheimer’s accounts for 70–80% of dementia cases.
46
What are the stages of Alzheimer’s disease?
Mild: occasional forgetfulness. Moderate: increased dependence (ADLs, driving, bathing). Severe: total dependence for all ADLs.
47
What is the nurse’s role in elder abuse?
Assess and report suspicion. Look for inconsistent stories, grooming/hygiene neglect, wounds in various healing stages, changes in affect.
48
What is polypharmacy and how should it be managed?
Polypharmacy: multiple meds from different providers/OTC. Managed with thorough medication reconciliation to avoid adverse effects.
49
What is the normal potassium (K+) range?
3.5–5.0 mEq/L.
50
What are common causes of hyperkalemia (>5.0 mEq/L)?
Renal failure, burns, crush injury, excessive potassium intake.
51
What mnemonic helps recall hyperkalemia symptoms?
MURDER: Muscle cramps/weakness, Urine abnormalities, Respiratory distress, Decreased cardiac contractility, EKG changes (peaked T, prolonged PR), Reflexes (hyperreflexia/flaccid).
52
What are treatments for hyperkalemia?
Insulin with dextrose, calcium gluconate 10%, sodium polystyrene sulfonate (Kayexalate), albuterol, non-K-sparing diuretics.
53
What are common causes of hypokalemia (<3.5 mEq/L)?
DITCHED: Drugs (diuretics/laxatives), Inadequate intake, Too much water intake, Cushing’s syndrome, Heavy fluid loss (vomiting/diarrhea), Electrolyte imbalances, Diuretics.
54
What mnemonic helps recall hypokalemia symptoms?
7 L’s: Lethargy, Low shallow breaths, Lots of urine, Leg cramps, Limp muscles, Low BP, Lethal dysrhythmias (ST depression, U-wave).
55
What is the treatment for hypokalemia?
Administer potassium. NEVER IV push (lethal).
56
What cardiac changes appear on EKG with hyperkalemia?
Peaked T-waves, prolonged PR interval.
57
What cardiac changes appear on EKG with hypokalemia?
ST depression, U-wave formation.
58
Why must potassium be given carefully IV?
IV push potassium can cause fatal cardiac arrest; always dilute and infuse slowly with monitoring.
59
What is asthma?
Chronic, intermittent, reversible airway disorder with bronchiole inflammation, mucus, and expiratory airflow limitation (wheezing).
60
What are risk factors for asthma?
Family history, allergens, air pollutants, GERD, NSAIDs/aspirin, non-selective beta blockers, food additives (MSG, beer, wine, shrimp).
61
What are ominous signs of worsening asthma?
Fatigue, absent/decreased breath sounds, cyanosis, inability to lie flat, paradoxical chest/abdominal movement.
62
What is status asthmaticus?
Severe prolonged asthma attack not responding to conventional treatment, showing ominous signs.
63
What is the first-line treatment for acute asthma attacks?
SABA: Albuterol, Levalbuterol. Side effects: tachycardia, tremors.
64
What adjunct meds are used in acute asthma treatment?
SAMA: Ipratropium; IV corticosteroids (Prednisone, Solu-Medrol); fluids to thin secretions.
65
What is the treatment for status asthmaticus if conventional fails?
Methylxanthines (Aminophylline, Theophylline), Magnesium sulfate. Watch for seizures, respiratory depression, dysrhythmias.
66
What teaching is needed for pulmonary function testing (PFT)?
Avoid bronchodilators 4–6h before, avoid smoking 6–8h before, avoid eating right before test.
67
What do peak flow meter zones mean?
Green ≥80%: continue meds. Yellow 50–79%: use rescue inhaler, retest, call PMD if not improved. Red <50%: use rescue inhaler and go to ER.
68
What are key differences between chronic bronchitis and emphysema (COPD)?
Chronic bronchitis: 'blue bloater,' productive cough ≥3mo for 2y. Emphysema: 'pink puffer,' alveolar damage, hyperinflation, CO2 retention.
69
What is heart failure (HF)?
Inability of the heart to pump enough blood to meet the body's needs (cannot maintain 4–6 L/min CO at rest).
70
What are the main causes of HF?
Diabetes, long-term hypertension, pulmonary hypertension, aging.
71
Differentiate right vs left sided HF symptoms.
Right: peripheral edema, JVD, ascites, hepatomegaly. Left: pulmonary edema, crackles, dyspnea, orthopnea, paroxysmal nocturnal dyspnea.
72
What is biventricular HF?
Combination of right and left-sided symptoms.
73
What is the NYHA classification of HF?
Class I: No limitation. Class II: Slight limitation. Class III: Marked limitation. Class IV: Severe limitation.
74
What is the key diagnostic lab for HF?
BNP (B-type natriuretic peptide). Normal <100 pg/mL. Higher levels = more severe HF.
75
What does the UNLOAD FAST mnemonic stand for in HF treatment?
Upright position, Nitrates, Lasix, Oxygen, ACE inhibitors, Digoxin, Fluids restriction, Afterload reduction, Sodium restriction, Tests (labs, EKG, digoxin level).
76
What must be checked before giving digoxin?
Check apical pulse (hold if <60 bpm), potassium level, and digoxin level.
77
What are signs of digoxin toxicity?
Halo vision, nausea, vomiting, bradycardia.
78
What patient teaching is key for HF management?
Daily weights (report >2lb/day), low sodium diet, monitor for digoxin toxicity, elevate HOB, adherence to meds.
79
What is multiple sclerosis (MS)?
Chronic autoimmune disease of CNS where myelin sheath is attacked, causing plaques, paralysis, vision and motor issues.
80
What are hallmark symptoms of MS?
Blurry vision, muscle weakness, numbness/tingling, ataxia, dysphagia, Lhermitte's sign (shock with chin to chest).
81
What meds are used for MS?
Immunomodulators (interferon), immunosuppressants (Imuran), antispasmodics (baclofen, dantrolene), corticosteroids. Rotate injection sites, infection precautions.
82
What is Parkinson’s disease?
Chronic progressive neurodegenerative disorder from loss of dopamine in substantia nigra, leading to excess acetylcholine.
83
What is the TRAP mnemonic for Parkinson’s?
Tremor (resting/pill-rolling), Rigidity, Akinesia/bradykinesia, Postural instability.
84
What meds are used for Parkinson’s?
Levodopa/Carbidopa (avoid high protein & B6, no MAOIs), MAO-B inhibitors (avoid tyramine foods), anticholinergics (benztropine), dopamine agonists.
85
What is Bell’s palsy?
Acute inflammation of cranial nerve VII, unilateral facial paralysis. Often post-viral. Resolves in 3–6 months.
86
What is Guillain-Barré syndrome (GBS)?
Autoimmune attack on peripheral myelin. Ascending symmetrical paralysis, can cause respiratory failure. Often post-infection.
87
What is ALS (Lou Gehrig’s)?
Progressive attack on motor neurons. Cognitive intact, but progressive paralysis. Death in few years, usually from respiratory failure.
88
What is myasthenia gravis (MG)?
Autoimmune attack on acetylcholine receptors at NMJ. Descending muscle weakness, ptosis, chewing/swallowing issues.
89
What tasks can UAPs perform?
ADLs, vital signs (stable patients), ambulation, perineal care, feeding (low aspiration risk), transport items. Cannot give meds or assess unstable patients.
90
What must UAPs do if they find abnormal results?
Report abnormal findings to the nurse immediately.
91
What can LPNs do?
Give PO meds (with limits), perform reassessments, provide re-teaching. Cannot give IV meds, blood products, or perform initial teaching/discharge.
92
What tasks cannot be delegated by an RN (TAPE mnemonic)?
Teaching (initial), Assessment (initial), Planning, Evaluation.
93
Which patients should be assigned to new nurses?
Stable patients with predictable outcomes. New nurses should avoid unstable or complex patients.
94
What are priority principles in delegation?
Delegate stable patients to UAP/LPN. RN retains responsibility for critical thinking, unstable patients, initial teaching/assessment.
Med Surg 2
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