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REVIEW MATERIALS
SUPPLEMENTAL
MI Implementation for MI
• Chest pain radiating to arms, jaw,
neck (which is unrelieved by rest or • Thrombolytic therapy-streptokinase, t-PA
nitroglycerin) • Bedrest
• Dyspnea • Beta-blockers, morphine sulfate, dysrhythmics,
• Indigestion anticoagulants
• Apprehension • Do not force fluids (will give heart more to work
• Low grade fever with)
• Elevated WBC (5-10, ESR, CK-MB,
LDH)
ANGINA
Stable Unstable Variant Intractable
Triggered by a Triggered by an Triggered by coronary Chronic and
predictable amount unpredictable amount of artery spasm; the attacks incapacitating and is
of effort or emotion. exertion or emotion and may tend to occur early in the refractory to medical
occur at night; the attacks day and at rest. therapy.
increase in number, duration,
and severity over time.
Defibrillation Cardioversion
• Start CPR first • Elective procedure, Informed Consent
• 1st attempt – 200 joules • Valium IV
• 2nd attempt – 200 to 300 joules • Synchronizer on
• 3rd attempt – 360 joules • 25-360 joules
• Check monitor between shocks for rhythm • Check monitor between rhythm
• PULSE PRESENT = NO
DEFIBRILLATION
CHF Implementations
• Administer digoxin, diuretics
• Low-sodium, low-calorie, low-residue diet
• Oxygen therapy
• Daily weight
• Teach about medications and diet
CVP: measures blood volume and efficiency of cardiac work; tells us right side of heart able to manage fluid
• “0” on mamometer at level of right atrium at midaxilliary line
• Measure with patient flat in bed
• Open stopcock and fill manometer to 18-20 cm
• Turn stopcock, fluid goes to patient
• Level of fluid fluctuates with respirations
• Measure at highest level of fluctuation
• After insertion
o Dry, sterile dressing
o Change dressing, IV fluids, manometer, tubing q24 hours
o Instruct patient to hold breath when inserted, withdrawn, tubing changed
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• Atrial Septal Defect (ASD)—abnormal opening between the two atria; audible murmur (if
defect is severe closure is done later in childhood)
• Patent Ductus Arteriosis (PDA)—failure of fetal structure to close after birth; ductus
areteriosis in the fetus connects the pulmonary artery to aorta to shunt oxygenenated blood from
the placenta to systemic circulation (which bypasses the lungs). Once the child is born that
structure should close because it is no longer needed because blood passes through to lungs;
vascular congestion, right ventricular hypertrophy; murmur, bounding pulse, tachycardia; surgical
to divide or ligate the vessel.
• Coarctation of the Aorta—narrow of aorta; high blood pressure and bounding pulse in areas
that receive blood proximal to the defect. Weak and absent blood distal to aorta. Surgical end-
to-end anastomosis.
• Transposition of great vessels—pulmonary artery leaves left ventricle and aorta leaves right ventricle;
oxygenated blood not going into systemic circulation
• Truncus arteriosus—failure of normal septation and embryonic division of the pulmonary artery and
aorta; rather than two distinctly different vessels there is a single vessel that overrides both ventricles and
gives rise to both pulmonary and systemic circulation; blood enters from both common artery and either
goes to the lungs or to the body; cyanosis, murmur, difficult intolerance
• Total anomalous venous return—absence of direct communication between pulmonary veins and left
atria; pulmonary veins attach directly to right atria or drains to right atria
i. second right
ii. intercostal space - aortic area
iii. second left intercostal space - pulmonic area
iv. third left intercostal space - Erb's point
v. fourth left intercostal space - tricuspid area
vi. fifth left intercostal space - mitral (apical) area
vii. epigastric area at tip of sternum
• newborn: 35 to 40 breaths/minute
• infant: 30 to 50 breaths/minute
• toddler: 25 to 35 breaths/minute
• school age: 20 to 30 breaths/minute
• adolescent/adult: 14 to 20 breaths/minute
• adult: 12 to 20 breaths/minute
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SUPPLEMENTAL
AIR EMBOLISM POSITIONING: Place the client on the left side in the trendelenburg
position. Lying on the left side may prevent air from flowing into the pulmonary veins. The
trendelenburg position increases intrathoracic pressure, which decreases the amount of
blood pulled into the vena cava during inspiration.
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Chest Tubes
Fill water-seal chamber with sterile water to 2 cm (middle chamber)
Fill suction control chamber with sterile water to 20 cm (chamber all the way to the
right)
Air-leak if bubbling in water-seal chamber (middle chamber)
Obstruction: “milk” tube in direction of drainage
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Removal o chest tube: pt. does valsalva maneuver, clamp chest tube, remove quickly,
apply occlusive dressing
Dislodged: apply tented dressing
Tube becomes disconnected from drainage system, cut off contaminated tip, insert
sterile connector and reinsert
Tube becomes disconnected from drainage system, immerse in 2cm of water
Tracheostomy Tube Cuff
• Purpose—prevents aspiration of fluids
• Inflated
o During continuous mechanical ventilation
o During and after eating
o During and 1 hour after tube feeding
o When patient cannot handle oral secretions
• NCLEX-RN exam is a “here and now” test; take care of problem now to prevent
harm to client.
• Do not ask “why” on the licensure exam
• Morphine Sulfate for pancreatitis causes spasms of the sphincter of Oddi;
Meperidine is drug of choice.
• Normal Intraocular Pressure is 10-21 mm Hg
• Ecchymosis (faint discoloration) around the umbilicus or in either flank indicates
retroperitoneal bleeding
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A1-adrenergic receptors: found in the peripheral arteries and veins and cause a powerful
vasoconstriction when stimulated
A2-adrenergic receptors: several tissues and contract smooth muscle, inhibit lipolysis, and
promote platelet aggregation.
B1: Found in the heart and cause an increase in heart rate, atrioventricular node conduction,
and contractility.
B2: Arterial and bronchial walls and cause vasodilation and bronchodilation.
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hypertension medication
• CHF • May take Q5min x3 doses
• Wet with saliva and place
under tongue
Chamomile
Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported
reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the
lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages.
Close monitoring is recommended for patients who are taking medications to prevent blood
clotting (anticoagulants) such as warfarin.
Echinacea
Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles,
Echinacea has been touted to be able to boost the body's ability to fight off infection.
Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver
toxicity. It should be avoided in combination with other medications that can affect the liver
(such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral).
Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and
sleep disorders. It is technically known as Hypericum perforatum. Chemically, it is composed
of at least 10 different substances that may produce its effects. The ratios of these different
substances varies from plant to plant (and manufacturer). Studies of its effectiveness by the
National Institutes of Health are in progress.
Reactions: The most common side effect has been sun sensitivity which causes burning of
the skin. It is recommended that fair- skinned persons be particularly careful while in the
sun. St. John's wort may also leave nerve changes in sunburned areas. This herb should be
avoided in combination with other medications that can affect sun sensitivity (such as
tetracycline/Achromycin, sulfa- containing medications, piroxicam (Feldend). St. John's wort
can also cause headaches, dizziness, sweating, and agitation when used in combination with
serotonin reuptake inhibitor medications such as fluoxetine (Prozac) and paroxetine (Paxil).
Garlic
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SUPPLEMENTAL
Uses: Garlic has been used to lower blood pressure and cholesterol (Dr. Lucinda Miller
notes that there is "...still insufficient evidence to recommend its routine use in clinical
practice.")
Reactions: Allergic reactions, skin inflammation, and stomach upset have been reported. Bad
breath is a notorious accompaniment. Studies in rats have shown decreases in male rats'
ability to make sperm cells. Garlic may decrease normal blood clotting and should be used
with caution in patients taking medications to prevent blood clotting (anticoagulants) such as
warfarin /Coumadin.
Feverfew
Reactions: Feverfew can cause allergic reactions, especially in persons who are allergic to
chamomile, ragweed, or yarrow. Nonsteroidal anti-inflammatory drugs (NSAIDs such as
ibuprofen (Advil), naproxen (Aleve) or Motrin) can reduce the effect of feverfew. A
condition called "postfeverfew syndrome" features symptoms including headaches,
nervousness, stiffness, joint pain, tiredness, and nervousness. Feverfew can impair the action
of the normal blood clotting element (platelets). It should be avoided in patients taking
medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin).
Ginko Biloba
Uses: This herb is very popular as a treatment for dementia (a progressive brain dysfunction)
and to improve thinking.
Reactions: Mild stomach upset and headache have been reported. Ginko seems to have
blood thinning properties. Therefore, it is not recommended to be taken with aspirin,
nonsteroidal anti-inflammatory drugs (Advil), naproxen (Aleve) or Motrin), or medications
to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko should be
avoided in patients with epilepsy taking seizure medicines, such as phenytoin (Dilantin),
carbamazepine (Tegretol), and phenobarbital.
Ginseng
Uses: Ginseng has been used to stimulate the adrenal gland, and thereby increase energy. It
also may have some beneficial effect on reducing blood sugar .in patients with diabetes
mellitus. (Dr. Miller emphasized that there is substantial variation in the chemical
components of substances branded as "Ginseng.")
Reactions: Ginseng can cause elevation in blood pressure, headache, vomiting, insomnia, and
nose bleeding. Ginseng can also cause falsely abnormal blood tests for digoxin level. It is
unclear whether ginseng may affect female hormones. Its use in pregnancy is not
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recommended. Ginseng may affect the action of the normal blood clotting element
(platelets). It should be avoided in patients taking aspirin, nonsteroidal antiinflammatory
drugs (such as ibuprofen (Advil), naproxen (Aleve) or Motrin), or medications to prevent
blood clotting (anticoagulants) such as warfarin (Coumadin). Ginseng may also cause
headaches, tremors, nervousness, and sleeplessness. It should be avoided in persons with
manic disorder and psychosis.
Ginger
Uses: Ginger has been used as a treatment for nausea and bowel spasms.
Reactions: Ginger may lead to blood thinning. It is not recommended to be taken with
medications that prevent blood clotting (anticoagulants) such as warfarin (Coumadin).
Saw Palmetto
Uses: Saw palmetto has been most commonly used for enlargement of the prostate gland.
(Dr. Miller emphasized that studies verifying this assertion are necessary.) Saw palmetto has
also been touted as a diuretic and urinary antiseptic to prevent bladder infections.
Reactions: This herb may affect the action of the sex hormone testosterone, thereby
reducing sexual drive or performance. Dr. Miller states that "While no drug-herb interactions
have been documented to date, it would be prudent to avoid concomitant use with other
hormonal therapies (e.g., estrogen replacement therapy and oral contraceptives...")
Black Cohosh
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