312 LEC PRELIM EXAMINATION Flashcards
Assessment shows client had Post-MI syndrome (Dressler’s syndrome). Where patient experiences fever, pericardial & pleural effusion 1-12 weeks after Myocardial Infarction. This disorder is called?
Pericarditis
Inflammation of the pericardium caused by Infective organisms (bacteria, viruses, fungi)
Pericarditis
fibrous thickening of the pericardium
“Chronic Constrictive Pericarditis
Patients verbalize pain radiating to the neck, shoulder & back. The pain is aggravated by inspiration, coughing & swallowing and feels worst in supine position. Thus, pain is relieved by sitting up & leaning forward.
Pericarditis
Assessment found scratchy high pitch sound called “Friction rub”, increase WBC count, and Atrial fibrillation/irregular and often very rapid heart rhythm
Pericarditis
A patient with pericarditis who undergo Echocardiography and CT scan will have a finding of _ of pericardium
thickening
Intervention for patient with uremic pericarditis
Hemodialysis
Intervention for patient with chronic constrictive pericarditis
Pericardiectomy
complications to monitor in patient with pericarditis
pericardial effusion
buildup of too much fluid in the double-layered, saclike structure around the heart (pericardium). The space between these layers typically contains a thin layer of fluid.
pericardial effusion
medical emergency that takes place when abnormal amounts of fluid accumulate in the pericardial sac compressing the heart leads to increased pressure, impairing ventricular filling and, and leading to a decrease in cardiac output and shock
cardiac tamponade
Patient assessment findings show Jugular distention/bulging of the major veins in your neck and muffled heart sounds
pericardial effusion 🡪 cardiac tamponade
Patient assessment findings show an abnormal drop in systolic blood pressure during inspiration. This means there is a decrease in cardiac output and a possible circulatory collapse
pericardial effusion 🡪 cardiac tamponade
Drainage procedures or surgery or emergency care to treat pericardial effusion
pericardiocentesis
A patient with pericardial effusion has a paradoxical pulse of systolic BP higher or more on expiration than on inspiration. How many mmHg?
10mmHg
the buildup of excess fluid between the layers of the pleura outside your lungs.
pleural effusion
buildup of fluid in the space around your heart.
pericardial effusion
A build-up of blood or other fluid in the pericardial sac puts pressure on the heart, which may prevent it from pumping effectively.
cardiac tamponade
Assessment found elevated WBC count, c-reactive protein (CRP), and cardiac isoenzymes
myocarditis
bulimic patients/eating disorder (bulimia) are taking what to facilitate purging that causes myocardial damage
ipecac syrup
this condition is caused by Viral, bacterial, fungal & parasitic infection,
Radiation therapy, and
Autoimmune disorders/immune system attacks own healthy tissues
Myocarditis
patients who induced in Chronic alcohol & cocaine abuse might develop what condition
myocarditis
Bulimic patients taking ipecac syrup to facilitate purging excessively may cause damage leading to
Myocarditis
due to inflammation, abnormal function includes ⭣ cardiac output, impaired blood circulation, and predispose client to Congestive Heart Failure (CHF). this condition is
Myocarditis
Myocarditis can occur because of ischemia/inadequate blood supply to an organ or part of the body. Myocarditis due to ischemia can cause
tachycardia, dysrhythmias
aside from Congestive Heart Failure (CHF), myocarditis can be associated to a chronic disease of the heart muscle known as
Cardiomyopathy
patient’s assessment findings show PAIN, Fever, Tachycardia, Dysrhythmias, Dyspnea, Malaise, Fatigue, Anorexia, Pale or cyanotic skin, signs of RSHF
Myocarditis
Echocardiography and CT scan used in assessment of pericarditis. in myocarditis, abnormal result is found using
chest radiography and echocardiography
Aside from antibiotic given as Treatment of underlying cause of Myocarditis. what other drugs are prescribed used to treat congestive heart failure (CHF) and heart rhythm problems (atrial arrhythmias)
cardiotonic drugs (digitalis)
aside from cardiopulmonary status (vs, dependent edema, etc), what complication is monitored to a patient with myocarditis
CHF, dysrhythmias
Sodium/Na+-restricted diet for patients with what condition
Myocarditis
A systemic inflammatory disease that usually develops after an URTI
Rheumatic Fever
bacteria causing Rheumatic fever
group A ß-hemolytic streptococci
patient assessment show major symptoms including Carditis, Polyarthritis, Subcutaneous nodules, and Erythema marginatum
Rheumatic Carditis/ Endocarditis
Endocarditis or Rheumatic Carditis is associated with Sydenham’s chorea also known as
St. Vitu’s dance
this major/classic symptom of endocarditis is Characterized by formation of Aschoff’s bodies, Murmur (valve damage), pericardial friction rub (pericarditis), and CHF
Carditis
this major/classic symptom of endocarditis is Characterized by Swelling of several joints (knees, ankle, hips, shoulders) that is warm, red and painful
Polyarthritis
this major/classic symptom of endocarditis is Characterized by Involuntary grimacing & inability to use skeletal muscles in a coordinated manner and Involvement of central nervous system
Chorea (Sydenham’s chorea, St. Vitu’s dance)
this major/classic symptom of endocarditis is Characterized by Sometimes marble-sized nodules appear around the joints
Subcutaneous nodules
this major/classic symptom of endocarditis is Characterized by Red, spotty rashes on the trunk that disappears rapidly leaving irregular circles on the skin
Erythema marginatum
this minor symptom of endocarditis is Characterized by pain in one or more joints without evidence of inflammation, tenderness, or limited movement
Arthralgia
a history of Rheumatic Fever or evidence of pre-existing rheumatic heart disease is a minor symptom of
Rheumatic Carditis/ Endocarditis
a fever of __ is a minor symptom of endocarditis
38.9 - 40°C or 101 - 104°F
a patient with Endocarditis will have ECG changes result of
prolonged P-R interval
Diagnostic tests shows 🡩 in erythrocyte sedimentation rate (ESR) and ASO titer (antibodies have been found. This means that you may have had a recent strep infection), and (+) C- reactive protein
Rheumatic Carditis/ Endocarditis
Rheumatic Carditis/ Endocarditis is Diagnosed clinically through the use of the
JONES criteria
JONES criteria must show presence of
2 major manifestation or
1 major + 2 minors with supporting evidence of a recent streptococcal infection
patient is experiencing 38.9 - 40°C or 101 - 104°F fever accompanied with chills, sudden on sent of sore throat, and diffuse redness of throat with exudates on oropharynx
streptococcal pharyngitis
a child patient complaint having Abdominal pain, has Enlarge & tender lymph nodes, and Acute sinusitis & acute otitis media
streptococcal pharyngitis
Infectious Disorders
Pericarditis, Myocarditis, Endocarditis, RHD
adequate treatment of streptococcal infection would prevent rheumatic carditis. this bacteria is known as
streptococcal pharyngitis
to control blood clot formation around the valves in endocarditis, what medication is given
Aspirin
for fever in endocarditis, what management is given
antipyretics, hydration
to prevent recurrence
in endocarditis, what medication is given
Antibiotic prophylaxis
An infection of the innermost layers of the heart. It may occur in people with congenital and valvular diseases.
Endocarditis
Inflammatory symptoms = induced by antibodies originally formed to destroy the group A beta-hemolytic streptococcal microorganisms.
INSTEAD
the antibodies mistakenly cross-react against the proteins in the connective tissue of the heart, joints, skin and nervous system
cross reaction causes = valvular damage OR a condition where there is an inflammation of the entire heart: the pericardium, myocardium, and endocardium.
Pancarditis
A child was assessed and findings found a major symptom of Polyarthritis (client complain of warm, red, and painful knees) and minor symptom of Arthralgia (pain in shoulders without evidence of inflammation)
Rheumatic Carditis/Endocarditis
inadequacy of the heart to pump blood throughout the body
Pump failure
accumulation of blood & fluid in organs & tissues due to impaired circulation
Congestive Heart Failure
This condition might be a result of a damage to muscular wall (M.I.) due to heart attack, Cardiomyopathy (Any disorder that affects the heart muscle), Coronary artery disease (CAD), or Valvular defects
Congestive Heart Failure
Types of Heart Failure
◼ Left-sided heart failure
◼ Right-sided heart failure
What condition indicates if diagnostic findings are:
Chest x-rays reveals cardiomegaly
(hypertrophy)
ECG reveals ventricular
hypertrophy and dysrhythmias
Echocardiography reveals cardiac
valvular changes and
chamber enlargement
Heart Failure
Multigraded angiographic (MUGA)
scans shows information about ejection
fraction. The condition could be?
Heart Failure
A patient with heart failure is given what diet
Low-sodium diet, fluid restriction
loss of apetite, nausea and vomiting, rapid, slow, irregular heart rate, disturbance in color vision are signs of
DIGITALIS toxicity
Digitalis, Diuretics, Vasodilators, ACE inhibitors, are medications given to patient with what condition
Heart Failure
Dopamine and Dobutamine exert positive inotropic effects in patients with
heart failure
Digoxin (Lanoxin) is an Inotropic Agent that decreases:
A) contractility
B) heart rate
C) conduction
D) it increases all
decreases:
A) contractility
B) heart rate
C) conduction
Which of the following statements about Digoxin is true?
A) It has negative sympa. Activity
B) It has positive parasympa. Activity
C) It has negative positive sympa. Activity
D) It is the generic name for Lanoxin.
E) It is a Digitalis
A) It has negative sympa. Activity
B) It has positive parasympa. Activity
D) It is the generic name for Lanoxin.
E) It is a Digitalis.
Which of the following medications is a Diuretic?
- Furosemide (Lasix)
- Digoxin (Lanoxin)
- Chlorothiazide (Diuril)
- Nitroglycerin
- Captopril
- Furosemide (Lasix)
- Chlorothiazide (Diuril)
assessment in patient with heart failure can be done by thinking __ are similar to what you hear when blowing back through a straw in a can of soda because Fluid backs up into here.
Lung sounds
Heart sounds of a patient in __ will resemble that of a Galloping Horse and feel like they are drowning
CHF
Congestion of Peripheral Tissues ->
Dependent edema and action
GI tract congestion -> Anorexia, GI distress, weight loss
Liver congestion -> signs related to impair liver function
are complications associated with what type of heart failure
RIGHT-SIDED HEART FAILURE
Decreased cardiac output -> activity intolerance and signs of decreased tissue perfusion
Pulmonary congestion
-> impaired gas exchange -> cyanosis and signs of hypoxia
-> Pulmonary Edema -> Cough with frothy sputum, Orthopnea, Paroxysmal Nocturnal Dyspnea
are complications associated with what type of heart failure
LEFT-SIDED HEART FAILURE
three main forms of arteriosclerosis
Atherosclerosis, Mönckeberg’s arteriosclerosis/medial calcific
sclerosis, Arteriolar sclerosis/arteriolosclerosis
the most common type of arteriosclerosis which is the leading contributor to
coronary artery and
cerebrovascular disease
Atherosclerosis
a specific type of
arteriosclerosis in which plaques (chiefly composed of
cholesterol) of fatty deposits form in the inner layer (tunica
intima) of the arteries w/c can restrict
blood flow
atherosclerosis
type of arteriosclerosis, in which there is an involvement of the middle layer
(tunica media) of the arteries, where there is
destruction of muscle and elastic fibers and formation of calcium deposits
Mönckeberg’s arteriosclerosis/medial calcific sclerosis
type of arteriosclerosis which is marked
by thickening of the walls of arterioles/hardening of
the arterial wall
Arteriolar sclerosis/arteriolosclerosis
The process of Atherosclerosis begins with Damage to the vascular system -> Fatty Streak development in the __ layer -> Plaque formation, leading to partial or complete occlusion of blood flow
intimal
partial or complete occlusion of blood flow because of plaque can lead to which complications
- Calcifications
- Ulceration
- Thrombosis
what forms of arteriosclerosis the male gender is at risk of having
atherosclerosis
a client with “type A” personality, Postmenopausal Estrogen Deficiency, has
High Carbohydrate Intake is at risk of
atherosclerosis
a client with atherosclerosis might experience
Hyperlipidemia
hypolipidemia
Hypertension
hypotension
Lipoprotein Lp(a)
Lipoprotein Lp(a)
Hardened (trans)unsaturated fat intake
Hyperlipidemia
Hypertension
The nicotinic acid in tobacco triggers the release of __, which raise the heart
rate and blood pressure. Nicotinic acid can also cause the coronary arteries to constrict.
Smokers have an increased risk of CAD and sudden cardiac death. The increase in
_ may be a factor in sudden cardiac death.
catecholamines
Which of the following substances in tobacco triggers the release of catecholamines?
A. Nicotine
B. Nicotinic acid
C. Carbon monoxide
D. Tar
Nicotinic acid
What effect does the increased blood carbon monoxide level, due to cigarette smoking, have on hemoglobin?
A. Decreases the amount of oxygen that hemoglobin can carry.
B. Increases the amount of oxygen that hemoglobin can carry.
C. Has no effect on the amount of oxygen that hemoglobin can carry.
D. Enhances the ability of the heart to pump blood.
Decreases the amount of oxygen that hemoglobin can carry, may decrease the heart’s ability to
pump.
- Use of __ adversely affects the vascular endothelium, resulting in increased platelet adhesion and leading to a higher probability of thrombus formation.
tobacco
High blood pressure whether it is genetic or caused by bad eating
habits can cause heart disease. A high intake of _ leads to
hypertension which allows plaque to stick to the insides of arteries.
sodium
Diabetes can cause __ because it causes increased amount of blood sugar which leads to premature cell death and slowed blood flow.
atherosclerosis
Alcohol consumption: You have probably heard that an occasional
glass of red wine is “good for the heart”. This is true if it is done in moderation and small amounts. However, too much of wine, or any
other alcoholic beverage can cause LDL levels to increase by as
much as _%. This also leads to plaque buildup in arteries.
40%
What effects do estrogen deficiency have on metabolic syndrome in postmenopausal women?
A. Hypertriglyceridemia, reduced HDL, and increased small dense LDL particles, insulin resistance, hypertension, increased central fat, reduction in lean body mass, and reduction in lean body mass.
B. Hypertriglyceridemia, increased HDL, and increased large LDL particles, insulin resistance, hypertension, increased central fat, and reduction in lean body mass.
C. Normal triglyceride levels, increased HDL, normal or slightly increased LDL levels, increased insulin sensitivity, normal blood pressure, increased peripheral fat, and increased lean body mass.
A. Hypertriglyceridemia (high blood triglyceride levels), reduced HDL (high-density lipoprotein, or ‘good’ cholesterol), and increased small dense LDL (low-density lipoprotein, or ‘bad’ cholesterol) particles, insulin resistance, hypertension (high blood pressure), increased central fat (fat deposited around the abdomen) and reduction in lean body mass (loss of muscle tissue) are all effects of estrogen deficiency in postmenopausal women.
many features of the
metabolic syndrome exhibit Hypertension, Dyslipidemia, Insulin resistance, Increased central fat and reduction in lean body mass, and Increased hypercoagulability and pro-inflammatory state. shown in which kind of patients
postmenopausal women with estrogen deficiency
hypertriglyceridemia (too many triglycerides/fat in your blood), reduced HDL, and
increased small dense LDL particles are under what condition where one has unhealthy levels of one or more kinds of lipid (fat) in blood.
Dyslipidemia
What conditions are used to assess the risk of developing atherosclerosis?
A. Hypertension, high cholesterol and triglycerides, abdominal obesity, elevated fasting blood sugar (FBS), and elevated homocysteine.
B. Low blood pressure, low cholesterol and triglycerides, peripheral obesity (fat deposited around the hips, buttocks, and thighs), low fasting blood sugar, and low homocysteine.
C. Optimal blood pressure, normal cholesterol and triglycerides, excess peripheral fat, optimal fasting blood sugar, and optimal homocysteine.
A. Hypertension (high blood pressure), high cholesterol and triglycerides, abdominal obesity, elevated fasting blood sugar, and elevated homocysteine are all used as risk factors to assess the likelihood of developing atherosclerosis.
Elevated homocysteine levels can have which of the following effects on the endothelium?
a. increase the production of nitric oxide
b. block the production of nitric oxide
c. have no effect on the production of nitric oxide
d. promote the breakdown of nitric oxide
blocks the production of nitric oxide on the endothelium making cell wall less elastic &
permitting plaque to build up
Based on the homocysteine test result, what is the borderline risk?
a. levels between 9-12 mol/L
b. levels between 12 and 15 mol/L
c. levels greater than 15 mol/L
levels between 12 and 15 mol/L
to lower homocysteine level, a diet of what is recommended
B-complex vitamin rich diet (folic acid)
Cholesterol screening, Smoking cessation, and HMG-CoA reductase inhibitors “Statins” are medical interventions for?
atherosclerosis
What is the role of cholesterol in the formation of arterial plaques?
- Cholesterol is converted into chylomicrons by the liver and then reprocessed by the gastrointestinal tract as lipoproteins.
- Cholesterol is converted into chylomicrons by the gastrointestinal tract and then reprocessed by the liver as lipoproteins.
Cholesterol is converted into chylomicrons by the gastrointestinal tract and then reprocessed by the liver as lipoproteins.
supplies blood and oxygen to heart muscle
coronary artery
bacteria associated with atherosclerosis
chlamydia pneumoniae
In postmenopausal women, many features of the
metabolic syndrome emerge with estrogen deficiency.
It exhibit a condition that refers to unhealthy levels of one or more kinds of lipid (fat) in your blood
Dyslipidemia
Elevated __ blocks the production of nitric
oxide on the endothelium making cell wall less elastic &
permitting plaque to build up
homocysteine
high density lipoproteins are what kind of cholesterol
good cholesterol
low density lipoproteins are what kind of cholesterol
bad cholesterol
Cholesterol is processed by
the gastrointestinal tract into
lipoprotein globules called
chylomicrons
Cholesterol is processed by
the gastrointestinal tract into
lipoprotein globules called
chylomicrons. These are
reprocessed by the liver as
lipoproteins
patient’s assessment found Elevated cholesterol &
triglycerides, Elevated FBS, and Elevated homocysteine. patient has
ATHEROSCLEROSIS
patient assessment findings shows hypertension, abdominal obesity and homocysteine test results are interpreted as greater than 15 mol/L. patient has signs of
ATHEROSCLEROSIS
aside from alcohol, another unhealthy habit is a major risk factor for atherosclerosis
cigarette smoking
the excess of lipids or fats in your blood also known as high cholesterol
hyperlipidemia
Hardened (trans)unsaturated fat intake, obesity, diabetes, and high carbohydrate intake are risk factors for which condition
atherosclerosis
Lipoprotein(a), or Lp(a), is an established and genetically determined risk factor for
atherosclerosis
Use of tobacco adversely affects the vascular endothelium, resulting in increased platelet adhesion and leading to a higher probability of __. A person at increased risk for heart disease is encouraged to stop tobacco use through any means possible: educational programs, counseling, consistent motivation and
reinforcement messages, support groups, and medications.
thrombus formation
ANGINA PECTORIS of cardiac origin
“Chest pain”
Sudden coronary obstruction caused
by thrombus formation over a
ruptured or ulcerated plaque
MYOCARDIAL INFARCTION
most common clinical
manifestation of myocardial
ischemia
ANGINA PECTORIS
the cause is insufficient
coronary blood flow,
resulting in a decreased
oxygen supply when there is
increased myocardial
demand for oxygen in
response to physical exertion
or emotional stress. ‘the need for oxygen
exceeds the supply’.
ANGINA PECTORIS
occurs as a result of sustained
ischemia, causing irreversible cellular
damage.
MYOCARDIAL INFARCTION
Types of Angina
Stable, Unstable, Variant (Prinzmetal’s)
type of angina which 75% coronary occlusion accompanies
exertion, Elevated HR or BP, and pt Eating a large meal
Stable Angina
type of angina with Arterial spasm in normal
or diseased coronary artery
Variant (Prinzmetal’s)
Unstable Angina is the Progressive worsening of stable angina with __% coronary occlusion
> 90%
type of angina where Chest pain of increased
frequency, severity & duration poorly relieved
by rest or oral nitrates
Unstable Angina
Stable Angina has Similar pain severity, frequency & duration with each episode. Chest pain may radiate for how long
15mins or less
Variant Angina chest pain occurs
at rest usually between what time
12am & 8am
chest pain that occurs at rest (usually bet.
12am & 8am), sporadic over _ mos &
diminishes over time (ECG: ST – elevation)
3-6
supply ischemia
unstable angina and printzmetal’s variant angina
demand ischemia
chronic stable angina
PRIMARY FACTOR of Myocardial Infarction
Atherosclerosis
Modifiable risk factors of ?
- Elevated serum cholesterol levels
- CIGARETTE SMOKING!!!
- Hypertension
- Hypotension
- Impaired glucose tolerance
- Obesity
- Physical inactivity
- Stress
Myocardial Infarction
an area of the myocardium is permanently
destroyed, typically because plaque rupture and
subsequent thrombus formation result in complete
occlusion of the artery.
MYOCARDIAL INFARCTION
Condition where Pain varies from a feeling of indigestion to a choking or heavy sensation in the upper
chest ranging from discomfort to agonizing
pain.
ANGINA PECTORIS
In __, Discomfort is poorly localized and may radiate to the aspect of the left upper arms
Angina Pectoris
The pain in Angina Pectoris is usually retrosternal, deep in the chest behind the
upper or middle third of the sternum
A feeling of weakness or numbness in the
arms, wrists, and hands, as well as shortness
of breath, pallor, diaphoresis, dizziness or
lightheadedness, and nausea and vomiting,
may accompany the pain. Anxiety may also occur.
ANGINA PECTORIS
An important characteristic of anginal pain is that it subsides when the precipitating cause
is removed or with __.
nitroglycerin
Positioning for Myocardial Infarction
semi Fowler’s
Oxygen must be given to patient with Myocardial Infarction by _/min through nasal cannula
2-4L/min
Diagnosis of this condition shows Elevated myoglobin Lactate dehydrogenase (LDH) , aspartate aminotransferase (AST), WBC, and erythrocyte sedimentation rate (ESR) .
MYOCARDIAL INFARCTION
In myocardial infarction, Troponin I increases __ the onset of pain.
7-14 hrs after
In myocardial infarction, Troponin T
increases within __ the onset of pain.
3-6 hrs after
Elevated serum creatine kinase isoenzyme (CK-MB) is primarily found in cardiac muscle in Myocardial Infarction. Which increase how many hours after the onset of chest pain
3-6 hrs
What changes occur in the ECG readings of a patient experiencing a myocardial infarction, in what order do these changes occur?
a) Changes occur first in the ST
segment then the T wave and finally the
Q wave. As the myocardium heals the ST
and T waves return to normal but the Q
wave changes persist.
b) Changes occur first in the T
segment then the ST wave and finally the
Q wave. As the myocardium heals the ST
and T waves return to normal but the Q
wave changes persist.
a) Changes occur first in the ST
segment then the T wave and finally the
Q wave. As the myocardium heals the ST
and T waves return to normal but the Q
wave changes persist.
involves the entire thickness of the myocardium
Transmural MI
damage has not penetrated through the entire thickness
Subendocardial MI
the plaque rupture and thrombus formation causes partial occlusion to the vessel that results in injury and infarct to the subendocardial myocardium
NSTEMI
characterized by complete occlusion of the blood vessel lumen. resulting in transmural injury and infarct to the myocardium, which is reflected by ECG changes and a rise in troponins
STEMI
thrombus angina also known as supply ischemia
Unstable angina
Fixed stenosis also known as demand ischemia
stable angina
The objectives of the medical management of angina
a) to increase the oxygen
demand of the myocardium and to increase the oxygen supply.
b) to decrease the oxygen
demand of the myocardium and to increase the oxygen supply.
b) to decrease the oxygen
demand of the myocardium and to increase the oxygen supply.
what is the result after Sudden coronary obstruction caused by thrombus formation over a ruptured or ulcerated plaque
acute coronary syndrome
The pain in __ is usually retrosternal, deep in the chest behind the upper or middle third of the sternum
Angina Pectoris
An important characteristic of __ is that it subsides when the precipitating cause
is removed or with nitroglycerin
anginal pain
primarily found in cardiac muscle in Myocardial Infarction
Elevated serum creatine kinase isoenzyme (CK-MB)
Patient is given Nitrates, Beta Blockers, Calcium Channel Blockers, Thrombolytics/ Fibrinolytics. The condition patient has
Myocardial Infarction
For pain management of Myocardial Infarction, patient is given MONA which means
Morphine, Oxygen, Nitroglycerin, Aspirin
For pain management of Myocardial Infarction, patient is given how many mg of Morphine
2- to 10-mg IV q
For pain management of Myocardial Infarction, patient is given 2- to 10-mg IV Morphine for how many minutes
q 5-15 minutes
Ischemia causes inversion of the __ because of altered repolarization
T wave
cardiac muscle injury causes elevation of the
ST segment
__ waves develop because of the absence of depolarization current from the necrotic issues and opposing current from other parts of the heart
Q waves
chest pain or discomfort not relieved by rest or nitroglycerin palpitations is a sign of
myocardial infarction
heart sounds include S3, S4 and new onset of a murmur is a sign of
myocardial infarction
fear with feeling of impending doom or denial that anything is wrong and increased jugular venous distention may be seen if the __ has caused heart failure
myocardial infarction
a cardiovascular sign where in addition to st-segment and t-wave changes, ECG may show tachycardia, bradycardia, or other dysrhythmias
myocardial infarction
shortness of breath, dyspnea, tachypnea, pulmonary edema, and crackles if myocardial infarction has caused what condition
pulmonary congestion
decreased urinary output and cool, clammy, diaphoretic, and pale appearance due to pathetic stimulation in myocardial infraction may indicate
cardiogenic shock
aside to cardiogenic shock - anxiety, restlessness, and lightheadness may indicate
a) increased sympathetic stimulation or a decrease in contractility and cerebral oxygenation
b) decrease sympathetic stimulation or a increase in contractility and cerebral oxygenation
a) increased sympathetic stimulation or a decrease in contractility and cerebral oxygenation
most patients with angina pectoris must self administer what on an as-needed basis
nitroglycerin
in taking sublingual nitroglycerin instruct the patient to
i. make sure the mouth is dry
i.i make sure the mouth is moist
ii. the tongue is still
iii. saliva is not swallowed until the nitroglycerin tablet dissolves
iv. if pain is severe, patient can crush the tablet between the teeth
iv.o if pain is severe, patient can not crush the tablet between the teeth
v. carried in original container (capped dark glass bottle)
vi. tablets should never be moved and stored in metal/plastic pillboxes
i.i make sure the mouth is moist
ii. the tongue is still
iii. saliva is not swallowed until the nitroglycerin tablet dissolves
iv. if pain is severe, patient can crush the tablet between the teeth
v. carried in original container (capped dark glass bottle)
vi. tablets should never be moved and stored in metal/plastic pillboxes
explain to patient that nitroglycerin is volatile and is inactivated by heat moisture air light & time. instruct the pt to renew the nitroglycerin supply every
6 months
in taking sublingual nurse must
i. inform the pt that medication should be taken in anticipation of any activity that may produce pain because nitroglycerin increases tolerance for exercise & stress when taken prophylactically
ii. advise pt if pain persists after taking 3 sublingual tablets at 5 minutes, emergency medical service should be called
iii. discuss possible side effects: flushing, throbbing headache, tachycardia
iii. advise pt to sit down to avoid hypertension & syncope
iv. advise pt to sit down to avoid hypotension & syncope
i. inform the pt that medication should be taken in anticipation of any activity that may produce pain because nitroglycerin increases tolerance for exercise & stress when taken prophylactically
ii. advise pt if pain persists after taking 3 sublingual tablets at 5 minutes, emergency medical service should be called
iii. discuss possible side effects: flushing, throbbing headache, hypotension, tachycardia
iv. advise pt to sit down to avoid hypotension & syncope
cardiogenic shock, pulmonary edema, mitral regurgitation, left ventricular failure, right ventricular failure, pulmonary emboli, papillary muscle rupture, systemic emboli, dysrhythmias, cardiac rupture, pericarditis, septal rupture, and mural thrombi are complications of
myocardial infarction
COPD A group of chronic
(obstructive) lung diseases
includes:
Emphysema
Chronic Bronchitis
Chronic Airflow Limitations
(CAL)
COPD, Bronchial Asthma, Bronchiectasis
Most important risk
factor for COPD
SMOKING!!!
Tobacco smoke triggers the
release of EXCESSIVE amounts
of __ that
breaks down elastin which is a major component of alveoli
o Impairs & inhibits the action of cilia
elastase protease
ACTIVE smokers – 100%
PASSIVE smokers –
80%
Clinical Manifestations
-General appearance
-Cyanosis, Clubbing of fingers
-Presence of “Barrel chest”
-Manifestations of RSHF/right sided heart failure
(dependent edema)
COPD
RR of COPD patient
40-50 breaths/min
Laboratory assessment
o Abnormal ABG results in COPD patient
hypoxemia, hypercarbia
COPD
Airway maintenance:
o Keep the client’s - in
alignment
head, neck and chest
assisst clients with __ to liquefy secretions and clear the airway
COPD
COPD
Airway maintenance:
Controlled coughing
o advise client to cough on
arising on the morning, before
mealtimes, before bedtimes
Proper instruction for
Controlled coughing.
the client sits in a chair or on the side of a bed with feet placed firmly on the floor. to cough effectively, Instruct the client to
turn the shoulders __ and to bend the head slightly downward hugging a pillow against the stomach.
inward
to do Controlled coughing for patients with COPD
Insturct the patient that After the _ deep breath/pursed-lip breathing, the client will bend forward slowly
3rd to 5th
O2
Therapy COPD
o Assess COPD client at least q2°
o Assess COPD client at least q4°
o usually, 2-4 L/min or even 1-2 L/min via nasal
cannula
o usually, 3-4 L/min or even 1-2 L/min via nasal
cannula
o up to 30% via venturi mask
o up to 40% via venturi mask
o Assess COPD client at least q2°
o usually, 2-4 L/min or even 1-2 L/min via nasal
cannula
o up to 40% via venturi mask
