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Health and Illness Concepts III Nursing: N2410 > Cardiovascular System (Exam Three) > Flashcards

Cardiovascular System (Exam Three) Flashcards

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1
Q

Describe heart failure.

A

Inability of the heart to maintain adequate cardiac output to meet the metabolic needs of the body

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2
Q

List signs and symptoms of left sided heart failure.

A
  • Paroxysmal Nocturnal Dyspnea
  • Elevated pulmonary pressure
  • Pulmonary Congestion/Edema –> cough, crackles, wheezes, pink frothy sputum, tachypnea
  • Restlessness
  • Confusion
  • Orthopnea
  • Tachycardia
  • Exertional Dyspnea
  • Fatigue
  • Cyanosis
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3
Q

List signs and symptoms of right sided heart failure.

A
  • Fatigue
  • Increased peripheral venous pressure
  • Ascites
  • Hepatomegaly
  • Spleenomegaly
  • Jugular Venous Distention
  • Anorexia
  • GI Distress: feelings of fullness, loss of appetite
  • Weight gain
  • Dependent edema
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4
Q

What diagnostic test is used to diagnose heart failure?

A

Echocardiogram

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5
Q

An echocardiogram provides what specific information about the heart?

A
  • Left ventricular ejection fraction (LVEF)
  • Heart valves
  • Presence of effusion
  • Presence of thrombus
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6
Q

What laboratory value is considered the number one indicator of heart failure?

A

Brain Natriuretic Peptide (BNP)

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7
Q

When is brain natriuretic peptide (BNP) released within the body?

A

When left ventricle is stretched

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8
Q

What is a normal brain natriuretic peptide (BNP) level?

A

< 300 pg/mL

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9
Q

A brain natriuretic peptide (BNP) level _________ is indicative of heart failure.

A

> 400 pg/mL

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10
Q

Why is it important for the nurse to know the patient’s baseline level brain natriuretic peptide (BNP)?

A

Levels may be higher in patients with chronic, stable heart failure

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11
Q

The nurse knows that nursing interventions are therapeutic if the brain natriuretic peptide (BNP) level does what?

A

Decreases

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12
Q

Describe the dilation compensatory mechanism.

HINT: Space

A

Enlargement of heart chambers

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13
Q

When does the dilation compensatory mechanism occur?

A

When pressure in left ventricle is elevated over time

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14
Q

Describe the hypertrophy compensatory mechanism.

HINT: Muscle

A
  • Adaptive increase in heart muscle mass

- Adaptive increase in heart wall thickness

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15
Q

Why does the hypertrophy compensatory mechanism occur?

A

Slow response to overwork and strain on heart

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16
Q

Hypertrophy can cause the ___________ of the heart to fail.

A

Ventricles

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17
Q

Can dilation and hypertrophy occur simultaneously within the ventricles of the heart?

A

No

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18
Q

A patient with heart failure is admitted to the medical-surgical floor with chronic peripheral edema. The nurse auscultates the patients lungs two hours after initial assessment and hears bilateral crackles. What is the priority nursing intervention? Why?

A
  • Call the physician!

- This is a sign and/or symptom of worsening heart failure

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19
Q

What is acute decompensated heart failure (ADHF)?

A
  • Sudden increase in heart failure symptoms

- Decrease in functional status

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20
Q

Acute decompensated heart failure (ADHF) often requires what?

A
  • Rapid escalation of therapy

- Hospitalization

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21
Q

What are considered early clinical manifestation of acute decompensated heart failure (ADHF)?

A
  • Increased pulmonary venous pressure
  • Increased respiratory rate
  • Decreased in PaO2
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22
Q

What are considered later clinical manifestation of acute decompensated heart failure (ADHF).

A
  • Interstitial edema
  • Tachypnea
  • SOB
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23
Q

What clinical manifestations are considered further progression of acute decompensated heart failure (ADHF).

A
  • Alveolar edema

- Respiratory acidosis

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24
Q

In heart failure patients, what is considered an early sign and/or symptom that the patient is beginning to decline?

A

Vital signs

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25
Q

A patient comes to the ED complaining of dyspnea. They state they they have a history of acute decompensated heart failure (ADHF). What is the priority nursing intervention(s)?

A
  • Apply oxygen

- Auscultate lung sounds

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26
Q

List the signs and symptoms of pulmonary edema.

A
  • Dyspnea
  • Orthopnea
  • Tachypnea
  • Blood-tinged frothy sputum
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27
Q

Describe paroxysmal nocturnal dyspnea.

A
  • Sensation of SOB that wakes the patient during nighttime

- Usually relieved in the upright position

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28
Q

How might a patient describe paroxysmal nocturnal dyspnea (PND) to the nurse?

A

Feelings of suffocation

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29
Q

Should a beta-blocker be administered to a patient experiencing pulmonary edema?

A

No

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30
Q

The nurse knows a patient with pulmonary edema cannot receive a beta-blocker because:

A
  • Causes bronchospasms

- Disrupts lung function

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31
Q

Why is a patient with heart failure commonly prescribed a diuretic(s)?

A

Decreases preload

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32
Q

Why is morphine commonly prescribed for patients with acute decompensated heart failure (ADHF)?

A
  • Decreases preload
  • Decreases afterload
  • Decreases dyspnea
  • Decreases anxiety
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33
Q

Why is dopamine, dobutamine, or digoxin administered to a patient with acute decompensated heart failure (ADHF)?

A
  • Increases heart rate

- Increases contractility

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34
Q

Dopamine, dobutamine, and digoxin fall under what drug class?

A

Positive inotropes

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35
Q

List medications that fall under the drug class of positive inotropes.

A
  • Dopamine
  • Dobutamine
  • Digoxin
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36
Q

The nurse administering positive inotrope therapy should educate the patient to notify the nurse if they develop what signs and symptoms?

A
  • Tachycardia
  • Orthostatic hypotension
  • Nausea
  • Vomiting
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37
Q

What is the therapeutic range of digoxin?

A

0.8 - 2.0 ng/mL

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38
Q

List signs and symptoms of digoxin toxicity.

A
  • Yellow halo
  • Vison changes
  • Nausea
  • Vomiting
  • Diarrhea
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39
Q

What specific metabolic state(s) increases the risk for developing digitalis toxicity?

A
  • Hypokalemia

- Hypercalcemia

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40
Q

If a patient has a transdermal vasodilator (nitrate) patch, is the nurse still able to administer sublingual nitroglycerin?

A

Yes

41
Q

When can diuretics be given during the day?

A

They can be given daily or multiple times a day

If only given once a day it should be scheduled in the morning to prevent nocturia

42
Q

What is another name for isosorbide dinitrate with hydralazine?

A

BiDil

43
Q

An Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) is often given for what chronic condition?

A

Chronic Heart Failure

44
Q

What vital signs should be assessed before and after administration of an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor)?

A
  • Blood pressure

- Monitor for hypotension

45
Q

What symptoms does the nurse need to educate on and monitor for when the patient is taking an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor)?

A
  • Change position slowly
  • New-onset dry, irritating, persistent, nonproductive cough
  • Angioedema
46
Q

When might a beta blocker be contraindicated for a patient? What should the nurse do if this occurs?

A
  • Patient has asthma
  • Patient has COPD

-Notify the physician

47
Q

A patient with heart failure will be on what type of diet?

A

Low sodium diet

48
Q

A patient with heart failure is restricted to ____ ________ of sodium per day.

A

2 grams (g)

49
Q

When should the nurse be concerned about weight gain in the patient with chronic heart failure?

A
  • 3 pound gain over 2 days

- 3 to 5 pound gain over a week

50
Q

A patient with chronic heart failure on the medical-surgical floor has gained 2 pounds over the last two days. What is the priority nursing management for this patient?

A
  • Assess for s/sx of pulmonary congestion

- Notify the physician

51
Q

A heart transplantation is contingent upon what factors?

A

Multiple different factors

52
Q

How long are individuals monitored for rejection after having a heart transplantation?

A

One year

53
Q

In the first year, after receiving a heart transplantation, the patient is at risk for what complications?

A
  • Rejection
  • Infection
  • Sudden cardiac death
54
Q

After the first year of heart transplantation, what are a major cause of death?

A
  • Cardiac vasculopathy

- Cancer

55
Q

___________ ______________ is the hearts inability to pump the blood forward.

A

Systolic dysfunction

56
Q

Describe diastolic dysfunction.

A

A decrease filling of the heart will result in a decreased stroke volume

57
Q

Systolic dysfunction affects which ventricle?

A

Left ventricle

58
Q

What are considered early manifestations of cardiogenic shock?

A
  • Tachycardia
  • Hypotension
  • Narrowed pulse pressure
  • Increased myocardial O2 consumption
59
Q

What previous disease process will cause the heart to need an increased myocardial consumption?

A

Myocardial infarction (MI)

60
Q

What are considered late manifestations of cardiogenic shock?

A
  • Tachypnea
  • Crackles
  • Pulmonary congestion
  • Pallor
  • Cool, clammy skin
  • Decreased capillary refill
  • Decreased urinary output
  • Anxiety
  • Confusion
  • Agitation
61
Q

Neurogenic shock is characterized by what clinical manifestations?

A
  • Hypotension
  • Bradycardia
  • Poikilothermic
  • Dry skin
62
Q

List the clinical manifestations of anaphylactic shock.

A
  • Angioedema
  • Wheezing
  • Stridor
  • Respiratory distress
  • Circulatory failure
63
Q

What is the priority nursing assessment and management for a patient with anaphylactic shock?

A

Airway maintenance!

64
Q

List the clinical manifestations presented during the early stage of septic shock?

A
  • Tachypnea
  • Tachycardia
  • Leukocytosis
65
Q

What occurs during a hyperdynamic state?

A
  • Increased cardiac output

- Decreased SVR

66
Q

What is considered the priority nursing intervention for a patient with septic shock?

A

Apply oxygen!

67
Q

What is considered cornerstone therapy for a patient experiencing either septic, hypovolemic, or anaphylactic shock?

A
  • Volume expansion

- Fluid resuscitation

68
Q

In order for volume expansion or fluid resuscitation to occur, what will a patient require?

A

2 large bore IV’s

69
Q

How will the nurse assess fluid responsiveness?

A
  • Vital signs
  • Elevated blood pressure
  • Urinary output
  • Capillary refill
  • Skin temperature
70
Q

The nurse knows that this form of shock does not require fluid resuscitation.

A

Cardiogenic shock

71
Q

Why are nitrates administered to a patient with cardiogenic shock?

A

Dilate coronary arteries

72
Q

Why are diuretics administered to a patient with cardiogenic shock?

A

Reduce preload

73
Q

Why are vasodilators administered to a patient with cardiogenic shock?

A

Increase afterload

74
Q

Why are β-Adrenergic blockers administered to a patient with cardiogenic shock?

A

Reduce heart rate

75
Q

How many sites should the nurse obtain blood cultures from a patient with septic shock? When are these blood cultures obtained?

A
  • 2 different sites

- 1 hour apart

76
Q

The nurse knows the blood glucose level for a patient with septic shock should be below what, regardless of diabetes?

A

Less than 180

77
Q

How often should the nurse perform blood glucose level checks for a patient with septic shock?

A

Every three hours

78
Q

A patient develops septic shock. The nurse knows that antibiotics must be administered within what time frame?

A

One hour

79
Q

List the different types of vasopressor drugs.

A
  • Epinephrine
  • Norepinephrine
  • Dopamine
  • Dobutamine
80
Q

Why are proton pump inhibitors, such as protonix, given to a patient with septic shock?

A

Prophylactic treatment

81
Q

What is the drug treatment of choice for a patient with neurogenic shock?

A
  • Vasopressors

- Atropine

82
Q

What type of shock is the only type of shock that is treated with atropine?

A

Neurogenic shock

83
Q

All spinal injuries affect _______________ regulation.

A

Temperature

84
Q

What is the primary nursing intervention for a patient with neurogenic shock?

A

Apply high-flow oxygen via non-rebreather mask

85
Q

What is included in the nursing assessment for tissue perfusion?

A
  • ABC’s!
  • Vital signs
  • Peripheral pulses
  • LOC
  • Capillary refill
  • Skin
  • Urine output >30 mL/hr
86
Q

What is SIRS?

A

Inflammation of the organs

87
Q

What is MODS?

A
  • A failure of two or more organ systems

- Results from SIRS

88
Q

The nurse knows the two organ systems that are most likely to fail first is/are:

A
  • Liver

- Kidneys

89
Q

What will the nurse examine in order to assess kidney function?

A

Urine output

90
Q

What will the nurse examine in order to assess liver function?

A
  • Jaundice
  • Pain
  • Low platelet levels
  • Ammonia levels
91
Q

List the signs and symptoms of central nervous system (CNS) dysfunction.

A
  • Temperature change

- Hypotonic reflexes (flaccid)

92
Q

Describe how shock leads to organ dysfunction.

A
  1. Shock –>
  2. Systemic inflammatory response syndrome (SIRS) –>
  3. Multiple organ dysfunction syndrome (MODS) –>
  4. Target organs (i.e. renal, lung, liver, CNS)
93
Q

Care for a patient with MODS focuses on:

A
  • Maintaining tissue oxygenation
  • Preventing and treating infection
  • Appropriate support of failing organs
94
Q

In order to maintain tissue oxygenation in a patient with MODS, how will the nurse decrease oxygen demand while increase oxygen deliver?

A
  • Sedation
  • Analgesia
  • Mechanical ventilation
  • Rest
95
Q

How do we prevent blood clots in a patient with SIRS?

A
  • Early ambulation
  • SCD’s
  • Anticoagulants (blood thinners)
96
Q

How do we prevent infection in a patient with SIRS?

A
  • Aseptic technique
  • Prophylactic antibiotics
  • Wash hands
97
Q

The nurse knows leaving catheters in a patient for prolonged periods of time can cause what? What is the priority for patients with catheters?

A
  • Infection

- Take them out as soon as possible

98
Q

Are we concerned about nutrition prior to sedating a patient with SIRS?

A

No

Health and Illness Concepts III Nursing: N2410 (15 decks)

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