Chap. 28, 29, 31: HTN, BP, Heart failure, Heart Disease

Question 1

What is normal, prehypertension, Stage I hypertension and Stage 2 hypertension

Answer 1

Normal: <120/80
Prehypertension: 120-139/80-89
Stage 1: 140-159/90-99
Stage 2: 160/100 or greater

Question 2

What is mean pressure and how is it calculated

Answer 2

Mean pressure is the average amount of pressure exerted during the cardiac cycle.
Calculation: diastolic X 2 + systolic/3

Question 3

What is pulse pressure:

Answer 3

Difference between systolic and diastolic pressure

Question 4

What are methods for prevention of HTN

Answer 4

Diet, exercise, stress reduction, adequate sleep, low alcohol intake, avoid smoking, low salt/cholesterol in diet

Question 5

goal bp for adults over 60? Goal bp for pts with CKD or DM

Answer 5

> 60: 150/90

CKD or DM: BELOW 140/90

Question 6

What are the treatment strategies for HTN in patients who do not have compelling conditions?

Answer 6

Stage 1: Thiazides for most; may consider ACE-I,ARB,BB, CCB or combination

Stage 2: 2 drug combo for most: thiazides and ACE-I, OR ARB, Or BB, OR CCB.

Question 7

What are compelling conditions, in order of most significance to least?

Answer 7

Heart failure, post MI, High CV risk, DM, CKD, and recurrent Stroke prevention

Question 8

What are initial therapy options for patients who have heart failure?

Answer 8

Thiazides, BB, ACE-I, ARBs, Aldost. Antagonists

Question 9

What are initial therapy options for patients who are post MI

Answer 9

BB, ACE-I, Aldosterone Antagonists

Question 10

What are the initial therapy options for patients who have high CV risk

Answer 10

Thiazides, bb, ace-i, ccb

Question 11

What are the initial therapy options for patients with diabetes

Answer 11

thiazides, BB, ACE-I, ARBs, CCBs

Question 12

What are the initial therapy options for patients with CKD?

Answer 12

ACE-I, ARBs

Question 13

what are the initial therapy options for patients with recurrent stroke prevention?

Answer 13

Thiazides, ACE-I

Question 14

What drugs affect preload, afterload, and contractility

Answer 14

Preload: amount of pressure exerted during passive ventricular filling (end of diastole): Diuretics

Afterload: Resistance that the left ventricle needs to overcome to circulate blood. ACE-I, ARBs, and CCBs

Contractility: ability of the heart to contract effectively: BBs and Digoxin

Question 15

What is a risk of using Beta Blockers

Answer 15

they suppress the SNS so the body does not respond to a “flight or fright” response. They also can cause bronchospasm and glucose intolerance.

Question 16

What are the risks of both CCBs, ACE-Is,

Answer 16

CCBs: heart block, CHF, constipation

ACE-Is: cough, hypotension, cost

Question 17

what are long term risks of HTN

Answer 17

CV: SHF, IHD,
Brain: CVA, encephalopathy
Kidney: small vessel necrosis, renal artery disease

Question 18

factors that affect Pulse rate

Answer 18

Age, gender, stress, exercise, fever, medications, hypoglycemia, hypovolemia, pain, position changes, disease processes.

Question 19

what is the difference between hypertensive urgency and hypertensive emergency? What are the treatment goals of each?

Answer 19

Hypertensive Urgency: Elevated hypertension without any evidence of impending or progressive target organ damage. (nosebleeds, severe h/a, anxiety). Rx: oral antihypertensives with a goal of normalizing BP within 24-48hrs.

Hypertensive Emergency: Severe hypertension that must be lowered immediately with evidence of progressive or impending target organ damage. (hypertension of pregnancy, acute MI, dissecting Aortic aneurysm and intracranial hemorrhage) all conditions assoc. w/hypertensive emergency. Rx: IV therapy, with 20%-25% reduction of BP within 1st hour of treatment, a further goal to 160/100 over 6hrs and then continued reduction of BP over several days.

Question 20

which portion of the BP tells you about the CO, stroke volume, and peripheral vascular resistance, which best identifies risk for decreased tissue perfusion or end organ damage?

Answer 20

Systolic: tells about CO and stroke volume
Diastolic: tells about peripheral vascular resistance
Mean: identifies risk for decreased tissue perfusion or end organ damage.

Question 21

What are the common medications used in heart failure and when are they indicated?

Answer 21

Common medications: Diuretics: decrease preload, Dilators: decrease afterload: ACE-I, ARBs, CCBs
Digoxin: Improve contractility: BBs, Digoxin

Question 22

when and where does mitral regurgitation occur

Answer 22

between S1 and S2.

Question 23

S1 represents what

Answer 23

the pulse beat. it is also when the AV valves close

Question 24

S2 represents what

Answer 24

closure of Semilunar valves

Question 25

where would you hear the sounds of mitral stenosis

Answer 25

After s2. (mid diastole when valves s/b open)

Question 26

what S/S would you see in ACUTE heart failure:

Answer 26

Increased BNP, resp. alkalosis, cool, clammy skin, pale extremities, (decreased tissue perfusion), Increased HR, s/s of hypoxia. May have murmors in systole.

Question 27

what are some CAUSES of ACUTE heart failure

Answer 27

new onset dysrhthmia, myocardial ischemia, infection, valvular collapse

Question 28

What are the S/S of Chronic Heart Failure

Answer 28

S/S: Increased JVD, periph. edema, Na retention, HTN, renal insufficiency: PND, S3, Rales in Bases, dysrhythmias, cardiomyopathy, increased Na, Cl, Increased BNP and enlarged cardiac shadow

Question 29

What is Cor Pulmonale and what are the S/S

Answer 29

Cor Pulmonale: a type of right sided HF as a result of high pulmonary pressure (low O2 and high CO2) S/S: elevated hr, rr, low bp, low O2 sat, low UO, edema, LOC alteration dusky membranes, delayed cap refill, distant in bases, upper lobe rhonchi.

Question 30

what are S/S of CHF and treatments

Answer 30

S/S: increased RR and HR, low O2 sats, S3, bilateral pitting edema, rales Rx: Oxygen, sit up, loop diuretics

Question 31

what is included in a perfusion assessment

Answer 31

LOC (1st thing), UO, VS

Question 32

what is the difference between primary and secondary hypertension

Answer 32

Primary (essential) unknown etiology | Secondary due to a known cause

Question 33

the pulse corresponds to the closing of which valves

Answer 33

Atrial valves

Question 34

S2-S1 is what

Answer 34

diastolic filling

Question 35

S1-S2 is what

Answer 35

systolic ejection

Question 36

aortic or pulmonary regurgitation will be heard

Answer 36

in diastole. Normally semilunar valves are closed in diastole

Question 37

when will mitral and tricuspid stenosis be heard

Answer 37

in diastole (normally av are open soundlessly in diastole).

Question 38

Mitral or triscuspid regurgitation is heard

Answer 38

in systole between s1-s2

Question 39

how is diastolic or systolic heart failure diagnosed

Answer 39

Echocardiogram. Both are a type of LEFT Sided HF. Systolic: ejection fraction <45% Diastolic: ejection fraction >45%.

Question 40

what are the causes of systolic HF, what is the pathophysiology of this condition

Answer 40

Causes: early HTN, Aortic stenosis, CAD, Arhythmias, myopathy. Path: enlarged ventricles fill with blood as there is a problem with ejection and contraction

Question 41

What are the causes of diastolic HF, what is the pathophysiology of this condition

Answer 41

HTN, Aortic stenosis late | Problem with ventricles becoming stiff and fill less than normal.

Question 42

how is systolic and diastolic heart failure treated

Answer 42

Systolic: Diuretics, ACE-I, BB limit fluids, mon. F&E, fibrotic disease Diastolic: Diuretics, ACE-I, BB, CCB: need adequate fluids and vasodilators, hypertrophy

Question 43

what are s/s of pulmonary HTN

Answer 43

Low O2, high CO2

Question 44

How is pulmonary HTN treated, diagnosed

Answer 44

Dx: BNP, ABGs, PE, ECGs Rx: O2, diuretics, bronchodilators, vasodilators

Question 45

what are nursing interventions for pulm. HTN

Answer 45

HOB raised, frequent position changes, treat hypoxia and hypercapnia.

Question 46

what are the differences between right and left sided heart failure

Answer 46

RSHF: heart cannot pump blood effectively and cant accommodate blood from venous return s/s: edema of lower extremities, ascites, enlarged liver, anorexia, nausea, abd. pain, gen. weakness, increased capill. hydrostatic pressure, JVD, impaired circulation, weight gain LSHF: LV cannot effectively pump blood into aorta and systemic circulation S/S: dyspnea, cough, pulm. crackles, low O2, nocturia, SOB at rest, tachypnea, orthopnea, S3, decreased cardiac output, decreased stroke volume, crackles at bases, weight gain, Cap. refill > 3sec.

Question 47

What is Dilated Cardiomyopathy (DCM)

Answer 47

Most common form, significant dilation of ventricles without simultaneous hypertrophy. Ventricles have increased Systolic and Diastolic volumes, decreased Ejection Fraction

Question 48

What are the S/S of DCM

Answer 48

increased volume, decreased ejection, wt. gain, edema, SOB,

Question 49

how is DCM diagnosed and treated? What are some nursing pearls

Answer 49

Dx: hx, exam, ecg, cardiac cath. myocardial biopsy, diastolic murmur. Rx: Diet (decrease Na, beta blockers, pacemaker, ACE-Is, ARBs, diuretics Pearls: CHF, Ventricular/atrial dysrrhythmias, emboli. MOST COMMON

Question 50

What is Restrictive Cardiomyopathy (RCM)

Answer 50

the most rare type of cardiomyopathy that is caused by amyloids/infiltrative disease. This is a DIASTOLIC dysfunction.

Question 51

What are the S/S of RCM

Answer 51

dyspnea, non.prod. cough, chest pain,

Question 52

how is DCM diagnosed and treated? What are some nursing pearls?

Answer 52

Dx: echo Rx: Beta blockers, diuretics, anticoagulants, transplantation Nursing Pearls: avoid nifidipine, increased sens. to digoxin

Question 53

what two neurotransmitters affect contractility of the heart

Answer 53

Acetylcholine: released by PNS: decreases heart rate Norepinephrine: released by SNS: "beta adrenergic" fibers that increases heart rate.

Question 54

what is the formula for calculating cholesterol?

Answer 54

HDL + LDL+ triglycerides/5= Total Cholesterol

Question 55

what is endocarditis? What the two types

Answer 55

microbial infection of the endocardium. 2types: rheumatic and infective endocarditis

Question 56

what are the S/S of endocarditis?

Answer 56

fever, heart murmur, petechiae, small painful nodules (Osler nodes) on the pads of fingers and toes, Hemorrhages with pale spots: Roth Spots, splinter hemorrhages: red-brown lines and streaks.

Question 57

who is at high risk for developing endocarditis?

Answer 57

prosthetic heart valves, tattoos, piercings, history of endocarditis, IV drug use, defective heart valves, congenital heart defects.

Question 58

who should receive prophylactic antibiotics, which procedures

Answer 58

patients with artificial heart valves or previous known endocarditis. Procedures: dental work, tonsillectomy, adenoidectomy, respiratory procedures (bronch), and surgery involving skin or muscle tissue.

Question 59

what is mitral regurgitation? what does it sound like and where do you hear?

Answer 59

mitral regurgitation is a condition in which blood flows back from the left ventricle into the left atrium during SYSTOLE. the leaflets do not close due to becoming thickened and fibrosed. High pitched blowing sound at apex of the heart

Question 60

What are the S/S of mitral regurgitation?

Answer 60

severe CHF, dyspnea, fatigue, weakness, palpitations, SOB with exertion, cough

Question 61

what are some causes of mitral regurgitation

Answer 61

SLE, infective endocarditis, cardiomyopathy, ischemic heart disease,

Question 62

How does mitral regurgitation lead to heart failure

Answer 62

blood regurgitates into atrium during systole, backward flow from ventricle leads to decreased blood flow from lungs into atrium. Lungs become congested, which adds strain to left ventricle. Increased blood volume from atrium fills ventricle, causing vent. hypertrophy, ventricle dilatation, and SHF developes

Question 63

what is mitral stenosis, what are the causes

Answer 63

a condition in which there is an obstruction of blood flow from the left atrium into the left ventricle Causes: rheumatic endocarditis thickens mitral valve leaflets and chordae tendineae leaflets fuse together and obstruct blood flow into the ventricle

Question 64

how does mitral stenosis lead to heart failure

Answer 64

right ventricle hypertrophies, which leads to dilation and increased heart rate and shortened diastole. The time for forward flow is reduced, the blood backs into pulm. veins. increased heart rate leads to decreased cardiac output, which leads to increase in pulm. pressure.

Question 65

what are the s/s of mitral stenosis

Answer 65

Mitral stenosis: DOE, prog. fatigue, decreased exercise tolerance, decreased cardiac output, dry cough, wheeze, hemoptysis, palpitations, orthopnea, PND, repeated resp. infections

Question 66

What is aortic regurgitation and its causes

Answer 66

aortic regurgitation is a condition in which blood flows back into the left ventricle from the aorta during DIASTOLE Causes: infective or rheumatic endocarditis, congenital syphillis, dissected aneurysm, blunt chest trauma, surgical replacement of aortic valve.

Question 67

what are the S/S of aortic regurgitation and where is this heard?

Answer 67

forceful heart beat, (head and neck) marked arterial pulsations, visible palpations at carotid or temporal art. exertional dyspnea, fatigue, orthopnea, PND, widened pulse pressure, water-hammer pulse heard: high pitched blowing noise, 3-4intercostal space at left sternal border DIASTOLIC murmur

Question 68

how does aortic regurgitation lead to HF

Answer 68

blood from aorta returns to left ventricle during diastole, in addition to blood normally delivered by left atrium. The left ventricle dilates and hypertrophies leading to increased SBP. Arteries compensate for increased pressure by REFLEX VASODILATION in which peripheral arterioles relax, peripheral resistance is decreased and decreased DBP.

Question 69

what is aortic stenosis and its causes

Answer 69

Aortic stenosis is the narrowing of the orifice between the left ventricle and aorta Cause: often degenerative calcifications, atherosclerotic arterial disease, DM, hypercholesteremia, HTN, and low HDL, rheumatic endocarditis

Question 70

what are the S/S of aortic stenosis and where is this heard

Answer 70

Exertional dyspnea, increased pulm. ven. pressure, orthopnea, PND, pulm. edema, dizziness, syncope, angina pectoris, pulse pressure may be low Heard: lough systolic murmur over aortic area and apex of the left ventricle. Low pitched crescendo-deccrescendo, rough, rasping, and vibration.

Question 71

how does aortic stenosis lead to heart failure

Answer 71

left ventricle overcomes obstruction to emptying by contracting more slowly and with increased power, which leads to increased pressure on the left ventricle, as a result the ventricular wall thickens.