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Gerontological RN exam > Chapter 13. Cardiovascular Disease > Flashcards

Chapter 13. Cardiovascular Disease Flashcards

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0
Q

Modifiable risk factors for cardiovascular disease include?

A

Smoking, high blood pressure, high blood cholesterol, physical inactivity, obesity, and diabetes.

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1
Q

Nonmodifiable risk factors for cardiovascular disease include?

A

Age, gender, hereditary, Including race

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2
Q

Pre-hypertension is defined as a systolic blood pressure And the diastolic blood pressure of?

A

120-139 and 80-89 mmHg.

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3
Q

Stage one hypertension is defined as ?

A

SBP of 140-159 & DBP of 90-99. Stage two hypertension is anything higher than this.

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4
Q

Hypertension can be divided into systolic-diastolic or isolated systolic. Which is the most common in older adults accounting for 65 to 75% of cases?

A

Isolated systolic

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5
Q

What are the challenges of treating isolated systolic hypertension?

A

Treating systolic pressure to normal levels without lowering diastolic pressure too much is often difficult. Elevated systolic blood pressure raises the risk of stroke, myocardial infarction, left ventricular hypertrophy, renal dysfunction and cardiovascular mortality.

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6
Q

Secondary hypertension is caused by?

A

Secondary hypertension occurs because of another cause and is potentially correctable. Causes include medications, renal disease come, substances such as salt and street drugs, endocrine disease, And obstructive sleep apnea.

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7
Q

Essential hypertension accounts for about 95% of the cases of hypertension and is seen more commonly and in what groups of patients?

A

Obese patients, those with a family history of hypertension, and certain groups such as African-Americans

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8
Q

Any patient with a blood pressure over 120/80 should be educated on lifestyle modifications including?

A

Restricting salt, moderation of alcohol, weight reduction, calcium and magnesium supplementation, smoking cessation, regular exercise, and stress management.

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9
Q

If lifestyle interventions do not bring blood-pressure into normal range what should be started?

A

Blood-pressure medications such as diuretics, beta blockers, calcium channel blockers, ace inhibitors etc.

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10
Q

Medications to treat blood pressure work best when?

A

They are used in combination with another medication. Combination of two drugs in low doses often work better than high doses of a single drug to lower blood pressure and lower dosing regimens can also minimize side effects. Often a diuretic is combined with a antihypertensive.

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11
Q

Some common side effects of beta blockers include?

A

Bradycardia, heart failure, bronchospasm, dyslipidemia, depression, insomnia, and fatigue.

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12
Q

Some common side effects of diuretics include?

A

Electrolyte abnormalities and orthostatic hypotension.

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13
Q

Common side effects with angiotensin-converting enzyme inhibitors include? (Captopril, lisinopril, enalapril).

A

Cough, angioedema, hyperkalemia, and acute renal failure with renal arteries stenosis .

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14
Q

Some common side effects with calcium channel blockers, Such as Amlodipine, diltiazem, and verapamil, include?

A

Adema, tachycardia, headache, and heart block.

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15
Q

Some common side effects with Alpha blockers such as terazosin and doxazosin include?

A

Postural blood pressure, dry mouth, and fatigue.

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16
Q

Common side effects for angio tension receptor blockers such as losartan and valsartan include?

A

Hyperkalemia and acute renal failure with renal artery stenosis.

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17
Q

What percentage of existing and new cases of heart failure occur in people over age 65?

A

75%

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18
Q

In heart failure reduced renal bloodflow leads to the activation of?

A

Renin angiotensin aldosterone system RAAS.

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19
Q

Heart failure is classified by?

A

Functional status using the New York heart Association’s classification.

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20
Q

Class one heart failure Is defined as?

A

No symptoms with regular activity.

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21
Q

Class two heart failure is defined as?

A

Mild symptoms with ordinary daily activity.

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22
Q

Class III heart failure is defined as?

A

Comfortable only at rest, symptoms with mild activity

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23
Q

Class 4 heart failure is defined as?

A

Symptoms at rest

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24
Q

Based on the American Heart Association and American College of cardiology class a heart failure is?

A

People at high risk for developing heart failure but who do not have heart failure or damage to the heart.

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25
Q

Stage B heart failure is?

A

People with damage to the heart but who have never had symptoms of heart failure, for example, those who have had a heart attack.

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26
Q

Stage C heart failure is defined as?

A

People with heart failure symptoms caused by damage to the heart, including shortness of breath, tiredness, inability to exercise.

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27
Q

Stage D of heart failure include?

A

People who have advanced heart failure and severe symptoms difficult to manage with standard treatment.

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28
Q

Systolic heart failure is primarily caused by?

A

Ischemic heart disease and myocardial infarction.

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29
Q

Diastolic dysfunction is primarily caused by?

A

Hypertension

30
Q

Systolic heart failure can be defined by a left ventricular ejection fraction of less then what percent?

A

<40%

31
Q

Diastolic heart failure occurs when?

A

When the ventricle is unable to fill with blood, most commonly because of a history of uncontrolled hypertension that leads to left ventricular hypertrophy. The thickened ventricles become stiff and noncompliant, leading to in adequate filling volumes and high filling pressures.

32
Q

Diastolic heart failure accounts for another one third of heart failure cases but predominates in what groups?

A

Older adults, especially women.

33
Q

Some common signs and symptoms of heart failure include?

A

Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, edema, weight gain, tachycardia, jugular vein distention, wheezing, crackles on long exam, S3 or S4 Gallup.

34
Q

Some common test performed to detect heart failure include?

A

Chest x-ray, 12 lead EKG, electrolyte panel, renal function tests, LFTs, urinalysis, CBC, thyroid function tests, BNP, echocardiogram, and cardiac stress test.

35
Q

Digoxins therapeutic range is?

A

0.5-0.8mg/dL. Signs and symptoms of toxicity include nausea vomiting diarrhea and halos around lights.

36
Q

What is the benefit of using diuretics in heart failure?

A

They improve vascular congestion by reducing volume overload and provide most immediate symptom relief.

37
Q

What is the benefit of using Ace inhibitors for heart failure?

A

They decrease activity of the RAAS. They reduce ventricular preload and afterload by causing vasodilation. They improve LVEF. They decrease LVH.

38
Q

What is the benefit of using beta blockers for heart failure?

A

They block the effects of circulating catecholamines (Nor epinephrine). They improve LVEF and reduce morbidity and mortality.

39
Q

What are the benefits of using digoxin in patients with heart failure?

A

They increase exercise capacity, improve tolerance and decrease hospitalizations. They are for patients with systolic heart failure who continue with symptoms despite Ace inhibitors, diuretics, & beta blockers (Standard therapy).

40
Q

What is the benefit of using spironolactone in heart failure?

A

It blocks aldosterone. It is indicated for class III or class IV heart failure. It decreases mortality and reduces hospitalizations.

41
Q

Verapamil/Diltiazem Are contradicted in what type of heart failure?

A

Contraindicated in systolic or combined heart failure. It is beneficial NPR diastolic heart failure. It decreases myocardial contractility

42
Q

Patients with heart failure should be educated on the following:

A

Limit sodium intake
Weigh themselves daily and record weight.
Report two and 3 pound weight gains Within 24-48 hours
Limit alcohol intake to one or two drinks a day
Avoid NSAIDs, Moderate fluid intake, exercise.

43
Q

Teach patients the following exacerbations of heart failure:

A 
Increased shortness of breath
Chest pain
Wheezing
Swelling in ankles
Inability to lie flat
44
Q

An acute coronary syndrome is caused by?

A

Rupture of an atherosclerotic Plaque that leads to either subtotal occlusion (unstable angina)or complete occlusion (MI) of a coronary artery.

45
Q

Myocardial ischemia Presents usually as angina, but it may have an atypical presentation in other groups such as older adults, those with diabetes, and women what might their symptoms be?

A

Shortness of breath, abdominal or back pain, Profound fatigue, or confusion.

46
Q

Treatment for an acute MI include?

A 
Morphine for pain
Oxygen
Nitroglycerin
Aspirin and beta blockers
Heparin
47
Q

An abnormal triglyceride result is?

A

> 150

48
Q

The following are risk factors for coronary vascular disease:

A

Smoking, hypertension, low HDL, family history of premature coronary vascular disease, age, -1 risk factor if HDL is equal or greater than 60.

49
Q

This scale ranks a person’s risk of having an acute MI based on the risk factors.

A

Framingham scores

50
Q

This class of cholesterol medication lowers triglycerides and raises HDL cholesterol

A

Fibrates such as gemfibrozil and fenofibrate or omega-3 acid ethyl esters.

51
Q

This cholesterol medication lowers LDL, raises HDL, and lowers TG’s

A

Statins, ex: Lovastatin, Simvastatin, and atorvastatin.

52
Q

This cholesterol medication lowers LDL and lowers triglycerides.

A

Zetia, a Cholesterol absorption inhibitor

53
Q

What effect does fish oil have on cholesterol?

A

Lowers triglycerides and raises HDL

54
Q

Some nonprescription therapy for reducing cholesterol include:

A

Increasing soluble dietary fiber, weight reduction, stress reduction, smoking cessation, exercise, soy protein, red rice yeast, and plants Sterols.

55
Q

Claudication, or pain with ambulation is often an initial warning sign of this disease process.

A

Peripheral arterial occlusive disease. It may also be the first indicator of arteriosclerosis. The presence of peripheral arterial occlusive disease is a marker for widespread Arteriosclerosis.

56
Q

This measurement can assist in determining the severity of peripheral arterial occlusive disease.

A

The ankle brachial index. Other diagnostic tests include lower extremity arterial segmental leg pressure study, CT angiogram, magnetic resonance angiogram, and arteriography.

57
Q

Nursing management for peripheral artery occlusive disease include:

A

Teach about smoking cessation, control of diabetes, Encourage blood pressure control and lipid management, teach about the prevention of foot ulcers, and teach patient about progressive walking to improve collateral circulation.

58
Q

Three medications a patient with PAOD may be started on :

A

An antiplatelet such as aspirin or Plavix, pentoxifylline, cilostazol.

59
Q

A progressive ambulation program for a patient with PAOD.

A

Walk a minimum of five days a week. Gradually increase the total amount of exercise time beginning at five minutes per day and increased to 30 to 45 minutes a day. Walk to the point of pain, then stop and rest until pain resolves.

60
Q

Venous insufficiency, varicose veins, venous ulceration and deep vein thrombosis are all part of?

A

Peripheral venous disease or PVD.

61
Q

venous insufficiency is the most common cause of?

A

Lower extremity swelling.

62
Q

Risk factors for venous insufficiency and varicose veins include?

A

Obesity, prolonged sitting or standing, tight-fitting garments, estrogen hormones, trauma, and family history

63
Q

Signs and symptoms of peripheral venous disease include?

A

Ankle and lower leg edema, reduced by leg elevation.
Aching or leg cramps.
Skin changes.

64
Q

The most effective therapy for venous insufficiency is?

A

To prevent swelling by using compression wraps Or venous compression stockings, applied first thing in the morning before the patient gets out of bed and removed at bedtime. A minimum of 20 mm Hg compression is required to effectively prevent swelling. periods of leg elevation, interspersed with exercise and walking are also helpful to reduce edema.

65
Q

Management of skin irritation and itching with peripheral venous disease can be managed using?

A

Emollient creams

66
Q

Treatment for sick sinus syndrome include?

A

Pacemaker to relieve pauses and treat bradycardia. Calcium channel or beta blockers to control rapid rates, once pacemaker is in place.

67
Q

Possible treatments for ventricular tachycardia

A

Beta blockers, amiodarone, implantable cardioverter defibrillator

68
Q

Atrial fibrillation causes a significant risk for?

A

Cerebrovascular accident or CVA. 15% of strokes occur in people with atrial fibrillation

69
Q

Some medications used to treat atrial fibrillation include:

A

Anticoagulants such as Coumadin, rhythm control medications such as amiodarone, rate control medications such as beta blockers or calcium channel blockers. Rhythm management may occur through synchronized cardioversion as well.

70
Q

This anticoagulant drug does not require INR monitoring.

A

Pradaxa (dabigatran)

71
Q

Patients on anticoagulants should be taught what regarding their diet?

A

They should be advised that dark green vegetables contain large amounts of vitamin K and can interfere with the action of the blood thinner. These foods should not be avoided but patient should keep their intake consistent from week to week.

72
Q

Should patients who are at risk of frequent falls or have cognitive impairments but administer their own medications be prescribed Coumadin?

A

No

Gerontological RN exam (15 decks)

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