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adult health nursing > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

what is the most common chronic disease in adults?

A

hypertension

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2
Q

normal BP

A

120/80

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3
Q

elevated BP

A

120s/ less than 80

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4
Q

HTN stage 1

A

130s/ 80s

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5
Q

HTN stage 2

A

140/90

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6
Q

hypertensive crisis

A

180/120

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7
Q

normal cardiac output

A

4-6 L

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8
Q

peripheral vascular resistance

A

resistance of arteries to blood flow

  • elasticity of arterial wall
  • diameter of arteries
  • blood viscosity
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9
Q

equation for BP

A

CO x PVR

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10
Q

what do signs and symptoms of hypertension indicate?

A

target organ damage has already occured

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11
Q

signs and symptoms of hypertension

A

headaches
fatigue
epistaxis
vision loss
chest pain
palpitations
SOB
renal failure
TIA, stroke = hemiplegia, speech difficulties

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12
Q

rate to deflate BP cuff

A

2-3 mm Hg per second

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13
Q

measuring BP considerations

A
  • avoid smoking, caffeine, activity 30 mins prior
  • empty bladder
  • both feet on ground
  • sit quietly for 5 mins
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14
Q

BP goal for hypertension

A

130/80

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15
Q

first line HTN medications

A
  • thiazides
  • ACE inhibitors
  • ARBs
  • Calcium channel blockers
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16
Q

second line HTN medications

A

other diuretics
beta blockers
alpha blockers
direct renin inhibitors
vasodilators

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17
Q

evidence of target organ damage in hypertensive emergency

A

MI
dissecting aortic aneurysm
intracranial hemorrhage

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18
Q

coronary arteries

A

Left main artery
Left anterior descending artery
Left circumflex artery
Right coronary artery

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19
Q

what kind of plaque is more dangerous?

A

a plaque with a thin cap because it is prone to rupture and cause embolic event

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20
Q

clinical manifestations of CAD

A

epigastric distress
SOB
radiating pain
angina

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21
Q

women’s manifestations of CAD

A

indigestion
N/V
palpitations
numbness
back pain

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22
Q

metabolic syndrome

A

Enlarged waist circumference
Elevated triglycerides
Low HDL
HTN
Elevated FBG

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23
Q

Normal lipid profile

A

cholesterol <200
triglycerides <150
LDL <100
HDL >40-50

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24
Q

medications for hyperlipidemia/ cholesterol

A

Statins
Fibrates
Bile acid sequestrants
cholesterol absorption inhibitor
PCSK9 agents

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25
Q

when to check blood sugar

A

wake up, before bed
before food
2 hrs after food

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26
Q

blood sugar targets

A

80-130 before meals
<180 after meals

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27
Q

why is tobacco bad for HTN

A
  • causes coronary artery vasoconstriction
  • increases oxidation of LDLs
  • increases clotting
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28
Q

angina precipitating factors: 4 Es

A

exertion
eating
emotional distress
extreme temps

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29
Q

angina symptoms

A

anxiety, doom
sweating
lightheadedness

also symptoms listed for CAD

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30
Q

normal troponin levels

A

< 0.034

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31
Q

ADRs to nitroglycerin

A
  • headache (think vasodilation in migraines)
  • tachycardia (compensating for hypotension)
  • flushing
  • hypotension
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32
Q

unstable angina vs MI

A

unstable angina = partial occlusion will progress to MI

MI = complete occlusion or vasospasm

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33
Q

EKG for NSTEMI

A

T wave inversion
ST depression
normal EKG

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34
Q

EKG for STEMI

A

ST elevation

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35
Q

EKG for unstable angina

A

normal EKG

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36
Q

Which conditions cause elevated troponin?

A

NSTEMI and STEMI

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37
Q

respiratory findings of acute coronary syndrome (Unstable angina and MI)

A

SOB
dyspnea
tachypnea
crackles

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38
Q

when should EKG be obtained

A

within 10 minutes of arrival to ED

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39
Q

how long does troponin stay elevated after MI?

A

two weeks

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40
Q

besides MI, what can cause elevated troponin

A

congestive heart failure
sepsis

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41
Q

what does elevated creatinine kinase indicate?

A

MI

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42
Q

when does elevated creatinine kinase peak?

A

within 24 hours of MI

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43
Q

myoglobin

A
  • heme protein that transports O2
  • increases for 1-3 hours of MI, peaks within 12 hours
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44
Q

how soon should artery be stented?

A

within 60 minutes of arrival for STEMI

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45
Q

when are thrombolytics used

A

when PCI is not available, should be given within 30 mins

46
Q

nursing interventions for acute coronary syndrome

A
  • assess VS and pain
  • establish 2 PIVs
  • EKG
  • draw labs for cardiac enzymes
  • prep for PCI
  • administer O2
47
Q

complications of acute coronary syndrome

A

pulmonary edema
heart failure
cardiogenic shock
dysrhythmias
cardiac arrest
pericardial effusion

48
Q

how many people will have heart failure at 40?

A

20%

49
Q

how to calculate stroke volume

A

End diastolic volume - End systolic volume

50
Q

ejection fraction

A

percentage of blood pumped out of the heart in one heartbeat

stroke volume / end diastolic volume

51
Q

HFrEF

A

systolic dysfunction

reduced ejection fraction r/t weakened heart muscle

ejection fraction <40%

52
Q

causes of systolic heart failure

A

cardiomyopathy
reduced blood supply d/t CAD
regurgitation or stenosis of valve disease
arrhythmia

53
Q

HFmrEF

A

Heart Failure mid ranged Ejection Fraction

ejection fraction 40-49%

54
Q

HFpEF

A

Heart Failure preserved Ejection Fraction

diastolic failure: heart can’t relax enough to fill with blood

ejection fraction >50%

55
Q

causes of diastolic heart failure

A

chronic HTN
aortic stenosis
cardiomyopathy (hypertrophic and restrictive)

56
Q

normal ejection fraction

A

around 60%

50-75%

57
Q

congestive heart failure

A

blood returning to the heart through the veins gets backed up

58
Q

left sided heart failure manifestations

A

SOB when lying down
pulmonary edema
- cough
- crackles
- wheezing
- pink sputum
- tachypnea

59
Q

right sided heart failure manifestations

A
  • edema in legs and ankles
  • GI symptoms due to fluid in abdominal organs
  • hepatospelnomegaly
  • ascites d/t liver congestion
  • JVD
60
Q

compensated vs decompensated HF

A

compensated - heart works well enough you don’t notice symptoms
decompensated - worsening signs and symptoms

61
Q

preload

A

stretching of myocardium during ventricular filling

62
Q

afterload

A

force needed to eject blood from ventricles

63
Q

how do beta blockers help heart failure

A

improve cardiac contractility

64
Q

how do angiotensin receptor neprilysin inhibitors help heart failure

A

relax blood vessels and decrease BP so blood can be pumped more easily

65
Q

VAD

A
  • ventricular assistive device
  • supports failing ventricles
66
Q

ICD

A

detects and corrects arrhythmias

67
Q

OTC meds to avoid in heart failure

A

NSAIDs
pseudophedrine etc SNS stimulants

68
Q

mortality for heart failure

A

20% die within 1 year of diagnosis

69
Q

when to notify provider of fluid gain

A

3 lbs in one day
5 lbs in one week

70
Q

sodium intake

A

most adults consume >3400 mg sodium

recommendation of 2300 mg limit

HF patients limit of 2000 mg

71
Q

caring for HF patients

A

daily weights
track I/Os

72
Q

valvular disease

A

stenosis or prolapse = regurgitation

73
Q

what two valves are more likely to have vavular disorders?

A

aortic and mitral because they are on the left side

74
Q

mitral stenosis

A

sluggish blood flow into left ventricle d/t hardening

atrial pressure increases

pulmonary congestion

75
Q

mitral regurgitation

A

blood flows backwards because leaflets don’t close completely

atrial pressure increases

pulmonary congestion

76
Q

effects of both aortic stenosis and regurgitation

A

left ventricular hypertrophy

left ventricular failure

pulmonary congestion

77
Q

valvular disorder risk factors

A

calcification with age
endocarditis
congenital
rheumatic fever
pregnancy d/t increased fluid volume
smoking
high lipoprotein
hypertension

78
Q

cardinal sign of valvular disorder

A

new murmur

other symptoms are same as HF

79
Q

identifying valvular disease

A

new murmur
EKG
echo
cardiac cath

80
Q

surgical treatment of valvular disease

A

valve repair: vavluloplasty or commissurotomy
replacement: open heart or TAVI

81
Q

who gets heterographs?

A

childbearing age women
patients >70 years
bleeding disorders
medication non-compliance

82
Q

how long do heterographs last?

A

7-15 years

83
Q

how long do mechanical valves last?

A

life long, with use of anticoagulants

84
Q

normal INR vs INR goal for warfarin

A

normal: 1
warfarin goal: 2-3

85
Q

dilated cardiomyopathy

A

muscle becomes thin and weak

86
Q

hypertrophic cardiomyopathy

A

thickening of both ventricles and septum

87
Q

restrictive cardiomyoathy

A

left ventricular hypertrophy

88
Q

risk factors for cardiomyopathy

A

viral infections

the rest are same as valvular disorders:
DM, HTN, high lipoprotein, genetics, pregnancy, sedentary, smoking, alcohol, cocaine, chemo

89
Q

cardiomyopathy symptoms

A

angina and HF symptoms

90
Q

LVAD

A

bridge to heart transplant

91
Q

where is cardiac cath inserted?

A

femoral or radial

92
Q

why is there risk of kidney injury with cardiac cath?

A

contrast dye is nephrotoxic

93
Q

DES

A

drug-eluted stent
endothelium will grow to cover stent
high risk for thrombus formation, requires ASA for life

94
Q

what is given IV during cardiac cath?

A

heparin

95
Q

what is used to prevent uncontrolled bleeding during cardiac cath?

A

vascular closure device

96
Q

care for after cardiac cath

A

bedrest 2-4 hours
EKG
telemetry
VS Q15 min x4, Q30 min x4, Q1 hr
analgesics - no NSAIDs
monitor for bleeding
monitor UOP - kidney risk
CSMTs
Neuro assessment

97
Q

CSMTs

A

circulation/color
sensation
movement
temperature

98
Q

complications of cardiac cath

A

CA dissection
perforation
vasospasm, arterial occlusion
MI, cardiac arrest
dysrhythmia
bleeding at insertion site, hematoma
retroperitoneal bleeding
AKI

99
Q

where does graft come from for CABG?

A

mammary arteries
greater saphenous vein

100
Q

care after CABG

A

pulmonary toileting and PAIN CONTROL
insulin to prevent hyperglycemia and sternal wound infection
ambulation ASAP when safe
ongoing neuro, cardiac, resp eval
strict I/Os
CSMTs
labs

101
Q

most common organisms to cause endocarditis

A

strep and staph aureus

102
Q

risk factors for endocarditis

A

prosthetic heart valves
congenital defects
IVDA
immunodeficiency
intravascular access device
surgeries and dental procedures
body piercing and tattoos

103
Q

s/sx of endocarditis

A

weight loss
night sweats
new or changing murmur
osler’s nodes (swollen finger tips)
janeway lesions (red marks on palms)
roth spots (bacterial clumps in eyes)
splinter hemorrhages (streaks under nails)
fever, fatigue, confusion, rigors

104
Q

identifying endocarditis

A

echo
blood cultures
EKG

105
Q

managing endocarditis

A

prophylactic antibiotics for high risk patients
4-6 weeks IV antibiotics in PICC
valve repair or replacement

106
Q

pericarditis

A

inflammation of sac around the heart

107
Q

normal amount of pericardial fluid

A

10-50 mL

108
Q

causes of pericarditis

A

pathogens - bacterial, viral, fungal
renal failure
aortic dissection
MI
cancer
50% idiopathic

109
Q

s/sx pericarditis

A

friction rub
fever
SOB
sweating
chest pain
ST elevation and PR depression
pericardial effusion

110
Q

pericarditis treatment

A

Pericardiocentesis
pain managements
NSAIDs - colchicine
steroids to reduce inflammation

adult health nursing (10 decks)

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