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NRSG 110: Med Surg 2 > [Exam 1] Chapter 29: Management of Patients with Complications from Heart Diseases (Page 818-833) > Flashcards

[Exam 1] Chapter 29: Management of Patients with Complications from Heart Diseases (Page 818-833) Flashcards

1
Q

What is heart failure?

A

Clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles to fill or eject blood

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2
Q

HF used to be referred as

A

congestive heart failure

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3
Q

Now, HF is recognized as a clinical lsyndrome characterized by signs and symptoms of

A

fluid overload or inadequate tissue perfusion.

Occurs when heart cannot generate CO sufficient to meet bodys demands.

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4
Q

HF is chronic, progressive condition that is managed with lifestyle changes and medications to prevent episodes of

A

acute decompensated heart failure, characterized by increased symptoms, decreased CO, and low perfusion

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5
Q

Two major types of HF are identified by

A

assessment of left ventricular function, usually echo-cardiogram

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6
Q

Most common type of HF is

A

alteration in ventricular contraction called systolic heart failure, which is characterized by weakened heart muscle

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7
Q

Second most common type of HF is

A

diastolic heart failure, which is cahracterized by a stiff and noncompliant heart muscle making it difficult for the ventricle to fill

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8
Q

How is EF calculated?

A

Subtracting the amount of blood present in the left ventricle at the end of systole from the amount present at the end of diastole and calculating the percentage of blood that is ejected

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9
Q

Normal EF is

A

55-65% of ventricular volume

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10
Q

EF is normal in what Hf?

A

Diastolic, known as heart failure with preversed EF

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11
Q

what is Heart Failure Class I

A

No limitation of physication

Ordinary activity does not cause undue fatigue

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12
Q

What is Heart Failure Class II

A

Slight limitation of physical activity

Comfortable at rest, but oridinary activity causes fatigue

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13
Q

What is Heart Failure Class III

A

Marked limitation of physical activity

Comfortable at rest, but less than ordinary activity causes fatigue

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14
Q

What is Heart Failure Class IV

A

Unable to carry out any physical activity

Symptoms of cardiac insufficiency at rest

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15
Q

What can cause Myocardial dysfunction and HF?

A

Coronary Artery Disease

Hypertension

Cardiomyopathy

Valvular Disorders

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16
Q

What is the primary cause of HF?

A

Atherosclerosis of the coronary arteries and coronary artery disease is found in the majority of patients with HF

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17
Q

Ischemia causes myocardial dysfunction because

A

it deprives heart cells of oxygen and causes cellular damage

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18
Q

What does MI cause?

A

focal heart muscle necrosis

death of myocardial cells

loss of contractility

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19
Q

What does sytemic or pulmonary hypertension do to the body?

A

Increases afterload, which increases cardiac workload and leads to hypertrophy of myocardial muscle fibers

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20
Q

What does sustained hypertension do?

A

Eventually leads to changes that impair the hearts ability to fill properly during diastole, and hypertrophied ventricles may dilate and fail

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21
Q

What is Cardiomyopathy?

A

Disease of the myocardium. Various types lead to HF and dysrhythmias.

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22
Q

Most common type of cardiomyopathy?

A

Dilated cardiomyopathy which causes diffuse myocyte necrosis and fibrosis and commonly leads to progressive HF

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23
Q

Dilated Cardiomyopathy can result from

A

an inflammatory process such as myocarditis or from a cytotoxic agent.

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24
Q

Criteria for Stage A HF?

A

Patients at high risk for developing left ventricular dysfunction but without structural heart disease

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25
Q

Treatment for Stage A HF

A

Heart healthy lifestyle

RF control of hypertension, lipids, diabetes, obesity

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26
Q

Criteria for Stage B HF?

A

Patients with left ventricular dysfunction or structural heart disease who have not developed symptoms of HF

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27
Q

Treatment for Stage B HF

A

Implement Stage A

Ace Inhibitor
Beta Blocker
Statins

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28
Q

Criteria for Stage C HF

A

Patients with left ventricular dysfunction or structural heart disease with current or prior symptoms of heart disease

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29
Q

Treatment for Stage C HF

A

Stage A/B

Diuretics
Aldosterone Antagonist
Sodium Restriction
Implantable Defribilator

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30
Q

Criteria for STage D HF

A

Patients with refractory end-stage HF requiring specialized interventions

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31
Q

Treatment for Stage D HF

A

A,B,C

Fluid restriction

End-of-life care

Extraoridnary measures

Inotropes

Cardiac Transplantion

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32
Q

Valvular heart disease is also a cause of HF. With Vascular dysfunction it becomes difficult to

A

move the blood forward, increasing pressure within the heart and increasing cardiac workload, leading to HF

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33
Q

What does cardiorenal syndrome describe?

A

How dysfunction in one of these systems leads to dysfunction in the other, resulting in increased morbidity and mortality

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34
Q

Significant myocardial dysfunction usually occurs before the patient experiences signs and symptoms of HF such a

A

shortness of breath, edema, or fatigue

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35
Q

As HF develops, body activtes what to fight back?

A

Neurohormonal comensatory mechanisms which represent bodys attempt to cope with the HF.

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36
Q

Systolic HF results blood doing what?

A

Decreased blood ejected from the ventricle

Sensed by baroreceptors. Sympathetic nervous sytem is then stimulated to release epinephrine and norepinephrine.

Purpose is to increase HR and contractility but has multiple negative effcts

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37
Q

Negative effects of epinephrine and norepinephrine cause what to the body?

A

Vasocontriction in the skin, GI Tract, Kidneys

Causes release of REnin to release Angiotensin II to increase blood pressure. Leads to fluid volume overload

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38
Q

When the cardiac chambers are overdistended, what is released?

A

ANP and BNP

Promote vasodilation and diuresis.

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39
Q

As the hearts worklkoad increases, contractility of the myocardial muscle fibers…

A

decreases

This results in an increase in end-diastolic blood volume in teh ventricle , stretching the myocardial muscle and increasing size of ventricles

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40
Q

Heart compensates for increased workload by

A

increasing the thickness of the heart muscle but leads to abnormal changes known as ventricular remodeling

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41
Q

Signs and Symptoms of HF related to

A

congestion and poor perfusion and the ventricle that is mosst affected

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42
Q

Left sided heart failure causes different manifesttions than

A

right-sided heart failure

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43
Q

Left-Sided Heart Failure: Pulmonary congestion occurs when

A

left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation

Increased volume increase pressure which decreases blood flow

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44
Q

Left-Sided Heart Failure: The blood volume and pressure build up in left atrium, decreasing

A

flow through the pulmonary veins into the left atrium . Pulmonary venous blood volume and pressure increase in the lungs, forcing fluid into pulmonary capilaries into pulmonary tissue and alveoli causing edema and impaired gas exchange

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45
Q

Left-Sided Heart Failure: Clinical manifestations of Pulmonary Congestion include

A

dyspnea, cough, pulmonary crackles, and low oxygen saturation levels

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46
Q

Left-Sided Heart Failure: Pulmonary Congestion and Heart Sounds

A

You may be able to hear S3

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47
Q

Left-Sided Heart Failure: With minimal to moderate activity, what may happen?

A

Dyspnea or shortness of breath

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48
Q

Left-Sided Heart Failure: Difficulty with Orthopnea, which is

A

difficulty breathing when lying flat.

Use pillows to prop themselves up in bed.

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49
Q

Left-Sided Heart Failure: SOme patients have Paroxysmal Noctural Dyspnea (PND) which is when

A

some patients have sudden attacks of dyspnea at night

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50
Q

Left-Sided Heart Failure: Problem with fluid that accumulates during the day and is reabsorbed at night?

A

LV cannot eject the increased circulating blood volume, the pressure in the pulmonary circulation increases , shifting fluid into the alveoli. Thus cannot exchange oxygen and CO2

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51
Q

Left-Sided Heart Failure: Cough with this is usually

A

Dry and nonproductive. Most complain of dry hacking cough that may be mislabed as asthma. Pink frothy sputum indicated acute decompensated HF with pulmonary edem

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52
Q

Left-Sided Heart Failure: Lung sounds

A

As it progresses, the crackles can be ausculted throughout the lung fields

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53
Q

Left-Sided Heart Failure: Amount of blood ejected from left ventricle decreases, leading to

A

inadequate tissue perfusion

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54
Q

Left-Sided Heart Failure: With a reduced CO and catecholamines decreases blood flow to the kidneys , urine output

A

drops.

Renal perfusion pressure falls nd RAAS is stimulated to increase blood pressure and intravascular volume.

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55
Q

Left-Sided Heart Failure: AS HF progresses, decreased output from left ventricle may cause other symptoms such ass

A

Decreased GI Perfusion

Decreased brain perfusion causes dizziness, lightheadness, confusion, restlessness, and anxiety due to decreased oxygen

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56
Q

Left-Sided Heart Failure: Decrease in SV causes the sympathetic nervous system to

A

increase the heart rate, often causing the patient to complain of palpitaitons

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57
Q

Right-Sided Heart Failure: When the right ventricle fails, congestion in the peripheral tissues and the viscera

A

predominates

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58
Q

Right-Sided Heart Failure: Peripheral tissues and viscerea predominates because

A

right side of the heart cannot eject blood effectively and cannot accommodate all of the blood that normally returns to it from the venous circulation

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59
Q

Right-Sided Heart Failure: Increased venous pressure leads to

A

jugular venous distention and increased capillary hydrostatic pressure throughout the venous system

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60
Q

Right-Sided Heart Failure: Systemic clinical manifestations include

A

edema of the lower extremities, hepatomegaly, ascites (accumulation of fluid in the perioneal cavity) and weight gain due to retention of fluid

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61
Q

Right-Sided Heart Failure: Edema usually affects

A

the feet and ankles and worsens when the patient stands or sits for a long period . Edema may decrease when patients elevate the legs

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62
Q

Right-Sided Heart Failure: Edema can progress to

A

The legs and thighs and eventually into the external genitalia and lower trunk

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63
Q

Right-Sided Heart Failure: Ascites evidenced by

A

increased abdominal girth and may accompany lower ody edema

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64
Q

Right-Sided Heart Failure: Sacral edema common on those who are on

A

bed rest, because sacral area is dependent

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65
Q

Right-Sided Heart Failure: Pitting edema is obvious after retention of how much fluid?

A

10 lb (4.5 L)

66
Q

Right-Sided Heart Failure: Hepatomeagaly and tenderness in right upper quadrant result from

A

venous engorgement of the liver.. May interefere with ability to function.

May force fluid into abdominal cavity

67
Q

Right-Sided Heart Failure: What else can come from venous engorgement?

A

Anorexia, Nausea, or Abdominal Pain

68
Q

HF may go undeteced until patient presents with

A

signs of pulmonary and peripheral edem a

69
Q

HF may also occur with other diseases, such as

A

kidney injury and COPD

70
Q

What is an essential part of the initial diagnostic workup?

A

Assessment of ventricular function. Echocardiogram is usually performed to determine EF, identify anatomic feaures such as structural abnormalities

71
Q

HF information may be obtained noninvasively by

A

radionuclide ventriculography or invasively by ventriculography

72
Q

Lab Studies for HF?

A 
Serum Electrolytes
BUN
Creatinine
Liver Function Tests
TSH
CBC
BNP
73
Q

What lab is a key diagnostic indicator of HF?

A

BNP

High levels are a sign of high cardiac filling pressure and can aid in diagnosis and managmenet of HF

74
Q

Medical Management: Goal of management of HF is to

A

relieve patient symptoms, to improve functional status and quality of life

75
Q

What drugs are prescribed for HF?

A

ACE Inhibitors

Beta-Blockers

Diuretics

76
Q

Angiotensin-Converting Enzyme Inhibitor: What do they relieve and help?

A

Relieve the signs and symptoms of HF especially in those with a left ventricular EF less than 35%.

77
Q

Angiotensin-Converting Enzyme Inhibitor: What do these accomplish?

A

Slow progression of HF, improve exercise tolerance and decrease number of hospitalizations

78
Q

Angiotensin-Converting Enzyme Inhibitor: What do they promote?/

A

Vasodilation adn diuresis , ultimately decreasing afterload and preload

79
Q

Angiotensin-Converting Enzyme Inhibitor: Vasodilation reduces resistance to

A

left ventricular ejection of blood, dimishing the hearts workload and improve ventricular emptying .

80
Q

Angiotensin-Converting Enzyme Inhibitor: Decrease the secretion of

A

aldosterone, a hormone that causes kidneys to retain sodium adn water. Also promote excretion of sodium and fluid thereby reduing left ventricular filling presure

81
Q

Angiotensin-Converting Enzyme Inhibitor: First medication prescribed for patients with

A

mild failure

82
Q

Angiotensin-Converting Enzyme Inhibitor: Dosage?

A

Started on low dose that is gradually increased until optimal dose is achieved and patient is hemodynamically stable

83
Q

Angiotensin-Converting Enzyme Inhibitor: Monitored for

A

hypotension, hyperkalemia , and alterations in renal function. Because they retain potassium, you don’t need potassium supplements

84
Q

Angiotensin-Converting Enzyme Inhibitor: Other adverse effects include

A

dry, persistent cough that may not respond to cough suppressants

85
Q

Angiotensin Receptor Blockers: Difference between this and ACE inhibitors?

A

ACE inhibitors block conversion of angtiotensin I to angiotensin II, ARBs block the vasoconstricting eftcts of angiotensin II at the angiotensin II receptors

86
Q

Hydralazine and Isosorbide Dinitrate: This commincation is another alternative for those who cannot take

A

ACE inhibitors

87
Q

Hydralazine and Isosorbide Dinitrate: Nitrates cause

A

venous dilation, which reduces the amount of blood return to the heart and lowers preload

88
Q

Hydralazine and Isosorbide Dinitrate: Hydralazine lowers

A

systemic vascular resistance and left ventricular afterload.

89
Q

Hydralazine and Isosorbide Dinitrate: May be more effective for what population?

A

Africa Americans who do not respond to ACE Inhibitors

90
Q

Beta Blockers: These are considerd to be a

A

first-line therapy and are routinely prescribed in addition to ACE inhibitors

91
Q

Beta Blockers: They block the adverse effects of

A

sympathetic nervous ystem

92
Q

Beta Blockers: Effect on body?

A

RElax blood vessels, lower blood pressure, decrease afterload, and decrease cardiac workload.

Impove functional status and reduce mortality and morbidity in patients with HF

93
Q

Beta Blockers: Recommended for patients with

A

aymptomatic systolic dysfunction , such as those with decreased EF.

94
Q

Beta Blockers: Therapeutic Effects may not be seen for

A

several weeks or even months

95
Q

Beta Blockers: Side effects?

A

Dizziness, hypotension, bradycardia, fatigue, and depresion

96
Q

Beta Blockers: Side effects most common in what time frame?

A

Initial few weeks of treatment . Because of that, started at low doses

97
Q

Beta Blockers: Since they can cause bronchiole constriction, drugs used in caution for those with

A

caution in patients with a history of bronchospastic diseases such as uncontroleld asthma

98
Q

Diuretics: Prescribed to remove excess

A

extracellular fluid by increasing rate of urine produced in patients with signs of fluid overload. Use smallest dose possible

99
Q

Diuretics: Which ones may be prescribed for someone with HF?

A

Loop, thiazide, and aldosterone blocking

100
Q

Diuretics: Loop diuretics inhibit

A

sodium and chloride reabsorption mainly in the ascending loop of Henle.

101
Q

Diuretics: HF patients with severe volume overload treated with what first?

A

Loop diuretic.

102
Q

Diuretics: Thiazide diuretics inhibit

A

sodium and chloride reabsorption in the early distal tubules.

103
Q

Diuretics: What must be monitored in those taking loop and tiazide diuretics

A

Potassium levels, because they both increase pottasium excretion

104
Q

Diuretics: Need for diureitcs canbe decreased if

A

patient avoids excessive fluid intake and adhere to low sodium diet

105
Q

Diuretics: What do Aldosterone Antagonists do?

A

They are potassium-sparing diuretics that block the effects of aldosterone in the distal tubule and collecting duct. REduce mortality in in patients with moderate to severe HF

106
Q

Diuretics: Whats monitored with Aldosterone Antagonists?

A

Serum creatinine and potassium levels. Not prescribed for those with elevated creatinine

107
Q

Diuretics: When would loop diuretics be administered by IV

A

for exacerbations of HF when rapid diuresis is necessary

108
Q

Digitalis : What does this do?

A

Increases the force of myocardial contraction and slows conduction through the atrioventricular node. Improves contractility , increasing left ventricular output.

109
Q

Digitalis : Effective in

A

decreasing the symptoms of HF and preventing hospitiliazation

110
Q

Digitalis : Key concern with this is

A

toxicity

111
Q

Digitalis : clinical manifestations of toxicity include

A

Anorexia, Nausea, Visual Disturbances, Confusion, And Bradycardia

112
Q

Digitalis : What is monitored here?

A

Serum potassium because digoxin enhanced in presence of hypokalemia and digitalis toxicity may occur

113
Q

Intravenous Infusions: What do they do?

A

Increase the force of myocardial contractions and may be indicated for hospitalized patients with acute decompensated HF

114
Q

Intravenous Infusions: This is used for those who do not respond to

A

routine pharmacologic therapy and are reserved for patients with severe ventrircular dysfunction

115
Q

Intravenous Infusions: Requirements for this??

A

Admission to ICU and may also have hemodynamic monitoring with pulmonary artery catheter

116
Q

Intravenous Infusions: Who would be candiate to have this at home?

A

End-stage HF who cannot be weaned.

117
Q

Milrinone: What is this?

A

Phosphodiesterase inhibitor that leads to an increase in intracellular calcium within myocardial cells, increasing their contractility

118
Q

Milrinone: Agent promotes

A

vasodilation resulting in decreased preload and afterload and reduced cardiac workload

119
Q

Milrinone: Administered IV to patients with

A

severe HF, including those waiting for heart transplant

120
Q

Milrinone: What is monitored?

A

Blood pressure because drug can cause vasodilation

121
Q

Milrinone: Major side effects are

A

hypotension and increased ventricular dysrhythmias.

122
Q

Dobutamine (IV) : Given to those with

A

significant left ventricular dysfunction and hypoperfusion.

123
Q

Dobutamine (IV) : Major action?

A

Increases the heart rate and can precipitate ectopic beats and tachydysrhythmias

124
Q

What is done for patients with predominant diastolic HF?

A

Hypertension and ischemic heart disease are evaluated and treated . They do not tolerate tachycardiai because it does not alow time for ventricular filling . Patients given beta blockers to control tachycardia

125
Q

When would anticoagulants be prescribed?

A

When the patient has a history of atrial fibrillation or thromboembolic event.

126
Q

NSAIDS should be avoided because

A

they decrease renal perfusion especially in oldere adults

127
Q

Nutritional Therapy for HF?

A

Following a low sodium and avoiding excessive fluid intake

128
Q

Nutritional Therapy: Purpose of sodium restriction is to

A

decrease the amount of circulating blood volume, which decreaes myocardial work which reduces fluid retention

129
Q

Other Interventions: If patient with HF has other underlying heart diseases, what may be considered?

A

coronary artery bypass surgery may be considered

130
Q

Other Interventions: Patients with HF who do not improve with standard ttherapy, may benefit from

A

cardiac resynchronization therapy, which invovles use of biventricular pacemaker to treat electrical conduction defects

131
Q

Other Interventions: Prolonged QRS duration indicates

A

a left bundle branch block, which is a type of delayed conduction seen in those with HF

132
Q

Other Interventions: Why would a pacing device be used in CRT?

A

Leads placed on left ventricular cardiac vein, right ventricle, and right atrium can synchronize the contractions of right and left ventricals to improve CO, optimize myocardial energy consumption and reduce mitral regurgitation

133
Q

Other Interventions: What is Ulrafiltration?

A

Alternative intervention for patients with severe fluid overload. Reserved for those with severe HF who are resistant to diureti ctherapy

134
Q

Other Interventions: How is Ultrafiltration performed?

A

Dual lumen central iv catheter is placed and patients blood is circulated through small bedside filtrtion machine

135
Q

Other Interventions: Whats monitored in Ultrafiltration?

A

Patients output of filtration fluid, blood pressure, and hemoglobin

136
Q

Nursing Process - Assessment: Focuses on

A

observing for effectiveness of therapy and fo rthe aptients ability to understand and implement self-management strategies.

137
Q

Nursing Process - Assessment , Health History: Focuses on

A

signs and symptoms of HF, such as dyspnea, fatigue, and edema

138
Q

Nursing Process - Assessment , Physical Examination: Observed for

A

REstlessness and anxiety that might suggest hypoxia from pulmonary congestion. LOC and RR also assessed.

139
Q

Nursing Process - Assessment , Physical Examination: Blood pressure carefully evaluated because

A

HF patients may present with hypotension or hypertension

140
Q

Nursing Process - Assessment , Physical Examination: Patient is ausculated for

A

S3 heart sound, which is an early sign that increased blood voume fills the ventricle with each beat

141
Q

Nursing Process - Assessment , Physical Examination: Abdomen examined for

A

tenderness and hepatomegaly

142
Q

Nursing Process - Assessment , Physical Examination: Patient asked to breathe normally while manual pressure is appleid over right upper quadrant. What is monitored for?

A

neck vein distention

143
Q

Nursing Process - Diagnosis: Potential complications include

A

Hypotension
Dysrhythmias
Thromboembolism
Pericardial Effusion

144
Q

Nursing Process - Planning: Major goals for patient are

A

promiting activity and reduciing fatigue, relieving fluid overload symptoms, decreasing anxiety and increasing patients ability to manage anxiety

145
Q

Nursing Process - Nursing Interventions, Promoting Activity Tolerance: Reduced physical activity leads to

A

Physical deconditioning that worsens te patients symptoms and exercises tolerance

146
Q

Nursing Process - Nursing Interventions, Promoting Activity Tolerance: Inacitivty risks include

A

pressure ulcers and venous thromboembolism

147
Q

Nursing Process - Nursing Interventions, Promoting Activity Tolerance: Exercise has many favorable effects for HF patient, including

A

increased functional capcity, decreased dyspnea, and improved quality of life

148
Q

Nursing Process - Nursing Interventions, Promoting Activity Tolerance: Referal to what may be recommended for newly diagnosed with HF

A

cardiac rehabilitation

149
Q

Nursing Process - Nursing Interventions, Managing Fluid Volume: Those with severe HF may receieve

A

IV diuretic therapy

150
Q

Nursing Process - Nursing Interventions, Managing Fluid Volume: Those with less severe symptoms are typally prescribed

A

oral diuretics

Should be given in morning so that diuresis does not interefere with nightitme rest

151
Q

Nursing Process - Nursing Interventions, Managing Fluid Volume: Fluid status is monitred closely by

A

ausculating the lungs, monitoring daily body weight and assisting the patient to adhere to low sodium diet

152
Q

Nursing Process - Nursing Interventions, Managing Fluid Volume: Teaching the patient about being positioned upright does what to the body?

A

Preload is reduced

Pulmonary congestion reduced

Pressure on diaphragm redued

153
Q

Nursing Process - Nursing Interventions, Controlling Anxiety: What does the nurse do when patient experineces anxiety?

A

Nurse takes steps to promote physical comfort, and provides psychological support.

154
Q

Nursing Process - Nursing Interventions, Minimizing Powerlessness: Contributing factors to this include

A

Lack of knowledge and lack of opportunity to make decisions, particularly if health care providers or family member sod not encourage the patient to participate in the treatment

155
Q

Nursing Process - Nursing Interventions, Assisting Patients and Family To Effectively Manage Health: What has shown to increase effectiveness of a discharge plan?

A

Comprehensive, Patient Centered Instructions

Scheduling PAtient Follow Up Visits within 7 days

Follow up by telephone 3 days after

156
Q

Nursing Process - Nursing Interventions, Monitoring and Managing Potential Complications: Because HF is a complex and progressive condition, pateints are at risk for many complications include

A

acute decompensated HF

Pulmonary Edema

Kidney Injury

Life threatening dysrhythmias

157
Q

Nursing Process - Nursing Interventions, Monitoring and Managing Potential Complications: Excesive and repeated diuresis can lead to

A

hypokalemia . with signs indicating dysrhythmias, hypotension, muscle weakness, and generalized weakness

158
Q

Nursing Process - Nursing Interventions, Monitoring and Managing Potential Complications: In patients receiving digoxin, hypokalemia can lead to

A

digitalis toxicity which increases likelihood of dangerous dysrhythmias

159
Q

Nursing Process - Nursing Interventions, Monitoring and Managing Potential Complications: Hypokalemias may occur especially with use of

A

ACE Imhibtors, ARBs, or spironolactone

160
Q

Nursing Process - Nursing Interventions, Monitoring and Managing Potential Complications: Prolonged diuretic therapy may produce

A

hyponatremia which can result is disorientation

161
Q

Nursing Process - Nursing Interventions, Monitoring and Managing Potential Complications: Volume depletion from excessive fluid may lead to

A

dehydration and hypotension . Also ACE Inhibitors and beta blockers

NRSG 110: Med Surg 2 (29 decks)

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