EXAM 2 Flashcards
1
Q
what is the normal ejection fraction?
A
55-70%
2
Q
what is considered a reduced ejection fraction?
A
less than 45%
3
Q
an ejection fraction greater than 45% is good or bad?
A
good
4
Q
what is the ejection fraction for left-sided heart failure?
A
reduced less than 45%
5
Q
what are the signs and symptoms of left sided heart failure?
A
SOB, tachypnea, low PaO2, tachycardia, orthopnea, crackles, fatigue, poor color, weak pulses, cool extremeties, mottling
6
Q
what are the signs and symptoms of right-sided heart failure?
A
JVD, generalized edema, hepatomegaly, ascites
7
Q
left sided HF can cause
A
right-sided HF
8
Q
what are the symptoms of a pulmonary edema?
A
pink frothy sputum
9
Q
WHAT ARE THE SYMPTOMS OF CHRONIC HF
A
fatigue dyspnea, orthopnea, paraoxysmal nocturnal dyspnea, cough, increased hr, a fib, edema, jvd, uo changes
10
Q
if your pt has a pink frothy sputum, what should you do?
A
apply oxygen, IV diuretics, CPAP or BiPAP
11
Q
what are the diagnostic studies for chronic heart failure?
A
echo
12
Q
what lap should you get for heart failure?
A
proBNP (most specific), cardiac biomarkers, chem 7 or 12
13
Q
what does an echo show?
A
ejection fraction
14
Q
what is the first line treatment for chronic heart failure?
A
diuretics
15
Q
what should you watch for with fureosemide?
A
potassium, urinary output, weight loss
16
Q
what are some diuretics that could be used?
A
lasix IVP or spironolactone
17
Q
what are the types of treatments for chronic heart failure?
A
diuretics, vasodilators, positive inotropes, ace inhibitors, ARBS, angiotensin receptors, aldosterone antagonists, beta-blockers
18
Q
when do you use vasodialators for HF pt?
A
in absence of hypotension
19
Q
how do vasodialators help hf patients?
A
reduces preload
20
Q
A
21
Q
what are some examples of positive inotopes?
A
digoxin
22
Q
what should you watch for when you give positive inotopes (digoxin)?
A
vision disturbances
23
Q
what is an adverse reaction with ace inhibitors?
A
angioedema
23
Q
what do ace inhbitors end in?
A
pril
24
what are the side effects of ace inhibitors?
low bp, dry hacky cough, high potassium, renal insufficiency
25
when do you give ARBS?
for tps that cannot tolerace ACE inhibitors
26
how do arbs work?
decrease afterload and promotes vasodilation
27
what do arbs end in?
sartan
28
when would you give angiotensin receptors?
when BNP is greater than 100
29
what are some examples of angiotensin receptors?
valsartan/sacubiltril
30
how do beta blockers work?
decrease heart rate and myocardial workload/afterload
31
what are some aldosterone antagonists?
spironolactone
32
what surgical management is used for pts with chronic heart failure?
internal cardiac defibrilator and pacemaker for dysrhythmia control
33
what is important for hf patients to do?
daily weights
34
when should you report weight gain?
1 kg in a day or 2 kg in a week
35
what type of diet is someone with heart failure on?
low sodium 1600 mg day
36
what is important to remember that heart failure patients cannot take?
NSAIDSw
37
what are the complications of heart failure?
pulmonary edema
37
what action should you do for your patient with heart failure?
elevate hob
38
what are the symptoms of pulmonary edema?
pink frothy sputum
38
when should you start the blood infusion/
30 minutes of obtaining blood from the lab
39
when should you obtain vital signs of someone with a blood transfusion/
after first 5 minutes then 15 minutes then 30 min for an hour, then hourly
40
what are the signs and ysmpotms of a reaction to the blood transfusion?
fever, chills, flank pain, chest pain
41
hypertension has a major risk factor for developing?
vision loss
42
if you suspect a transfusion reaction what should you do?
stop infusion, get vital signs, get ns bag and infuse, and notify HCP
43
what race has a greater chance of developing hypertension?
african americans
44
what are the risk factors for hypertension?
smoking, obesity, inactivity, excessive alcohol usewhat
45
are the signs and symptoms of hypertension?
headaches, vision changes, SOB, nosebleeds
45
what is hypertension stage 1?
130-139/80-89
46
what is elevated blood pressure?
120-129/ less than 80
47
what is normal blood pressure?
120/80
48
what is hypertension stage 2?
140 or higher/ 90 or higher
49
what is a hypertensive crisis?
higher than 180/ higher than 120
50
what lifestyle changes should you make regarding hypertension?
control cholesterol, eat dash diet, ldl lower than 100
51
what is a DASH diet?
fruits, veggies, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, nuts
52
how many drinks can men and women drink a day?
men: 2 or less ; women: 1 or less
53
what medications are given to pts with hypertension?
diuretics, calcium channel blockers
54
how much exercise should someone with hypertension be doing a week?
90-150 minutes/week or 30 min a day
55
what diuretic is given for hypertension?
thiazide, calcium channel blockers, ace inhibitors, arbs
56
what should you monitor for with thiasize?
hypotension, low potassium
57
what should you avoid when taking a calcium channel blocker?
avoid grapefruit juice
58
what do ace inhibitors do?
block formation of angiotensin Ii
59
what do ace inhibitors end in ?
pril
60
what do arbs end in?
sartan
61
how do arbs wrok?
blocks action of angiotensin 2
62
how long do arbs take to wrok
3-6 weeks
63
what should you use in a hypertensive crisis?
iv vasodilator hydralazine
64
what are the signs and symptoms of peripheral artery disease?
muscle pain-ache, cramp, numbness
65
what is the goal of a hypertension emergency?
reduce bp by 20-25% over 24 hours
66
for an ankle-brachial index, what needs to be treated?
anything less than 0.9
67
what is the most effective exercise for individuals with claudications?
walking
68
what is the treatment of peripheral artery disease?
prevent progression of disease
69
what are the signs and symptoms of deep vein thrombosis?
pain, swelling, tenderness, discoloration, redness, warmth
70
what is the number 1 thing to do to prevent dvt?
ambulation
71
what anticoagulants are given for pts with dvts?
unfractionated heparin, low molecular weight heparin, warfarin
72
what are the signs and symptoms of a pulmonary embolism?
sob, low o2 sat, high hr, low bp, sweating, chest pain, hemoptysis
72
what are the complications of a dvt?
pulmonary embolism/
73
what does the skin look like for chronic venous insufficiency
brownish leathery skin discoloration
74
how does the wound bed appear for chronic venous insufficiency?
"ruddy" or beefy not punched out
74
how should you keep the leg for chronic venous insufficency
elevated
75
what are good sources of iron?
dark green veggies, beets, dried beans, legumes, fortified grains, meat eggs
75
what are good sources of b12?
meat, seafood, eggs, dairy products
76
what are good sources of folic acid?
dark green veggies, dried beans, legumes, fortified grains, nuts, bran, yeast, avocados, oranges, bananas, liver
77
what are the signs and symptoms of iron deficiency anemia?
hypoxia, fatigue, pallor, tachycardia, tachypnea, jaundice
78
vitamin b12 is also known as
cobalamin
78
what are the side effects of iron supplements?
constipation and black poop
79
what are the risk factors for vitamin b12 anemia?
gastric bypass, crohns disease, celiac disease, strict vegetarians, long term use of ppis
80
what are the symptoms of vitamin b12 anemia?
sore, red, beefy, shiny tongue, n/v, anorexia, abd pain, peripheral neuropathy, altered mental status, visual changes, high hr, sob, dizziness
81
what are the signs and symptoms of folic acid deficiency anemia?
pallor, high hr, tachypnea, dizziness, fatigue
82
what are the prevention/treatments of sickle cell
hydration, pain meds, antibiotics, oxygenw
82
what are the signs and symptoms of sickle cell disease?
pain, swelling, fatigue, sob, growth delay
83
what are the actions you should do if your pt has sickle cell anemia?
give oxygen, hydrate, manage pain, give antipyretics, supportive measures
83
what are the signs and symptoms of aplastic anemia besides fatigue, sob, high hr?
infections, bleeding, headache
84
what are thes igns and symptoms of glucose 6 phosphate dehydrogenase?
pallor, jaundice, dark urine, fatigue, sob, high hr, enlarged spleen
85
what is the treatment for G6PD?
Avoid fava beans
86
what is primary polycthemia vera?
increased RBC, WBC, and platelets; occurs bc of JAK2 gene mutation
87
what is secondary polycthemia vera/
increased rbc and wbc and platelets remain normal; happens because of hypoxia, high altitudes, heavy smoking
88
what are the signs and symptoms of polycthemia vera?
sob, splenomegaly, blurred vision, itchiness after bathing, weakness
89
what are the signs and symptoms of thrombocytopenia?
petechiae, purpura, ecchymosis, prolonged bleeding
90
what is thrombocytopenia?
low platelets
91
what should you teach your patient with bleeding precautions?
bleeding gums, cuts bleed longer than others, watch platelet count, avoid aspirin, no contact sports, weak helment, avoid IM shots, avoid intercourse if extremely low, replace platelets after surgery
92
how many people must verify the blood?
two
93
what do you need to obtain before starting the blood transfusion?
informed consent
94
what labs should you get for iron deficient anemia?
serum iron tests
95
what is the treatment of iron deficiency anemia?
iron supplements 150-200 mg/day
96
iron is best obsorbed with
citric acid
97
what should a pt take dietary iron?
before meals
98
what are risk factors for b12 anemia?
excess alcohol, meds that decrease gastric acid (PPIs)
99
vitamin B is caused by?
pernicious anemia
100
what are the signs and symptoms of vitamin b12 anemia?
altered mental status, depression, sore/red/beefy, shiny tongue
