exam1 chs 32 33 34 35 Flashcards
Right sided heart failure includes these s/s
peripheral tissue congestion
‘
-Dependent edema+ascities
-GITract congestion->anorexia,Gi distress,wt loss
-Liver congestion-> s/s related to impaired liver funx
Left sided heart failure includes these s/s
-Decreased Cardiac Output->activity intolerance, s/s of decreased tissue perfusion
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-Pulmonary Congestion->impaired gas exchange->cyanosis+hypoxia
-Pulmonary Congestion->pulmonary edema->cough frothy sputum,orthopnea,(PND)Paryoxymal nocturnal dyspnea
General HF symptoms
sob, swelling of feet and legs,confusion and or imparied memory, incrfeased nocturia, cough with frothy sputum, swollen or tender abdomen and loss of appetitie, chronic lack of energy,
Rx’s that promotoe vasodialation
dobutamine, nitroprusside
venodialation meds
morphine, nitrates
naturesis
diurectics, lasix
increased inotropy rx’s
dobutamine, dopamine, milrinone
Lets talk about ejection fraction
it is the amount of blood pumped out fo the ventricle(systole-contracting)/total amount of blood IN ventricle(dyastole-relaxing) =ejection fraction%
what do you do to increase force of contraction Rx wise
Digoxin, B agonist (dobutamine, dopamine), bipridynes Milrinone…fyi dobutamine works better to increase blood pressure
what do we have to do to REDUCE cardiac work load rx wise
to decrease preload use diuretics,nitrates, venodialators
to decrease afterload use arterial vasodialators
to decrease preload and afterload (ACEI, ARB, nitrates, sodium, nitroprusside
to prolong survival
B adrenoreceptor blockers
How to treat congestive heart failure U.N.L.O.A.D. F.A.S.T.
Upright position Nitrates Lasix Oxygen Aminophylline Digoxin Fluids (decrease) Afterload( decrease) Sodium Restriction Tests(dig level, abgs, potassium level)
Which of the following instructions given to a patient who is about to undergo Holter monitoring is most appropriate?
A) “You may remove the monitor only to shower or bathe.”
B) “You should connect the monitor whenever you feel symptoms.”
C) “You should refrain from exercising while wearing this monitor.”
D) “You will need to keep a diary of all your activities and symptoms.”
D) “You will need to keep a diary of all your activities and symptoms.”
A Holter monitor is worn for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor.
A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE). Which of the following assessments are appropriate for this patient (select all that apply)?
A) Assess for return of gag reflex.
B) Assess groin for hematoma or bleeding.
C) Monitor vital signs and oxygen saturation.
D) Position patient supine with head of bed flat.
E) Assess lower extremities for circulatory compromise.
A) Assess for return of gag reflex.
C) Monitor vital signs and oxygen saturation.
The patient undergoing a TEE has been given conscious sedation and has had the throat numbed with a local anesthetic spray, thus eliminating the gag reflex until the effects wear off. Therefore it is imperative that the nurse assess for gag reflex return before allowing the patient to eat or drink. Vital signs and oxygen saturation are also important assessment parameters resulting from the use of sedation. A TEE does not involve invasive procedures of the circulatory blood vessels. Therefore it is not necessary to monitor the patient’s groin or lower extremities in relation to this procedure.
The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. Which of the following allergies is most important for the nurse to assess before this procedure? A) Iron B) Iodine C) Aspirin D) Penicillin
B) Iodine
The physician usually will use an iodine-based contrast to perform this procedure. Therefore it is imperative to know whether or not the patient is allergic to iodine or shellfish.
The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. Which of the following is an age-related change that contributes to this finding?
A) Stenosis of the heart valves
B) Decreased adrenergic sensitivity
C) Increased parasympathetic activity
D) Loss of elasticity in arterial vessels
D) Loss of elasticity in arterial vessels
An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel and hypertension results.
The nurse is providing care for a patient who has decreased cardiac output related to heart failure. The nurse recognizes that cardiac output is
A) Calculated by multiplying the patient’s stroke volume by the heart rate.
B) The average amount of blood ejected during one complete cardiac cycle.
C) Determined by measuring the electrical activity of the heart and the patient’s heart rate.
D) The patient’s average resting heart rate multiplied by the patient’s mean arterial blood pressure.
A) Calculated by multiplying the patient’s stroke volume by the heart rate.
Cardiac output is determined by multiplying the patient’s stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a 1-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output.
Which of the following cardiovascular effects of aging should the nurse anticipate when providing care for older adults (select all that apply)? A) Arterial stiffening B) Increased blood pressure C) Increased maximal heart rate D) Decreased maximal heart rate E) Increased recovery time from activity
A) Arterial stiffening B) Increased blood pressure D) Decreased maximal heart rate E) Increased recovery time from activity Well-documented cardiovascular effects of the aging process include arterial stiffening, possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age.
Auscultation of a patient’s heart reveals the presence of a murmur. This assessment finding is a result of
A) Increased viscosity of the patient’s blood.
B) Turbulent blood flow across a heart valve.
C) Friction between the heart and the myocardium.
D) A deficit in heart conductivity that impairs normal contractility.
B) Turbulent blood flow across a heart valve.
Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.
While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which of the following practices should the nurse implement into the assessment during auscultation?
A) Position the patient supine.
B) Ask the patient to hold his or her breath.
C) Palpate the radial pulse while auscultating the apical pulse.
D) Use the bell of the stethoscope when auscultating S1 and S2.
C) Palpate the radial pulse while auscultating the apical pulse.
In order to detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. The diaphragm is more appropriate than the bell when auscultating S1 and S2. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation.
A 59-year-old man has presented to the emergency department with chest pain. Which of the following components of his subsequent blood work is most clearly indicative of a myocardial infarction (MI)? A) CK-MB B) Troponin C) Myoglobin D) C-reactive protein
B) Troponin
Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of CK-MB and myoglobin. CRP levels are not used to diagnose acute MI.
Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient?
a. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
b. Have the patient sit in a chair with the feet flat on the floor.
c. Assist the patient to the supine position for BP measurements.
d. Obtain two BP readings in the dominant arm and average the results.
ANS: B
The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, and the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second
The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient?
a. Low dietary fiber intake
b. No regular aerobic exercise
c. Weight 5 pounds above ideal weight
d. Drinks a beer with dinner on most nights
ANS: B
The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient’s alcohol intake is within guidelines and will not increase the hypertension risk
Which action should the nurse take when administering the initial dose of oral labetalol (Normodyne) to a patient with hypertension?
a. Encourage the use of hard candy to prevent dry mouth.
b. Instruct the patient to ask for help if heart palpitations occur.
c. Ask the patient to request assistance when getting out of bed.
d. Teach the patient that headaches may occur with this medication.
ANS: C
Labetalol decreases sympathetic nervous system activity by blocking both á- and b-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are possible side effects of other antihypertensives
After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective?
a. The patient avoids eating nuts or nut butters.
b. The patient restricts intake of chicken and fish.
c. The patient has two cups of coffee in the morning.
d. The patient has a glass of low-fat milk with each meal.
ANS: D
For the prevention of hypertension, the Dietary Approaches to Stop Hypertension (DASH) recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.
A patient has just been diagnosed with hypertension and has been started on captopril (Capoten). Which information is important to include when teaching the patient about this medication?
a. Check blood pressure (BP) in both arms before taking the medication.
b. Increase fluid intake if dryness of the mouth is a problem.
c. Include high-potassium foods such as bananas in the diet.
d. Change position slowly to help prevent dizziness and falls.
ANS: D
The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP should be taken in the nondominant arm by newly diagnosed patients in the morning, before taking the medication, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate
Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this medication when the patient reveals a history of
a. asthma.
b. daily alcohol use.
c. peptic ulcer disease.
d. myocardial infarction (MI).
ANS: A
Nonselective b-blockers block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. b-Blockers will have no effect on the patient’s peptic ulcer disease or alcohol use. b-Blocker therapy is recommended after MI
A 56-year-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that
a. a BP recheck should be scheduled in a few weeks.
b. dietary sodium and fat content should be decreased.
c. there is an immediate danger of a stroke and hospitalization will be required.
d. diagnosis of a possible cause, treatment, and ongoing monitoring will be needed.
ANS: D
A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level
Acute coronary syndrome
unstable angina, stemi and on stemi
what causes Sudden cardiac death?
most of the time is arrythmic issue or some coronary problem with a loss of cardiac output no profusion to the organs..most cases are due to dysrythmias
what pumps blood out fo the heart?
Ventricles
if you are going to have heart issues where in the heart would you think its orginia would be? and why?
Atria…b/c they only pump 20% of blood and pump it passivly. they dont have too muich presponsibility and power so they woudlbe the first to go
if ventricles do not pumpm blood wouldthe problem be serious or minor
serious
ventriclular arrythimias are very….
serious
vfib is all called
deaths door can easily kill a pt
an acute MI pt can also have a
v-fib or vtach beacue of the MI or they can just suddenly drop dead
T/F just because you had an arrythmic event one time doesnt mean you will never have it again
false
in younger patients with no HX or s/s it can arise….
suddenly out of no where
what are som risk factors for sudden cardiac death
answer
if a pt presents with no hx of cardiac issues and poist tests are inconclusive, what can the doctor order for the patient?
a halter monitor for 24 hours so the pt can wear during normal dialy activities. to see where there might be a problem or electrophysiology lab its a conduction probelm fornthe most part
AICD is
a surgically pace maker that will read rhythm and shoco the pt to adjust rhythm
amioderone and nursing implications
ans:
sudden cardiac death is mostl;y a
conduction ventricles dysrythmic issue
vtach
very bad
if pt presents with chest pain which labs are ordered
ckmb, troponin ecg, cardiac cath
enzymes tell you there is damaged
but do not tell you which ones
what is a cabag
?
what is a cardiac cath
?
what is a stent..
it opens up the occluded vesicle
a stent is
to open up the vessel
a bypass is when
they give up on your vessels and totaly bypass them by borrowing a vessel from goin or leg
whe pt presents with acute coronary syndrome
.
cardiac disease prevention
stop smoking, eat heart healthy food, take choleersol meds, manage dbts well
Eat good fats like
mono or poly saturatied fats like olive oil or peanuts
omega 3 fatty acids icnrease
HDL’s
what are cholesterol drugs
statin, niacin
niacin.complaints.s/e
take aspirin or at night
talk about niacin and nursing stuff
.
zetia worksmoslty of
gi absorption of cholesterol
palvix nursing implication
bleeddgin asses for s/s of blessding tell md if stolls are black and bruising easily
risk factors fo cad that icnrease work load of heart
smokeing and HTN work load icnrease of left ventricle
