Unit 2 and 3 Chapter 32 Cardiomyopathy and Pulmonary Edema

Question 1

What is Pulmonary Edema?

Answer 1

*Fluid in and around the alveoli
*Interferes with gas exchange
*Increases work of breathing

Question 2

What is present during x-ray with pulmonary edema?

Answer 2

Infiltration

Question 3

S/s of Pulmonary edema

Answer 3

• Crackles
• Dyspnea at rest
• Disorientation or acute confusion (especially in older adults as early symptom)
• Tachycardia
• Hypertension or hypotension
• Reduced urinary output
• Cough with frothy, pink-tinged sputum
• Premature ventricular contractions and other dysrhythmias * Anxiety
• Restlessness
• Lethargy
  *cold, clammy, or cyanotic

Question 4

Is Pulmonary Edema life-threatening?

Answer 4

A. yes

CPE leads to progressive deterioration of alveolar gas exchange and respiratory
failure. Without prompt recognition and treatment, a patient’s condition can
deteriorate rapidly – like 15 minutes!!

Question 5

What is the priority for patients with pulomary edema?
A. administration of antihypertensive medications
B. 100% oxygenation via oxygenation device
C. administration of furosemide
D. Administration of desmopressin

Answer 5

B. 100% oxygenation via oxygenation device

Question 6

Treatment plan for patients dx with Pulmonary Edema

Answer 6

• he priority nursing action is to administer oxygen therapy at 5 to 12 L/min by simple facemask or at 6 to 10 L/min by nonrebreathing mask with reservoir (which may deliver up to 100% oxygen) to promote gas exchange and perfusion
• pply a pulse oximeter and titrate the oxygen flow to keep the patient’s oxygen saturation above 90%.
• If the patient’s systolic blood pressure is above 100, administer sublingual nitroglycerin (NTG) as prescribed to decrease afterload and preload every 5 minutes for three doses while establishing IV access for additional drug therapy.
• The health care provider prescribes rapid-acting diuretics, such as furosemide or bumetanide. Give furosemide IV push (IVP) over 1 to 2 minutes to avoid ototoxicity
• . Monitor vital signs frequently, at least every 30 to 60 minutes.
• Bumetanide may be administered IVP over 1 to 2 minutes to avoid ototoxicity or as a continuous infusion to provide consistent fluid removal over 24 hours.
• If the patient’s blood pressure is adequate, IV morphine sulfate may be prescribed to reduce venous return (preload), decrease anxiety, and reduce the work of breathing.
• Ultrafiltration
  *

Question 7

When is Ultrafiltration used?

Answer 7

In severe cases of fluid overload and renal dysfunction or diuretic resistance, ultrafiltration may be used.

Question 8

What are the benefits of Ultra filtration?

Answer 8

• Decrease in cardiac filling pressures
• Decrease in pulmonary arterial pressure
• Increase in cardiac index
• Reduction in norepinephrine, renin, and aldosterone

Question 9

What is Cardiomyopathy?

Answer 9

Cardiomyopathy is a subacute or chronic disease of cardiac muscle, and the cause may be unknown.

Question 10

What are the 4 types of Cardiacmyopathies?

Answer 10

• -Dilated cardiomyopathy,
• -Hypertrophic cardiomyopathy,
• -Restrictive cardiomyopathy,
• Arrhythmogenic right ventricular cardiomyopathy

Question 11

What is Dilated Cardiomyopathy

Answer 11

-Dilated cardiomyopathy (DCM) is the structural abnormality most commonly seen.
-Ventricular wall thickness is normal, but both ventricles are dilated and weakened (left ventricle is usually worse) and systolic function is impaired.

Question 12

What population is most affected from Dilated cardiomyopathy?

A. 72 eldery women n
B. a 12 year old child
C. 40- year with past history of smoking
D. 68 year old with benign prosthetic hypertrophy

Answer 12

C. 40- year with past history of smoking

Question 13

What is the cause of Dilated Cardiomyopathy

Answer 13

Causes may include…
* alcohol abuse,
* chemotherapy,
* infection,
* inflammation,
* poor nutrition

Question 14

S/s of Dilated Cardiomyopathy

Answer 14

-fatigue and weakness
-Left sides heart failure
-dysrythmias
-heart block
-systemic or pulmonary emboli*
-S3 and S4 gallops
-Moderate to severe cardiomegaly
-Decreased CO
-dyspnea on exertion (DOE),
-decreased exercise capacity,
-fatigue,
-palpitations
-low cardiac output
-hypertention

Question 15

What is the life expectancy for a patient with Dilated Cardiomyopathy?
A. 10 years
B. 20 years
C. 5 years
D. 30 years

Answer 15

C. 5 years

will need consulting and family therapy due to poor prognosis

Question 16

Which of the following is the most common type of cardiomyopathy

A. Dilated cardiomyopathy,
B. Hypertrophic cardiomyopathy,
C. Restrictive cardiomyopathy,
D. Arrhythmogenic right ventricular cardiomyopathy

Answer 16

A. Dilated cardiomyopathy,

Question 17

What would you see on a ECG for a patient with Dilated cardiomyopathy

Answer 17

heart block

Question 18

What is the typical tx for Dilated cardiomyopathy

Answer 18

-heart failure tx
-heart transplant

Question 19

Life expectancy for Dilated cardiomyopathy without heart transplant

Answer 19

Most die within 5 years after the onset of manifestations.

Question 20

Heart transplant

Answer 20

Heart transplantation (surgical replacement with a donor heart) is the treatment of choice for patients with severe DCM cardiomyopathy.

The procedure may also be done for end-stage heart disease caused by coronary artery disease, valvular disease, or congenital heart disease.

Question 21

Candidate requirements for heart transplant

Answer 21

• Life expectancy less than 1 year
• Age generally younger than 65 years
• New York Heart Association (NYHA) Class III or IV
• Normal or only slightly increased pulmonary vascular resistance
• Absence of active infection
• Stable psychosocial status
• No evidence of current drug or alcohol misuse

Question 22

S/s of Heart transplant rejection

Answer 22

• Shortness of breath
• Fatigue
• Fluid gain (edema, increased weight)
• Abdominal bloating
• New bradycardia
• Hypotension
• Atrial fibrillation or flu er
• Decreased activity tolerance
• Decreased ejection fraction (late sign)

Question 23

What is a common complication of post Heart transplant

Answer 23

Be very careful about handwashing and aseptic technique because patients are immunosuppressed from drug therapy.

Infection is the major cause of death and usually develops in the immediate post-transplant period or during treatment for acute rejection.

Question 24

What type of medication should a patient be on with a heart transplant for life?

Answer 24

IMMUNOSUPPRESSANT

-Cyclosporine