4.1

Non modifiable risk factors of CAD

age, gender, ethnicity, family history, genetics

Yellow and brown ankles is an indicator of?

PVD

Side effects of statins

myopathy, increased liver enzymes

Nursing assessment for CAD

nonmodifiable risk factors, modifiable risk factors, smoking history, drug history, social history, nutritional history, family history, health history

A client with coronary artery disease and a recent diagnosis of venous thrombosis calls the outpatient clinic to report sudden onset of shortness of breath. Which action by the nurse is best? 1 Suggest that the client call 911. 2 Have the client take slow, deep breaths. 3 Schedule the client to be seen in the clinic in 1 hour. 4 Have the client take a low dose aspirin tablet immediately.

1

Smoking cessation assessment

5 A Model to Quit Smoking Ask: about tobacco use? Advise: to quit Assess: willingness to quit in the next month Assist: with quitting -set date within 2 weeks -medications, motivation, triggers, social support -refer to quit line 1-800-quit-now Arrange: to follow up -especially in first week *Drugs and Behavioral Interventions work best*

Which assessment finding will the nurse anticipate in a client with severe atherosclerotic disease? A. Carotid artery bruit B. HDL 60 mg/dL C. Palpable peripheral pulses D. BP 120/58 mm Hg

A

A patient being treated for tuberculosis (TB) with a standard four-drug regimen continues to have positive sputum smears for acid-fast bacilli. Which actions should the nurse implement? (Select all that apply.) Select all that apply. A. Assist the patient with short-term goals and plan teaching according to these goals. B. Provide the patient with all the educational materials about drug-resistant TB. C. Refer the patient to a pulmonary specialist, who can assist the patient with the treatment regimen. D. Ask the patient whether medications have been taken as directed. E. Ask the patient about any barriers to obtaining medications.

A, B, D, E

The nurse is conducting an admission assessment on a male client. Which assessment data does the nurse identify as a risk factor for cardiovascular disease? Select all that apply. A. BMI of 26 B. BP of 120/66 mm Hg C. Triglycerides 140 mg/dL D. Moderate exercise for 20 to 30 minutes weekly E. Exposure to secondhand cigarette smoke F. History of repeated streptococcal tonsillitis G. Family history of cardiovascular disease

A, D, E, G

A R T S

Absence of pulse and hair Round, red, smooth wounds Toes are pale (eschar) Sharp pain with stress (intermittent claudication)

Define Adherence

Adherence in this setting is patient-focused and is the extent to which a person's actions or behaviors coincide with advice or instruction from a healthcare provider intended to prevent, monitor, or ameliorate a disorder.

Normal level for triglycerides

below 150 mg/dL

Bruit

blowing, swooshing sound heard through a stethoscope when an artery is partially occluded

intermittent claudication

pain and discomfort in calf muscles while walking; a condition seen in peripheral arterial disease

Nicotine treatment

replacement therapy: gum, patches, reduce cravings -Buproprion (zyban) or Varenicline (chantix)

What purpose does the DASH diet have

stopping hypertension

Nictotine Withdrawal

the process that occurs in the body when nicotine, an addictive drug, is no longer used

Nutrition therapy for CVD

• Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains. • Consume low-fat dairy products, poultry (without the skin), fish, legumes, nontropical (e.g., canola) vegetable oils, and nuts. • Limit intake of sweets, sugar-sweetened beverages, and red meats. • Aim for a dietary pattern that includes 5% to 6% of calories from saturated fat; limiting trans fats.

What is the main difference between PVD and PAD?

PVD is not an oxygen problem, PAD is an oxygen problem. Veins return deoxygenated blood to the heart whereas arteries cannot get oxygenated blood to the rest of the body

The ______ level (normal value is 95 to 100 mm Hg), or partial pressure of oxygen, indicates how well the lungs are functioning. The _______ level (normal value is 35 to 45 mm Hg), or partial pressure of carbon dioxide, indicates how well the lungs are functioning in blowing off or retaining carbon dioxide as needed to help correct the acid-base imbalance. The bicarbonate level, or ______ (normal value is 21 to 28 mEq/L [21 to 28 mmol/L), indicates how well the kidneys are excreting or reabsorbing base as needed.

PaO2 PaCO2 HCO3

Two main red flags in a PVD assessment?

Pain-unrelieved at rest Paresthesia

The nurse is caring for a client with peripheral arterial disease (PAD). Which symptom will the nurse anticipate? Decreased pain when legs are elevated Unilateral swelling of affected leg Reproducible leg pain with exercise Pulse oximetry reading of 90%

Reproducible leg pain with exercise The symptom the nurse assesses the client with PAD is reproducible leg pain with exercise. Claudication (leg pain with ambulation due to ischemia) is reproducible in similar circumstances.Unilateral swelling is typical of venous problems such as deep vein thrombosis. With PAD, pain decreases with legs in the dependent position. Pulse oximetry readings reflect the amount of oxygen bound to hemoglobin. PAD results from atherosclerotic occlusion of peripheral arteries.

What is the primary risk factor for COPD?

Smoking

Modifiable risk factors for CAD

Smoking, inactivity, hypertension, diabetes mellitus, obesity, excessive alcohol consumption, cholesterol management and stress.

Paresthesia

abnormal sensation of numbness and tingling without objective cause

ABI test

ankle brachial index test

Myopathy

any pathologic change or disease of muscle tissue

infarction

area of dead tissue

Eschar

dead matter that is sloughed off from the surface of the skin, seen in PAD

Nicotine stimulates the release of?

dopamine, norepinephrine, GABA, glutamate, and endorphins

essential hypertension

elevated blood pressure of unknown cause that develops for no apparent reason; sometimes called primary hypertension

Avoid what when taking statins?

grapefruit juice

secondary hypertension

high blood pressure caused by the effects of another disease

Short-term effects of noctoine are

increased BP, breathing, and heart rate

Normal level for cholesterol

less than 200 mg/dL

The clinic nurse is reviewing medication instructions with a patient taking nicotine replacement gum for smoking cessation. Which statement by the patient indicates a need for additional teaching by the nurse? "I will not drink or eat while chewing the gum." "I can continue to smoke a cigarette once in a while when taking this drug." "I will continue to use birth control while taking this drug." "While chewing the gum, I will periodically hold the gum between my cheek and teeth."

"I can continue to smoke a cigarette once in a while when taking this drug." Cigarette smoking while using nicotine-replacement therapy (NRT) agents such as gum may cause nicotine overdose

Cardiovascular assessment

- measure orthostatic BP and pulse, and assess for vertigo; - palpate apical and peripheral pulses; - auscultate heart at apex for S3 --- which is an early sign of heart failure; - palpate for edema in the sacrum, legs, and feet; - palpate skin for warmth in peripheral areas to include nose, ear lobes, hands, and feet; - assess for DVT by observing calves for redness and palpating for warmth and tenderness; - measure circumference of both calves and thighs and compare in size

A client with carotid atherosclerotic plaques had a right carotid endarterectomy performed 2 hours ago. Which intervention would the nurse implement when the client begins to demonstrate clinical manifestations of progressive hypotension? 1 Notify the health care provider immediately 2 Increase the intravenous (IV) flow rate 3 Raise the head of the client's bed 4 Place the client in the Trendelenburg position

1

A patient is admitted to the long-term care setting. The nurse notes that the patient does not read or write well. Which nursing actions are priority while developing a teaching plan to increase adherence? (Select all that apply.) Select all that apply. 1. Include the family in the orientation to the unit and include them in the teaching process. 2. Assess what grade level the patient can read and write and tailor teaching strategies accordingly. 3. Assess what the patient knows about their health issues. 4. Determine the patient's motivation and readiness to learn. 5. Give the patient brochures with more pictures and explanations with short sentences.

1, 2, 3, 4

What actions would the nurse take to address the COPD exacerbation? 1. Monitor oxygenation status 2. Administer methylprednisolone 3. Increase oxygen 4. Request a prescription for an electrocardiogram 5. Encourage use of incentive spirometer 6. Use humidified oxygen 7. Request a prescription for coagulation factors 8. Administer as-needed blood pressure medications

1, 2, 5, 6

The nurse determines a patient has not been taking antihypertensive medication as prescribed. How should the nurse proceed? (Select all that apply.) 1. Review and reinforce the need to take the medication as prescribed. 2. Ask the provider to prescribe a different medication because the patient does not want to take this medication. 3. Assess the patient's perception and attitude towards the risks associated with missing doses of medication. 4. Emphasize the risk of stroke or heart attack if the patient does not adhere to the treatment plan. 5. Evaluate the teaching plan to determine if there is a need to reeducate the patient.

1, 3, 5

Which client is suspected to have an increased risk of hyperlipidemia? Select all that apply. One, some, or all responses may be correct. 1 Client with corneal arcus 2 Client with periorbital edema 3 Client with decreased skin turgor 4 Client with paleness of conjunctivae 5 Client with yellow lipid lesions on eyelids

1, 5

How does Niacin work?

1. In the liver 2. Moderate decrease in LDL 3. Moderate increase in HDL 4. Mild decrease in Trigs

When teaching about prevention of coronary artery disease (CAD) for a 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg), smokes 1 pack a day of cigarettes, and has siblings with CAD, which topics are most important for the nurse to include? Select all that apply. One, some, or all responses may be correct. Incorrect1 1. Age 2 Height 3 Weight 4 Tobacco 5 Family history

3, 4

hich client would be at an increased risk for coronary artery disease (CAD)? Select all that apply. One, some, or all responses may be correct. Incorrect1 Client with total cholesterol 175 mg/dL and LDL cholesterol 80 mg/dL 2 Client with total cholesterol 190 mg/dL and HDL cholesterol 40 mg/dL 3 Client with total cholesterol 200 mg/dL and HDL cholesterol 45 mg/dL 4 Client with total cholesterol 250 mg/dL and LDL cholesterol 120 mg/dL 5 Client with total cholesterol 160 mg/dL and LDL cholesterol 125 mg/dL

4

Normal level for HDL

40

•pH •PCO2 (Carbon Dioxide) •HCO3 (Bicarbonate)

7.35 - 7.45 35-45 mmHg 22-26 mEq/L

Normal levels for LDL

<130 mg/dL

What is the acronym for PAD

A R T S

ateriosclerosis

A thickening or hardening of the walls of an artery, with impairment of blood circulation

Diagnosing PVD & PAD

ABI Doppler ultrasound

What is the trick for remembering the drug treatment for PAD and PVD

AC and AC

What are the two antiplatelets used for PAD and PVD

ASA Clopidogrel

Which treatment is preferred to reduce blood pressure and keep the lipid profile within normal limits for a patients with atherosclerosis? Niacin and lovastatin Aspirin and pravastatin Ezetimibe and simvastatin Amlodipine and atorvastatin

Amlodipine and atorvastatin

What are the ABCs of PVD and PAD treatment?

Angioplasty Bypass Cut out

Omega-3 ethyl esters

Antilipemic Agent; Omega-3 Fatty Acids

Treatment for PAD and PVD

Antiplatelets Cholesterol lowering medications

Which additional airway disease is sometimes encompassed within the broad category of COPD and may be a contributing factor in dev. of COPD?

Asthma

The nurse is assessing learning needs for a patient who has coronary artery disease. The nurse finds that the patient has recently made dietary changes to decrease fat intake and has stopped smoking. Which is the best initial response by the nurse? A. "Are you having any difficulty in maintaining the changes you have already made?" B. "You did an excellent job of changing your eating habits and quitting smoking. This is so important for your heart health. Nice work!" C. "Which additional changes in your lifestyle would you like to implement at this time?" D. "Although the changes you made are important, it is essential that you make other changes, too."

B

Which normal physiologic process contributes most to the need for acid-base balance? A. Continuous organ production of bicarbonate from carbonic acid B. Continuous alveolar exchange of oxygen and carbon dioxide C. Continuous metabolic production of free hydrogen ions D. Continuous kidney formation of urine from blood

B

Which type of vitamin is nicotinic acid? A B C D

B

A 45-year-old male client having an annual physical asks the nurse about his risk for developing a myocardial infarction (MI). Which modifiable risk factors will the nurse assess to guide the client's teaching plan? Select all that apply. A. Age B. Tobacco use C. Gender D. Diet E. Family history F. Weight

B, D, F

Niacin

B3

Which action of ezetimibe prevents the risk for atherosclerosis? -by decreasing BP -by decreasing cholesterol synthesis -by inhibiting cholesterol absorption

By inhibiting cholesterol absorption

What 2 obstructive airway diseases are most often categorized as COPD?

Chronic bronchitis Emphysema

Prevention of CAD

Control cholesterol Dietary measures Physical activity Medications Cessation of tobacco use Manage HTN Control diabetes

Which drug may interact with statins? Niacin Ezetimibe Amlodipine Cyclosporine

Cyclosporine

The nurse is caring for a client who is being treated for hypertensive crisis. Which prescribed medication would the nurse question? Enalapril Dopamine. Labetalol Enalapril Sodium nitroprusside

Dopamine The nurse would question the prescription for dopamine. Dopamine is used for its inotropic and vasoconstrictive properties to raise blood pressure, and would not be used in hypertensive crisis.Enalapril, an angiotensin-converting enzyme inhibitor, may be used intravenously in hypertensive emergencies. Sodium nitroprusside, a direct-acting vasodilator, may be used intravenously to lower blood pressure quickly in hypertensive emergencies. Labetalol, an intravenous calcium channel blocker, is used in hypertensive crisis when oral therapy is not feasible.

Physical activity for CVD

Engage in aerobic physical activity consisting of three to four sessions per week, lasting 40 minutes per session. Physical activity should involve moderate-to vigorous intensity.

Which common side effect of niacin would the nurse educate a patient about? Flushing Flatulent Constipation Abdominal bloating

Flushin

Risk factors for vascular problems

Hypertension Essential Secondary Hyperlipidemia Atherosclerosis

How do statins work?

Inhibits first step in cholesterol synthesis

■Increased risk for hypertension ■Stroke ■Neurocognitive deficits ■Weight gain ■Diabetes ■Pulmonary and cardiovascular disease

Long Term Effects of Sleep Apnea

What drugs do statins interact with?

Macrolide ABX, azole antifungals, fibric acid drugs, and certain immunosuppresants should be avoided due to increasing risk of myopathy.

Varenicline is prescribed for a middle-aged patient for smoking cessation. What is the priority nursing action for this patient? Telling the patient that nausea and vomiting are likely Teaching the patient to avoid sunlight while on the medication Monitoring every 4 hours for orthostatic hypotension Monitoring the patient for increased temperature

Monitoring every 4 hours for orthostatic hypotension

What could PAD cause?

Necrosis and loss of limb

Which drug is approved by the FDA as a dietary adjunct to reduce triglyceride levels >500? Ezetimibe Amlodipine Nicotinic Acid Omega-3 ethyl esters

Omega-3 ethyl esters

How often would a low risk patient at the age of 20 have their total serum cholesterol level checked? Annually Every 2 years Over the age of 65 Once every 5 years

Once every 5 years

Which condition may result from systemic atherosclerosis?

Peripheral artery disease

What is the SSHT of PVD and PAD

Safety (same as diabetes, don't forget constriction) Skin Shoes Hydration Toe Nails

Sleep Apnea is an __________ obstruction

Upper airway

S/S of PVD using the acronym V E I N Y

Voluptuous pulses Edema Irregularly shaped sores No sharp pain Yellow and brown ankles

Iscemia

a condition in which there is an insufficient oxygen supply due to a restricted blood flow to a part of the body

Arthlerosclerosis

a type of arteriosclerosis, involves the formation of plaque within the arterial wall and is the leading risk factor for cardiovascular disease (CVD). Usually the disease affects the larger arteries, such as coronary artery beds; aorta; carotid and vertebral arteries; renal, iliac, and femoral arteries; or any combination of these.

Ezetimibe

cholesterol absorption inhibitor

Populations at greatest risk for CVD

•Middle-aged and older adults •Men •African Americans