Patho - Winter 2020

do all patients with A.fib get put on anticoagulants

no

how do you test for orthostatic hypotension

supine, after standing for 1 minute, and after standing for 3 minutes A drop of 20 in systolic or 10 in diastolic is diagnostic

What are the most serious arrhythmias?

1. V. fib 2. V. tach (pulseless) 3. SVT / V.tach (w a pulse) Obviously, asystole and PEA

The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below:

140/90

how much blood is in the heart at one time

8%

ventricular contraction during a. fib

80-180, this makes pulse measurements difficult because you may have a lack of pulse corresponding to ventricular contractions

what drugs decrease preload, after load, and overall workload of the heart? how?

ACE inhibitors Promote vasodilation, decreasing the after load (or work that the LV has to overcome to pump blood to systemic circulation) and decrease filling of left ventricle (preload), decreasing pulmonary congestion

What drugs have been studied to increase survival of those with HF

ACE inhibitors and beta-blockers diuretics help with symptom management but have not been shown to extend life

which valves are AV? Semilunar?

AV = mitral and tricuspid semilunar = aortic and pulmonic

When trying to educate a client about the release of free radicals and the role they play in formation of atherosclerosis, which statement is most accurate?

Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels.

what is afterload

Afterload is the resistance to ejection of blood from the heart The residual blood left in the heart is the residual volume, and pressure is applied to the valves upon contraction.

how does HDL work

HDL participates in the reverse transport of cholesterol by carrying cholesterol from the peripheral tissues back to the liver where it can be excreted.

what is a major risk factor for developing artherosclerosis

Hypercholesterolemia

which lipoprotein is the main carrier of cholesterol? Protein? TG?

LDL - cholesterol HDL - protein VLDL - TG

what is the daily peak time for MAP

MAPs will be at their highest early in the morning

what is malignant HTN

Malignant hypertension is a sudden extreme elevation in both systolic and diastolic pressure, producing life-threatening complications. young black men are at very high risk

ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?

Most ECG-detected ischemic events are clinically silent.

what is the primary treatment for angina? And how does it work?

Nitroglycerin, which is used in the treatment of angina, produces its effects by releasing nitric oxide in vascular smooth muscle of the target tissues.

A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:

Pulmonary embolism They are also at risk for recurrent episodes of DVT, and development of chronic venous insufficiency.

how do you differentiate between angina and MI

Rest and intake of nitroglycerin relieve chest pain with angina but not with an MI

What is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?

SA node - AV node - bundle of His - bundle branches - Purkinje fibers

Post-surgical ways to prevent DVT

SCDs early ambulation

what do the P, QRS, and T waves/complexes represent?

The P wave represents the depolarization of the sinoatrial node. The QRS complex represents the depolarization of the ventricles. The T wave represents repolarization of the ventricles, not the atrium

do the glomerular capillaries in the kidneys have large or small pores

The glomerular capillaries in the kidneys have small openings called fenestrations that pass directly through the middle of the endothelial cells. This allows large amounts of small molecular and ionic substances to filter through the glomeruli without having to pass through the clefts between the endothelial cells.

what is the pericardium

The pericardium forms a fibrous covering around the heart, holding it in a fixed position in the thorax and providing physical protection and a barrier to infection. The pericardium is a tri-layer sac consisting of a tough, outer fibrous layer and a thin, inner serous layer.

A major symptom of a dissecting aneurysm

abrupt presence of excruciating pain, described as tearing or ripping

what are the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall

baroreceptors

what are the two first line therapy drugs that are often prescribed for HF

beta blockers and ACE inhibitors

While intubated for surgery, a client has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?

bradycardia due to direct activation of the SNS

What substances can you not have before getting your BP checked?

caffeine and cigarettes (must be more than 30 minutes before testing)

Which blood vessels function without the benefit of having walls comprised of three muscular layers?

capillaries

s/s of cerebral edema

confession and headache

When explaining to a client why there was only minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain that this is primarily due to:

development of collateral circulation that build channels between some of the smaller arteries, usually when the flow is decreased gradually.

Which enzyme has a powerful vasodilator effect on arterioles and increases capillary permeability?

histamine

A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?

hypertriglyceridemia

When will the nurse plan to assess a client's blood pressure to confirm the possible diagnosis of orthostatic hypotension?

in the morning when they arise

what do the baroreceptors in the carotid artery do

increase sympathetic stimulation on the heart and blood vessels

how do diuretics work?

inhibit resorption of Na/water and therefore decrease vascular volume to decrease blood pressure

what races are most likely to have HTN and least likely

most likely = African Americans and south asians least likely = East Asians are the least likely to have hypertension (19%).

A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer, thus resulting in decreased vessel lumen radius?

norepinephrine

what patients are at greatest risk of developing orthostatic hypotension

post-operative patients on bed rest

Following angioplasty for a blocked coronary artery following a myocardial infarction, a client is prescribed serial 12-lead ECGs for three days. On the second day, the nurse notices a distinct difference in the QRS morphology from the previous ECG. Which is the best action for the nurse to take?

repeat the ECG with proper lead placement

Premature ventricular complexes can occur in healthy hearts in response to what stimulation?

sympathetic nervous system stimulation such as stress

Which blood vessel layer is made primarily of muscle?

tunia media Tunia externa is primarily collagen Tunia intima is endothelial cells