unit 9 cardiac pt2

The home health nurse is caring for a client who has a diagnosis of hypertension. What assessment question most directly addresses the possibility of worsening hypertension? "Are you eating less salt in your diet?" "How is your energy level these days?" "Do you ever get chest pain when you exercise?" "Do you ever see spots in front of your eyes?"

"Do you ever see spots in front of your eyes?"

When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? "See if rest relieves the chest pain before using the nitroglycerin." "Call 911 if you develop a headache following nitroglycerin use." "Place the nitroglycerin tablet between cheek and gum." "Only take one nitroglycerin tablet for each episode of angina."

"See if rest relieves the chest pain before using the nitroglycerin."

A newly diagnosed client with hypertension is prescribed a thiazide diuretic. What client education should the nurse provide to this client? "Eat a banana every day because this medication causes moderate hyperkalemia." "Take over-the-counter potassium pills because this medication causes your kidneys to lose potassium." "This medication can cause low blood pressure and dizziness, especially when you get up suddenly." "This medication increases sodium levels in your blood, so cut down on your salt."

"This medication can cause low blood pressure and dizziness, especially when you get up suddenly."

Physical finding PAD4

- decreased cap refill (greater than 3 seconds) -decreased or nonsalable pulses -loss hair on calf -mottled skin -dependent rubor (redness) of extremity

EX thrombollytic therapy

-abciximab and eptifibatidedissolving a clot or preventing the clot first 24 h

DVT encourage

-ambulation -dorsiflexion/plantar flexion -occasionally elevate the legs above the level of the heart while the client in bed (avoid pillows under the knees)

PE s/s

-anxiety -sudden impending doom -pain upon inspiration -dyspnea

PVD 3

-elevate legs to reduce swelling should not elevate above heart slows arterial blood flow -gradual collateral circulation exercise discomfort rest then do it again - keep limbs warm, tissue damage (to hot items)

lab results of HTN

-elevated BUN and creatine -elevated blood corticoids -blood glucose and cholesterol studies

ACE inhibitors

-enalapril -prevents the conversion of angiotensin I and II which prevents vasoconstriction - monitor BP/P -report cough its persistent nature and occasional relationship to angioedema

Essential HTN EX

-family hx -excessive sodium -physical inactivity -obesity -african american -smoking

HTN s/s

-headaches -facial flushing -dizziness -retinal change -nocturia

Risk factors PAD4

-hypertension -hyperlipidemia -DM -smoking

PAD findings 2

-intermittent claudification -numbness or burning pain primarily in feet when in bed -pain that is relieved by placing legs at rest in a dependent posistion

secondary HTN4

-kidney disease -cushing disease -pregnancy -medications

Promote vasodilation and avoid vasoconstriction 3

-provide a warm enviroment -have client wear insulated socks -never apply direct heat -client avoid exposure to cold -avoid stress, caffeine, and nicotene

The nurse is talking with a patient about her hypertension and her antihypertensive drug therapy. The patient enjoys generally good health apart from her high blood pressure. When assessing the response to an antihypertensive drug regimen what blood pressure would be the goal of treatment? 156/96 mm Hg or lower 140/90 mm Hg or lower Average of 2 BP readings of ≤150/80 mm Hg 120/80 mm Hg or lower

140/90 mm Hg or lower

mechanism of action is to block the conversion of angiotensin 1 to angiotensin 2,(a potent vasoconstrictor) promotes fluid and sodium loss, and decrease peripheral vascular resistance.

ACE inhibitors

A home health nurse is seeing an elderly female client for the first time. During the physical assessment of the client's feet, the nurse notes several circular ulcers around the tips of the toes on both feet. The bases of the ulcers are pale, and the client reports the ulcers to be very painful. From these assessment findings, the nurse suspects that the cause of the ulcers is which of the following? Arterial insufficiency Venous insufficiency Neither venous nor arterial Trauma

Arterial insufficiency

Which condition contributes to secondary hypertension? Hepatic function Arterial vasoconstriction Calcium deficit Acid-based imbalance

Arterial vasoconstriction

A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? Assess chest pain and administer prescribed drugs and oxygen Assess blood pressure and administer aspirin It is not important to assess the client or to notify the physician Assess the client's physical history

Assess chest pain and administer prescribed drugs and oxygen

A patient with a diagnosis of deep vein thrombosis (DVT) is being treated with unfractionated heparin, which is being administered intravenously. The nurse who is providing care for this patient should consequently prioritize what assessments? Assessing the patient for internal or external hemorrhage Monitoring the patient's intake and output, and assessing for signs of fluid volume deficit Assessing the patient for adventitious lung sounds and assessing SaO2 levels Assessing the patient's pain levels

Assessing the patient for internal or external hemorrhage

created by the difference in the pressure of the blood as it leaves the heart and the resistance it meets flowing out to the tissues.

BP

Which of the following assessment results is considered a major risk factor for PAD? LDL of 100 mg/dL BP of 160/110 mm Hg Cholesterol of 200 mg/dL Triglyceride level of 150 mg/dL

BP of 160/110 mm Hg

An adult patient's blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient's nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage? C-reactive protein (CRP) levels Sodium, chloride, and potassium levels Arterial blood gas (ABG) results Blood urea nitrogen (BUN) and creatinine levels

Blood urea nitrogen (BUN) and creatinine levels

#1 caused by agina and MI

CAD

PE caused by

DVT

The nurse is caring for an acutely ill client who is on anticoagulant therapy. The client has a comorbidity of renal insufficiency. How will this client's renal status affect heparin therapy? Heparin is contraindicated in the treatment of this client. Heparin may be given subcutaneously, but not IV. Lower doses of heparin are required for this client. Warfarin will be substituted for heparin.

Lower doses of heparin are required for this client.

What cause ischemia

MI

An adult client is admitted to the ED with chest pain. The client states that he had unrelieved chest pain for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions? Thrombolytics (fibrinolytics), oxygen administration, and nonsteroidal anti-inflammatories Morphine sulphate, oxygen, and bed rest Oxygen and beta-adrenergic blockers Bed rest, albuterol nebulizer treatments, and oxygen

Morphine sulphate, oxygen, and bed rest

A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend? Purchasing a self-monitoring BP cuff Discussing methods for stress reduction Advising smoking cessation Administering glycemic contro

Purchasing a self-monitoring BP cuff

A 40-year-old man newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the rationale behind that advice to the patient? Smoking directly causes high blood pressure. Smoking increases the risk of heart disease. Smoking causes obesity, which exacerbates hypertension. Smoking increases cardiac output.

Smoking increases the risk of heart disease.

Family members bring a client to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data? The symptoms indicate angina and should be treated as such. The symptoms indicate a pulmonary etiology rather than a cardiac etiology. The symptoms indicate an acute coronary episode and should be treated as such. Treatment should be determined pending the results of an exercise stress test.

The symptoms indicate an acute coronary episode and should be treated as such.

Calcium channel blockers

Verapamil: movement of calcium ions through cell membrane causing vasodilation and lowering BP -monitors BP/P -Constipation with verapamil so intake foods hing in fiber -avoid grapefruit juice

The nurse is caring for a client who is known to have a high risk for venous thromboembolism. What preventive actions should the nurse recommend? Select all that apply. High-protein diet Weight loss Regular exercise Smoking cessation Calcium and vitamin D supplementation

Weight loss Regular exercise Smoking cessation

the client has a b/p of 180/120, what should the nurse do immediately?

What is double check the reading and report to the reading to the provider

A 60-year-old woman has been brought to the emergency department (ED) by ambulance after she experienced a sudden onset of dyspnea and phoned 911. The woman is obese but claims an unremarkable medical history and denies chest pain. When assessing this patient, the nurse in the ED should be aware that: Dyspnea is definitive for a respiratory, rather than cardiac, etiology. The absence of known risk factors usually rules out myocardial infarction (MI) or angina as a cause of dyspnea. Women often present with an MI much differently than do men. Acute coronary syndrome (ACS) manifests with chest pain rather than with shortness of breath.

Women often present with an MI much differently than do men.

Reinforce client teaching about this side effect of an ACE inhibitor which will need to be reported to the provider, and the medication should be discontinued.

angioedema or a dry persistent cough if patient can better tolerate a different medication

________________refers to the loss of elasticity or hardening of the arteries that accompanies the aging process.

arteriosclerosis

PAD results from

atherosclerosis that usually occurs in the arteries of the lower extremities and is characterized inadequate flow of blood

aneurysm rupture

budge leaks

Will alter the movement of calcium ions through the cell membrane, causing vasodilation, and lowering of the blood pressure.

calcium channel blockers

Ischemia

can lead to tissue necrosis(infarction) if blood supply and oxygen are not resolved -ischemia is reversible

Atrovastin

can relieve manifestation associated with PAD (intermittent claudication)

These 4 lifestyle modifications for a client at risk for hypertension can be made to reduce the likelihood of becoming hypertensive

cease cigarette smoking, control weight, exercise regularly, and maintain low fat low cholesterol diet

chest pain and agina do

decrease blood flow to heart

peripheral vascular disease3

decrease cap refill, dependent rubor, increase risk of ulcer and gangriene

urses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood. increases blood volume and improves the potential for greater cardiac output. decreases the production of neurotransmitters that constrict peripheral arterioles.

decreases the production of neurotransmitters that constrict peripheral arterioles.

eflects arterial pressure during ventricular relaxation.

diastolic BP

W/ DVT

do not palpated you can lightly touch it, single pillow elevate one leg, no ambulation

A nurse is caring for a patient with venous disease in the lower extremities and is ordered radiologic testing. The nurse educates the patient on which exam will likely be ordered for lower venous disease?

duplex ultrasound

Sustained elevated blood pressure with no known cause and is about 95% of cases

essential/Primary hypertension?

This medication works by promoting sodium and water excretion, thus reduce circulating blood volume.

furosemide

hypertension can have few or no symptoms, but the nurse will assess for these symptoms in a client.

headaches in the morning, dizziness, fainting, retinal changes, visual disturbances, and nocturia.

A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: high LDL level. low LDL level. normal LDL level. fasting LDL level.

high LDL level.

high bp

high volume in the veins and arteries increase BP work hard keep sodium down where salt goes so does water

assessment data includes blurred vision, dizziness, disoriented, and a b/p 240/130

hypertensive crisis

increase in what

increase salt and increase in BP increase work flow on kidneys, heart and increase damage

Large Embolous

increased hypoxia to pulmonary tissue and impaired blood flow

Vena Cava filter

insertion of a filtering the vena cava to prevent further emboli from reaching pulmonary vasculture

angiography

insertion of catheter coronary artery narrowing and occlusions

Percutaneous transluminal angioplasty

invasive intra arterial procedure using a ballon and stent to open and help maintain the patency of the vessel

cardiac catherization (CC)

invasive procedure used to evaluate the presence and degree of coronary artery blockage

Coronary artery disease

is more related blood flow to the heart and nourishing the heart; heart itself not able to get the blood flow it needs becomes ischemic (not enough o2 to heart muscle) lead to tissue necrosis lead to infarction if o2 levels is not restored

When blood flow to the heart comprised

ischemia causes chest pain

When these are properly functioning they either retain fluid when a client is hypotensive or excrete fluid when a client is hypertensive.

kidney

HTN leads to

kidney damage , enlarge heart and makes heart muscle get weak and lead to coronary artery disease

Hypertrophy of the

left ventricle can develop heart pumps against resistance caused by hypertension

A client who has just been diagnosed with hypertension has been instructed to take a daily blood pressure measurement. The systolic blood pressure reading measures the volume of blood ejected from the: left ventricle. right ventricle. left atrium. right atrium.

left ventricle.

What should you do with BP

measure in the same arm

Statins

muscle pain and joint pain to look for; lactic acidosis 65 y/o mortality 50%, reflux

An abrupt interruption of oxygen to the heart muscles produces

myocardial ischemia

client is on spironolactone (Aldactone) 25mg/day and likes to eat a lot of bananas, what is the best intervention

nstruct them to avoid these types of foods due to the increase in hyperkalemia, spironolactone is a potassium sparing medication.

The nurse has to give metoprolol (Lopressor) what nursing intervention should be done prior to giving this medication

obtain a blood pressure and pulse

What lifestyle factors will the nurse discuss with the client who has a blood pressure of 130/88? Select all that apply. physical activity dietary sodium weight reduction the DASH diet alcohol moderation

physical activity dietary sodium weight reduction the DASH diet alcohol moderation

When a client is taking furosemide this is the type of food the client should be encouraged to eat.

potassium rich foods

A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? prior intracranial hemorrhage recent consumption of a meal shellfish allergy use of heparin

prior intracranial hemorrhage

aneurysm

push blood with knot at end increase pressure, increase volume pressure weakens walls of buldge

A client who is newly diagnosed with high blood pressure has a 20-pack-year tobacco history. The nurse recommends smoking cessation for this client because nicotine: raises heart rate, constricts arterioles, and reduces the heart's ability to eject blood. decreases heart rate, constricts arterioles, and reduces the heart's ability to eject blood. increases heart rate, constricts arterioles, and increases the heart's ability to eject blood. decreases circulating blood volume.

raises heart rate, constricts arterioles, and reduces the heart's ability to eject blood.

This chemical is released by the kidneys to raise BP and increase vascular fluid volume in response to renal hypo perfusion.

renin

A patient has a new prescription captopril following a clinic visit. What should the nurse include in teaching about the drug? Select all that apply

report cough check BP/P

the client has a history of smoking, obesity, and physical inactivity, the nurse understands these to be this.

risk factor for essential hypertension

a diet high in ____ and ____is a modifiable risk factor for hypertension.

salt and fat

BP med

same time consistently, same arm if BP taken, usually taken in morning

The nurse finds kidney disease in the client history and understands this is a risk factor of this disorder.

secondary hypertension

This electrolyte if elevated may cause increase in BP due to increasing the clients blood volume.

sodium levels

acute period after surgery

they will have to hold platelets aggulets at least 7-10 days in order to have surgery don't bleed will need heparin or enoxparin

manifestion of acute coronary syndrome are due

to an imbalance between myocardial oxygen supply and demand

The nursing considerations for furosemide are ____, ____ & ____.

weight client daily, measure intake and output, and monitor serum potassium level