Patho: Quiz 4
deep vein thrombosis (DVT): TRIAD effect
stasis of blood - decreased blood flow, blood pooling in lower extremities increased blood coagulability - increased clot formation vessel wall injury
aortic aneurysm: clinical manifestations
substernal/back/neck pain, dyspnea (SOB), brassy cough, distention of neck veins, edema of face and neck
STEMI: complications
sudden death, pericarditis, stroke, thromboemboli, mechanical defects
aortic dissection: clinical manifestation
sudden onset of tearing/sharp/stabbing pain in chest and back - can radiate to shoulders, neck, jaw, and abdomen
The nurse knows that the primary long-term regulation of blood pressure is exerted by which body system?
the kidneys
Which blood vessel layer is composed primarily of smooth muscle cells?
tunica media
The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is:
unknown
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?
vascular smooth muscle cells (SMCs)
varicose veins
80-90% of venous blood from lower extremities is transported through deep channels--when the flow in the channels is impaired or blocked these develop
deep vein thrombosis (DVT): risk factors
hyperactivity of blood coagulation, hyper-estrogenic states, immobility, cancer, trauma to lower extremities, smoking
deep vein thrombosis (DVT): clinical manifestations
swelling, pain (dull & achy), deep muscle tenderness, fever, malaise
hypertension: complications
target-organ damage (eyes/retinas, kidneys/renal system, heart (MI, CHF), brain (strokes, aneurysms)
aortic dissection: etiology
tear in the wall of the aorta that results in forceful blood flow through middle layers of aortic wall can lead to weakening and separation of the aortic wall
peripheral arterial disease (PAD): clinical manifestations
the P's: pain (intermittent claudication - pain with walking), pulselessness, pallor, cool to touch
chronic venous insufficiency: etiology
veins are incompetent (valves aren't working) can't push blood back up to the heart very well
deep vein thrombosis (DVT): diagnostics
venography, ultrasonography, D-dimer assessment, increased WBC
systolic pressure
ventricular contraction
diastolic pressure
ventricular relaxation
infective pericarditis: risk factors
viral infections, bacterial/mycobacterial infections, connective tissue diseases, radiation, trauma, drug toxicity
A telehealth nurse is talking with a client who has a history of right-sided heart failure. The nurse should question the client about which assessment finding that would indicate the client's condition is worsening?
weight gain
A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be:
"Aspirin will help prevent blood clotting."
UA/NSTEMI (unstable angina/non-ST-segment elevation myocardial infarction): etiology
(1) development of unstable plaque (2) obstruction or adrenergic stimuli (3) severe narrowing (4) inflammation (5) physiologic state causing ischemia
A client is diagnosed with orthostatic hypotension. The nurse knows that which drugs can predispose the client to orthostasis? Select all that apply.
-antihypertensives -psychotropics -diuretics
An adult's documented blood pressure (BP) readings over the past 2 years include: 140/82 mm Hg, 144/82 mm Hg, 150/82 mm Hg, 160/82 mm Hg, and 162/82 mm Hg. Which interpretation(s) of these BP trend will the provider discuss with this client? Select all that apply.
-client's systolic BP is hypertensive -client has increased risk for future cardiovascular events
A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which reason? Select all that apply.
-for its vasodilation effect -to relieve coronary pain
A clinically obese client diagnosed with stage 2 hypertension is resistant to taking antihypertensive medication because he has no symptoms and "feels fine." The nurse will encourage this client to attempt lowering his blood pressure to prevent the development of which complication? Select all that apply.
-renal failure -coronary artery disease -stroke -loss of vision
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client? Select all that apply.
-smoking cessation -dietary measures to reduce LDL levels -weight reduction if overweight
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below:
140/90
Which client should most benefit from treatment with anti-thrombin agents?
57-year-old client who has recently been diagnosed with unstable angina
total cholesterol levels
<200
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.
A client with chronic renal failure secondary to diabetes has just been diagnosed with secondary hypertension. This increase in blood pressure is likely caused by which physiologic factor?
Activation of the renin-angiotensin-aldosterone mechanism
Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?
Atherosclerosis and unstable angina
UA/NSTEMI: classes
Class I: new-onset severe angina Class II: angina at rest within the past month, but not within the last 48 hours Class III: angina at rest within 48 hours
Which vascular changes can occur in older adults because of the increase in blood pressure during the aging process?
Decreased elasticity in arterial connective tissue
STEMI: diagnostics
ECG = elevated ST-segment
UA/NSTEMI: diagnostics
ECG demonstrates ST-segment depression and T-wave changes
orthostatic hypotension: complications/manifestations
FALL RISK dizziness, syncope, blurred vision, palpitations
A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring?
HDL
The student attends a health fair and has his serum cholesterol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?
It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.
The nurse's brother is not convinced that he should quit smoking. He asks his sister (the nurse) to demonstrate for him the more immediate effects of smoking on his health. Which of the following could be used to help convince the brother to stop smoking?
Measure his blood pressure and show him how much higher it is when he is smoking.
infective pericarditis: treatment
NSAIDs, antibiotics, corticosteroids
While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process?
Peripheral vascular resistance
A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response?
The most common cause is a staph infection.
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?
Will prevent the conversion of angiotensin I to angiotensin II
aortic dissection: risk factors
hypertension, atherosclerosis, family history, genetic disorders (Marfan's, Ehlers-Danlos)
orthostatic hypotension: etiology
abnormal drop in BP when standing decreased blood flow to CNS
aortic aneurysm: etiology
abnormal localized dilation of the aorta weakened spot of the artery wall
STEMI: clinical manifestations
abrupt onset with significant, severe, crushing pain that's often described as constricting or suffocating substernal, radiates to left arm, neck, or jaw pain is prolonged and cannot be relieved by nitroglycerin
The most common causes of left-sided heart failure include:
acute myocardial infarction
orthostatic hypotension: risk factors
age (slowed circulatory response), decreased blood volume/fluid deficit, medication (diuretics, antihypertensives), prolonged immobility (weakening in muscles helping to return blood to heart), malnutrition and dehydration
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of deep vein thrombosis (DVT). Which nursing intervention should the nurse implement?
apply sequential pneumatic compression devices to lower extremities
triglycerides
bad <150 (ideal is <100)
LDL (low density lipoprotein)
bad cholesterol <100
vasospastic angina (Prinzmetal or variant angina)
caused by vasoconstriction no atherosclerosis
An older adult client is newly diagnosed with hypertension. Which vascular changes in the aging adult can lead to hypertension?
decreased elasticity of the aorta and large arteries
ST-elevated myocardial infarction (STEMI) is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?
decreases metabolic demands of the heart
From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?
deep vein thrombophlebitis of the leg
cardiomyopathy
disease of the heart muscle
Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which disorder was the player's most likely cause of death?
hypertrophic cardiomyopathy (HCM)
An older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug?
hypotension
A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:
hypovolemic shock due to acute intravascular volume loss.
infective endocarditis: treatment
identifying and eliminating the causative microorganism (antibiotics)
vasculitis: etiology
immune mediated inflammation and necrosis on blood vessel wall caused by direct injury to vessel, infectious agents
aortic aneurysm: complications
impinge blood flow to spinal cord, erosion of vertebrae, systematic arterial insufficiency
hypertrophic cardiomyopathy (HCM): treatment
implantable cardioverter-defibrillators (ICDs), betablockers
An 86-year-old client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related change predisposes older adults to the development of heart failure?
increased vascular stiffness
infective endocarditis: etiology
infection of the inner heart surface characterized by invasion of heart valves and mural endocardium leading cause: staphylococcal infections also: streptococci, enterococci, HACEK group
infective pericarditis: etiology
inflammation of the pericardium
venous disorders
interfere with fluid outflow from capillaries resulting in edema/congestion and trapping cellular waste ex. DVT
maintenance of BP during position change
involves rapid initiation of cardiovascular (increasing HR), neurohumoral, and muscular (pumping blood out of legs) responses when the standing position is assumed in the absence of circulatory reflexes or blood volume, blood pools in the lower part of the body, CO falls, blood pressure drops, and blood flow to the brain is inadequate
venous ulcers
large, wet, gooey (slough) irregular border on ankles hard to heal
UA/NSTEMI: clinical manifestations
pain associated has a persistent and severe course and characterized by 1/3: 1. occurs at rest lasting more than 20 minutes 2. severe and described as frank pain and of new onset (within 1 month( 3. more severe, prolonged, or frequent than previously experienced
Which of the following are characteristic signs of acute arterial embolism?
pallor, pulselessness, and pain
Exudate in the pericardial cavity is a characteristic of which cardiac condition?
pericardial effusion
A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is suffering?
pericardial effusion (accumulation of fluid in pericardial space)
A client is seen in the emergency room reporting sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?
pericarditis
peripheral arterial disease (PAD): etiology
plaque buildup on large arteries that are not in the heart, occludes it
dilated cardiomyopathy (DCM): etiology
power failure - not going the full distance (decreased output) heart chambers thin and stretch, growing larger impaired systolic function
deep vein thrombosis (DVT): etiology
presence of thrombus in vein and accompanying inflammatory response in the vessel wall (blood clot inside vein) begins attached to venous wall (blocks flow) - can become unattached and travel (leads to pulmonary embolism)
hypertension: risk factors
primary - genetics, race, age, family history (black, male) secondary - because of another disease (diabetes, kidney disease)
The nurse knows that vasopressin (antidiuretic hormone, ADH) plays which role in blood pressure control?
promotes retention of water
While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:
recording weight every day at the same time with same type of clothing
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for hypertension. The nurse questions the prescription of an ACE inhibitor for a client with which condition?
renal artery stenosis
long term BP control
renal system (controls ECF volume, excessive SNS stimulation)
mean arterial pressure (MAP)
1/3 systolic + 2/3 diastolic needs to be at least 60 for enough perfusion
A client is immobilized following a hip injury. The client has developed lower leg discoloration with edema, pain, and tenderness in the midcalf area. How should the nurse document these clinical findings?
deep vein thrombosis
infective endocarditis: risk factors
dental/surgical procedures, IV drug use, infection
acute coronary syndrome (ACS): treatment
reperfusion therapy, aspirin (antiplatelet agent), oxygen, pain medication (morphine) stent with balloon angioplasty may be placed
arterial disorders
result in impaired oxygen delivery to tissues (ischemia/ hypoxia) ex. PAD, CAD
A 56-year-old woman presents at the clinic complaining of the unsightliness of her varicose veins and wants to know what can be done about them. The nurse explains that the treatment for varicose veins includes which intervention?
sclerotherapy or surgery
infective pericarditis: clinical manifestations
sharp chest pain with quick onset - pain dependent on respirations and position (relief when leaning forward) friction rub
hypertension: etiology
sustained elevation of BP primary - genetics, race, age, family history (black, male) secondary - because of another disease (diabetes, kidney disease)
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?
headache and confusion
What is the most important factor in myocardial oxygen demand?
heart rate
The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which initial sign of this condition?
a pulsating mass in the abdomen
peripheral arterial disease (PAD): complications
anything distal to blockage will become ischemic and possibly necrotic ulcers, gangrene
peripheral arterial disease (PAD): diagnostics
arteriography (contrast injected to see occlusions- stent may be placed), Doppler ultrasound of lower extremity pulses, MRI, CT scan
The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?
arterioles
chronic stable angina
associated with a fixed coronary obstruction that produces a disparity between coronary blood flow and metabolic demands of the myocardium
peripheral arterial disease (PAD): risk factors
atherosclerosis, age, diabetes mellitus, smoking
hypertrophic cardiomyopathy (HCM): etiology
blockage - doing all the work but can't travel out of aorta (decreased output) heart muscles thicken asymmetrically (hypertrophied) abnormal diastolic function
A client is admitted to the intensive care unit suspected of having infective endocarditis. Which test is the most definitive diagnostic procedure that is done and used to guide treatment for this type of client?
blood culture
A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment, the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?
cardiac tamponade (space around heart fills with blood or other fluid putting pressure on heart and keeps it from beating)
stable angina
chest pain that occurs when a person is active or under severe stress initial manifestation of ischemic heart disease in about 1/2 of persons with CAD
unstable angina
chest pain that occurs while a person is at rest and not exerting themselves
hypertrophic cardiomyopathy (HCM): clinical manifestations
chest pain, syncope, heart murmur, palpitations, dyspnea, arrythmias
infective endocarditis: complications
hemorrhages, congestive heart failure, renal insufficiency
The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:
history of cigarette smoking and elevated blood pressure
chronic ischemic heart disease: etiology
chronic stable angina (fixed obstruction), silent myocardial ischemia (absence of pain), vasospastic angina (vasoconstriction)
Which client with cardiomyopathy does the nurse identify as having the greatest risk for a complication?
client with ejection fraction of 25% and atrial fibrillation
arterial ulcers
coin shaped, dry bottoms of feet/toes bright red or black base
Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?
constrictive pericarditis
When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?
conversion from aerobic to anaerobic metabolism
dilated cardiomyopathy (DCM): treatment
diuretics, beta-blockers, ACE inhibitors, anticoagulants
pericardium function
double-layered serous membrane that isolates the heart from other thoracic structures maintains its position in the thorax prevents it from overfilling a barrier to infection
chronic venous insufficiency: clinical manifestations
edema, brown skin pigmentation, skin atrophy, venous ulcers
The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia?
elevated total cholesterol
A client has been diagnosed with diabetes mellitus. Which lab result would the practitioner expect?
elevation of triglycerides
dilated cardiomyopathy (DCM): clinical manifestations
fatigue, dyspnea, lower extremity edema, chest pain, heart palpitations
vasculitis: clinical manifestations
fever, myalgia (muscle pain), arthralgia (joint pain), malaise
infective endocarditis: clinical manifestations
fever, signs of systemic infection, change in existing heart murmur, vegetative lesions, systemic inflammation, malaise
hypertrophic cardiomyopathy (HCM): risk factors
genetic - autosomal dominant
HDL (high density lipoprotein)
good cholesterol recycles LDL in liver reducing circulation of bad fats >50 women, >40 men
atherosclerosis: etiology
hardening of the arteries due to plaque buildup (large- & medium-sized arteries), excessive LDL
Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?
hypercholesterolemia
atherosclerosis: risk factors
hypercholesterolemia, elevations in LDL levels, age, family history, being male
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:
hypertension
STEMI (ST-segment elevation myocardial infarction): etiology
ischemic death of myocardial tissue associated with atherosclerotic disease of the coronary arteries 50% in left anterior descending artery
deep vein thrombosis (DVT): treatment
leg elevation, compression therapy, heat, early ambulation, anticoagulation drug therapy
dilated cardiomyopathy (DCM): risk factors
mixed (genetic & nongenetic) hereditary, infections, toxins, alcoholism, chemotherapeutic agents, metals, other disorders
The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.
myocardial infarction prevention
acute BP control
nervous system, CV system, humoral system (RAAS, ADH/vasopressin, epinephrine & norepinephrine)
