perfusion exam
a client with HTN tells the nurse that she stopped taking her blood pressure pills for a few weeks and only takes them when she feels sick. Which is the best action for the nurse to take? -educate the client about complications associated with high blood pressure -ask client questions to determine current understanding of high BP -emphasize importance of taking BP medications now to continue to feel well -show client current BP and compare that with normal BP levels
-ask client questions to determine current understanding of high BP
Which statement by a client who had an ischemic ulcer on foot indicated need for intervention by nurse? -i drink 3 L of water per day -i smoke about 1 pack of cigarettes per day i have a glass of wine with dinner every night -i drop my foot off the edge of the bed at night
-i smoke about 1 pack of cigarettes per day
during a health fair, the nurse measures an adult's BP as 200/120 mmHg. Which rationale is the basis for planning the next nursing intervention? -increased risk for a cerebrovascular accident (CVA) -elevated pressure reflects white coat syndrome -walking around the fair probably raised the BP -information should be obtained regarding prescribed medications
-increased risk for a cerebrovascular accident (CVA)
When a client with intermittent claudication has been instructed to stop smoking and does not understand why it is necessary, which response by the nurse is best? -tobacco smoking causes many health problems -nicotine use is a risk factor for heart and lung diseases -nicotine makes blood vessels smaller and will worsen your pain -smoking is prohibited for both clients and staff members in the hospital
-nicotine makes blood vessels smaller and will worsen your pain
normal sinus rhythm
60-100 bpm all complexes normal and evenly spaced (P, QRS, T)
LDL cholesterol
<130
Total Cholesterol
<200 mg/dL
Sinus Bradycardia
<60 bpm normal sinus rhythm -hypoglycemia, hypothermia, hypothyroidism, cardiac Hx, medications, MI -cool and clammy, syncope, dizzy
Sinus Tachycardia
>100 normal sinus rhythm -rapid firing from SA node -damage to heart from disease, HTN, fever, stress, alcohol, nicotine, pain, imbalance of electrolytes, hyperthyroidism -dyspnea, lightheaded, rapid pulse, palpitations, syncope
Ventricular tachycardia (V-tach)
A condition in which the heartbeat is quite rapid; if rapid enough, ventricular tachycardia will not allow the heart's chambers to fill with enough blood between beats to produce blood flow sufficient to meet the body's needs.
the SA node causes the atria to contract and the signal passes through the
AV node (bundle of hiss and purkinje fibers), causes ventricles to contract
ACE inhibitors meds
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Prinivil), Ramipril (Altace), benazepril (lotensin)
cardioglycosides
Digoxin; increase cardiac output, decrease HR but increase force of contraction
Loop Diuretics
Furosemide (Lasix) -block chloride and sodium resorption and results in dilation of blood vessels -can cause severe dehydration and electrolyte loss, hypokalemia
Thiazide diuretics
Hydrochlorothiazide (HCTZ) -inhibit resorption of sodium, potassium, and chloride -causes relaxation of arterioles which decrease preload/afterload -watch for hypercalemia, hyponatremia, hypokalemia, may have probs with clotting
after the nurse completes teaching for a client with foot pain who had peripheral arterial disease, which client statement indicates further teaching is needed? I will wear socks I will elevate my foot I will increase fluid intake I will drink moderate amounts of alcohol
I will elevate my foot
ARBs considerations
NO cough, chest pain, hypoglycemia, UTI, anemia, contraindicated in pregnancy, watch for hyperkalemia
S1, S2
S1: AV valves close S2: SL valves close
electrical impulse starts in the
SA node (pacemaker)
Potassium sparing diuretics
Spironolactone (Aldactone) -aldosterone inhibiting diuretics, decrease volume (sodium and water) -hyperkalemia, do not give ACE inhibitors
stroke volume
The amount of blood ejected from the heart in one contraction.
systole
Ventricular contraction and closure of the AV valves occurs and blood is pumped out of the ventricles.
risk factors for impaired perfusion
advanced age, family hx, immobility, increased stress/cholesterol, gender (effects more men), SMOKING, obese, poor diet, sedentary, alcohol use
calcium channel blocker meds
amlodipine (Norvasc), diltiazem (Cardizem), nifedepine (Procardia), verapamil (isoptin)
Preload
amount of cardiac muscle tension (STRETCH) at the end of diastole
Aspirin (ASA) Clopidogrel (Plavix)
antiplatelet medications -contraindicated in active bleeding, vitamin K deficiency, thrombocytopenia -clopidogrel given as prophylaxis for TIAs and post MI
a client who is admitted to the ED with a BP of 240/150 mmHg reports severe headache, blurred vision, and swelling of ankles. Which prescribed action would the nurse take first? obtain blood glucose collect urine and blood sample assess client's pulse and respiration determine amount of ankle edema
assess client's pulse and respiration
P wave
atrial depolarization or contraction
Anticoagulants
block part of clotting cascade; monitor prothrombin; PTT low clots grow, PTT high you die
Angiotensin Receptor Blockers ARBs (SARTAN)
block receptor sites for angiotensin 2, smooth vascular muscle and adrenal gland
a client is admitted to hospital with a long hx of uncontrolled HTN. Which lab result will be most important for nurse to review? blood glucose WBC count blood urea nitrogen lactic dehydrogenase
blood urea nitrogen
a 30 yr old who is diagnosed with hyperlipidemia and HTN asks the nurse to explain why treatment is important. Which response would the nurse make?
both high blood pressure and high cholesterol contribute to development of heart disease
Ventricular Flutter
can look like v-tach but at a must faster rate
The nurse is assessing the perfusion and circulatory status of a postpartum client 3 hours after birth. Which clinical finding does the nurse expect? irregular heartbeat thready peripheral pulses cap refill less than 3 seconds urinary output of less than 20 mL
cap refill less than 3 seconds
ACE inhibitors considerations
captopril has short halflife, enalapril is only ACE that can be given parenterally, first-line treatment, DRY cough, angioedema, avoid NSAIDs
pulse deficit
cardiac contraction are not strong enough to pump blood to peripheries
older adults age related changes (perfusion)
cardiac valves calcify, conduction system decreases (dec. pacemaker cells), decrease muscle fibers in myocardium, left ventricle thickens, aorta/large arteries thicken, baroreceptors become less sensitive
arterial system
carries oxygenated blood away from the heart, to the tissues
2 hours after cardiac catheterization that was accessed through the right femoral route, a clent reports numbness/pain in right foot. Which action will the nurse take first? call primary HCP check pedal pulses bilaterally take BP and pulse teach about postcatheterization embolus
check pedal pulses bilaterally
ventricular rate
count the QRS complexes
diuretics
decrease BP by reducing volume, prevent reabsorption of sodium and water, watch for orthostatic hypotension
Beta-adrenergic blockers (LOL) considerations
do not suddenly stop, do not give nonselective to COPD, nonselective can mask tachycardia and hypogylcemia, impotence
Which sites would be monitored for a pulse to assess the status of circulation to foot? carotid artery femoral artery popliteal artery dorsalis pedis artery posterior tibial artery
dorsalis pedis artery posterior tibial artery
perfusion
flow of blood through arteries and capillaries delivering nutrients and oxygen to cells
afterload
force ventricles must exert to open semilunar valves
Infants age related changes (perfusion)
heart is bigger in relation to rest of body, systolic BP is lower r/t weak left ventricle (will eventually increase)
cardiac output
heart rate x stroke volume; amount of blood pumped by heart each minute
asystole
hearts electrical system has stopped working (no heartbeat)
Heparin
inhibit clotting factors thrombin and Xa subQ or IV antidote: protamine sulfate
Warfarin
inhibit vitamin K and production of clotting factors can cause purple toes, necrosis, monitor INR, avoid vitamin K
a client tells the nurse the their legs begin to hurt after walking several blocks and goes away with rest. Which condition would the nurse consider as the most likely cause of the client's pain? spinal stenosis buerger disease rheumatoid arthritis intermittent claudication
intermittent claudication
Atrial Flutter
irregular beating of the atria; often regular rhythm
why should you avoid smoking?
it causes vasospasm, decreased HDL (good cholesterol), causes platelets to stick and increases clot risk
Which dietary choices would the nurse teach the client with peripheral arterial disease?
limit salt intake eat whole-grain breads use liquid vegetable oils increase fruits and veg avoid processed meats avoid calcium
ARBs meds
losartan (cozaar), valsartan (diovan)
a 68 yr old client has multiple risk factors for peripheral arterial disease (age, siblings w/diabetes, sedentary, family hx of heart disease). Which risk factor is the highest priority for client teaching? old age low activity level blood glucose control family hx of cardiac disease
low activity level
Beta-adrenergic blockers (LOL)
lower heart rate by BLOCKING beta receptors, suppresses renin which causes vasodilation
Which medication would be prescribed to reduce HTN in a pregnant client? lithium miglitol calcium gluconate magnesium sulfate
magnesium sulfate
Troponin T/I
may indicate cardiac necrosis or acute MI if elevated
Triglycerides
men: 40-160 women: 35-135
HDL cholesterol
men: >40 women: >50
venous system
moves deoxygenated blood toward the heart, from capillaries to rt side
Clacium channel blockers (PINE) considerations
no grapefruit juice, hypotension, palpitations, constipation, peripheral edema, contraindicated in patients with MI, AV block, hypotension
Which info obtained by the nurse about a client would represent risk factors for the client's admission dx of HTN? daily use of 1 aspirin occasional cocaine use reduced Hgb levels african american heritage increased HDL
occasional cocaine use african american heritage
Impaired Central Perfusion
occurs when cardiac output is inadequate *reduction of oxygenated blood reaching the body tissues (systemic).* - If severe (hypovolemic), associated with shock because we don't have the volume needed. - If untreated, leads to ischemia, cell injury, and cell death (localized)
Which findings would the nurse expect when assessing a client with peripheral arterial disease? pallor of feet warm extremities ulcers on toes thick, hardened skin delayed cap refill
pallor of feet ulcers on toes delayed cap refill
When a client with a hx of heart failure on daily weights has gain 4lbs since the previous day, which action would the nurse take? perform a head-to-toe assessment place client on restricted fluid intake discuss restricted sodium diet document findings in health care record
perform a head-to-toe assessment
After reviewing client's CBC, which finding is most important for the nurse to communicate to HCP? hct 41% hgb 12 g/dL platelet count 75,000 WBC 5100
platelet count 75,000
S/Sx of poor perfusion in infants
poor feeding, poor weight gain, fatigue, failure to thrive, dusky color (ashen)
Which is the purpose of encouraging active leg and foot exercises for client who just had hip surgery? maintain muscle strength reduce leg discomfort prevent clot formation improved wound healing
prevent clot formation
semilunar valves
pulmonary valve and aortic valve
When a client with a hx of HTN that is usually successfully treated with medications has a blood pressure of 160/100 mmHg during a clinic appt, which action would the nurse take next? teach client about the need for low sodium diet ask the client when BP medications were last taken question the client about symptoms such as headache or chest pain call for ambulance to transport client to ED
question the client about symptoms such as headache or chest pain
atrial fibrillation
rapid, random, ineffective contractions of the atrium
after obtaining BP of 172/104 mmHg and 164/98 mmHg during a screening, which action would the nurse take next? provide health teaching about low-sodium diet call paramedics for transport to hospital suggest ways to decrease the clients stress level refer the clients to a primary HCP
refer the clients to a primary HCP
rhythm on EKG
regular: interval between waves is reg irregular: interval between waves is irregular (measure P to R or R to P)
Systemic Vascular Resistance (SVR)
resistance to ejected blood created by diameter of blood of blood vessels receiving blood; SVR is related to the amount of dilation or constriction in the blood vessel.
selective v. nonselective beta blockers
selective: affect beta 1 (heart) Metoprolol (lopressor) Atenolol (tenormin) Propranolol (inderol) nonselective: affect beta 1 and 2 (heart and lungs) Nadolol (corgard) Labetolol (trandate) carvedilol (coreg)
When a client's cardiac monitor shows a PQRST wave for each beat, with regular rhythm and rate of 120 bmp, how will the nurse document the rhythm? atrial fibrilation sinus tachycardia ventricular fibrilaiton fist-degree atrioventricular block
sinus tachycardia
Clacium channel blockers (PINE)
slows AV and SA node conduction, blockage of Ca+ promotes muscle relaxation, vasodilation
S/Sx of poor perfusion in toddlers
squatting, fatigue, developmental delay
Angiotensin-converting enzyme (ACE) inhibitors (PRIL)
stops conversion of angiotensin 1 into angiotensin 2, no vasoconstriction
Contractility
strength of myocardial contraction
ventricular fibrillation
the rapid, irregular, and useless contractions of the ventricles
defibrillation
treat Vtach, Vfib, asystole
Vasodilators
treat angina and HTN; open
vasopressors
treat hypotension; constrict
atrioventricular valves
tricuspid and mitral (bicuspid)
Which lab value will be most important for the nurse to monitor to determine whether a client with chest pain had acute coronary artery syndrome (ACS)? troponin T c-reactive protein low-density lipoprotein b-type natriuretic protein
troponin T
Which topics would the nurse include in teaching a client with a new dx of HTN? reason for daily low-dose aspirin use use of home BP monitor adverse effects of tobacco on BP avoidance of any alcohol consumption benefits of moderate daily exercise
use of home BP monitor adverse effects of tobacco on BP benefits of moderate daily exercise
low molecular weight heparin (lovenox)
used for bridge therapy, subQ only
Antidysrhythmics
used to treat premature ventricular contractions, tachycardia, and Afib, HTN
QRS complex
ventricular depolarization or contraction; atrial rest or repolariztion
Diastole
ventricular relaxation and filling
T wave
ventricular repolarization or rest
antiplatelet agents
works to keep platelets from sticking
