Exam 1- Health and Illness II
Parameters of stage 1 and stage 2 Hypertension (HTN)
Stage 1: systolic between 130-139 and diastolic between 80-89 Stage 2: systolic 140 or higher and diastolic 90 or higher
Hyperlipidemia medications
Statins, Niacin, Omega-3 Fatty Acid, Bile-Acid Sequestrants, Proprotein Convertase Subtilisin/Kexin 9 (PCSK9) Inhibitors, Cholesterol Absorption Inhibitor
Mitral valve regurgitation assessment findings
S3 gallop Holosytolic murmur New systolic murmur Pulmonary edema Pale skin Edema in the legs and ankles Irregular heartbeat / ST segment elevations
Indications for a pacemaker
Sinus node dysfunction (SND) and high-grade atrioventricular (AV) block
S/S of hypernatremia
Skin flushed, dry, flaky / Seizures Agitation / Attention span decreased Lethargy; Low-grade fever Thirst/twitching Increased urine specific gravity Edema (pulmonary) Reduce cardiac contractility, urine output
Diagnostic tests for infective endocarditis
positive throat test for GABHS, positive anti strep O or ASP titer. Jones Criteria
Therapeutic effects of spironolactone
potassium sparing diuretic/ aldosteron antagonist for edema of HF, hypertension, HF
Characteristics of PVCs and nursing interventions
Rate usually regular, P wave present before normal sinus beats, QRS normal except for ectopic beat, then wide and funny looking, treat cause is warrant
beta blocker guidelines
Reduce myocardial contractility, HR, SVR, and BP Contraindicated: Severe bradycardia, acute decompensated HF Caution use: Asthma, diabetes
Hydralazine
Reduces SVR and BP by direct arterial vasodilation
Mitral valve prolapse patient education points
Take drugs as prescribed Adopt healthy eating habits. Avoid caffeine. Exercise Contact the HCP or emergency response system (ERS) if symptoms develop or worsen (e.g., palpitations, fatigue, shortness of breath, anxiety).
Ejection Fraction
The amount of blood filled inside the left ventricles that are being contracted out
Which statement by a patient after a mechanical valve replacement indicates to the nurse that further instruction is needed?
The biggest risk I have during invasive health procedures is bleeding because of my anticoagulants
Causes of Pericarditis
Viruses: Most common Post MI Renal failure Endocarditis
The reversal agent for warfarin is?
Vitamin K
Warfarin (Coumadin) patient education points related to blood testing
Vitamin K. For VKA-related bleeding, treatment with prothrombin complex concentrate (human) (Kcentra), IV vitamin K and/or fresh frozen plasma is recommended.
Vitamin K
Warfarin inhibits activation of the vitamin K-dependent coagulation factors
signs of heart transplant rejection
abdominal pain, chills, fatigue, low fever, nausea, body aches, dizziness, palpitations, hypotension, SOB, edema
risk factors of DVT
age, genetics, ethnicity, history of diagnosis, obesity, active cancer, recent trauma
Therapeutic effects of enalapril
antihypertensive/ACE inhibitor for hypertension, HF, left ventricular dysfunction
S/S of beta blockers
bradycardia, hypotension, wheezing, GI effects, weight gain, depression, fatigue and sexual dysfunction
Which statement accurately describes mitral valve prolapse?
bucking of the valve into the left atrium during ventricular systole
Assessment findings for infective endocarditis
elevated ESR and CRP
Mitral Valve Regurgitation
flaps of the mitral valve improperly close, therefore, blood leeks backwards ( back into the left atrium)
S/S of hypermagnesemia
magnum magnesium- keeps muscles calm and quiet: bradycardic vitals, hypotension, EKC dysrhythmias, depressed respirations, hypoactive bowel sounds, drowsiness and lethargy, weakness, absent DTR
Sinus Bradycardia signs and symptoms
Fainting, easily fatigued, dizziness, difficulty breathing, confusion, chest pain, hypotension
Blood Sugar - Normal parameters
Fasting 74-106 mg/dL (4.1-5.9 mmol/L) Casual ≤200 mg/dL (<11.1 mmol/L)
S/S of hypertension
Fatigue, dizziness, nosebleeds, confusion, N and V, SOB, palpitations
Drug Therapy DVT and VTE
Fibrinolytic agent Unfractionated heparin IV Low-molecular-weight heparin (e.g., enoxaparin [Lovenox]) Warfarin (Coumadin) for long-term therapy Analgesia
Pacemaker patient education points
Follow-up appointments for pacemaker function checks, incision care, arm restrictions, avoid direct blows, avoid high-output generator, no MRI's unless pacer approved, avoid anti theft devices, monitor pulse, pacemaker ID card, medic alert ID
Conditions impacting Myocardial O2 supply
Heart rate, contractility, wall tension
Modifiable risk factors for CAD
High serum lipids, hypertension, tobacco use, obesity, physical inactivity, diabetes, metabolic syndrome
What is an LVAD?
Left ventricle assist device
Risk factors for AAA
Male gender smoking history elderly HTN Caucasian family hx
Atrial fibrillation patient education points related to drug therapy
Meds will be given to either control heart rate or reduce clotting
Patients with mechanical heart valves require anticoagulation for? 6 months 1 year 6 years indefinetly
Indefinitely
Furosemide (Lasix) therapeutic effects
Inhibit NaCl reabsorption in the ascending limb of the loop of Henle Increase excretion of Na+ and Cl− More potent diuretic effect than thiazides, but shorter duration of action
Metoprolol tartrate
Inhibits sympathetic nervous stimulation of the heart Reduces heart rate, contractility, and BP Reduces ischemia Decreases afterload Cardioselective β-blockers include atenolol and metoprolol
Peripheral Artery Disease (PAD) Nursing Diagnosis
Narrowing of arteries which results in reduced blood flow ineffective tissue perfusion, activity intolerance
Aortic Valve Stenosis
Narrowing of the large blood vessel branching off the heart (aorta)
Ventricular fibrillation pathophysiology and patient signs/symptoms
No rate, no p wave, no PR interval, no discernible rhythm, no QRS. Dizziness, dyspnea, and hypotension because of decreased CO, increase heart rate
Which drug would the nurse expect to be prescribed for a patient with a mechanical heart valve? Ace Inhibitors Anticoagulants Antiarrhythmics Beta Blockers
Anticoagulants
Nursing interventions for infective endocarditis
Assess vital signs together with heart sounds to detect a murmur, assess the patient for joint tenderness, decreased range of motion (ROM), and muscle tenderness. Examine the patient for petechiae, splinter hemorrhages, and Osler's nodes.
Leading cause of PAD?
Atherosclerosis, a gradual thickening of the intima
Pathophysiology of atrial fibrillation
Atrial rate 350-600, ventricular rate varies, irregularly regular rhythm, no discernible p wave, no PR interval, QRS usually normal
MVP patient teaching
Avoid caffeine If you use diet pills or other over-the-counter drugs, check for common ingredients that are stimulants Begin, or maintain, an exercise program to achieve optimal health. Contact the HCP or emergency response system (ERS) if symptoms develop or worsen (e.g., palpitations, fatigue, shortness of breath, anxiety).
The risk factors for CVD
Being older than 65, genetics, family history, ethnicity, high cholesterol, high blood pressure, smoking, tobacco use
Chest pain emergency management
Beta-blockers, Anginas, Oxygen, vitals, telemetry
Valvular Heart Disease Diagnostic tests
Blood tests, Electrocardiograms, Stress tests, echocardiograms, coronary angiograms, MRIs, Coronary computed tomography angiograms
S/S of hypercalemia
Bone pain Arrythmias Cardiac arrest Kidney stones Muscle weakenss Excessive urination
S/S of hypomagnesemia
Buck wild: tachycardia, dysrhythmias, VFib, dyspnea, diarrhea, confusion, irritability, insomnia, seizures, increased DTR, twitching, numbness
Nursing interventions for patients with ventricular fibrillation
CPR, medications (ACLS), immediate defibrillation
assessment findings of AAA
CT scan, ultrasonography, cardiovascular instability, lower extremity pain, Diverticulitis, pancreatitis
Amlodipine
Cause vascular smooth muscle relaxation resulting in decreased SVR and arterial BP
Post-thrombotic Syndrome
Chronic inflammation and chronic venous hypertension. Chronic venous hypertension is caused by vein wall and vein valve damage
Contraindications of heart transplant
Chronologic age over 70 years or physiologic age over 65 years Life-threatening illness (e.g., cancer) that will limit survival to <5 years despite therapy Advanced cerebral or peripheral vascular disease not amenable to correction Active infection, including HIV infection Severe pulmonary disease that will likely result in the patient being ventilator-dependent after transplant
The nurse is reviewing the data of clients with prehypertension. Which client is at risk of stage 1 hypertension based on the data? A. normal cardiac output, increased hematocrit B. increased cardiac output, increased hematocrit C. decreased cardiac output, normal hematocrit D. normal cardiac output, normal hematocrit
Client B
S/S of digoxin toxicity
Confusion, loss of appetite, nausea, vomiting, diarrhea, vision problems
S/S of hypocalcemia
Convulsions/chovteks Arrythmias Tetany/trousseaus Stridor and spasms
Assessment findings and patient education points for PAD
Cool clammy skin, thick brittle nails, numbness or tingling on the fingers and toes, weakness, fatigue, tight burning, soreness on the ankles
Heart failure patient education points
D-diet-low sodium and fluid R. risk for falls B- bp and BNP- should not be increasing E-elevate legs D- daily weights (3lbs/day or 5-7 lbs in a week) S-sex (shouldn't have until they can climb 2 flights of stairs w no SOB) S-Stockings
S/S of left-sided heart failure
"drowning" Dyspnea Rales (crackles) Orthopnea Weakness Nocturnal paroxysmal dypnea Increased HR (trying to move blood to organs) Nagging cough Gaining weight
S/S of right-sided heart failure
"swelling" Swelling of legs, hands, and liver Weight gain Edema (pitting) Large neck (JVD) Lethargic Irregular HR Nocturia Girth (increased abd)
PAD nursing interventions
(1) adequate tissue perfusion; (2) relief of pain; (3) increased exercise tolerance; (4) intact, healthy skin on the extremities; and (5) increased knowledge of disease and treatment plan.
Complications of heart failure
(CVDs), particularly long-standing hypertension (HTN), coronary artery disease (CAD), and myocardial infarction (MI)
Nursing interventions for AAA
-assess for signs of ischemia, chest pain, tachycardia -assess hemodynamic status -assess for signs of peripheral edema -palpate abdomen for masses -monitor urine output -assess peripheral pulses
Normal lab value of sodium
135-145 mEq/L
Furosemide side effects
1. hypotension 2. hypokalemia 3. gastrointestinal upset 4. weakness
normal lab value of magnesium
1.3-2.1 mEq/L
normal lab value of potassium
3.5-5.0 mEq/L
Which prescribed action would the nurse QUESTION when caring for a patient who has HF, with BP of 102/70, pulse 106, and lung crackles? A. Infuse normal saline B. Give furosemide IV C. administer potassium chloride D. titrate oxygen by mask
A. Infuse normal saline
Which action would the nurse implement first for a client whose serum potassium level has increased to 5.8? A. assess vitals B. call lab to repeat test C. inform cardiac arrest team D. perform electrocardiogram
A. assess vitals
Which lab test is important for a nurse to monitor when a patient is admitted with acute coronary syndrome? A. troponin B. myoglobin C. homocysteine D. creatinine kinase
A. troponin
Risk factors for endocarditis
Acquired valve disease (e.g., mitral valve prolapse with regurgitation, calcified aortic stenosis) Cardiomyopathy Congenital heart disease Heart lesions (e.g., ventricular septal defect, asymmetric septal hypertrophy) Marfan's syndrome Pacemaker Prior IE Prosthetic heart valve(s) Rheumatic heart disease (e.g., mitral valve regurgitation)
Risk factors of VTE
Active cancer or cancer treatment old age >60 Significant medical conditions - heart disease, metabolic, endocrine or respiratory illnesses, acute infectious disease, inflammatory conditions (e.g. IBD) history of diagnosis HRT or OCP use Varicose veins A recent period of immobilization
Which cardiac valve disorder causes a sudden onset of cardiovascular collapse?
Acute aortic regurgitation Prolapse = buckling
Non-modifiable risk factors of hypertension
Age, diabetes, gender, family history, ethnicity, socioeconomic status
non-modifiable risk factors for CAD
Age, gender, ethnicity, family history, genetics
Modifiable risk factors for hypertension
Alcohol and tobacco use, obesity, stress, sedentary lifestyle, elevated serum lipids
S/S of hypokalemia
Alkalosis Shallow respirations Irritability Confusion, drowsiness Weakness, fatigue Arrythmias Lethargy Thready pulse ↓ Nausea, vomiting
Which signs of hypokalemia would the nurse monitor in the postop surgical client with a nasogastric tube attached to continuous low suction? A. irritability B. dysrythmias C. muscle weakness D. abdominal cramps E. acidosis
B. Dysrhythmias and C. muscle weakness
When the nurse is auscultating a client's heart, where would S1 be loudest? A. base B. apex C. left lateral border D. right lateral border
B. apex
Which nursing action has the highest priority when providing care for a client who has had an acute MI? A. prevent nausea and vomiting B. monitor for cardiac dysrhythmias C. use prescribed medication to lower fever D. teach about the phases of cardiac rehab
B. monitor for cardiac dysrhythmias
Which autoimmune disease can result in damage to the heart? A. uveitis B. rheumatic fever C. myasthenia gravis D. graves disease
B. rheumatic fever
Lab values to watch in patients with heart failure
BNP, metabolic panel, CBC, BUN, Creatinine, Glucose, Thyroid function
Which explanation would the nurse give about the purpose of the procedure when a client with angina is scheduled to have cardiac catheterization? A. to obtain the pressures in the heart chambers B. to determine the existence of congenital heart disease C. to visualize the disease process in the coronary arteries D. to measure the oxygen content of various heart chambers
C. to visualize the disease process
The nurse provides education for a client who has recieved a prescription for spironolactone. The nurse concludes that the teaching is effective when the client plans to consume which type of juice? A. prune juice B. orange juice C. tomato juice D. cranberry juice
D. Cranberry
Which medication would a nurse conclude is the cause of a decreased HR in a client receiving a cardiac glycoside, a diuretic, an angiotensin enzyme inhibitor, and a vasodilator? A. diuretic B. vasodilator C. ACE inhibitor D. cardiac glycoside
D. cardiac glycoside
Which concern when caring for a client prescibed furosemide 40mg every day in conjunction with dixogin would prompt the nurse to ask the health care provider about potassium supplement? A. Digoxin causes significant potassium depletion B. the liver destroys potassium as digoxin is detoxified C. lasix requires adequate serum potassium to promote diuresis D. digoxin toxicity occurs rapidly in the presence of hypokalemia
D. digoxin toxicity occurs rapidly in the presence of hypokalemia
which type of shock would the nurse monitor for a client with a ruptured AAA? A. obstructive B. neurogenic C. cardiogenic D. hypovolemic
D. hypovolemic
Common drug therapies and diagnostic studies for peripheral artery disease (PAD)
Doppler ultrasound studies Segmental BPs ABI Duplex imaging Angiography Magnetic resonance angiography Cilostazol or pentoxifylline
Assessment findings for patients with mitral valve stenosis
Dyspnea on exertion, hemoptysis, fatigue. Atrial fibrillation on ECG. Palpitations. Loud, accentuated S1. Low-pitched, diastolic murmur
Acute decompensated heart failure ADHF clinical manifestations
Early: Increased pulmonary venous pressure, mild increase in the respiratory rate, decrease PaO2 Later: Interstitial edema, tachypnea, shortness of breath Further progression: Alveolar edema, respiratory acidosis
Indications of heart transplant
End-stage HF refractory to medical care Severe, decompensated, inoperable, valvular heart disease Recurrent life-threatening dysrhythmias not responsive to maximal interventions, including defibrillators Any other heart abnormalities that severely limit normal function and/or have a mortality risk of more than 50% within 2 years
Nursing Management for patients on Anticoagulants
Examine urine and stool for overt and occult signs of blood. Evaluate platelet count for signs of heparin-induced thrombocytopenia. Evaluate appropriate laboratory coagulation tests for target therapeutic levels. Evaluate lower extremity for bruising or hematoma development if intermittent pneumatic compression device used. Perform assessments frequently for signs and symptoms of bleeding (e.g., hypotension, tachycardia) or clotting. Notify the HCP of any abnormalities in assessments, vital signs, or laboratory values.
Signs and symptoms of AAA rupture
Hypovolemic shock with tachycardia, hypotension, pale clammy skin, decreased urine output, altered level of consciousness, and abdominal tenderness
What specific labs are ordered for patients with mechanical heart valves? blood glucose and CBC troponin INR/PT BUN and Creatinine
INR/PT
Drug therapy for CAD
Lipid-lowering drug therapy, drugs that limit lipoprotein production, niacin, antiplatelet therapy
M.O.N.A.
M- morphine O- oxygen N- nitrates A- aspirin
S/S of hyperkalemia
M-Muscle Cramps U-Urine Abnormalities R-Renal Failure D-Decreased cardiac contractility E-excessive K+ intake R-reflexes (hypo or hyper)
Angina management
MONA
Reasons hypertension drug therapy may not be working
Overactive renal nerve
MI Signs/Symptoms
PULSE: Persistent chest pains Upset stomach Lightheadedness Shortness of breath Excessive sweating
6 P's of acute arterial ischemia
Pain, pallor, paralysis, pulse deficit, paresthesia, and poikilothermia
Pericarditis complications
Pericardial effusion and cardiac tamponade. Pericardial effusion is a build-up of fluid in the pericardium.
Difference between Primary and Secondary HTN
Primary-unknown cause-usually due to lifestyle issue Secondary- specific cause, sudden development
S/S of hyponatremia
Stumor, coma Anorexia (nausea, vomiting) Lethargy Tendon reflexes (decreased) Limp muscles (weakness) Orthostatic hypotension Seizures/headache Stomach cramping
Are patient with aortic stenosis S.A.D.? Stenosis, Artery, Disease Stenosis, Angina, Disease Syncope, Angina, Dyspnea Syncope, Artery, Disease
Syncope, Angina, Dyspnea
Dilated and hypertrophic: cardiomyopathy pathophysiology
Systolic dysfunction of the left or both ventricles that reduce the amount of blood that goes to the rest of the body
Hypertensive Crisis - BP reading and medication
Systolic higher than 180, diastolic more than 120 Labetalol, nicardipine, esmolol
Therapeutic effects of nitroglycerin
Vasodilator/nitrate to decrease preload and afterload for HF, acute MI, angina
assessment findings of VTE
uniliteral calfs, ultrasound , cellulitis,
assessment findings of DVT
venous compression ultrasonogram, ultrasound, CT, D-dimer assay, baker cyst, cellulitis, lymphedema, PAD
