exam 3
Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?
constrictive pericarditis
How do you treat asymptomatic hypotension?
continue to monitor
what is aortic dissection?
hemorrhage into the vessel wall with longitudinal tearing of the wall to form a blood- filled channel
which is not a common cause of heart failure?
hypothyroidism
__________ shock results from acute blood loss
hypovolemic
Where is Buerger's Disease commonly seen?
in men younger than 45
When should a statin be administered
in the evening
Where is the Raynaud Phenomenon commonly seen?
in women age 15-40
systolic heart failure
inability of the heart to pump sufficiently because of an alteration in the ability of the heart to contract; term used to describe a type of heart failure
What is myocarditis?
inflammation of heart muscle
What is pericarditis?
inflammation of the sac of the heart
What is the acute stage of Buerger's Disease?
inflammatory thrombus blocks vessel
S&S of Buerger's Disease?
intermittent claudication of feet hands or arms, pain at rest, ischemic ulcerations, change in color and temperature, paresthesias, superficial vein thrombosis, cold sensitivity
What is the preferred route to administer epinephrine during anaphylactic shock?
intramuscularly
vasospasm
involuntary contraction of a blood vessel
What is a true aneurysm?
involves all the layers of an intact (but attenuated) arterial wall or the thinned ventricular wall of the heart
what does an MI lead to?
ischemia and necrosis of the myocardium
coronary artery disease is often subdivided into chronic __________ heart disease and acute coronary syndrome
ischemic
the lungs, GI system, and __________ are most susceptible to damage as a result of shock
kidneys
what does ischemia lead to?
lack of oxygen and nutrients
what does mitral valve stenosis occur with?
left atrial distension and impaired filling of the LF ventricle
what ejection fraction indicates heart failure?
less than 40%
medications ending in -statin are...
lipid-lowering agents and are indicated for patients who have coronary artery disease (CAD)
cardiac __________ is characterized by compression of the heart because of the accumulation of fluid, pus, or blood in the pericardial sac
tamponade
afterload
the amount of resistance to ejection of blood from the ventricle
inotrope (or inotropic)
the condition of the heart muscle's contractility. inotropic agents, or inotropes, are drugs that change the force of the heart's contractions
diastolic heart failure
the inability of the heart to pump sufficiently because of an alteration in the ability of the heart to fill; term used to describe a type of heart failure
A dissecting aortic aneurysm can cause Obstructive shock, how?
the large blood vessel attached to the heart tears and cannot transport blood to and from the heart effectively
a patient has en ejection fraction (EF) of 35%. what does this indicate?
the patient is in systolic heart failure
upon assessment, the nurse notes a patient has crackles and dyspnea. what does this indicate?
the patient's left side of the heart is affected
contractility
the process by which the muscular walls of blood vessels contract, narrowing the vessels and reducing blood flow
What is the chronic stage of Buerger's Disease?
thrombosis and fibrosis causes ischemia
which. cardiac enzyme is the most cardiac specific?
troponin
cholesterol is dependent on other particles for its transport through the body. true or false?
true
deep vein thrombosis most commonly occurs in the lower legs. true or false?
true
he key components of the blood work used to diagnose myocardial infarction are the troponin assays. true or false?
true
more people die of cardiovascular disease than of any other pathology in the united states each year. true or false?
true
the body is able to initiate numerous mechanisms that can compensate for heart failure. true or false?
true
what kind of aneurysm is this?
true
Which blood vessel layer is composed primarily of smooth muscle cells?
tunica media
Risk factors of the Raynaud Phenomenon?
use of vibrating machinery, work in cold environments, exposure to heavy metals, high homocysteine levels
______ veins are dilated, tortuous veins of the lower extremities
varicose
the group of vascular disorders that are marked by blood vessel necrosis and inflammatory injury is the _______
vasculitides
A patient complains of persistent leg cramps when at rest and has had a leg ulcer at the medial malleoli surrounded by bluish-brown skin. The patient has hypertension. What is the cause of the leg disorder?
venous insufficiency
Which of the following is not a risk factor for atherosclerosis?
venous stasis
EF >50% means
ventricles are unable to relax
preload
volume of blood in ventricles at end of diastole
What is cardiomyopathy?
weakened heart
Increasing blood pressure within the aorta progressively ________ vessel walls and __________ the aneurysm
weakens, enlarges
when do myocardial infarctions occur?
when plaque builds up and forms a clot in an artery, restricting blood flow
vasodilation
widening of blood vessels
when will a patient with a NSTEMI receive a PCI?
within 24 hours
A patient has a baseline blood pressure of 86/42 mmHg and is resting comfortably in their room talking on their phone. Their current blood pressure is 84/42 mmHg. What is the nurse's best course of action?
continue to monitor the patient
Which diagnosis is often an indication for a prescription for a statin?
coronary artery disease
what is the MAIN cause of a myocardial infarction?
coronary artery disease (CAD)
what causes an MI?
coronary artery disease (CAD), coronary artery vasospasm, decreased oxygen supply, increased oxygen demand
what can left sided heart failure lead to?
crackles, difficulty breathing
congenital defects that result in shunting of blood from the right side of the heart to the left are known as __________ disorders
cyanotic
What is a symptom of hypotension?
dizziness
A patient is diagnosed with cardiogenic shock. Which medication will the RN expect to be prescribed?
dobutamine
what are some symptoms of heart failure?
dyspnea, fatigue, retained fluid,
what tests diagnose heart failure?
echocardiogram, electrocardiogram (ECG), brain natriuretic peptide (BNP)
Is the ST segment elevated or depressed in a myocardial infarction?
elevated
what is ischemia?
Condition that occurs when there is a decrease in blood supply to an organ, tissue or muscle group
ischemia
Lack of blood supply
the greatest risk factor for the development of atherosclerosis is high __________
cholesterol
what is a STEMI?
complete blockage of a coronary artery and a medical emergency
Describe Cardiac Tamponade
compression of the heart due to accumulation of fluid in the pericardial cavity
what is cardiogenic shock?
heart is suddenly unable to pump enough blood to meet our body's needs
deep vein thrombosis constitutes an increased risk of _________ embolism
pulmonary
What do statins do?
reduce the amount of cholesterol the liver makes
when a valve does CLOSE properly this is...
regurgitation
chemoreceptors
respond to chemicals
A teenager is seen in the emergency room with reports of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen 3 weeks before in the clinic and treated with antibiotics for strep throat. He was better for a few days but now he seems to have gotten worse in the last 2 days. What should the nurse suspect is wrong with this client?
rheumatic fever
what can ACUTE mitral valve regurgitation be caused by?
rheumatic heart disease (from untreated bacterial infection), endocarditis, heart attack
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this client most likely is experiencing which type of shock?
septic
What is distributive shock?
septic and anaphylactic shock
How do statins affect CAD?
slow progression in order to prevent a MI
when a valve does OPEN properly this is...
stenosis
diastolic heart failure can lead to
stiff ventricles that resist filling
what are the symptoms of an MI?
sudden chest pain, shortness of breath, indigestion, nausea, anxiety
How is the Raynaud Phenomenon diagnosed?
symptoms persistent for AT LEAST 2 years
Which client would the nurse recognize as needing to be assessed for orthostatic hypotension?
An 80-year-old client who has experienced two falls while attempting to ambulate to the bathroom
List and understand the 7 Ps of acute arterial embolism
- Pistol shot (acute onset, sudden) - Pallor = pale (lack of oxygen) - Polar (cold) - Pain (due to ischemia) - Pulselessness (no blood flow) - Paresthesia = numbness - Paralysis = no movement
infarct (infarction)
area of cell death resulting from an infarction; sudden blockage of an artery
what are some characteristics of a pericardial effusion?
- Pressure-volume relationship between normal pericardial and cardiac volume is extremelysensitive - Usually related to inflammatory or infectious processes - Can cause Cardiac Tamponade
What are some symptoms of LEFT sided heart failure?
- Pulmonary Edema (pink frothy sputum) - Shortness of breath - Fine breath crackles - Paroxysmal nocturnal dyspnea - Cool extremity = Brain Perfusion
what is a positive inotropic effect? (frank-starling mechanism)
- increased strength of contraction - increased stroke volume
How does RAAS affect blood pressure?
- increasing sodium (salt) reabsorption - increasing water reabsorption (retention) - increasing vascular tone (the degree to which your blood vessels constrict, or narrow)
How is anaphylactic shock treated?
- intramuscular (IM) epinephrine
Which of the following are characteristic signs of acute arterial embolism?
Pallor, pulselessness, and pain
what are the two types of myocardial infarctions (MI)?
STEMI and NSTEMI
What are some symptoms of cardiac tamponade?
- Jugular Vein Distension - Increased central venous pressure - hypotension -Narrow pulse pressure - Muffled Heart Sound - Bradycardia
Which symptoms indicate peripheral arterial disease?
- Pain with walking - Hairlessness of leg skin - Pallor of leg skin
A client awaiting a heart transplant is experiencing decompensation of the left ventricle that will not respond to medications. The health care provider (HCP) suggests placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. Which response most accurately describes the purpose of a VAD?
"Decreases the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which statement demonstrates an accurate understanding of his new diagnosis?
"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."
A client asks the purpose of an exercise stress test. What is the nurse's BEST response?
"The test is used to measure functional status during stress."
A client diagnosed with deep vein thrombosis (DVT) asks the nurse about the possible complications should the clot move through the bloodstream. How would the nurse respond?
"We will be assessing with ultrasound to monitor the clot's size and location regularly and intervene to prevent complications."
An older adult client newly diagnosed with systolic hypertension asks her health care provider why this happens. Which response is MOST accurate?
"With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."
what are some complications of neurogenic shock?
- Autonomic dysreflexia - Spinal cord ischemia - DVT - Cardiovascular collapse
what are some causes of hypovolemic shock?
- Blood loss (ex hemorrhage) - Loss of plasma (burns) - Loss of ECF (dehydration, third-spacing issues) - dehydration - trauma - renal disease - congestive heart failure
What are the clinical manifestations of LEFT heart failure?
- Bluish color in the fingertips and lips - Cough, which may bring up phlegm or mucus tinged with blood - Fatigue and weakness, even after resting - Rapid or irregular heartbeat (arrhythmia) - Sudden, unexpected weight gain - Swelling in the ankles, legs, feet and/or abdomen - Trouble concentrating
What is the difference between Buerger's Disease and Raynaud phenomenon?
- Buerger's can lead to tissue damage or amputation - Raynaud's typically impacts smaller vessels that supply blood to the skin - Raynaud's is usually in response to cold temperatures or stress - to treat Raynaud's, avoiding cold temperatures and managing stress can help prevent episodes - to treat Buerger's disease, the most effective prevention is to stop all forms of tobacco use.
what are some complications of septic shock?
- CO decrease - poor tissue perfusion - hypotension - coagulation cascade - multiple organ dysfunction syndrome - death
What happens during cardiomyopathy?
- Cardiac muscle becomes hypertrophied, atrophied, constrictive, restrictive, and over-stretching. - Irreversible damage to heart muscle
What are some symptoms of an MI?
- Chest discomfort - Nausea - Vomiting - Gas Pain/GI Distress - Dizziness - Cool extremities - Urine output decreases
Which are symptoms of peripheral venous disease?
- Diminished pulse in the legs and feet - Discoloration
What are some symptoms of cardiomyopathy?
- Dyspnea - Change in LOC - Confusion
What are the 7 compensatory mechanisms for Heart Failure?
- Frank-Starling mechanism - increased heart rate - increased myocardial contractility - systemic vasoconstriction -activation of the renin-angiotensin-aldosterone system (RAAS) - sympathetic nervous system activation - ventricular remodeling
What are some symptoms of RIGHT sided heart failure?
- Hepatomegaly (enlarged liver) - Splenomegaly (enlarged spleen) - Anorexia - Indigestion - Increase abdominal girth• - Bloated feeling, Ascites - Paroxysmal nocturia - Peripheral edema - Jugular vein distension
what are some manifestations of cardiogenic shock?
- Hypoperfusion w/hypotensions - Cyanotic lips, nail bed, skin - Decrease in UO (r/t low renal blood flow) - Decreased LOC - Decreased CO - indications of tissue hypoxia
How do you treat symptomatic hypotension?
- IV fluids - blood products - rest - deep breathing - have patients get up slowly
what are the arterial vascular diseases?
- Intermittent claudication - Raynaud's disease - Buerger's disease (Thromboangiitis obliterans)
what are some manifestations of obstructive shock?
- JVD - Elevated central venous pressure (CVP) - tachycardia - respiratory distress - hypotension - tachypnea - chest pain
How does RAAS impact shock?
- RAAS activation is likely an early event in septic shock. - Elevated renin levels are a better predictor of worse outcomes in septic shock than lactate levels. - Angiotensin II levels may not increase enough to maintain blood pressure and tissue perfusion in septic shock. - Alterations in the RAAS can lead to impaired angiotensin II signaling. - in severe vasodilatory shock, ACE activity is usually decreased, leading to high renin levels.
What are the differences between right and left heart failure?
- Right heart failure = right ventricle of the heart is unable to pump enough blood to the lungs - Left heart failure = left ventricle cannot pump enough blood out to the rest of the body
What are the clinical manifestations of RIGHT heart failure?
- Shortness of breath during activity, when lying flat, or upon waking at night - Swelling in the feet, ankles, legs, and/or abdomen - Chest pain or discomfort - Palpitations (pounding or fast heartbeat) -Coughing - Wheezing - Fatigue - Dizziness - Difficulty concentrating - Bluish lips and fingers - Fluid build-up in the lower back or belly - Distension of the abdomen - Frequent urination
what are some characteristics of mitral valve stenosis?
- Slow, stable course in the early years and progressive acceleration in later years - resistance to flow through the valve increase, the left atrium becomes dilated and LFatrial pressure rises - increase LF atrial pressure eventually is transmitted to the pulmonary venous system=pulmonary congestion - As condition progresses, symptoms of decrease CO occur, tachycardia and reduce diastolicfilling time also occurs
What is Virchow's triad and how does it relate to the development of blood clots?
- Stasis: allow the accumulation of procoagulant proteases, such as thrombin, that may overcome the local anticoagulant pathways and induce thrombosis - Hypercoagulability: causing the blood to clot too much or in the absence of bleeding - Endothelial damage: after endothelial cell injury, endothelial cells and platelets are activated promoting the expression of cell adhesion molecules
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan?
- Stop smoking - Reduce dietary sodium intake - Consume a diet rich in fruits, vegetables, and low-fat dairy products - Limit alcohol consumption
what are some risk factors for septic shock? (think SEPSIS)
- Suppressed immune system - Extreme age (infants or elderly) - Procured organ (transplant) - Surgical procedure - Indwelling devices - Sickness
what are the venous vascular diseases?
- Varicose Vein - Venous Insufficiency - Deep Vein Thrombosis - Phlebitis
What are some post MI complications?
- Ventricular fibrillation - Recurrent MI - Heart Failure - Renal Failure
What is the Frank-Starling mechanism?
- a physiological principle that explains how the heart responds to changes in venous return - increases in venous return cause the heart's chambers to fill with more blood, causing the heart to stretch and contract more forcefully and pump more blood to the rest of the body
What are common side effects or statins?
- abdominal pain - cramps - nausea - constipation - muscle breakdown, leading to rhabdomyolysis
What are the non-modifiable risk factors for Atherosclerosis? Are they the same for Hypertension?
- age - gender - family history - ethnicity yes, these are the same for hypertension
How is septic shock treated?
- aggressive fluid resuscitation - blood cultures before antibiotics - vasopressors (if needed)
what are some causes of septic shock?
- bacteria - fungi - viruses
What does neurogenic shock cause?
- bradycardia - hypotension - difficulty regulating body temperature
S&S of ischemia?
- chest pain/discomfort (angina) - SOB - Lightheadedness or dizziness - tingling/numbness in an arm or leg
S&S of anaphylactic shock?
- coughing - shortness of breath - chest pain or tightness - difficulty swallowing - tightness of throat - hives - inflammation and redness - dizziness - cyanosis - weak pulse - nausea or vomiting - anxiety and confusion
what is a negative inotropic effect? (frank-starling mechanism)
- decreased strength of contraction - decreased stroke volume
What symptoms will a patient experiencing Orthostatic Hypotension exhibit?
- dizziness - pallor - excessive sweating above the level of the lesion - blurred vision - possibly fainting
What can a decreased cardiac output lead to?
- dizziness - tachycardia - pallor - diaphoresis - blurred vision - confusion
Which are clinical manifestations of venous disease?
- dull, aching pain - edema
Which diagnostic testing will help to identify the patient with Heart Failure?
- echocardiogram - ecg - chest x-ray - blood tests - cardiac catheterization
A nurse is evaluating hypertension risk factors with a client. Of the risk factors in the client's history noted, which risk factor(s) for hypertension is nonmodifiable?
- family history - race
what are some causes of anaphylactic shock?
- food products (children) - insect venom (adults) - medications
what are some characteristics of virchow's traid?
- forms inappropriate blood clots and they can travel to lungs (PE/obstruction) - Contributes to VTE and blood clots
what happens during the progressive stage of shock?
- heart is overworked and cannot meet oxygen demands - cells continue to work anaerobically - BP drops
What are the modifiable risk factors for Atherosclerosis? Are they the same for Hypertension?
- high blood pressure - high cholesterol - smoking - obesity - lack of physical activity - unhealthy diet - poorly controlled diabetes yes, these are the same for hypertension EXCEPT htn is also a risk factor for atherosclerosis
cardiac output is decreased due to...
- hypovolemia - sepsis - shock - dehydration
When does the Frank-Starling mechanism fail and why or how?
- it fails when the heart muscle is so stretched (due to excessive preload) that it can no longer effectively contract TYPICALLY HAPPENS WITH: - Cardiac muscle damage - ventricular walls become stiff, leading to decreased stroke volume. - heart muscle cannot relax properly - extreme increases in preload due to fluid overload - decreased cardiac output, impacting systemic circulation. - excessive fluid buildup in the lungs - peripheral edema due to increased venous pressure.
How is neurogenic shock treated?
- maintain patient's airway - stabilize spinal cord - be cautious with fluids - give atropine and vasopressors (as needed)
What are the differences between a mitral valve stenosis, mitral valve regurgitation, and mitral valve prolapse?
- mitral valve prolapse: the valve becomes too floppy - mitral regurgitation: the valve leaks and blood flows the wrong way - mitral stenosis: the valve does not open as wide as it should
what happens during the irreversible stage of shock?
- multiple organ dysfunction system (MODS) has taken place - organs fail - recovery is unlikely
what are some causes of obstructive shock?
- obstruction of blood flow through central circulation - Dissecting aortic aneurysm - Cardiac tamponade - Evisceration of abdominal contents - Pneumothorax
Which are clinical manifestations of arterial disease?
- pain when walking - pallor -gangrene
what are some complications of anaphylactic shock?
- pulmonary injury (ARDS) - acute renal failure - GI complications-> redistribution of blood flow away from gut, gastric ulcers - Multiple organ dysfunction syndrome (MODS)
How does RAAS impact heart failure?
- releases more of the hormone angiotensin II to try to compensate for the lack of blood flow, which makes heart failure worse - increased preload and afterload
How is hypovolemic shock treated?
- stop the bleeding - IV access - administer fluids or blood
what happens during the compensatory stage of shock?
- sympathetic nervous system is stimulated (aka. figt or flight) - body shunts blood to the vital organs (heart, brain, and lungs) - BP and HR usually normal - lactic acidosis develops
what are some manifestations of distributive shock?
- tachypnea - tachycardia - hypotension - altered mental status - shortness of breath - cough - fever
what are some manifestations of hypovolemic shock?
- thirst - increase HR (early sign) - thready and weak pulse (r/t to decrease CO) - Cool clammy skin (r/t shunting of blood/vasoconstriction - fatigue - weakness - dizziness
what are some causes of neurogenic shock?
- trauma to spinal cord - cerebral ischemia - subarachnoid hemorrhage - meningitis
How is cardiogenic shock treated?
- treat the underlying cause - provide oxygen - inotropic drugs (to increase contractility and improve CO)
What should nurses do for ALL patients experiencing shock?
- watch the ABCs (airway, breathing, circulation) - preform mental status assessments - monitor temperature and skin changes - assess for restoration of adequate tissue perfusion
How does increased perfusion pressure in HTN lead to target organ damage?
1) directly damaging the endothelial lining of blood vessels through mechanical stress, leading to inflammation and plaque formation 2) disrupting the autoregulation of blood flow in specific organs, causing either excessive blood flow or inadequate perfusion depending on the vascular response
what are the three stages of shock?
1. Compensatory 2. Progressive 3. Irreversible
List steps in the process of atherosclerosis and describe briefly what happens in each step.
1. Endothelial damage and immune response: Damage to your endothelium triggers chemical processes that cause white blood cells to travel to the injury site, these cells gather and lead to inflammation within your artery. 2. Fatty streak formation: first visible sign it's a yellow streak or patch of dead foam cells at the site of endothelial damage. Continued foam cell activity causes further damage to your endothelium. 3. Plaque growth: Dead foam cells and other debris keep building up, turning a fatty streak into a larger piece of plaque. A fibrous cap (made of smooth muscle cells) forms over the plaque which prevents bits of plaque from breaking off into your bloodstream. As the plaque grows, it narrows your artery's opening and there is less room for blood flow. 4. Plaque rupture or erosion: a blood clot forms in your artery due to plaque rupture or plaque erosion. Plaque rupture happens when the fibrous cap that covers the plaque breaks open. With plaque erosion, the fibrous cap stays intact, but endothelial cells around the plaque get worn away. Both events lead to the formation of a blood clot which blocks blood flow and can lead to a heart attack or stroke.
how are myocardial infarctions (MI) diagnosed?
12-lead ECG, serum cardiac enzymes (troponin, creatine kinase, myoglobin)
normal ejection fraction (EF)
55-65%
what is a normal ejection fraction?
55-70%
Which blood pressure reading is considered hypotensive?
86/42 mmHg
normal brain natriuretic peptide (BNP)
> 100
what kind of aneurysm is this?
dissecting
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 distributive shock?
Shock due to widespread vasodilation
What are the risk factors for an aortic dissection?
Age 40-60, Male, HTN, Marfan Syndrome, Pregnancy
what is pericardial effusion?
Accumulation of fluid in pericardial cavity
what is cardiac tamponade?
Any accumulation in the pericardiac sac causes pressure over the heart
Dysrhythmias can occur in clients with heart failure. The dysrhythmia that occurs most frequently in heart failure is...
Atrial fibrillation
what are the 3 main factors that contribute to thrombosis?
Stasis, hypercoagulability, endothelial damage
Which are anticipated vital signs for a patient with neurogenic shock?
BP 74/42 mmHg, and HR 48 bpm
Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which hemodynamic consequences?
Backflow from the left ventricle to left atrium
what is virchow's triad?
Stasis, hypercoagulability, endothelial damage
whats a hematoma?
Bleeding under the tissue from trauma
Which type of blood vessel cells in the tunica media layer produce vasoconstriction and/or dilation of blood vessels?
Vascular smooth muscle cells (SMCs)
How can you tell if a patient is has unstable angina?
DIAGNOSIS: - ECG (hyperactive T-wave, flattening of the T-waves, inverted T-waves, and ST depression) - blood tests (elevated cardiac troponin levels) - stress test (assess how the heart functions during exertion) - Coronary angiography (visualize the coronary arteries and identify blockages) SYMPTOMS: - Chest discomfort when resting - Intense Pain that lasts longer than usual angina episodes. - Pain that occurs without a clear trigger or pattern. - Chest pain that doesn't improve with nitroglycerin. - Shortness of breath - nausea and vomiting - sweating - dizziness
How can you tell if a patient is having a STEMI?
DIAGNOSIS: - ECG (ST-segment elevation) - blood tests (elevated cardiac troponins) SYMPTOMS: - chest pain - dyspnea - sweating - nausea and vomiting - dizziness and lightheadedness - anxiety - palpitations
How can you tell if a patient is having a NSTEMI?
DIAGNOSIS: - ECG (depressed ST segment, no progression to Q wave) - blood tests (elevated levels of cardiac enzymes like creatine kinase-myocardial band (CK-MB), troponin I, and troponin) SYMPTOMS: - chest pain - dyspnea - sweating - nausea and vomiting - palpitations
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
From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?
Deep vein thrombophlebitis of the leg
How is an ECG preformed? What disorder is being evaluated?
HOW IS IS TESTED: electrodes are placed at certain spots on the chest/arms/legs, connected to an ECG machine by lead wires, then electrical activity of the heart is measured, interpreted, and printed out USED TO TEST FOR: - abnormal heart rhythm - heart defect - coronary artery disease - heart valve disease - enlarged heart - previous heart attack
What is the Raynaud Phenomenon?
Vasospastic disorder of small cutaneous arteries
What is heart failure with reduced ejection fraction (HFrEF)?
EF is less than 40%
What is heart failure with preserved ejection fraction (HFpEF)?
EF is more than 40%
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
what is endocarditis?
Endocardial lining is infected
What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise?
Exercise can increase blood vessel growth and help to decrease symptoms
The client has symptoms of a focal inflammatory condition of medium-sized and large arteries which includes diplopia. Which condition does the client have?
Giant cell temporal arteritis
The nurse is teaching a class on reduction of cardiovascular disease. Which action/activity demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia?
Going for a brisk walk with a friend and talking to him about continuing to exercise regularly
Which juice should be avoided when taking a statin?
Grapefruit
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
What is the good cholesterol and why?
HDL, it helps remove cholesterol from the bloodstream and transport it back to the liver for excretion
What does septic shock result from?
a bacterial infection
How is an echocardiogram test preformed? What disorder is being evaluated?
HOW IS IS TESTED: placing a transducer on the chest and aiming it at the heart that transmits and receives sound waves that bounce off the heart, a computer compiles these findings and turns them into a picture of the heart USED TO TEST FOR: - Heart valve problems - Heart muscle damage - Congenital heart defects - Heart failure - Cardiomyopathy - Endocarditis - Aortic aneurysm - Blood clots - Cardiac tumors
How is a Creatine Kinase (CK-MB) test preformed? What disorder is being evaluated?
HOW IS IT TESTED: health care professional will take a blood sample from a vein in your arm, a small amount of blood will be collected into a test tube or vial USED TO TEST FOR: - heart attack - myocarditis - cardiac trauma - cardiac surgery - damage to heart muscle
How is a troponin test preformed? What disorder is being evaluated?
HOW IS IT TESTED: health care professional will take a blood sample from a vein in your arm, a small amount of blood will be collected into a test tube or vial USED TO TEST FOR: - heart attack - unstable angina - myocarditis - pericarditis - cardiomyopathy
How is a BNP test preformed? What disorder is being evaluated?
HOW IS IT TESTED: health care professional will take a blood sample from a vein in your arm, a small amount of blood will be collected into a test tube or vial USED TO TEST FOR: - heart failure
How is an exercise stress test preformed? What disorder is being evaluated?
HOW IS IT TESTED: healthcare provider takes pictures of your heart before and after you exercise, a cardiologist compares the amount of blood flow to the muscle of your heart at rest and after stress USED TO TEST FOR: - Coronary artery disease (CAD) - Arrhythmia - Angina - Heart failure - Heart valve disease - Cardiomyopathy
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 mitral valve regurgitation?
Incomplete closure of the mitral valve
what is mitral valve stenosis?
Incomplete opening of mitral valve during DIASTOLE
What is the Frank-Starling mechanism?
Increase in preload, diastolic filling, stretching of myocardial fibers increase the force of the NEXT CONTRACTION
what is aortic valve stenosis?
Increased resistance to ejection of blood from the left ventricle into the aorta
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
what is pericarditis?
Inflammation of the pericardial sac
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
What is the bad cholesterol and why?
LDL, it carry cholesterol from the liver into cells for use
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
What is a type A aortic dissection?
More common proximal lesions, involving the ascending aorta only or both the ascending and the descending aorta
what medications treat an MI? (think MONA)
Morphine, Oxygen, Nitroglycerin, Aspirin
what are the risk factors for pericardial effusion?
Neoplasm, Cardiac surgery, Trauma, Cardiac rupture, Dissecting aortic aneurysm
What is Buerger's Disease?
Nonatheroscelrotic, segmental, recurrent inflammatory disorder of the small and medium arteries and veins in arms/leg
At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 AM, the client's MAP has fallen definitively below normal. The client is at risk for:
Organ damage and hypovolemic shock
A 37-year-old woman is admitted to the unit with a differential diagnosis of rule out pheochromocytoma. What are the MOST common symptoms the nurse would expect this client to exhibit?
Periodic severe headache and marked variability in blood pressure
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis?
Peripheral edema, weight gain
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 is at high risk for the development of rheumatic heart disease. The MOST important information for the nurse to provide would be:
Prompt diagnosis and treatment of streptococcal infections
The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent:
Pulmonary embolism
A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. What is a potential diagnosis for this client?
Raynaud disease
The nurse is assessing a client with hypertension who is prescribed a calcium channel blocker (CCB). The client reports an increase in peripheral edema since starting on the medication. Which effect of CCB will the nurse teach the client contributes to developing edema?
Relaxation of smooth muscle preventing vasoconstriction of arterioles
What is the PRIMARY cause of heart failure in infants and children?
Structural heart defects
How will the symptoms between a thoracic aneurysm and an abdominal aneurysm differ?
THORACIC: Pain in the chest neck/back/or jaw, Coughing, Shortness of breath, A hoarse voice, Swelling in the neck/head/or arms, Heart failure ABDOMINAL: Pain in the abdomen/or back, Passing out, Clammy skin, Dizziness, Nausea and vomiting, Rapid heart rate, Shock
Which client is at the GREATEST risk of developing rheumatic heart disease?
Teenager with untreated strep throat
What is a true aneurysm?
aneurysm is bounded by a complete vessel wall; Blood remains in the vascular compartment
Heart failure and circulatory shock are both conditions of circulatory system failure. Which statement regarding these conditions is correct?
They have the same compensatory mechanisms.
What is a type B aortic dissection?
Those not involving the ascending aorta and usuallybeginning distal to subclavian artery
what is another name for buerger's disease
Thromboangiitis obliterans
A 45-year-old client is undergoing exercise stress testing. At which point will the test be halted and not allowed to continue?
When the client experiences chest pain
What does hypovolemic shock result from?
a lack of volume in the body or intravascular space CAUSED BY: - massive bleeding - third spacing - loss of volume
an emergency department nurse is admitting four patients. which patient is a candidate for immediate percutaneous coronary intervention (PCI)?
a patient with a STEMI who reports severe left arm pain
What is shock?
a result of an insult to the body that leads to decreased tissue perfusion and oxygenation
what is a percutaneous coronary intervention (PCI)?
a stent is placed to remove the blockage and restore perfusion
what medications treat heart failure?
angiotensin receptor blockers (ARBs), beta blockers, diuretics, digoxin
What is an aortic aneurysm?
abnormal dilation of a blood vessel
What is not a cause of hypotension?
activation of sympathetic nervous system
A patient is diagnosed with hypovolemic shock. What does the nurse anticipate being included in the plan of care?
administration of blood products and intravenous fluids
what are some causes of cardiogenic shock?
an MI, sustained arrhythmias, cardiac contusion, or cardiac surgery
What is Pericardial Effusion?
an abnormal accumulation of fluid in the pericardial cavity
What does anaphylactic shock result from?
an allergy
What is the difference between an aortic aneurysm and an aortic dissection?
an aneurysm is a bulge in the aorta, while a dissection is a tear in the inner lining of the aorta
A client is rushed to the emergency department with assessment findings of urticaria, wheezing, chest tightness, and difficulty breathing. The client is MOST likely experiencing which type of shock?
anaphylactic
when will a patient with a STEMI receive a PCI?
as soon as possible
aortic dissections most commonly involve the _________ aorta, and second most common site is the ___________ aorta
ascending, thoracic
A patient who recently started taking a statin reports new muscle cramps and weakness. What is the nurse's primary intervention?
assess for rhabdomyolysis
When should statins be administered?
at bedtime
How is the Raynaud Phenomenon treated?
avoid temperature extremes, teach to wear appropriate clothing, no tobacco products, avoid caffeine, no vasoconstrictor drugs
A Myocardial Infarction is a potential cause of Cariogenic shock, why?
because when a significant portion of the heart muscle is damaged due to lack of blood flow during a heart attack, the heart's ability to pump blood effectively is severely compromised, leading to inadequate blood supply to the body's organs
What is happening in the compensatory stage of shock?
blood is being shunted to vital organs to maintain nearly normal vital signs
what is mitral valve regurgitation?
blood leaking back through the mitral valve into the left atrium
What is hypotension?
blood pressure < 90/60 mmHg
BP = CO x SVR <- what does each of these abbreviations mean?
blood pressure = cardiac output X systemic vascular resistance
which serum lab can assist in diagnosing heart failure?
brain natriuretic peptide (BNP)
what are the MOST COMMON causes of aortic valve stenosis?
congenital valve malformations and acquired calcification of a normal tricuspid valve
What are the negative impacts Pericardial effusion will have?
can put pressure on the heart and affect how the heart works, if untreated it may lead to heart failure or death
CO = SV x HR <- what does each of these abbreviations mean?
cardiac output = stroke volume X heart rate
what can pericarditis lead to?
cardiac tamponade
What does cardiogenic shock result from?
caused by an insult in the heart CAUSED BY: - an MI - stressor (such as trauma) - ineffective pumping, decreased CO
What does neurogenic shock result from?
cervical or high thoracic injury (above T6) causing massive vasodilation
S&S of the Reynaud Phenomenon?
change in colors of finger toes ears and nose, coldness , numbness followed by a throbbing aching pain, tingling, swelling
EF <40% means
decreased cardiac output and pump failure
What is a false aneurysm?
defect in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space
Is the ST segment elevated or depressed in angina?
depressed
Baroreceptors
detect changes in blood pressure
_____ cells form a continuous lining of the entire vascular system
endothelial
what can right sided heart failure lead to?
enlarged liver and spleen, ascites, jugular vein distention, edema
What is the first intervention when working with a patient who is hypotensive?
ensure the patient is safe
Rupture occurs when vessel wall tension _______ the wall's ability to stretch; risk increases with a diameter _________ than ________ cm
exceeds, greater, 5.5
aortic dissection involved a "ballooning out" of a section of blood vessel wall
false
blood flow that has been lost as a result of myocardial infarction cannot be reestablished. true or false?
false
most aneurysms are located in the venous compartments of the circulatory system. true or false?
false
septic shock is far less common in the past, given advances in prevention and treatment. true or false?
false
the type of cholesterol most harmful to health is LDL. true or false?
false
what kind of aneurysm is this?
false
what does right sided heart failure cause?
fluid backup in the rest of the body (other than lungs)
what does left sided heart failure cause?
fluid backup into the lungs
systolic heart failure can lead to
fluid overload
what is NOT a symptom of an MI?
headache
systolic heart failure is
heart failure with a decreased EF
Statins are contraindicated in patients with ________ disorders
liver
What is a false aneurysm?
localized dissection or tear in the inner wall of the artery with formation of an extravascular hematoma that causes vessel enlargement
what is hypovolemic shock?
loss of too much blood/fluid in the body
what can CHRONIC mitral valve regurgitation be caused by?
mitral valve prolapse, coronary artery disease, autoimmune disease, heart arrhythmias, connective tissue diseases
vasoconstriction
narrowing of blood vessels
what are the types of distributive shock?
neurogenic, anaphylactic, septic
what kind of aneurysm is this?
none (normal vessel)
what is obstructive shock?
obstruction of blood flow
Which type of shock is Cardiac Tamponade associated with?
obstructive shock
What are the risk factors for aortic aneurysms?
older than 65, male, caucasian. family history, smoking, hypertension, atherosclerosis, peripheral vascular disease, obesity, sedentary, diabetes mellitus
what is a NSTEMI?
partial blockage of a coronary artery
Which lab values does not need to be assessed routinely when a patient is on a statin?
partial thromboplastin time (PTT)
Which types of disease make up vascular disease?
peripheral venous disease, peripheral arterial disease
what is the MOST COMMON cause of septic shock?
pneumonia
diastolic heart failure is
preserved EF
what is the difference between primary HTN and secondary HTN?
primary hypertension has no identifiable cause, while secondary HTN is caused by another underlying medical condition
