N330 Exam 3

What diagnoses can cause an Emergeny HTN crisis?

MI HF with pulmonary edema stroke AA renal failure

Can increased HDL increase the risk for for CV disease?

NO HDL reduces the risk and does not cause hypertension

a patient present with intermittent claudication (very painful pain when active) in lower extremeties, fatigue, weakness. The patient says rest tends to relieve the symptoms but it tends to get worse at night and wakes them up. One night he woke up and jumped up from the pain and bumped his foot. upon assessment the nurse notices an ulcer. She also notices that he has hair loss on his lower extremeties and thick ridged nails while shes looking at the ulcer

PVD

HTN 1

SBP 130-139 OR DBP 80-89

HTN stage 2

SBP >140 or DBP >90

Hypertensive crisis would be diagnosed if systolic pressure is ________ and/or diastolic pressure is ______________

SBP >180 DBP>120

You have a female client who is presenting with dyspnea, indigestion like chest pain, and unusual fatigue. What might you expect considering women commonly experience these symptoms in......?

CAD, atypical angina more commonly reported by women than by men with CAD= dyspnea, indigestion, and unusual fatigue

elevated BP

Systolic between 120-129 AND diastolic less than 80

Which instructions would you give to a client with PAD for home health?

Avoid crossing legs restricts blood flow Inspect feet daily detect injury, infection, or skin breakdown, remember PAD (arterial PVD) can cause ulcers to toes, heels and other high pressure area in extremeties. black eschar/dry gangrene Do not use compression stockings restricts blood flow Can cause hair loss, thick ridged nails, and rubor skin think dry and hair loss due to lack of circulation from arteries

a patient present with crackles a low SPO2 of 85, dry non-productive cough, ventricular gallop upon auscultation and dyspnia when exerting. He complains that he has not been able to pee much.

Left sided heart failure

occasional cocaine use African American heritage and blood pressure?

These are both 2 high risk categories for hypertension Cocaine= stimulant that causes tachycardia and hypertension HTN in African American US population is more prevalent than others

A patient presents with dry/irritating cough, scant amount of sputum, sternal soreness.

Tracheobronchitis

barrel chest

a condition characterized by increased anterior-posterior chest diameter caused by increased functional residual capacity due to air trapping from small airway collapse. A barrel chest is frequently seen in patients with chronic obstructive diseases, such as chronic bronchitis and emphysema.... EMPHYSEMA

a pt. comes in anxious and dyspneic (shortness of breath). The nurse checks their pulse and notices that it is weak/rapid and her skin is cool and clammy. The patient coughs. Frothy and blood tinged sputum is expelled. The nurse checks her lungs sounds and notices crackles. As time passes the patient begins to go in and out of conciousness.

acute pulmonary edema left sided HF complication

To correct a patient with PAD about warming their extremeties, What should you educate them on?

applying heat to the abdomen causes reflex dilation of the arteries in the extremeties and increases blood flow with without adverse effects like burns raising internal temp by drinking a hot drink prevents vascular constriction and warms the extremeties increase heat of environment to help prevent arterial constriction and improve peripheral circulation

My patient has signs of oral cyanosis (bluish mucosa) why should I be concerned?

central cyanosis indicated hypoxemia requires further assessment and actions: SPO2, and administration of oxygen

When taking the history for a client who is being treated for obstructive sleep apnea, which findings would the nurse expect?

chronic fatigue poor sleep quality causes tired feelings all the time which also causes poor concentration enlarged tonsils obstruct the airway and lead to OSA poor concentration

The client with PAD says that they use a heating pad to warm their extremeties to increase blood flow. Why is this wrong?

client's extremeties are less able to respond to thermal stress because of peripheral vascular problems and burns occur with the application of a heating pad to the extremeties

decreased or increased urine output with right sided ventricular heart failure?

decreased because diminished cardiac output decreased blood flow to the kidneys, there will be decreased urinary output

The older adult's valves stiffen as elastin decreases and collagen increases. How does this affect the older adult?

due to stiff valves, the valves' ability to open and close is reduced this causes pooling of blood in the heart and vascular system which causes a backflow of blood this backflow of blood will be heard as HEART MURMURS

in left sided-heart failure because of pulmonary congestion and inadequate oxygen delivery to body cells we see what

dyspnea

The nurse is monitoring a postoperative client for what clinical manifestations of PE?

dyspnea (most common) d/t increased alveolar dead space which impedes ventilation hemoptysis pulmonary blood flow is obstructed partially or completely; when infarcted areas have alveolar damage, red blood cells move into alveoli impending doom that is caused by dyspnea and chest pain crackles apprehensive and alert

pursed lips in COPD client is used to improve what?

expiratory effort and volumes

What atypical signs might an older adult have when being assessed for HF?

fatigue, weakness, somnolence increased resistance to diuretics if decreased renal function

a client with emphysema reports increased shortness of breath and becoming increasingly anxious. the healthcare provider presrcibes o2 at 1mL/min via nasal cannula. the nurse recognizes that this prescription is appropriate for what reason?

high concentrations of o2 eliminate respiratory drive use to high levels of CO2 and low levels of O2. (can't successfully breathe in o2 and can't successfully breathe out CO2. Oxygen is the stimulus for clients to breathe instead of natural breathing stimulus too much oxygen will knock out this oxygen stimulation to breathe

What is the purpose of incentive spirometry in a client with pneumonia?

improve inspiratory muscle action prevent or reverse atelectasis

Highest risk for the development of a DVT?

inactivity may form as a result of a venous stasis. The thrombus could lodge in a vein and cause venous occlusion inactivity is a major cause of this

What should you worry about if a patient has stable angina and you think it might be turning into unstable angina?

increasing frequency of anginal episodes may indicated unstable angina and acute coronary syndrome which is urgent because this is caused by prolonged cardiac ischemia if the patient says the angina is usually relieved via resting it is not considered to be unstable

Why is teaching pursed lip breathing so important for a client with COPD?

keeps the airway open longer to decrease the work that goes into breathing clients with COPD are taught to breathe out through pursed lips to help keep air passages open until exhalation is complete. CAN also increase shortness of breath by decreasing breath rate does not increase air taken in during inspiration

Your patient has right venous thrombosis what may you see?

low oxygen sats may indicate PE (this is an emergent finding) severe right calf pain right calf redness and swelling elevated HR could happen if PE but the oxygen administration would decrease the HR

To evaluate the effectiveness of treatment for a client with exacerbation of left ventricular failure, which clinical indicators will the nurse monitor?

lung sounds pulmonary congestion, crackles heart sounds S3 and S4 gallops heart rate tachycardia dyspnea on exertion shortness of breath

What should you observe in older men, specifically, if a heart failure pt is taking diuretics?

observe for bladder distention caused by obstruction from enlarged prostate in urethra

acute bacterial pharyngitis throat manifestations

petechiae on soft palate severe hyperemia of pharyngeal mucosa erythema of the tonsils with yellow exudates

A client is experiencing a DVT after surgery. What signs are you looking for if the piece broke off and became a PE?

pleuritic chest pain caused by inflammatory reaction of lung parenchyma or by pulmonary infarction or ischemia induced by obstruction of small pulmonary arteries pain is sudden in onset and is exacerbated by breathing Tachycardia-occurs in attempt to meet oxygen demands of the body and respond to increased vascular resistance to the lung pale face d/t reduced oxygen and possible shock

a client with COPD is breathing rapidly and using accessory muscles for respiration. the nurse auscultates the lungs and hears crackles and wheezes. which action should the nurse make?

raise the HOB to high-fowler and administer 2mL/min of o2 per nasal cannula sitting facilitates breathing by increasing lung expansion 2L of O2 promotes respirations while preventing carbon dioxide narcosis

indication of correct usage of incentive spirometer for a client with pneumonia?

records the volume of inspired air performs 10 breaths per session every hour takes a long, slow, deep breath keeping the mouthpiece in place helps improve inspiratory muscle action exhale fully , then insert mouthpiece and inhale

How do you want to decrease BP in a hypertensive emergency

reduce BP by 25% in an hour control the BP in 24-48 hours

after obtainin a BP of 172/104 and 164/98 during a BP screening, which action should the nurse take next?

refer client to a primary health care provider require further evaluation

a pt. presents with swelling in her legs. you notice her stomach looks swollen (ascites) and upon palpation you find her spleen is palpable and enlarged and her liver is enlarged. The patient complains about her swollen tummy saying she can't believe how fat she has gotten, she has barely ate anything (anemia). She has gained more than 7 lbs (more than 5) this week and has gained 2 lbs in the last day!!!!

right side HF

patient presents with edema, ascites, hepatomegaly, tachycardia, and fatigue

right ventricular heart failure

Which throat manifestations are the key features for a client with acute viral pharyngitis? Select all that apply petechiae on the soft palate scant or no tonsillar exudate slight erythema of the pharyngeal mucosa erythema of the tonsils with yellow exudates

scant or no tonsilar exudate slight erythema of the pharynx and tonsils

Which action would be used to decrease risk for postoperative respiratory complications in an older client with decreased vital capacity?

teach the client coughing and deep-breathing exercises older adults have a decrease in vital capacity and are at an increased risk for complications from both anesthesia and surgery teaching coughing and deep-breathing exercises may help in preventing common postoperative complications: atelectasis and pneumonia

patients with ____________ experience a fast heart rate and breath (tachypnea, tachycardia), as the body struggles to take in more oxygen through the lungs and deliver it

urinary albumin with a spot

For a patient who is obese what can you teach them regarding their diagnosis of HTN?

weight loss it is one of the most powerful lifestyle mods in lowering BP

How does hypertrophy of heart lead to reduced CO?

when the heart walls thicken the amount of space available in the chamber decreases. when the amount of space in the chamber decreases the chamber can hold less volume (blood) when there is less blood volume in the chamber this decreases reduced contractility and strength this leads to reduction of CO CO=HRxSV