Duquesne Pathophysiology Exam 2
Left sided HF signs and symptoms
*lung symptoms* Dyspnea Crackles (lungs sound wet) Paroxysmal nocturnal dyspnea Tachypnea Changes in BP Orthopnea: can't breathe while laying flat Pulmonary Congestion Low O2 stats (~95%)
What fraction of body fluid is extracellular and what fraction is intracellular?
1/3 extracellular 2/3 intracellular
Which patient is most at risk for hyperkalemia?
30 yr old who just underwent a large blood transfusion
What is normal ejection fraction and what % indicates possible heart failure?
55%-70% CHF <40%
The nurse is caring for a client who has been admitted to the hospital for an acute exacerbation of heart failure. Blood pressure is 104/62 mm Hg, pulse is 96/min, respirations are 22/min, and oxygen saturation is 91%. Which of these findings supports the diagnosis of heart failure?
B type natriuretic peptide
What are some causes of fluid volume excess?
CHF (chronic heart failure) renal failure long term steroid therapy increase ADH (anti-diuretic hormone) increased Na+ intake
acute coronary syndrome
Caused by atherosclerosis of the coronary arteries, causing blockage or occlusion includes unstable angina: STEMI and NSTEMI
Chvostek's sign
Cheek, facial spasm when Cheek is tapped due to hypocalcemia
What is compartment syndrome?
Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow.
Which is the term used to define heart failure caused by pulmonary disease?
Cor Pulmonale
When the nurse is obtaining the health history for a client with mitral valve stenosis, which question will be most relevant to ask?
Did you ever have strep throat during childhood? *strep can lead to mitral valve stenosis, infection damages heart valves
myocardial infarction
Diseased condition with is caused by reduced blood flow in a coronary artery due to atherosclerosis and occlusion of an artery by an embolus or thrombus irreversible damage and cell death
What is secondary hypertension?
Elevated BP with a specific cause, accounts for 5% to 10 % of hypertension in adults.
What are some common causes of dehydration/ fluid volume deficit?
Emesis (vomiting) diarrhea gastric decompression excessive diaphoresis (sweating) extensive diuretic use (such as furosemide or HCTZ) renal/kidney disorders respiratory disorders
Raynaud's phenomenon
Episodic vasospasm in arteries of the fingers smoking, hypertension, cold weather, emotional stress more prevalent among women
What is primary hypertension?
Essential or idiopathic, elevated BP without an identified cause, accounts for 90 - 95% of all cases of hypertension
What are some nonmodifiable and some modifiable risk factors for HTN?
FHx, age, ethnicity/genetics diet/lifestyle weight, metabolic syndrome ETOH/smoking
mitral valve stenosis
Flow of blood from left atrium to left ventricle is impaired surgery needed to treat decreased stroke volume and CO
cardiac tamponade
Fluid in pericardium builds up and results in compression of the heart
Which manifestation, if identified in a client admitted with heart failure, should a nurse associate with the development of hyponatremia?
GI suction
Which lab result could be associated with an increased risk of atherosclerosis and coronary artery disease?
HDL of 30mg *this is very low
Antiduretic hormone (ADH)
Hormone produced by the kidneys that regulates water reabsorption
What are some common causes of bacterial endocarditis?
IVDA trauma dental procedures GU procedures, indwelling urinary catheters GI procedures respiratory infections
What does aldosterone do?
Increases reabsorption of sodium and increases secretion of potassium
What is angina?
Insufficient oxygen to the heart muscle causing sudden, severe substernal pain radiating to the left arm
Which term describes myocardial cells temporarily deprived of blood supply?
Ischemia
What is ventricular tachycardia?
It is a tachycardia, or fast heart rhythm, that originates in one of the ventricles of the heart.
What is an aneurysm?
Local dilation or outpouching/ballooning of an arterial wall or cardiac chamber
chronic pericarditis
Long lasting gradual inflammation of the pericardium Pericardium has healed but the sac is destroyed from previous inflammation
What are the 6 P's of compartment syndrome?
Pain, Polar, Pallor, Pulseless, Paresthesia, Paralysis
What are some clinical manifestations of fluid volume deficit?
Poor skin turgor (tenting)** dry mucous membranes sunken eyes sunken fontanels in infants decreased urine output and oliguria (concentrated urine) fatigue, dizziness, syncope weight loss decreased BP with increase HR** longitudinal furrows on tongue
What electrolytes are at higher concentrations in intracellular fluid?
Potassium (K+) Magnesium (Mg++) Phosphates Proteins
Compensatory mechanisms of heart failure
SNS activation increased preload myocardial hypertrophy
What is the most reliable indicator for determining an acute MI?
ST elevation
STEMI
ST elevation myocardial infarction full heart attack, elevation on EKG
Hypertension with a specific identifiable cause is known as ____________?
Secondary
What electrolytes are at higher concentrations in extracellular fluid?
Sodium (Na+) Chloride (Cl-) Bicarbonate (HCO3-) Calcium (CA++)
What is a vasospasm?
Sudden involuntary constriction of arterial smooth muscle causing an obstruction to blood flow
What is atrial fibrillation?
The heart's upper chambers (atria) beat out of coordination with the lower chambers (ventricles). No P waves seen on EKG. Dysfunction of SA node but AV node compensates and can still pump out blood.
What is ventricular fibrillation?
This is when the ventricle quivers and is unable to initiate a contraction. This occurs when many ectopic ventricular foci fire at the same time. DEATH IS IMMINENT IF NOT TRATED IMMEDIATELY.
The nurse reviews laboratory data for a client admitted to the emergency department with chest pain. Which serum value requires the most immediate action by the nurse?
Troponin 0.7 ng/mL
What is orthostatic hypotension?
When a person's blood pressure falls when moving from a seated or lying position to a standing position. typically a drop in >20mmHG and an increase in HP by 20-30 beats/min
heart failure
a chronic condition in which the heart is unable to pump out all of the blood that it receives also called congestive HF
Which statement describes pericardial effusion?
a collection of fluid in the pericardial sac
pericardial effusion
accumulation of fluid in the pericardial cavity cardiac tamponade procedure needed Ewarts sign (decreased breath sounds over left lung)
What is secondary lymphedema?
acquired form that is caused due to an obstruction by trauma such as mastectomy, soft tissue injury, parasitic/filarial worms, or disease process
What is ischemia?
an inadequate blood supply to an organ or part of the body, especially the heart muscles.
Which clinical condition will result in changes in the integrity of the arterial walls and small blood vessels?
atherosclerosis
What are the backward and forward effects of left sided heart failure?
backward- dyspnea, orthopnea, cough, paroxysmal nocturnal dyspnea, cyanosis, basilar crackles forward- fatigue, oliguria, increased HR, faint pulses, restlessness, confusion, anxiety
What are the backward ad forward effects of right sided heart failure?
backward- hepatomegaly, ascites, splenomegaly, anorexia, subcutaneous edema, JVD forward- same as left-sided heart failure
LDL cholesterol
bad cholesterol should be less than 130 mg
A client is diagnosed with lower-extremity deep venous thrombosis (DVT) after a cross-country road trip. Which clinical manifestations most characteristic of a DVT does the nurse expect to assess? Select all that apply.
calf pain edema warmth redness
A patient reports with shortness of breath and is diagnosed with a pericardial effusion. The nurse knows that what serious complication can manifest if not treated?
cardiac tamponade
kidneys on heart
cells in kidney release renin and initiate RAAS cascade salt and water retention
Which of the following is the most common symptom of a myocardial infarction (MI)?
chest pain
clinical manifestations of an MI
chest pain dyspnea diaphoresis crackles jugular venous distention fever, vomiting
myocardial ischemia
chest pain is main symptom blockage of blood to the heart muscle stable and unstable angina
stable angina
chest pain that occurs when a person is active or under severe stress
unstable angina
chest pain that occurs while a person is at rest and not exerting himself
right sided heart failure
comes after left sided HF or pulmonary dysfunction
A nurse is assessing a client with a possible fluid and electrolyte imbalance. Which manifestation, if identified in this client, should the nurse associate with the development of either hyponatremia or hypernatremia?
confusion
What is backward heart failure?
congestion of blood behind the pumping chamber resulting in accumulation of blood in the pulmonary circulation
What are signs and symptoms of pericarditis?
cough chest pain dyspnea friction rub
A client with heart failure suddenly becomes tachycardic, is gasping for breath, and begins coughing frothy pink-tinged sputum. A nurse listens to breath sounds, expecting to hear bilateral:
crackles
What is the difference between hypertensive crisis and hypertensive urgency?
crisis- sudden increase of BP with evident acute end-organ damage (diastolic >120mHg) urgency- sudden BP elevation without evidence of end-organ damage
What are some causes of hypotension (HoTN)?
damage to vasomotor center/neurons vasovagal response/ syncope abnormal heart rhythms decrease blood volume (due to hemorrhage/burns, diarrhea, etc)
What is valvular incompetence?
damaged valves no longer maintain unidirectional flow due to excessive venous pressure can lead to edema, stasis dermatitis, pain, ulcer formation
Does % total body water increase or decrease as you age?
decrease
Which of the following are factors that make up the etiology of heart failure? Select all that apply.
decreased CO increased afterload increased preload
right sided HF signs and symptoms
dependent edema in lower half of body kidney and spleen issues fluid buildup in abdomen fatigue, weakness, dyspnea right distended jugular vein
Which of the following are initial signs and symptoms of an MI?
diaphoresis vomiting and nausea fever pain radiating to neck and shoulders hypertension
What is the difference between dilated and hypertrophic cardiomyopathy?
dillated is dilation of one of both ventricular chambers hypertrophic is thickened, hyperkinetic muscle mass primarily of the left ventricle and commonly asymptomatic
What are some clinical manifestations of dilated cardiomyopathy?
dyspnea, fatigue pedal edema displaced apical pulse S3 gallop JVD pulmonary congestion reduced contractility
Which findings in a client who has had major abdominal surgery indicate a possible venous thrombosis of the leg? Select all that apply.
edema tender area of skin warmth along leg
What are some clinical manifestations of fluid volume excess?
edema/ pulmonary edema** weight gain circulatory overload (JVD, bounding pulse)** orthopnea dyspnea/ SOB** bulging fontanels in infants malaise/ fatigue/ headache/ confusion cerebral herniation
When caring for a client who presents to the emergency department with an ST-segment-elevation myocardial infarction (STEMI), which laboratory result will the nurse expect?
elevated serum troponins I and T
What are some abnormal routes of electrolyte excretion? -this is the same for hyponatremia/ hypokalemia/ etc.
emesis/ diarrhea NG suction/ gastric decompression paracentesis hemodialysis wound drainage
What is edema?
excess accumulation of fluid in interstitial space/tissue
natiuretic peptides
excretion of H2O and sodium by the kidneys KEY indicator to diagnosis of heart failure BNP and ANP released
Which organs can be damaged by persistent hypertension? Select all that apply.
eyes heart brain kidneys
Valvular Dysfunction: Regurgitation
failure of valve to close completely leaflets fail to shut 3 types: aortic, mitral, and tricuspid
Valvular Dysfunction: Stenosis
failure of valves to open completely extra pressure work for the heart two types: aortic and mitral
What are some clinical manifestations of infective endocarditis?
fever new or changed cardiac murmur petechia weight loss back pain night sweats embolism heart failure
Which are effects of increased secretion of renin and aldosterone by the kidneys, in response to decreased cardiac output?
fluid retention vasoconstriction increased BP increased cardiac workload
A client is admitted to the hospital with a diagnosis of pericarditis. The nurse assesses the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems?
friction rub
A client with pericarditis is admitted to the cardiac unit. What assessment finding does the nurse expect in this client?
friction rub at the left lower sternal border
HDL cholesterol
good cholesterol men= greater than 60mg women=greater than 60mg
Trousseau's sign
hand/finger spasms with sustained blood pressure cuff inflation due to hypocalcemia
Atherosclerosis
hardening of medium and large sized arteries plaque forms in arteries from buildup of cholesterol
Hypertension
high blood pressure normal fluctuations occur day to day
Hypercalcemia
high calcium (higher than 11mg) bone tumors and multiple myeloma diminished reflexes, muscle weakness, confusion
Which value may be protective in the development of atherosclerosis?
high levels of LDL= bad cholesterol
Hypermagnesemia
high magnesium (higher than 2.5mg) renal failure is biggest cause laxative abuse decreased reflexes, lethargy
Hyperphosphatemia
high phosphate (higher than 4.5mg) laxative abuse end stage renal disease joint stiffness and pain increased excitability of neuromuscular system
hyperkalemia
high potassium (greater than 5.0mg) renal failure acidosis muscle twitching hyperactive reflexes
Hypernatremia
high sodium (greater than 145mg) tube feedings and IV infusions fever, edema, dehydration
Preload
how much blood that is flowing into the heart vol of blood in ventricles at the end of diastole
A nurse assesses a newly admitted client and finds that the client has hyperactive reflexes. Which potential electrolyte imbalance(s) should the nurse suspect? Select all that apply:
hypomagnesemia hypocalcemia hyperkalemia
Beck's triad
hypotension distended neck veins muffled heart sounds
What are some causes of dilated cardiomyopathy?
idiopathic alcohol myocarditis postpartum genetics ischemia long-standing HTN nutritional deficit
What are some common causes of myocarditis?
immune-mediated diseases (IBD,SLE) physical agents (ETOH) infection (HIV,Flu, Strep, Candida)
Which are compensatory responses of the sympathetic nervous system that help to maintain cardiac output? Select all that apply.
increased HR increased force needed to pump blood venoconstriction
What are some clinical manifestations of aneurysms?
increased intracranial pressure hemorrhagic stroke sudden, severe tearing pain radiating into the back/abdomen
What are some effects of chronic HTN?
increased morbidity and morality damage to kidneys, circulatory vessel, heart, eyes, and other organs can lead to stroke and heart disease
Inefective Endocarditis
infection of the endocardium bacterial infection through the blood
phlebitis
inflammation of a vein
myocarditis
inflammation of the heart muscle
acute pericarditis
inflammation of the pericardium presumed to be viral in nature
Beurger's Disease
inflammatory and immune disorder affects young men who are smokers
A client tells the nurse, "My legs begin to hurt after walking for several blocks. The pain goes away when I stop walking, but it comes back again when I resume walking." Which condition would the nurse consider as the most likely cause of the client's pain?
intermittent claudication
What are some clinical manifestations of an arterial obstruction?
intermittent claudication pain with activity cyanosis, cool on palpation ulcer around one toe
What are some effects of hypertensive emergencies?
ischemic stroke subarachnoid/intracerebral hemorrhages myocardial infarction acute heart failure aortic dissection
Which information about the cause of Prinzmetal/Variant angina is correct?
it is from a spasm of a heart artery
Aortic stenosis results in the incomplete emptying of the:
left ventricle
left sided heart failure
left ventricle hypertension and damage 35% or less blood being pumped out of the LV with each beat
what is the biggest cause of heart failure?
long standing hypertension
Hypocalcemia
low calcium (less than 9mg) pancreatitis nerve excitability cramping hyperactive reflexes + troussea sign
Hypomagnesemia
low magnesium (lower than 1.5mg) chronic alcoholism diuretic use diabetic ketoacidosis + trousseau sign
Hypophosphatemia
low phosphate (lower than 2.5mg) malnourished pts, low intake of potassium anorexia, malaise, diminised reflexes
hypokalemia
low potassium (less than 3.5mg) excessive use of diuretics NG suction prolonged use renal disease, insulin admin
Hyponatremia
low sodium in the blood (less than 135mg) excess ADH Diuretics (thiazide) tap water enemas fatigue, muscle cramps, weakness
Which assessment finding will the nurse expect when caring for a client with right ventricular failure?
lower leg edema
embolus
moving blood clot
aortic stenosis
narrowing of the aorta surgery needed to treat
NSTEMI
non-ST elevation myocardial infarction cardiac tissue damaged, elevation in cardiac enzymes not as severe as STEMI
creatine kinase
only elevated for up to 72 hrs after MI
Ejection Fraction (EF)
percentage of blood volume in the ventricles at the end of diastole that is ejected during systole; a measurement of contractility
Which of the following describe manifestations that could be seen in someone who has a calcium level fo 6.4 mg/dL? Select all that apply.
positive trousseau's sign muscle cramping/twitching
What are some clinical manifestations of a venous obstruction?
pulmonary embolism calf/groin tenderness edema positive Homan's sign
troponin levels
remain elevated for longer after MI
RAAS system
renin-angiotensin-aldosterone system
After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening?
right sided HF
Which of the following conditions is most closely associated with fatigue, dependent edema and distended jugular veins?
right sided heart failure
What is the difference between left-sided heart failure and right-sided heart failure?
right sided is more backwards failure and decreased pumping action to move blood out to the body, left sided is a result of left ventricular failure and cant fill with enough blood so backs up in the veins
venous thrombus (DVT)
secondary to a PE calf or groin tenderness positive homans sign swelling of infected limb
total cholesterol
should be less than 200mg
A client is diagnosed with Buerger's disease (thromboangiitis obliterans). The nurse anticipates teaching the client about which treatment option?
smoking cessation
A client with a history of angina tells the nurse that chest pain usually occurs after going up two flights of stairs or after walking four blocks. The nurse interprets that the client is experiencing which of the following types of angina?
stable angina
thrombus
stationary blood clot
What does ADH (antidiuretic hormone) do?
stimulates the kidneys to reabsorb water (the kidneys conserve water when the body dehydrates)
What is the difference between systolic dysfunction and diastolic dysfunction with low EF?
systolic- impaired myocardial contractility due to loss of cardiac muscle and reduced ATP production (EF<15%) diastolic- ventricle is noncompliant and does not fill effectively caused by CAD and HTN (normal EF)
What are some modifiable risk factors for atherosclerosis?
tobacco/smoking HTN high levels of LDL and low HDL cholesterol diabetes/ obesity
cardiac enzymes
troponin and creatine kinase
Which are considered acute coronary syndrome (ACS) diseases?
unstable angina NSTEMI STEMI
What is the difference between phlebitis and vasculitis?
vasculitis- inflammation of the intima of an artery phlebitis- inflammation of the lining of a vein
variant angina
vasospasm occurs under emotional stress or exertion
Afterload
working against resistance to get the blood out increased workload for the heart