Exam 1- Health and Illness II

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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


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