Cardiovascular System (Exam Three) Flashcards
(98 cards)
1
Q
Describe heart failure.
A
Inability of the heart to maintain adequate cardiac output to meet the metabolic needs of the body
2
Q
List signs and symptoms of left sided heart failure.
A
- Paroxysmal Nocturnal Dyspnea
- Elevated pulmonary pressure
- Pulmonary Congestion/Edema –> cough, crackles, wheezes, pink frothy sputum, tachypnea
- Restlessness
- Confusion
- Orthopnea
- Tachycardia
- Exertional Dyspnea
- Fatigue
- Cyanosis
3
Q
List signs and symptoms of right sided heart failure.
A
- Fatigue
- Increased peripheral venous pressure
- Ascites
- Hepatomegaly
- Spleenomegaly
- Jugular Venous Distention
- Anorexia
- GI Distress: feelings of fullness, loss of appetite
- Weight gain
- Dependent edema
4
Q
What diagnostic test is used to diagnose heart failure?
A
Echocardiogram
5
Q
An echocardiogram provides what specific information about the heart?
A
- Left ventricular ejection fraction (LVEF)
- Heart valves
- Presence of effusion
- Presence of thrombus
6
Q
What laboratory value is considered the number one indicator of heart failure?
A
Brain Natriuretic Peptide (BNP)
7
Q
When is brain natriuretic peptide (BNP) released within the body?
A
When left ventricle is stretched
8
Q
What is a normal brain natriuretic peptide (BNP) level?
A
< 300 pg/mL
9
Q
A brain natriuretic peptide (BNP) level _________ is indicative of heart failure.
A
> 400 pg/mL
10
Q
Why is it important for the nurse to know the patient’s baseline level brain natriuretic peptide (BNP)?
A
Levels may be higher in patients with chronic, stable heart failure
11
Q
The nurse knows that nursing interventions are therapeutic if the brain natriuretic peptide (BNP) level does what?
A
Decreases
12
Q
Describe the dilation compensatory mechanism.
HINT: Space
A
Enlargement of heart chambers
13
Q
When does the dilation compensatory mechanism occur?
A
When pressure in left ventricle is elevated over time
14
Q
Describe the hypertrophy compensatory mechanism.
HINT: Muscle
A
- Adaptive increase in heart muscle mass
- Adaptive increase in heart wall thickness
15
Q
Why does the hypertrophy compensatory mechanism occur?
A
Slow response to overwork and strain on heart
16
Q
Hypertrophy can cause the ___________ of the heart to fail.
A
Ventricles
17
Q
Can dilation and hypertrophy occur simultaneously within the ventricles of the heart?
A
No
18
Q
A patient with heart failure is admitted to the medical-surgical floor with chronic peripheral edema. The nurse auscultates the patients lungs two hours after initial assessment and hears bilateral crackles. What is the priority nursing intervention? Why?
A
- Call the physician!
- This is a sign and/or symptom of worsening heart failure
19
Q
What is acute decompensated heart failure (ADHF)?
A
- Sudden increase in heart failure symptoms
- Decrease in functional status
20
Q
Acute decompensated heart failure (ADHF) often requires what?
A
- Rapid escalation of therapy
- Hospitalization
21
Q
What are considered early clinical manifestation of acute decompensated heart failure (ADHF)?
A
- Increased pulmonary venous pressure
- Increased respiratory rate
- Decreased in PaO2
22
Q
What are considered later clinical manifestation of acute decompensated heart failure (ADHF).
A
- Interstitial edema
- Tachypnea
- SOB
23
Q
What clinical manifestations are considered further progression of acute decompensated heart failure (ADHF).
A
- Alveolar edema
- Respiratory acidosis
24
Q
In heart failure patients, what is considered an early sign and/or symptom that the patient is beginning to decline?
A
Vital signs
25
A patient comes to the ED complaining of dyspnea. They state they they have a history of acute decompensated heart failure (ADHF). What is the priority nursing intervention(s)?
- Apply oxygen
| - Auscultate lung sounds
26
List the signs and symptoms of pulmonary edema.
- Dyspnea
- Orthopnea
- Tachypnea
- Blood-tinged frothy sputum
27
Describe paroxysmal nocturnal dyspnea.
- Sensation of SOB that wakes the patient during nighttime
| - Usually relieved in the upright position
28
How might a patient describe paroxysmal nocturnal dyspnea (PND) to the nurse?
Feelings of suffocation
29
Should a beta-blocker be administered to a patient experiencing pulmonary edema?
No
30
The nurse knows a patient with pulmonary edema cannot receive a beta-blocker because:
- Causes bronchospasms
| - Disrupts lung function
31
Why is a patient with heart failure commonly prescribed a diuretic(s)?
Decreases preload
32
Why is morphine commonly prescribed for patients with acute decompensated heart failure (ADHF)?
- Decreases preload
- Decreases afterload
- Decreases dyspnea
- Decreases anxiety
33
Why is dopamine, dobutamine, or digoxin administered to a patient with acute decompensated heart failure (ADHF)?
- Increases heart rate
| - Increases contractility
34
Dopamine, dobutamine, and digoxin fall under what drug class?
Positive inotropes
35
List medications that fall under the drug class of positive inotropes.
- Dopamine
- Dobutamine
- Digoxin
36
The nurse administering positive inotrope therapy should educate the patient to notify the nurse if they develop what signs and symptoms?
- Tachycardia
- Orthostatic hypotension
- Nausea
- Vomiting
37
What is the therapeutic range of digoxin?
0.8 - 2.0 ng/mL
38
List signs and symptoms of digoxin toxicity.
- Yellow halo
- Vison changes
- Nausea
- Vomiting
- Diarrhea
39
What specific metabolic state(s) increases the risk for developing digitalis toxicity?
- Hypokalemia
| - Hypercalcemia
40
If a patient has a transdermal vasodilator (nitrate) patch, is the nurse still able to administer sublingual nitroglycerin?
Yes
41
When can diuretics be given during the day?
They can be given daily or multiple times a day
If only given once a day it should be scheduled in the morning to prevent nocturia
42
What is another name for isosorbide dinitrate with hydralazine?
BiDil
43
An Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) is often given for what chronic condition?
Chronic Heart Failure
44
What vital signs should be assessed before and after administration of an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor)?
- Blood pressure
| - Monitor for hypotension
45
What symptoms does the nurse need to educate on and monitor for when the patient is taking an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor)?
- Change position slowly
- New-onset dry, irritating, persistent, nonproductive cough
- Angioedema
46
When might a beta blocker be contraindicated for a patient? What should the nurse do if this occurs?
- Patient has asthma
- Patient has COPD
-Notify the physician
47
A patient with heart failure will be on what type of diet?
Low sodium diet
48
A patient with heart failure is restricted to ____ ________ of sodium per day.
2 grams (g)
49
When should the nurse be concerned about weight gain in the patient with chronic heart failure?
- 3 pound gain over 2 days
| - 3 to 5 pound gain over a week
50
A patient with chronic heart failure on the medical-surgical floor has gained 2 pounds over the last two days. What is the priority nursing management for this patient?
- Assess for s/sx of pulmonary congestion
| - Notify the physician
51
A heart transplantation is contingent upon what factors?
Multiple different factors
52
How long are individuals monitored for rejection after having a heart transplantation?
One year
53
In the first year, after receiving a heart transplantation, the patient is at risk for what complications?
- Rejection
- Infection
- Sudden cardiac death
54
After the first year of heart transplantation, what are a major cause of death?
- Cardiac vasculopathy
| - Cancer
55
___________ ______________ is the hearts inability to pump the blood forward.
Systolic dysfunction
56
Describe diastolic dysfunction.
A decrease filling of the heart will result in a decreased stroke volume
57
Systolic dysfunction affects which ventricle?
Left ventricle
58
What are considered early manifestations of cardiogenic shock?
- Tachycardia
- Hypotension
- Narrowed pulse pressure
- Increased myocardial O2 consumption
59
What previous disease process will cause the heart to need an increased myocardial consumption?
Myocardial infarction (MI)
60
What are considered late manifestations of cardiogenic shock?
- Tachypnea
- Crackles
- Pulmonary congestion
- Pallor
- Cool, clammy skin
- Decreased capillary refill
- Decreased urinary output
- Anxiety
- Confusion
- Agitation
61
Neurogenic shock is characterized by what clinical manifestations?
- Hypotension
- Bradycardia
- Poikilothermic
- Dry skin
62
List the clinical manifestations of anaphylactic shock.
- Angioedema
- Wheezing
- Stridor
- Respiratory distress
- Circulatory failure
63
What is the priority nursing assessment and management for a patient with anaphylactic shock?
Airway maintenance!
64
List the clinical manifestations presented during the early stage of septic shock?
- Tachypnea
- Tachycardia
- Leukocytosis
65
What occurs during a hyperdynamic state?
- Increased cardiac output
| - Decreased SVR
66
What is considered the priority nursing intervention for a patient with septic shock?
Apply oxygen!
67
What is considered cornerstone therapy for a patient experiencing either septic, hypovolemic, or anaphylactic shock?
- Volume expansion
| - Fluid resuscitation
68
In order for volume expansion or fluid resuscitation to occur, what will a patient require?
2 large bore IV's
69
How will the nurse assess fluid responsiveness?
- Vital signs
- Elevated blood pressure
- Urinary output
- Capillary refill
- Skin temperature
70
The nurse knows that this form of shock does not require fluid resuscitation.
Cardiogenic shock
71
Why are nitrates administered to a patient with cardiogenic shock?
Dilate coronary arteries
72
Why are diuretics administered to a patient with cardiogenic shock?
Reduce preload
73
Why are vasodilators administered to a patient with cardiogenic shock?
Increase afterload
74
Why are β-Adrenergic blockers administered to a patient with cardiogenic shock?
Reduce heart rate
75
How many sites should the nurse obtain blood cultures from a patient with septic shock? When are these blood cultures obtained?
- 2 different sites
| - 1 hour apart
76
The nurse knows the blood glucose level for a patient with septic shock should be below what, regardless of diabetes?
Less than 180
77
How often should the nurse perform blood glucose level checks for a patient with septic shock?
Every three hours
78
A patient develops septic shock. The nurse knows that antibiotics must be administered within what time frame?
One hour
79
List the different types of vasopressor drugs.
- Epinephrine
- Norepinephrine
- Dopamine
- Dobutamine
80
Why are proton pump inhibitors, such as protonix, given to a patient with septic shock?
Prophylactic treatment
81
What is the drug treatment of choice for a patient with neurogenic shock?
- Vasopressors
| - Atropine
82
What type of shock is the only type of shock that is treated with atropine?
Neurogenic shock
83
All spinal injuries affect _______________ regulation.
Temperature
84
What is the primary nursing intervention for a patient with neurogenic shock?
Apply high-flow oxygen via non-rebreather mask
85
What is included in the nursing assessment for tissue perfusion?
- ABC's!
- Vital signs
- Peripheral pulses
- LOC
- Capillary refill
- Skin
- Urine output >30 mL/hr
86
What is SIRS?
Inflammation of the organs
87
What is MODS?
- A failure of two or more organ systems
| - Results from SIRS
88
The nurse knows the two organ systems that are most likely to fail first is/are:
- Liver
| - Kidneys
89
What will the nurse examine in order to assess kidney function?
Urine output
90
What will the nurse examine in order to assess liver function?
- Jaundice
- Pain
- Low platelet levels
- Ammonia levels
91
List the signs and symptoms of central nervous system (CNS) dysfunction.
- Temperature change
| - Hypotonic reflexes (flaccid)
92
Describe how shock leads to organ dysfunction.
1. Shock -->
2. Systemic inflammatory response syndrome (SIRS) -->
3. Multiple organ dysfunction syndrome (MODS) -->
4. Target organs (i.e. renal, lung, liver, CNS)
93
Care for a patient with MODS focuses on:
- Maintaining tissue oxygenation
- Preventing and treating infection
- Appropriate support of failing organs
94
In order to maintain tissue oxygenation in a patient with MODS, how will the nurse decrease oxygen demand while increase oxygen deliver?
- Sedation
- Analgesia
- Mechanical ventilation
- Rest
95
How do we prevent blood clots in a patient with SIRS?
- Early ambulation
- SCD's
- Anticoagulants (blood thinners)
96
How do we prevent infection in a patient with SIRS?
- Aseptic technique
- Prophylactic antibiotics
- Wash hands
97
The nurse knows leaving catheters in a patient for prolonged periods of time can cause what? What is the priority for patients with catheters?
- Infection
| - Take them out as soon as possible
98
Are we concerned about nutrition prior to sedating a patient with SIRS?
No
