Exam 3 part 4

Question 1

s/s of forward effect of left sided heart failure

Answer 1

decreased CO
- decreased blood supply to tissue
- Fatigue
- Weakness
- Dyspnea
- cold intolerance
- Dizziness

Question 2

backup effect of left sided heart failure

Answer 2

low ejection fraction 40% or lower, weak cardiac contractions
- Blood backs up into the lungs, increasing pressure; pulmonary edema

Question 3

s/s of backup effect of left sided heart failure

Answer 3

Related to Pulmonary congestion because of the increased pressure
- Dyspnea and orthopnea
- Coughing with frothy sputum
- Paroxysmal nocturnal dyspnea (severe nighttime shortness of breath) - acute pulmonary edema. - Wakes up gasping for air, coughing up some frothy, blood-stained sputum (hemophysis)
- Rails/crackles
- Harder to inhale
- Cyanosis and signs of hypoxia due to decreased gas exchange and hemoglobin not fully oxygenated

Question 4

right sided heart failure backup effect

Answer 4

weak contractions, ejection fraction of 40% or lower, blood flows back toward the extremities and internal organs causing edema

Question 5

right sided heart failure backup effect s/s

Answer 5

• Edema in feet/legs
• Hepatomegaly, splenomegaly impaired liver and spleen function
• Ascites
• Distended neck veins

Question 6

right sided heart failure forward effect s/s

Answer 6

same as left side
decreased CO
- decreased blood supply to tissue
- Fatigue
- Weakness
- Dyspnea
- cold intolerance
- Dizziness

Question 7

heart failure compensatory mechanism

Answer 7

• Activate Sympathetic nervous system (tachycardia, pallor, tachypnea - deliver oxygen to tissues so they don’t die)
• Activation of renin-angiotensin system (increased thirst and less peeing during the day - oliguria)
• release AII (vasoconstriction)
• release ADH (pee less)
• release Aldosterone (Na and water retention)

Question 8

right sided heart failure causes

Answer 8

pulmonary hypertension
pulmonary valve stenosis
pulmonary disease

Question 9

left sided heart failure causes

Answer 9

Systemic hypertension
Aortic stenosis
left ventricular infarction

Question 10

main cause of heart failure

Answer 10

left ventricular infarction

Question 11

Diagnosis of heart failure

Answer 11

• Establishing the cause and extent of cardiac dysfunction
• based on s/s patient presents with
• Patient history
• BNP levels (100 pg/mL +)

Question 12

Hypovolemic shock

Answer 12

• Loss of whole blood
• Loss of plasma

Question 13

cardiogenic shock

Answer 13

The heart fails to pump blood adequately.
- Decreased cardiac output lowers BP.
- The sympathetic system responds.
- Vasoconstriction increases resistance to blood flow.
- Increased workload on the heart worsens heart failure

Question 14

cardiogenic shock cause

Answer 14

• MI
• Acute valve damage, ventricular septal defect
• Sustained arrhythmias

Question 15

obstructive shock

Answer 15

Inability of heart to fill - cardiac tamponade

Question 16

distributive shock

Answer 16

• Blood vessels dilate.
• Not enough blood to fill the circulatory system.
• Blood flow decreases.
• Less blood is returned to the heart.
• Less blood is circulated to the body

Question 17

Causes of Distributive Shock

Answer 17

Decreased sympathetic activity: neurogenic
- Brain or spine injury; anesthetics; insulin shock; emotion
Vasodilator substances in blood
- Type I hypersensitivity (anaphylactic shock)
- Inflammatory response to infection (sepsis)
Vessel damage from severe hypovolemia
- loss of sympathetic tone (neurogenic shock)

Question 18

septic shock

Answer 18

due to systemic infection
- Inflammatory mediators released into the circulation
- Cause systemic signs of inflammation
- Activate pathways
(Coagulation, complement, fibrinolytic)

Question 19

Anaphylaxis

Answer 19

Systemic response to the inflammatory mediators released in type I hypersensitivity
- Histamine, acetylcholine, kinins, leukotrienes, and prostaglandins all cause vasodilation.
- bronchoconstriction

Question 20

cardiac effusion

Answer 20

Fluid accumulates in the pericardial sac slowly, no symptoms, heart adjusts

Question 21

cardiac tamponade

Answer 21

Fluid accumulates rapidly, causing pain and compressing the heart, making it unable to fill

Question 22

ventricular septal defect

Answer 22

• Hole in septum between two ventricles (left is thicker than right)
• When blood comes from left atria into left ventricle and blood goes through defect between vents
• All blood entering circulation is fully oxygenated, but there is less of it
  LEFT TO RIGHT

Question 23

Tetralogy Fallot

Answer 23

all 4 defects at birth must occur
1 - VSD
2- pulmonary stenosis
3 - right ventricular hypertrophy (wall of right vent is thicker than left
4 - over riding aorta - aorta closer to septum and ventricular septum defect
RIGHT TO LEFT

Question 24

Acyanotic condition

Answer 24

VSD - all of the blood that is entering systemic circulation is fully oxygenated

Question 25

Cyanotic condition

Answer 25

Tetralogy Fallot - When heart contracts, blood moves from right side to left side into aorta, so the blood doesn’t go to the lungs and Doesn’t get oxygenated (blood is mixed oxygenated and deoxygenated)

Question 26

What are cardiac enzymes and how are they used

Answer 26

Troponin, myoglobin, CK - raises in these enzymes signify that there has been an MI. the higher the level, the more cardiac damage has occurred

Question 27

What is BNP and how is it used

Answer 27

Brain natriuretic peptide. Used to diagnose heart failure, evaluate the effectiveness of treatment, and evaluate the severity of the heart failure. Level of BNP will lower if treatment is effective

Question 28

paroxysmal nocturnal dyspnea

Answer 28

Acute pulmonary edema - Pt wakes up gasping for air, coughing up frothy, blood-tinged sputum (hemphysis)

Question 29

who would you expect to see paroxysmal nocturnal dyspnea in

Answer 29

Left sided heart failure patients

Question 30

Why do people suffering from heart failure suffer from hypervolemia?

Answer 30

Blood isn’t being pumped efficiently, so it pools in the lungs and the extremities. Kidneys are also triggered to retain sodium and water, further increasing the volume

Question 31

Dromotropic effects of cardiac medications

Answer 31

Cardiac conduction - how fast are the action potentials moving through the system? (neg = decreased conduction velocity)

Question 32

inotropic effects of cardiac medications

Answer 32

Force of ventricular contraction - Positive inotropic - greater force of contraction - Negative - weaker force of contraction

Question 33

Chronotropic effects of cardiac medications

Answer 33

Heart rate - Negative - slows it down - Positive - speeds it up

Question 34

What virus causes AIDS

Answer 34

Human immunodeficiency virus

Question 35

what are some s/s and associated illnesses seen in AIDS patients?

Answer 35

- Opportunistic infections -- Respiratory: pneumocystis pneumonia, pulmonary TB -- Gastrointestinal: esophageal candidiasis, CMV, herpes simples esophagitis -- Nervous system - Malignancies - Kaposi sarcoma, non-Hodgkin's lymphoma - Wasting syndrome: involuntary weight loss of >10% of starting weight, diarrhea, chronic weakness and fever - Metabolic disorders: insulin resistance and diabetes, lipodystrophy (abnormal fat loss or accumulation), hyperlipidemia and mitochondrial disorders

Question 36

What is the difference between being diagnosed HIV positive and being diagnosed with AIDS

Answer 36

T helper cell count goes below 200

Question 37

primary immunodeficiency

Answer 37

Genetic - Humoral (B-cell) deficiencies - hypogammaglobulinemia - Cellular (T-cell) deficiencies - thymic aplasia - Severe combined immunodeficiency disorder (SCID): deficient in B and T Cell due to non-functional - T-helper cells. bubble boy disease - Wiskott-Aldrich syndrome: production of abnormal or nonfunctional immune cells - decreased antibody production

Question 38

secondary immunodeficiency

Answer 38

Acquired—consequence of another event - Malnutrition - Immunosuppressant drugs - AIDS - Kidney disease - Hodgkin lymphoma - Chemotherapy

Question 39

MI treatments

Answer 39

- rest, oxygen therapy and analgesics - anticoagulants - thrombolytic agents (dissolve the clot, given within first hour) -- first hour - streptokinase, urokinase, tissue plasminogen activator (followed by low does aspirin or anticoagulants - warfarin) - Low dose ASA therapy - Coronary bypass surgery - Percutaneous coronary intervention

Question 40

angina treatments

Answer 40

- Nitroglycerin - Directed toward symptom relief - Life style changes - Drugs (decrease workload of the heart) -- Nitrates - increase diabetes of coronary vessels which increases blood flow to myocardium -- Beta blockers -- Calcium channel blockers

Question 41

how is aging is associated w the development of hypotension

Answer 41

- Decreased thirst reflex, decrease in blood volume - Decreased baroreflex - supposed to cause vasoconstriction, increased heart rate, increased force of cardiac contraction - Autonomic nervous system dysfunction - baroreflex doesn’t react quickly enough to postural changes

Question 42

Blood pressure regulation - renin-angiotensin-aldosterone pathway and what stimulates the activation of the pathway

Answer 42

Heart failure and shock (hypoperfusion of tissues and organs) activate the pathway - pathway raises blood pressure to increase tissue perfusion

Question 43

What compensatory mechanism occurs in the heart in patients suffering from hypertension or aortic valve stenosis that helps to maintain cardiac output

Answer 43

Increased afterload (force that heart generates to open up aortic valve)