exam 3- presntations and videos

Question 1

heart
what is it

how much moves

Answer 1

Hollow, cones shaped organ, necessary for life

Moves more then 1800 gallons of blood/day

Question 2

pericardium

atria/ventricals

Answer 2

encases the heart and anchors it to surrounding structures-fits snuggly to prevent overflowing

Atria -top
Ventricles –bottom of heart

Question 3

heart beat

systole

diastole

Answer 3

One heart beat = contraction and relaxation of heart—aka cardiac cycle

Systole contraction-ventircles are contracting/atria filling-5o ml of blood remaining

Diastole atria are contracting and ventricles are relaxing filling

Question 4

stroke volume

how often

Answer 4

Stroke Volume: Difference between the end diastolic volume and the end systolic volume -

70—80 tomes a minute

Question 5

cardiac output

what is

what indicator of

what happens if not pumping correctly

Answer 5

HR X Stroke Volume

Indicator of: amount of blood pumped into ventricles in one minute—how well heart is functioning as a pump-how well heart is working//

if not pumping correctly, cardiac output and tissue perfusion are decreased

Question 6

ischemia

necrosis

Answer 6

I-depreivation of oxygen, body tissues do not get enough blood/

/N- one step further, tissues will start to die as a Result of not enough oxygen in blood

Question 7

preload

frank starling mechaniism

Answer 7

Preload: new rubber band-stretch and release which will snap back into place and shape-overstretching will become relaxed and lose ability to recoil –overstretching cardiac muscle fibers eventually leads to ineffective contraction

Frank Starling Mechanism: -repeatedly stretch past a certain point it will eventually lose elasticity-cant snap back into oringal shape/size

Question 8

compliance

afterload

Answer 8

Compliance: take a lot of force/work to inflate at first. As it stretches more often it becomes more complaint and expands easily with less force as time goes on

Afterload: force ventricles must overcome to eject blood volume

Question 9

s/s of low potassium level

Answer 9

leg cramps

heart fluttering

Question 10

Diagnostic Tests cardiac

Answer 10

Cardiac Cath - npo,allergies to iodine, assess aspirin, vs

CT Scan-iodine allergy, npc 4 hr

Echocardiogram

Electrocardiogram

Lipids -low fat meal then no food for 8-12 hrs

Dobutamine Stress Test -npo , discontinue beta blockers, ace

Treadmill Stress Test -comfortbael clothes, npo and no smoking

TEE-npo, vs

Question 11

pt assessment cardiac

Answer 11

History—

Personal and family history

Diet history

Socioeconomic factors

Current health problems -perceived or actual

Functional history

Question 12

risk factors for cardiac

Answer 12

Smoking

Obesity

Physical inactivity

Question 13

age related changes cardiac

e/c
valves-cause
co/bp/contr

Answer 13

efficiency and contractiblity decreases-leads to decresaded ardiac output.

Valves become more thicker/ rigid causing increased BP.

Older adults have decreased cardiac output, INC blood pressure, Decreased contractility

Question 14

Patient Physical Assessment
cardiac

what looking at

Answer 14

General appearance

Skin color/temperature

Extremities

Capillary refill

Edema

Blood pressure//Heart Rate

Question 15

normal hr

school age
adult
athlete

Answer 15

Pediatric/School Aged 70-110

Adult  60-100

Athletes may have lower heart rate

Question 16

heart failure
what kind of problem

results in what
cardiac output

Answer 16

Filling & pump/Contracting problem…

results in  metabolic needs of the body are not met due to not enough blood being pumped—

cardiac output falls leading to decreased tissue perfusion and vascular congestion/Congestive heart failure

Question 17

impaired myocardial function

most at risk for hf

causes of heart failure

Answer 17

coronary heart disease/MI-most risk

cardiomyopathy

rhematic fever

ineffective endocarditis

Question 18

increase cardiac output

causes of heart failure

Answer 18

hypertension

2.Valve disorder

3. anemia
4. Congenital heart defects

Question 19

acute noncardaic conditions

causes of heart failure

Answer 19

Volume overload

2.hyperthyroidim

3. fever/infection
4. Pulmonary emboli

Question 20

Incidence, prevalence & Risk factors

incidence
prevelance
risk factors
life exp
risk for

Answer 20

Incidence and prevalence increase with age

Prevalence & Mortality: African Americans have higher risk

Risk factors: impaired myocardial function- mi, hypertension

Life expectancy: dependent on underlying cause, and how quickly its treatment

Risk for sudden cardiac death increased

Question 21

systolic vs diabolic failure

manifestations

Answer 21

S-Weakness, fatigue, and decreased exercise tolerance.

D-Shortness of breath, tachypnea, and respiratory crackles

Question 22

left sided heart failure
culprit

Answer 22

coronary heart disease and hypertension

Question 23

when Left ventricle function fails

what falls
backwards effect
backs where

Answer 23

Cardiac output falls

Backward effects pressure in left ventricle/atrium increase which….

Backs up into the pulmonary system inc congestion and pressure

Question 24

lef sided hf manifestations

Answer 24

fatigue/activity intolerance/dizziness

dyspnea,

SOB ,

cough,

orthopnea(SOB when laying flat),

congested lung sounds

Question 25

Right sided culprit

Answer 25

–restrict blood flow to lungs Culprit acute chronic repository issues

Question 26

when Right ventricle is impaired cant do what-> increased what

Answer 26

cant pump blood  accumulate in systemic venous system Increased venous pressure

Question 27

Classic Manifestations:- right sided hf

Answer 27

abdominal organs congested , JVD , peripheral edema

Question 28

acute vs chronic

Answer 28

acute-abrupt onset resulting in decreased cardiac function/output chronic-progressive deterioration leading to cardiomyopathies, vascular disease, chd

Question 29

Diagnosis of Heart Failure History & Physical How will your patient present to you??

Answer 29

peripheral edema, too tight shoes, tired, not sleeping good, sleeping in chair, stopping halfway, cant catch breath, tired, lethargic

Question 30

diagnostic test for hf

Answer 30

BNP (Brain natriuretic peptide): hormone released by heart when blood volume changes, inc in HF-levels are normally less then 100 Electrolytes-potassium sodium and chloride BUN & Creatinine-renal function Blood Gases-resp status Chest X ray-congestion EKG-dysrymthias, ischemia , infarction Echo-blood flow through heart

Question 31

ACE inhibitors & ARBS what kinds assessment cough monitor take/slow HF drugs

Answer 31

“PRIL” Medications & “ARTAN” Medications Assessment vasodilation, lower systolic pressure ACE cough dry, persistent cough, constantly clearing throat monitor-bp,hr, potassium,wbc, renal function take at same time each day/slow position changes

Question 32

Beta Blockers assessments HF drugs

Answer 32

“OLOL” Medications Assessment pulse and bp prior

Question 33

Diuretics-what di what drugs assessment watch obtain/drink/avoid/sudden/ eat HF drugs

Answer 33

– will help reduce preload Furosemide, metolazone, bumetanide, spironolactone Assessment increases urine output, input, Watch electrolyte imbalances; hypokalemia –may be on potassium supplement obtain weight/vs, drink water, avoid sudden changes, eat high potassium

Question 34

Positive Inotropic Agents what does what drug assesmetn report, monitor, no, eat HF drugs

Answer 34

Increases cardiac output and improve contractility Digoxin Assessment take apical pulse for 1 minute. report anorexia,nv,monitor renal failure, no antacids, eat high potassium

Question 35

Respiratory Status, Positioning & Edema Heart failure assess position elevate

Answer 35

asses pulse ox-might need oxygen therapy fowlers position- adequeute ventilation and help breath easier elevate extremities, might have teds on

Question 36

Nutrition & Activity heart failure

Answer 36

sodium restriction-possibly fluid gentle progressive exercise

Question 37

surgery heart failure

Answer 37

valve replacement heart transplant or circulatory resistance(balloon pump)

Question 38

Heart Failure Health Promotion decreased cardiac output excess fluid volume activity intlerance knowledge defect

Answer 38

Decreased cardiac output support them, resp system, assess vitals, asses pulse ox, oxygen therapy, fowlers position Excess fluid volume  FV, diuretics, IV transition oral, watch electrolyte imbalance, monitor labs and ECG, avoid foods high in sodium, I and o, restrict fluids Activity intolerance  help with ADL, encourage to participate as able/tolerated. Knowledge deficit daily wights, if gain more then2 pounds a day- call doctor, don’t want gaining weight.// /take BP, take pulse, keep all appointments and follow ups

Question 39

teaching HF\ diet meds weight monitor

Answer 39

low sodium diet meds daily weight monitor I and o

Question 40

Pulmonary Edema what is it what caused by

Answer 40

What is it?  accumulation of fluid in intestinal tissue and avloli in lungs-MEDICAL EMERGENCY Caused by cardiac and non cardiac issues

Question 41

patho pulmonary edema contractibility ventricle unable resulting in

Answer 41

Contatialbility of left ventricle impaired severely ventricle is unable to eject the blood that enters it Resulting in sharp rise in end diastolic pressure, pulmonary capillaries are congested and interfere with gas exchange

Question 42

manifestations of pulmonary edema resp cardio nuero

Answer 42

respiratory tachypenia,dyspnea, orthopena cardio tachycardia,hypotension, cool clammy skin nuero restless, anxiety, confusion

Question 43

Pulmonary Edema Treatment Medications/Treatment

Answer 43

morphine-anxiety and improve breathing relaxes lungs oxygen, cpap brathing treatments, diuretics and vasodilators

Question 44

Pulmonary Edema Treatment emergency

Answer 44

Be prepared: in emergency , need resp equipment,-- fatigue, impaired gas exchange, acid base imbalances can lead to cardiac arrest

Question 45

Pulmonary Edema Treatment focusing on diagnostic tests

Answer 45

Focusing on: restoring effective gas exchange, reducing pressure and fluid in pulmonary vasular system Diagnostic Tests: ABG, chest x ray,

Question 46

pulmonary edema improve gas echange cardiac ouput fear

Answer 46

IGE-assess rest status, high fowlers, administer oxygen, CDB co-vs, heart sounds, iv, I and o fear- emountinal support

Question 47

what is blood pressure

Answer 47

tension or pressure exerted on blood on aretial walls, certain amounts of pressure are required to keep walls open and capillary perfusion and ixygenation of all tissue

Question 48

hypertension

Answer 48

excess pressure in the arterial portion of the systemic circulation

Question 49

Systolic averafe felt rises

Answer 49

less then 120 average felt as peripheral pulse pressure rises as the heart contracts during systole, ejecting its blood

Question 50

diastolic relax minumin average

Answer 50

cardiac relaxation and filling maintain a minimum pressure to maintain blood flow average is less then 90

Question 51

Hypertension diagnosed normal elevated hypertension stage 1 hypertension stage 2 hypertensive crisis

Answer 51

Based on the average of three or more readings taken on separate occasions < 120 <80-normal elevated-120-129  and <80 HTN1-130-139  OR 80-89 HTN 2At least 140 OR At least 90 Crissi>180   AND/OR >120

Question 52

modifiable risk factors hypertension

Answer 52

High sodium intake Low electrolytes Obesity Alcohol consumption Insulin resistance

Question 53

non modifiable risk factors hypertension

Answer 53

Genetic factors Family history Age Race

Question 54

manifestations of hypertension

Answer 54

Asymptomatic in early stages Headache Nocturia Confusion Nausea/vomiting Visual disturbances

Question 55

Sustained BP affects the: cardiovascular

Answer 55

rate of atherosclerosis increases, inc risk of cardiac coronary heart disease and stroke

Question 56

Sustained BP affects the: nueroligal

Answer 56

cerebral infarct(stroke) microaneurysms hypertensive encephalopathy- high bp, altered loc, increased cranial pressure, papiledema, seizures

Question 57

Sustained BP affects the: renal

Answer 57

nephrosclerosis of small nephrons in kidneys renal insufficiency

Question 58

Lifestyle Modification hypertension diet physical activity alc/tobacco stress meds

Answer 58

DASH- reduce sodium, fat maintain potassium /caclium level, —grains, veggies, fruit lean meat Physical Activity-regular exercise -30-45 mins Alcohol and Tobacco- smoking directly related to heart disease, alcohol in moderation Stress Reduction Stress increases vasoconstriction increasing BP…solution relaxation techniques/alternative therapies Medications: ACE, ARBs, Calcium Channel Blockers, Beta Blockers, Vasodilators, diuretics

Question 59

Alpha-Adrenergic Blockers meds first dose assess can cause antihypertensive

Answer 59

Doxazosin Prazosin First dose is bedtime,-fainting assess bp/apical, dizziness, orthostatic hypotension,nasal congestion

Question 60

Angiotensin-Converting Enzyme (ACE) Inhibitors meds nursing considerations cough assess when take report positional antihypertensive

Answer 60

“pril” drugs Prevents constriction and sodium/water retention --Watch BUN, creatinine and potassium levels/ /ace cough assess bp, 1 hr before meals, report edema, slow positional changes

Question 61

Angiotensin II Receptor Blockers (ARBs) meds assess when take report positional antihypertensive

Answer 61

“artan” drugs assess bp, 1 hr before meals, report edema, slow positional changes

Question 62

Calcium Channel Blockers meds assess toxicity keep watch antihypertensive

Answer 62

“pine” drugs, diltiazem assess bp, apical pulse,constipation toxicity-nausea, weakness, bradycardia keep nitrate available watch liver, renal function

Question 63

Beta Blockers meds assess report antihypertensive

Answer 63

“olol” drugs assess bp, apical, report bradycardia, decreased co, hypotension, bronchospasm

Question 64

Centrally Acting Sympatholytic meds take/ pathces/ causes/ relieves take/ dont/ do not changes antihypertensive

Answer 64

Clonidine take at bedtime patches to dry skin causes dry mouth relives dry mouth with water take with meals, dont abruptly discontinue, do not drive dt drowsiness slow positional changes

Question 65

Vasodilators meds what does changes antihypertensive

Answer 65

Hydralazine //vasodilation, decreased bp, slow positional changes,

Question 66

Diuretics meds nrursing considerations antihypertensive

Answer 66

Furosemide Hydrochlorothiazide Spironolactone   Risk of hypokalemia-muscle cramps, leg pain,//take bp and I and o SP-potassium sparing, avoid salt substitutes

Question 67

hyperlipidemia

Answer 67

Hyperlipidemia = High Cholesterol

Question 68

High Density Lipoproteins (HDL): what does optimal

Answer 68

help clear cholesterol from arteries, transporting to liver for excretion Optimal > 60mg/dL

Question 69

triglycerides desired

Answer 69

amount of fat in blood desired is less then 150

Question 70

Low Density Lipoproteins (LDL): what does optimal high levels

Answer 70

primary carrier of cholesterol Optimal <100 mg/dL high levels= promote atherosclerosis, deposits cholesterol on artery wall

Question 71

Atherosclerosis what does/cause

Answer 71

deposits of fats and fibron that obtsuct and harden the arteireis, impair blood flow to peripgeral tissues--PVD

Question 72

desired HDL,LDL,trig

Answer 72

Desired: high HDL, Low LDL, Low Triglycerides

Question 73

Treatment of Hyperlipidemia modifacations overall goal medication goal

Answer 73

Lifestyle Modifications Overall goal to lower total cholesterol, triglycerides & LDL, raise HDL Medication: Goal lower ldl

Question 74

Treatment of Hyperlipidemia chlosteroal lowering agents w/ nursing consideration meds that inhibit platelet aggregation

Answer 74

Statins: atorvastatin, pravastatin, simvastatin Nursing Considerations monitor cholesterol level, liver enzymes, cpk levels Medications to inhibit platelet aggregation aspirin, and clopidogrel

Question 75

Peripheral Vascular Disease primary syomtome

Answer 75

Impaired blood supply to tissues: primary symptom-Intermittent claudication pain with activity/ cramping while walking /aching calves, legs thighs and buttocks accompanied by weakness and is relieved by rest

Question 76

how else will PVD present pains p___ pilses temp color smin ulcer

Answer 76

Intermittent claudication –pain with activity dt low blood supply Rest Pain during inactivity, burning sensation and increased with leg elevation and decreased with dependent(hanging) legs Paresthesia – numbness /decreased sensation Pulses diminished or abset Temperature; cool Color with elevation pallor Color when dependentdark red color Skin thin, shiny and hariless Breakdown & Ulceration on toes or side of legs

Question 77

Peripheral Vascular Disease diagnosis

Answer 77

History and physical –when pain Diagnostic Tests : Segmental pressure measurements - Doppler Ultrasound Oximetry Angiography

Question 78

PVD treatments smoking walking foot care suport hose rest revasulrazaition

Answer 78

Smoking cessation, nicotine cases further vasospasms-reduced blood flow Walking gentle exercise Foot care  sores, blisters, prevent ulceration No support hose elastic will further reduce circulation Rest with claudication encourage to rest then go back to activity Revascularization surgery for progressive severe or disabling pvd

Question 79

Medication goals pvd

Answer 79

Inhibit platelet aggregation vasodilation decrease blood viscosity

Question 80

PVD assessment-cms sudden changes compare assess position changes

Answer 80

Sudden change in CMS??—cold painful pulseless//looking for color, motion and sensation Compare sides & notify Assess pulses, pain, color, temperature, cap refill Position changes promote blood flow

Question 81

pain/skin intergirty PVD

Answer 81

Pain assess pain & warmth vasodilation improves atrial flow and reduces pain Skin Integrity risk of oxygen and nutrient deprivation to skin Clean and dry skin Position changes prevent breakdown –looking for ulcers, blisters, tight fitting shoes, apply bed cradle and egg crate mattress

Question 82

pvd promote activity tolerance what to discuss

Answer 82

PAT- assist with cares, gradual increase in activity, positional changes smoking cessation, sings of bleeding, skin surveleince, diet and exercise

Question 83

Raynauds Disease what is it what limits

Answer 83

Episodes of intense vasospasm in the small arteries of fingers & toes limits artieal blood flow

Question 84

raynauds manifestations

Answer 84

Intermittent pain with skin color changes; Blue-White-Red disease occurs on digits

Question 85

raynauds treatment

Answer 85

Avoid Cold/dress warm & Avoid Smoking Stress management Vasodilators Dietary habits, increasing activity, maintain BMI

Question 86

Acute Arterial Occlusion -stages- occlusion results resulting

Answer 86

A peripheral artery may be occluded by the development of a thrombus (clot)or emboli results in impaired blood flow to tissues resulting in ischemia, then necrosis, then gangrene

Question 87

thrombus embolism

Answer 87

Thrombus- blood clot that adheres to vessel wall Embolism-obstruction of vessels by debris

Question 88

Manifestations- Acute Arterial Occlusion

Answer 88

Tissue Ischemia--- Painful, pale and cool, distal pulses are absent, paresthesia, cyanosis and mottling dec cap refill

Question 89

Diagnosis, Acute Arterial Occlusion

Answer 89

Arteriography- used to confirm, locate occlusion, and determine extent

Question 90

Medications Acute Arterial Occlusion med goal dischsarge

Answer 90

: Anticoagulation or iv heparin Goal:prevent further clot destruction and reoccuratn emboli Oral Anticoagulants at discharge Follow up labs and education, what can/cant eat

Question 91

Surgery Acute Arterial Occlusion

Answer 91

Embolectomy (within 4-6 hours) procedure of choice to prevent further occlusion risk of complications and limb loss if surgery is delayed 12 or more hours

Question 92

arterial arteries Peripheral- atherroclerosis, vascular disease Pain Pulses color temp edema skin changes ulcerations-where gangerene compressions treatment assessment

Answer 92

Pain-intermittent claudication, rest-inc with elevation, dec with dependent Pulses-diminsihed color-pallor w elevation, when dependent rubor temp-cool edema-absent or mild skin changes-thin shiny hairless, thick toenails ulcerations-deep, toes feet gangerene-may occur compressions-no treatment-smoking cessation, foot care, regular exercise assessment-CMS

Question 93

venous thrombosis low pressure Disorder of Venous Circulation

Answer 93

Venous Thrombosis: blood clot that forms in wall of vein, supperfical and deep, infmallation and obstruction Low pressure & flow within venous system more common then atrial,

Question 94

Deep Vein Thrombosis: common causes

Answer 94

hospitalization, surgery and immobilization

Question 95

superficial venous thrombosis manifestations

Answer 95

Localized pain and tenderness at site Redness and warmth along course of affected vein Swelling & redness can be from where iv catheters are placed

Question 96

Deep vein thrombosis manifestations

Answer 96

At times asymptomatic Dull, aching in extremity with walking Tenderness, warmth Cyanosis of affected extremity Edema of affected extremity

Question 97

how diagnose and how treat dvt

Answer 97

diagnosed with ultrasound treated with anticoagulants

Question 98

Pulmonary Embolism

Answer 98

clot that break loose and enters right side of heart and occludes blood flor to lungs

Question 99

how to diagnose venous disorders

Answer 99

Leg pain swelling, check peripheral pulse Duplex Venous Ultrasound vsiuation of vein, velocity of blood flow

Question 100

treatment venous disorders med labs dosage normal/therpatuc

Answer 100

Anticoagulation: IV heparin (Prolongs clotting times) aPTT-closely monitor this lab Dosage: Goal is to reach therapeutic Normal (control) aPTT: 30 to 40 seconds Therapeutic aPTT = twice the control value

Question 101

treatment bridge med level anticipate pulmonary embolism

Answer 101

Oral (Coumadin) check INR-therpatic levels are 2-3 Anticipate oral & IV therapy

Question 102

Coumadin Education & Teaching

Answer 102

Lab follow up Dietary Teaching: Avoid vitamin K rich foods (Dark Leafy Vegetables)

Question 103

surgery for venous disorders

Answer 103

Venous Thrombectomy, Vena Cava Filter

Question 104

Priorities in Care-venous disorders pain ineffective tissue perfusion impaired mobility risk for ineffective tissue perfusion

Answer 104

Pain: measure area and cirucmfenrce, maintain bedrest os ordered, give pain meds, reassess pain Ineffective Tissue Perfusion: asses pulses, skin intergrity, cap refill, elevate extremities, ted stocking -remove at ngiht, mild soap to cleanse area Impaired mobility: positon changes, rom, minimize atrophy, cough and deep breath Risk for ineffective tissue perfusion:assess resp status, pe system--sob ancuety, impending doom, vital signs

Question 105

Chronic Venous Insufficiency what is what caused by

Answer 105

Inadequate venous return over a prolonged period of time – caused by varicose veins, dvt, or trauma

Question 106

manifestations Chronic Venous Insufficiency

Answer 106

mild leg edema itching discomfort with standing reddish brown color normal pulses Stasis ulcers around ankle Thin and shiny cyanotic looking surrounding skin

Question 107

Treatment-Chronic Venous Insufficiency goal compression elev walking cross keep

Answer 107

Goal focus on reducing edema and treating ulcerations Compression hose- beneficial! –remove once a day and while sleeping elevation walking, avoid long periods of standing and sitting dont cross legs keep legs soft/dry

Question 108

venous disorders- DVT Pain Pulses color temp edema skin changes ulcerations-where gangerene compressions treatment assessment

Answer 108

Pain-mild, aching, itching Pulses-regular color-cyanosis + brown red tempnormal edema-worsens with standing skin changes-brown, around shiny ulcerations-ankle gangerene-no compressions-yes treatment-elevation, teds, dont cross, assessmentCMS

Question 109

varicose veins caused by impairs

Answer 109

Irregular veins with incompetent valves Caused by: long standing The constant pressure, impairs the ability of venous valves to close

Question 110

varicose veins manifestations

Answer 110

severe aching leg pain, leg fatigue, leg heaviness, itching, feelings of heat in the legs.

Question 111

treatments varicose veins

Answer 111

compression therapy regular daily walking, prolonged sitting discouraged surgery

Question 112

Lymphedema primary secondary

Answer 112

Primary – rare; associated with genetic disorders Secondary – acquired Due to damage, obstruction or removal of lymphatic vessels

Question 113

lymphedema manifestations

Answer 113

soft, spongey skin, subq tissue becomes rough and fibric

Question 114

Lymphedema treatments

Answer 114

Gentle exercise Compression Antibiotics limb elevation of affected side above heart limb restriction (labs/blood/iv) Dietary restriction- Sodium

Question 115

Lymphedema promote tissue integrity montior fluid volume

Answer 115

pit-assess skin, compression sotckins, elevate extremities,skin clean, dry monitor fluid volume-i and o, restrictd sodium,