What statement by a PT with Raynaud’s disease requires further teaching?
- “Smoking cessation is important”
- “Caffeine should be eliminated from my diet”
- “Moving to a warmer climate will help me”
- “Taking my nifedipine as prescribed will decrease the vessels spasms”
Answer: 3 If PT moves to a warmer climate, they may use the AC more, and be less careful during periods of cooler weather such as in places like Florida.
SATA Which of these things should a PT with Raynaud’s Disease Avoid?
- mittens
- warm water
- alcohol
- smoking
- cooking hot food
- anxiety
- taking proscribed calcium channel blockers
Answer: 3,4,6,7 These increase vasoconstriction reducing the arterial blood flow, the other answer increase vasodilation which increases arterial blood flow.
What are the types of Aneurysms and what do they look like?
Saccular: Memory trick (saccular sounds like (singular), singular sack on one side of the artery.
Fusiform: Memory trick 2 sacks (fused together) on both sides of artery creating a 360 aneurysm.
Dissecting: Memory trick (dissects = tear in the artery) which fills with blood and expands like a balloon with each beat.
SATA which of these are the signs & symptoms of an Aneurysm?
- back & flank pain
- emesis
- nausea
- cramping
- bloody diarrhea
- abdominal fullness
- tumors
- pulsating abdominal mass
- severe sudden back pain
- Severe ischemia
Answer: 1,3,6,8,9 are common symptoms of an aneurysm as listed in the box on page 428.
Which of these is a major symptom of varicose veins?
- sores on the back of ankles and heals
- goosebumps
- spider veins
- petechia
Answer: 3 as described on page 429, varicose veins are caused by increased pressure on the legs due to prolonged standing or pressure such as during pregnancy, or obesity causing varicosities in the superficial veins.
SATA which of these are therapeutic measures for Varicose Veins?
- leg warmers
- compression stockings
- compression pumps
- compression bandages
- orthopedic slippers
- laser or light therapy
- radiofrequency or laser ambulation
- laser resurfacing
- bariatric socks
- Bepaint
Answer: 2, 3, 4, 7, 8 as described on page 429 under Therapeutic Measures
SATA A PT who is used to a diet high in sugars, fats, and salts is diagnosed with HF and put on potassium wasting diurectics. Which foods may the nurse use to compromise with the PT to increase potassium?
- refried beans
- apples
- starfruit
- potato chips seasoned with salt (substitutes)
- low fat, Icecream
- grapes
- dark chocolate
- spinach, with low fat, low sodium dressing
- cocoanut
- mexican jumping beans, with pesto
- olives
- garlic
- honey
- papaya
Answer: 1, 4, 5, 7, 8, 14 as described in the box on page 761 these foods are high in potassium, and their reduction in both salt and sugars will help the PT compromise with their new diet.
A nurse is caring for a PT who states “My shortness of breath usually occurs when I try to rush through daily activities, or whenever I have to increase my activity to do something” what type of dyspnea is she experiencing?
- exertional Dyspnea
- orthopnea
- 4-pillow orthopnea
- proximal nocturnal orthopnea
Answer: 1 Exertional Dyspnea, described on page 462
A PT in the hospital has increasing dyspnea when lying flat, sitting up, and when lying supine. They are using three pillows when sleeping. What type of Dyspnea is this?
- nocturnal dyspnea
- 2-pillow orthopnea
- chronic dyspnea
- 3-pillow orthopnea
Answer: 3 3-pillow orthopnea, described on page 462
A PT says they are having difficulty falling asleep due to the fear of waking up feeling like their going to suffocate. What type of Dyspnea is this?
- dyspnea
- orthopnea degree 7
- exertional dyspnea type 2
- proximal nocturnal dyspnea
Answer: 5 described on page 462, also answers 2 & 3 don’t exist.
What are the causes of Left-Sided HF
- Aortic Stenosis- obstructs blood flow resulting in increased volume
- Cardiomyopathy-effects the heart’s ability to contract increases the workload
- Coarctation of Aorta- restricts outflow resulting in an increase of resistance from the aorta
- Hypertension #1 Major Cause: Elevates pressure causing more resistance
- Heart Muscle infection-Damaged myocardium=increased workload
- Heart Attack (MI)-impairs the heart’s ability to contract+increased workload
- Mitral Regurgitation- increases volume because blood is pumping backward.
What are the causes of Right-Sided HF?
Atrial septal defect- Left atrial blood flow into the right atrium results in increased right ventricular blood volume
Cor Pulmonale- resistance due to elevated BP
Left-sided HF #1 major cause- resistance due to fluid backup, and elevated BP
Pulmonary Hypertension- increased resistance due to increased pressure
Pulmonary valve stenosis-Increased volume due to restricted right ventricular blood flow.
SATA A Patient is diagnosed with Acute HF, what signs and symptoms confirm this diagnosis?
- anxiety
- crackles or wheezes
- slow labored respiration
- warm pink skin
- green frothy sputum
- severe dyspnea & orthopnea
- all of the above
Answer: 1,2,6 all s/s described in the box on 461. Respirations would be fast, sputum would be pink and frothy, the skin would be cold, clammy, and pale.
SATA A PT is diagnosed with chronic HF, what signs and symptoms confirm this diagnosis?
- High blood counts
- crackles and wheezes
- slow heart rate
- nocturia
- rapid respirations
- cap refill -3
- altered mental status
- lack of dyspnea
- dry cough
- Edema
Answer: 2,4, 7, 9, 10
High blood counts is incorrect, Anemia is a common symptom so blood counts would be low
Slow heart rate is incorrect, the low cardiac output triggers the sympathetic nervous system to cause tachypnea
Rapid respirations is incorrect, Cheyne-Strokes are a common symptom due to the lack of CO2 causing shallow breathing patterns, and apnea lasting 30 secs at a time.
Cap refill -3 is incorrect, cyanosis is a common symptom due to the decreased oxygenation
Dyspnea is definitely a common symptom due to the pulmonary congestion decreasing gas exchange
Right-Sided HF signs & symptoms
- Ascites
- dependant peripheral edema
- Mallabsorption, anorexia, and pain due to the ascites pressing on the GI structures
- Jugular vein distention
- Nocturia
- Enlarged Liver Hepatomegaly
- Splenomegaly enlarged spleen
- Tachycardia
- Weight gain
Left-Sided HF signs & symptoms
- Cheyne Stokes respirations
- Crackles & Wheezes
- Cyanosis
- Dry cough
- Dyspnea on exertion
- Nocturia
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Tachypnea, and Tachycardia
SATA A Nurse has a client with HF. Suddenly the PT develops Severe! tachycardia, dyspnea, and lung crackles. The nurse suspected pulmonary edema and immediately finds RN. What intervention can she anticipate will be ordered?
- administer oxygen
- insert a Foley Catheter
- administer furosemidede
- administer IV morphine
- Transport client to the coronary unit
- position client in a low-Fowlers side-lying position
- All of the above
Answer: 1,2,3,4
Explanation: Pulmonary Edema is Life-threatening! Oxygen is always proscribed, and PT is placed in the High Fowlers position to ease the work of breathing. Furosemide is a rapid diuretic and will eliminate the fluid quickly. A Foley catheter is given to accurately measure the fluid output. IV morphine decreases preload, decreases anxiety, and reduces the work of breathing. Transporting PT to the coronary care unit is not the priority, and may not be necessary if treatment is successful.
What is the difference between STEMI & NSTEMI
- STEMI is full blockage of on artery resulting in an extremely dangerous MI
- NSTEMI is a partial blockage of an artery, not as dangerous. Memory trick (NSTEMI=Not so STEMI, Not so blocked Artery).
What are some Signs & Symptoms of MI?
Classic Symptoms
- Crushing viselike chest pain radiating to arm, shoulders, neck, and back
- Shortness of breath
- Dizziness
- Nausea
- Vomiting
- Sweating
Atypical Symptoms
- No chest pain
- Fatigue
- Cramping in the chest
- Anxiety
- Feeling of impending doom
- Falling
Symptoms Found Mostly in Women
- Epigastric or Abdominal pain
- Chest discomfort, pressure, or burning
- Arm, shoulder, neck, jaw, or back pain
- Discomfort or pain between shoulder blades
- Fatigue
- Ingestion or gas pains
- Nausea or vomiting
Symptoms Usually Found in Older Adults
- Sudden shortness of breath, fainting, restlessness, or fall.
- Older Adults may experience Atypical symptoms and have fewer MI complications because they have more time to develop collateral circulation, especially those over 85
- Reperfusion Therapies and Bypass surgeries are more effective on older adults.
What is the goal time to increase circulation to the heart after the patient comes to the emergency department?
90 minutes or less, PT should chew on an uncoated aspirin tab during the onset of pain which should be reported within 5 minutes if unrelieved.
SATA What are the Therapeutic Intervention for someone with an MI?
- Oxygen
- Meds (ACE Inhibitors, Anticoagulants, Antiarthymics, Antiplatelet (e.g. aspirin), Morphine, Nitrates, Statins, Thrombolytics, Vasodilators,
- Purcuntaneous Vasodilators and Stents
- Myocardial Revascularization (coronary artery bypass grafting)
- Daily Weight
- Bedrest
- Low sodium diet/ no caffeine
- Cardiac rehabilitation
- All of the above
Answer: 9 All of the above
Which of these or symptoms of hypokalemia?
- weak irregular thready pulse
- bounding pulse
- lack of vitamin C
- vitamin D deficiency
Answer: 1 described on page 355
SATA A patient is experiencing Hyperkalemia what symptoms may be shown by this PT?
- varicose veins
- edema
- muscle twitches and cramps
- muscle weakness
- fast bounding heart rate
- low BP
- heavy breathing
Answer: 3,4,6
Normal Symptoms include muscle twitches and cramps, muscular weakness, irregular heart rate, weak pulse, low BP. see page 355
Is eating and drinking fluids encouraged after a cardiac catheter procedure?
Yes, this helps eliminate the dye from the body
