week 12 alterations in cardiac function

Question 1

atherosclerosis

Answer 1

the abnormal accumulation of lipids and fibrous tissue in vessels

Question 2

coronary atherosclerosis

Answer 2

blockages and narrowing of coronary vessels reduce blood flow to the myocardium
CAD is caused by myocardial ischemia

Question 3

leading cause of death in US

Answer 3

heart disease

Question 4

most prevalent cardiovascular disease

Answer 4

CAD

Question 5

CAD s/s

Answer 5

angina pectoris
epigastric distress
radiating pain to jaw or left arm

Question 6

CAD risk factors

Answer 6

DM
peripheral arterial disease
HTN
smoking
elevated LDL
AAA

Question 7

CAD prevention

Answer 7

diet to control cholesterol, fat
exercise
smoking cessation
medication
disease mgmt (DM, HTN)

Question 8

cholesterol med groups

Answer 8

-statins
fibrates
resins (chole or cole)
absorption inhibitors (Zetia)
omega 3 (fish oil caps)

Question 9

angina pectoris

Answer 9

syndrome characterized by episodes of intense pain or pressure in anterior chest

caused by insufficient coronary blood flow
worsened by emotional stress or physical exertion

Question 10

stable angina

Answer 10

predictable, consistent
occurs with exertion
relieved by rest, NTG

Question 11

unstable angina

Answer 11

frequency and severity of sx increased

may not be relieved with rest, NTG

Question 12

intractable/refractory angina

Answer 12

severe incapacitating pain

Question 13

variant angina

Answer 13

pain at rest with reversible ST-segment elevation

caused by coronary artery vasospasm

Question 14

silent ischemia

Answer 14

objective evidence of ischemia but patient reports no pain

Question 15

angina assessment

Answer 15

tightness, choking, heavy sensation
frequently retrosternal, may radiate to neck, jaw, shoulders, back, arms (usually left)
anxiety accompanies pain
other sx: dyspnea, dizziness, n/v
subsides with rest, NTG

Question 16

angina medication

Answer 16

nitrates (ntg)
beta blockers (-olol)
calcium channel blockers (norvasc, cardizem)
antiplatelets: plavix
anticoags

Question 17

most common chronic disease among US adults

Answer 17

hypertension (HTN)

Question 18

hypertension increases risk for

Answer 18

premature death, disability
MI, CHF
stroke
CKD

Question 19

hypertension definition

Answer 19

systolic BP > 140
diastolic BP >90

based on 2+ accurate measurements taken 1-4 weeks apart

Question 20

primary/essential HTN

Answer 20

95% of HTN pts

no identifiable cause

Question 21

secondary HTN

Answer 21

5% of pts

associated with renal disease, sleep apnea, pregnancy

Question 22

symptoms of HTN

Answer 22

often asymptomatic (“silent killer”)

retinal/eye changes
renal damage
MI
cardiac hypertrophy
stroke

Question 23

HTN risk factors

Answer 23

smoking
obesity, sedentary lifestyle
DM
age
microalbuminuria or GFR < 60

Question 24

HTN assessment

Answer 24

retinal exam
12 lead EKG
labs

Question 25

HTN medical mgmt

Answer 25

maintain BP < 140/90 | in older adults BP < 150/90

Question 26

HTN lifestyle modifications

Answer 26

weight reduction DASH diet decrease sodium intake

Question 27

goals of HTN pharm therapy

Answer 27

decrease peripheral resistance decrease blood volume decrease rate/strength of myocardial contraction

Question 28

stage 1 HTN medication

Answer 28

african-americans, pts > 60 receive calcium channel blocker or thiazide diuretic non african-americans and pts < 60 get ACE-1 or ARB

Question 29

HTN gerontologic considerations

Answer 29

educate pt and family on medication routine, since it may be complex medication may be expensive try to treat with a single drug

Question 30

hypertensive emergency

Answer 30

BP > 180/120 | must be lowered immediately to prevent damage to target organs

Question 31

hypertensive urgency

Answer 31

BP elevated but no evidence of immediate or progressive target organ damage

Question 32

hypertensive emergency treatment

Answer 32

reduce BP 20-25% in first hour reduce to 160/100 within 6 hrs gradual reduction to normal within days IV vasodilators (sodium nitroprusside, enalaprilat, nitroglycerin)

Question 33

hypertensive urgency treatment

Answer 33

oral agents to normalize BP over 24-48 hrs beta blocker (labetalol) ACE inhibitor (captopril) alpha 2 agonist (clonidine)

Question 34

left sided heart failure

Answer 34

left side of the heart must work harder to pump the same amount of blood; failure to properly pump out blood to the body; often reduced ejection fraction

Question 35

right sided heart failure

Answer 35

when the left ventricle fails, increased fluid pressure is transferred back through the lungs, ultimately damaging the heart's right side the right side loses pumping power, blood backs up in the body's veins causing peripheral edema

Question 36

ejection fraction

Answer 36

percentage of how much blood the left ventricle pumps out with each contraction between 50-70% is normal measured by echocardiogram or MUGA

Question 37

The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema?

Answer 37

decreased left ventricular pumping when the demand on the heart increases, there is resistance to left ventricular filling and blood backs up into the pulmonary circulation; pulmonary edema quickly develops