Exam 2: NR 324 / NR324 (2026–2027 UPDATED) Adult Health I | Verified Question & Answer | 100% Accurate Solutions | Guaranteed Grade A – Chamberlain

Exam 2: NR 324 / NR324 (2026–2027 UPDATED) Adult Health I | Verified Question & Answer | 100% Accurate Solutions | Guaranteed Grade A – Chamberlain Q. What is stroke volume ANSWER Amount of blood ejected with each heart beat Q. What is cardiac output ANSWER Amount of blood pumped by each ventricle in 1 minute Normal 4-8 L/min Cardiac index CO divided by body surface area Normal 2.8-4.2 L/min/m2 Q. What regulates the cardiovascular ssytem ANSWER Autonomic nervous system, Baroreceptors, chemoreceptors Q. What are the Gerontological Consideration ANSWER Risk for cardiovascular disease (CVD) increases with age. CVD leading cause of death in adults 85 Q. What are some age related changes ANSWER Increased collagen, decreased elastin Decreased response to stress Heart valves become thick and stiff. Number of pacemaker cells decrease. Decreased number and function of β-adrenergic receptors Blood vessels thicken and less elastic Increase in SBP and decrease or no change in DBP Incompetent venous valves Orthostatic hypotension Postprandial hypotension Q. What are some subjective data for cardiovascular system ANSWER History of present illness Past health history Past and current medications Surgery or other treatments Q. What are some objective data for cardiovascular system ANSWER Vital signs Peripheral vascular system Inspection Palpation Auscultation Q. When taking orthrostatic BP you should never ANSWER have a difference of 20 mm Example ( laying 120/80, sitting 160/100 ) Q. What is BMP ANSWER ( B-type natriuretic peptide) will be increased in there is heart failure Q. What are the cholesterol level ANSWER Total cholesterol 200 LDL- (bad) 130 HDL-( happy ) 40 Q. What are the nursing responsibility for cardiac cath ANSWER check site, lay flat, log roll, check pulses, Bed rest for 2 hours Q. How much sodium should a cardio patient get in 24 hours ANSWER 2300 grams Q. What are the cardiac biomarkers ( troponin) ANSWER Troponin T (cTnT) Troponin I (cTnI) Rises within 4-6 hours, peaks 10-24 hours, detected for up to 10-14 days Q. What are the cardiac biomarkers ( creatine kinase ( CK) ANSWER Three isoenzymes CK-MB cardiac specific Rises in 3-6 hours, peaks in 12-24 hours, returns to baseline within 12-48 hours Q. Cardiac catheterization ANSWER Right-sided to measure pressures Left-sided to evaluate coronary arteries Q. How do the Baroreceptors Factors Influencing BP ANSWER Sensitive to stretching Send impulses to sympathetic vasomotor center Q. Blood pressure (BP) ANSWER the force exerted by the blood against the walls of the blood vessel, is primarily a function of cardiac output (CO) and systemic vascular resistance. Q. What is the Systolic BP ANSWER the force exerted by the blood against the walls of the blood vessel Q. What is the Diastolic BP ANSWER pressure in the arterial system during ventricular filling Q. What is a normal BP ANSWER 120 /80 Q. What is prehypertension ANSWER 120/139/80-89 Q. What is hypertension stage 1 ANSWER 140-149/90-99 Q. What is hypertension stage 2 ANSWER 160/100 Q. What are the sign and symptoms of Hypertension ANSWER "Silent killer", Often asymptomatic S/S reflect effects on target organs/tissues Fatigue , Activity intolerance, Dizziness, Palpitations, Angina Dyspnea Q. What kind of studies are done for hypertension ANSWER Urinalysis, BUN and serum creatinine, Creatinine clearance Serum electrolytes, glucose, Serum lipid profile, Uric acid levels, ECG, Echocardiogram Q. What does MAP mean ANSWER it is the average pressure in the arterial system if the mean 60mm HG for adequate tissue prefusion Q. Primary (essential or idiopathic) hypertension ANSWER elevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension. Q. Secondary hypertension ANSWER elevated BP with a specific cause that often can be identified and corrected. relates to a underlying cause Q. What is Coronary artery disease ANSWER a type of blood vessel disorder that is included in the general category of atherosclerosis Q. What are the clinical manifestation of a hypertension crisis ANSWER Hypertensive encephalopathy, Headache, n/v, seizures, confusion, coma, Renal insufficiency Cardiac decompensation, MI, HF, pulmonary edema Aortic dissection Q. What are the nursing /collaborative management for hypertension crisis ANSWER Hospitalization, IV drug therapy: titrated to MAP Monitor cardiac and renal function, Neurologic checks Determine cause, Education to avoid future crisis Q. What is a Hypertensive crisis ANSWER term used to indicate either a hypertensive urgency or emergency, develops over hours or days and BP is severely elevated 220-140 Q. What is a Hypertensive urgency ANSWER develops over days to weeks. This is a situation in which a patient's BP is severely elevated (usually above 180/110 mm Hg) but there is no clinical evidence of target organ disease. Q. What is Atherosclerosis ANSWER major cause of CAD - lipids within the artery. C-reactive protein is produced by the liver and is a nonspecific marker of inflammation and can be increased in patients with CAD. Define Hypertension a persistent systolic BP (SBP) ≥140 mm Hg, diastolic BP (DBP) ≥90 mm Hg, or current use of antihypertensive drug. Define prehypertension Systolic BP: 120 to 139 mm Hg Diastolic BP: 80 to 89 mm Hg What is Primary (essential or idiopathic) hypertension is an elevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension. What are some contributing factors for hypertension increased SNS activity, overproduction of sodium-retaining hormones and vasoconstricting substances, increased sodium intake, greater than ideal body weight, diabetes mellitus, tobacco use, and excessive alcohol consumption What are the risk factors for primary hypertension Age, Alcohol, Tobacco use, Diabetes mellitus, Elevated serum lipids ,Excess dietary sodium, Gender, obesity, sedentary lifestyle What are the clinical manifestation of hypertension Fatigue, Dizziness, Palpitations, Angina, Dyspnea What are some complication of Hypertension are target organ diseases occurring in the heart (hypertensive heart disease), brain (cerebrovascular disease), peripheral vessels (peripheral vascular disease), kidneys (nephrosclerosis), and eyes (retinal damage). What are some Collaborative Care for hypertension Control blood pressure Reduce CVD risk factors and target organ disease Lifestyle modifications, directed toward reducing the patient's BP and overall cardiovascular risk, are indicated for all patients with prehypertension and hypertension. What drug therapy and patient teaching can you do Follow-up care Identify, report, and minimize side effects Orthostatic hypotension Sexual dysfunction Dry mouth Frequent urination Time of day to take drug What are some nursing Nursing Implementation Primary prevention via lifestyle modification Individual patient evaluation and education Screening programs Cardiovascular risk factor modification Coronary artery disease (CAD) is the most common type of cardiovascular disease and accounts for the majority of these deaths. What is atherosclerosis comes from two Greek words: athere, meaning "fatty mush," and skleros, meaning "hard." This combination indicates that atherosclerosis begins as soft deposits of fat that harden with age. C-reactive protein (CRP), a protein produced by the liver, is a nonspecific marker of inflammation. Chronic elevations of CRP are associated with unstable plaques and the oxidation of low-density lipoprotein (LDL) cholesterol, further contributing to atherosclerosis. The incidence of CAD and MI is highest among white, middle-aged men What are the Modifiable risk factors for CAD include elevated serum lipids, elevated blood pressure, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states, and elevated homocysteine level. Elevated Serum Lipids is one of the four most firmly established risk factors for CAD What is the second most modifiable risk factors in CAD Hypertension Management of High-Risk Persons Recommend preventive measures for all persons at risk for CAD. Risk factors such as age, gender, ethnicity, and genetic inheritance cannot be modified. Collaborative and Nursing Management: CAD ( nutrition) ↓ Saturated fats and cholesterol ↑ Complex carbohydrates and fiber ↓ Red meat, egg yolks, whole milk ↑Omega-3 fatty acids The incidence of cardiac disease is greatly increased in older adults and is the leading cause of death in older persons. myocardial ischemia the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen Angina, or chest pain, is the clinical manifestation of reversible myocardial ischemia. Either an increased demand for oxygen or a decreased supply of oxygen can lead to myocardial ischemia. Angina is rarely sharp or stabbing, and it usually does not change with position or breathing. What are the Clinical Manifestations of CAD Angina Pain Pressure/ache Indigestion or burning Squeezing, heavy, choking, or suffocating sensation can radiate to shoulder, down the arm , jaw, neck What are the Clinical Manifestations of CAD ( Chronic Stable Angina) refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms. only last 5-15 min What is Silent ischemia ischemia that occurs in the absence of any subjective symptoms. Patients with diabetes have an increased prevalence of silent ischemia because of nerve damage Nocturnal angina Occurs only at night but not necessarily during sleep Angina decubitus Chest pain that occurs only while lying down Relieved by standing or sitting Chronic Stable Angina Collaborative Care Goal: ↓ O2 demand and/or ↑ O2 supply Short-acting nitrates Dilate peripheral and coronary blood vessels Give sublingually (tablet) or by spray If no relief in 5 minutes, call EMS; if some relief ,repeat every 5 minutes for maximum 3 doses Patient teaching Can use prophylactically Long-acting nitrates To reduce angina incidence Main side effects: headache, orthostatic hypotension Methods of administration Oral Nitroglycerin (NTG) ointment Transdermal controlled-release NTG Patient with chronic stable angina with a high or low risk CAD need to take a ACE inhibitors , These drugs result in vasodilation and reduced blood volume It is recommended that patients with left ventricular dysfunction, elevated BP, or who have had an MI start and continue β-adrenergic blockers indefinitely, These drugs decrease myocardial contractility, HR, SVR, and BP, all of which reduce the myocardial oxygen demand. What kind of test do you do on a patient with a history of CAD Chest x-ray, Laboratory studies, 12-lead ECG, Calcium-score screening heart scan, Echocardiogram , Exercise stress test Pharmacologic nuclear imaging What is a stent is an expandable meshlike structure designed to keep the vessel open by compressing the arterial wall. What is a STEMI total occlusion of coronary artery What is a non -STEMI partial occlusion of coronary artery- What does ACS mean Acute Coronary Syndrome What is ACS associated with deterioration of a once stable atherosclerotic plaque. The once stable plaque ruptures, exposing the intima to blood and stimulating platelet aggregation and local vasoconstriction with thrombus formation. This unstable lesion may be partially occluded by a thrombus NSTEMI) or totally occluded by a thrombus STEMI). Unstable angina is chest pain that is new in onset, occurs at rest, or has a worsening pattern. The patient with chronic stable angina may develop UA( unstable angina), or UA may be the first clinical sign of CAD. UA is unpredictable and is an emergency How does a myocardial infarction (MI) occur because of sustained ischemia, causing irreversible myocardial cell death (necrosis). Explain how a MI occurs Result of sustained ischemia (20 minutes), causing irreversible myocardial cell death (necrosis) 80%-90% secondary to thrombus Ischemia starts in subendocardium Necrosis of entire thickness of myocardium takes 4 to 6 hours Loss of contractile function What are the sign and symptoms of ACS Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration Heaviness, pressure, tightness, burning, constriction, crushing, Substernal, retrosternal, epigastric, Common locations: substernal, retrosternal, or epigastric areas; pain may radiate to neck, jaw, arms, More common in AM, Atypical in women, elderly No pain if cardiac neuropathy (diabetes) What is the initial phase of MI Catecholamine release - stimulation of SNS Release of glycogen, Diaphoresis Vasoconstriction of peripheral blood vessels Skin: ashen, clammy, and/or cool to touch What is the most common complication of MI Dysrhythmias, Present in 80% of MI patients Can be caused by ischemia, electrolyte imbalances, or SNS stimulation, Life-threatening dysrhythmias seen most often with anterior MI, heart failure, or shock Complication of Mycocardial infarction Heart failure, Occurs when the pumping power of the heart is reduce , can be subtle or severe Cardiogenic shock occurs when oxygen and nutrients supplied to the tissues are inadequate because of severe left ventricular failure. Has high mortality rate Serum cardiac markers are proteins released into the blood from necrotic heart muscle after an MI. Very important in the dx of MI Cardiac-specific troponin cardiac-specific troponin T (cTnT) , cardiac-specific troponin I (cTnI). markers are highly specific indicators of MI specificity for myocardial injury , increase 4 to 6 hours after the onset of MI, peak at 10 to 24 hours, and return to baseline over 10 to 14 days What are the collaborative care Acute Coronary Syndrome Initial interventions,12-lead ECG,Semi-fowler's position Oxygen,IV access ,Nitroglycerin (SL) and ASA (chewable) Morphine ( MONA) Treat dysrhythmias, Frequent vital sign monitoring Nursing Management Chronic Stable Angina and (ACS) CAD/chest pain/angina/ MI Valve disease Heart failure/cardiomyopathy, Hypertension, diabetes, anemia, lung disease, hyperlipidemia, Drugs, History of present illness What are the Nursing management for ACS Pain: nitroglycerin, morphine, oxygen Continuous monitoring ECG ST segment Heart and breath sounds VS, pulse oximetry, I&O Rest and comfort Balance rest and activity Begin cardiac rehabilitation What are the n nursing management for ACS Evaluation Stable vital signs Relief of pain Decreased anxiety Realistic program of activity Effective management of therapeutic regimen What is heart failure An abnormal clinical syndrome involving inadequate cardiac pumping/filling Insufficient blood supply/oxygen to tissues Used to be called congestive heart failure (CHF) Heart failure is associated with numerous types of cardiovascular diseases, particularly long-standing hypertension, coronary artery disease (CAD), and myocardial infarction (MI). What are the primary risk factors for Heart Failure Hypertension CAD What are the contributing factors in Heart Failure Advanced age, Diabetes, Tobacco use, Obesity High serum cholesterol What are the primary causes of Heart Failure Coronary artery disease, including myocardial infarction Hypertension, including hypertensive crisis Rheumatic heart disease Congenital heart defects (e.g., ventricular septal defect) Pulmonary hypertension Cardiomyopathy (e.g., viral, postpartum, substance abuse) Hyperthyroidism Valvular disorders (e.g., mitral stenosis) Myocarditis What does cardiac output (CO) depend on 1) preload, (2) afterload, (3) myocardial contractility, and (4) heart rate (HR). What are the two classification of Heart Failure Systolic versus diastolic Left-sided versus right-sided Pathophysiology of Systolic HF Inability to pump blood forward Caused by Impaired contractile function (MI) Increased after-load ( hypertension) Cardiomyopathy ( Valvular heat disease) Mechanical abnormalities ( Valvular heat disease) Decreased left ventricular ejection fraction (EF, amount of blood ejected from the LV with each contraction) Pathophysiology of Diastolic HF Impaired ability of the ventricles to relax and fill during diastole, resulting in decreased stroke volume and CO Heart failure with normal EF Result of left ventricular hypertrophy from hypertension, (Most common) MI, valve disease, or cardiomyopathy What are the Etiology and Pathophysiology of Coronary Artery Disease Atherosclerosis is the major cause of CAD. It is characterized by deposits of lipids within the intima of the artery. Endothelial injury and inflammation play a central role in the development of atherosclerosis. What are the complication of Coronary Artery Disease (Peripheral Vascular Disease (PVD) ) HTN speeds up atherosclerosis,Intermittent claudication Muscle pain during activity, relieved by rest Caused by ischemia What are the complication of Coronary Artery Disease (Nephrolsclerosis) Reduced blood flow to kidneys 2° to reduced vessels lumen. Decreased perfusion leading to end-stage renal disease What are the most common complications of hypertension target organ diseases occurring in the heart (hypertensive heart disease), brain (cerebrovascular disease), peripheral vessels (peripheral vascular disease), kidneys (nephrosclerosis), and eyes (retinal damage). What is collateral circulation With the gradual increase in the size of lesions the body creates new pathways for the blood Very slow process Physiological response to ischemia Does not fully replace lost volume What are some nonmodifiable CAD risk factors Age, Gender, (Males females), Ethnicity, (Whites African Americans), Genetic Predisposition What are some modifiable CAD risk factors Hyperlipidemia, HTN, DM, Smoking, Physical inactivity, Obesity What are the manifestation of CAD ( Chronic Stable Angina) Chest pain noted on exertion or with any activity that causes myocardial O2 demand. Due to CAD blood vessel cannot meet the demand. Pain that generally lasts less than 5 minutes. Pain resolves when Precipitating factor is removed What are the Diagnostic Tests test that can be done for CAD History and Physical examination Bilateral BP measurements Ensure appropriate cuff is used, take minimum of 2 readings Lab studies, UA, creatinine clearance, Electrolytes, BUN, glucose, creatinine,ECG, Echocardiogram What is the Collaborative and Nursing Management: CAD Lipid-lowering drug therapy, Fibric acid derivatives (Lopid) Decrease triglycerides and increase HDL, GI side effects Antiplatelet therapy , ASA, Clopidogrel (Plavix) What are the Clinical Manifestations of ACS Unstable Angina New in onset, Occurs at rest, Worsening pattern, Increase in frequency, Unpredictable, Medical emergency, Symptoms in women may be more vague . UA is unpredictable and is an emergency. What is the immediate treatment of MI M: Morphine O: oxygen N: Nitroglycerin A: ASA or Plavix What is Heart Failure An abnormal clinical syndrome involving inadequate cardiac pumping/filling Insufficient blood supply/oxygen to tissues Used to be called congestive heart failure (CHF) What are the Contributing risk factors in Heat Failure Advanced age, Diabetes, Tobacco use, Obesity, High serum cholesterol What is Systolic Failure Heart Failure LV unable to contract properly due to cardiomyopathy or necrotic tissue Increased afterload Hallmark will be decreased ejection fraction (EF) EF = percentage of end diastolic blood volume that is ejected during systole Normal for adult is 55-70% What is Diastolic Failure Heart Failure Decreased ability of ventricles to relax and allow filling Leads to decreased stroke volume/CO High filling pressure 2° to non compliant ventricles What is Left side Heart Failure losess the ability to pump , move o2 from the lungs to LA and than to LV to the heart this this the larger chamber What are the symptoms of L sided Heart failure pulmonary edema( crackles) Dyspnea Frothy pink tinged sputum S3 S4heart sounds What is R sided Heart failure RV heart failure happens as a result of L side failure. when LV fails increased fluid pressure transfer back through the lungs - damaging the heart r side. blood back up into the veins and swelling , congestion in legs, abdomen, GI tract and liver occur What are the symptoms of R sided Heart failure edema in legs and ankles, pulmonary edema, JVD, weight gain, What are the clinical manifestation of Heart Failure Dependent on age, underlying type and extent of heart disease, and which ventricle is affected FACES Fatigue Limitation of Activities Chest congestion/cough Edema Shortness of breath What should normal BP look like? 120/80 What should elevated BP look like? 120-129/80 What does Hypertension, stage 1 look like? 130-139/80-89 What does Hypertension, stage 2 look like? ≥140/≥90 What are risk factors for primary hypertension? Age, Alcohol, Tobacco Use, Diabetes Mellitus, Elevated serum lipids, Excess dietary sodium, Gender, Family History, Obesity, Ethnicity, Sedentary Lifestyle, Socioeconomic status, Stress Symptoms of Severe hypertension? fatigue, dizziness, palpitations, angina, dyspnea Diagnostic studies for Hypertension U/A, BMP, CBC, serum lipid profile, uric acid, ECG, ophthalmic exam gold standard: Blood pressure checks What are some drug therapy for Hypertension? Adrenergic inhibiting agents, ACE inhibitors, A-II receptor blockers, CCBs, diuretics, vasodilators What are some common side effects of drug therapy for hypertension? Orthostatic hypotension, sexual problems, dry mouth, frequent vomiting What are some lifestyle modifications for hypertension? Avoid tobacco products (Nicotine causes vasoconstriction and elevated BP) -Moderation of Alcohol Intake (Men: 2 drinks/day; women: 1 drink/1 day) -Physical Activity ( Moderate intensity aerobic activity, at least 30 minutes, most (at least 5) days of the week for a goal of 150 minutes/week. Combine moderate and vigorous activities; age associated guidelines. Muscle-strengthening activities at least 2 times/wk. Flexibility and balance exercises 2 times/wk; especially older adults (decreased falls) What is occurring in the heart ?during Left-sided HF? Inability of the LV to empty adequately during systole AND fill adequately during diastole. -Blood backs up into the left atrium What is the most common form of Heart Failure? Left sided HF stroke volume x heart rate=? Cardiac output What occurs to the heart during Right-Sided Heart failure? RV fails to pump effectively, fluid backs up into venous system, fluid moves into tissues and organs, Left-sided HF is the MOST COMMON CAUSE. What is normal EF? 50%-70%, in HF, 5% What lab ranges in lipid panel are risk factors for CAD? Cholesterol 200 or fasting triglyceride level of 150. What are optimal levels of LDL? 100 Moderate risk for CAD for LDL is? 130-159 High risk for LDL is? 160 HDL for men should be? 40 mg/dL HDL for women should be? 50 mg/dL What are some medications used to treat CAD or those at risk for it? anti-platelet therapy, (aspirin), clopidegril, lifestyle changes, lipid lowering drugs (statins) What happens during an echocardiogram? Patient lays supine and rolls over to their left. Ultrasound is done in heart to see the blood flow, EF is measured. What meds are used to treat Chronic Stable Angina? Aspirin, Short-acting nitrates, Sublingual nitroglycerin Long-acting nitrates, Ace inhibitors, ARBs, B-blockers, CCBs, Lipid lowering drugs. What are some adverse effects of nitroglycerin? Headache, dizziness, flushing, ortho hypotension What is the most important patient teaching for nitroglycerin? Proper use and storage (discard tablets after 6 months) Methods of administration for Nitroglycerin? Oral, Nitroglycerin (NTG) ointment What is the first choice of medication for chronic stable angina? Nitroglycerin tablets If not medically then PCI (coronary catheter) Then CABG Graft. What 2 conditions can be classified as Coronary Artery diseases? Chronic Stable Angina & Acute Coronary Syndrome. What conditions are classified as an Acute Coronary Syndrome? Unstable angina, Non-ST-segment-elevation MI, ST-segment-elevation MI. What is the result of Deterioration of once stable plaqueRupturePlatelet aggregationThrombus? Partial occlusion of coronary artery: NSTEMI OR Total occlusion of coronary artery: STEMI What is the main difference between a NSTEMI & STEMI MI? In STEMI, heart muscle is DYING. Blockage is emergent**really bad one. In NSTEMI, Inverted or depressed ST What cardiac enzymes are released by muscle when it is damaged? Troponin- released when cardiac muscle is dead. May show up 4-6 hrs later. Peak at 12-24 hrs then goes awaay What do you do if a patient is having a STEMI? Get them to Cardiac catheterization OR treat them with TPA, AKA clot busters. Who is MONA and what is she used for? When a patient is having a heart attack. MONA-she fineee Morphine Oxygen Nitro Aspirin What is the primary diagnostic tool for Unstable Angina and MI 12 Lead ECG If a patient is waiting to have a cardiac catheter and they are having a NSTEMI, what do you provide them in the meantime? Start them on Heparin AND Aspirin, if there's a clot we wanna keep it from getting worse. What requirements must a patient meet for thrombolytic therapy? 1. Chest pain must be less than 12 hours and 12 lead shows STEMI. 2. No absolute contraindications What is the antidote for Heparin protamine sulfate What is the antidote for thrombolytic therapy? None! can't reverse. What is happening during PAD. Not getting oxygenated blood to extremities. Walking up a hill will require more of a demand for oxygen in feet but legs will start aching because supply cannot meet the demand. Known as Intermittent claudication What are some assessment findings for PAD? Thin, shiny, and taut skin -Loss of hair on the lower legs -Diminished or absent pedal, popliteal, or femoral pulses -Pallor of foot with leg elevation. -Reactive hyperemia of foot with dependent position. What does prolonged ischemia in lower extremities lead to? Atrophy of skin & underlying muscles -Delayed healing -Wound infection -Tissue necrosis -Arterial ulcers (very round, defined) over bony prominences -Most serious: Nonhealing arterial ulcers and gangrene What are some diagnostics for PAD? Doppler ultrasound-segmental BP -Duplex imaging-bidirectional, color doppler -Ankle-brachial index (ABI) table 37.3 -Angiography nd magnetic resonance angiography, table 31.7 What is the best exercise for clients with PAD? Walking for 30-45 minutes daily a week for 3 times a week. If pain is felt, stop, sit and rest , let the demand go down. And walk a little more again. Goal is for tolerance to improve What medications should patients with PAD take? ACE inhibitors, Antiplatelet agents, meds for intermittent claudication What should patients avoid if they are taking ACE inhibitors and antiplatelet meds? OTC medications, herbal supplements, NSAIDS, anything with anticoagulants in them What is Hemophilia? A disorder in which blood doesn't clot normally. MISSING CLOTTING FACTORS What is thrombocytopenia? Platelet count less than 100,000 What is the normal range of ESR? 0-29 What is the normal range for PTT (Partial thromboplastin time)? 25-35 What is a teaching for a patient with a new prescription for an oral iron supplement? Increase fluid and dietary fiber, (orange juice increases absorption, black tarry stools is expected, What disease is associated with group A streptococcal pharyngitis? RHEUMATIC HEART DISEASE....caused by this bacteria. AKA strep throat. Patients with Rheum. heart disease bc of the scarring on the heart? Heart murmur, mitral stenosis, cardiac enlargement, s/s of HF. s/s of mono or polyarthritis How can patients manage Rheumatic heart disease? Early detection & treatment of group A streptococcal, antibiotics, NSAIDS, corticosteroids, rest, education, s/s of valvular disease. Where is the Mitral valve located? between LA and LV What is used to confirm diagnosis of MVP? Echocardiography What are the 3 main risk factors for VTE or DVT? 1. Venous stasis 2. Damage to endothelium 3. Hypercoagulability of the blood What are risk factors for VTE? Obese, pregnant, chronic HF or A-fib, traveling on long trips without exercise, prolonged surgery, prolonged immobility. damage to endothelium, chemotherapy, diabetes, sepsis, catheterization, trauma, burns. Also risk factors: Women who are childbearing age and take estrogen-based oral contraceptives, are postmenopausal and take oral hormone therapy, are over age 35, have family history of VTE. What does smoking do to the blood? Increases plasma fibrinogen, homocysteine levels and activates intrinsic coagulation pathway. If a DVT is occurring what is the issue with the lower extremities? Trouble getting blood back to the heart. What are 3 VTE measures? 1. Early and progressive mobilization 2. Graduated compression stockings 3. Intermittent pneumatic compression devices (IPCs) What is the drug therapy for patients with VTE? Anticoagulants 24 hrs after surgery -Short term: SQ heparin or LMWH. For a patient who has a condition that makes them immobile for a long time what kind of drug therapy are they on? Warfarin- antidote vitamin K, long term anticoagulant How much time does it take for warfarin to build up to a therapeutic level? 2 to 3 days What lab value is monitored in patients who are taking Warfarin (Coumadin)? INR, normal range is 0.8-1.2, INR should be high for a patient on Warfarin What food should patients taking warfarin avoid eating and why? Green leafy vegetables, because they are high in Vitamin K What type of care should a patient receive if they already have a DVT or a VTE? Continuous IV heparin; monitor aPTT. Physician may decide if patient is candidate for thrombolytic therapy (TPA, clot busters) indication: Patients with low risk of bleeding and acute, extensive, symptomatic, proximal VTE. Must have systemic anticoagulation, before, during, and after thrombolysis What is a problem that can develop as a patient is receiving IV heparin? Heparin induced thrombocytopenia (HIT) What is the antidote for enoxaparin? protamine sulfate If patient has a bleeding risk, what meds should he/she avoid? Anticoagulant therapy Will patients at low risk for VTE receive anticoagulants prophylactically? No What kind of patients should receive Unfractioned heparin (UH) or LMWH? Moderate or high risk for VTE What kind of medication is Xarelto and Eliquis? Anticoagulant (blood thinner ) What is INR? The amount of time it takes for the blood to clot. What should the INR range be for patients at risk for VTE? Maintain 2.0 to 3.0, continue taking for 3 months or more. What is recommended for an acute VTE? BED REST, bc the worry is the clot breaking off and turning into a pulmonary embolism. What are the Expected Outcomes/Evaluation? Minimal to no pain Intact skin Increased knowledge of disorder and treatment plan No signs of hemorrhage or occult bleeding. Who is most susceptible to iron deficiency anemia? 1. Very young 2. Poor diet 3. Women in reproductive years What are some etiology for iron deficiency anemia? Inadequate dietary intake -Malabsorption -Blood loss (provide isotonic fluids) -Hemolysis -Pregnancy Where is iron best absorbed? duodenum and proximal or 1st part of jejunum Considerations of Iron supplements Enteric coated or sustained release capsules do NOT work. Daily dosage should be 150 to 200 milligrams of elemental iron. Take is 3-4 times a day Iron solutions can stain the skin-Use separate needles to inject medication. Draw it up with one needle then take that needle off then put on a fresh needle to administer it. Use Z-track (pulling the skin) Have food high in iron to maximize absorption Routine screening to see H & H levels. Take with vitamin C-increases absorption. Take oral iron with a straw, brush teeth after administration. What kind of disorder is Sickle Cell Disease (SCD)? Autosomal recessive disorder, Abnormal hemoglobin (HgbS) causes the RBC to stiffen & elongate Which blood type is a universal donor? O negative Which blood type is a universal recipient AB positive