NR 324 EXAM 2 2023 with 100% correct questions and answers

Risks for PAD Smoking Obesity Elevates cholesterol Ssx of PAD Intermittent claudication Pain with elevation Shiny skin/no hair Capillary refill 3 seconds No pulses Treatment of PAD Low cholesterol diet Plavix Walking Risks for PVD Smoking Obesity Family history High sodium diet Age FVE Ssx of PVD Ulceration Unhealed wounds Leathery skin Treatment of PVD Wound care Compression Elevation Risks for AFib Sleep apnea Family history Surgery MI, CAD, HF Ssx of Afib Dizziness Weakness Diaphoresis Pale Nausea Orthostatic hypotension Capillary refill 3sec Palpitations Treatment of AFib Anticoagulate Surgery Cardioversion Main concern with AFIB Stroke Diagnosis of Afib is made with ______ EKG Preload Volume of blood in the ventricles at the end of diastole Managing preload problems Decrease fluid Sodium restriction Diuresis Afterload Resistance/Tension left ventricle must overcome to circulate blood Non-modifiable risks of HTN Age Gender Race Genetics Modifiable risks of HTN Obesity Diet Smoking Lifestyle Recommended diet for HTN Low sodium (DASH) DASH diet High fruits/veggies Low sodium Low fat Includes: -whole grains -fish -poultry -beans -seeds -nuts -vegetable oils Limits: -sodium -sweets -sugary beverages -red meats Management of elevated BP Lower slowly First goal = 140/90 Angina Chest pain Cause of angina Plaque that is not completely blocking artery Risks for angina Age Gender Smoking Stress Obesity Poor diet Ssx of angina Better with rest/Nitro Does not occur when resting Not as intense as MI Lasts less than 15 minutes Risks of Acute Coronary Syndrome Family history Gender (male) Age Ethnicity Lifestyle HTN (control!) DM Stress Diet Ssx of ACS Chest pain Jaw pain Radiating pain Left arm pain Sweating Pain lasts longer than 15 minutes Excruciating pain unaffected by Nitro/rest Lab tests for ACS Troponin (elevated) Diagnostic tests for ACS EKG -Change in ST -STEMI (worse) vs Non-Stemi Stress test -If not acute Medications for ACS Aspirin Morphine Nitro Beta blockers ACE inhibitors Risks of ACS Renal failure Chest pain (post-procedure) Bleeding Risks for HF Uncontrolled HTN MI CAD Valvular disease Infection AFIb Prevention of HF Disease control No smoking Healthy diet Regular exercise Ssx of HF SOB Tachycardia Crackles (L side) Cough (L side) JVD Orthopnea Edema Weight gain Acities (R sided) Pink frothy sputum Fatigue Altered mental status Lab tests for HF BNP (elevated) BMP (K+, BUN/Creatine) Diagnostic testing HF Echocardiogram EKG Chest X-Ray Echocardiogram for HF - findings Ejection fraction 40% HF medications Diuretics (lasix) Potassium (unless renal failure) Oxygen Beta blockers ACE inhibitors Complications of HF Pulmonary edema Worsening HF Renal failure DVT High potassium foods Fruits: -Apricots -Avocado -Banana -Canteloupe -Dried fruit -Grapefruit juice -Honeydew -Orange/orange juice -Prunes -Raisins Veggies: -Baked/refried/back beans -Butternut squash -Broccoli, cooked -Carrots, raw -Greens (except kale) -Mushrooms, cannned -Potatoes, white/sweet -Spinach, cooked -Tomatoes/tomato products -Vegetable juices Others: -Bran/bran products -Chocolate -Granola -Milk -Nuts/seeds -Peanut butter -Salt-free broth -Yogurt Cardiac output The amount of blood ejected by the heart in 1 minute -Measured in liters -Determined by heart rate and stroke volume -Normally about 5L/min Stroke volume Volume of blood ejected during systole Concepts that effect perfusion Preload Contractility Afterload Heart rate Conditions with increased preload Hypervolemia Regurgitation of cardiac valves Heart failure Conditions with increased afterload Hypertension Vasoconstriction Factors that increase cardiac output Increased oxygen demand Increased contractility Medications Increased heart rate Factors that decrease cardiac output Irregular heart beat Pulmonary emboli Heart Failure High blood pressure Acute coronary syndrome High blood pressure Sign that the heart and blood vessels are being overworked May lead to atherosclerosis or CHF if untreated -Impaired central perfusion Impaired peripheral perfusion Vein disease vs arterial disease Risk factors for heart disease Type II diabetes Hypertension Abnormal blood lipid levels Tobacco Physical activity Obesity Diagnostic studies of the cardiovascular system EKG Chest X-ray Complications of hypertension TIA, Stroke Retinopathy Peripheral vascular disease Renal failure Left ventricular hypertrophy Coronary heart disease HF Hypertension nursing care D: Daily weight I: I&O U: Urine output R: Response of BP E: Electrolytes T: Take pulses I: Ischemic episodes (TIA) C: Complications of 4 C's (CAD, CRF, CHF, CVA) Hypertension medications Ace inhibitors B-blockers Calcium antagonists Ace inbitors -PRIL Ex: Captopril (capoten), Enalapril (vasotec), Benzapril (Lotensin) B-Blockers -OLOL Ex: Inderal Propranaolol, Tenormin Atenolol Calcium antagonists Calan isoptin (verapamil) Cardizem (diltiazem) Procardia (nifedlipine) Heart attack ssx in med and women Heavy chest pain Cold/sweaty Pain the neck or left arm Nausea Sudden onset of symptoms SOB More tired than usual Heart attack ssx in women Flu-like symptoms Feelings of indigestion or heartburn Symptoms for a number of days Heartburn Stable angina Fixed stenosis Stable fibrous plaque Clinical features of stable angina Demand-led ischemia Related to effort Predictable Symptoms over long term Stable angina risk assessment Symptoms on minimal exertion Exercise testing -duration of exercise -degree of ECG changes -abnormal BP response CT coronary angiogram Acute coronary symdrome Dynamic stenosis Ruptured or inflamed plaque Clinical features of ACS Supply-led ischemia Symptoms at rest Unpredictable Symptoms over short term Frequent or nocturnal symptoms ACS risk assessment ECG changes at rest ECG changes with symptoms Elevation of troponin Cardiac enzymes Troponin (MI, ACS) CK-MB CK total BNP (HF) BNP 100 No CHF BNP 100-500 Probable CHF BNP 500 Indicative of CHF LDL Normal = 130mg/dL HDL Normal = 45mg/dL ST-elevation heart attack STEMI -ST segment above baseline -Heart muscle damaged all the way through -Needs immediate attention Non ST-Elevation heart attack Less urgent Try morphine Echocardiogram Ultrasound of the heart Can be done by trained tech Shows valves, ejection fraction Ejection fraction How much blood is leaving left ventricle Normal = 55-70% Stress test Heart monitored during stress (tredmill) Looks for blockage via EKG changes -Stopped if chest pain or serious changes -Can be performed with IV meds -Avoid caffeine 6-8 hours before, okay to eat Angiogram Looking inside vessels -Lightly sedated -Cath through radial, femoral, or brachial artery + inject dye -Evaluate for blockage Post-angiogram care Lay flat, bed bound (use fraction pans) Check every 15 minutes (bleeding, pulses of LE) Education: signs of poor circulation, bleeding, other complications Assess for development of hematoma Post-stent placement chest pain Needs EKG, not normal Left sided heart failure -Lungs- Failure of heart to keep up with the necessary cardiac output Most common HF LHF ssx Paroxysmal nocturnal dyspnea Elevated pulmonary capillary wedge pressure Pulmonary congestion -cough -crackles -wheezes -blood-tinged sputum -tachypnea Restlessness Confusion Orthopnea Tachycardia Exertional dyspnea Fatigue Cyanosis Risk factors for LHF Hx of MI Hx of valve disorder Untreated FVE (preload) Untreated HTN (afterload) Diagnostic tests for LHF BNP (r/o COPD) Echocardiogram (EF 40%) Right sided HF Blood backs up to the body -Usually caused by LHF -Problem with preload RHF ssx Fatigue Increased peripheral venous pressure Ascities Enlarged liver/spleen Distended jugular veins Anorexia & c/o GI distress Weight gain (water retention) Dependent edema (worry about last) RHF nursing care Daily weights Lasix Low sodium diet Treating CHF U: Upright position N: Nitrates L: Lasix O: Oxygen A: Ace inhibitors D: Digoxin F: Fluids (decrease) A: Afterload (decrease) S: Sodium restriction T: Test dig level, ABG, K+ level Lasix Usually lasts about 6 hours Check K+ level Check creatinine (2 = bad) -Improved lung sounds/respiratory conditions = med working Signs of worsening HF F: Fatigue A: Activity intolerance C: Congestion E: Edema S: Shortness of breath Atrial Fibrillation Issue with electrical current (SA node vs ectopic sites) Atria quivers due to spastic electrical impulses (effects cardiac output) Does not always cause symptoms in older adults Biggest issue = risk for stroke Blood stagnates in atria forming blood clots Early signs of A-Fib Dizzy Pale Weak (early signs of decreased cardiac output) Risk factors for A-Fib Age Heart issues Cardiomyopathy Pericarditis OSA Aortic stenosis Narrowing of valves Stiffness of valves (heart pumps harder) Can be congenital Aortic stenosis ssx SOB Fatigue Dizziness Low pitch murmur Mitral regurgitation Floppy valves More common in women Mitral regurgitation treatment Valve replacement Mitral regurgitation ssx High pitch murmur SOB General weakness Infective endocarditis Infection of the heart valves in the endocardium Can be bacterial or fungal Happens with dental work Infective endocarditis ssx Aching Joint pain Fever Chest pain, leaning forward Risk factors for Infective endocarditis Immunocompromised Dental work Hx of heart surgery (stent) Diagnostic testing for Infective endocarditis Blood cultures Transesophageal echocardiogram Treatment of Infective endocarditis IV antibiotics Peripheral artery disease Affects blood flow to various limbs and extremities throughout the body Can lead to decreased feeling in extremities, heart disease and increase risk for infection Causes of PAD Narrowing vessels Diet Smoking Obesity Symptoms of PAD Numbness/tingling in arms, legs, hands, feet Leg cramping Weakness Cold limbs Intermittent claudication Shiny skin/no hair No pulses Pain with elevation Wounds that do not heal Venous insufficiency Problem with blood returning back to the heart -Valves stop working -Veins weaken/stretch with excess fluid Venous insufficiency ssx Twisty veins Leathery skin Non-healing wounds Risk factors for venous insufficiency Obesity Smoking Genetics High salt diet FVE -Symptoms best in morning and worsen throughout the day -May have wet socks Treatment of venous insufficiency Elevate legs Wound care Compression stockings Exercise Deep vein thrombosis Compare one side tot he other Risk for PE Prevention of DVT Ambulate SEDs Prophylactic warfarin, heparin, lovenox Tx of DVT Bed rest Heparin drip Dx of DVT Venous doppler US Risk factors for DVT Surgery Pregnancy AFib Venous insufficiency Immobility Symptoms of DVT Unilateral swelling Diminished pulses Pain/tenderness Heparin Interferes with activation of fibrin and fibrinogen from thrombin that keeps the clots from forming Does not break up a clot -Rapid acting -Given subcutaneously or IV -Dosed by pharmacy and given on pump (based on wt) -Check PTT and CBC (platelets) -Bleeding precautions Normal platelets 150,000 - 400,000 Patient education: Heparin Educate on signs of hematuria and blood in stools Warfarin sodium Coumadin Used to prevent clot formation with DVT, PE, A-Fib, TIA and coronary occlusive problems -Blocks vitamin K in blood to reduce clots -Effected by amount of dietary vitamin K (keep consistent) -Needs frequent PT-INR Normal PT-INR Between 2-3 Prothrombin time Amount of time it takes blood to clot PTT Heparin PT-INR Coumadin Normal bicarbonate level 22-26 mEq/L Normal Chloride level 96-106 mEq/L Normal phosphate level 2.4-4.4mg/dL Normal sodium level 135-145mEq/L Osmolarity Concentration of molecules per volume of solution Osmolality Concentration of molecules per weight of water -Preferred measure to evaluate concentration of plasma, urine, and body fluids Normal plasma osmolality 280-295mOsm/kg Plasma osmolality 295 high solute concentration, low water content -water deficit Plasma osmolality 275 Low solute concentration, high water content Water excess Osmolality of urine 100-1300 mOsm/kg Hydrostatic pressure Force of fluid in a compartment pushing against a cell membrane or vessel wall -Blood pressure -Major force that pushes water out of the vascular system and into interstitial space at the capillary level Elastic compression stockings Increase hydrostatic pressure causing shift of fluid into plasma BNP Produced by cardiomyoctes in response to increased atrial pressure and high serum sodium levels -Suppress secretion of aldosterone, renin, and ADH -Promote excretion of sodium and water Indications for CVADs Med administration -Cancer -Infection -Pain -Drugs at risk for causing phelbitis Nutritional replacement Blood samples Blood transfusions Renal failure Shock, burns Hemodynamic monitoring Heart failure Autoimmune disorders Disadvantages of CVADs Increased risk of systemic infection Invasive procedure Extravasation may occur if there is displacement or damage to the device Disadvantage of PICC lines Increased risk for DVT and phlebitis What causes the pain that occurs with myocardial ischemia? Lactic acid accumulation during anaerobic metabolism PR Interval Time of depolarization and repolarization of ventricles 0.12-0.20 seconds