NRSG 533 MN adult Exam 3 Questions With All Correct Answers

NRSG 533 MN adult Exam 3 Questions With All Correct Answers BP - ANSWER- -affected by contractility, preload, and afterload (strongest variable) -Block angiotensin II - block vasoconstriction -Angiotensin II - potent vasoconstriction -epi - works on heart -No ripe- vasoconstriction of vascular system Primary hypertension - ANSWER- idiopathic, most common, no cause Secondary hypertension - ANSWER- has a specific cause that can be identified corrected When you think HTN think - ANSWER- ischemia HTN ischemia effects - ANSWER- -heart, brain, kidney, eyes, lungs # For HTN - ANSWER- -proxy of telling us how tight the pressure in vessel - blood moving through artery Higher BP means - ANSWER- less blood flow through arteries High BP is not symptomatic until - ANSWER- you hit the organ failure stage Normal BP - ANSWER- Systolic 120 and Diastolic 80 Elevated BP - ANSWER- S: 120-129 and D: 80 Stage 1 hypertension - ANSWER- S: 130-139 or D: 80-89 Stage 2 hypertension - ANSWER- S: greater than or equal to 140 or D: greater than or equal to 90 HTN emergency - ANSWER- 180/120 with end organ damage Treat with IV nitroprusside reduce by 25% in first hour HTN urgency - ANSWER- -no target organ damage -Treat with PO meds - clonidine -returns to their normal -reduce by 25% -don’t want to drop BP to fast, bc it can effect brain, pump loosen, pressure not enough profusion How to calculate MAP - ANSWER- MAP= 1/2SBP + 2/3DBP Calculating reducing MAP - ANSWER- MAP= 180, reduce by 25% =180 x .25 =45 New MAP = 135 HF symptoms don’t manifest - ANSWER- in heart but heart is main problem because its not putting out enough blood to maintain rest of body needs Why liver is not affected by HF - ANSWER- bc of hepatic circulation - blood flow from other places Kidneys and HF - ANSWER- -kidneys can compensate for a short period of time -Kidneys affect water retention due to lack of profusion -vasoconstriction - increase blood volume in body Left sided HF symptoms - ANSWER- -SOB -dyspnea -wheezing -moist cough -confusion -crackles in lungs Right sided HF symptoms - ANSWER- -peripheral edema, pitting -JVD (pulsating) -Liver tenderness - hepatomegaly -Anorexia - loss of appetite -weight gain (2/3 lbs per day or 5 lbs per week) Major causes of right sided heart failure - ANSWER- -smoking -COPD -enphazemia Systolic HF (contractility problem) - ANSWER- -HFref (reduced) -left sided -ejection fraction 40 % Causes of HFref - ANSWER- -ischemic CAD (70%) -dilated cardiomyopathy (30% familial) -Myocarditis - viral -valvular heart disease - aortic stenosis -Tachycardia - metabolic, thyroid -atrial fibrillation -Adriamycin for cancer treatment Diastolic heart failure (filling problem) - ANSWER- -HFpef (perserved) -left sided -EF WNL or 50% or higher Causes of HFpef - ANSWER- -aging -Thickening of heart muscle - HTN -diabetes -obesity -alcohol/substance abuse -viral -cardiomyopathy Diagnosis of HF - ANSWER- -CXR (cardiomegaly, pulmonary congestion), -BNP (brain natriuretic peptide) -echocardiogram Stage A HF treatment focuses on - ANSWER- -blocking conversion of angiotensin I to angiotensin II ( ACE Inhibitors) -block angiotensin II (ARBS) ACE inhibitor prototypes - ANSWER- -lisinopril -vasotec -altace -prinivil ACE inhibitor - ANSWER- -improves symptoms, exercise capacity, LVEF and electrolytes -recommended for all patients unless contraindicated ACEI side effects - ANSWER- -cough -hypotension -renal insufficiency -hyperkalemia ACEI morbidity and mortality - ANSWER- -remains high in HF patients who are just on ace inhibitor -up to 50 % will die if treated with ACEI alone Angiotensin II receptor blockers (ARBS) - ANSWER- -block angiotensin II outside the pathway influenced by ACEI potent vasodilator -valsartan reduced BP and systemic resistance in patients receiving ACEI further confirming that the addition of an ARB has addition effects