lOMoARcPSD|17222949
Med Surg 2 Exam 1 Blueprint Answers
Medical-Surgical Nursing II (Herzing University)
Studocu is not sponsored or endorsed by any college or university
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Cardiomyopathy –Assessment NSG223 03.02.03
● begins with a detailed history of the presenting signs and symptoms
● nurse identifies possible cause factors (heavy alcohol intake, recent illness or pregnancy, or history of
the disease in immediate family members)
● If the patient reports chest pain, a thorough review of the pain, including its precipitating factors, is
warranted
● review of systems includes the presence of orthopnea, PND, and syncope or dyspnea with exertion
● number of pillows needed to sleep, usual weight, any weight change, and limitations on activities of
daily living are assessed
● patient's usual diet is evaluated to determine the need to reduce sodium intake, optimize nutrition, or
supplement with vitamins
● physical assessment focuses on signs and symptoms of heart failure
○ baseline assessment includes key components
■ Vital signs
■ Calculation of pulse pressure and identification of pulsus paradoxus
■ Current weight and any weight gain or loss
■ Detection by palpation of the point of maximal impulse, often shifted to the left
■ Cardiac auscultation for a systolic murmur and S3 and S4 heart sounds
■ Pulmonary auscultation for crackles
■ Measurement of jugular vein distention
■ Assessment of edema and its severity
Cardiomyopathy – Diagnostics NSG223 03.02.01
● Diagnosis is usually made from findings disclosed by the patient's history and by ruling out other
causes of heart failure such as myocardial infarction
● echocardiogram is one of the most helpful diagnostic tools
○ structure and function of the ventricles can be observed easily
● Cardiac MRI may be used, particularly to assist with the diagnosis of HCM
● ECG demonstrates dysrhythmias (atrial fibrillation, ventricular dysrhythmias) and changes consistent
with left ventricular hypertrophy (left axis deviation, wide QRS, ST changes, inverted T waves)
○ ARVC/D, there often is a small deflection, an epsilon wave, at the end of the QRS
● chest x-ray reveals heart enlargement and possibly pulmonary congestion
● Cardiac catheterization is sometimes used to rule out coronary artery disease as a causative factor
● Endomyocardial biopsy may be performed to analyze myocardial cells
Cardiomyopathy – Pharmacological mgt NSG223 03.02.04
● directed at controlling symptoms
Valvular Disorders – Manifestations NSG223 03.01.01
● Mitral Valve Prolapse
○ Most never have symptoms
○ fatigue
■ may occur regardless of activity level
and amount of rest or sleep
○ shortness of breath
■ not correlated with activity levels or pulmonary function
○ lightheadedness
○ dizziness
1
Downloaded by Nelson Awino ()
, lOMoARcPSD|17222949
○ syncope
○ palpitations
■ Atrial or ventricular dysrhythmias may produce the sensation of palpitations
■ have been reported while the heart has been beating normally
○ chest pain
■ not correlated with activity and may last for days
○ anxiety
■ may be a response to symptoms
■ some report anxiety as the only symptom
● Mitral Regurgitation
○ Chronic is often asymptomatic
○ acute (resulting from a myocardial infarction) usually manifests as severe congestive heart
failure
■ Dyspnea
■ fatigue
■ weakness
■ Palpitations
■ shortness of breath on exertion
■ cough from pulmonary congestion
● Mitral Stenosis
○ first symptom is often dyspnea on exertion (DOE) as a result of pulmonary venous hypertension
○ Symptoms usually develop after the valve opening is reduced by one third to one half its usual
size
○ may experience progressive fatigue and decreased exercise tolerance as a result of low cardiac
output
○ enlarged left atrium may create pressure on the left bronchial tree, resulting in a dry cough or
wheezing
○ may expectorate blood (hemoptysis) or experience palpitations, orthopnea, paroxysmal
nocturnal dyspnea (PND), and repeated respiratory infections
■ result of increased blood volume and pressure, the atrium dilates, hypertrophies, and
becomes electrically unstable (patients experience atrial dysrhythmias)
● Aortic Regurgitation
○ develops without symptoms in most
○ Some patients are aware of a forceful heartbeat, especially in the head or neck
○ Marked arterial pulsations visible or palpable at carotid or temporal arteries may be present due
to increased force and volume of blood ejected from a hypertrophied left ventricle
○ Exertional dyspnea and fatigue follow
○ Signs and symptoms of progressive left ventricular failure include breathing difficulties
(orthopnea and paroxysmal nocturnal dyspnea (PND))
● Aortic Stenosis
○ Many are asymptomatic
○ When symptoms develop, patients usually first have exertional dyspnea
■ caused by increased pulmonary venous pressure due to left ventricular failure
○ Orthopnea
○ paroxysmal nocturnal dyspnea (PND)
○ pulmonary edema
○ Reduced blood flow to the brain may cause dizziness and syncope
○ Angina pectoris is a frequent symptom
2
Downloaded by Nelson Awino ()
, lOMoARcPSD|17222949
■ results from increased oxygen demand of the hypertrophied left ventricle with decreased
blood supply due to decreased blood flow into the coronary arteries and decreased time
in diastole for myocardial perfusion
○ Blood pressure is usually normal but may be low
○ Pulse pressure may be low (30 mm Hg or less) due to diminished blood flow
Valvular Disorders – Medical mgt NSG223 03.03.01
● Mitral Valve Prolapse
○ directed at controlling symptoms
○ If dysrhythmias are documented and cause symptoms, patient is advised to eliminate caffeine
and alcohol from the diet and to stop the use of tobacco products
■ Most patients don’t require medication, but some are prescribed antiarrhythmic
medications
○ Prophylactic antibiotics are not recommended prior to dental or invasive procedures
○ Chest pain that doesn't respond to nitrates may respond to calcium channel blockers or beta-
blockers
○ Heart failure is treated the same as it would be for any other case of heart failure
○ severe mitral regurgitation and symptomatic heart failure may require mitral valve repair or
replacement
● Mitral Regurgitation
○ Management is the same as for heart failure
○ Patients with mitral regurgitation and heart failure benefit from afterload reduction (arterial
dilation) by treatment with
■ angiotensin-converting enzyme (ACE) inhibitors ex. captopril (Capoten), enalapril
(Vasotec), lisinopril (Prinivil, Zestril) or ramipril (Altace), or hydralazine (Apresoline)
■ angiotensin receptor blockers (ARBs) ex. losartan (Cozaar) or valsartan (Diovan)
■ beta-blockers ex. carvedilol (Coreg)
○ Once symptoms of heart failure develop, patient needs to restrict their activity level to minimize
symptoms
○ Symptoms are an indicator for surgical intervention by mitral valvuloplasty (surgical repair of the
valve) or valve replacement
● Mitral Stenosis
○ Patients may benefit from anticoagulants to decrease the risk of developing atrial thrombus
○ may require treatment for angina
○ If atrial fibrillation develops, cardioversion is attempted to restore normal sinus rhythm
■ unsuccessful, ventricular rate is controlled with beta-blockers, digoxin, or calcium
channel blockers
● patients require anticoagulation for thromboembolism prevention
○ Patients are advised to avoid strenuous activities, competitive sports, and pregnancy as they
increase heart rate
○ Surgical interventions
■ valvuloplasty, usually a commissurotomy to open or rupture the fused commissures of
the valve
■ Percutaneous transluminal valvuloplasty or valve replacement may be performed
● Aortic Regurgitation
○ symptomatic patient, or patients with decreased left ventricular function, is advised to avoid
physical exertion, competitive sports, and isometric exercise
■ should be instructed to restrict sodium intake to avoid volume overload
3
Downloaded by Nelson Awino ()
Med Surg 2 Exam 1 Blueprint Answers
Medical-Surgical Nursing II (Herzing University)
Studocu is not sponsored or endorsed by any college or university
Downloaded by Nelson Awino ()
, lOMoARcPSD|17222949
Cardiomyopathy –Assessment NSG223 03.02.03
● begins with a detailed history of the presenting signs and symptoms
● nurse identifies possible cause factors (heavy alcohol intake, recent illness or pregnancy, or history of
the disease in immediate family members)
● If the patient reports chest pain, a thorough review of the pain, including its precipitating factors, is
warranted
● review of systems includes the presence of orthopnea, PND, and syncope or dyspnea with exertion
● number of pillows needed to sleep, usual weight, any weight change, and limitations on activities of
daily living are assessed
● patient's usual diet is evaluated to determine the need to reduce sodium intake, optimize nutrition, or
supplement with vitamins
● physical assessment focuses on signs and symptoms of heart failure
○ baseline assessment includes key components
■ Vital signs
■ Calculation of pulse pressure and identification of pulsus paradoxus
■ Current weight and any weight gain or loss
■ Detection by palpation of the point of maximal impulse, often shifted to the left
■ Cardiac auscultation for a systolic murmur and S3 and S4 heart sounds
■ Pulmonary auscultation for crackles
■ Measurement of jugular vein distention
■ Assessment of edema and its severity
Cardiomyopathy – Diagnostics NSG223 03.02.01
● Diagnosis is usually made from findings disclosed by the patient's history and by ruling out other
causes of heart failure such as myocardial infarction
● echocardiogram is one of the most helpful diagnostic tools
○ structure and function of the ventricles can be observed easily
● Cardiac MRI may be used, particularly to assist with the diagnosis of HCM
● ECG demonstrates dysrhythmias (atrial fibrillation, ventricular dysrhythmias) and changes consistent
with left ventricular hypertrophy (left axis deviation, wide QRS, ST changes, inverted T waves)
○ ARVC/D, there often is a small deflection, an epsilon wave, at the end of the QRS
● chest x-ray reveals heart enlargement and possibly pulmonary congestion
● Cardiac catheterization is sometimes used to rule out coronary artery disease as a causative factor
● Endomyocardial biopsy may be performed to analyze myocardial cells
Cardiomyopathy – Pharmacological mgt NSG223 03.02.04
● directed at controlling symptoms
Valvular Disorders – Manifestations NSG223 03.01.01
● Mitral Valve Prolapse
○ Most never have symptoms
○ fatigue
■ may occur regardless of activity level
and amount of rest or sleep
○ shortness of breath
■ not correlated with activity levels or pulmonary function
○ lightheadedness
○ dizziness
1
Downloaded by Nelson Awino ()
, lOMoARcPSD|17222949
○ syncope
○ palpitations
■ Atrial or ventricular dysrhythmias may produce the sensation of palpitations
■ have been reported while the heart has been beating normally
○ chest pain
■ not correlated with activity and may last for days
○ anxiety
■ may be a response to symptoms
■ some report anxiety as the only symptom
● Mitral Regurgitation
○ Chronic is often asymptomatic
○ acute (resulting from a myocardial infarction) usually manifests as severe congestive heart
failure
■ Dyspnea
■ fatigue
■ weakness
■ Palpitations
■ shortness of breath on exertion
■ cough from pulmonary congestion
● Mitral Stenosis
○ first symptom is often dyspnea on exertion (DOE) as a result of pulmonary venous hypertension
○ Symptoms usually develop after the valve opening is reduced by one third to one half its usual
size
○ may experience progressive fatigue and decreased exercise tolerance as a result of low cardiac
output
○ enlarged left atrium may create pressure on the left bronchial tree, resulting in a dry cough or
wheezing
○ may expectorate blood (hemoptysis) or experience palpitations, orthopnea, paroxysmal
nocturnal dyspnea (PND), and repeated respiratory infections
■ result of increased blood volume and pressure, the atrium dilates, hypertrophies, and
becomes electrically unstable (patients experience atrial dysrhythmias)
● Aortic Regurgitation
○ develops without symptoms in most
○ Some patients are aware of a forceful heartbeat, especially in the head or neck
○ Marked arterial pulsations visible or palpable at carotid or temporal arteries may be present due
to increased force and volume of blood ejected from a hypertrophied left ventricle
○ Exertional dyspnea and fatigue follow
○ Signs and symptoms of progressive left ventricular failure include breathing difficulties
(orthopnea and paroxysmal nocturnal dyspnea (PND))
● Aortic Stenosis
○ Many are asymptomatic
○ When symptoms develop, patients usually first have exertional dyspnea
■ caused by increased pulmonary venous pressure due to left ventricular failure
○ Orthopnea
○ paroxysmal nocturnal dyspnea (PND)
○ pulmonary edema
○ Reduced blood flow to the brain may cause dizziness and syncope
○ Angina pectoris is a frequent symptom
2
Downloaded by Nelson Awino ()
, lOMoARcPSD|17222949
■ results from increased oxygen demand of the hypertrophied left ventricle with decreased
blood supply due to decreased blood flow into the coronary arteries and decreased time
in diastole for myocardial perfusion
○ Blood pressure is usually normal but may be low
○ Pulse pressure may be low (30 mm Hg or less) due to diminished blood flow
Valvular Disorders – Medical mgt NSG223 03.03.01
● Mitral Valve Prolapse
○ directed at controlling symptoms
○ If dysrhythmias are documented and cause symptoms, patient is advised to eliminate caffeine
and alcohol from the diet and to stop the use of tobacco products
■ Most patients don’t require medication, but some are prescribed antiarrhythmic
medications
○ Prophylactic antibiotics are not recommended prior to dental or invasive procedures
○ Chest pain that doesn't respond to nitrates may respond to calcium channel blockers or beta-
blockers
○ Heart failure is treated the same as it would be for any other case of heart failure
○ severe mitral regurgitation and symptomatic heart failure may require mitral valve repair or
replacement
● Mitral Regurgitation
○ Management is the same as for heart failure
○ Patients with mitral regurgitation and heart failure benefit from afterload reduction (arterial
dilation) by treatment with
■ angiotensin-converting enzyme (ACE) inhibitors ex. captopril (Capoten), enalapril
(Vasotec), lisinopril (Prinivil, Zestril) or ramipril (Altace), or hydralazine (Apresoline)
■ angiotensin receptor blockers (ARBs) ex. losartan (Cozaar) or valsartan (Diovan)
■ beta-blockers ex. carvedilol (Coreg)
○ Once symptoms of heart failure develop, patient needs to restrict their activity level to minimize
symptoms
○ Symptoms are an indicator for surgical intervention by mitral valvuloplasty (surgical repair of the
valve) or valve replacement
● Mitral Stenosis
○ Patients may benefit from anticoagulants to decrease the risk of developing atrial thrombus
○ may require treatment for angina
○ If atrial fibrillation develops, cardioversion is attempted to restore normal sinus rhythm
■ unsuccessful, ventricular rate is controlled with beta-blockers, digoxin, or calcium
channel blockers
● patients require anticoagulation for thromboembolism prevention
○ Patients are advised to avoid strenuous activities, competitive sports, and pregnancy as they
increase heart rate
○ Surgical interventions
■ valvuloplasty, usually a commissurotomy to open or rupture the fused commissures of
the valve
■ Percutaneous transluminal valvuloplasty or valve replacement may be performed
● Aortic Regurgitation
○ symptomatic patient, or patients with decreased left ventricular function, is advised to avoid
physical exertion, competitive sports, and isometric exercise
■ should be instructed to restrict sodium intake to avoid volume overload
3
Downloaded by Nelson Awino ()
