Nu 372 Final Exam With Correct Answers
h h h h h h hh
Anginah-hANSWERh-chesthpainhbroughthabouthbyh*myocardialhischemia*
*Manifestations:*
-*ChesthPain*:hsubsternal,hprecordial,hmayh*radiatehtohneck/arms/shouldershorhjaw*
-Usuallyhlastsh*2-5hminutes*
-Quality:htight,hsqueezing,hconstricting,hheavyhsensation,hburning,hdull,haching,hconstant
-
Dyspnea,hpallor,htachycardia,hanxietyhandhfear,hindigestion,hnausea,hvomiting,hupperhbackh
pain
-ECGhchanges:h*T-wavehinversionhandhdepressedhSThsegments*h(*invertedhT-
waveh=hmyocardialhischemia*)
*Treatment*:
-
*Nitroglycerin*:hgoalhishtohreducehoxygenhdemandhandhincreasedhoxygenhsupplyhtohthehmyo
cardium
-*Organichnitrates*:hshorthandhlong-
termhforms,husedhtohtreathacutehanginahattackshandhpreventhangina
*Nursinghinterventions*:
-knowhwhenhthehanginahishhappening
-decreasehdemandshofhO2hneededhonhthehheart
-increaseheffectivenesshofhmedication
-reducehanxiety
-patienthshouldh*stophallhactivityhandhsithandhrest*hinhbedh(*semi-fowlerhposition*)
-*administerhoxygen*h2hL/minhthroughhnasalhcannula
,-assesshpatientsh*pain,hvitalhsigns,hRR*
-*Tellhpatienthtohcarryhnitroglycerinhathallhtimes*
Stablehanginah-hANSWERh-Mosthcommonhtype
-Chesthpainhthathoccurshwhenhahpersonhish*activehorhunderhseverehstress*h(cold,hetc.)
-Usuallyh*subsideshwithhrest*
-*Treatment*:hnitrates,hreducinghstress/activity
*ClinicalhManifestations*:hanginahthathusuallyhoccurshwhenhworkhofhthehhearthincreasedhbyhph
ysicalhexertion:hphysicalhactivity,hemotion,hstress,heatinghahheavyhmeal,hexposurehtohcold
Unstablehanginah-hANSWERh-Anginahthathish*nothrelievedhwithhrest*
-Requiresh*medicalhintervention*
-Occurshwithh*increasedhfrequency,hseverity,handhduration*
-Painhoccurshwithhdecreasinghlevelhofhactivityhorhstress
-Mayhoccurhwhenhthehpatienthishjusthresting
-Patienthish*athriskhforhmyocardialhinfarction*h(MI)
*Clinicalhmanifestations*:
-*chesthpains*hduringhperiodshofhresthorhveryhlittlehactivity
Nitroglycerinh-hANSWERh*ShorthactinghsublingualhNitroglycerin*:
-Drughofhchoicehforhtreatinghacutehangina
-Takesheffecthinh*1-2hminutes*
-Decreaseshmyocardialhworkloadhandhoxygenhdemand
,-Makehsurehnohlesions/abrasionshunderhthehtonguehthathcouldheffecthabsorption
-*Dohnothswallow*:hcouldhcausehmedicinehtohlosehitsheffectivenesshifhithentershthehstomach
-
*1hsublingualhtablet*hdissolvedhunderhthehtonguehorhinhthehbuccalhpouchhashsoonhashanginahbe
gins.h*Repeatheveryh5hminutes*,hifhneeded,htohah*maximumhofhthreehdoses*hwithinha
15-
minutehperiod.hClienthmusth*callhforhmedicalhassistance*hifhanginahishnothrelievedhafterhthi
rdhdose
*LongerhactinghNitroglycerinhprep*:
-comeshinhanhoralhtablet,hointment,horhtransdermalhpatches
-usedhtoh*prevent*hanginahattacks—*NOThtohtreathacute*hattacks
-mainhproblemhish*developmenthofhtolerance*
-*nitratehfreehperiods*hcanhlimithtolerancehbyhschedulinghwithhahperiodhofh*8-10hhrs*hperhday
-scheduledhtohgiveh*athnight*hwhenhpatienthishlesshlikelyhtohexperiencehangina
*Transbuccalhadministration*:
-
Checkhthehinsidehofhthehpatientshcheekhtohmakehsurehtherehareh*nohulcerationshorhabr
asions*hthathcouldhinterferehwithhthehabsorptionhofhthehdrug
-Havehthehpatienth*placehbetweenhgumshandhcheek*huntilhfullhabsorbed
-Dohnothswallow
-*Rotatehfromhsidehtohsidehwithheachhdose*
*Transdermalhadministration*:
-discusshthehadministrationhwithhthehpatient
-
makehsurehthehpatienthknowshtoh*takehoffholdhtransdermalhpatcheshandhwashhthehareahbeforeh
replacinghahnewhone*htohpreventhseverehhypotension
-
, informhpatientshthaththeyhshouldh*labelhinhbighwritinghtheirhtubes*htohpreventhsomeoneh(orht
hemselves)hfromhusinghithashhandhlotionhwhichhwouldhcausehdrughtoxicity
h h h h h h hh
Anginah-hANSWERh-chesthpainhbroughthabouthbyh*myocardialhischemia*
*Manifestations:*
-*ChesthPain*:hsubsternal,hprecordial,hmayh*radiatehtohneck/arms/shouldershorhjaw*
-Usuallyhlastsh*2-5hminutes*
-Quality:htight,hsqueezing,hconstricting,hheavyhsensation,hburning,hdull,haching,hconstant
-
Dyspnea,hpallor,htachycardia,hanxietyhandhfear,hindigestion,hnausea,hvomiting,hupperhbackh
pain
-ECGhchanges:h*T-wavehinversionhandhdepressedhSThsegments*h(*invertedhT-
waveh=hmyocardialhischemia*)
*Treatment*:
-
*Nitroglycerin*:hgoalhishtohreducehoxygenhdemandhandhincreasedhoxygenhsupplyhtohthehmyo
cardium
-*Organichnitrates*:hshorthandhlong-
termhforms,husedhtohtreathacutehanginahattackshandhpreventhangina
*Nursinghinterventions*:
-knowhwhenhthehanginahishhappening
-decreasehdemandshofhO2hneededhonhthehheart
-increaseheffectivenesshofhmedication
-reducehanxiety
-patienthshouldh*stophallhactivityhandhsithandhrest*hinhbedh(*semi-fowlerhposition*)
-*administerhoxygen*h2hL/minhthroughhnasalhcannula
,-assesshpatientsh*pain,hvitalhsigns,hRR*
-*Tellhpatienthtohcarryhnitroglycerinhathallhtimes*
Stablehanginah-hANSWERh-Mosthcommonhtype
-Chesthpainhthathoccurshwhenhahpersonhish*activehorhunderhseverehstress*h(cold,hetc.)
-Usuallyh*subsideshwithhrest*
-*Treatment*:hnitrates,hreducinghstress/activity
*ClinicalhManifestations*:hanginahthathusuallyhoccurshwhenhworkhofhthehhearthincreasedhbyhph
ysicalhexertion:hphysicalhactivity,hemotion,hstress,heatinghahheavyhmeal,hexposurehtohcold
Unstablehanginah-hANSWERh-Anginahthathish*nothrelievedhwithhrest*
-Requiresh*medicalhintervention*
-Occurshwithh*increasedhfrequency,hseverity,handhduration*
-Painhoccurshwithhdecreasinghlevelhofhactivityhorhstress
-Mayhoccurhwhenhthehpatienthishjusthresting
-Patienthish*athriskhforhmyocardialhinfarction*h(MI)
*Clinicalhmanifestations*:
-*chesthpains*hduringhperiodshofhresthorhveryhlittlehactivity
Nitroglycerinh-hANSWERh*ShorthactinghsublingualhNitroglycerin*:
-Drughofhchoicehforhtreatinghacutehangina
-Takesheffecthinh*1-2hminutes*
-Decreaseshmyocardialhworkloadhandhoxygenhdemand
,-Makehsurehnohlesions/abrasionshunderhthehtonguehthathcouldheffecthabsorption
-*Dohnothswallow*:hcouldhcausehmedicinehtohlosehitsheffectivenesshifhithentershthehstomach
-
*1hsublingualhtablet*hdissolvedhunderhthehtonguehorhinhthehbuccalhpouchhashsoonhashanginahbe
gins.h*Repeatheveryh5hminutes*,hifhneeded,htohah*maximumhofhthreehdoses*hwithinha
15-
minutehperiod.hClienthmusth*callhforhmedicalhassistance*hifhanginahishnothrelievedhafterhthi
rdhdose
*LongerhactinghNitroglycerinhprep*:
-comeshinhanhoralhtablet,hointment,horhtransdermalhpatches
-usedhtoh*prevent*hanginahattacks—*NOThtohtreathacute*hattacks
-mainhproblemhish*developmenthofhtolerance*
-*nitratehfreehperiods*hcanhlimithtolerancehbyhschedulinghwithhahperiodhofh*8-10hhrs*hperhday
-scheduledhtohgiveh*athnight*hwhenhpatienthishlesshlikelyhtohexperiencehangina
*Transbuccalhadministration*:
-
Checkhthehinsidehofhthehpatientshcheekhtohmakehsurehtherehareh*nohulcerationshorhabr
asions*hthathcouldhinterferehwithhthehabsorptionhofhthehdrug
-Havehthehpatienth*placehbetweenhgumshandhcheek*huntilhfullhabsorbed
-Dohnothswallow
-*Rotatehfromhsidehtohsidehwithheachhdose*
*Transdermalhadministration*:
-discusshthehadministrationhwithhthehpatient
-
makehsurehthehpatienthknowshtoh*takehoffholdhtransdermalhpatcheshandhwashhthehareahbeforeh
replacinghahnewhone*htohpreventhseverehhypotension
-
, informhpatientshthaththeyhshouldh*labelhinhbighwritinghtheirhtubes*htohpreventhsomeoneh(orht
hemselves)hfromhusinghithashhandhlotionhwhichhwouldhcausehdrughtoxicity
