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Nurs 332 - Test #4

Nursing in Health & Illness I: Cardiology

Name the major contributing factors to heart failure. Advancing age, CAD, MI, arrhythmias, HTN (3X), Rheumatic heart disease, cardiomyopathy, valvular disorders, diabetes, obesity...
What are the three contributing factors of stoke volume or VS (hint: not talking HR or CO) Preload, afterload, and contractility.
What is preload? Volume of blood in the LV at the end of diastole (filling).
What is afterload? Resistance against which the ventricles pump (BP).
What is contractility? Force of myocardial contraction.
What is ejection fraction (EF), and it's normal value? % of blood ejected from LV; normal is 60-67 if healthy
What end-goal to all cardiac compensatory mechanisms have? Keep up O2 sats for all organs.
What are some S/S of hypoxia? Confused, restlessness, tachycardia, tachypnea, 
angina, cyanosis (late)
T/F: In populations over 55, HTN has > incidence in women? Ture. More common in men below 55.
What are the four non-modyfiable risk factors of HTN? Age, gender, family hx, ethnicity
What are the s/s of mild-moderate HTN? There are none.
What are the s/s of severe HTN? Fatigue, reduced activity tolerance, dizziness, palpitations, angina, dyspnea, *h/a, *nosebleeds (*very high BP > 190-200/120-ish)
What are complications of HTN? CAD, left ventricular hypertrophy, heart failure, CVD, PVD, nephrosclerosis, retinal damage
What are the three major physical problems associated with HTN? Renal failure, COPD, cardiac issues (valvular disorders)
What are some assessment clues that one may be at risk for severe HTN? Symptoms of severe HTN: H/A, nocturia, vision changes, edema, nosebleeds; stress levels, type A personality...like Liz.
What is the first step in tx of HTN? Modifiable risk factors...d/c smoking, fix diet, etc.
In HTN crisis, what range of diastolic pressure would one expect to see? >140 mm Hg
What are the S/S of HTN crisis? H/A, N, V, seizures, confusion. Tx: bring down BP SLOWLY.
What are the main causes of atherosclerosis? BP, genetics, high lipids, DM, smoking, stress
What are the risk factors for metabolic syndrome? Must have 3/5: Waist circ of 40/35", HTN, HDL of 40/50 or less, fasting BG>100, triglycerides >150
How do symptoms differ when a client is experiencing angina R/T drug abuse, vs. natural causes? Clients will likely have: sinus tacky, anxiety, and even coronary spasms (lead to damage)
What does PQRST stand for, r/t questioning a client c/o angina? P - precipitating events Q - quality of pain R - radiation S - severity T - timing
What is ACS (Acute Coronary Syndrome)? Acute coronary syndrome (ACS) refers to any group of symptoms attributed to obstruction of the coronary arteries
If a client comes in to the ED having c/o chest pain one exertion that ended up being relieved by rest, what would his tx plan likely look like? Stress test, taught to modify risk factors, may need angiography/stent/CABG or something...considered stable angina.
What are proper Rx's for a client Dx'd w/ stable angina? ASA (and/or coumadin), nitrates, ACE inhibitors, beta blockers
What do we use to tx MI? MONA: Morphine, oxygen, nitrates, and asprin
How do Troponin levels change post-MI, and at what times? Rises in 4-6 hours, peaks in 10-24, normalizes in 10-14 days
How do CK-MB levels change post-MI, and at what times? Rises at 6 hours, peaks at 18 hours, normalizes in 24-36 hours
What do clients headed for a PCI need? Nitro (watch BP, give tylenol for H/A), Morphine, REAL HEPARIN, tPA?
What is the main goal for a client post-MI? STOP NECROSIS OF CELLS
What are normal BUN and creatinine levels? BUN: 10-20, creatinine: 04. to 1.3-ish.
What preparations should be made pre-cath-lab PCI? NPO, EKG, leg prep, Ativan, consent, video, ask: allergies to iodine/shellfish, labs (renal-ridding of dye)
What percentage of arterial occlusion must be present to necessitate installment of a stent? 85%
What would a client take to prevent thrombosis associated w/new stent placement? Integrelin (eptifibatide)...NOT heparin, as post-tx will already have > aPPt
What are some post-PCI implications? Supine until aPPT <150 (1-2+ hours)
What are some possible post PCI meds? ASA, Plavix, Nitrates, beta-blockers (-olols), calcium channel blockers (diltiazem), and ACE inhibitors (-prils)
How do beta-blockers affect cardiac workload? Reduce contractility, HR, and after-load.
How does lasix affect cardiac workload? Reduction of pre-load
How do calcium channel blockers act to affect hemodynamics Reduce HR and contractility
How do ACE inhibitors act to affect hemodynamics? Reduces vasoconstriction
What are some reasons one may have chronic stable angina? Coronary spasms, prinzmetal's, or cocaine
What is the most serious complication of MI? Cardiogenic shock (85% mortality)
What are some common results of cardiogenic shock? Marked decrease in CO, loss of 45-50% of the myocardium,
What is the primary physiological goal when a client is in cardiogenic shock? Increase contractility and workload of the heart to maintain blood flow.
What are the S/S of cardiogenic shock? Decrease LOC, oliguria, hypoTN, cold/moist skin, metabolic acidosis, acute HF
What are complications of MI? Cardiogenic shock (worst), thromboembolism, ventricular rupture (least common), dysrhythmias (most common - 80%), pericarditis, valvular issues (rare)
What are the S/S of left-sided HF? Dyspnea, orthopnea, crackles, cough, increased HR, anxious
What are the S/S of right-sided HF? Increased CVP (s/b 2-8), edema, nocturia, SOB
How does one measure ejection fracture? Cardiac catheterization.
What sort of test will help rule out lung issues with a client the c/o SOB, increased WOB, and has crackles on auscultation? Brain naturetic peptide or bNP. S/B 5-450, but will typically be in 1000s in CHF.
Describe class I heart failure... No symptoms w/activity, client doesn't know.
Describe class II heart failure... Fatigue with exertion, maybe some angina if CAD is present.
Describe class III heart failure... Noticeable dyspnea, fatigue, palpitations w/ activity
Describe class IV heart failure... Can't do shit w/o discomfort.
What are some complications of HF? Thank CLAP: Pleural effusion, hepatomegaly (liver), left ventricular thrombus (clot), arrhythmias
What kind of sodium intake would a nurse be recommending for a client with mild to severe CHF? 2g for mild; 500-1000mg severe
What kind of daily weight gain would a client with CHF need to report? >= 3lbs in one day
What are the S/S of heart failure? F - fatigue A - activity intolerance C - cough/congestion E - edema S - shortness of breath
If a client has all of the symptoms for MI, but cardiac markers show no elevation, what should be suspected? Aneurism
What are the S/S of acute arterial ischemia? Remember the P's: Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia.
What is the pharmacotherapy for Reynaud's? CCB
Created by: scottheadrick