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68WM6 Ph 2 Test 4


What two things play an important role in regulating blood pressure? Blood Flow and Peripheral Vascular Resistance
Renin is released from the ________, whereas Angiotensin-Converting Enzyme (ACE) is released from the ________. Kidneys and Lungs
How does high blood pressure increase the workload of the heart? High blood pressure damages the arteries and causes an increased resistance of the arterioles to the flow of blood
In malignant hypertension, what physiological event is responsible for the damage to organs? Damage to the small arterioles.
Why does hypertension often go untreated? It is frequently asymptomatic until target organ damage begins
What antihypertensive medications are used in treating hypertension? ACE inhibitors, Calcium channel blocker, Diuretics, Beta-blockers, Angiotensin II Receptor Blockers, Alpha-Agonist
How long will a patient with primary hypertension that is prescribed drug therapy for the first time need to stay on the drug therapy? There is no cure for the disease, and treatment will be life long
When a patient is taking an adrenergic drug, the nurse should expect to observe what side effects? Increased heart rate is one of the effects of adrenergic drugs.
A patient who has just begun taking an ACE inhibitor telephones the nurse and reports feeling very dizzy when standing up and wonders if she should discontinue the medication. How should the nurse respond? Dizziness is a common initial side effect of this medication, which is usually transient. The patient should be instructed to rise from a lying position slowly to avoid orthostatic hypotension and avoid falling.
What nursing assessment confirms that the angiotensin II receptor antagonist a patient is taking is effective? Reduction of blood pressure. Angiotensin II receptor antagonists bind angiotensin II receptor sites in the vascular smooth muscle, brain, heart, kidneys, and adrenal gland and block blood pressure-elevating and sodium-retaining effects of angiotensin II.
Propranolol (Inderal), a beta adrenergic blocker, controls hypertension by? The beta-adrenergic blocking agents block beta receptor stimulation in the heart, which then inhibits cardiac response to sympathetic nerve stimulation. This will result in a decrease in heart rate, cardiac output, and blood pressure.
A client is taking amlodipine (Norvasc) for control of hypertension. The nurse would give the client what instructions about its use? Amlodipine and other calcium channel blockers may be taken without regard to food, although nifedipine needs to be taken on an empty stomach. Most calcium channel blockers are not to be taken with grapefruit juice.
A pt with a history of cardiac insufficiency complains of SOB. The nurse auscultates his lungs and notes bilateral crackles throughout both fields & bilateral +2 edema of lower extremities. The nurse anticipates his health care provider will prescribe? furosemide (Lasix) [Diuretics are the mainstays of treatment in heart failure and hypertension.]
The nurse places highest priority on attending to what adverse effects experienced by a client receiving nesiritide (Natrecor)? Among the most significant adverse effects of nesiritide are hypotension, ventricular dysrhythmias, and renal insufficiency. Other adverse effects include headache, dizziness, nausea, hypersensitivity reactions, and back pain.
Antihypertensive drug therapy for a “newly” diagnosed, stage 1 hypertensive African-American patient would most likely include what? Calcium channel blockers and diuretics have been shown to be more effective in African Americans than in white patients. Thiazide diuretics are also recommended for newly diagnosed stage 1 hypertension.
How is hypertension diagnosed? Diagnosis is not based on a one time reading, but an average of two or more.
What day of cardiac rehab should the patient ambulate 400-800 feet unassisted? Day 5
When would a patient know that they have done too much at home? Become exhausted, break out into cold sweat, become light-headed, feel nauseated, short of breath, chest pain
Define pleural effusion? An accumulation of fluid in the thoracic cavity between the visceral and parietal layers.
The right ventricle pumps blood to the lungs through what valve? Pulmonic Valve
The right and left coronary arteries branch off what blood vessel? The Aorta
The SA node is located where? The superior portion of the right atrium.
What is an electrocardiogram (ECG/EKG)? A graphic study of the electrical activities of the myocardium to determine transmission of cardiac impulse through the conduction tissue.
Identify the four events that lead to the development of shock: -Blood volume decrease (volume problem). -Heart failure as an effective pump (pump problem). -Peripheral blood vessel dilation (tank problem). -Obstruction of blood flow.
Identify the four types of shock: 1. Hypovolemic 2. Distributive 3. Obstructive 4. Cardiogenic
Four stages of shock Initiation, Compensatory, Progressive, Refractory (Irreversible)
Identify the 3 compensatory mechanisms in the second stage of shock. Neural, Endocrine, Chemical
What is a sensitive indicator of systemic perfusion? Urine output: >30ml/hr
What types of fluids are administered to the patient with hypovolemic shock? Crystalloid, colloid, blood
What are the priorities for caring for a patient with shock? ABC's
Name 5 modifiable risk factors for developing PVD Smoking, hypertension, hyperlipidemia, obesity, lack of exercise, emotional stress, and diabetes mellitus
What is a nonmodifiable factor that can be a major factor attributing to injury of the intimal layer of a artery? Aging
What does PATCHES stand for? Pulses, Appearance, Temperature, Capillary Refill, Hardness, Edema, Sensation
Name four invasive procedures used to diagnose PVD. Phlebography, I-fibrinogen uptake test, Angiography, D-dimer serum test
The antidote for heparin is? Protamine sulfate
The antidote for coumadin is? Vitamin K
What is the most common location for an aneurysm? Abdominal Aorta
What is the first clinical manifestation (sign or symptom) seen with Buerger’s Disease? Claudication of the arch of the foot.
Raynaud’s disease is characterized as? Intermittent arterial spasm
Which diagnostic test is preferred to diagnose thrombophlebitis? Impedence Plethysmography (IPG)
Which test measure venous filling times? Trendelenburg Test
A positive Homan’s sign is a reliable indicator of DVT. (T/F) False. Only 10% of DVT patients exhibit a positive Homan’s sign.
The Unna Boot is covered with elastic wrap that hardens like a cast to promote venous circulation. (T/F) True
The nurse has an order to give a newly ordered dose of ticlopidine (Ticlid) to a client. The nurse checks the client’s medical record to be sure the client does not have a history of what? Liver disease
During thrombolytic therapy, the nurse monitors the patient for adverse effects. What is the most frequent undesirable effect of thrombolytic therapy? Internal and superficial bleeding
A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to him that this drug is used to: Dissolve the clot in his coronary artery
What are 4 valvular heart disorders? Mitral stenosis & insufficiency. Aortic stenosis & insufficiency. Tricuspid stenosis & insufficiency. Pulmonary stenosis & insufficiency
Where are the aortic and mitral valves located? Between the left ventricle and the aorta; between the left atrium and left ventricle
Why are antibiotics used in the treatment of VHD? Prophylaxis in the prevention of infective endocarditis
A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The nurse recognizes that the reason for the two anticoagulants is because? Heparin is often used to initiate therapy when oral anticoagulants are prescribed until laboratory tests indicate an adequate therapeutic response.
A patient has received too much warfarin. The nurse would expect to give which antidote for warfarin toxicity? Vitamin K
Why must the INR be monitored for a patient with valve replacement? Patient’s with valve replacement must be on anticoagulant therapy (warfarin) to prevent thrombus formation.
What are subjective symptoms of rheumatic heart disease? Joint pain, fatigue, lethargy, and abdominal pain
What is the focus of nursing interventions for a patient with rheumatic heart disease? Minimizing joint pain and maintaining bed rest for pts with carditis
What is pericarditis? Inflammation of the pericardium, the membranous sac enveloping the heart.
Three nursing diagnosis R/T nursing care of a patient with pericarditis, endocarditis, and myocarditis are? 1. Decrease CO R/T inflammatory process 2. Pain R/t inflammatory process 3. Fluid volume excess r/t ineffective pumping action
50% of heart transplants are performed due to what? Cardiomyopathy
What are the major goals for a cardiac transplant Pt? To understand pre, intra, and post-op procedures and will maintain a realistic attitude concerning surgical outcome.
What would not be included by the nurse when teaching a client about the adverse effects associated with the use of azathioprine (Imuran)? Increased appetite
Identify the flow of electricity through the heart's conduction system: The pulse is generated by the SA node> AV node> Bundle of His, (right and left bundle branches) Purkinje's Fibers.
Identify the waves of a normal complex, the electrical activity they represent and the normal time intervals: P wave: atrial depolarization. PR interval: time it takes impulse to travel from SA node through AV node (0.12-0.20 secs). QRS complex: ventricular depolarization (0.06-0.12 secs). T wave: ventricular repolarization
Dysrhythmias are a result of what? Either an alteration of the formation of the impulse through the SA node to the rest of the myocardium or irritability of the myocardium cells.
The nurse is preparing to administer adenosine to a patient with supraventricular tachycardia. Important considerations before administration include what? Continuous cardiac monitoring is required when administering any IV medications to treat dysrhythmias.Due to the short half-life of adenosine, the IV bolus should be administered rapidly.The initial dosage of adenosine is rapid IV bolus followed by flush
The label for emergency IV lidocaine administration should read: “lidocaine for dysrhythmias” or “lidocaine without preservatives.”
Which nursing diagnosis focuses on the physiologic aspects of dysrhythmias? Decreased cardiac output
Where is the current discharged during cardioversion? The QRS complex
Identify three symptoms of a patient with a dysfunctioning pacemaker: Change in LOC, Bradycardia, Hypotension
What condition is classified by a hardening and loss of elasticity of the arteries? Arteriosclerosis
Deposits in the arteries known as plaque result in what? Narrowing of the lumen of the arteries and reduced blood volume
What are the two main types of risk factors to consider for CAD? Non-modifiable risk factors: Family History Age Gender Ethnicity
The middle walls of the heart? tunica media
The inner walls of the heart? tunica interna
What are the effects of aging on peripheral vascularity? Vascular walls become thick and less elastic.
What is the first symptom of decreased arterial circulation? Pain: due to arterial insufficiency and ischemia.
What is intermittent claudication?
What does the diagnostic test called plethysmography test for? Assesses changes in blood volume in veins
What is venography Catheter is inserted into the vein and contrast dye in injected; the gold standard diagnostic test looking for DVT (vein clot)
What are the classic five P's? Pain, Pallor, Pulselessness, Paresthesia, Paralysis
What skin temperature finding is significant in PVD? Edema with heat is coming from the arteries; edema without heat or with cold is coming from the veins.
What is an embolectomy? removal of an embolism
What is an endarterectomy? Surgical removal of the inner wall of the carotid to remove the blockage or thickening.
What is a percutaneous transluminal angioplasty? an invasive procedure in which a catheter from a femoral or brachial artery is placed in the coronary artery and a ballon is inflated against the narrowing wall, thus reducing arterial constriction.
What are the nursing diagnosises for Arteriosclerosis Obliterans? Activity intolerance, related to ischemic pain or immobility; Tissue perfusion, ineffective peripheral, related to decreased arterial blood flow.
Diagnostic tests used for arterial embolism? Ultrasonography, Angiography
Surgical interventions used to treat arterial embolism? Endarterectomy, Embolectomy, Thrombectomy
What is a nursing diagnosis for arterial embolism? Tissue perfusion, ineffective peripheral, related to decreased arterial blood flow.
Diagnostic tests for arterial aneurysm? Fluoroscopy, Chest radiograph, CT scans
What is the first priority of care for arterial aneurysm? Control hypertension.
What are the nursing diagnosises for arterial aneurysm? Tissue perfusion, ineffective peripheral, related to decreased blood flow; anxiety, related to feelings of impending death.
What is Buergers Disease? Inflammation of blood vessels that is associated with formation of clots and fibrosis of the blood vessel wall; gravitates to the peripheral veins and arteries of the hands and feet.
What is the priority of care for arteriosclerosis obliterans? Prevent complete occlusion.
What is the most common symptom of Buergers Disease? Instep claudication (pain with exercise in the arch of the foot)
What is the most important objective finding of Buergers Disease? Decreased sensitivity to cold in the extremities.
What is the pattern of heart contraction? Both atria, then both ventricles.
Valve flaps prevent the backflow of blood from the pulmonary artery into what? Right ventricle.
What is an important time sensitive intervention related to arterial embolism that becomes a complete blockage? Surgery must be performed within 6-10 hours to prevent necrosis and loss of the extremity.
When a patient is receiving heparin therapy, the nurse should observe for what? emesis, urine, and stools for blood
Define an aneurysm? an enlarged, dilated portion of an attery that is more than 1 and 1/2 times its original circumference; must involve all three layers of the vessel wall.
What is another name for Buerger's disease? Thromboangiitis obliterans
Who is most commonly effected by Buerger's disease? men between the age of 25 to 40 years old.
To decrease pain from angina, how should the the patient take his prescribed nitroglycerin? sublingually prophylactically before strenuous exercise
Patient teaching for peripheral arterial disorder of the lower extremities includes? importance of avoiding exposure to cold and chilling
Pt teaching for pt discharge with MI should be? to begin a cardiac rehabilitation program
Signs and symptoms of right-sided heart failure? Dependent edema of the extremities, enlargement of the liver, oliguria, jvd, and abdominal distention
The primary function of patient teaching after an MI? assisting the patient in developing a healthy lifestyle
An important nursing intervention when caring for a pt with remote telemetry is to? NEVER REMOVE TELEMETRY AND ALLOW PATIENT TO SHOWER WITHOUT A PHYSICIAN WRITTEN ORDER TO ALLOW IT.
The name of the neurohormone released from the left ventricle in response to volume expansion and presure overload that has emerged as the blood marker for the identification of individuals with HF is? B-type natriuretic peptide (BNP)
The normal range for the B-type natriuretic peptide (BNP) is? 0 to 100pg/mL
Myocardial muscle protein released into circulation after myocardial injury and is useful in diagnosing a myocardial infarction? Tropinin 1
The most useful noninvasive diagnostic tool for evaluating the patient with heart failure is? ECHOCARDIOGRAM
Electrocardiogram findings during an MI are less likely to show? ST-segment elevation in women than men
The correct nursing interventions for the nursing diagnosis of “decreased cardiac output” are? 1)assess for and report decreased bp and arrhythmias, 2)assess for oliguria, and 3) administer oxygen therapy as ordered
Thrombolytic agents such as streptokinase and tissue plasminogen activators such as alteplase and activase are MOST effective in a patient with acute MI signs and symptoms when? IN THE FIRST 30 MINUTES TO 1 HOUR
What is an Unna's boot? 1) hardens into a “boot” that may be left on for 1 to 2 weeks, 2) is a moist, impregnated gauze wrapped around the patient’s foot and leg, and 3) protects the ulcer and provides constant and even support to the area.
Correct patient taching information for a pt with Raynaud’s disease includes? 1) avoid cold, 2)practice stress-reduction techniques, and 3) comply with smoking cessation
The normal period in the heart cycle during which the muscle fibers lengthen, the heart dilates, and the cavities fill with blood, roughly the period of relaxation is called? Diastole
Heart failure is usually treated with? Cardiotonic drugs (digitalis), diuretic agents, ACE inhibitors, beta-adrenergic blockers, nitrates
What are the two major venous disorders? thrombophlebitis and varicose veins
What is a Cold Stimulation Test? Patient's hand is submerged in an ice water bath for 20 seconds; skin temperature changes are recorded by a thermistor attached to each finger; ongoing temperatures are compared.
What causes ischemia of the heart muscle? When myocardial oxygen demand exceeds the myocardial oxygen supply; results in chest pain/angina
What causes Raynaud's disease? intermittent arterial smasms
Expected objective finding of Raynaud's disease includes? ulceration of fingers and toes r/t circulation inadequacy and residual waste products
What is thrombophlebitis? inflammation of a vein in conjunction with the formation of a thrombus; characterized by pain and edema when the vein is obstructed
What is duplex scanning? a dopler and ultrasound test at the same time
What is a D-dimer test? a lab test that measures fibrin degradation fragment that is made from fibrolysis
How is thrombophlebitis treated? warm compresses intermittently; heparin; thrombectomy (umbrella in the vena cava to prevent flow of emboli into the lungs)
Who has the highest incidence of varicose veins? women ages 40 to 60
What is venous stasis? chronic blood pooling in the veins
What is varicose veins? vessel wall weakens and dilates, stretching the valves and leaving the vessel unable to support a column of blood
What is Trendelenburg's test? Pt lies down and affected extremity is raised to empty the veinsl a tourniquet is applied above the knee, and the pt stands; direction and filling time of the veins are recorded both before and after the tournequet is removed.
What is venous stasis ulcers caused by? deep vein insufficiency and stasis of the blood in the venous system
What is an important medical management of venous stasis ulcers? Diet, because large amounts of protein in the form of albumin is lost through the ulcers.
Classic signs of venous stasis ulcers? cell death, tissue sloughing, and skin impairment
Types of debridement? Mechanical(using moistened gauze, allowed to dry and rip off debris), Chemical(enzyme ointments that break down necrotic tissue), and Surgical (removes debris using a scalpel)
What are antiplatelet agents used for? prevention of stroke in patients who have had a completed thrombotic stroke or precursors to stroke and are unable to tolerate aspirin.
What is important to assess when giving thrombolitic agents? Assess for bleeding every 15 min during the 1st hr of therapy, every 15-30 min during the next 8 hr, and at least every 4 hr for the duration of therapy.
How is a thrombolytic administered for peripheral arterial occlusion? Directly into the thrombus through a central line that contains proximal and distal infusion wires.
Created by: princess3734