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H&C Ch 26 - 27 CV II
HF, valvular disorders, PVD NUR 235
| Question | Answer |
|---|---|
| Heart failure is the ________________ _______________ of the heart (two words) | impaired contraction |
| True or false, acute heart failure is almost always terminal | false, in some cases it may be reversible p. 693 |
| What ethnic groups have more prevalence of heart failure ? | African Americans and Hispanic Americans |
| What is the primary cause of HF ? | CAD p693 |
| What is the most common type of cardiomyopathy ? | dilated |
| Why is valvular disease also a cause of HF? | With valvular dysfunction, it becomes increasingly difficult for blood to move forward, increasing pressure within the heart and increasing cardiac workload, leading to HF p694 |
| How do cardiac dysrhythmias contribute to HF ? | altered electrical stimulation impairs myocardial contraction and decreases the overall efficiency of myocardial function. |
| What are located int eh aortic and carotic bodies that decreased blood flow ? | barorecptors |
| What happens when baroreceptors sense reduced blood flow in the heart (what is released?) | epi and nor epinephrine |
| what does epi and nor epinephrine do in its initial rsponse to reduced blood flow ? | increases heart rate and contractility to support the failing myocardium |
| Decreased contractility causes an incrase in _________________ volume in the ventricle | end-diastolic |
| how does the heart compensate for the increased workload ? | increases thickness of heart muscle (cardiomyopathy) |
| Left sided heart failure causes what type of symptoms | respiratory, SOB, crackles |
| What is orthopnea ? | difficulty breathing while laying flat |
| what is PND ? | paroxysmal nocturnal dyspnea - attacks of SOB at night |
| what is another name for abnormal lung sounds | adventitious lung sounds |
| where are crackles usually heard in left sided failure | bibasilar |
| where does congestion occur in right sided failure | peripheral tissues p. 696 |
| what is hepatomegaly | enlarged liver |
| what is acites | serous fluid in the peritoneal cavity with weight gain due to fluid retention |
| where is edema typically seen with right sided failure ? | feet and ankles |
| where would tenderness occur in hepatomegaly ? | RUQ |
| why does anorexia happen with heart failure ? | engorgement of abdominal organs |
| why does a heart failure patient manifest restlessness or anxiety | low brain perfusion |
| what is a normal ejection fraction | 55 to 65% p697 |
| what stage is this NYHA classification : Unable to carry out any physical activity without discomfort Symptoms of cardiac insufficiency at rest If any physical activity is undertaken, discomfort is increased. | IV |
| what stage is this NYHA classification : Slight limitation of physical activity Comfortable at rest, but ordinary physical activity causes fatigue, palpitation, or dyspnea. | II |
| what drug classes are generally used for heart failure ? | SGLT2, diuretic, ACE, ARB or ARNI p699 |
| what are the nursing considerations for SGLT2 inhibitors ? | kidney dysfunction, UTIs, genital yeast infections |
| what are the nursing considerations for ACE inhibitors and ARBs ? | high K level, low BP, kidney dysfunction |
| What drug class does spironolactone belong to ? | potassium sparing diuretic |
| What drug class does lasix belong to ? | loop diuretic |
| how should potassium be repleted when taking a diuretic ? | Replace potassium with increased oral intake of food rich in potassium or potassium supplements, if indicated p 701 |
| A persistent dry cough is often associated with what drug class ? | ACE inhibitors |
| Your patient has been started on a beta blocker 2 weeks ago and reports no improvement in symptoms. What education do you provide ? | The therapeutic effects of beta-blockers may not be seen for several weeks or even months |
| How does digoxin help heart failure patients ? | increases the force of myocardial contraction and slows conduction through the atrioventricular node p702 |
| What drugs are used for patients who do not respond to routine therapy for heart failure or who have severe ventricular dysfunction ? | inotropes |
| What drug class is dopamine ? | vasopressor |
| when would anticoagulants be used in a heart failure patients ? | if they havae afib or embolic event p. 703 |
| what is the sodium restriction for heart failure | less than 2gm / day |
| Your 32 year old patient's mother asks why her son who has heart failure is not ordered a fluid restriction. What education do you provide ? | Fluid restrictions were recommended for many years; however, ACC/AHA GMDT no longer advocates them as they are not implicated in any patient benefits |
| True or False. NYHA class III and IV should not engage in any cardio rehab program. | Patients with all types of HF benefit from a regular exercise program, which may be a component of a cardiac rehabilitation program |
| what instructions do you provide a patient for low sodium diet (there are 5) p. 709 | check food labels , Avoid canned or processed foods; eat fresh or frozen foods instead. Consult the written diet plan and the list of permitted and restricted foods. Avoid salt use. Avoid excesses in eating and drinking. |
| what instructions do you provide to heart failure patients regarding exercising ? | Participate in a daily exercise program. Increase walking and other activities gradually, provided they do not cause unusual fatigue or dyspnea. balance activity with rest periods. Avoid activity in extremes of heat and cold |
| verbalize the blood flow through the heart (p. 717) | eft side of the heart to the aorta, arteries, arterioles, capillaries, venules, veins, vena cava, and right side of the heart. |
| Pain characteristic of Arterial insufficiency | intermittent claudication constant |
| Pain characterist of venous insufficiency | aching throbbing cramping |
| pulses in arterial insufficiency | diminished or absent |
| pulses in venous insufficiency | present but difficult to palpate through edema |
| skin appearance in arterial insufficiency | dependent rubor with elevation pallor of foot |
| skin appearance in venous insufficiency | pigmentation in medial and lateral mallelous , skin reddish-blue |
| shape of an arterial ulcer is generally | circular |
| shape of a venous ulcer is genearally | irregular bordered |
| leg edema in arterial insufficiency is generally ________ | minimal |
| leg edema in venous insufficiency is generally _________ to _________ | moderate to severe |
| what diganostic test is an objective indicator of arterial disease ? | ABI |
| what are common errors in measuring the ABI ? | incorrect cuff size for BP, inusfficient cuff inflation, rapid cuff deflation p. 721 |
| what is a normal ABI ? | 1-1.40 is normal |
| What is an abnormal ABI ? | ABI less than 0.9 |
| what can assess blood flow ? duplex ultrasonograpy or CT scan | duplex ultrasound |
| what does an angiography show when performed for vascular insufficiency ? | identifies areas of vascular narrowing |
| what is the difference between arteriosclerosis and atherosclerosis ? | arteriosclerosis = hardening of arteries atherosclerosis = accumulation of lipids, calcium etc in the artery |
| DVT and PE are both conditions of ___________________________ | venous thromoembolism |
| superficial veins include: | long (greater) saphenous, short (lesser) saphenous, cephalic, basilic, and external jugular veins |
| what 3 factors are identified to play a role in development of VTE | Virchow triad : endothelial damage, venous stasis, and altered coagulation p. 738 |
| what causes a hypercoagulable state ? | oral contraceptive agents, elevated CRP levels, and several blood dyscrasias (abnormalities) p. 738 |
| how can VTE be prevented ? | ambulation and exercise; anti-embolism stockings; pneumatic compression devices; admin. of subcutaneous unfractionated heparin or low-molecular-weight heparin; lifestyle changes, which include weight loss, smoking cessation, and regular exercise. |
| what is a thrombectomy ? | a mechanical method of clot removal |
| what is the antidote for heparin ? | protamine sulfate |
| what is the antidote for enoxaparin | protamine sulfate |
| what is the antidote for warfarin ? | vitamin K, fresh frozen plasma or prothrombin complex |
| what is the antidote for apixaban or rivaroxaban ? | andexanet or activate charcoal |
| what is the antidote for betrixaban ? | there is none p. 741 |
| what medication is the "clot buster" | alteplase, reteplase, tenecteplase, urokinase p. 741 |
| your patient is travelling on a cruise and takes warfarin, what education do you provide her ? | carry identification indicating you are taking an anticoagulant, avoid use of sharps (eg. tattoos) , avoid changes in diet p 742 |
| what are the clinical manifestations of a PE ? | p. 743 dyspnea, sudden substernal pain, rapid and weak pulse, shock, syncope, and sudden death |
| what diagnostics are used to rule out a PE ? | CXR, ECG, pulse ox, ABG, D dimer, pulmonary arteriogram, VQ scan |
| what is the goal of treatment for a PE ? | prevent new embolii from forming and dissolve the current one (with tPa) |
| what long term medications may be used for long term treatment options of a PE | warfarin and DOACs |
| what symptoms are manifested in chronic venous insufficiency ? | pain described as aching or heavy, edema, altered pigmentation, dilated superficial veins, and stasis dermatitis p 745 |
| how does the skin present with chronic venous insufficiency ? | skin becomes dry, cracks, and itches; subcutaneous tissues become fibrotic and atrophy, increasing the risk of skin injury and infection. p. 745 |
| what the common complications of chronic venous insufficiency? | Venous ulcers, cellulitis, and dermatitis p. 745 |
| Your assigned patient has orders to remove compression stockings at night. What assessment is done after removal ? | skin is inspected for signs of cellulitis or dermatitis, and the calves are examined for abnormalities. Any skin changes or tenderness is reported. |
| when are compression stockings contraindicated ? | in patients with severe arterial disease, arterial bypass grafts, severe cardiac insufficiency, allergy to components of compression stockings, and severe neuropathy with sensory loss or microangiopathy |
| Arterial ulcers are described as : | small, deep, circular ulcerations on the tips of toes or in web spaces between the toes. Ulcers often occur on the medial side of the hallux or lateral fifth toe |
| venous ulcers are described as: | typically large, superficial, and highly exudative and are usually located over the medial or lateral malleolus (gaiter area). |
| when is hyperbaric treatment used for ulcer healing | when no signs of wound healing after 30 days has passed with standard treatment |
Created by:
Kelly Quijano
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