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NUR 150-test 2
Chronic-test 2
| Question | Answer |
|---|---|
| Atherosclerosis leads to | heart attack/stroke |
| diff btw Arteriosclerosis & Atherosclerosis | normal part of aging vs accumulations of lipids/plaques |
| Arteriosclerosis | hardening of arteries |
| Atherosclerosis | accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue—plaques |
| Risk factors for Atherosclerosis; non-modifiable | heredity, race, sex, age |
| Risk factors for Arteriosclerosis; modifiable | high chol & LDL, diabetes, smoking, HTN, sedentary lifestyle |
| Metabolic syndrome | central obesity, high BP, high triglycerides, low LDL, insulin resistance |
| Total cholesterol | <200 |
| Triglycerides | <150 |
| LDL | <100 |
| HDL | >50 |
| Total cholesterol/HDL | 4/1 |
| <30% of diet | fat |
| 50-60% of diet | carbohydrates |
| Cholesterol intake recommended | 300mg 0r < |
| water soluble fibers | lower serum cholesterol |
| Low-fat | <3gm fat/serving |
| Statins | strong evidence that they reduce future risks of cardiac events & death, primarily lower LDL, raise HDL sometimes, decrease triglycerides |
| Statins; SE | myositis (muscle aches & pains)-report to MD immediately, monitor LFTs, take at night, NO grapefruit juice |
| Angina | Chest pain; discomfort results from imbalance btw myocardial oxygen supply & demand |
| Angina-priority pt assessments | Labs/Diagnostic; lipid profile, homocysteine, CRP, troponin, cardiac enzymes, TEE |
| Angina-nursing mngmt | maintain bedrest(Fowler’s), O2 as ordered, monitor for pain |
| Angina-pt teaching | rest if pain, avoid sudden exertion, exposure to cold, tobacco, limit OTC meds that ^heart rate/BP(“drines”,caffeine), low-fat/high fiber diet |
| Nitro SE | vasodialation,h/a, decreased B/P, vertigo, flushing, N/V, syncope |
| Nitro teaching | take 1, in 5min take another, in 5min another, chew 1 aspirin/call 911 |
| Beta Blocker”olol” SE | bradycardia, lethargy, GI disturbances, decreased B/P, depression, impotence |
| Beta Blocker standard of care | check apical heart rate for 1min, hold for <60 |
| Cath Lab-standard of care | w/in 60 minutes |
| Cardiac Cath surgery-NSG assessments | bleeding, pulse checks |
| Normal BP | <120/<80 |
| Prehypertension BP | 120-139/80-89 |
| HTN, stage 1 | 140-159/90-99 |
| HTN, stage 2 | >160/>100 |
| Primary HTN | No specific etiology, 90-95% |
| Primary HTN-r/t | age, gender, family hx, ethnicity, sedentary lifestyle, socioeconomic status, stress, obesity, alcohol, smoking, diabetes, elevated lipid levels, high sodium diet |
| Secondary HTN | specific cause identified & corrected, 5-10% |
| Secondary HTN-r/t | renovascular, cushing’s disease, oral contraceptives, primary aldosteronism, renin secreting tumors, pheochromocytoma |
| Most common causes of secondary HTN | renal parenchymal & renovascular disease |
| HTN-Clinical manifestations | h/a, epistaxis, dizziness, weight changes, DOE, diaphoresis, palpitations, visual disturbances |
| Target Organ disease-organ most impacted by high BP | heart |
| HTN-Lifestyle modifications | weight reduction, moderate ETOH intake, regular physical activity, decrease Na intake, adequate potassium/calcium/magnesium intake, stop smoking |
| DASH | ^fruits & veggies (10-11 servings), decreased fats (26%,<10%saturated), low fat dairy products, <3,000mg NaCl/day |
| HTN-Meds | diuretics, adrenergic inhibitors, vasodilators, ACE inhibitors, ARBs, CCBs |
| Metoprolol/Lopressor(adrenergic inhibitor)action | beta-adrenergic blockers, decrease HR/CO, decrease renin release from kidney |
| Adrenergic Inhibitors | Alpha 1 receptor blockers, dilate blood vessels, 1st dose phenomenon, NA and fluid retention w/ ^ doses |
| 1st Dose Phenomenon | 1st dose or dose^ leads to Hypotension |
| “Prils” action | vasodialate, decrease aldosterone, ACE in the lining of blood vessels, ACE block enzyme that converts A-I to A-II |
| ACE-SE | angioedema(lifethreatening-tongue swelling), hypotension(1st dose effect), hyperkalemia(monitor potassium), cough |
| Ischemic Stroke | thrombosis/clot, 85% |
| Hemorrhagic Stroke | cerebral aneurysm/vessel blows, 15% |
| Can this person receive TPA/Thrombolytics? | not if currently bleeding, hemophiliacs, recent surg, severe^HTN, clotting issues(pt/ptt/inr) |
| Stroke Diagnosis | S&S/CT(to check for clot, check labs, then TPA)/MRI |
| Stroke-General Sx | numbness of face/arm/leg, weakness/difficulty walking, dizziness, confusion, trouble speaking/suddenly can’t form words, visual disturbances/sudden blackened vision, sudden severe h/a |
| Neurological Assessment | LOC(Glasgow coma), pupil response; PERRLA, speech; ability & quality, swallowing ability, motor function, spontaneous, grips, sensory function |
| PERRLA | pupils equal round reactive light accommodation |
| Swallowing ability-precautions | aspiration prec; no straws, HOB^, consistency of thickening, food on unaffected side |
| Famous wheelchair ? | on stronger side |
| Stroke-signs/meds/tx | TIA, ASA/Plavix, surgery(carotid endarterectomy, angioplasty, stents), treat HTN, treat atrial fib |
| Rehab concepts | repetition of activities encourages new CNS pathways, short/frequent sessions 5x/day 10 min each, assistive devices |
| Heart Failure #1 cause | atherosclerosis |
| Systolic Failure | ventricle loses ability to contract, heart cannot pump blood adequately |
| Diastolic Failure | ventricle loses ability to relax, heart cannot fill properly w/ blood |
| HF is due to | decreased myocardial contractility secondary to; CAD,HTN, valvular disorders, hypertropic cardiomyopathy, dysrhythmias, toxic substances, viral syndrome |
| Cardiac Output | stroke vol x heart rate |
| LV Failure-S&S | lungs; fatigue, SOB, dyspnea, DOE, orthopnea, paroxysmal nocturnal dyspnea, cough, crackles, edema, weight gain |
| RV Failure-S&S | secondary to LV failure; venous congestion, edema, dependent edema, pitting edema, sacral edema, peri-orbital edema, ascites, anasarca, distended neck veins, hepatomegaly, nocturia, weight gain |
| HF-Diagnosis | CXR, Echocardiogram-EF<50%, BNP-^w/ cardio issues>100 |
| HF-Nutritional Therapy | low sodium diet;2000-4000mg/day, fluid restriction;1-2L/day, potassium, magnesium |
| HF-1st line Drug Therapy | ACE inhibitors, ARBs |
| ACE Inhibitors | promote vasodilatation and diuresis, excretion of Na and retention of K, decrease afterload & preload |
| ACE Inhibitors-to balance potassium^ | give two diuretics |
| Digitalis (Lanoxin/digoxin) | ^ force of myocardial contraction, slows conduction(HR), enhances diuresis |
| Digitalis-interventions | monitor dig level, monitor for dig tox, maintain K w/in normal range(hypoK leads to dig tox-<3.5), monitor BUN & creatinine |
| Digoxin-Therapeutic level | 0.5-2.0ng/mL |
| Digitalis Toxicity-Early S&S | fatigue, loss of appetite, N/V |
| Digitalis Toxicity-Late S&S | bad taste in mouth, confusion, vision changes, rhythm changes |
| HF-Patient Education pts | S&S of decompensation, meds, drug-drug interactions, daily weight, smoking cessation, alcohol, cardiac rehab, HF clinics |
| 2.2lbs | 1liter |
| Sodium/Na | 135-145mEq/L |
| Potassium/K | 3.5-5mEq/dL |
| Magnesium | 1.3-2.3mg/dL |
| BUN | 10-20mg/dL |
| Creatinine | 0.7-1.4mg/dL |
| Mitral Valve Prolapse | ballooned leaflet back into atrium, valve does not remain closed, results in blood regurgitating back into L atrium |
| Mitral Regurgitation | valves don’t close completely, blood flows back into L atrium, effects lungs & RVsevere CHF |
| Raynaud’s Syndrome | sensitivity to cold, women |
| Buerger’s Disease | autoimmune vasculitis, men, tobacco, bluish discoloration in big toe |
| PVD-Causes | pump failure, obstructed vessels, aging process, obstructed lymphatic vessels |
| PVD-Assessment | 6 Ps-pain, pallor, pulselessness, paresthesia, polar, paralysis |
| PVD-Antiplatelets | asprin, enteric-coated asprin-325mg/162mg/81mg, plavix |
Created by:
neffielewis
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