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NUR 150-test 2

Chronic-test 2

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 & RVsevere 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