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