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What is Afterload?
the amount of resistance to enjection of blood from the ventricle
What is stroke volume?
Amount of blood ejected per heart beat, the avg is 70 ml per heart beat
In regards to a MI what is some teaching regarding BM's?
- -Don't bare down, can trigger a vagal response and cause bradycardia
- -stool softeners
What happens to the myocardium during an infarction?
the contractibility decreases and O2 is cut off causing muscle death or ischemia
What is the lab that is specific to the Heart and is the most sensitive indicator of an MI?
Troponin, positive for an MI if greater than 4
When do the levels of troponin rise and how long do they stay elevated?
they rise within a few(3-4) hours and stay elevated for up to 3 weeks
Dysrhythmias, Heart Failure, Cardiogenic Shock, and Structural defects are all ATYPICAL symptoms of WHAT?
Acute Coronary Syndrome (ACS)
Anxiety attacks, exercise, stress, cold, heavy meals, strong emotions and stimulant use can all trigger what?
What is the action of Nitroglycerin?
dialates the Coronary arteries, decrease myocardial O2 consumption
Which phase of cardiac rehab is: Diagnosis, teaching, medication regimen, rest, activity balance, reassurance?
Which phase of cardiac rehab is: after d/c, supervised exercise program, intense education, can take 1-6 months?
Which phase of cardiac rehab is : long term out pt program, self directed, builds on previous accomlpishments?
Why is walking a part of plan of care?
Walking is good ;) moderation and supervised exercise is part of cardiac rehabilitation.
What are the distinguishing characteristics of dilated cardiomyopathy?
ventricle is enlarged but muscle is not
Exertional dyspnea is a clincal manifestation of what?
How is fluid volume assesed?
- -Pulmonary congestion
- -aortic regurgitation
- -exercise intolerance
What are some clinical manifestations of L sided heart failure?
- Pulmonary crackles
- low O2 Sats
What is PND,(Proximal Nocternal Dyspnea)?
respiratory distress that wakes them up at night
What are some clinical manifestations of R sided heart failure?
- JVD *Jugular Vein Distention*
- dependant edema
- weight gain
What is a BNP and what does it diagnose?
A BNP (B-type Natriuretic Peptide)is the lab that is indicitive of heart failure if less than 100 no heart failure, greater than 100 = heart failure.
How to reduce fluid volume excess?
- -Administer Diuretics or ACE inhibitors
- -sodium restriction
What is Furosemide?
a diruetic also known as lasix
What are some adverse effects of lasix?
- can lower BP to much and also can cause hypokalemia, and hypotension
- *DAILY weight* and labs!
What is important to remember when administering coumadin (Warfarin)?
- -check PT/INR every day to make sure it is at a theraputic level
- -avoid foods high in Vitamin K, such as spinach, broccili.
What are some interventions to promote circulation in regards to peripheral arterial insufficiency?
- *STOP SMOKING*
- -daily skin inspection
- -teach when to seek medical care
abnormally dialated, superficial veins caused by incompetent valves are called what?
What is some things you can teach pt to prevent getting vericose veins?
- frequent walking,
- elevate legs
- compression stockings
- avoid prolonged standing and/or sitting
What is Propranolol(inderal)?
a beta blocker that decreases heart rate and BP, can cause brady cardia and *impotance*, pulmonary edema, CHF and depression
What is a beta blocker?
- a class of medications that
- -Decrease myocardial contractility, HR, SVR, BP
- -Used in 1st hours of MI to reduce the size of the infarct
- -Continue medications indefinitely
WHat are some common side effects of Beta blockers?
- dizziness, fatigue, lethartgy,impotence
- hypotension, bradycardia, ****FALLS RISK***
What is primary hypertension?
HTN with an unidentified cause in 90-95% of cases
What are some risk factors for HTN?
- -family HX
- -race(african american)
- -insulin resistance
- -excessive alcohol, smoking or stress
- *diagnosis requires that BP be elevated on at least three occasions during several weeks**
What is the goal of treatment with Antihypertensive drugs?
prevent complications and death by acheiving and maintaining a BP of less then 140/90, even 139/89 :)
What is intermittent claudication?
- a muscle cramp that is caused by excertion and relieved by rest.
- (Ischemic muscle ache or pain
- Precipitated by exercise, walking
- Resolves within 10 minutes or less with rest and is reproducible )
What is (PAOD) peripheral arterial occlusive disease?
- –Progressive changes to intimal lining
- Causes scarring and narrowing –Decreased lumen size
What are the clincal manifestations of PAOD?
- -loss of hair on lower extremities
- -thin shiny skin
- -intermittent claudication
- -rest pain
- -pallor on the feet
- -sensory loss
- -deminished or absent pedal pulses
What are calcium channel blockers?
Medications that increase sodium excretion and cause arteriolar vasodilation by preventing the movement of extracellular calcium into the cells.
What is the theraputic effect of Calcium channel blockers for CAD(Coronary Artery disease) ?
- Increases the relaxation of the smooth muscle that surrounds the coronary arteries and causes them to dialate which increases the blood flow to the heart and decreases the work load of the heart.
- * Avoid grapefruit juice*
What is the normal for total cholesterol level?
below 200 mg/dL
What is the normal level for LDL cholesterol?
Below 100 mg /dL
What is the normal level for HDL cholesterol?
60mg/dL and above
What is the normal level for triglycerides?
below 150 mg/dL
What are some common side effects from loop diuretics?
- if BP is low can make it lower, watch for hypotension,
- can lower potassium and cause hypokalemia
What is pt teaching regarding Buergers disease?
- *STOP SMOKING*
- -avoid cold enviroment
- -decrease stress
- -encourage cardiovascular exercise
- -avoid vasoconstricting drugs
What are some risk factors for DVT?
- -prolonged immobility
- -surgery trauma, cancer, obesity,
- -birth control pills
- clotting disorders, and >65 years old
What are some clinical manifestations of Glomerulonephritis?
What is the color of the urine in pts with glomerulonephritis?
many RBCs are in it so it is the color of "cola" or "Tea"
What are the types of incontinence?
- *stress-caused by sneeze, cough
- *urge-unable to reach toilet in time
- *Reflex-no control, paralyzed
- *overflow-weak muscles
- *functional-physical or mental alterations
- *iatrogenic-extrinsic factor
What substances are normally filtered by the kidneys and not normal to be found in the urine?
Glucose and protien there is almost no blood in urine less than 0.5 is ok
What is ARF(Acute renal failure)?
Kidneys cannot remove the body's metabolic wastes or perform their regulatory functions
What are some clinical manifestations of Acute renal failure?
- *oliguria/anuria* (most common)
- -low urinary output
- -pain in the back, or lower flanks
What are some clinical manifestations of nephrotic syndrome?
- •Peripheral Edema
- –Decreased serum albumin
- •Fluid shifts from vascular space to tissues
- •Weight gain
- •Massive proteinuria
- –LDLs increase in an attempt to compensate for albumin loss
- •Elevated lipid levels can lead to atherosclerosis
What are some nursing interventions for difficulty urinating?
- provide privacy
- warm bath
- bladder retraining
- treat infection(if one)
- prevent overdistention
What is ESWL(Extracorporeal shock wave lithotripsy)?
the most common, non invasive treatment for kidney stones, if they are too big.
What is End stage renal disease(ESRD)?
The end stage of renal disease---DUH ! :) if pt does not get on dialysis soon they will die :(
What is the disease that increases the risk of developing ESRD?
What is azotemia?
elevated BUN and Creatnine
What do the phophorus binding meds do?
- –Bind phosphate in bowel and excrete
- –Example: Sevelamer hydrochloride (Renagel)
- Pt teaching*
- »Should be administered with each meal
- -Side effect: Constipation
What is rest pain?
Pain caused by not enough blood getting to extremities, not a disease just a symptom!
What is prevention for UTI?
- large amounts of fluid
- pee after sex
- good hygeine
What are clinical manifestations in the elderly of a UTI?
- altered mental satus
How is the renin angiotensin system related to hypovolemia and hypotension?
when BP and fluid are low renin is release and creates angiotensin 1 which the body automaticly converts to angiotensin 2 (BAD!!) so an ACE inhibitor is given which prevents angiotensin 1 from converting to angiotensin 2