NUR2 Test 3
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- Affects stroke volume
- Resistance or pressure in aorta and peripheral arteries that the L ventricle must work against to eject blood from the heart.
- Vasodilation = AL decrease
- Vasoconstriction = AL increase
- The amount of blood ejected per heart beat (70mL average)
- Determined by preload, afterload, & contractility
- Increase PL = Increase SV
- Increase AL= Decreased SV
- Increased contractility = Increased SV
What is the direct of the blood through the heart?
- Sup/Inf Vena Cava --> R Atrium (RA)
- RA through tricuspid valve --> R Ventricle (RV)
- RV through pul. Valve --> pul. artery and lungs
- Lungs --> pul. Vein --> L Atrium (LA)
- LA through mitral valve --> L ventricle (LV)
- LV through aortic valve --> Aorta
Which is larger Left or Right Ventricle?
Left Ventricle is usually 2.5 times larger
How much of the O2 from the lungs does the heart take?
- Specialized cells in carotid arteries and aortic arch that
- signals body to increase/decrease BP & HR
The degree of stretch of the ventricular cardiac muscle at the end of diastole
Cardiac patient teaching in regards to bowel regimen
- Don’t bare down b/c of vegal nerve response (can provoke dysrhythmias & bradycardia)
- Take stool softeners
Desirable total cholesterol level
Below 200 mg/dL
Near optimal LDL cholesterol level
What is the goal for LDL and HDL cholesterol lvls?
Brain (B-type) Natriuretic Peptide (BNP)
- Indicator of heart failure protein released in heart failure Hormone released by heart from increase in atrial volume and ventricular pressure
- Promotes venous and arterial vasodilation
What should nurse ensure with patients about to undergo Cardiac Catheterization?
Ensure they are not allergic to Iodine
What should nurse do after Cardiac Catheterization?
- Palpate site of CC for hematoma.
- Strict bed rest 4-6 hrs
- Instruct pt. not to move leg
Hardening of the arteries without atheroma (plaques)
What causes Angina?
- Pain caused by insufficient coronary blood flow; atherosclerosis AND increased demand for O2
- *Anxiety attack can mimic chest pain
- *Diabetics will not experience chest pain
- *Decreases myocardial oxygen consumption
Pt. teaching about Beta blocker induced impotence
If they have this they can switch to another type of medication
Glycoprotein IIb/IIIa agents
- Prevent platelet aggregation
- *Watch for s/s of bleeding*
- Eptifibatide (Integrilin)
- Abciximab (Reopro)
- Tirofiban (Aggrastat)
- Accurate/reliable indicator of myocardial injury used if pt.waits > 24hrs to seek tx.
- Positive for MI if > 4
- Most sensitive indicator of MI
- Test does not indicate if MI occurred but neg. result rules out MI
- Starts to increase 1-3 hrs, peak within 12hrs
MONA treatment MI
- M= Morphine; decrease pain, anxiety, workload on heart
- O= Oxygen; increased O2 will decrease workload on heart
- N= Nitrates; relieve angina pain
- A= ASA
Activity Restriction in regards to cardiac pt.s
Balance amount/intensity of activity to attain health benefit without causing symptoms.
Normal lvl for Digitalis/Digoxin
What does S3 or S4 heart sounds indicate?
Murmur, caused by; CAD, hypertrophy, aortic stenosis, ventricularfailure, mitral valve regurgitation
When is S3 heart sound heard?
When is S4 heart sound heard?
Fibrous plaque associated with Coronary Artery Disease
- Progressive change in the arterial wall
- Normally endothelium cells repair themselves instantly, but with CAD endothelium cells slow repair allows LDL to thicken arterial wall.
Acute Coronary Syndrome (ACS)
Umbrella term for any symptoms of acute MI
- Results from sustained ischemia (>20 min)
- Irreversible myocardial cell death
- Occurs when coronary artery is occluded or in a vasospasm
- Cells eventually die from hypoxia
Initial treatment for MI
- ECG, monitor VS, lab studies
- Decrease cardiac workload and anxiety
S/S of Left-sided heart failure
- Decrease O2 sats
- Tachycardia & tachypnea
S/S of Right-sided heart failure
Jugular vein distention
Why should nurse complete daily weights on cardiac patients?
To assess changes in fluid volume
Cardiac patient discharge teaching (as per Joint commission)
- Daily weights
- What to do if symptoms return
S/S of Peripheral Arterial Disease (PAD)
- Thin, shiny, taught skin
- Loss of hair on lower legs
- Diminished/absent peripheral pulses
- Pallor of the feet, uneven peripheral pulses bi-lateral
- Symptom of PAD
- Pain caused by too little blood flow generally in legs when
Treatment for claudication
Walk 30-60 minutes per day or until pain discomfort begins
General care for PAD
- Protect from trauma
- Wear well-fitting shoes
- Avoid tight-fitting socks
- Inflammatory disease involving fingers where blood vessel become blocked
- Most often associated with smoking
- *Treatment is to stop smoking*
Causes of venous thrombosis
- *Prolonged immobility* and other stasis of blood
- Trauma to vein
What must be monitored with administration of Warfarin (Coumadin)?
How to diagnose HTN
Requires at least 3 elevated readings over several weeks
Lifestyle modification for pt.s with HTN
- *Self monitor BP*
- Weight loss
- Reduce sodium
- Regular physical activity
Medication education for HTN patients
- Names, actions, doses, side effects of all drugs
- Do not abruptly d/c
- Never double-up to account for a missed dose
- Watch for orthostatic hypotension
- Monitor OTC ingredients
Substances that shouldn’t be in urine
- Protein (trace amount ok)
- Blood (trace ok)
- Vasa Recta in kidneys detect a decrease in BP
- Low BP stimulates renin secretion
- Renin converts angiotensin to angiotensin I
- ACE from lungs converts angiotensin I to II
- Vasa Recta senses increase in BP and secretion of rennin ceases
Very little urine output (<30 mL/hr)
- Inflammation of the glomerular capillaries;
- Acute = acute nephritic syndrome
Clinical manifestations of Glomerulonephritis
- HTN, Weight loss, Azotemia
- *Dark red or “cola” colored urine
- *check daily weights*
Abnormally high levels of nitrogen-containing compounds in urine
Clinical manifestations of acute renal failure
- Oliguria(decrease lvl of urine output)
- Anuria (very little to no urine output)
- Azotemia (highlvl of nitrogen compounds in urine)
Types of urinary incontinence
- Stress- intacturethra (sneeze, laugh)
- Urge- strong urgebut unable to reach toilet in time
- Reflex- bladder empties w/o any control
- Overflow- weak muscle
- Functional- no muscle weakness, physical/mental limits
- Iatrogenic- incontinence effected by medication/intrinsic factors
Clinical manifestation of Nephrotic Syndrome
- Edema;periorbital, ascites
Common side effect of loop diuretics
- Depletion of water, sodium, potassium
- Postural hypotension
Atypical symptoms of acute Coronary Syndrome (ACS)
- Absencein pain
- Feelingsof doom
Phases of cardiac rehab
- Phase1: Inpatient; measures abilities, light walking, pt. & family education of lifestyle changes
- Phase2: Closely supervised ambulatory outpatient program
- Phase3: Lifetime maintenance
What is a distinguishing characteristic of dilated cardiomyopathy?
- Also know as congestive, the heart is enlarged and weak
- Ventricular dilation w/o increase size of muscle
- *Exertion dyspnea*
What are clinical manifestations of restrictive cardiomyopathy?
- Swollen feet/hands
- Dyspnea w/ exertion
Manifestation of Raynaud’s Disease
- Skin color goes;
- white --> blue --> red
How can you prevent complications of venous insufficiency?
- Elevate legs q2 hrs for15 min
- Sleepwith feet raised 6 inches
- Compression stockings
- Avoid prolonged sitting/ cross legs/ tight clothes & socks Monitorskin daily
Prevention of varicose veins
- Don’t stand for extended periods of time
- Walk to promote circulation
- Most common
- Unable to determine single cause for increase BP
What can you do to prevent UTI?
- *Drink plenty of fluids*
Clinical manifestations of UTI in elderly
- Confusion/altered mental status
Extracorporeal shock wave lithotripsy (ESWL)
- Non-invasive procedure that blasts kidney stones with shockwaves to break them up.
- Used for stones too large to pass through ureters
Patient teaching about Phosphorus-binding medications
Take with food
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