NUR 2320 EXAM 2 MED SURG 3 BLUEPRINT
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, 1
Pink blue red yellow
AV Disorders & Aneurysms → 7-8 Q’s
Care of Patients w/ Cardiac Problems PPT
Iggy Ch. 35: Aortic Valve Disorders
Valvular Heart
Disease
Aortic stenosis: NARROWING valve Aortic regurgitation (insufficiency): LEAKY
● Hardens, not able to open & close
→ blood is not able to propel ● Leaflets are dilate, loose, or
FORWARD deformed
● Most common issue ○ Blood LEAKS backwards into LV
● “wear & tear” → Can occur due to during diastole
aging ○ Normally
● May live w/ this for long periods of ● Can cause LV hypertrophy
time, may not affect them until they ● Can be due to:
start to present w/ S&S ○ infectious endocarditis
● Obstructs LV outflow during systole ○ congenital abnormalities
○ Can cause LV hypertrophy ○ Hypertension
○ Creates high afterload ○ Marfan's syndrome
● CHF S&S ● CHF S&S d/t failure
○ Dyspnea ○ Nocturnal angina w/
○ Angina diaphoresis
○ Syncope on exertion ○ DOE
○ Fatigue ○ Orthopnea
○ Peripheral cyanosis ○ Palpitations
○ Murmur ○ Murmur
■ r/t valve not closing ○ Paroxysmal nocturnal dyspnea
properly ○ widened Pulse pressure
○ Narrowed pulse pressure ■ .Higher systolic and
■ r/t the heart resting less diminished diastolic
bc it is
contracting/working
harder to propel blood
forward.
○ Right sided HF → late in
disease
● Can be due to:
○ congenital issues
○ rheumatic disease
■ strep throat
Assessment
● Sudden illness onset or slowly developing symptoms over many years
● Ask about:
○ attacks of rheumatic fever
○ activity tolerance
○ infective endocarditis
○ possibility of IV drug abuse
● Echocardiogram
○ To visualize patency of valves
● Transesophageal echo
● Cardiac Cath
○ To visualize blood flow
, 2
● Stress test
● Chest x-ray
Management
● Diuretics
● B-Blockers
● Digoxin
● Oxygen
● Learn how to Balance rest & exercise
● Noninvasive valve repair
○ Valvuloplasty
● Minimally invasive
○ Tavr → Transcatheter aortic valve replacement
● Open heart
○ Repair or replace
Infective Defined
Endocarditis ● Microbial infection involving the endocardium (or heart valves)
Risk factors
● IV drug abusers
● Valve replacement recipients
● Systemic infections (ex. sepsis)
● Structural cardiac defects
● **
Signs & Symptoms
● Fever w/ chills
● Night sweats
● Malaise, fatigue
● Anorexia, wt loss
● Osler's nodes
● Murmur
● Heart failure
● Arterial embolization → can show up as a PE, stroke, etc.
● Neurologic changes → r/t clots
● Petechiae → showing up r/t emboli
Management
● Diagnostics
○ Positive blood cultures → 2 sets from 2 different sites to locate/confirm bacteria
○ New regurgitant murmur
○ Evidence of endocardial involvement by echocardiography
■ To try to visualize location of infection
● Nonsurgical
○ Meds: Antimicrobials
○ Activities balanced with adequate rest
● Surgical
○ Removal of infected valve
○ Repair or removal of congenital shunts
○ Repair of injured valves and chordae tendineae
○ Draining/ surgical removal of abscesses in heart or elsewhere r/t infection
■ prevents valves from working properly
AV Disorders & Aneurysms (Continued) → 7-8 Q’s
Care of Patients w/ Vascular Problems PPT
Iggy Ch. 36: Aneurysms 738-41
Arteriosclerosis
&
Arteriosclerosis Atherosclerosis
Atherosclerosis
● Thickening or hardening of arterial wall ● Type of arteriosclerosis
● Often associated with aging involving formation of plaque
, 3
● IF sped up d/t disease process or congenital within arterial wall
conditions → becomes concerning ● From cholesterol
● Try to minimize effects w/
cholesterol meds & exercise
● Usually affects larger arteries
→ where most blockages will
be
● Patho not totally understood:
thought to occur from blood
vessel damage that causes
inflammation
Nursing
● Monitor BP d/t high incidence in those with atherosclerosis
● Palpate pulses in all major sites of body & note differences
● Assess for:
○ temperature differences
○ prolonged capillary refill can indicate poor circulation
○ bruit = abnormal
■ The sound of blood trying to get through a narrowed pathway.
■ Heard in carotid, aortic, femoral, & popliteal.
Aneurysms of Aneurysm
Central Arteries ● Permanent localized dilation or out-pouching of artery
● Can enlarge artery to twice its normal diameter, “bubble-like”
● Can appear anywhere → including brain
○ Side effects depend on location
Causes
● Atherosclerosis common cause
● HTN, HLD, & Smoking
**
RUPTURE=Emergency
● why? → can bleed out FAST → All types need to be treated FAST
Types & Locations of Aneurysms
Dissecting ● Located on Aorta
(Aortic ○ As a result, blood does not flow forward/properly
Dissection) ● Caused by sudden tear in aortic lining
○ Trauma/Pressure causes a tear in the lining of the vessel
away from the outer layer & blood gets trapped btwn the
layers; less blood flows past the point where there is a tear
○ The “trapped” blood btwn the layers causes more pressure &
higher risk for rupture
○ Blood is now leaking
○ As aneurysm enlarges, blood flow to organs is diminished
● Pain described as:
○ **Tearing, ripping, stabbing
○ Location: Back, neck, chest, throat, jaw, teeth
● Patient may also complain of:
| STUDY GUIDE | QUESTIONS AND
ANSWERS | MED SURG EXAM PREP | 100%
VERIFIED | A+ GUARANTEE
Updated Questions and Answers | 100% Verified Exam Prep
, 1
Pink blue red yellow
AV Disorders & Aneurysms → 7-8 Q’s
Care of Patients w/ Cardiac Problems PPT
Iggy Ch. 35: Aortic Valve Disorders
Valvular Heart
Disease
Aortic stenosis: NARROWING valve Aortic regurgitation (insufficiency): LEAKY
● Hardens, not able to open & close
→ blood is not able to propel ● Leaflets are dilate, loose, or
FORWARD deformed
● Most common issue ○ Blood LEAKS backwards into LV
● “wear & tear” → Can occur due to during diastole
aging ○ Normally
● May live w/ this for long periods of ● Can cause LV hypertrophy
time, may not affect them until they ● Can be due to:
start to present w/ S&S ○ infectious endocarditis
● Obstructs LV outflow during systole ○ congenital abnormalities
○ Can cause LV hypertrophy ○ Hypertension
○ Creates high afterload ○ Marfan's syndrome
● CHF S&S ● CHF S&S d/t failure
○ Dyspnea ○ Nocturnal angina w/
○ Angina diaphoresis
○ Syncope on exertion ○ DOE
○ Fatigue ○ Orthopnea
○ Peripheral cyanosis ○ Palpitations
○ Murmur ○ Murmur
■ r/t valve not closing ○ Paroxysmal nocturnal dyspnea
properly ○ widened Pulse pressure
○ Narrowed pulse pressure ■ .Higher systolic and
■ r/t the heart resting less diminished diastolic
bc it is
contracting/working
harder to propel blood
forward.
○ Right sided HF → late in
disease
● Can be due to:
○ congenital issues
○ rheumatic disease
■ strep throat
Assessment
● Sudden illness onset or slowly developing symptoms over many years
● Ask about:
○ attacks of rheumatic fever
○ activity tolerance
○ infective endocarditis
○ possibility of IV drug abuse
● Echocardiogram
○ To visualize patency of valves
● Transesophageal echo
● Cardiac Cath
○ To visualize blood flow
, 2
● Stress test
● Chest x-ray
Management
● Diuretics
● B-Blockers
● Digoxin
● Oxygen
● Learn how to Balance rest & exercise
● Noninvasive valve repair
○ Valvuloplasty
● Minimally invasive
○ Tavr → Transcatheter aortic valve replacement
● Open heart
○ Repair or replace
Infective Defined
Endocarditis ● Microbial infection involving the endocardium (or heart valves)
Risk factors
● IV drug abusers
● Valve replacement recipients
● Systemic infections (ex. sepsis)
● Structural cardiac defects
● **
Signs & Symptoms
● Fever w/ chills
● Night sweats
● Malaise, fatigue
● Anorexia, wt loss
● Osler's nodes
● Murmur
● Heart failure
● Arterial embolization → can show up as a PE, stroke, etc.
● Neurologic changes → r/t clots
● Petechiae → showing up r/t emboli
Management
● Diagnostics
○ Positive blood cultures → 2 sets from 2 different sites to locate/confirm bacteria
○ New regurgitant murmur
○ Evidence of endocardial involvement by echocardiography
■ To try to visualize location of infection
● Nonsurgical
○ Meds: Antimicrobials
○ Activities balanced with adequate rest
● Surgical
○ Removal of infected valve
○ Repair or removal of congenital shunts
○ Repair of injured valves and chordae tendineae
○ Draining/ surgical removal of abscesses in heart or elsewhere r/t infection
■ prevents valves from working properly
AV Disorders & Aneurysms (Continued) → 7-8 Q’s
Care of Patients w/ Vascular Problems PPT
Iggy Ch. 36: Aneurysms 738-41
Arteriosclerosis
&
Arteriosclerosis Atherosclerosis
Atherosclerosis
● Thickening or hardening of arterial wall ● Type of arteriosclerosis
● Often associated with aging involving formation of plaque
, 3
● IF sped up d/t disease process or congenital within arterial wall
conditions → becomes concerning ● From cholesterol
● Try to minimize effects w/
cholesterol meds & exercise
● Usually affects larger arteries
→ where most blockages will
be
● Patho not totally understood:
thought to occur from blood
vessel damage that causes
inflammation
Nursing
● Monitor BP d/t high incidence in those with atherosclerosis
● Palpate pulses in all major sites of body & note differences
● Assess for:
○ temperature differences
○ prolonged capillary refill can indicate poor circulation
○ bruit = abnormal
■ The sound of blood trying to get through a narrowed pathway.
■ Heard in carotid, aortic, femoral, & popliteal.
Aneurysms of Aneurysm
Central Arteries ● Permanent localized dilation or out-pouching of artery
● Can enlarge artery to twice its normal diameter, “bubble-like”
● Can appear anywhere → including brain
○ Side effects depend on location
Causes
● Atherosclerosis common cause
● HTN, HLD, & Smoking
**
RUPTURE=Emergency
● why? → can bleed out FAST → All types need to be treated FAST
Types & Locations of Aneurysms
Dissecting ● Located on Aorta
(Aortic ○ As a result, blood does not flow forward/properly
Dissection) ● Caused by sudden tear in aortic lining
○ Trauma/Pressure causes a tear in the lining of the vessel
away from the outer layer & blood gets trapped btwn the
layers; less blood flows past the point where there is a tear
○ The “trapped” blood btwn the layers causes more pressure &
higher risk for rupture
○ Blood is now leaking
○ As aneurysm enlarges, blood flow to organs is diminished
● Pain described as:
○ **Tearing, ripping, stabbing
○ Location: Back, neck, chest, throat, jaw, teeth
● Patient may also complain of:
