NR 324 Adult Health Exam 2

NR 324 Adult Health Exam 2 What is stroke volume - Amount of blood ejected with each heart beat What is cardiac output - Amount of blood pumped by each ventricle in 1 minute Normal 4-8 L/min Cardiac index - CO divided by body surface area Normal 2.8-4.2 L/min/m2 What regulates the cardiovascular ssytem - Autonomic nervous system, Baroreceptors, chemoreceptors What are the Gerontological Consideration - Risk for cardiovascular disease (CVD) increases with age. CVD leading cause of death in adults 85 What are some age related changes - Increased collagen, decreased elastin Decreased response to stress Heart valves become thick and stiff. Number of pacemaker cells decrease. Decreased number and function of β-adrenergic receptors Blood vessels thicken and less elastic Increase in SBP and decrease or no change in DBP Incompetent venous valves Orthostatic hypotension Postprandial hypotension What are some subjective data for cardiovascular system - History of present illness Past health history Past and current medications Surgery or other treatments What are some objective data for cardiovascular system - Vital signs Peripheral vascular system Inspection Palpation Auscultation When taking orthrostatic BP you should never - have a difference of 20 mm Example ( laying 120/80, sitting 160/100 ) What is BMP - ( B-type natriuretic peptide) will be increased in there is heart failure What are the cholesterol level - Total cholesterol 200 LDL- (bad) 130 HDL-( happy ) 40 What are the nursing responsibility for cardiac cath - check site, lay flat, log roll, check pulses, Bed rest for 2 hours How much sodium should a cardio patient get in 24 hours - 2300 grams What are the cardiac biomarkers ( troponin) - Troponin T (cTnT) Troponin I (cTnI) Rises within 4-6 hours, peaks 10-24 hours, detected for up to 10-14 days What are the cardiac biomarkers ( creatine kinase ( CK) - Three isoenzymes CK-MB cardiac specific Rises in 3-6 hours, peaks in 12-24 hours, returns to baseline within 12-48 hours Cardiac catheterization - Right-sided to measure pressures Left-sided to evaluate coronary arteries How do the Baroreceptors Factors Influencing BP - Sensitive to stretching Send impulses to sympathetic vasomotor center Blood pressure (BP) - the force exerted by the blood against the walls of the blood vessel, is primarily a function of cardiac output (CO) and systemic vascular resistance. What is the Systolic BP - the force exerted by the blood against the walls of the blood vessel What is the Diastolic BP - pressure in the arterial system during ventricular filling What is a normal BP - 120 /80 What is prehypertension - 120/139/80-89 What is hypertension stage 1 - 140-149/90-99 What is hypertension stage 2 - 160/100 What are the sign and symptoms of Hypertension - "Silent killer", Often asymptomatic S/S reflect effects on target organs/tissues Fatigue , Activity intolerance, Dizziness, Palpitations, Angina Dyspnea What kind of studies are done for hypertension - Urinalysis, BUN and serum creatinine, Creatinine clearance Serum electrolytes, glucose, Serum lipid profile, Uric acid levels, ECG, Echocardiogram What does MAP mean - it is the average pressure in the arterial system if the mean 60mm HG for adequate tissue prefusion Primary (essential or idiopathic) hypertension - elevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension. Secondary hypertension - elevated BP with a specific cause that often can be identified and corrected. relates to a underlying cause What is Coronary artery disease - a type of blood vessel disorder that is included in the general category of atherosclerosis What are the clinical manifestation of a hypertension crisis - Hypertensive encephalopathy, Headache, n/v, seizures, confusion, coma, Renal insufficiency Cardiac decompensation, MI, HF, pulmonary edema Aortic dissection What are the nursing /collaborative management for hypertension crisis - Hospitalization, IV drug therapy: titrated to MAP Monitor cardiac and renal function, Neurologic checks Determine cause, Education to avoid future crisis What is a Hypertensive crisis - term used to indicate either a hypertensive urgency or emergency, develops over hours or days and BP is severely elevated 220-140 What is a Hypertensive urgency - develops over days to weeks. This is a situation in which a patient's BP is severely elevated (usually above 180/110 mm Hg) but there is no clinical evidence of target organ disease. What is Atherosclerosis - major cause of CAD - lipids within the artery. C-reactive protein is produced by the liver and is a nonspecific marker of inflammation and can be increased in patients with CAD. Define Hypertension - a persistent systolic BP (SBP) ≥140 mm Hg, diastolic BP (DBP) ≥90 mm Hg, or current use of antihypertensive drug. Define prehypertension - Systolic BP: 120 to 139 mm Hg Diastolic BP: 80 to 89 mm Hg What is Primary (essential or idiopathic) hypertension - is an elevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension. What are some contributing factors for hypertension - increased SNS activity, overproduction of sodium-retaining hormones and vasoconstricting substances, increased sodium intake, greater than ideal body weight, diabetes mellitus, tobacco use, and excessive alcohol consumption What are the risk factors for primary hypertension - Age, Alcohol, Tobacco use, Diabetes mellitus, Elevated serum lipids ,Excess dietary sodium, Gender, obesity, sedentary lifestyle What are the clinical manifestation of hypertension - Fatigue, Dizziness, Palpitations, Angina, Dyspnea What are some complication of Hypertension - are target organ diseases occurring in the heart (hypertensive heart disease), brain (cerebrovascular disease), peripheral vessels (peripheral vascular disease), kidneys (nephrosclerosis), and eyes (retinal damage). What are some Collaborative Care for hypertension - Control blood pressure Reduce CVD risk factors and target organ disease Lifestyle modifications, directed toward reducing the patient's BP and overall cardiovascular risk, are indicated for all patients with prehypertension and hypertension. What drug therapy and patient teaching can you do - Follow-up care Identify, report, and minimize side effects Orthostatic hypotension Sexual dysfunction Dry mouth Frequent urination Time of day to take drug What are some nursing Nursing Implementation - Primary prevention via lifestyle modification Individual patient evaluation and education Screening programs Cardiovascular risk factor modification Coronary artery disease (CAD) - is the most common type of cardiovascular disease and accounts for the majority of these deaths. What is atherosclerosis - comes from two Greek words: athere, meaning "fatty mush," and skleros, meaning "hard." This combination indicates that atherosclerosis begins as soft deposits of fat that harden with age. C-reactive protein (CRP), - a protein produced by the liver, is a nonspecific marker of inflammation. Chronic elevations of CRP are associated with unstable plaques and the oxidation of low-density lipoprotein (LDL) cholesterol, further contributing to atherosclerosis. The incidence of CAD and MI - is highest among white, middle-aged men What are the Modifiable risk factors for CAD - include elevated serum lipids, elevated blood pressure, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states, and elevated homocysteine level. Elevated Serum Lipids - is one of the four most firmly established risk factors for CAD What is the second most modifiable risk factors in CAD - Hypertension Management of High-Risk Persons - Recommend preventive measures for all persons at risk for CAD. Risk factors such as age, gender, ethnicity, and genetic inheritance cannot be modified. Collaborative and Nursing Management: CAD ( nutrition) - ↓ Saturated fats and cholesterol ↑ Complex carbohydrates and fiber ↓ Red meat, egg yolks, whole milk ↑Omega-3 fatty acids The incidence of cardiac disease is greatly increased - in older adults and is the leading cause of death in older persons. myocardial ischemia - the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen Angina, or chest pain, - is the clinical manifestation of reversible myocardial ischemia. Either an increased demand for oxygen or a decreased supply of oxygen can lead to myocardial ischemia. Angina - is rarely sharp or stabbing, and it usually does not change with position or breathing. What are the Clinical Manifestations of CAD Angina Pain - Pressure/ache Indigestion or burning Squeezing, heavy, choking, or suffocating sensation can radiate to shoulder, down the arm , jaw, neck What are the Clinical Manifestations of CAD ( Chronic Stable Angina) - refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms. only last 5-15 min What is Silent ischemia - ischemia that occurs in the absence of any subjective symptoms. Patients with diabetes have an increased prevalence of silent ischemia because of nerve damage Nocturnal angina - Occurs only at night but not necessarily during sleep Angina decubitus - Chest pain that occurs only while lying down Relieved by standing or sitting Chronic Stable Angina Collaborative Care - Goal: ↓ O2 demand and/or ↑ O2 supply Short-acting nitrates Dilate peripheral and coronary blood vessels Give sublingually (tablet) or by spray If no relief in 5 minutes, call EMS; if some relief ,repeat every 5 minutes for maximum 3 doses Patient teaching Can use prophylactically Long-acting nitrates - To reduce angina incidence Main side effects: headache, orthostatic hypotension Methods of administration Oral Nitroglycerin (NTG) ointment Transdermal controlled-release NTG Patient with chronic stable angina with a high or low risk CAD - need to take a ACE inhibitors , These drugs result in vasodilation and reduced blood volume It is recommended that patients with left ventricular dysfunction, elevated BP, or who have had an MI - start and continue β-adrenergic blockers indefinitely, These drugs decrease myocardial contractility, HR, SVR, and BP, all of which reduce the myocardial oxygen demand. What kind of test do you do on a patient with a history of CAD - Chest x-ray, Laboratory studies, 12-lead ECG, Calcium-score screening heart scan, Echocardiogram , Exercise stress test Pharmacologic nuclear imaging What is a stent - is an expandable meshlike structure designed to keep the vessel open by compressing the arterial wall. What is a STEMI - total occlusion of coronary artery What is a non -STEMI - partial occlusion of coronary artery- What does ACS mean - Acute Coronary Syndrome What is ACS associated with - deterioration of a once stable atherosclerotic plaque. The once stable plaque ruptures, exposing the intima to blood and stimulating platelet aggregation and local vasoconstriction with thrombus formation. This unstable lesion may be partially occluded by a thrombus NSTEMI) or totally occluded by a thrombus STEMI). Unstable angina - is chest pain that is new in onset, occurs at rest, or has a worsening pattern. The patient with chronic stable angina may develop UA( unstable angina), or UA may be the first clinical sign of CAD. UA is unpredictable and is an emergency How does a myocardial infarction (MI) occur - because of sustained ischemia, causing irreversible myocardial cell death (necrosis). Explain how a MI occurs - Result of sustained ischemia (20 minutes), causing irreversible myocardial cell death (necrosis) 80%-90% secondary to thrombus Ischemia starts in subendocardium Necrosis of entire thickness of myocardium takes 4 to 6 hours Loss of contractile function What are the sign and symptoms of ACS - Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration Heaviness, pressure, tightness, burning, constriction, crushing, Substernal, retrosternal, epigastric, Common locations: substernal, retrosternal, or epigastric areas; pain may radiate to neck, jaw, arms, More common in AM, Atypical in women, elderly No pain if cardiac neuropathy (diabetes) What is the initial phase of MI - Catecholamine release - stimulation of SNS Release of glycogen, Diaphoresis Vasoconstriction of peripheral blood vessels Skin: ashen, clammy, and/or cool to touch What is the most common complication of MI - Dysrhythmias, Present in 80% of MI patients Can be caused by ischemia, electrolyte imbalances, or SNS stimulation, Life-threatening dysrhythmias seen most often with anterior MI, heart failure, or shock Complication of Mycocardial infarction - Heart failure, Occurs when the pumping power of the heart is reduce , can be subtle or severe Cardiogenic shock - occurs when oxygen and nutrients supplied to the tissues are inadequate because of severe left ventricular failure. Has high mortality rate Serum cardiac markers - are proteins released into the blood from necrotic heart muscle after an MI. Very important in the dx of MI Cardiac-specific troponin - cardiac-specific troponin T (cTnT) , cardiac-specific troponin I (cTnI). markers are highly specific indicators of MI specificity for myocardial injury , increase 4 to 6 hours after the onset of MI, peak at 10 to 24 hours, and return to baseline over 10 to 14 days What are the collaborative care Acute Coronary Syndrome - Initial interventions,12-lead ECG,Semi-fowler's position Oxygen,IV access ,Nitroglycerin (SL) and ASA (chewable) Morphine ( MONA) Treat dysrhythmias, Frequent vital sign monitoring Nursing Management Chronic Stable Angina and (ACS) - CAD/chest pain/angina/ MI Valve disease Heart failure/cardiomyopathy, Hypertension, diabetes, anemia, lung disease, hyperlipidemia, Drugs, History of present illness What are the Nursing management for ACS - Pain: nitroglycerin, morphine, oxygen Continuous monitoring ECG ST segment Heart and breath sounds VS, pulse oximetry, I&O Rest and comfort Balance rest and activity Begin cardiac rehabilitation What are the n nursing management for ACS Evaluation - Stable vital signs Relief of pain Decreased anxiety Realistic program of activity Effective management of therapeutic regimen What is heart failure - An abnormal clinical syndrome involving inadequate cardiac pumping/filling Insufficient blood supply/oxygen to tissues Used to be called congestive heart failure (CHF) Heart failure is associated with - numerous types of cardiovascular diseases, particularly long-standing hypertension, coronary artery disease (CAD), and myocardial infarction (MI). What are the primary risk factors for Heart Failure - Hypertension CAD What are the contributing factors in Heart Failure - Advanced age, Diabetes, Tobacco use, Obesity High serum cholesterol What are the primary causes of Heart Failure - Coronary artery disease, including myocardial infarction Hypertension, including hypertensive crisis Rheumatic heart disease Congenital heart defects (e.g., ventricular septal defect) Pulmonary hypertension Cardiomyopathy (e.g., viral, postpartum, substance abuse) Hyperthyroidism Valvular disorders (e.g., mitral stenosis) Myocarditis What does cardiac output (CO) depend on - 1) preload, (2) afterload, (3) myocardial contractility, and (4) heart rate (HR). What are the two classification of Heart Failure - Systolic versus diastolic Left-sided versus right-sided Pathophysiology of Systolic HF - Inability to pump blood forward Caused by Impaired contractile function (MI) Increased after-load ( hypertension) Cardiomyopathy ( Valvular heat disease) Mechanical abnormalities ( Valvular heat disease) Decreased left ventricular ejection fraction (EF, amount of blood ejected from the LV with each contraction) Pathophysiology of Diastolic HF - Impaired ability of the ventricles to relax and fill during diastole, resulting in decreased stroke volume and CO Heart failure with normal EF Result of left ventricular hypertrophy from hypertension, (Most common) MI, valve disease, or cardiomyopathy What are the Etiology and Pathophysiology of Coronary Artery Disease - Atherosclerosis is the major cause of CAD. It is characterized by deposits of lipids within the intima of the artery. Endothelial injury and inflammation play a central role in the development of atherosclerosis. What are the complication of Coronary Artery Disease (Peripheral Vascular Disease (PVD) ) - HTN speeds up atherosclerosis,Intermittent claudication Muscle pain during activity, relieved by rest Caused by ischemia What are the complication of Coronary Artery Disease (Nephrolsclerosis) - Reduced blood flow to kidneys 2° to reduced vessels lumen. Decreased perfusion leading to end-stage renal disease What are the most common complications of hypertension - target organ diseases occurring in the heart (hypertensive heart disease), brain (cerebrovascular disease), peripheral vessels (peripheral vascular disease), kidneys (nephrosclerosis), and eyes (retinal damage). What is collateral circulation - With the gradual increase in the size of lesions the body creates new pathways for the blood Very slow process Physiological response to ischemia Does not fully replace lost volume What are some nonmodifiable CAD risk factors - Age, Gender, (Males females), Ethnicity, (Whites African Americans), Genetic Predisposition What are some modifiable CAD risk factors - Hyperlipidemia, HTN, DM, Smoking, Physical inactivity, Obesity What are the manifestation of CAD ( Chronic Stable Angina) - Chest pain noted on exertion or with any activity that causes myocardial O2 demand. Due to CAD blood vessel cannot meet the demand. Pain that generally lasts less than 5 minutes. Pain resolves when Precipitating factor is removed What are the Diagnostic Tests test that can be done for CAD - History and Physical examination Bilateral BP measurements Ensure appropriate cuff is used, take minimum of 2 readings Lab studies, UA, creatinine clearance, Electrolytes, BUN, glucose, creatinine,ECG, Echocardiogram What is the Collaborative and Nursing Management: CAD - Lipid-lowering drug therapy, Fibric acid derivatives (Lopid) Decrease triglycerides and increase HDL, GI side effects Antiplatelet therapy , ASA, Clopidogrel (Plavix) What are the Clinical Manifestations of ACS Unstable Angina - New in onset, Occurs at rest, Worsening pattern, Increase in frequency, Unpredictable, Medical emergency, Symptoms in women may be more vague . UA is unpredictable and is an emergency. What is the immediate treatment of MI - M: Morphine O: oxygen N: Nitroglycerin A: ASA or Plavix What is Heart Failure - An abnormal clinical syndrome involving inadequate cardiac pumping/filling Insufficient blood supply/oxygen to tissues Used to be called congestive heart failure (CHF) What are the Contributing risk factors in Heat Failure - Advanced age, Diabetes, Tobacco use, Obesity, High serum cholesterol What is Systolic Failure Heart Failure - LV unable to contract properly due to cardiomyopathy or necrotic tissue Increased afterload Hallmark will be decreased ejection fraction (EF) EF = percentage of end diastolic blood volume that is ejected during systole Normal for adult is 55-70% What is Diastolic Failure Heart Failure - Decreased ability of ventricles to relax and allow filling Leads to decreased stroke volume/CO High filling pressure 2° to non compliant ventricles What is Left side Heart Failure - losess the ability to pump , move o2 from the lungs to LA and than to LV to the heart this this the larger chamber What are the symptoms of L sided Heart failure - pulmonary edema( crackles) Dyspnea Frothy pink tinged sputum S3 S4heart sounds What is R sided Heart failure - RV heart failure happens as a result of L side failure. when LV fails increased fluid pressure transfer back through the lungs - damaging the heart r side. blood back up into the veins and swelling , congestion in legs, abdomen, GI tract and liver occur What are the symptoms of R sided Heart failure - edema in legs and ankles, pulmonary edema, JVD, weight gain, What are the clinical manifestation of Heart Failure - Dependent on age, underlying type and extent of heart disease, and which ventricle is affected FACES Fatigue Limitation of Activities Chest congestion/cough Edema Shortness of breath