NURS 3366 Patho Exam 3 Latest Update With Verified Answers

NURS 3366 Patho Exam 3 Latest Update With Verified Answers S&S & patho of LHF - ANSWER Cardiogenic Pulmonary Edema: Crackles in the lungs, ↓SO2, Orthopnea, PND (Paroxysmal Nocturnal Dyspnea) Hemoptysis, SOB. ↓LV Contractility or MI of LV → weakens LV → ↑Afterload → ↑Preload → Preload pushes back from LV to LA to PV to PC to fill Alveolar →Cardiogenic Pulmonary Edema S&S & patho of RHF - ANSWER PVR: Liver Congestion, Ascites, Peripheral Edema, Low UO, Longer Capillary Refill, Fatigue, JVD, Confusion RV ↓ in Contractility or MI weakens RV ↑AFTERLOAD ↑ PRELOAD → RV to RA to SVC JUGULAR VEINS → JUGULAR VEIN DISTENTION or to IVC to PERIPHERY to LIVER CONGESTION & ASCITES & EDEMA OF LEGS & FEET S&S of COR PULMONALE - ANSWER Fatigue/ Weakness, SOB, Confusion, Hypotension, Low UO, Long Cap Refill. Peripheral Edema Chronic Bronchitis or Chronic Lung Disease that causes RHF Mucus & c ongestion fills the lungs lungs become very stiff → ↑ pressure in pulmonary vasculature → congestion & pressure makes it difficult for the RV to pump blood into PA an d lungs so → fluid backs up → RV to RA SVC & IVC to JVD, LIVER CONGESTION, ASCITIES, LEG EDEMA peripheral edema To DX CHF BY MEASURING: VS to dx mi by measuring: - ANSWER CHF:MEASUREMENT OF BNP NORMAL = 50 pg/ml MILD HF BNP = 130 SEVERE HF BNP = 1000 mi: measurement of troponin (measures injured cells in the myocardium) (or ck which measures injured cells all together) ↑titer = ↑severity on both TX CHF with - ANSWER positive inotropic drug - digoxin to ↑ Contraction vasodilator - NTG, ACE Inhibitors to ↓Resistance Diuretics to ↓Preload S&S & Patho of CARDIOGENIC SHOCK - ANSWER HEART RELATED ISSUES, VAVLE PROBLEMS, DYSRHYTHMIA, MI, HYPOTENSION, ETC → ↓ CONTRACTION → ↓ PERFUSION → IMPAIRS CELLULAR FXN → HYPOXIA OF CELLS → HYPOTENSION Hypotension, dyspnea ↓consciousness, ↓ +++.UO, Long Cap Refill, pale cool skin. TX of Cardiogenic Shock - ANSWER Positive inotropic drug to ↑contraction -DIGOXIN Peripheral vasodilator to ↓afterload to ↓resistance & vasodilate arteries. S&S & patho of Coronary Arterial DZ - ANSWER Ischemic Pain in ♥ = painful constriction/tight Duration of tightness - 3-5 min. Needs N TG Exacerbated w/ exercise. Lessens at Rest. Left arm pain, back pain and Jaw pain. Plaque occludes artery narrows & irritates it → inflammation ↑ C-Reactive Protein → ↓CO ischemic pain → Necrosis of heart tissue and cells = MI → ♥ is O2 deprived S&S of LCA - ANSWER Poor Perfusion : usual suspects: Diminished pulse, prolonged capillary refill, Pale Cool skin and delayed healing S&S & Patho of RCA - ANSWER Poor Perfusion : usual suspects: Diminished pu lse, prolonged capillary refill, Pale Cool skin and delayed healing. ↓HR ↓CO RV is affected → SA Node Bradycardia → PNS → affects digestion, urination, ↓HR ↓CO S&S of Angina - ANSWER Tight, heavy Indigestion like 3-5 mins, clears a fter NTG. Exacerbated w/exercise. Lessens at rest. Levine Sign - clench a fist over sternum. left arm, jaw & back pain Lactic Acid Build Up & Stretching of ischemic Myocardium → Irritates Myocardial Nerve Fibers NF transmit pain impulses to area of spinal tract C3-T4 le ft arm, jaw & back pain S&S & TX differences between Stable Angina Vs Unstable Angina - ANSW ER Stable: needs 1 NTG if S&S (Tight, chest. Exacerbated w/exercise. Lessens at r est. Levine Sign). TX: NTG & Aspirin Unstable: Needs 3 NTG to have pain go away plus EKG shows acute ischem ic changes. TX: ↑coronary patency. IV NTG, IV Morphine, Angioplasty Difference between Stable vs Unstable Angina - ANSWER Stable: Plaqu e slowly develops in coronary arter y → ischemia → Arteriogenesis COLLATERAL CIRCULATION → new coronaries Unstable: Worsening of ischemia. Acute Coronary Syndrome ACS.