NSG 533 Exam 3 Queries And Solutions (Verified 100% correctly) Latest Version

NSG 533 Exam 3 Queries And Solutions (Verified 100% correctly) Latest Version Universal stages of Heart Failure (HF) - answers - At-risk for HF - Pre HF - HF - Advanced HF According to the universal definition, what is "at-risk for HF"? - answers - do not have HF, but at risk - no current or prior s/s - no structural, functional, or biomarker evidence supporting HF According to the universal definition, what is "HF" - answers - clinical syndrome - current or prior s/s of HF - caused by structural of functional cardiac abnormality - elevated natriuretic peptide levels - evidence of pulmonary or systemic congestion Who is most at risk for HF - answers black males and females; older women Two biggest causes of HF - answers 1. Ischemic heart disease (CAD) 2. HTN Calculate EF - answers SV/LVEDV Synonym for inotropy - answers contraction (hfref) Synonym for lusitropy - answers relaxation (hfpef) Two organizations for classification of HF - answers 1. American Heart Assocation (A,B,C,D) - based on structure 2. New York Heart Association (None, I, I, II, III, IV, V) - based on physical activity limitations How to distinguish cardiac dysfunction versus cardiac HF - answers cardiac dysfunction has structural abnormalities w/o symptoms Once a patient develops symptoms along with structural abnormalities, they have HF Compensatory mechanisms for HF - answers 1. Hemodynamics (Frank Starling Law) - can give inotropes as short term use to increase contractility (long-term can cause mortality) 2. SNS activation (increase contractility, tachycardia, vasoconstriction) 3. RAAS activation (angiotensin II binds to AT 1 Receptor - vasoconstriction) Two types of angiotensin II - answers 1. Circulating 2. Tissue-derived Effects of circulating angiotensin II on HF - answers - causes vasoconstriction - increases secretion of ADH - increase aldosterone secretion - increases sodium reabsorption Are aldosterone levels high or low in HF? - answers 20x higher than normal Effects of aldosterone on HF - answers - increases sodium and water reabsorption - decreased potassium and magnesium - decreased baroreceptor reflex - sympathetic activation List the comprehensive risk factors of Coronary Artery Disease - answers - dyslipidemia - genetic studies - modifiable risk factors - non-modifiable risk factors - novel risk factors What are two classes of medications an individual with hfref will be started on? - answers 1. Beta blocker (to counter SNS) 2. Acei (to counter RAAS) What hormones worsen HF - answers - Angiontensin II (RAAS) - catecholamines (SNS) - endothelin - aldosterone Hormones that are good for HF - answers - natriuretic peptides (ANP, BNP, CNP) - adrenmedullin - bradykinin - nitric oxide Types of ventricular remodeling - answers - concentric (thickened heart wall, diastolic HF, too stiff, hfpef) - eccentric (thin heart wall, systolic HF, contraction dysfunction, hfref) Blood flow of the heart from right side to left side - answers 1. Deoxygenated blood from the systemic system enters the superior/inferior vena cava 2. Right atrium 3. Tricuspid valve 4. Right ventricle 5. Pulmonary valve 6. Pulmonary artery 7. Lungs where blood is oxygenated 8. Pulmonary veins 9. Left atrium 10. Mitral/bicuspid valve 11. Left ventricle 12. Aortic valve 13. Aorta 14. Oxygenated blood to the systemic system S/s right sided HF - answers - jugular vein distension - edema - ascites - hepatomegaly S/s left sided HF - answers - pulmonary congestion - SOB - Crackles - orthopnea Two types of left sided HF - answers hfref (systolic) Hfpef (diastolic) Endothelial dysfunction - answers loss of the ability to vasodilate; imbalance of vasoconstrictors (endothelin) and vasodilators (nitric oxide) Effect of neprilysin - answers degrades BNP (arni can help - LCZ696) Hfpef criteria - answers impairment in: - filling - relaxation - LA pressures Myocardial remodeling hfpef vs hfref - answers hfpef: dysfunction is d/t comorbidities and inflammatory markers coming in contact with the endothelium Hfref: dysfunction is d/t damage within the actual myocyte What can elevated BNP also be confused with? - answers HF or renal failure