Exam 2 NR 545

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Exam 2 NR 545

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2024/2025

Institution NR 545

Course NR 545

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Chest Pain AKA Angina Patho: Chest pain associated with decreased blood flow or ischemia to the myocardial tissue. Chest pain PA Physical Assessment: chest heaviness Pressure Squeezing Fullness Pain radiates to left shoulder, arm, or jaw. Elevation of blood pressure during attack Chest pain Pharm : Nitroglycerin- relaxes and widens blood vessels Dosing: 0.3-0.6mg every 5 minutes for max of 3 doses Long-term treatment to consider: ACE Inhibitors & Beta-Blockers Chest pain Risks and complications: Acute Coronary Syndrome Myocardial Infarction blood flow to the heart is minimized. Buildup of cholesterol MI Patho imbalance between myocardial oxygen supply and demand Prolonged for greater than 30 minutes can lead to cardiac tissue death. MI PA Pain at rest Not relieved with nitro Lightheaded Impending doom Nausea Diaphoresis Wheezing MI Dx Troponins elevated, often stay elevated for one week after infarction. EKG- ST elevation or new left bundle branch block Atherosclerosis when blood vessels that carry oxygen to organs and tissues is restricted. Hardening of vessels from buildup of fats, cholesterol in the artery walls Happens gradually. Formed plaque can break off and burst, triggering a blood clot. Atherosclerosis patho inflammatory process that begins with damage to the endothelium often result of HTN, smoking, high cholesterol, or other risk factors. Fatty streak to fibrous plaque and then complicated lesion Atherosclerosis PA modifiable risk factors Fluid retention Fatigue Neck vein distension Edema Calf pain Atherosclerosis Dx Dx: Stress tests Chest Xray EKG Ankle-Brachial Index to assess blood pressure in the extremities. Atherosclerosis Pharm Pharm: Antiplatelets (Aspirin) Statins- reduce inflammation. ACE Inhibitor- relax blood pressure and reduce work and pressure on heart. Can be treated with lifestyle management. Heart Failure complex clinical syndrome that results from structural or functional impairment of ventricular or ejection of blood, which in turn leads to the cardinal clinical symptoms of dyspnea and fatigue, edema, and rales. Heart Failure PA Pre-existing conditions such as diabetes, liver failure, renal disease, anemia. Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea (PND), nocturnal angina, Cheyne-Stokes respirations (ask families or caretaker) Fatigue, lethargy, decreased functional capacityPatient takes medications as directed, observing, and adhering to dietary requirements

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Exam 2 NR 545 ii ii ii

ChestiiPainiiAKAiiAnginaiiPatho:iiChestiipainiiassociatediiwithiidecreasediibloodiiflowiioriiischemiaiitoiit
heiimyocardialiitissue.
ChestiipainiiPA PhysicaliiAssessment:iichestiiheaviness
Pressure
Squeezing
Fullness
Painiiradiatesiitoiileftiishoulder,iiarm,iioriijaw.
Elevationiiofiibloodiipressureiiduringiiattack
ChestiipainiiPharmii:iiNitroglycerin-iirelaxesiiandiiwidensiibloodiivessels
Dosing:ii0.3-0.6mgiieveryii5iiminutesiiforiimaxiiofii3iidoses
Long-termiitreatmentiitoiiconsider:iiACEiiInhibitorsii&iiBeta-Blockers
ChestiipainiiRisksiiandiicomplications:iiAcuteiiCoronaryiiSyndrome
MyocardialiiInfarction bloodiiflowiitoiitheiiheartiiisiiminimized.
Buildupiiofiicholesterol
MIiiPatho imbalanceiibetweeniimyocardialiioxygeniisupplyiiandiidemand
Prolongediiforiigreateriithanii30iiminutesiicaniileadiitoiicardiaciitissueiideath.
MIiiPA Painiiatiirest
Notiirelievediiwithiinitro
Lightheaded
Impendingiidoom
Nausea
Diaphoresis
Wheezing
MIiiDx Troponinsiielevated,iiofteniistayiielevatediiforiioneiiweekiiafteriiinfarction.
EKG-iiSTiielevationiioriinewiileftiibundleiibranchiiblock
Atherosclerosis wheniibloodiivesselsiithatiicarryiioxygeniitoiiorgansiiandiitissuesiiisiirestricted.
Hardeningiiofiivesselsiifromiibuildupiiofiifats,iicholesteroliiiniitheiiarteryiiwalls
Happensiigradually.
Formediiplaqueiicaniibreakiioffiiandiiburst,iitriggeringiiaiibloodiiclot.
Atherosclerosisiipatho
inflammatoryiiprocessiithatiibeginsiiwithiidamageiitoiitheiiendotheliumiiofteniiresultiiofiiHTN,iis
moking,iihighiicholesterol,iioriiotheriiriskiifactors.
Fattyiistreakiitoiifibrousiiplaqueiiandiitheniicomplicatediilesion
AtherosclerosisiiPA modifiableiiriskiifactors
Fluidiiretention
Fatigue
Neckiiveiniidistension
Edema
Calfiipain
AtherosclerosisiiDx Dx:iiStressiitests
ChestiiXray
EKG
Ankle-BrachialiiIndexiitoiiassessiibloodiipressureiiiniitheiiextremities.

, AtherosclerosisiiPharm Pharm:iiAntiplateletsii(Aspirin)
Statins-iireduceiiinflammation.
ACEiiInhibitor-iirelaxiibloodiipressureiiandiireduceiiworkiiandiipressureiioniiheart.
Caniibeiitreatediiwithiilifestyleiimanagement.
HeartiiFailure
complexiiclinicaliisyndromeiithatiiresultsiifromiistructuraliioriifunctionaliiimpairmentiiofiiventric
ulariioriiejectioniiofiiblood,iiwhichiiiniiturniileadsiitoiitheiicardinaliiclinicaliisymptomsiiofiidyspneaiiandiifati
gue,iiedema,iiandiirales.
HeartiiFailureiiPA Pre-
existingiiconditionsiisuchiiasiidiabetes,iiliveriifailure,iirenaliidisease,iianemia.
Dyspneaiioniiexertion,iiorthopnea,iiparoxysmaliinocturnaliidyspneaii(PND),iinocturnaliiangina,iiCheyne
-Stokesiirespirationsii(askiifamiliesiioriicaretaker)
Fatigue,iilethargy,iidecreasediifunctionaliicapacityPatientiitakesiimedicationsiiasiidirected,iiobserving,ii
andiiadheringiitoiidietaryiirequirements.
Alcoholiioriitobaccoiiuse
HistoryiiofiirheumaticiiheartiidiseaseiioriiChaga'siidisease
Discomfortiiwheniilayingiidown.
Hypertension
Tachycardia
HFiiDx
CBC,iielectrolytes,iiBUN,iiserumiicreatinine,iihepaticiienzymes,iiandiiaiiurinalysisiitoiiscreeniifori
idiabetesiimellitus

FastingiilipidiipaneliiandiiTSH
B-typeiinatriureticiipeptideii(BNP)iiandiiN-Terminaliipro-BNPii(NT-
proBNP)iiareiireleasediifromiiaiifailingiiheartiiandiiaiisensitiveiimarkeriiforiitheiipresenceiiofiiHF
Neweriimarkers,iisolubleiiST-2,iiandiigalectin-3iiareiiusediitoiidetermineiitheiiprognosisiiofiiHFiipatients
ChestiiXrayiitoiishowiitheiisizeiiandiishapeiiofiitheiiheart,iiasiiwelliiasiipulmonaryiivasculature
Electrocardiogramii12-
lead;iiassessiiforiicardiaciirhythm,iiandiiifiiLViihypertrophyiiisiipresent,iiprioriiMI,iiQRSiiwidth.iiAiinormali
iECGiicaniiexcludeiianyiiLViisystoliciidysfunction.

Echocardiogramiitwo-dimensionalii(2-
D)iiassessmentiiofiiLViisizeiiandiifunction,iiasiiwelliiasiivalvulariifunctioniioriidysfunctioniiandiiwalliimoti
oniiabnormalitiesii(indicativeiiofiiprioriiMIiidamage).iiWithiiDoppleriicaniialsoiiassessiiRViisizeiiandiipul
monaryiipressuresiiforiievaluationiiandiimanagementiiofiicor-pulmonale.
MRIiiisiitheiigoldiistandardiiforiiassessingiiLViimassiiandiivolume
HFiiPharm Pharm:iiFirstiilineiipharmacologicaliimanagementiiofiiheartiifailureiiisiiasiifollows:

AsymptomaticiiTreatment:
AceiiInhibitorii-iiVenous/Arterialiivasodilation
-iiDrug/Dosing:iiEnalaprilii2.5mgiithreeiitimesiiaiiday

AngiotensiniiIIiiReceptoriiBlockerii-iiVenous/Arterialiivasodilation
-iiDrug/Dosing:iiLosartanii25-40mgiiperiiday

SymptomaticiiTreatment:
BetaiiBlockersii-iiBlocksiireceptorsiiofiiadrenergiciinervousiisystem

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Uploaded on: October 21, 2024
Number of pages: 10
Written in: 2024/2025
Type: Exam (elaborations)
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