Nu 372 Final Exam With Correct Answers
Angina |- |ANSWER |-chest |pain |brought |about |by |*myocardial |ischemia*
*Manifestations:*
-*Chest |Pain*: |substernal, |precordial, |may |*radiate |to |neck/arms/shoulders |or |jaw*
-Usually |lasts |*2-5 |minutes*
-Quality: |tight, |squeezing, |constricting, |heavy |sensation, |burning, |dull, |aching, |constant
-Dyspnea, |pallor, |tachycardia, |anxiety |and |fear, |indigestion, |nausea, |vomiting, |upper |back
|pain
-ECG |changes: |*T-wave |inversion |and |depressed |ST |segments* |(*inverted |T-wave |=
|myocardial |ischemia*)
*Treatment*:
-*Nitroglycerin*: |goal |is |to |reduce |oxygen |demand |and |increased |oxygen |supply |to |the
|myocardium
-*Organic |nitrates*: |short |and |long-term |forms, |used |to |treat |acute |angina |attacks |and
|prevent |angina
*Nursing |interventions*:
-know |when |the |angina |is |happening
-decrease |demands |of |O2 |needed |on |the |heart
-increase |effectiveness |of |medication
-reduce |anxiety
-patient |should |*stop |all |activity |and |sit |and |rest* |in |bed |(*semi-fowler |position*)
-*administer |oxygen* |2 |L/min |through |nasal |cannula
,-assess |patients |*pain, |vital |signs, |RR*
-*Tell |patient |to |carry |nitroglycerin |at |all |times*
Stable |angina |- |ANSWER |-Most |common |type
-Chest |pain |that |occurs |when |a |person |is |*active |or |under |severe |stress* |(cold, |etc.)
-Usually |*subsides |with |rest*
-*Treatment*: |nitrates, |reducing |stress/activity
*Clinical |Manifestations*: |angina |that |usually |occurs |when |work |of |the |heart |increased |by
|physical |exertion: |physical |activity, |emotion, |stress, |eating |a |heavy |meal, |exposure |to |cold
Unstable |angina |- |ANSWER |-Angina |that |is |*not |relieved |with |rest*
-Requires |*medical |intervention*
-Occurs |with |*increased |frequency, |severity, |and |duration*
-Pain |occurs |with |decreasing |level |of |activity |or |stress
-May |occur |when |the |patient |is |just |resting
-Patient |is |*at |risk |for |myocardial |infarction* |(MI)
*Clinical |manifestations*:
-*chest |pains* |during |periods |of |rest |or |very |little |activity
Nitroglycerin |- |ANSWER |*Short |acting |sublingual |Nitroglycerin*:
-Drug |of |choice |for |treating |acute |angina
-Takes |effect |in |*1-2 |minutes*
-Decreases |myocardial |workload |and |oxygen |demand
,-Make |sure |no |lesions/abrasions |under |the |tongue |that |could |effect |absorption
-*Do |not |swallow*: |could |cause |medicine |to |lose |its |effectiveness |if |it |enters |the |stomach
-*1 |sublingual |tablet* |dissolved |under |the |tongue |or |in |the |buccal |pouch |as |soon |as |angina
|begins. |*Repeat |every |5 |minutes*, |if |needed, |to |a |*maximum |of |three |doses* |within |a
15-minute |period. |Client |must |*call |for |medical |assistance* |if |angina |is |not |relieved |after
|third |dose
*Longer |acting |Nitroglycerin |prep*:
-comes |in |an |oral |tablet, |ointment, |or |transdermal |patches
-used |to |*prevent* |angina |attacks—*NOT |to |treat |acute* |attacks
-main |problem |is |*development |of |tolerance*
-*nitrate |free |periods* |can |limit |tolerance |by |scheduling |with |a |period |of |*8-10 |hrs* |per |day
-scheduled |to |give |*at |night* |when |patient |is |less |likely |to |experience |angina
*Transbuccal |administration*:
-Check |the |inside |of |the |patients |cheek |to |make |sure |there |are |*no |ulcerations |or |abrasions*
|that |could |interfere |with |the |absorption |of |the |drug
-Have |the |patient |*place |between |gums |and |cheek* |until |full |absorbed
-Do |not |swallow
-*Rotate |from |side |to |side |with |each |dose*
*Transdermal |administration*:
-discuss |the |administration |with |the |patient
-make |sure |the |patient |knows |to |*take |off |old |transdermal |patches |and |wash |the |area |before
|replacing |a |new |one* |to |prevent |severe |hypotension
-inform |patients |that |they |should |*label |in |big |writing |their |tubes* |to |prevent |someone |(or
|themselves) |from |using |it |as |hand |lotion |which |would |cause |drug |toxicity
, *Headache |is |common |side |effect |for |both |long |and |short |acting |nitrates*
Cardiomyopathy |- |ANSWER |-a |disease |that |affects |the |heart |muscle |and |its |ability |to
*pump* |effectively
-Heart |is |*enlarged* |and |the |walls |become |*thick |and |rigid*
*Complications*: |Heart |becomes |weaker |and |has |a |*hard |time |pumping |blood* |leading |to
*heart |failure |and |dysrhythmias*
*Causes*:
-*Acquired*: |develops |from |another |disease
-*Inherited*: |results |from |genetic |conditions |passed |from |parent |to |the |child
-*Idiopathic*: |unknown |why |it |happens
*Diagnostic |tests*:
-*Echocardiography*: |to |measure |the |*ejection |fraction*
-*Chest |X-ray*: |to |see |enlargement |of |heart
-*Cardiac |catheterization*: |to |view |inside |the |heart
*Management*:
*Pharmacological |therapy*:
-Ace |inhibitors, |calcium |channel |blockers, |beta |blockers, |Digoxin |(*slow |the |HR |down*)
-*Digoxin*: |monitor |for |hyper-contractile |pump
Angina |- |ANSWER |-chest |pain |brought |about |by |*myocardial |ischemia*
*Manifestations:*
-*Chest |Pain*: |substernal, |precordial, |may |*radiate |to |neck/arms/shoulders |or |jaw*
-Usually |lasts |*2-5 |minutes*
-Quality: |tight, |squeezing, |constricting, |heavy |sensation, |burning, |dull, |aching, |constant
-Dyspnea, |pallor, |tachycardia, |anxiety |and |fear, |indigestion, |nausea, |vomiting, |upper |back
|pain
-ECG |changes: |*T-wave |inversion |and |depressed |ST |segments* |(*inverted |T-wave |=
|myocardial |ischemia*)
*Treatment*:
-*Nitroglycerin*: |goal |is |to |reduce |oxygen |demand |and |increased |oxygen |supply |to |the
|myocardium
-*Organic |nitrates*: |short |and |long-term |forms, |used |to |treat |acute |angina |attacks |and
|prevent |angina
*Nursing |interventions*:
-know |when |the |angina |is |happening
-decrease |demands |of |O2 |needed |on |the |heart
-increase |effectiveness |of |medication
-reduce |anxiety
-patient |should |*stop |all |activity |and |sit |and |rest* |in |bed |(*semi-fowler |position*)
-*administer |oxygen* |2 |L/min |through |nasal |cannula
,-assess |patients |*pain, |vital |signs, |RR*
-*Tell |patient |to |carry |nitroglycerin |at |all |times*
Stable |angina |- |ANSWER |-Most |common |type
-Chest |pain |that |occurs |when |a |person |is |*active |or |under |severe |stress* |(cold, |etc.)
-Usually |*subsides |with |rest*
-*Treatment*: |nitrates, |reducing |stress/activity
*Clinical |Manifestations*: |angina |that |usually |occurs |when |work |of |the |heart |increased |by
|physical |exertion: |physical |activity, |emotion, |stress, |eating |a |heavy |meal, |exposure |to |cold
Unstable |angina |- |ANSWER |-Angina |that |is |*not |relieved |with |rest*
-Requires |*medical |intervention*
-Occurs |with |*increased |frequency, |severity, |and |duration*
-Pain |occurs |with |decreasing |level |of |activity |or |stress
-May |occur |when |the |patient |is |just |resting
-Patient |is |*at |risk |for |myocardial |infarction* |(MI)
*Clinical |manifestations*:
-*chest |pains* |during |periods |of |rest |or |very |little |activity
Nitroglycerin |- |ANSWER |*Short |acting |sublingual |Nitroglycerin*:
-Drug |of |choice |for |treating |acute |angina
-Takes |effect |in |*1-2 |minutes*
-Decreases |myocardial |workload |and |oxygen |demand
,-Make |sure |no |lesions/abrasions |under |the |tongue |that |could |effect |absorption
-*Do |not |swallow*: |could |cause |medicine |to |lose |its |effectiveness |if |it |enters |the |stomach
-*1 |sublingual |tablet* |dissolved |under |the |tongue |or |in |the |buccal |pouch |as |soon |as |angina
|begins. |*Repeat |every |5 |minutes*, |if |needed, |to |a |*maximum |of |three |doses* |within |a
15-minute |period. |Client |must |*call |for |medical |assistance* |if |angina |is |not |relieved |after
|third |dose
*Longer |acting |Nitroglycerin |prep*:
-comes |in |an |oral |tablet, |ointment, |or |transdermal |patches
-used |to |*prevent* |angina |attacks—*NOT |to |treat |acute* |attacks
-main |problem |is |*development |of |tolerance*
-*nitrate |free |periods* |can |limit |tolerance |by |scheduling |with |a |period |of |*8-10 |hrs* |per |day
-scheduled |to |give |*at |night* |when |patient |is |less |likely |to |experience |angina
*Transbuccal |administration*:
-Check |the |inside |of |the |patients |cheek |to |make |sure |there |are |*no |ulcerations |or |abrasions*
|that |could |interfere |with |the |absorption |of |the |drug
-Have |the |patient |*place |between |gums |and |cheek* |until |full |absorbed
-Do |not |swallow
-*Rotate |from |side |to |side |with |each |dose*
*Transdermal |administration*:
-discuss |the |administration |with |the |patient
-make |sure |the |patient |knows |to |*take |off |old |transdermal |patches |and |wash |the |area |before
|replacing |a |new |one* |to |prevent |severe |hypotension
-inform |patients |that |they |should |*label |in |big |writing |their |tubes* |to |prevent |someone |(or
|themselves) |from |using |it |as |hand |lotion |which |would |cause |drug |toxicity
, *Headache |is |common |side |effect |for |both |long |and |short |acting |nitrates*
Cardiomyopathy |- |ANSWER |-a |disease |that |affects |the |heart |muscle |and |its |ability |to
*pump* |effectively
-Heart |is |*enlarged* |and |the |walls |become |*thick |and |rigid*
*Complications*: |Heart |becomes |weaker |and |has |a |*hard |time |pumping |blood* |leading |to
*heart |failure |and |dysrhythmias*
*Causes*:
-*Acquired*: |develops |from |another |disease
-*Inherited*: |results |from |genetic |conditions |passed |from |parent |to |the |child
-*Idiopathic*: |unknown |why |it |happens
*Diagnostic |tests*:
-*Echocardiography*: |to |measure |the |*ejection |fraction*
-*Chest |X-ray*: |to |see |enlargement |of |heart
-*Cardiac |catheterization*: |to |view |inside |the |heart
*Management*:
*Pharmacological |therapy*:
-Ace |inhibitors, |calcium |channel |blockers, |beta |blockers, |Digoxin |(*slow |the |HR |down*)
-*Digoxin*: |monitor |for |hyper-contractile |pump
