NUR 504 Final Exam
Aneurysm - answer Forms in the middle layer of a weakened artery, then pushes on
outer layer
AAA is the most common
HTN is the biggest risk factor
CT scan is the best way to diagnose
Interventions → monitor BP, maintain BP
If size is less than 5 cm, monitor it and HTN management, if bigger than 5 cm or it is
producing symptoms then surgery can be done
Do not palpate or press down hard
Do not do an ultrasound because it will rupture it
aneurysmectomy - answer resection and repair - high mortality rate (old - however may
still be seen)
open up the patient, clamp the artery, stop the heart and have machine do the work
High mortality rate because it is a big surgery
Endovascular stent grafts - answer procedure of choice
Complications of repair:
•Conversion to open surgical repair
•Bleeding
•Aneurysm rupture
•Peripheral embolization (blood clot in peripherals)
•Misplacement of stent graft
•Endoleak (opens up and the stent has a leak)
Abdominal Aortic Aneurysm (AAA) - answerCommonly asymptomatic and frequently
rupture
Pain is gnawing quality, unaffected by movement, lasts hours/days
Abdominal, flank, back pain
DO NOT PALPATE THE MASS, RISK FOR RUPTURE
Check pulses distal to site, Cap refill, temperature, color
S/S of rupture of aneurysm - answerAssess for severe pain of sudden onset in the back
or lower abdomen à may radiate to groin buttocks or legs.
s/s of rupture: (hypovolemic shock)
•hypotension
,•diaphoresis
•decreased LOC
•Oliguria
•Loss of pulses distal to rupture
•Dysrhythmias
lack of oxygenated blood to brain (decreased LOC), kidneys will not make enough urine
(30 cc/hr) → decreased output
Thoracic Aneurysm - answerAsymptotic but found by accident
Back Pain, dyspnea, hoarseness, difficulty swallowing
Rupture → sudden back or chest pain
•Assess for signs of rupture
•Blood pressure control
•Frequent focused perfusion assessment
•Specifically blood pressure, pulses, and peripheral circulation
Check pulses → distal pulses
Aortic Dissection - answerEMERGENCY SITUATION, sudden tear in tissue
HTN is a big cause
Sharp, ripping, tearing, stabbing pain
N/V, impending doom feeling
Start with HTN, then go into low BP
Call for help, then give fluids/blood
endocarditis - answerMost common cause is infection in the valves
When blood stops → clots and infection risk (valves)
IVDA → IV drugs can cause the infections
New cardiac murmur from valve impairment
Systemic embolization → very small clots that clog smaller vessels
Petechiae on the skin !!!!!!!!!
Patients can go home with a PICC, for IV antibiotics
S/S → Development of Heart Failure, Fever, chills, night sweats, malaise and fatigue,
anorexia and weight loss, Cardiac murmur, Systemic embolization-clots break loose
and travel randomly through the systemic system leading to occlusion of smaller
vessels
Endocarditis Interventions - answer•Utilization of aseptic techniques
•Focused cardiovascular assessment
•Energy conservation - rest periods
•Anti-embolic stockings
•Monitor for signs of heart failure
Frequent assessment of mental status
,•IV antibiotics x4-6 weeks
•Central IV catheter care w/ aseptic technique
•Monitor for sign & symptoms of reoccurring or worsening infection
•Dental care (directly affects the heart, bacteria can go to the heart from mouth)
•Sign & Symptoms of embolic conditions and heart failure.
myocarditis - answerMost common cause is Viral diseases
Heart muscles cannot work properly, the ability to pump blood
Fluid is going to back up into body and lungs
S/S → Dyspnea, Orthopnea, Leg swelling, Palpitations, Syncope
•Focused CV assessment
•Hemodynamic monitoring
•Strict I& O
•Cluster care/bedrest
•Cardiac diet
myocarditis Medications - answerDiuretics → reduces volume to help heart pump
Ace Inhibitors → keeps BP down, help vasodilation and decrease resistance the heart
has to pump out, which can increase BP
Beta blockers → slows down heart to give heart more time to fill up
Inotropic → effects contractility, increase force of contraction, know they are working by
blood pressure increases, urine output increasing
pericarditis - answerInflammation of sac around the heart
Can lead to cardiac tamponade if it fills up too quickly
Friction rub → HALLMARK SIGN
Decreases amount of blood being pumped out because fluid around heart does not let
heart pump effectively
Substernal pain that radiates on the left side of neck to shoulder, worse when laid flat
Colchicine can be used to treat/prevent, NSAIDS for comfort
Pulsus Paradoxus (decrease in BP when breathing)
•Treatment of the underlying cause
•Pericardiocentesis: drainage of the fluid within the pericardial space.
•pericardiectomy - surgical excision of the pericardium
Cardiac tamponade - answerMEDICAL EMERGENCY, Take action IMMEDIATELY
Decreases cardiac output by fluid in the sac compressing the heart
Reduction in EF, less than 60%, reduces BP
Low urine output because of low BP
Becks Triad !!!!!!!!!
, Dobutamine → increases strength of contractility
•Pericardiocentesis Repeat echocardiogram should be completed within 24 hours post
procedures to assess for fluid reaccumulation
Beck's triad - answerhypotension, JVD, muffled heart sounds
HALLMARK sign for Cardiac Tamponade
Cardiomyopathy - answerChronic disease of heart muscle
Affects stroke volume and EF, amount of blood ejected from the LV
The body is not getting the blood and nutrients it needs all over the body
Monitor and improve cardiac output, monitor for HF and treat symptomatically
Dilated Cardiomyopathy - answerMost common
When the LV is very big, contractility is decreased, decreased stroke volume and
cardiac output, less blood going into the body
Can be asymptomatic for years because of compensation (tachycardia)
Left sided HF is the later symptoms
A fib, heart block, blood clots
Vasodilators → more difficult to push out against resistance, helps stop this resistance
Pacers, Heart Transplant, medication management
hypertrophic cardiomyopathy - answerEffects ability of the LV to fill with blood, not
enough space for blood to fill up, muscle is swollen
Problem during diastole, heart muscle doesn't get enough oxygen
Usually inherited and born with
Might hear a heart murmur
S/S → Syncope, Sudden cardiac death, Heart failure, Angina, Dyspnea, Fatigue,
Palpitations, Pulse irregularities, Ventricular dysrhythmias
restrictive cardiomyopathy - answerLV is chamber is small and blood gets pulled back
into the atria
LV cannot effectively pump blood into body, Stiff rigid muscle wall
No vasodilators for treatment
S/S → same as others
coronary artery bypass graft (CABG) - answerMost common surgery in older adults,
affects quality of life but not longevity
Occluded coronary arteries are bypassed by patients own vessels
Aneurysm - answer Forms in the middle layer of a weakened artery, then pushes on
outer layer
AAA is the most common
HTN is the biggest risk factor
CT scan is the best way to diagnose
Interventions → monitor BP, maintain BP
If size is less than 5 cm, monitor it and HTN management, if bigger than 5 cm or it is
producing symptoms then surgery can be done
Do not palpate or press down hard
Do not do an ultrasound because it will rupture it
aneurysmectomy - answer resection and repair - high mortality rate (old - however may
still be seen)
open up the patient, clamp the artery, stop the heart and have machine do the work
High mortality rate because it is a big surgery
Endovascular stent grafts - answer procedure of choice
Complications of repair:
•Conversion to open surgical repair
•Bleeding
•Aneurysm rupture
•Peripheral embolization (blood clot in peripherals)
•Misplacement of stent graft
•Endoleak (opens up and the stent has a leak)
Abdominal Aortic Aneurysm (AAA) - answerCommonly asymptomatic and frequently
rupture
Pain is gnawing quality, unaffected by movement, lasts hours/days
Abdominal, flank, back pain
DO NOT PALPATE THE MASS, RISK FOR RUPTURE
Check pulses distal to site, Cap refill, temperature, color
S/S of rupture of aneurysm - answerAssess for severe pain of sudden onset in the back
or lower abdomen à may radiate to groin buttocks or legs.
s/s of rupture: (hypovolemic shock)
•hypotension
,•diaphoresis
•decreased LOC
•Oliguria
•Loss of pulses distal to rupture
•Dysrhythmias
lack of oxygenated blood to brain (decreased LOC), kidneys will not make enough urine
(30 cc/hr) → decreased output
Thoracic Aneurysm - answerAsymptotic but found by accident
Back Pain, dyspnea, hoarseness, difficulty swallowing
Rupture → sudden back or chest pain
•Assess for signs of rupture
•Blood pressure control
•Frequent focused perfusion assessment
•Specifically blood pressure, pulses, and peripheral circulation
Check pulses → distal pulses
Aortic Dissection - answerEMERGENCY SITUATION, sudden tear in tissue
HTN is a big cause
Sharp, ripping, tearing, stabbing pain
N/V, impending doom feeling
Start with HTN, then go into low BP
Call for help, then give fluids/blood
endocarditis - answerMost common cause is infection in the valves
When blood stops → clots and infection risk (valves)
IVDA → IV drugs can cause the infections
New cardiac murmur from valve impairment
Systemic embolization → very small clots that clog smaller vessels
Petechiae on the skin !!!!!!!!!
Patients can go home with a PICC, for IV antibiotics
S/S → Development of Heart Failure, Fever, chills, night sweats, malaise and fatigue,
anorexia and weight loss, Cardiac murmur, Systemic embolization-clots break loose
and travel randomly through the systemic system leading to occlusion of smaller
vessels
Endocarditis Interventions - answer•Utilization of aseptic techniques
•Focused cardiovascular assessment
•Energy conservation - rest periods
•Anti-embolic stockings
•Monitor for signs of heart failure
Frequent assessment of mental status
,•IV antibiotics x4-6 weeks
•Central IV catheter care w/ aseptic technique
•Monitor for sign & symptoms of reoccurring or worsening infection
•Dental care (directly affects the heart, bacteria can go to the heart from mouth)
•Sign & Symptoms of embolic conditions and heart failure.
myocarditis - answerMost common cause is Viral diseases
Heart muscles cannot work properly, the ability to pump blood
Fluid is going to back up into body and lungs
S/S → Dyspnea, Orthopnea, Leg swelling, Palpitations, Syncope
•Focused CV assessment
•Hemodynamic monitoring
•Strict I& O
•Cluster care/bedrest
•Cardiac diet
myocarditis Medications - answerDiuretics → reduces volume to help heart pump
Ace Inhibitors → keeps BP down, help vasodilation and decrease resistance the heart
has to pump out, which can increase BP
Beta blockers → slows down heart to give heart more time to fill up
Inotropic → effects contractility, increase force of contraction, know they are working by
blood pressure increases, urine output increasing
pericarditis - answerInflammation of sac around the heart
Can lead to cardiac tamponade if it fills up too quickly
Friction rub → HALLMARK SIGN
Decreases amount of blood being pumped out because fluid around heart does not let
heart pump effectively
Substernal pain that radiates on the left side of neck to shoulder, worse when laid flat
Colchicine can be used to treat/prevent, NSAIDS for comfort
Pulsus Paradoxus (decrease in BP when breathing)
•Treatment of the underlying cause
•Pericardiocentesis: drainage of the fluid within the pericardial space.
•pericardiectomy - surgical excision of the pericardium
Cardiac tamponade - answerMEDICAL EMERGENCY, Take action IMMEDIATELY
Decreases cardiac output by fluid in the sac compressing the heart
Reduction in EF, less than 60%, reduces BP
Low urine output because of low BP
Becks Triad !!!!!!!!!
, Dobutamine → increases strength of contractility
•Pericardiocentesis Repeat echocardiogram should be completed within 24 hours post
procedures to assess for fluid reaccumulation
Beck's triad - answerhypotension, JVD, muffled heart sounds
HALLMARK sign for Cardiac Tamponade
Cardiomyopathy - answerChronic disease of heart muscle
Affects stroke volume and EF, amount of blood ejected from the LV
The body is not getting the blood and nutrients it needs all over the body
Monitor and improve cardiac output, monitor for HF and treat symptomatically
Dilated Cardiomyopathy - answerMost common
When the LV is very big, contractility is decreased, decreased stroke volume and
cardiac output, less blood going into the body
Can be asymptomatic for years because of compensation (tachycardia)
Left sided HF is the later symptoms
A fib, heart block, blood clots
Vasodilators → more difficult to push out against resistance, helps stop this resistance
Pacers, Heart Transplant, medication management
hypertrophic cardiomyopathy - answerEffects ability of the LV to fill with blood, not
enough space for blood to fill up, muscle is swollen
Problem during diastole, heart muscle doesn't get enough oxygen
Usually inherited and born with
Might hear a heart murmur
S/S → Syncope, Sudden cardiac death, Heart failure, Angina, Dyspnea, Fatigue,
Palpitations, Pulse irregularities, Ventricular dysrhythmias
restrictive cardiomyopathy - answerLV is chamber is small and blood gets pulled back
into the atria
LV cannot effectively pump blood into body, Stiff rigid muscle wall
No vasodilators for treatment
S/S → same as others
coronary artery bypass graft (CABG) - answerMost common surgery in older adults,
affects quality of life but not longevity
Occluded coronary arteries are bypassed by patients own vessels
