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Exam_1_study_guide_2020_part_2.doc, Study notes of Nursing

Utah Valley University (UVU)Nursing

Explain respiratory changes associated with aging Laryngeal cartilage ossifies Atrophy of vocal muscles Increased diameter of trachea and upper bronchioles Decreased number of cilia Increased anterior-posterior diameter (kyphosis) Decreased chest wall flexibility Intercostal muscle atrophy Progressive loss of elasticity Flattening of alveoli and decreased alveolar surface area Decreased response to changes in O2 and CO@ levels, decreased PaCO2 Increased dead space, air trapping Increased risk for atelectasis Decreased cough reflex, section clearance

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Older Adult

•Explain respiratory changes associated with

aging Laryngeal cartilage ossifies

Atrophy of vocal muscles

Increased diameter of trachea and upper

bronchioles Decreased number of cilia

Increased anterior-posterior diameter

(kyphosis) Decreased chest wall flexibility

Intercostal muscle atrophy

Progressive loss of

elasticity

Flattening of alveoli and decreased alveolar surface area

Decreased response to changes in O2 and CO@ levels, decreased PaCO2

Increased dead space, air trapping

Increased risk for atelectasis

Decreased cough reflex, section clearance

Respiratory Diagnostic procedures

•Interpret ABG

results Normal

pH 7.35-7.45

PaO2 80-100

PaCO2 35-45

HCO3 22-26

O2 88-100

•Discuss diagnostic procedure for TB.

TB skin test-induration of 5+ at risk, induration of 10=no risk

Interferon gamma release assay-QuantiFERON/TB T-spot TB (blood tests)

Sputum culture-how dx is discovered

Chest x-ray-holes from destroyed lung tissue, consolidation, enlarged lymph nodes

• Explain Mantoux test interpretation

Skin test-if there is a hard and raised bump with swelling, then test is

positive TB antibodies in body but not active infection

No reaction-no tb, negative result

• Identify how TB is confirmed

•Describe the nursing responsibilities and potential complications related to caring

for a client following a bronchoscopy

Pre-procedure-obtain consent, instruct pt. to be NPO for 6-12hr before

procedure Post-procedure-keep pt. NPO until gag reflex returns. Monitor for

recovery from sedation. Blood tinged mucus is not abnormal. If biopsy was

done, monitor for hemorrhage and pneumothorax.

•Describe the nursing responsibilities and potential complications related to caring

for a client undergoing thoracentesis

Pre-procedure-explain procedure to pt., obtain consent

Intra-procedure-usually performed in pt. rm, position pt. upright with elbows on

overbed table and feet supported, instruct pt. to not talk or cough

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Older Adult

Explain respiratory changes associated with aging Laryngeal cartilage ossifies Atrophy of vocal muscles Increased diameter of trachea and upper bronchioles Decreased number of cilia Increased anterior-posterior diameter (kyphosis) Decreased chest wall flexibility Intercostal muscle atrophy Progressive loss of elasticity Flattening of alveoli and decreased alveolar surface area Decreased response to changes in O2 and CO@ levels, decreased PaCO Increased dead space, air trapping Increased risk for atelectasis Decreased cough reflex, section clearance Respiratory Diagnostic procedures
Interpret ABG results Normal pH 7.35-7. PaO2 80- PaCO2 35- HCO3 22- O2 88-
Discuss diagnostic procedure for TB. TB skin test-induration of 5+ at risk, induration of 10=no risk Interferon gamma release assay-QuantiFERON/TB T-spot TB (blood tests) Sputum culture-how dx is discovered Chest x-ray-holes from destroyed lung tissue, consolidation, enlarged lymph nodes
Explain Mantoux test interpretation Skin test-if there is a hard and raised bump with swelling, then test is positive TB antibodies in body but not active infection No reaction-no tb, negative result
Identify how TB is confirmed
Describe the nursing responsibilities and potential complications related to caring for a client following a bronchoscopy Pre-procedure-obtain consent, instruct pt. to be NPO for 6-12hr before procedure Post-procedure-keep pt. NPO until gag reflex returns. Monitor for recovery from sedation. Blood tinged mucus is not abnormal. If biopsy was done, monitor for hemorrhage and pneumothorax.
Describe the nursing responsibilities and potential complications related to caring for a client undergoing thoracentesis Pre-procedure-explain procedure to pt., obtain consent Intra-procedure-usually performed in pt. rm, position pt. upright with elbows on overbed table and feet supported, instruct pt. to not talk or cough

Post-operative-observe for s/sx of hypoxia and pneumothorax, verify breath sounds in all fields. Encourage deep breathing exercises. Send labeled specimens to lab promptly. o Identify priority assessments after a thoracentesis Upper Respiratory

Influenza
- Identify expected findings Malaise, fatigue, fever, chills, body aches, cough, congestion, n/v, resp. failure
- Identify signs of pulmonary complications related to influenza Pneumonia, resp failure
Head and neck cancer
- Identify clients at risk for head and neck cancer Tobacco and alcohol use, GERD, environmental factors, genetics, damaged DNA from carcinogens cause mutation of cells
- Surgical therapy: identify post-operative interventions for laryngectomy and radical neck dissection Focus on airway management, wound care, nutrition, communication, psychosocial issues r/t body issues Maintenance of patent airway Keep pt. in semi fowlers to decrease edema and inflammation Frequent suction r/t increase in secretions Deep breathing and coughing exercises Frequent pain, VS assessment Wound care, drainage assessment Check patency of drainage tubes q4h Frequent oral care
- Identify reportable complications related to a laryngectomy Increased risk of infection, hemorrhage Monitor patency of airway R/T edema and inflammation
Tracheostomy care (recommend ATI airway management (tracheostomy) skills module) - Identify safe care of the client with a tracheostomy - Identify priority assessments VS, including heart rate, RR, BP, O2, ensure patency of IV and drainage tubes, place obturator inside outer cannula after insertion, remove obturator, auscultate lung sounds after the cuff is inflated, note and record ventilator settings, observe amount of blood at insertion site, redness, inflammation, edema, ulcerations - Identify priority interventions Provide means for communication, teach tracheostomy management, tracheostomy care, position to facilitate ventilation (HOB 30- 45), aspiration precautions, tube feedings, nutritional consultation, psychosocial needs, suctioning - Explain when and how to suction Assess need for suctioning hourly. Indications include visible coughing, course crackles or wheezes, moist

fungi Inhaled via cough, sneeze, aspirate Functional changes-increases inflammation, blood flow, vascular permeability, airway edema, consolidation, increased mucous production, decreased gas exchange Complications-atelectasis, pleural effusion, sepsis, resp. failure Expected findings-tachypnea, dyspnea, pleuritic chest pain with coughing- inflamed pleura, decreased O2 sat, altered mental status, crackles, pops, wheezes, pleural rub, dullness to percussion, atelectasis, tachycardia, non-productive cough

Explain methods for enhancing airway clearance Turn, cough, deep breathing Early mobilization, ambulation Incentive spirometry, acapella Prevention of aspiration Gag reflex assessment Prevention of opioid over sedation Ow therapy, humidification HOB 30-45% Chest physiotherapy Proper nutrition and hydration
Identify common interventions to prevent pneumonia
- Aspiration HOB 30-45%, gag reflex assessment, swallow eval
- Community acquired Obtain vaccine for at risk population, practice hand hygiene, cough etiquette, avoid sick people, smoking cessation
- Hospital acquired Vaccination, hand hygiene, limit visitors, staff members who may be sick, report worsening of symptoms, rest, cough/sneeze etiquette, ABO tx, adequate hydration
Identify commonly administered medications under the following classifications given to a client with pneumonia and discuss why they are used and the expected therapeutic effect: - Antibiotic Macrolides-erythromycin Fluoroquinolones- levofloxacin B lactams-amoxicillin/clavulanate Anti-pneumococcal piperacillin/tazobactam Used to treat bacterial pneumonias - Bronchodilator Adjunct therapy used to open airways, used for co-morbid conditions - Anti-inflammatory Used to decrease inflammatory response in lungs, decreased swelling, px
Identify therapeutic positioning to promote ventilation and perfusion of the lungs HOB 30- Avoid laying flat or sitting straight up Tripod positioning
Lung cancer
- Identify risk factors

80-90% of lung cancer cases are linked to smoking genetic factors environment hazards

Identify clinical manifestations Chronic cough, dyspnea, pleuritic chest px, hemoptysis, pleural effusion Diagnosed via chest XR, CT, mri, biopsy Bronchoscopy Thoracentesis
Identify common treatments and side effects Chemotherapy-most common, side effects Include Immunosuppression, anorexia, N/V, hair and weight loss, body aches and px Radiation-may be used as primary TX for pt. who cannot tolerate surgery, side effects Include esophagitis, skin irritation, N/V, anorexia, radiation pneumonitis Surgical tx-procedures that may be performed Include monectomy, lobectomy, or segmental or wedge resection
Pneumothorax
Differentiate between pneumothorax and tension pneumothorax Pneumothorax: air in pleural space, results in decreased lung expansion Tension pneumothorax: total lung collapse, can affect other organs
Identify the clinical manifestations of a pneumothorax Dyspnea Decreased movement of involved chest wall Diminished or absent breath sounds on the affected side Hyper-resonance on percussion
Identify the clinical manifestations of a tension pneumothorax Cyanosis Air hunger Extreme agitation Tracheal deviation away from affected side Subcutaneous emphysema Neck vein distention Hyper-resonance to percussion
Review assessment and care of a client with a chest tube
Identify reportable findings Ensure patency of drainage system Assess drainage site for S/SX of infection: redness, Increased warmth, selling, increased purulent drainage Do not clamp tube Monitor volume of fluid drained: vol > 1-1.5L of drainage vol > 1200mL in 1stHr, report to MD, drained rapidly reportable Subcutaneous emphysema: occurs when air leaks into the surrounding tissue-crackling sensation felt with palpation Encourage coughing, deep breathing, incentive spirometry, ambulation

Discuss prevention of transmission in the acute care setting Those with suspected TB should be placed on airborne isolation Receive chest XR, sputum smear and culture, receive appropriate drug therapy Single occupancy room with negative air pressure-HEPA masks worn-cough, hand hygiene Screen close contacts of pt. with TB
Identify health teaching and prevention of transmission for the client with TB Close medication adherence TB meds must be taken for 6- 12months Education about medication side effects Decreased exposure to close contacts TB skin tests
Explain essential client education related to medication therapy Pt education includes medication adherence Directly observed therapy-for pt. most at risk for non-adherence. Public health measure Fixed dose combo drugs for pt. who refuse DOT, follows same guidelines as HIV tx Education about side effects and serious complications - Identify prototype drugs used (see ATI pharmacology made easy) Isoniazid-side effects-hepatotoxicity, affects memory and consent, peripheral neuropathy Rifampin-hepatotoxicity, peripheral neuritis Ethambutol-optic neuritis - Identify reportable findings associated with medication therapy Baseline liver function tests must be monitored every 2-4weeks. Obstructive Pulmonary
Define obstructive pulmonary disease Diseases of obstructed airway
Differentiate between asthma and COPD Asthma-trigger/irritant/immune reaction Characterized by inflammatory response Bronchoconstriction Airway thickening Autoimmune disorders can cause flare ups COPD-airflow obstruction caused by emphysema, chronic bronchitis Characterized by persistent airflow obstruction caused by inflammation of alveoli and airways Slowly progressive
Asthma
Explain the pathophysiology of asthma. Trigger/irritant/immune activation Hyper response to immune triggers causes increased capillary permeability,

increased mucus production and decreased ciliary action Characterized by bronchoconstriction, airway thickening Risk factors: family history, allergens, air pollutants, respiratory tract infections, exercise, environmental factors, medication sensitivity, stress/emotional distress, foods, GERD, smoking Class S/SX: wheezing, chest tightness, cough, dyspnea/tachypnea

Identify signs of worsening symptoms. Hypoxemia Anxiety/restlessness Decreased peak flow readings Inability to speak in full sentences Use of accessory muscles (retractions)
Identify interventions for a severe and life-threatening asthma exacerbation (status asthmasticus) Administration of rescue bronchodilators, glucocorticoids Monitor ABGs, SpO2 Administer O2 Elevated HOB Prepare for emergency intubation and mechanical ventilation
Explain the appropriate use of peak flow meter. Measures how well air is moving out of lungs Measurement of pt. progress Set over w week period Pt personal best=80% or more=green (good) 80-50%=yellow (moderate),

50%=red (bad) - Discuss client education when interpreting flow meter results. Peak flow meter is an assessment of a pt. asthma action plan 50% of baseline=notify provider
Review prototype medications for asthma (see ATI Pharmacology made easy) Bronchodilators Albuterol-short acting, prototype, rescue medication, rapid acting Salmeterol-long acting, lasts up to 12 hrs., not rescue medication Ipratropium-anticholinergic, long acting, affects cholinergic receptors Glucocorticoids Beclomethasone-inhaled-may not be used to an intermittent asthma pt. Fluticasone-inhaled-used for persistent asthma Prednisone-oral Leukotriene agonists Montelukast-oral
Discuss client education regarding triggers that may cause an asthma attack. Explain what asthma is and s/sx of exacerbation Good asthma control Possible hindrances: denial, poor perception of disease Environmental and trigger control Identify possible triggers, possible preventable measures Avoidance of allergens and other triggers Need to maintain good hydration Correct use of inhaler, spacer, nebulizer Medication adherence

Use of ancillary muscles Orthopnea Cor pulmonale Thinner appearance Increased expiratory time Clubbing on hands o Identify signs and symptoms. Chronic, intermittent cough, often unproductive Dyspnea on exertion Breathlessness, heaviness in chest Increased WOB Air hunger Use of ancillary muscles Wheezing, chest tightness Fatigue Weight loss Diminished breath sounds Hypoxemia Barrel chest Pursed lip breathing

Identify complications of COPD Cor pulmonale: R sided HR r/t increased pressure in the lungs, heart must work harder Acute exacerbations, raspatory failure - Explain how COPD can lead to respiratory failure. A COPD pt. might wait too long to seek medical help DCing bronchodilators or corticosteroids - Identify signs and symptoms of impending respiratory failure.
Identify appropriate priority interventions for COPD Thin secretions-cough, deep breathing, hydration Prevention of further injury Decreased inflammation Increased ventilation via administration of bronchodilators and corticosteroids Decreased risk for complications-pneumonia, flu vaccines Decreased breathlessness, increased quality of life - Oxygen administration and safety issues Indications for O2 therapy-goal of >90% O2 during rest, improve quality of life, O2>88% during exercise and/or exertion Complications-combustion, CO2 narcosis, O2 toxicity, infection, skin breakdown - Breathing techniques Cough, deep breathing HOB 30- Incentive spirometry, acapella Pursed lip breathing Tripod positioning

Airway clearance techniques Providing adequate hydration to thin secretions Bronchodilator therapy Huff coughing Chest physiotherapy-percussion and vibration Incentive spirometry, acapella
Strategies for nutrition enhancement Eat high calorie foods first Limit liquids at mealtimes Rest before meals Try more frequent meals and snacks Add margarine, butter, mayo, sauces, gravies, peanut butter to food Try cold foods-feel less full than hot foods Ready made meals available during increased SOB Eat larger meals when not tired Avoid food that cause gas Choose dessert options that contain egg
Prevention of respiratory acidosis Clear airway ASAP-artificial ventilation Administration of ABU TX to treat disease Diuretics to decrease excess fluid around lungs and heart Bronchodilators Corticosteroids Treat underlying condition
Review prototype medications to treat COPD (see ATI pharmacology made easy) Short acting bronchodilators Albuterol Ipratropiu m Long acting bronchodilators Spiriva Salmeterol Formoterol Indacaterol Aclidinium Theophylline Inhaled steroids Fluticasone Budesonide Combo inhalers Salmeterol and fluticasone (Advair) Formoterol and budesonide (Symbicort)
Cor Pulmonale
Explain Cor Pulmonale. R sided HR r/t increased pressure in the lungs, heart must work harder

insertion site for hematoma and bleeding, monitor VS and ECG, assess for hypo/HT, dysrhythmia, S/SX of PE Hypertension

Consider the effects of aging as related to hypertension The increase in BP with age is mostly associated with structural changes in arteries and especially with large artery stiffness In the elderly, the most powerful predictor of risk is increased pulse pressure r/t decreased diastolic and increased systolic BP
Identify risk factors for hypertension
- Differentiate between modifiable and nonmodifiable Modifiable-alcohol, tobacco use (nicotine causes vasoconstriction, cholesteral builds up), type 2 diabetes, increased serum lipid and triglycerides, increased dietary NA, obesity, sedentary lifestyle, stress Non-modifiable-increased age, biological sex, family history, ethnicity, socioeconomic status
- Explain client education for preventive measures and lifestyle modifications Following DASH diet and decrease Na, routine HTN screening, BP screen, health assessment, decrease alcohol use, smoking cessation, diet and exercise regiments to decrease DM 2 and hyperlipidemia and pulls oxygen out of blood and into muscles, decrease stress and introduction of productive coping mechanisms
Discuss contributing factors for poor medication compliance in long term management of hypertension Lack of education about medication side effects Lack of education about pathology, complications, management of HTN Socioeconomic factors
Identify complications of hypertension Heart attack, CVA, atherosclerosis, aneurysm, HR, weakened and narrow blood vessels in kidneys and eyes, metabolic syndrome, trouble with memory or understanding, dementia - Explain how hypertension effects kidney function When arteries in kidney are damaged by HTN, they’re unable to filter blood, also have difficulty with regulating levels of Na, hormones and acids - Explain how hypertension contributes to coronary artery disease HTN damages arterial walls and can accumulate fat, plaque and cholesterol, increased atherosclerosis, can caused angina, can contribute to A fibs and arrhythmia o Retinopothy Pressure of the blood being sent to the retina
Explain how abrupt withdrawal or non-compliance with antihypertensive medications cause a hypertensive crisis. HTN crisis occurs more often in pt. with a HX of HTN who haven’t adhered to their drug regiments or who have been undermedicated Rapidly increased BO can cause shearing of the endothelial surface r/t turbulent blood flow Can lead to increased vascular damage and increased release of vasoconstrictors

Beta blockers
- Explain their action
- Identify common side effects
- Explain the effect of non-specific beta blockers in clients with obstructive respiratory disorders
- Identify essential client education B adrenergic blockers-acebutolol, atenolol, betaxolol, bisoprolol, esmolol, metoprolol, nebivolol Non-cardio selective-nadolol, pindolol, propranolol Non-selective agents may cause bronchospasm, especially in pt. with history of asthma Action-cardio selective agents block B adrenergic receptors decrease BP by blocking B adrenergic effects, decreased CO2, decreases sympathetic vasoconstrictor tone, decreases renin secretion by kidneys Non-selective block B1 and B2 adrenergic receptors, decrease BP by blocking B1 and B2 effects Side effects: orthostatic hypotension, sexual problems, drug may decrease tachycardia r/t hypoglycemia, may adversely affect glucose metabolism, may cause bronchospasms
ACE inhibitors
- Explain their action
- Identify adverse effects: cough, hyperkalemia, hypotension, angioedema Ace inhibitors-benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, trandolapril Action-Inhibits ACE, decreases conversion to angiotension1 to angiotensin 2, inhibit A-II mediated vasoconstriction Adverse effects-ASA and NSAIDS may decrease effectiveness, diuretics increase drug effect, don’t use with K sparing diuretics, can cause increase in creatinine, inhibits breakdown of bradykinin which may cause dry, hacking cough
Diuretics
- Review their action and how they treat hypertension
- Discuss complications related to diuretic therapy Thiazide and related diuretics-chlorothiazide, HCTZ Inhibit NaCl reabsorption in distal tubule, increases excretion of Na and Co, decreases in ECF, decreases BP moderately Loop diuretics-bumetanide, furosemide, torsemide Inhibit NaCl reabsorption in loop of Henle, short duration of action, decreases effectiveness for HTN K sparing-amiloride, triamterene Inhibit Na retaining and K excretion of aldosterone, decreases K and Na exchange in distal tubule Aldosterone receptor blocker-spironolactone Side effects-orthostatic hypotension, hypokalemia, alkalosis, digoxin toxicity, hyperkalemia (k sparing), use in caution with pt. who takes ACE inhibitors or all blockers (k sparing, aldosterone) Coronary Artery Disease and Acute Coronary Syndrome
Identify modifiable and nonmodifiable risk factors Non-modifiable-age, biological sex, ethnicity, family history, genetics

indigestion, SOB, fatigue, elderly may experience change in LOC, SOB , PE, dizziness, dysrhythmia, increased HR and BO, N/V, fever

Differentiate between the pain manifestations of chronic stable angina and a myocardial infarction There are not any.
Explain the significance of a ST segment elevation in a myocardial infarction (STEMI) A STEMI caused by a thrombus creates ST elevation in ECG leads facing the area of death of cell tissue (M)I, in order to limit MI size, artery must be opened within 90 mins of presentation
Identify complications of an MI Dysrhythmia, HR, cardiogenic shock, papillary muscular dysfunction, L vent aneurysm, ven dressler syndrome, septal wall rupture and L ven wall free rupture
Identify purpose of a pacemaker Electronic device used to pace the heart when the normal conduction pathway is damaged
Identify collaborative treatment for an MI IV thrombolytic TX, traditional coronary artery bypass graft surgery, minimally invasive direct coronary artery bypass, off pump coronary artery bypass, trans myocardial laser revascularization, drug therapy, nutritional therapy
Explain why aspirin is used during an MI BC it is an anticoagulant and is drug of choice for MI TX. Decrease aggregation.
Explain how morphine sulfate is beneficial during an MI It helps relieve CP, vasodilator, decreases cardiac workload by decreasing myocardial O2 consumption, decreases contractility, decreases BP and HR
Describe the purpose of percutaneous coronary intervention Is the first TX for pt. with confirmed STEMI. Goal is to open the blocked artery within 90mins of arrival to facility that has an interventional cardiac catheterization lab
Identify medications that increase risk of complications Concurrent use with anticoagulants increases adverse rxn
Explain postoperative care following cardiac catheterization Pain, catheter site assessment-chest pain Look for increased bleeding S/SX of infection Monitor VS Neurovascular assessment of extremity used Monitor ECG for dysrhythmia Monitor IV anticoagulants Client ED about meds, s/sx to report to MD
Define coronary artery bypass graft and its purpose Procedure that redirects blood around a section of a blocked or partially blocked artery in the heart to increase blood flow, procedure involves taking a healthy blood vessel from the leg, arm or chest and connecting it to the blocked artery in the heart Purpose-severe angina r/t atherosclerosis-leaving heart short of blood, L main artery severely narrowed or blocked, prior artery blockage for which temp angioplasty isn’t appropriate, pt. has previous angioplasty or stent (PCI) that

was unsuccessful or restenosis

Identify nursing responsibilities related to caring for a client undergoing angioplasty, coronary artery bypass grafts and peripheral bypass grafts CABG-monitor for s/sx of recurrent angina, frequent assessment of VS, heart rate and rhythm, evaluation of catheter insertion site for s/sx of bleed, monitoring of hemodynamic status, airway assessment, management of chest would and/or tubes, pain management, early ambulation, cough and deep breathes Angioplasty-assess whether pt. had diagnostic or interventional catheter, inter cath-has increased risks, assess whether pt. was taking anticoagulants, ECG baseline preprocedure, assess catheter site, monitor for bleeding, swelling, redness, pain- hematoma can be a sign of internal bleed, monitor for arrhythmia
Fibrinolytic therapy
- Explain the purpose Intended only for pt. with STEMI Aims to limit infarction size by dissolving heart thrombus in coronary artery and reperfusing muscle
- Explain the optimal time to administer fibrinolytics following a myocardial infarction Goal is to give TX within 30mins of pt. arrival to ED
Nitroglycerin
- Explain its action and the anticipated therapeutic effect Promote peripheral vasodilation, decreased preload and afterload, promote coronary artery vasodilation, may prevent or control coronary vasospasm, decrease SVR, venous pooling, decreases venous blood return, increases blood flow to ischemic areas
- Explain client education when taking nitroglycerin Ensure easy access, store away from light, heat to prevent degradation, once opened use within 6 months, place nitro under tongue, spray into mouth, warn about adverse effects, can use prophylactically
- Explain how to instruct clients in preventing tolerance to the nitroglycerin when using transdermal patches Need to be removed in the evening for 10-14hrs to prevent tolerance Inflammatory and Structural Heart disorders
Discuss risk factors for inflammatory heart disorders HTN High cholesterol Poor diet Sedentary lifestyle Smoking Atherosclerosis
Acute pericarditis
Describe signs and symptoms Progressive, severe, sharp chest pain, worse with inspiration and when lying flat. Pain may radiate to neck, arms, L shoulder-can be referred to the trapezius muscle, dyspnea r/t avoidance of chest pain, pericardial friction rub-pt. hold breath
Describe appropriate interventions for pain related to this disorder. Administer anti-inflammatories with food to prevent GI upset, HOB 45
Explain why the pain of pericarditis usually treated with NSAIDS Treats the inflammation

therapy following valve replacement Mechanical valves have an increased risk of thromboembolism, therefore anticoagulant therapy is recommended long term

Discuss complications of valvular and inflammatory heart disease Valvular-aortic valve stenosis, mitral valve stenosis, aortic regurgitation, mitral regurgitation, endocarditis, tricuspid regurgitation, MI, infective endocarditis, stenosis, regurgitation Inflammatory-HR, MI, CVA, arrhythmia, sudden cardiac death - Heart failure - Cardiac tamponade Compression of the heart caused by fluid collecting in the sac surrounding the heart, puts pressure on the heart and keeps it form filling completely. Commonly caused by pericarditis Vascular Disorders
Explain how atherosclerotic plaques contribute to the formation of aortic aneurysms Atherosclerotic causes the walls of the aorta to weaken and become damaged Increased BP through the aorta can then cause the aortic wall to expand and bulge
Describe a bruit. When an artery is narrowed or has a bulging wall there may be turbulent blood flow, can cause a buzzing or humming sound heard during auscultation
Identify complications of aneurysms Bleeding, hemorrhage, hypovolemic shock, shock it tachycardia, hypotension, pale and clammy skin, decreased urine output, altered LOC, ABD px
Aortic dissection
Describe signs and symptoms Excruciating anterior (ripping) chest pain (type A), pain located in back, ABD, legs (type B), neurologic effects if aortic arch involved- altered LOC, weakened or absent carotid and femoral pulses, dizziness, syncope, angina, MI, L HR, murmur, cardiogenic shock, death
Describe the pain associated with this disorder Px different than in MI because px is sudden and not gradual, px may migrate and follow path of dissection
Explain why blood pressure management is essential BP monitoring is essential because pt. BP needs to be as low as possible to decrease the amount of dissection, IV antihypertensives titrated, monitor BPQ2-3 mins, SBP >110-120mmHg
Rupture If rupture occurs into retroperitoneal space, bleeding may be controlled by surrounding anatomical structure, preventing death If rupture occurs into thoracic or ABD cavity, pt. can die from hemorrhage
Thrombus formation Can impede the transport of substances from the blood, hypoxia can occur- leading to wall weakening and inflammation
Thoracic aortic aneurysms
Describe signs and symptoms

Tenderness or CP Back px Hoarseness Cough SOB

Surgical therapy: grafts
- Explain the importance of an adequate BP in maintaining graft patency Prolonged decreased BP may result in graft thrombosis Avoid severe HTN-it may cause undue stress on arterial anastomoses, resulting in leakage of blood or rupture at suture lines
Clopidogrel In a pt. with PAD Is a critically imp. therapy Carries only FDA labeled indication for cardiovascular risk decreases in pt. with established PAD - Explain why it is used for vascular disorders Widely used to prevent vascular thrombotic events, upper and lower GI bleeding may be Increased by antithrombotic agents Increased by antithrombotic agents - Explain why this medication increases risk for GI bleeding - Identify signs of GI bleeding Black or tarry stools, bright red blood in vomit, ABD cramps, dark or bright red blood mixed with stool, dizziness or faintness, feeling tired, paleness, SOB
Peripheral artery disease
- Identify risk factors Decreased CVD risk factors, smoking, diabetes, A1C <7.0%, hyperlipidemia, HTN
- Intermittent claudication: Caused by narrowing or blockage in the main artery taking blood to the legs. Due to atherosclerosis symptom that describes muscle px on mild exertion classically in the calf muscle - Explain the pathophysiology - Explain the cause of pain
Explain acute arterial ischemia A vascular disease involving an interruption in the arterial blood supply to a tissue, organ, or extremity that, if left untreated, can lead to tissue death Can be caused by embolism, thrombosis of an atherosclerotic artery, or trauma
Describe clinical manifestations of PAD of the lower extremities S/SX: intermittent claudication (leg pain with exercise that goes away within 10 minutes of rest), present with atypical leg symptoms (burning, heaviness, pressure, soreness, tightness, weakness) paresthesia (numbness/tingling), thin skin, shiny, taut, hair loss on lower extremity, decreased pedal popliteal or femoral pulses, pallor, reactive hyperemia, critical limb ischemia-condition characteristics by chronic ischemic rest pain lasting < weeks, arterial leg ulcers, gangrene - Describe an arterial ulcer Pale, ischemic base, well defined edges usually found on toes, heels, lateral

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