right, atrium, tricuspid, ventricle, pulmonic, valve, artery, arterioles, capillaries, venules, vein, left, atrium, mitral, ventricle, aortic, aorta
_____(Right) ____(atrium),______(tricuspid) valve, right _______(ventricle), _______(pulmonic) _____(valve), pulmonary _______(artery), pulmonary _____(arterioles), pulmonary _______(capillaries) [gas exchange with alveoli occurs here], pulmonary _______(
a
think of right side of heart as
A. venous deoxygenated
B. arterial oxygenated
C. venous oxygenated
B. arterial deoxygenated
b
think of left side of heart as
A. venous deoxygenated
B. arterial oxygenated
C. venous oxygenated
B. arterial deoxygenated
aorta, legs, pedal, arterioles, capillary, venules, veins, inferior
_____(aorta), major arteries in _____(legs) (ileac, femoral, popliteal), ____(pedal) arteries (D.P. & P.T.), ________(arterioles) of tissue beds of legs and feet, ______(capillary) beds [gas exchange here: O2 from blood to tissue, CO2 from tissue to blood
c
______ are thin-walled vessels that take deoxygenated blood from tissue beds all over the body back to the right side of the heart/deoxygenated blood in and towards the heart
A. capillaries
B. arteries
C. veins
D. venules
b
most ______ disorders occur in the _____ and usually have to do with some degree of failure to keep entire amount of blood flowing in its proper direction�that is upward, towards the heart
A. arterial, heart
B. venous, legs
C. venous, heart
D. arterial, l
d
this flow back to the heart is often called "________ " and also sometimes called "venous drainage of tissues."
A. arterial return
B. drainage tank
C. venous lungs
D. venous return
systole, push, venous, towards, heart, open
during ________(systole), when blood is being pushed into arteries by the heart, the systolic pressure is also helping to _______(push) _______(venous) blood back __________(towards) the ______(heart); vein valves in the legs are ____(OPEN) during this ti
b
_____�oxygenated blood out and away from heart
A. capillaries
B. arteries
C. veins
D. venules
venous, congestion, peripheral
as a result, some venous blood tends to stay and settle out in the veins of the leg and foot tissues�this is known as _______(venous) congestion (think of ________(CONGESTION) of _______(peripheral) tissues when you think of venous insufficiency).
venous, congestion, gravity, incompetence
factors contributing to ______(venous) ________(congestion) include:
1) _______(gravity) "winning"
a) ex-- simply being on one's feet too long can cause gravity to pull fluid downward into distal leg tissues.
b) unless severe, this is a type of venous con
b
is most often caused by leg vein valves wearing out and becoming "floppy"�they don't close tightly during diastole, allowing backflow into distal veins of legs & feet (venous congestion)
2) this congestion can be pictured as a pool of non-moving blood in
a
this congestion can be pictured as a pool of non-moving blood in the veins this is called venous stasis and results in increased hydrostatic pressure inside the affected veins.
3) this increased pressure pushes fluid into tissues of legs and feet, causing
b
sometimes the area becomes so engorged with edema that the skin cells cannot function properly & the tissue easily breaks down (especially over bony prominences such as heels, ankles, coccyx), causing
A. chronic venous insufficiency
B. venous stasis ulcer
c
increased hydrostatic pressure can also cause such backflow pressures to surface veins that they can become twisted & distorted- ____________; these are not usually a health hazard but can become painful and cosmetically distressing to your patients.
A. c
d
contributing factors to development of CVI:
A. aging, inherited predisposition, obesity, sometimes pregnancy (especially multiple), and job-related issues (such as years of standing)AND/OR lack of assistance from musculature, such as when there is good mu
a
a ______ is a clot that develops on the wall of a vein, most of the time in deep veins (not usually surface veins) of thighs & calves 1) once _____ develops, the vein and entire area around vein can become inflamed & swollen, this is called thrombophlebit
c
once DVT develops, the vein and entire area around vein can become inflamed & swollen
2) this is called ____________ ("thrombo"�blood clot; "phleb" means "having something to do with veins")
A. Deep Vein Thrombosis (DVT)
B. Chronic Venous Insufficiency (C
a
S&S
a) local redness, pain, warmth, edema (ie, inflammatory signs), usually seen only unilaterally (in one leg), can be extreme or hardly noticeable, also, may have no S&S at all.
A. Deep Vein Thrombosis (DVT)
B. Chronic Venous Insufficiency (CVI)
C. thro
d
those at highest risk for DVT:
1) have one or more elements of ____________________; this is the
classic triad of:
a) injury to endothelium of vein
b) stasis of blood flow, this can be from an underlying venous disorder such as CVI and/or, inactivity of t
c
hypercoagulability states
(1) most often hypercoagulability is caused by some degree of _______________________ (if there is less water in the blood, blood is more concentrated, so clotting factors & platelets can "find each other" more easily to cause pa
d
summary of situations in which one or more elements of __________ is present; people who:
sit a lot or for long periods ("desk jockeys," airline travelers, couch potatoes), have casts or other immobilizing devices on legs, are bed-ridden or wheelchair-bou
b
possible DANGEROUS sequela of DVT: ______
A. Deep Vein Thrombosis (DVT)
B. pulmonary embolus (PE)
C. dehydration
D. Virchow's triad
embolus, arterioles, 30
pulmonary ________(embolus)
1) if thrombus or part of one breaks free from an existing DVT, it can then become a venous embolus; understanding circulatory flow, here is the usual pattern of travel: DVT of leg IVC RARVPAusually gets stuck in tiny pulmonary
b
2) 30% of people with DVT develop this
3) S&S - chest pain, SOB, hemoptysis (blood in sputum), shock
A. Deep Vein Thrombosis (DVT)
B. pulmonary embolus (PE)
C. perfusion
D. Virchow's triad
dvt, moving, hydration, elevate, heparin, aspirin
Treatment for _____(dvt):
encourage mobility�get your patients ________(moving)! Also, devices used on patient's legs to keep strong muscle tone around veins, encourage _______(hydration), ________(elevate) legs / feet it increases venous, be careful of s
arteries, thick, muscled
________(arteries) are ____(thick)-walled, _______(muscled) vessels that accept oxygenated blood from the heart and circulate it to tissue beds all over the body
the ability of arteries to work efficiently in maintaining flow of oxygenated blood from hear
tone, vasomotor, arterial, flexible, bp
muscle _____(tone) of arterial wall �AKA __________(vasomotor) tone
1) part of _______(arterial) walls are made of muscle cells/fibers which respond to various influences and needs of the body
2) these muscular elements can constrict and dilate the artery
lumen, smooth, patent, free
state of _______(lumen)�healthy lumen lining is ___________(smooth) & _________(patent) (open) - ie, ________(free) ofblockage of any sort, so forward blood flow is smooth, uninterrupted.
vasomotor, lumen, perfusion
the above two components (GOOD ______________(VASOMOTOR) TONE and PATENT ______(LUMEN)) contribute to good __________(perfusion) of distal tissues
c
is process of delivery of oxygen and nutrients via arterial system to tissue beds all over body. delivery
A. Deep Vein Thrombosis (DVT)
B. pulmonary embolus (PE)
C. perfusion
D. Virchow's triad
perfusion, output, arterial
good or bad ______(perfusion) results in good or bad tissue oxygenation & is determined by cardiac ________(output) (discussed later) & other factors such as state of ___________(arterial) vessels (ie, do the arteries have good vasomotor tone & patent lum
perfusion, 110/60, 115/70
S&S that are usually associated with good _________(perfusion) (ie, desired findings upon assessment)
1) DESIRED BP range is ~ _______(110/60) to _________(115/70) ("normal" is under 120/80)
2) NORMAL pulses.
a) "pulses" are the pulsations in the arterial
pulses, carotid, neck, pedal, top, feet
2) NORMAL _____(pulses).
a) "pulses" are the pulsations in the arterial system that occur with every heart contraction
b) they can be palpated ("felt") in several areas; most easily felt are:
(1) the ______(carotid) pulses in the ___(neck)
(2) the radial
capillary, refill, arterial, equal, 2
NORMAL _________(capillary) ____(refill)-- AKA "nail blanching"
a) how quickly does your ______(arterial) system refill the empty capillaries?
b) normal: < or ____(equal) to ___(2) seconds (means arterial system efficiently refills the capillaries in <2 s
a
because commonality of ALL of them is insufficient amount of O2 getting to distal tissue, ie, ischemia.
b. is almost always due to atherosclerosis a process in which arteries become stiffer (sclerosis) and collect fat (athero) and other unwanted substance
c
arterial diseases sometimes known as arterial insufficiency because commonality of ALL of them is insufficient amount of O2 getting to distal tissue, ie, ischemia.
b. arterial insufficiency is almost always due to __________________________, a process in
d
chronic disease of arterial system usually related to aging, in which artery walls become thick & hardened (sclerose = to harden); etiology:
1) over time, arterial vessels are increasingly damaged by hypertension (HTN), smoking, diabetes, infection, high
c
fatty deposit)-- hence the name that is most often used for arterial disease�________.
2) not only do collagen fibers collect in arteriosclerotic walls, but so do LDLs�they become "fatty deposits."
3) when these fatty deposits enter the arterial wall, the
a
the combination of stiff arteries, deposits of fat, and inflammatory and clotting responses ultimately leads to formation of a fibrous capsule with a fatty middle section in the wall of the artery� eventually as it grows, the ________ protrudes into the a
b
because of narrowed, stiff, atheromatous arteries that often have plaques, the end result of most arterial disorders is ________
A. plaque
B. compromised perfusion (delivery)
C. atherosclerosis
D. arteriosclerosis
arterial, disease, vasomotor, loss, non-patent, lumen
commonalities of ________(arterial) _________(disease) in ALL parts of body:
a) alteration in _______(vasomotor) tone - ____(loss) of flexibility & responsiveness�ie, loss of
"just right" status of muscle wall; instead, there is constant constriction & br
femoral, arteries, calves
when _____(femoral) _______(arteries) are affected there might be pain in _______(calves), especially when patient walks.
arterial, pale, delayed, heal, less, cardiac, urine
_________(arterial) disorder decreased perfusion &ischemia that are specific to the part of the body affected:
a) periphery (mainly arteries in arms, legs)
(1) pulses: diminished/ absent
(2) delayed capillary refill: >2
(3) skin: _____(pale), cool, someti
d
some of risk factors of arterial disease:
a. non-modifiable risk factors:
A. diet / obesity /sedentary lifestyle
B. heavy alcohol consumption
C. smoking
D. family history (athero /hypercholesterolemia.)aging
c
modifiable risk factors of arterial disease
A. vasoconstrictor
B. lipodystrophy
C. smoking, heavy alcohol consumption, diet / obesity /sedentary, both diabetes
D. family history (athero /hypercholesterolemia.)aging
b
a characteristic of DM2 in which there is increased circulating LDLs
A. vasoconstrictor
B. lipodystrophy
C. smoking, heavy alcohol consumption, diet / obesity /sedentary, both diabetes
D. family history (athero /hypercholesterolemia.)aging
a
also, nicotine is a powerful
A. vasoconstrictor
B. lipodystrophy
C. smoking, heavy alcohol consumption, diet / obesity /sedentary, both diabetes
D. vasodilator
a
literally a disease of any arterial vessels outside the heart, but the term is most commonly applied to arterial problems of the legs.
b. like all arterial vessel problems, usually manifests as problems of ischemia due to narrowed, peripheral arteries; sp
b
ischemic pain in muscles of legs which sometimes causes limping (the word "claudication" has its roots in the Latin word "claudicare", which means "to limp")
b) exacerbated with exercise & decreases with rest (hence the term"intermittent" )
S&S of ischemi
d
like venous thrombi, arterial thrombi form where flow is sluggish, and/or where there is narrowing of vessels and/or injuries in vessel walls, but there are a couple of major differences having to do with direction of flow
1) when veins get blocked, flow
c
the consistent elevation of systemic arterial blood pressure, measured with sphygmomanometer as "blood pressure (BP)", with normal/ optimal being ~110/70 (or at least <120/80
A. peripheral arterial disease(PAD)
B. intermittent claudication
C. hypertension
b
90/60
A. peripheral arterial disease(PAD)
B. hypotension
C. hypertension
D. arterial thromboembolic
32:34
c
140/90
A. peripheral arterial disease(PAD)
B. hypotension
C. hypertension
D. arterial thromboembolic
d
� uncommon type of HTN; caused by altered hemodynamics associated with a disease process such as an adrenal tumor, renal problems
A. primary hypertension
B. hypotension
C. hypertension
D. secondary hypertension
a
caused by a complex set of factors; also called essential or idiopathic HTN; 92 to 95% of all hypertensives have, 3rd leading cause of death in the world, high dietary intake of sodium water retention higher pressure in circulatory system
A. primary hyp
primary, htn, atherosclerosis, sympathetic, raas
pathophysiology of _____(primary) _____(HTN)
1) primary HTN is linked to many factors in various combinations, but certain
conditions are usually present to some degree:
a) _____(atherosclerosis) and/or
b) overactivity of _______(sympathetic) nervous syst
sympathetic, psych, epine, intra
Primary HTN
overactivity of ______(sympathetic) nervous system
a) for poorly understood reasons, the sympathetic nervous system
becomes chronically overactive.
b) this overactivity can be due to:
(1) overt or subtle, sustained, _______(psych)ological and/
over, raas, kick, need, overactive
________(over)activity of ______(RAAS) (renin-angiotensin-aldosterone-system) a) NORMALLY, RAAS is a compensatory system that is usually activated when there is a DROP in BP, and the result is vasoconstriction & increased blood volume to increase BP.
b) f
overactivity, raas, sympathetic, decrease, lumena, intima, increase, inflammation
sequela of these two states of __________________(overactivity) __________(raas), ____________(sympathetic):
a) chronic higher pressures against the blood vessels stimulate arterial smooth muscle to "shore up" against the extra pressure by building up the
htn, neuro, strokes, retina, infarct, protein, urine, heart, attacks
____(htn) most often affects the arterial vasculature of 3 primary systems:
a) ___________(neuro)logical system; some examples:
(1) brain: ______(strokes)�loss of function of parts of brain, in this case would be due to ischemia from the narrowed arterial
c
a localized dilatation or outpouching of arterial vessel wall
1) atherosclerosis & usually HTN weaken arterial walls, eventually creating bulges in certain areas
2) minute injuries to intimal lining accumulate & allow blood to seep from lumen into layers
aneurysms, brain, weakness, side
areas of typical ___________(aneurysms):
1) _________(brain): if leaks or ruptures, can cause S&S of stroke�_________(weakness) on one _______(side) of body and/or change in level of consciousness and/or sudden horrific headache�many possible S&S
2) aorta
aneurysms, aorta, small, 5cm, abdomen, thoracic, accident, xray
areas of typical ________(aneurysms):
1) brain: if leaks or ruptures, can cause S&S of stroke�weakness on one side of body and/or change in level of consciousness and/or sudden horrific headache�many possible S&S
2) ______(aorta): particularly susceptible
treatment, arterial, stress, smoking, hdl, omega, high
_______(Treatment), nursing implications, of __________(arterial) problems
1. prevention / treatment of HTN, atherosclerosis, and generally any kind of arterial disorder (including coronary artery disease�CAD�which we will discuss in next
section) include
hdl, high, protein, low, cholesterol, greater, 40, exercise
_______(HDL) is ______(high)-density lipoprotein�______(high) level of _______(protein), _____(low) level of _______(cholesterol).
b) serves as a type of scavenger, "picking up" excess cholesterol from blood vessels & delivering it to liver for processing
for, sympathetic, beta-blockers, raas, ace, clots, coumadin
____(for) medicinal approaches (linked to patho):
a. to combat overactivity of ________(sympathetic) nervous system: sometimes ____________(beta-blockers) are given.
b. to combat vasoconstrictive overactivity of ______(RAAS): sometimes _____(ACE) inhibito
not, elevate, arterial, harder, flow, ischemia
______(not) it be helpful to _______(elevate) feet (like in venous disease) in someone with peripheral __________(arterial) problem, It would be ____(harder) for arterial ____(flow) to _____(ischemia) areas
a
HR faster than normal, called _______( greater 100beats/min); some possible causes:
A. tachycardia
B. bradycardia
C. dysrhythmia
D. none of the above
a
respiratory rate" (RR) and "normal" is ~ _______breaths per minute
A. 12-20
B. 10-15
C. 21-25
D. 26-30
b
slower than normal, called _________( less 60 beats/min);
A. tachycardia
B. bradycardia
C. dysrhythmia (arrhythmia)
D. none of the above
bradycardia, vagus, acetyl, decrease, hr, ischemia, right
slower than normal, called ___________(bradycardia) (less 60 beats/min); neurohormonal influences of the parasympathetic nervous system (PNS)
a) PNS governs "slower" processes (digestion, urination, etc)
b) related to the heart, the _______(vagus) nerve s
c
rhythm pattern can become irregular instead of normal sinus rhythm
A. tachycardia
B. bradycardia
C. dysrhythmia (arrhythmia)
D. none of the above
dysrhythmia, ischemic, infarcted, electrolyte, age, atrial, ventricular
called _________(dysrhythmia) (or arrhythmia);
a) causes include:
(1) ________(ischemic) or ____________(infarcted) tissue interferes with normal impulse conduction
(2) __________(electrolyte) imbalances, especially related to K+ (hypo & hyper)
(3) ______
atrial, fibrillation, quiver, elderly, 3, long, hypoxic, hf
_____________(atrial) ________(fibrillation)�"Afib" (example of atrial dysrhythmia)
a) a chaotic series of electrical impulses in the atria that cause them to _____(quiver) ineffectively instead of contracting smoothly.
b) fairly common amongst _______(el
afib, small, significant, decrease, co, no, kick
____(afib) ______(small) but sometimes __________(significant) ________(decrease) in ____(CO); etiology:
(1) usually atria have a small coordinated contraction at the end of diastole�this is called "atrial kick"� helps propel more blood into ventricles be
afib, pooling, arterial, thrombi, emboli, stroke, venous, emboli, lungs
______(afib) _______(pooling) of blood in atria; etiology & sequelae:
(1) if the atria muscles are quivering instead of delivering blood to the ventricles in a coordinated fashion, some blood will remain in the atria & form static pools ("sludge-like")�pe
vfib, chaotic, deadly, no, co, death
ventricular fibrillation�"____(Vfib)" (example of ventricular dysrhythmia)
a) a ________(chaotic) series of electrical impulses in the ventricles that cause them to quiver ineffectively instead of contracting smoothly.
b) Vfib is the most __________(deadl
stroke, volume, contract, changes, negative
______(stroke) _______(volume) (SV) changes that may pathologically affect CO:
a. ___________(contract)ility ________(changes) that are pathologic would be __________(negative) inotropic changes;
examples:
venous, increased, preload, volume
______(venous) preload changes that can be pathologic
1) ________(increased) ___________(preload) usually = increased blood ________(volume); pathologically this would equate to fluid volume overload & would increase workload on a sick heart.
2) decreased
increased, afterload, rv, athero, pulmonary, bronchitis
pathologically ____________(increased) ______________(afterload) makes it harder) for the ventricles) to eject) blood into the receiving arteries:
a) for _____(RV): _____(athero)sclerosis of _____________(pulmonary) artery & branches; lung disorders such
increased, afterload, lv, athero, htn, volume
pathologically ___________(increased) ________(afterload) makes it harder for the ventricles to eject blood into the receiving arteries:
a) for RV: atherosclerosis of pulmonary artery & branches; lung disorders such as chronic bronchitis.
b) for ____(LV):
decreased, afterload, lv, vasodilation, shock, anaphylaxis
pathologically ________(decreased) _______(afterload) for the _____(LV) is usually related to massive peripheral arterial ____________(vasodilation), which can result in _____(shock) states. (examples of massive vasodilation that we have seen: septic shoc
d
a disorder in which the coronary arteries are narrowed and/or
occluded
A. aneurysms
B. Chronic venous insufficiency (CVI)
C. HF
D. Coronary artery disease (CAD)
cad, elevated, homocysteine, crp,
risk factors and causes of ______(CAD) are HTN & all the same risk factors associated with HTN & atherosclerosis.
3) in addition, risk of getting CAD:
a) increases with ________(elevated) serum levels of __________(homocysteine), an amino acid that can co
cad, plaque, athero, inflam, negative, inotropic, infarction
patho of ______(CAD)
1) as with arterial vascular problems in other parts of the body, ischemia is the primary problem in CAD- coronary vessels are narrowed and occluded by ______(plaque)s, due to the _______(athero)sclerotic / ____(inflam)matory processe
spectrum, ischemia, mild, reversed, max, infarction
_______(spectrum) of _________(ischemia):
a) various cells in the cardiac tissue can be affected to different degrees and may all be in different stages of O2 deprivation
b) therefore, important to think of the above processes and ability to reverse them
a
a painful constriction or tightness; in this case it is short for angina pectoris (AKA "chest pain") and refers to ischemic pain in the heart muscle.
A. angina
B. HTN
C. HF
D. Coronary artery disease (CAD)
angina, tightness, 3, 5, exercise, increase, pain
characteristics of classic ______(angina)
a) usually patient often will describe it as _________(tightness), heaviness ("elephant sitting on me"); sometimes burning, indigestion-like; will sometimes place clenched fist over sternum
b) intensity varies acc
angina, buildup, lactic, stretching, myocardium, afferent
pathophysiology of _____(angina) perception:
a) ______(buildup) of _____(lactic) acid and abnormal ______(stretching) of ischemic ________(myocardium) irritate myocardial nerve fibers
b) the _______(afferent) sensory nerve fibers in the area transmit the
cad, asymptomatic, stable, acs
classifications of _____(CAD) states:
1) CAD status of a person is based on degree of coronary occlusion and ischemia, which is usually reflected in severity of S&S
2) a person with CAD can:
a) be _________(asymptomatic)
OR
b) if they become symptomatic,
stable, angina, cad, predictable, well-controlled, meds
______(stable) _____(angina)
a. main characteristic of this category of _____(CAD)�pain pattern is very _______(predictable) and ___________(well-controlled) by lifestyle changes, ______(meds), etc.; ex-- "I always feel tightness in the center of my chest
angina, slowly, ateriogenesis, better, collateral, circulation, better, stable
patho of stable _______(angina)
1) the blockage that causes the angina has developed ______(slowly) and there are no dramatic changes to it.
2) when there is a slow development of plaque in a coronary artery, the steady but small and subtle ischemia to ti
treat, stable, angina, maximize, patency, nitro, aspirin
________(treat)ment of _____(stable) ______(angina)
1) anything that helps to:
a) ________(maximize) coronary _______(patency) & therefore increase perfusion to myocardium
b) decrease workload of the heart
2) the above accomplished by including treatments
acs, several, flow, blocking, clot, arterial, embolus, plaque
acute coronary syndrome _______(ACS):
a. this is when one of _________(several) possible coronary-artery-____(flow)-________(blocking) situations occurs:
1) sudden _____(clot) development.
2) an ________(arterial) _______(embolus) flows into a narrowed co
unstable, angina, worse, nitro, not, work, ekg, shows, blockage
______(unstable) ________(angina)-- when someone with stable angina develops a change for the _____(worse) (usually sudden) in their pattern of S&S
a) usually indicates worsening or change in existing coronary plaques that leads to worsening of ischemia
b
unstable, angina, ekg, acute, treat, patency, perfusion, iv, surgery
______(unstable) ________(angina)-- when someone with stable angina develops a change for the worse) (usually sudden) in their pattern of S&S
(2) ______(EKG) usually shows ___(acute) ischemic changes
c) patient usually ends up admitted to the hospital, wh
mi, necrosis, severe, pain, ck, troponin, clot-busting
myocardial infarction___(mi)
a) an infarction is when some myocardial cells are starting to undergo _______(necrosis)
b) ***note: though some of the cells have become necrosed, which is irreversible, if the patient is very early into the infarcting proces
acs, tachy, brady, dysrhythmia, fatigue, mental, hypo, dyspnea, >2, oliguria
miscellaneous S&S that often occur in ____(ACS) in addition to (or even instead of angina
1) central nervous system (CNS) reaction to pain- N&V, large amount of sweating (diaphresis)
2) variations in HR & rhythm
a) ______(tachy)cardia (from epinephrine --
hypertrophy, cardiomegaly, compensatory, point, continue, hf
________(hypertrophy) leading to ___________(cardiomegaly) (enlarged heart) - increase in size of cells over time due to cells "working harder" to compensate for less oxygen
is an effective _________________(compensatory) mechanism UP TO A _______(POINT)
b
usually adversely affects "full opening"
2) valve orifice is constricted & narrowed so blood cannot easily flow forward through it.
3) blood flowing through smaller opening generates more turbulence�there is a rumbling sound know as a murmur
A. incompeten
a
this problem is also called valvular prolapse, insufficiency or
regurgitation
2) usually adversely affects "full closing"
3) results in regurgitation of blood back into the chamber it came from
4) backflow of regurgitation also can cause turbulence murmur
c
occurs because of three possible pathologic precipitants:
a) PUMP PROBLEM: heart contractility has been weakened
and /or
b) INCREASED RESISTANCE: there is increased afterload to forward flow.
and /or
c) INCREASED PRELOAD: fluid volume overload (increased
hf, small, co, raas, harmful, work, harder
____(hf)
this results in two general sequelae:
a) diminished/_____(small) ____(CO), so that there is inadequate perfusion of tissues (the body not getting what it needs in terms of O2 & nutrients)
b) eventual problems related to "back-up" of fluid and gen
a
_________ must struggle against high afterload (AKA SVR --systemic vascular resistance) due to
1) HTN
and/or
2) pathologically increased, peripheral arterial, vasoconstriction
and/or
3) narrowed / blocked, systemic arteries.
A. LHF
B. RHF
C. DVT
D. None o
b
________ must struggle against high afterload (AKA PVR --pulmonary vascular resistance) due to
1) pathologically increased
pulmonary arterial
vasoconstriction
and/or
3) narrowed / blocked
pulmonary arteries.
and/or
4) lung problems such as
chronic bronchi
hf, ventricle, ischemia, electrolyte, hr, preload
____(hf) _______(ventricle) is weak & has decreased contractility due to:
1) __________(ischemia) or MI,
and/or
2) ________(electrolyte) disturbances
and/or
3) ______(HR) & rhythm probs
is overwhelmed by fluid overload (increased __________((preload).
a
Vasoconstriction of peripheral arterial vessels occurs in an attempt to keep blood circulating in the central areas of the heart, brain, kidneys further increase in afterload
A. LHF
B. RHF
C. DVT
D. None of the above
b
Increased aldosterone body "hangs on" to Na & therefore also hangs on to water increase in preload --ie, worsening fluid overload occurs.
A. LHF
B. RHF
C. DVT
D. None of the above
a
general S&S of decreased CO; include:
fatigue, weakness, mental status change, deterioration of responsiveness, hypotension, dyspnea, prolonged capillary refill (>2 seconds), low urine output, S&S of fluid backup into lungs (lung congestion, ie, lung edem
lhf, edema, crackles, hemoptysis, orthopnea, up, rr, low, so2
_____(lhf)
S&S of pulmonary _____(edema):
(1) ______(crackles) upon auscultation of lungs, cough, often with frothy blood-tinged sputum __________(hemoptysis), the froth is due to air mixed with fluid, the blood-tinged or pink color is due to back pressur
b
S&S of decreased CO, S&S of fluid backup into periphery (i.e, peripheral edema):: jugular venous distention JVD
(2) liver congestion, so enlarged liver
(3) ascites --the state of extra fluid in the abdominal cavity due to fluid being pushed out of engorge
c
RHF due to a lung disease(Pulmonary Vascular Resistance)
A. Ischemia
B. pneumonia
C. Cor Pulmonela
D. Dyspnea
lung, congestion, caused, lhf
_______(Lung) __________(congestion) (pulmonary edema) is ________(caused) by _____(LHF) and its retrograde ("back-up") flow.
lung, congestion, causes, rhf
_______(Lung) _______(congestion) (such as in chronic bronchitis) _____(causes) ______(RHF) & retrograde venous flow.
treat, hf, positive, inotropic, vasodilator, diuretics
______(treat)ment of ___(HF):
1) to increase strength of "pump" & thus increase forward blood flow:
a) _____(positive) ______(inotropic) drugs such as digoxin
b) also, may need to decrease heart rate if too high so that workload of heart is lessened.
2) t
b
an abnormally __________serum BNP level confirms that HF is occurring
A. small
B. elevated
C. normal
D. micro
c
A patient has intermittent claudication and a history of atherosclerosis. What other findings are most likely?
a. pitting edema of the ankles.
b. jugular vein distention.
c. cool feet with diminished pulses.
d. S&S of increased preload.
d
A patient is diagnosed with venous insufficiency. What treatment is most likely and why?
a. tissue plasminogen activator (tPA), because it is used to dissolve arterial clots.
b. drop the legs lower than the heart so that circulation can bypass DVTs.
c. co
b
A patient with a history of atherosclerosis and HTN is complaining of chest pain, SOB, and pain radiating to his left arm. He is diagnosed with an MI of his left ventricular wall.
3. What S&S would be expected and would indicate decreased CO /perfusion?
a
a
A patient with a history of atherosclerosis and HTN is complaining of chest pain, SOB, and pain radiating to his left arm. He is diagnosed with an MI of his left ventricular wall
Lab work done during the MI most likely shows high blood levels of certain s
d
A patient with a history of atherosclerosis and HTN is complaining of chest pain, SOB, and pain radiating to his left arm. He is diagnosed with an MI of his left ventricular wall. He develops a blood pressure of 80/50. Which statement is most accurate?
a.
d
A patient with a history of atherosclerosis and HTN is complaining of chest pain, SOB, and pain radiating to his left arm. He is diagnosed with an MI of his left ventricular wall.
Several days later the patient manifests S&S of heart failure. Given the ar
b
A patient with a history of atherosclerosis and HTN is complaining of chest pain, SOB, and pain radiating to his left arm. He is diagnosed with an MI of his left ventricular wall.
When the patient was suspected of developing the heart failure (HF), lab wo
c
A 40-year-old man is undergoing a yearly physical. Everything is fine except that the nurse practitioner hears a murmur. All the following are likely etiologies EXCEPT:
a. pulmonic valve insufficiency.
b. a heart valve that is ischemic from a coronary art
c
A patient with CAD reports that he gets angina only when he walks more than a mile. It always goes away when he rests or takes a NTG. Which statement best fits this patient?
a. He has unstable angina due to worsening of an atherosclerotic plaque.
b. He ha
d
A patient with CAD reports that he gets angina only when he walks more than a mile. It always goes away when he rests or takes a NTG.
The patient in the question above is on medications. All the following are likely EXCEPT that he takes
a. NTG to maximize
d
A patient in atrial fibrillation has an increased likelihood of
a. no cardiac output and dying immediately.
b. an arterial embolus to the lungs.
c. a venous embolus to the brain.
d. a thromboembolic event.
a
Lab work done on a heart patient shows a potassium of 5.5 (normal = 3.5 - 5.0). The patient is at risk for
a. ventricular fibrillation because his heart cells will be more irritable.
b. bradycardia because his heart cells will be more sluggish.
c. atrial
b
A patient has a DVT of the right calf. Which of the following is the LEAST LIKELY to develop?
a. Pain at the DVT site.
b. Loss of pulse in right foot.
c. Erythema of the skin in the local DVT area.
d. Shortness of breath.
d
14. An otherwise healthy patient has had hypertension (HTN) for many years. Which of the following is most likely true?
a. He has secondary hypertension.
b. Etiologic factors of the HTN include epinephrine depletion.
c. The atrial natriuretic peptide syst
a
A patient with chronic bronchitis says: "Look how swollen my legs and feet and belly are. This has been increasing over the last couple of years. What's going on?" As his nurse, you would most likely suspect that the patient has all the following EXCEPT
a
b
A patient in the hospital is recovering from hip surgery.
She begins to complain of chest pain and dyspnea. Her RR is 30. A lung scan is performed and the V/Q ratio is reported to the nurse as "high." This patient has most likely suffered a(n)
a. MI.
b. p
c
A patient in the hospital is recovering from hip surgery.
She begins to complain of chest pain and dyspnea. Her RR is 30.
Arterial blood gases (ABGs) are drawn. The results are: pH: 7.50; PaO2: 100; PaCO2: 29; HCO3: 26. This altered state is called
PCO2:
b
A patient in the hospital is recovering from hip surgery.
She begins to complain of chest pain and dyspnea. Her RR is 30. Arterial blood gases (ABGs) are drawn. The results are: pH: 7.50; PaO2: 100; PaCO2: 29; HCO3: 26.
PCO2: 35-45, PO2: 80-100, HCO3: 22-
c
A child with laryngotracheobronchitis is likely to
a. have stridor from trying to exhale air from inflamed alveoli.
b. develop a walled-off area of viral infection in the laryngeal area.
c. have stridor from trying to inhale air through inflamed bronchi.
d
A victim of a stab wound to the chest develops a pneumothorax. Which type of pneumothorax is most likely in his case?
a. Consolidative.
b. Tension
c. Bronchial
d. Open
a
A common denominator of a bed-ridden nursing home patient and an unconscious alcoholic is their high risk for
a. aspiration pneumonia.
b. bronchogenic carcinoma.
c. nosocomial pneumonia.
d. miliary tuberculosis.
c
The nurse taking care of a pulmonary patient notes that he is very thin and barrel-chested, has a respiratory rate of 28, and uses accessory muscles to breathe.
The nurse thinks it is most likely that the patient's S&S are due to
a. chronic bronchitis.
b.
d
The nurse taking care of a pulmonary patient notes that he is very thin and barrel-chested, has a respiratory rate of 28, and uses accessory muscles to breathe.
An arterial blood gas report shows pH = 7.50, PCO2 = 32, PO2= 90, SO2= 92% HCO3 = 26.
PCO2: 35
b
A patient complains of a one-week history of fever, cough, and purulent sputum. The nurse listening to the patient's lungs notes greatly diminished breath sounds in one area of the left lung and concludes that it is probably an area of consolidation. What
c
A patient with a medical history of CHF presents to her health care provider complaining of PND, 2-pillow orthopnea, DOE, and hemoptysis. She most likely has
a. primary pulmonary hypertension. (error-- this wasn't in your notes)
b. noncardiogenic pulmonar
a
A patient has overdosed with heroin. He is unconscious and his RR is 8.
PCO2: 35-45, PO2: 80-100, HCO3: 22-26
Which of the following set of blood gases is most likely, given this information alone?
a. pH= 7.25; PaO2= 70; pCO2 = 50; HCO3= 24.
b. pH= 7.49;
a
A patient has overdosed with heroin. He is unconscious and his RR is 8.
PCO2: 35-45, PO2: 80-100, HCO3: 22-26
The correct answer above is called:
a. respiratory acidosis
b. metabolic acidosis
c. respiratory alkalosis.
d. metabolic alkalosis
so2, saturated, oximeter, 97, 100
____(SO2)
a) oxygen saturation�this indicates O2 that is carried by hemoglobin
b) cycle of oxygenation:
(1) in lungs, where the O2 concentration is high, Hgb will bind with O2 for transport to the tissues
(2) if all four O2-binding sites on the hemoglobin
d
if the CO2 is out of norm, the acidosis or alkalosis has a ___________ origin.
A. neuro
B. pulmonary
C. metabolic
D. respiratory
c
if the HCO3 is out of norm, the acidosis or alkalosis has a ________ origin.
A. neuro
B. pulmonary
C. metabolic
D. respiratory
respiratory, acidosis, out, rr, low, co2, high
_______(Respiratory) _________(acidosis)
1) state of low pH caused by inhibition of normal breathing pattern, such as diminished effectiveness of breathing or decreased respiratory rate (hypoventilation).
2) this results in retention & accumulation of CO2
respiratory, alkalosis, hyperventilation, co2, low
__________(Respiratory) _________(alkalosis)
1) state of high pH caused by increase in normal breathing pattern, such as _____________(hyperventilation).
2) increased rate of breathing results in blowing off" more ______(CO2) less CO2 in the blood means n
metabolic, acidosis, hco3, low, dka
______(Metabolic) __________(acidosis)
1) state of low pH caused by accumulation of acid gang due to metabolic problems like renal failure & diabetic ketoacidosis
2) acid gang accumulation overwhelms the alkali guy, so _____(HCO3) will be ____(low).
Patie
metabolic, alkalosis, hco3, high, vomiting
_________(Metabolic) _______(alkalosis)
1) state of high pH caused by metabolically- induced loss of acid gang and/or accumulation of alkali guy
2) _____(HCO3) will be _____(high).
Patient with extreme ___________(vomiting) loss of HCl
blood acid level be
c
a pattern of rapid & deep breathing for the purpose of blowing off accumulated acid. metabolic acidosis
A. perfusion
B. ventilation
C. kussmaul
D. exhalation
b
_________ can be thought of as the portion of inhalation in which air passes into bronchi & alveoli (lung tissue) rest of the body.
A. perfusion
B. ventilation
C. kussmaul
D. exhalation
a
___________ can be thought of as the portion of inhalation in which the blood vessels of the lungs bring CO2 to the alveoli & take away O2 to pass on to the rest of the body.
A. perfusion
B. ventilation
C. kussmaul
D. exhalation
d
diaphragm & intercostal muscles "elastically" return to "resting state" and CO2 is expelled from the body.
A. perfusion
B. ventilation
C. kussmaul
D. exhalation
a
dyspnea upon lying down; usually related to LHF
A. orthopnea
B. dyspnea
C. hypoventilation, AKA bradypnea
D. hyperventilation, AKA tachypnea
c
defined as RR < 12 breaths per minute
A. orthopnea
B. dyspnea
C. hypoventilation, AKA bradypnea
D. hyperventilation, AKA tachypnea
d
defined as RR > 20 breaths per minute
A. orthopnea
B. dyspnea
C. hypoventilation, AKA bradypnea
D. hyperventilation, AKA tachypnea
a
shallow breathing.
A. hypopnea
B. hyperpnea
C. apnea
b
increased depth (tidal volume) of respirations
A. hypopnea
B. hyperpnea
C. apnea
c
no respirations at all
A. hypopnea
B. hyperpnea
C. apnea
a
disorders often seen in pulmonary diseases
A. nasal flaring in young children, hemoptysis, purulent sputum, inappropriate us of accessory muscles
B. nasal flaring in adults, hemoptysis, purulent sputum, inappropriate us of accessory muscles
C. nasal flari
b
A patient presents who is complaining of dyspnea. He has a RR of 32 and an SO2 of 91%. He is using intercostal muscles during expiration. Altogether this describes one presentation of
A. Respiratory Failure
B. Respiratory Distress
C. Purulent Sputum
D. no
a
patient can no longer breathe adequately on his own; usually the SO2 and PO2 are very low and the PCO2 is very high.
A. Respiratory Failure
B. Respiratory Distress
C. Purulent Sputum
D. none of the above
c
diseases refers to disease processes related to difficulty with inhalation.
b. since problems with inhalation usually means decreased O2 getting in, one sign often found with this category is hypoxemia
A. Constrictive
B. Obstructive
C. Restrictive
D. Dest
c
measured numerically as low SO2 and/or low PO2, with pH & PCO2 only sometimes affected
A. Constrictive
B. Obstructive
C. Restrictive
D. Destructive
d
normal amount of air breathed in and out per minute is ~ 4 liters.
A. Perfusion
B. Inhalation
C. exhalation
D. Ventilation
a
normal amount of blood in the lungs available for gas exchange per minute is ~ 5 liters
A. Perfusion
B. Inhalation
C. exhalation
D. Ventilation
normal, v/q, 0.8
_____(normal) ____(V/Q) ratio: ____(0.8) (4 / 5)
vq, mismatch, can't, see, scan
____(VQ) _________(mismatch)" means the V/Q ratio is out of the norm�either lower or higher than normal
a) ________(can't) actually "____(see)" a mismatch when assessing your patients, although it usually exists to some degree in most restrictive pulmona
b
is what happens if a person is having difficulty with ventilation�it is likely that he is not getting the usual number of liters of air from the atmosphere to the blood, in pneumonia, alveoli get filled up with secretions and portions collapse less air c
c
is what happens if a person is having difficulty with perfusion�it is likely that during inhalation, he is not getting the usual number of liters of blood to alveoli for gas exchange a pulmonary embolus blocks one or more branches of the pulmonary arteria
a
deformity-- kyphosis, obesity, neuromuscular weakness from diseases that affect the junction between neurons and muscle cells-- polio, myasthenia gravis.
A. Chest restriction
B. Airway restriction
C. Lung tissue Restriction
D. Pleural Restricion
b
foreign body, tumors of trachea & bronchi.
2) inflammation of upper airways�croup
a) most diseases that cause inflammation in larynx & bronchi are caused by virus inflammation airways narrowed stridor
is usually heard upon inspiration (a high pitched, ras
b
croup (laryngotracheobronchitis) - inflammation of larynx & bronchi
(1) usually occurs in infants & children younger than 1 year.
(2) S&S�fever, increased RR, barking cough, stridor
(3) tx�cool mist, sometimes steroids.
A. Chest restriction
B. Airway rest
c
extra fluid in pleural space
A. Closed Penumothorax
B. Open Pneumothorax
C. Pleural Effusion
D. pneumonia
d
normally, the space between the visceral and parietal pleura has very little fluid�just enough for lubrication
b) the amount increases when something causes irritation / inflammation to pleura: ex:
(1) cancer cells in the lung.
(2) heavy coughing from bro
c
cancer cells in the lung.
A. Closed Penumothorax
B. Open Pneumothorax
C. Pleural Effusion
D. pneumonia
a
presence of air in the pleural space caused by a rupture in the visceral pleura OR the parietal pleura & chest wall
a) results in disruption of normal negative pressure of lungs; ie, thorax pressure becomes the same as the atmosphere as air comes in patho
b
when there is trauma from the outside.
(b) classic case�broken rib punctures pleura.
A. Closed Pneumothorax
B. Open Pneumothorax
a
when trauma is from the inside�often called a tension pneumothorax because air builds up in the thorax enough to put pressure on other lung too.
(b) can happen when a patient has an underlying disease, such as when a weakened, emphysemic alveoli ruptures
c
pneumonia�acute infection of the lower respiratory tract caused by bacteria, viruses, fungi, or parasites
a) overview
(1) 6th leading cause of death in the US; especially takes its toll on elderly
(2) risk factors: either end of age-spectrum; immunocompro
d
Lung tissue Restriction, acute infection of the lower respiratory tract caused by bacteria, viruses, fungi, or parasites, 3 types
A. Closed Penumothorax
B. Open Pneumothorax
C. Pleural Effusion
D. pneumonia
a
Lung tissue Restriction organisms are most commonly gram positive and less virulent
(a) sometimes called "walking pneumonia"�don't have to be hospitalized)
(b) exception�immunocompromised & debilitated individuals in the community can get virulent CAP bec
b
most commonly caused by virulent gram negative microbes like pseudomonas
(b) these patients need very strong antibiotics.
A. CAP
B. Nosocomial Pneumonia
C. Aspiration Pneumonia
c
aspiration usually means to inhale something that shouldn't be going into the lungs�nasal drip, food, liquid, foreign body �with resultant inflammation to lung tissue.
(b) this type of pneumonia can be a CAP or a nosocomial type
(c) usually happens in deb
pnemonia, alveoli, debris, infilitrates collapse, lung, atelectasis, stiff
patho of ________(pneumonia):
(1) microorganisms settle into _______(alveoli) & are attacked by alveolar macrophages
(2) if this attack is ineffective or if body is overwhelmed by numbers of organisms, full-scale activation of body's defense mechanisms ta
pneumonia, crackles,small, breath, abnormal, xray
c) S&Ss of any kind of ______(pneumonia)
(1) fever, chills, malaise, pleural pain, cough, dyspnea
(2) upon auscultation:
(a) _______(crackles) (from inflammatory fluid in alveoli) or
(b) locally _______(small) ______(breath) sounds (consolidated tissue ha
pulmonary, edema, noncardiogenic, injury, increase, permeability, pink, sputum
________(pulmonary) _______(edema)�excess water in alveoli; see page 719
a) usually thought of as cardiogenic (already discussed in heart section) vs __________(noncardiogenic)
b) noncardiogenic etiology: ____(injury) to capillary endothelium (ex�smoke fr
a
arise from epithelium of respiratory tract (lung is also the site of metastasis for many other types of cancer)
a) most common cause (90%)�> cigarette smoking�one in 10 smokers will develop lung cancer
b) patho: carcinogens in tobacco smoke (has > 40) cau
high, vq, embolus, virchow
problems that result in ____(HIGH) ____(VQ) (can't get blood to the air�less perfusion than normal), ie, obstruction of vessel in lung
a. structural problems of vessels can cause this: strictures in pulmonary vessels, malformations, birth defects
b. most
obstructive, accessory, pf
_________(obstructive) their S&S often are a result of this "forcing out:"
a) often patients must use ____________(accessory) muscles to do this; use of accessory muscles is often manifested as retractions�supraclavicular, substernal, & intercostal muscle
a
Obstructive Disorder:a chronic inflammatory disorder of the airways due to bronchial hyperresponsiveness to stimuli such as allergens in environment.
2) can begin at any age�about half of all cases develop in childhood and 1/3 in adulthood, usually under
asthma, wheezing, alkalosis
Obstructive disorder _____(asthma( usually have ______(wheezing) upon exhalation, though in bad cases the wheezing can also be upon inhalation.
b) often have accessory muscle use�intercostal & supraclavicular retractions while exhaling�and prolonged expir
b
Obstructive disorder a. collective term for emphysema and/or chronic bronchitis
1) patho is different, but some characteristics are the same in both.
a) in MOST cases, the cause of both types of is smoking
b) S&S in both include prolonged expirations, cer
emphysema, elastase, breaks, protein, blebs
Obstructive disorder ________(emphysema) airway inflammation & abnormally increased activity of proteolytic enzymes like ___________(elastase) (an enzyme that _______(breaks) down the ______(protein) that make lungs so flexible & "elastic") due to this lo
emphysema, tachypnea, pink, thin, ap, barrel, chest
Obstructive disorder_________(emphysema) a degree of ________(tachypnea) is almost always present�RR of 26 to 30/min
b) because of hyperventilation, patients with emphysema known as "pink puffers" --they can stay_____(pink) (ie, fairly well-oxygenated) as
emphysema, help, tripod, pursed, alkalsosis
________(emphysema) often emphysemics will unconsciously use certain techniques to _____(help) to exhale and to get more air:
(1) "____(tripod)" position to maximize chest expansion
(2) "______(pursed) lip" breathing to increase pressure in chest to get a
c
defined as hypersecretion of mucus and chronic productive cough for at least 3 months of the year for at least 2 consecutive years;
2) patho: inspired irritants (usually from smoking)
known as "blue bloaters"
also can have clubbing of the fingers
A. asthm
bronchitis, bloater, hyper, useless, acidosis
Obstructive Disorder chronic ________(bronchitis)
etiology of "______(bloater):"
(1) _____(hyper)ventilation won't do any good _____(useless)
(a) the body "knows" that, unlike the pink puffer, it will not help very much to increase the respiratory rate in
a
Obstructive Disorder No barrel chest
Minimal changes in ventilatory patterns
Blue (chronically hypoxemiccyanotic, clubbed fingers)
No special position because it doesn't help; only "keeping still" helps a bit so they don't increase need for oxygen
Wt gain
b
Obstructive Disorder Barrel chest (from air trapping lungs "huge")
Tripod position, hyperventilating as part of norm ("puffer").
Pink (adequate oxygenation unless having exacerbation)
Wt loss; very thin.
ABGs: chronic respiratory alkalosis (if becomes res
b
Obstructive Disorder no bronchial component
Equal destruction of alveoli & capillaries
A. Chronic Bronchitis
B. Emphysema
C. Asthma
D. COPD
a
Obstructive Disorder Patho: bronchial component: cough, mucus, poor exchange of O2 & CO2
No tissue destruction
A. Chronic Bronchitis
B. Emphysema
C. Asthma
D. COPD
c
deficient HCO3
A. Respiratory Acidosis
B. Respiratory, Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
d
Too much HCO3
A. Respiratory Acidosis
B. Respiratory, Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
b
deficient HCO2
A. Respiratory Acidosis
B. Respiratory, Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
a
Too much HCO2
A. Respiratory Acidosis
B. Respiratory, Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
b
Gram Negative Pneumonia
A. CAP
B. Nosocomial
C. Aspiration
a
Gram Positive Pneumonia
A. CAP
B. Nosocomial
C. Aspiration
a
Venous injuries are
A. warm
B. cold
b
Arterial injuries
A. warm
B. cold
c
An 80-year old woman with a medical history of HTN and CAD goes to her NP for a check-up. She complains that her vision has been slightly blurry but otherwise has no changes in her usual S&S. Her VS (vital signs) are as follows: BP 168/100, HR 100, RR 20.
d
Which concept map best explains the proteinuria and/or hematuria?
a. Heart disease� high density lipoproteins accumulate and overcome renal
threshold� spill into urine� proteinuria� HDL now too low.
b. HTN + CAD � weakened walls of renal veins�substances
b
A patient with CAD presents to her NP with a change in her usual pattern of angina. Her usual pattern for the last several years is to have anginal pain (rated "3/10") after walking up a flight of stairs, but the pain usually quickly subsides after restin
a
A patient with CAD presents to her NP with a change in her usual pattern of angina. Her usual pattern for the last several years is to have anginal pain (rated "3/10") after walking up a flight of stairs, but the pain usually quickly subsides after restin
d
In the hospital, the patient begins complaining of worsening pain ("8/10"). The RN suspects she is having a myocardial infarction, and the MI is located in her right ventricle. All of the following fit with the RN's thinking EXCEPT
a. the patient's EKG mo
b
pathology underlying why diuretics (meds that increase urination) are given in a person with heart failure ______?
A. decreased cardiac output�kidneys sense this and increase renin as a compensatory response� RAAS kicks in but its results exacerbate the p
g
mini-concept map that explains S&S of LHF
A. decreased cardiac output�kidneys sense this and increase renin as a compensatory response� RAAS kicks in but its results exacerbate the problem.
J. classic pulmonary edema S&S of SOB, orthopnea, hemoptysis
C. o
e
person has chronic lung disease-lungs very stiff-pulmonary vascular resistance increases-RV struggles to push blood into the high pressure pulmonary system -RV fails-back pressure eventually results in peripheral edema
A. decreased cardiac output�kidneys
j
clinical presentation of LHF
A. decreased cardiac output�kidneys sense this and increase renin as a compensatory response� RAAS kicks in but its results exacerbate the problem.
J. classic pulmonary edema S&S of SOB, orthopnea, hemoptysis
C. one of the S&S
i
a treatment for a person with heart failure
A. decreased cardiac output�kidneys sense this and increase renin as a compensatory response� RAAS kicks in but its results exacerbate the problem.
I. decrease systemic vascular resistance (SVR), a type of after
c
jugular venous distention
A. decreased cardiac output�kidneys sense this and increase renin as a compensatory response� RAAS kicks in but its results exacerbate the problem.
I. decrease systemic vascular resistance (SVR), a type of afterload, by giving va
a
main etiology of fluid overload in any kind of heart failure
A. decreased cardiac output-kidneys sense this and increase renin as a compensatory response� RAAS kicks in but its results exacerbate the problem.
I. decrease systemic vascular resistance (SVR)
d
mini-concept map that explains S&S of RHF
A. decreased cardiac output-kidneys sense this and increase renin as a compensatory response� RAAS kicks in but its results exacerbate the problem.
I. decrease systemic vascular resistance (SVR), a type of afterlo
f
BNP (B-type natriuretic peptide)
A. decreased cardiac output-kidneys sense this and increase renin as a compensatory response� RAAS kicks in but its results exacerbate the problem.
I. decrease systemic vascular resistance (SVR), a type of afterload, by gi
h
explains crackles heard in lungs upon auscultation with a stethoscope
A. decreased cardiac output-kidneys sense this and increase renin as a compensatory response� RAAS kicks in but its results exacerbate the problem.
I. decrease systemic vascular resista
stroke, volume, contractility, preload, afterload
stroke, volume, contractility, preload, afterload
b
central nervous system (CNS) reaction to pain- N&V, large amount of sweating ______
A. perfusion
B. diaphoresis
C. kussmaul
D. kinase
a
High RR low SO2
A. respiratory distress
B. respiratory failure
C. respiratory furious
D. none of the above
b
Low SO2, O2, and PH with high PCO2
A. respiratory distress
B. respiratory failure
C. respiratory furious
D. none of the above
b
If the lungs are sick the _____compensate
A. Lungs
B. Kidneys
C. metabolic
D. none of the above
a
If the metabolic side is sick the _____compensate
A. Lungs
B. Kidneys
C. metabolic
D. none of the above