Download Nurs 620 Maryville Exam 2: Hypertension, Hyperlipidemia, and Coronary Artery Disease and more Exams Nursing in PDF only on Docsity!
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Risk factors for hypertension - CORRECT ANSWERS 1. age & sex- women older than 55 & men older than 45 2.Obesity 3.Excessive dietary intake of salt 4.cigarette smoking 5.chronic alcohol consumption 6.Family history of high blood pressure and/or cardiovascular disease 7.African American race 8.Stress 9.Sedentary lifestyle Blood pressure goals for JNC8 - CORRECT ANSWERS Healthy patients over 60 years of age is okay if it is below 150/ Healthy patients less than 60 years of age the blood pressure is okay if less than 140/ Patients with dx of DM or CKD regardless of age, goal BP is less than 140/ lifestyle modifications for - CORRECT ANSWERS Weight reduction (BMI 18.5- 24.9) DASH diet less than 2.4g a day of sodium Increase Pysical activity to 30min most days of the week Stop smoking Alcohol less than 2 drinks a day JNC8 preferred agents: - CORRECT ANSWERS -general population: thiazide CCB Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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ACEI
ARB
-black: (without CKD) CCB or thiazide -DM: thiazide CCB ACEI ARB -CKD: ACE ARB Which medications for HTN should not be used together - CORRECT ANSWERS ACE and ARBS HTN therapy for patients over 75years old with impaired kidney function - CORRECT ANSWERS CCB Thiazides Classification of HTN per AHA - CORRECT ANSWERS Normal BP: less than 120 Systolic, diastolic less than 80 Elevated: 120-129 systolic, less than 80 diastolic Stage 1 HTN: 130-139/80- Stage 2 HTN: 140+/90+ Hypertensive crisis: 180+/120+ Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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- Inadequate diuretic Tx
- Med issues such as inadequate doses, drug actions and interactions (e.g. NSAIDs, illicit drugs, sympathomimetics, OCPs), or OTC drugs and herbals
- Excess EtOH intake
- Underlying ID causes of HTN (2ndary)
- White coat hypertension Complications of HTN - CORRECT ANSWERS Left ventricular hypertrophy Heart failure Ischemic Stroke Intracerebral hemmorage Ischemic heart disease CKD, ESRD Signs of target organ damage in Hypertension - CORRECT ANSWERS Headaches vision changes papillary edema change in mental status s/s heart failure hematuria, proteinuria, elevated creatinine Dyslipidemia--> Desirable/optimal serum lipid levels ****** - CORRECT ANSWERS Total cholesterol: less than 200mg/dl Triglycerides: less than 150mg/dl HDL: women greater than 45, men greater than 40, cardio protective is greater than 60 LDL: less than 100, DM 50- Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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Screening for hyperlipidemia - CORRECT ANSWERS High Risk-
- More than 1 risk factor
- HTN, Smoking, Family hx
- Single risk factor that is severe
- i.e. siblings w/ CAD at a young age
- Very heavy smoking history
- Start screening at age 25 for men, age 35 for women
- Repeat screening every 3 years Low Risk-
- In the general population, guidelines indicate screening based on sex and age
- Males - age 35
- Females - age 45
- Rescreening recommended every 5 years symptoms of hyperlipidemia - CORRECT ANSWERS A person with hyperlipidemia usually has no signs or symptoms. In familial, or inherited, hyperlipidemia, there may be yellowish fatty growths around the eyes or the joints. Hyperlipidemia is usually detected during a routine blood test, or following a cardiovascular event, such as a heart attack or stroke. How to manage hyperlipidemia - CORRECT ANSWERS • Therapy should be initiated when a patient's 10-year risk for a first atherosclerotic cardiovascular disease (ASCVD) event is 7.5%
- This calculator can be found at
- http://tools.cardiosource.org/ASCVD-Risk-Estimator/ When would you initiate drug therapy for high cholesterol according to lab results? - CORRECT ANSWERS • Therapy should be initiated when a patient's 10-year risk for a first atherosclerotic cardiovascular disease (ASCVD) event is 7.5% Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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MI- obstruction within a coronary artery or arteries that blocks flow to the head resulting in inadequate blood supply to epicardium. Non-modifiable risk factors for CAD - CORRECT ANSWERS age (increased), gender (male), ethnicity (African american), family history, genetics Modifiable risk factors for CAD - CORRECT ANSWERS Smoking HTN DM obesity diet activity level hyperlipidemia Women: menopause w/o estrogen replacement or women on birth control. contributing factors for CAD - CORRECT ANSWERS Diabetes, obesity, sedentary lifestyle, stress Diagnostics for CAD - CORRECT ANSWERS ECG, exercise ECG (stress test), nuc scan( non exercise stress test), cardiac cath, intravascular ultrasonogrophy. CRP Management of CAD - CORRECT ANSWERS Start with Risk factor modification Control the symptoms (Nitro sublingual) preventing disease progression fibrolytic agents PCI CABG Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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Medications for CAD - CORRECT ANSWERS beta blockers, aspirin, statins, nytrates acute coronary syndrome (ACS) Stages - CORRECT ANSWERS Stable angina- pain with exertion, resolves with rest Unstable angina- pain at rest variant angina - varies Myocardial infarction Non MI causes of chest pain - CORRECT ANSWERS PE- ask about hx of DVT's, extended traveling Aortic dissextion Tension pnumo cardiac temponade esophogeal rupture panic attacks HPI of chest pain - CORRECT ANSWERS Onset (abrupt or gradual) Size of pain (substernal, chest wall, localized) Provocation/palliation(which activies make it better or worse) Quality of pain (sharp, dull, pleuritic, squeezing) Radiation Timing (constant or episodic, duration of episodes, when it began) Associated symptoms (syncope, dyspnea) Typical chest pain of Acute Mi - CORRECT ANSWERS Substernal compression or crush pressure tightness, heaviness, cramping, aching Unexplained indigestion, belching, epigastric pain radiating pain to neck, jaw, shoulders, back or both arms Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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Diagnostic workup for murmurs - CORRECT ANSWERS -ECG (also think about halter monitor) -Chest radiograph -Cardiac ultrasound -Echo -Stress test Cardiology referral Asymptomatic systolic murmur - CORRECT ANSWERS Ejection murmur- usually high pitched, heard best at MSB Reguritation murmurs - CORRECT ANSWERS mitral valve incompetence •Causes -Rheumatic mitral valve disease -Bacterial endocarditis -Dilated cardiomyopathy -Papillary muscle rupture -Endocardial fibrosis •Fen-fen Ejection Murmurs - CORRECT ANSWERS •Early aortic and pulmonic valve disease •Calcific aortic stenosis •Aortic sclerosis •IHSS-Idiopathic hypertrophic subaortic stenosis •Atrial septal defects Causes of ejection murmurs - CORRECT ANSWERS •Causes Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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-Fever -Anemia -Pregnancy -Hyperthyroidism -Exercise -Aortic regurgitation -Bradycardia -ASD-arterial septal defect -HTN -aging Atrial Fibrillation - CORRECT ANSWERS -Irregularly irregular rhythm
•Presentation -Rapid HR -Dizziness -SOB -Lightheadedness -Hypotension Dignostic work up for afib - CORRECT ANSWERS •ECG •TSH •BMP •Chest pain •JVD •Crackles •S Treatment for afib - CORRECT ANSWERS •Establish rate control Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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- Hepatojugular reflux
- S
- Crackles
- Pleural effusions Heart failure diagnostic work up - CORRECT ANSWERS •History •Physical •Lab test -Serum B-type natriuretic peptide > 100 pg/dl •ECHO Cardiogram (ultrasound) •ECG •CXR Heart Failure Treatment - CORRECT ANSWERS •ACE-I •ARB •BB •Entresto (sacubitril and valsartan) -In place of an ACE-I, cannot be used in combination •Diuretics -Thiazides -Metolazone -Loop diuretic -Aldosterone blockers •Digitalis •Oral anticoagulation •Antiplatelet therapy Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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•Low salt diet •Water restrictions •Daily weight monitoring •CardioMEMs -Implantable device to monitor arterial pressures •Exercise training •Patient education Syncope - CORRECT ANSWERS -Reversible loss of consciousness -Transiently insufficient cerebral perfusion
•Presentation -Loss of consciousness or near loss -Dizziness -Feeling faint Diff diagnosis for syncope - CORRECT ANSWERS •Cardiac -Arrhythmias -PE •Neurally Mediated •Vasovagal •Situational •Cerebrovascular -CVA -Seizures -metabolic HPI and PE for syncope - CORRECT ANSWERS What were the presenting symptoms? Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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•Those with CAD •AA individuals HPI for PVD - CORRECT ANSWERS -Do they have any risk factors? -Are they having any symptoms? -Are they noticing any swelling in the legs? -Are they noting any discoloration or wounds to the skin? -What about pulses, are they noticed a diminished pulse, any blue coloration to the feet? -Are they having pain with walking? -Are they having pain at rest? Review of systems, we really want to focus on the cardiovascular, pulmonary, and peripheral systems, and physical exam the same. Etiolgy of PVD - CORRECT ANSWERS •Large arteries -Atherosclerosis -Thromboembolism -Trauma -Arteritis of various types including •Buerger's disease •Fibromuscular dysplasia •Takayasu's Medium and small vessel occlusions -Diabetes -Chronic recurrent trauma -Multiple small emboli -Collagen vascular diseases Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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-Dysproteinemias -Polycythaemia vera -Pseudoxanthoma elasticum -Drug reaction -Vasospasm Stages of PVD - CORRECT ANSWERS 1. Reduced pulses
- Intermittent claudication
- Pain when resting
- Ulcers 5 p's of PVD - CORRECT ANSWERS 1. Pain
- Pallor
- Pulselessness
- Paralysis
- Paresthesia 3,4,5 are surgical emergancies Clinical presentation of PVD - CORRECT ANSWERS Asymptomatic: Without obvious symptomatic complaint (but usually with a functional impairment). Classic Intermittent Claudication: Lower extremity symptoms confined to the muscles with a consistent (reproducible) onset with exercise and relief with rest. "Atypical" leg pain: Lower extremity discomfort that is exertional, but that does not consistently resolve with rest, consistently limit exercise at a reproducible distance. Arterial and Venous PVD assessment - CORRECT ANSWERS Pulses: •Pulses are based on a scale of Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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risk modification -Tobacco cessation -Lifestyle modifications -Diet-low cholesterol/low fat diet -Medication -Exercise training -Vascular surgery-revascularization -Interventional Radiology -Gene-Based Therapy Drugs for PVD - CORRECT ANSWERS •Drugs that lower cholesterol & control high blood pressure •Decrease blood viscosity ØPentoxifylline or Warfarin •Antiplatelet agents: their primary long-term benefit is reduction in cardiovascular events and mortality ØASA doses of 81mg to 325mg QD have shown protective benefits. ØTiclopidine, Dipyridamole (avoid in geriatric), and Clopidogrel also have shown promise in disease prevention Other procedures for PVD - CORRECT ANSWERS •Angioplasty •Stents •Grafts •Thrombolytic therapy •Stent-Grafts DVT - CORRECT ANSWERS -formation of a blood clot deep in the circulatory system (veins) Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
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-Is caused by any factor, condition, injury that results in a clot formation in the body. Usually the legs but not exclusively. Risk factors for DVT - CORRECT ANSWERS •Genetic clotting disorders •Immobility, prolonged bedrest, inactivity •Paralysis •Injury/trauma •Surgery/dehydration •Oral contraceptives/hormonal replacement therapy •Overweight and obesity states •Tobacco use •Cancer/malignancy •Prolonged sitting •Family hx of DVT or PE •Age of 60+ •Heart failure/CV conditions •Bowel diseases that have an inflammatory etiology •Pregnancy/postpartum •Varicose veins Symptoms of DVT - CORRECT ANSWERS •Sometimes asymptomatic •Swelling in affected extremity-usually unilateral •Pain in the calf •Leg cramps/tenderness/soreness •Erythema •Pallor •Cyanosis Nurs 620 Maryville Exam 2 156Questions and Answers (Latest Update
