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Unit II Exam Study Guide for NUR345 Adult Health II, Exams of Nursing

A study guide for the Unit II Exam of NUR345 Adult Health II. It covers topics such as differentiating between MI and chronic stable angina, nursing care of patients, medications, patient teaching, CAD, heart failure, heart valve disorders, and aneurysms. a comprehensive list of symptoms, nursing interventions, and patient education for each topic. It also includes information on modifiable risk factors, nutritional therapy, and drug therapy for CAD. The study guide is useful for nursing students preparing for the Unit II Exam.

Typology: Exams

2022/2023

Available from 11/19/2023

joseph-waihenya
joseph-waihenya 🇺🇸

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Unit II Exam Study Guide NUR345 Adult Health II

I. Be prepared to differentiate between and MI and chronic stable angina: symptoms, and nursing care of patient including medications and patient teaching. a. MI i. Symptoms:

  1. chest pain, radiating chest pain to left arm, jaw, or back, unrelieved by nitroglycerine or rest, sweating, hard to breathe, increased HR and BP, or irregular HR, nausea and vomiting, anxious and scared (fear of impending doom) ii. Nursing Interventions:
  2. Assessing pt pain
  3. Assess cardiovascular system a. EKG, monitor BP, HR
  4. Oxygen NC
  5. 2 working IV sites
  6. monitor respiratory sounds – crackles
  7. strict bedrest
  8. collect cardiac enzymes
  9. administer medications

a. anticoagulants – lovenox and heparin i. monitor bleeding, assess gums, stool, urine, drop in BP or increase in HR b. antiplatelets – aspirin and Plavix i. watch for GI bleeding ii. stop taking medication 5-7 days before surgery and inform pt of these medications c. morphine – for chest pain i. assess for hypotension, respiratory depression d. Nitrates – nitroglycerin i. Vasodilator – assess BP, chest pain, EKG, headache, flushing, dizziniess e. ACE inhibitors i. Watch for nagging dry cough, increased potassium, level, hypotension f. Beta blockers i. Monitor HR and BP ii. Not for pts with asthma or COPD iii. No grapefruit juice g. ARBS: - Sarton i. Watch for increased potassium h. Cholesterol lowering meds – statins

i. Assess for muscle pain and monitor liver function i. Calcium channel blockers i. Monitor HR, hypotension, and ensure good oral hygiene b. Chronic stable angina i. Symptoms

  1. Referred pain in the left shoulder and arm
  2. Pain that usually lasts 3-5 minutes as a result of a precipitating factor
  3. Pain at rest is unusual ii. Nursing Care
  4. Nitroglycerin – sublingual, ointment, transdermal
  5. Decrease o2 demand or increase o2 supply
  6. Beta blockers, calcium channel blockers, ACE inhibitors,
  7. Balloon angioplasty, stent
  8. Supplemental oxygen, vital signs, EKG, pain relief, auscultation of heart sounds II. Review all diagnostic and medication templates. Review Dig and Lasix also a. Nitroglycerin i. Antianginal – increases coronary blood flow by dilating coronary arteries ii. SE: dizziness, headache hypotension, tachycardia

iii. Pt education: caution pt to change positions slowly and to report dry mouth or blurred vision b. Plavix i. Antiplatelet agent – inhibits platelet aggregation ii. SE: GI bleeding, neutropenia, bleeding iii. Monitor CBC, monitor bleeding time iv. Pt education: advise pt to report weakness, chills, sore throat, rash, or unusual bleeding c. Losartan i. Antihypertensive (ARB) – blocks vasoconstrictors ii. SE: dizziness, hypotension, nasal congestion, angioedema iii. Assess for angioedema, monitor daily weights, correct volume depletion iv. Pt education: instruct pt to report swelling of face, eyes, lips, or tongue d. Hydralazine i. Vasodilator – lower blood pressure ii. SE: tachycardia, sodium retention iii. Monitor BP frequently iv. Pt education: pts should weigh themselves twice weekly e. Torsemide i. Loop diuretic – inhibits reabsorption of sodium and chloride ii. SE: dehydration, hypovolemia, metabolic alkalosis, hypotension iii. Monitor BP and pulse, assess for hearing loss or tinnitus

iv. Pt education: caution pt to change positions slowly, teach pt to take medication in AM to prevent sleep interruptions f. Digoxin i. Antiarrythmia – increases the force of myocardial contraction ii. SE: fatigue, bradycardia, nausea, vomiting iii. Monitor EKG and pulse frequently, check dig levels and potassium levels iv. Pt education: teach pt to take pulse before taking medication and to hold if pulse is below 60, have pt report any signs of dig toxicity – vision changes, dizziness g. Lasix i. diuretic – inhibits reabsorption of sodium and chloride ii. SE: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic acidosis iii. Assess for rash, if administering twice daily give at 7 am and 2 pm to avoid sleep interruptions iv. Pt education: report any rash, muscle weakness, cramps, nausea, dizziness, numbmess, or tingling of extremities h. Cardiac exercise stress test i. Heart monitor while pt is undergoing stress (exercise or medicine induced) ii. Used to evaluate heart under stress

iii. Possible complications: fatal cardiac arrhythmias, severe angina, MI, fainting iv. Pt education: encourage pt to report any symptoms as soon as they start i. Cardiac catheterization i. Visualization of heart through great vessels ii. Used to see chambers, arteries, and vessels iii. Potential complications: cardiac arrhythmias, perforation of heart myocardium, pneumothorax iv. Pt education: encourage pt to void before test, post op – report any signs of numbness, tingling, pain, or loss of function of involved extremity j. Echocardiogram i. Ultrasound of heart to evaluate structure and function ii. Pt education: inform pt that test is painless k. Venous Doppler i. Used to evaluate patency of venous system ii. Pt education: cigarette smoking is prohibited 30 mins prior to test l. Holter monitoring i. Continuous heart monitoring ii. Pt education: instruct pt on how to care for monitor, how to maintain an accurate diary, and inform pt not to bathe during monitoring III. Review care of the patient with CAD-including diet teaching and modifiable risk factors a. Physical fitness

i. 30 minutes more than 5 days a week ii. regular physical activity = weight reduction, reduction is systolic BP, increase in HDL b. Nutritional therapy i. Therapeutic lifestyle changes ii. Increase omega-3 fatty acids c. Drug therapy i. Restrict lipoprotein production ii. Increase lipoprotein removal iii. Decrease cholesterol absorption iv. Antiplatelet therapy

  1. ASA
  2. Clopidorgrel (Plavix) IV. Review heart failure: signs, symptoms, and nursing care of patient a. Left sided heart failure i. Causes: MI, hypertension, CAD, cardiomyopathy ii. Back up of blood into the left atrium and pulmonary veins iii. Symptoms: paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, pulmonary congestion (cough, crackles, wheezes, blood tinged sputum, tachypnea), restlessness, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis b. Right sided heart failure

i. Causes: left sided heart failure, cor pulmonale, right ventricular MI ii. Backup of blood into right atrium and venous systemic circulation iii. Symptoms: JVD, hepatomegaly, splenomegaly, peripheral edema, vascular congestion of GI tract, fatigue, anorexia, weight gain c. Nursing Care for acute heart failure i. High Fowler’s position ii. Supplemental oxygen iii. EKG monitoring iv. Ultrafiltration v. Loop diuretics, IV nitroglycerin, IV sodium nitroprusside, Morphine sulfate, Nesiritide vi. Intraaortic balloon pump therapy vii. Ventricular assist devices viii. Destination therapy d. Nursing Care for Chronic HF i. ACE inhibitors, ARBS, aldosterone antagonists, nitrates, beta blockers, positive intropic agents, digitalis e. Nutritional therapy i. Diet and weight reduction ii. Recommend DASH diet iii. Sodium usually restricted to 2.5 g per day iv. Daily weights at the same time wearing the same clothes

  1. Weight gain of 3 lb over 2 days or 3-5 lbs over a week should be reported to health care provider V. Review inflammatory heart disease: risk factors, symptoms, nursing care of patient including assessment, planning, interventions a. Infective Endocarditis i. Risk Factors
  2. Cardiac conditions – rheumatic heart disease, prosthetic valves
  3. Cardiac lesions
  4. Invasive procedures – child birth, dental procedures, IV drug use, renal dialysis, bronchoscopy ii. Symptoms:
  5. Low-grade fever, chills, fatigue, anorexia, weight loss
  6. Splinter hemorrhages
  7. Activity intolerance
  8. Petechiae
  9. Heart murmur iii. Nursing Care
  10. Prophylactic treatment
  11. Long term IV drug therapy – PICC line ; 4-6 week IV antibiotics
  12. Antipyretics
  13. Bed rest during febrile state
  14. Monitor temp
  1. Avoid others with infections
  2. Planned activity with rest periods
  3. Oral hygiene
  4. Frequent lab draws b. Acute Pericarditis i. Causes
  5. bacterial, viral, TB, fungal, MI, trauma, cancer, rheumatic fever ii. symptoms
  6. sharp chest/shoulder/upper back pain
  7. changes with respiration pattern
  8. dyspnea
  9. “feels full around chest”
  10. Hallmark sign = pericardial friction rub; scratching, grating, high- pitched sound on left sternal border iii. Nursing Management
  11. Semi-fowlers position or upright and leaning forward
  12. NSAIDS/ASA/corticosteroids
  13. Antibiotics if bacterial cause
  14. O
  15. Bed rest
  16. Monitor cardiac rhythm
  17. Pericardiocentesis

VI. Review heart valve disorders: signs and symptoms, treatments including valve replacement a. Mitral valve stenosis i. Increased left atrial pressure and volume with increased pulmonary vasculature pressure ii. Symptoms: exertional dyspnea, fatigue, palpitations, hemoptysis, loud S1, low-pitched rumbling diastolic murmur b. Mitral valve regurgitation i. Blood back flows from left ventricle to left atrium ii. Most often caused by MI, chronic rheumatic heart disease, IE, and mitral prolapse c. Mitral valve prolapse i. Valve “buckles” back into left atrium ii. Symptoms: most are asymptomatic, activity intolerance, mid-systolic click, chest pain that is NOT responsive to nitrates iii. Pt teaching: stay hydrated, regular exercise, NO caffeine d. Aortic valve stenosis i. Secondary to rheumatic fever or degenerative stenosis ii. Left ventricular failure iii. Symptoms: angina, syncope, dyspnea on exertion, murmur e. Aortic valve regurgitation i. Backward flow of blood from ascending aorta into left ventricle during diastole

ii. Left ventricular hypertrophy, decreased myocardial contractility, increased blood volume in left atrium, pulmonary hypertension, right ventricular failure f. Diagnosis for valvular heart disease: i. echocardiogram, EKG, CXR, cardiac catheterization g. Overall symptoms for valvular disorders i. angina, syncope, CHF, heart murmur, cyanosis, decreased urine output, dysrhythmias h. Nursing interventions i. Raise HOB ii. Oxygen iii. Antibiotics, digitalis, vasodilators, anticoagulants, beta blockers iv. Conserve energy v. Daily weight vi. Sodium restriction i. Valve replacement: i. Metal cage or disks (mechanical valves) – will need anticoagulation therapy for life ii. Tissue valve – will initially need anticoagulation , but may not have to be lifelong iii. Commissurotomy – used for stenosis – removes calcium deposits on leaflets of valve

iv. Annuyloplasty – tightens or reinforces ring around valve – used to treat regurgitation or leaky valve v. Valvuloplasty – used to treat valve regurgitation VII. Review peripheral artery disease: signs, symptoms, nursing care of patient a. Blood has issues getting to rest of body from heart b. Symptoms: i. Activity intolerance – intermittent claudication ii. Absent/decreased pulses iii. Sluggish capillary refill iv. Skin changes – thick nails, loss of hair, smooth/shiny skin, cool/pale skin, red/blue discoloration in dependent position, ulcers v. Circulation to legs will decrease if legs are elevated c. Nursing care i. Risk factor modification – no crossing legs, smoking cessation, controlling cholesterol, controlling BP ii. Drug therapy – statins, HTN medics, ASA, Plavix iii. Activity – exercise to point of feeling pain, the rest, then continue iv. Nutritional therapy – weight loss d. Surgical therapy i. Femoral-popliteal bypass graft ii. Balloon angioplasty iii. Amputation

VIII. Review peripheral vascular disease: signs and symptoms and nursing care of patient a. Venous thrombosis i. Symptoms: palpable/firm, tender to the touch, red/warm

  1. Extremity pain, edema, increased calf circumference ii. Collaborative care
  2. Prevention
  3. Extremity elevation in bed
  4. Warm/moist heat
  5. Increased fluids
  6. Anticoagulants b. Varicose veins i. Abnormal dilated veins with incompetent valves ii. Symptoms: ache/pain after prolonged standing iii. Pt teaching: compression stocking, weight reduction, avoid prolonged standing or sitting c. Venous leg ulcers i. Moist dressings ii. High protein diet – Vit A & C, zinc – aid in wound healing iii. Compression of the leg is essential to healing – elastic wraps, unna boot IX. Review aortic aneurysms and aortic dissection: signs and symptoms and nursing care of patient a. Outpouching or dilations; ¾ are abdominal

b. True aneurysm i. Fusiform – circumferential, relatively uniform in shape ii. Saccular – pouchlike with narrow neck connecting bulge to one side of arterial wall c. False aneurysm i. Pseudoaneurysm; not an actual aneurysm – disruption of all the layers of arterial wall and bleeding is contained by surrounding structures d. Thoracic aorta i. Often asymptomatic ii. Deep diffuse chest pain iii. Pain may extend to the interscapular area e. Ascending aorta/aortic arch i. Angina – decreased blood flow to coronary arteries ii. Hoarseness – laryngeal nerve pressure iii. If presses on superior vena cava

  1. Decreased venous return – distended neck veins, edema of head and arms f. Abdominal aortic aneurysm i. Often asymptomatic ii. Often detected on a physical exam or unrelated testing iii. Abdominal or back pain iv. Embolize plaque

g. Collaborative care i. Surgical risks ii. Small aneurysm

  1. Conservative therapy – watch and try to keep smaller a. Risk factor modification, decrease blood pressure, monitor annually iii. Large aneurysm (5 cm in women) (5.5 cm in men)
  2. Surgical intervention a. May also occur in i. Younger, low risk patients ii. Rapidly expanding aneurysm iii. Symptomatic patients iv. High rupture risk iv. Ruptured aneurysm
  3. Emergent surgery
  4. Preop a. Hydration b. Stabilize electrolytes, coagulation, and hematocrit h. Nursing management i. Monitor for signs of rupture
  1. Diaphoresis, paleness, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in level of consciousness, pulsating abdominal mass ii. Health promotion
  2. Health promotion to patients and caregivers
  3. Reduce cardiovascular risk factors
  4. Ensure graft patency after surgery iii. Post op
  5. Maintain graft patency a. Normal BP, IV fluids and blood components, CVP monitoring, urinary output monitoring, avoid sever hypertension
  6. Monitor cardiovascular status a. Continuous EKG, electrolyte monitoring, oxygen administration, antidysrhythmic and antihypertensive medications, pain control, resume cardiac medications
  7. Infection prevention a. Antibiotic, temperature, EBC, adequate nutrition, observe surgical incision
  8. Gastrointestinal status

a. Record NG tube output, abdominal assessment, passing of flatus = return of bowel function, assess for bowel ischemia

  1. Neurologic status a. LOC, pupil size and response to light, facial symmetry, speech, ability to move upper extremities, quality of hand grasps
  2. Peripheral perfusion status a. Pulse assessment – mark with felt-tipped pen b. Extremity assessment – temperature, capillary refill time, sensation, movement of extremities
  3. renal perfusion status a. urinary output, fluid intake, daily weight, CVP/PA pressure, blood urea nitrogen/creatinine i. aortic dissection i. tear in inner wall of aorta – blood flows in different layers of arterial wall
  • result of false lumen through which blood flows ii. classified by location and duration of onset iii. high percentage in ascending aorta due to increased pressure iv. decreased blood supply to other organs, leading to cardiac failure v. can rupture of aorta – death immediately