HF
Describe left side heart failure including the pathophysiology and risk factors
Left: decreased cardiac output, and inability to pump blood into the systemic circulation causing a “back-up” into the pulmonary circulation.
EF below 40%
Acute or chronic (mild to severe)
1st sign- s3 gallop (early filling of the atrium)
later sign: Hypertrophy or ischemia and pulmonary congestion/edema
Risk factors: Lt: CAD, MI, HTN, HLD, DM, obesity, diet and exercise, cardiomyopathy, valve disorders, arrhythmias, ect
Name two modifiable risk factors for PAD and 2 non-modifiable.
Modifiable: smoking, HTN, HLD, DMT2, diet, sedentary lifestyle, obesity
Non-modifiable: Age, men, ethnicity
In chronic venous insufficiency the problem lies with pushing blood flow from the heart to the limbs OR pulling blood flow from the limbs to the heart?
Limb to the heart: Vacuum problem
You are taking care of a patient who starts displaying signs of a myocardial infarction. What labs and diagnostic tests do you expect the doctor to order?
CK-MB, troponin, EKG, chest X-ray, D-dimmer, ABG, CRP, cardiac cath
What are the risk factors for developing hypertension. Name 5
smoking, diet/fatty foods (hyperlipidemia, atherosclerosis, lifestyle, obesity/stress, age, race (AA), family hx, ETOH, salt intake/caffeine
Describe right side heart failure including the pathophysiology and risk factors
Rt: distended Rt atrium and ventricle and inability to pump blood into the pulmonary circulation causing a “back-up” into venous circulation.
Rt: caused by Lt sided HF, COPD (conditions that restrict blood flow to the lungs; acute or chronic pulmonary diseases)
How can we educate the patient with PAD on preventing further tissue damage
Avoid heating pad and Hot water bottles- risk for burns
Do not cross the legs
Different from PAD, what are risk factors for venous insufficiency? name 3
HF, immobility, females, older, obesity, pregnancy, NURSES, standing for long periods,
You are caring for a pregnant client in her third trimester. She reports having large veins in her legs that are painful. What education do you give this client.
Those are varicose veins caused by the increased pressure of the increased blood volume and cardiac output asserting pressure on the veins. You should prop your legs up when you can, avoid sitting or standing for long periods of time, wear compression stockings
Describe the difference in Primary HTN and Secondary HTN. What are the causes of both?
Cause for primary is unknown (idiopathic). Cause for secondary is an underlying condition (CKD, narrowing of arteries, endocrine disorders, excess aldosterone, cortisol, or catecholamines)
Describe the early and late signs of left sided heart failure and right sided heart failure
LT: (LUNG) fatigue, activity intolerance, cyanosis, weak peripheral pulses, tachycardia, SOB/SOA, Dizziness, s3, s4
Late: pulmonary edema: pink frothy sputum
RT late: (rest of the body): JVD
RUQ pain (liver enlargement)
Peripheral edema, distended abd, weight gain, nocturnal polyuria, anorexia/nausea, ascites, dependent edema, venous stasis
***Signs of Central Perfusion Insufficiency= confusion and low urine output.
Describe the ulcers seen on patients with PAD. Give 5 descriptions
Ulcer: pale, even edges, toe, feet, dry, deeper,
What are the signs and symptoms of venous insufficiency? Name 5
Dark pigmentation- brown, venous stasis, Weeping, distended veins (varicose veins), dull pain/discomfort with standing- Need to elevate leg, Thick fibrous subq tissue, itchy skin
You are taking report on a patient coming up from the emergency department with complaints of burning and prinking sensation in their legs and pain with walking. What types of treatment and interventions will you expect to start on this client? What is the patients diagnosis?
Cardiopulmonary program, walking program, skin inspection with wound dressing changes, added nutrients to diet, O2 therapy possibly,
What are the S&S of hypertension including a HTN emergency
Silent killer, Headache, Later stages: , Blurry vision, Confusion, Worsening of HA, Dizziness, Nausea,
Chest pain/Angina, Anxiety, Ventricular hypertrophy
What are five educational topics for patients with heart failure? Include electrolyte information, things to avoid, care at home, comfort measures and ect.
Daily wts
Elevation/compression
MAWDS (medications, activity, weight, diet symptoms)
Avoid cold
Sodium restricted diet
Fluid restrictions
K levels
Dig levels
Name 3 interventions for clients with PAD
walking program increases collateral circulation (walk until pain- rest- and then walk again)- forms new arterial pathways; avoid tight restrictive clothing, revascularization surgery
What are interventions or treatments for venous insufficiency? Name 5
compression stocking, elevation, Zinc oxide, ACE wrap, thrombectomy (clot removal), surgical ligation (stripping of the veins)
The patient is a 64-year-old African-American man who is diagnosed with hypertension. He is 6 feet tall and weighs 300 lbs. He smokes two packs of cigarettes per day. He works as a salesman and has two to three alcoholic drinks a week. He admits that he does not get as much exercise as he used to when he was 40 years old. His mother and brother have high blood pressure, and his father died of a heart attack at age 68. This patient was later seen in the ED with severe headache, extremely high blood pressure, dizziness, blurred vision, and shortness of breath. He appears very frightened and anxious. His diagnosis is hypertensive crisis. Describe other S&S of hypertensive crisis and the appropriate interventions for this problem.
chart 36-2 in edition 9:
Assess:
• Severe headache
• Extremely high blood pressure (BP)
• Dizziness
• Blurred vision
• Shortness of breath
• Epistaxis (nosebleed)
• Severe anxiety
Intervene:
• Place patient in a semi-Fowler's position.
• Administer oxygen.
• Start IV of 0.9% normal saline (NS) solution slowly to prevent fluid overload (which would increase BP).
• Administer IV beta blocker or nicardipine (Cardene IV) or other infusion drug as prescribed; when stable, switch to oral antihypertensive drug.
• Monitor BP every 5 to 15 minutes until the diastolic pressure is below 90 and not less than 75; then monitor BP every 30 minutes to ensure that BP is not lowered too quickly.
• Observe for neurologic or cardiovascular complications, such as seizures; numbness, weakness, or tingling of extremities; dysrhythmias; or chest pain (possible indicators of target organ damage).
What are 4 interventions and treatment for a client with HTN. Include specifics about diet, medications, and home care. Consider possible surgical treatment.
Low sodium (no canned food, cheese, red meat, prepackaged meals, deli meats, snack nuts, chips)
DO: take garlic (except for liver failure and increased bleeding). DASH Mrs. Dash; herbs,
Antihypertensive:
Diuretics:
Check BP before and after
Tx: stent placement
Exercise
Fluid restriction/Stick I&O
List 5 diagnostic tools, treatments (including medications), and interventions for heart failure.
Low Na diet, compression stockings (Rt), daily wts, elevate legs (Rt), deep breathing and cough (Lt), avoid NSAIDS (renal damage, fluid and Na retention), Monitor lytes, Tx underline cause of HF,
Telemetry, Meds: ACE inhibitors, Diuretics, BB, ARBS, Calcium channel blockers (AA population), Vasodilators, DX: ECHO- valves, enlargement, EF <40%, BNP, Troponin, CRP, Chest x-ray: cardiomegaly, pulmonary edema, Right sided in particular: liver enzyme labs (ALT and AST)
List 6 specific signs and symptoms of PAD
Coldness in lower extremity, Shiny hairless skin, thicken toenails, diminished pulses (Doppler), REST Pain- sit on side of bed, Paresthesia (burning AND PRICKLING SENSATIONS), dry wound, NO Edema, GANGRENE, amputations, Infections, Intermittent claudication (pain/cramping with walking), cool feet
Rubor (red coloration with dangling),
*** Paralysis, pallor and coldness is consistent with complete arterial obstruction
What will the ulcers present with in clients with venous insufficiency? Give 4 descriptions
Ulcers: uneven wounds, more drainage, EDEMA, medial ankle (malleolus), more shallow/superficial,
Mr. Jones’s is being transferred to the telemetry unit from the ER after complaints of chest pain, coughing with pink-frothy sputum and SOA. After arriving to the unit his skin becomes cool and clammy. His respirations are labored and he is complaining of abdominal pain. Upon physical examination, Mr. Jones is diaphoretic and gasping for air, with jugular venous distension, bilateral crackles, and an expiratory wheeze. His SpO2 is 88% on room air and it was noted that his urine output had been approximately 20 mL/hr since admission. His BP is 190/100 mmHg, HR 130 bpm and irregular, RR 43 bpm. Describe what is happening to Mr. Jones physiologically.
Because his heart cannot pump blood efficiently to the body, the blood is backing up into the lungs. This causes pulmonary edema and right sided heart failure with fluid backing up to the rest of his body. His pulmonary edema is so severe that he is struggling to breathe and struggling to oxygenate appropriately.
Name 5 education topics to discuss with your client in regards to controlling their Blood pressure. Include things to avoid, side effects, exams, diet, and ect.
Diet, Document home BP, Smoking cessation, Stress management, Report s/s with meds , Withdraw syndrome, Dr. visits, Retina exam
Avoid vasodilation (hot tubes, strenuous activity)
s/e meds: orthostatic Hypotension