Perfusion 1
A client is admitted to the hospital with severe headache, tinnitus, and a BP of 202/122 mmHg after running out of medications. After being treated for hypertensive emergency, which approach by the nurse at discharge is best?
1. Assess for barriers to taking the prescribed medication.
2. Instruct the client’s spouse to manage medication.
3. Instruct the client to count the number of pills left at home.
4. Tell the client to purchase a medication organizer.
1
Malignant hypertension, or hypertensive emergency, is most commonly caused by untreated or uncontrolled hypertension. This may occur when a client misses medication doses, resulting in abrupt cessation of the drug. Clients should be counseled about the importance of taking medications as prescribed. Hypertensive emergencies are life-threatening. Less-common causes of hypertensive emergencies include illicit drug use, neoplasms, glomerulonephritis, hyperthyroidism, and pheochromocytoma (tumor of the adrenal gland).
Nurses have an important role in assessing factors for nonadherence to medications. Keeping schedules simple and affordable promotes adherence. Assessing for adverse effects and avoiding unnecessary refills also helps avoid confusion and error with regard to dosing.
A client diagnosed with primary hypertension asks the nurse about the risk factors for this condition. The nurse confirms the client’s understanding of teaching with what response? (SATA)
1. “Taking too much ibuprofen increases my risk.”
2. “My kidney disease worsened my blood pressure.”
3. “I may be eating too much dietary sodium.”
4. “Obesity often leads to primary hypertension.”
5. "Lack of exercise makes hypertension more likely.”
3, 4, 5
Sodium intake greater than 3,000 mg per day increases risk for hypertension, and reducing sodium intake reduces blood pressure. Weight gain is associated with higher risk for primary hypertension. Inactivity is a risk factor for the development of primary hypertension.
Major risk factors for primary hypertension (formerly called essential hypertension) include high salt and fat intake, obesity, inactive lifestyle, age, family history, race, excessive alcohol consumption, personality traits or depression, and cardiovascular risk factors such as dyslipidemia and diabetes.
Secondary hypertension has identifiable causes, including (but not limited to) medications, renal disease, Cushing syndrome, hyperthyroidism, hyperaldosteronism, pheochromocytoma, obstructive sleep apnea, and coarctation of the aorta (especially in children).
The nurse evaluates a client with decreased cardiac output (CO) related to acute heart failure. What best indicates improved CO for this client?
HR 80 beats/min
Walk down a flight of stair w/o dyspnea
Relief od chest pain with prescribed nitroglycerin
Standing w/o reports of dizziness
Walk down a flight of stair w/o dyspnea
Many factors, including chronic conditions and fluid status, impact whether CO is sufficient. Normal CO is 4–8 L/min. Decreased CO can cause angina and dyspnea with activity. Improvement of CO is evidenced by resolution of these symptoms.
If a patient is unable to receive thrombolytics for ischemic stroke, SBP should be maintained below 160.
True or False
FALSE
Perfusion to the brain is important. If a patient is not a candidate for tpa, increased pressure will allow greater perfusion to the brain. This is called "permissive hypertension" and may allow BP up to 220/120.
The education we should provide our stroke patients and their families.
What are 1. Signs and symptoms 2. Discharge Medications 3. Individual risk factors 4. Follow up appointments 5. When to call EMS?
The nurse suspects that a client has a venous thromboembolism (VTE). What test would gather evidence in support of this diagnosis? (SATA)
Weber Test
Tinel Sign
D-dimer
Venous ultrasound
D-dimer
Venous ultrasound
The nurse must be familiar with common tests for VTE and educate and prepare the client as needed. Common signs for DVT are unilateral swelling (measure calf diameter), warmth, tenderness, and erythema. Less-common diagnostic tests for VTE include MRI and CT.
What clinical sign does the nurse find when assessing a client with right-sided heart failure?
Clubbing
Leg Edema
Pulmonary crackles
Dry Cough
Leg Edema
Congestive heart failure symptoms are caused by a diminished ability of the right ventricle to pump blood, allowing it to back up into the vena cava (increased preload). This causes blood to pool in the extremities, abdomen, neck, and liver.
After assessing a client, the nurse teaches the client about peripheral vascular disease (PVD). The nurse reviews what test used in diagnosing PVD?
Ankle brachial pressure index
Echocardiogram
Allen test
Cardiac stress test
Ankle brachial pressure index
The ankle brachial index is the BP ratio between the lower legs and the arms. It is calculated after taking measurements in the upper and lower extremities. BP in the lower legs is normally higher than in the arms, and abnormalities indicate narrowing of arteries (i.e., PVD).
Name three important nursing assessment responsibilities prior to tPA administration.
Accurate body weight
2 large bore IV lines
appropriate blood pressure, SBP below 180
BE FAST stands for?
Balance
Eyes
Face
Arms
Speech
Time
t discharge, a client with heart failure due to systolic dysfunction is prescribed lisinopril, an angiotensin-converting enzyme (ACE) inhibitor. Which teaching does the nurse include for this medication?
1. “It relaxes blood vessels, which lowers blood pressure.”
2. “It is safe to take during pregnancy.”
3. “This drug may contribute to hyperkalemia.”
4. "Report a cough immediately.”
1, 3, 4
Lisinopril is an ACE inhibitor, which are frequently used to treat heart failure and hypertension. ACE inhibitors improve lung function by increasing alveolar-capillary membrane diffusing capacity and pulmonary vascular function. Side effects include hypotension, acute renal failure, and hyperkalemia.
ACE inhibitors occasionally induce life-threatening angioedema. While the risk is low, the wide use of these drugs requires that nurses be alert for reports of asymmetric swelling of nondependent tissue, especially in the face. Face, tongue, lips, and upper airway swelling can lead to rapid airway compromise.
The nurse cares for a client with left-sided heart failure. Which actions does the nurse implement?
(SATA)
Administer diuretic as prescribed
Document rhythm strips every shift
Assess HR frequently
Assess peripheral pulses for strength and quality
Provide a low sodium diet
Administer diuretic as prescribed
Document rhythm strips every shift
Assess HR
Assess peripheral pulses for strength and quality
Provide a low sodium diet
Frequent assessment to monitor changes in pulses, cardiac rhythm, vital signs, and symptoms allows for prompt intervention.
A nurse assesses a client with chronic hypertension. What signs does the nurse identify as a chronic complication of hypertension? (SATA)
1. Weakness
2. Dyspnea at rest
3. Protein in urine
4. Leg pain when climbing stairs
5. Vomiting
2,3,4
Dyspnea at rest is associated with congestive heart failure. High blood pressure contributes directly to the development of congestive heart failure by increasing the heart’s workload and leading to thickening of the ventricle walls. Proteinuria and albuminuria are early indicators of renal injury, a serious complication that can be caused by chronic hypertension. High pressures damage the kidneys’ ability to filter toxins, and evidence of this damage is seen as proteins leak out into the urine. Peripheral artery disease is a complication of hypertension in which plaques in leg arteries and hardened vessel walls compromise blood flow to the legs. The condition causes pain, aching, or heaviness in the legs, feet, and buttocks after activity.
Hemorrhagic stroke SBP goal is above 160.
True or False
FALSE
Hemorrhagic stroke, SBP should be decreased to limit pressure and bleeding
Before PO intake, we must perform this screening on our stroke patients.
Dysphagia screen
The nurse on the cardiac step-down unit plans a meal tray for a client recovering from myocardial infarction (MI) after stent placement. Which diet choices does the nurse offer that are consistent with Dietary Approaches to Stop Hypertension (DASH)? (SATA)
1.Slice of apple pie
2.Macaroni & Chesse
3.Pork Chop & Green beans
4.Whole-grain toast & jelly
5.Fresh fruit Cup
4, 5
The DASH diet suggests limits for calories, sodium, and fat. It also encourages avoidance of a sedentary lifestyle.
The diet recommends less than 2,300 mg of sodium daily, but people with comorbidities such as diabetes and heart disease should have less. Water is drawn to sodium, which is why thirst worsens when eating salty snacks such as potato chips. Increased sodium intake causes fluid retention, which increases BP because more fluid is in the bloodstream and blood vessels. Decreasing sodium intake can help reduce the amount of excess fluid in the blood, decreasing BP.
A client arriving in the ER reports chest pain radiating to the shoulder and shortness of breath that began two days earlier. What lab test is most important to evaluate?
Lactate dehydrogenase
Creatinine kinase-MB
Troponin- l
Myoglobin
Troponin- l
When myocardial tissue is damaged, several biomarkers are released into the blood that can be best detected with lab tests at particular intervals. Onset time of chest discomfort is used to guide which tests will be helpful. Troponin-I is the preferred lab test to support the diagnosis of myocardial infarction (MI).
The nurse assesses a client who is scheduled for same-day surgery. The client reports chest and shoulder pain, perspiration, and shortness of breath. Which action does the nurse take first?
Complete the preoperative checklist and call for transport to the operating room.
Initiate protocol for the Medical Emergency Team, and notify the physician.
Request a chest x-ray and call for an ECG to be completed.
Check the client's electrolytes and perform a CBC.
Initiate protocol for the Medical Emergency Team, and notify the physician.
These signs and symptoms are consistent with suspected acute myocardial infarction, a medical emergency that warrants activating an inpatient Medical Emergency Team or Rapid Response Team. Hospitals and facilities have protocols in place to help the nurse with a client experiencing a suspected myocardial infarction.
DTN guidelines for tpa administration is what?
60 minutes
Ischemic stroke patients with current or previous history of Afib/Aflutter must be discharged with this class of medication.
Anticoagulant
The nurse teaches the client about symptoms for hypertension. Additional education is required when the client states which symptom indicates elevated blood pressure?
Leg swelling
Blurred Vision
Headaches
Head Fullness
Leg Swelling
Hypertension is not always accompanied by symptoms. When symptoms do occur, they vary depending on what organ is affected (e.g., eye, kidney, heart, or brain). Symptoms can include headache, nausea or vomiting, tinnitus, blurred vision, confusion, dizziness, or a feeling of fullness in the head.
A client with multiple pulmonary emboli (PE) is scheduled for placement of an inferior vena cava (IVC) filter. What statement by the nurse explains the purpose of this intervention?
“The device is inserted to dissolve blood clots in the heart.”
“Medication is delivered to enhance anticoagulation therapy.”
“It alerts the health care provider when clots develop.”
“The device trap blood clots traveling to the lungs.”
“The device trap blood clots traveling to the lungs.”
Many pharmacological and mechanical methods are used to prevent venous thromboembolism (VTE). IVC filters are vascular filters implanted in the inferior vena cava and used to trap emboli floating in the vena cava. They help prevent pulmonary emboli by preventing any circulating clots from traveling to the lungs. They are usually placed using fluoroscopy. They are typically used for clients with a history of deep vein thrombosis or recurrent PE but may be used prophylactically for those at high risk for PE. These filters can be temporary (retrievable) or permanent.
What is the treatment that has to be given within 3 hours for suspected ischemic stroke
tpa- thrombolytics
3 hours is the gold standard but may be given up to 4.5 hours of stroke symptoms and benefit outweigh risk
Time intervals for monitoring vitals signs & neuro assessment with an acute stroke who receiving IV t-PA
Every 15 minutes
The patient is being discharged on statin after CVA but states "My cholesterol is normal why do I need this?" The nurse understands what?
Due to the increased risk, the goal is to keep cholesterol levels lower