Before a transesophageal echocardiogram, a nurse gives a client an oral topical anesthetic spray. When the client returns from the procedure, the nurse observes no active gag reflex. What nursing action is a priority?

withhold food and fluids.

During auscultation of the lungs, what would a nurse note when assessing a client with left-sided heart failure?

wheezes with wet lung sounds

The nurse auscultates the apex beat at which anatomical location?The nurse auscultates the PMI (point of maximal impulse) at which anatomic location?

fifth intercostal space, midclavicular line

left midclavicular line, fifth intercostal space

The nurse in a cardiac clinic is taking vital signs of a 58-year-old man who is 3 months status post myocardial infarction (MI). While the physician is seeing the client, the client's spouse approaches the nurse and asks about sexual activity. "We are too afraid he will have another heart attack, so we just don't have sex anymore." The nurse's best response is which of the following?

The physiologic demands are greatest during orgasm and are equivalent to walking 3 to 4 miles per hour on a treadmill."

The nurse prepares to auscultate heart sounds. Which nursing interventions would be most effective to assist with this procedure?

Explain to the client that the nurse will be listening to different areas of the chest and may listen for a long time, but that does not mean that anything abnormal is heard.

The nurse is caring for a client with a damaged tricuspid valve. The nurse knows that the tricuspid valve is held in place by which of the following?

Chordae tendineae

Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue?

endocardium

For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which data is necessary to collect if the client is experiencing chest pain?

description of the pain

he nurse is assessing the cardiovascular status of a client who was found unresponsive in a lobby area. Following transfer of the client, the family asks how blood circulates through the body. The nurse is most correct to state the proper circulation as which? Place the pattern of circulation in the correct order beginning in the right atrium. Use all options.

• Right ventricle
• Pulmonary artery
• Pulmonary vein
• left atrium
• Left ventricle
• Aorta

What does decreased pulse pressure reflect?

reduced stroke volume

The nurse is reviewing the morning laboratory test results for a client with cardiac problems. Which of the following would the nurse regard as a priority to report to the physician?

K+ 3.1 mEq/L

The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. The nurse makes it a priority to notify the physician for which of the following reasons?

The client is at risk for renal failure due to the contrast agent that will be given during the procedure.

You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of myocardial infarction. Which test would you expect to show elevated levels?

Enzymes

You are doing an admission assessment on a client who is having outpatient testing done for cardiac problems. What should you ask this client during your assessment?

“Have you had any episodes of dizziness or fainting?”

Admission lab values on a patient admitted with congestive heart failure are as follows: potassium 3.4 mEq/L; sodium 148 mEq/L; calcium 9.8 mg/dL; and magnesium 1.5 mEq/L. Which lab value is abnormal?

Sodium

The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected?

Crackles

The nurse prepares to apply ECG electrodes to a male client who requires continuous cardiac monitoring. Which action should the nurse complete to optimize skin adherence and conduction of the heart’s electrical current?

Clip the client’s chest hair prior to applying the electrodes.

The nurse is caring for a patient with a diagnosis of pericarditis. Where does the nurse understand the inflammation is located?

The thin fibrous sac encasing the heart

A 52-year-old female patient is going through menopause and asks the nurse about estrogen replacement for its cardioprotective benefits. What is the best response by the nurse?

“Current evidence indicates that estrogen is ineffective as a cardioprotectant; estrogen is actually potentially harmful and is no longer a recommended therapy.”

74 y.o male with acute decomp. HF, hx of several MI's, ejection fration 28%. Not responding to diuretics. IV dobutamine, for pulmonary artery catheter 4 myocardial contractility

Hx: symptoms, pain, SOB edema, family hx, RX activiity, fatigue, coping, stress.

Physical: BP, Pulse, jugular vein, lung sounds, heart murmurs, assess the abdomemn, edema.

Labs: creatinine, BUN and GFR. catheter for cardiac function, volume status, guide therapy. Dobutamine via IV to increase heart contractility, increases HR, cause dysrhythmias, monitor cardiac status.

Nursing: Observe IV site, dobutamine can cause inflam. and tissue ischemia. monitor, dysr. cont BP, cardioresp monitoring, renal stus

HTN TX- white pts Stage I (140-159/90-99)

consider a delay in uncomplicated stage I patients

1) lifestyle changes-lose weight, reduce salt and alc stop smoking

2) <60 Ace In (pril) or ARB (sartan ) and if needed add ccb(diltizem or amlodipine) or Thiazide(zide/furosemide)

3)>=60 CCB () or Thiazide () and if needed ACE In or ARB

HTN Tx--black pts Stage I (140-159/90-99)

consider a delay in complicated stage I patients

1) lifestyle changes-lose weight, reduce salt and alc stop smoking

2) CCB (diltizem/amlodipine) or Thiazide/furosemide if needed add ACE In (pril) or ARB (sartan) or

3) combine CCB () and Thiazide()

HTN Tx for stage 2 >160/100

Start with 2 drugs CCB or Thiazide +

Ace IN or ARb

Special Cases

Kidney Disease, diabetes, coronary disease, stroke HF

HTN

Asymptomatic, dizziness, activity intolerance, aplpitaitons, angina, dyspnea, headche, nose bleeds

Objective=obthalmic exam, labs, EKG, CXR

Goal-less than 140/90, decrease volume SVR

HTN TEST

• Blood-CBC, Hematocrit Males 42-52%, Female 35-47%, Hgb, Males 13-18 g/dL Females 12-16 g/dL; Platelets 150k-450K; WBC 4500-1100,00 (mm3)
• BNP- Useful in diagnosis of HF BNP > 100 is suggestive of HF
• Focus on BUN and creatinine to evaluate renal involvement (10-20 mg/dL)-end products of protein met. ↑Bun reflects reduced renal perfusion from ↓ C/O or IV fluid deficient
• Baseline electrolytes
• Lipid panel -eval risk of developing cad esp w/family hx or diagnoses a lipid abnormality. Lipids profile after 12 hr fast

HTN teaching

• Be specific about the name, action, dosages, and side effects of prescribed meds to patients
• Help the patient schedule convenient times for taking meds and measuring BP
• Instruct client not to abruptly stop meds
• Instruct client about K+ diet supplements if taking thiazide or loop diuretics
• Explain the many meds can cause orthostatic hypotension and ways to reduce effects

HTN Nursing Diagnosis

Anxiety r/t complexity of management regimen, possible complications, and lifestyle changes associated with hypertension•Sexual dysfunction r/t side effects of antihypertensive medication•Ineffective therapeutic regimen management r/t lack of knowledge, unpleasant side effects of medication, return of normal BP while on meds, high cost of meds, inconvenient schedule for taking meds, lack of trusting relationship with HCP•Disturbed body image r/t diagnosis•Ineffective tissue perfusion r/t complications of HTN (cerebral, cardiovascular, renal, retinal) 60

Resistant HTN

Improper BP measurement, excess NA, inadeaqute meds, excess alchohol

Hypertensive Urgencies

Pt w/markedly elevated BP but without acute TOD usually do not require hospitalization but should receive immediate combination oral antihypertensive therapy

Bp is very elevated/no evidence of impending or progressive target organ damage. Goal: normalize BP w/I 24-48 hrs, take BS q 5 min then 15-49 min intervals. Fast acting oral agents, BB(labetalol), Ace-I captopril beta 2 agonis9clonidine

Hypertensive Emergencies

Hypertensive Emergency-Goal: reduction of the mean BP by up to 25% within the first hour of treatment than 160/100 over a period of up to 6 hours, IV vasodilators: Nitroprusside/NTG, enalaprilat, hydralazine, TOD w HTN

How to tx-Careful assessment, meds for BP reduction, careful parameters for reducing bp to prevent adverse consequcence (special circ. Aortic dissection (sbp< 100) and acute ischemic stroke)

Target organ damage

response to injury intimal layer exposed to activated WBC, growth factors released that induce smooth muscle proliferation, stiffened arterial wall and narrowed lumen. Heart-left ventricular hypertropy, HF, angina, Brain=stroke, Kidneys=CKD or retinopathy

Hypertension crisis

exacerbation of chronic htn: failure to comply with regimen

Hyperlipidemia