NUR 631 - Exam 3 With Complete Solutions

If the patient reports a skipped or missed beat(s), particularly with the sensation that the heart stopped momentarily, this may indicate the presence of: -ANSWER ectopic atrial beats (which are very common and mostly benign) occurring with excessive caffeine, alcohol, or tobacco use In the elderly population, a report of palpitations should prompt what test in addition to ECG? -ANSWER TSH level On some occasions, atrial ectopic beats are precursors to (2): -ANSWER atrial tachycardia or atrial fibrillation Supraventricular arrhythmias occur most commonly in patients with (4): -ANSWER COPD rheumatic heart disease valvular dysfunction hypothyroidism Ventricular ectopy is more likely to be caused by cardiac pathology than atrial ectopy and may lead to sudden death. These are (3): -ANSWER - premature ventricular contractions - ventricular tachycardia - ventricular fibrillation PVCs are very common and, if isolated or asymptomatic, do not require an extensive workup. However, investigation is indicated if the patient reports that the palpitations / tachycardia lasted how long? -ANSWER 30 seconds All reports of palpitations require which test? -ANSWER ECG Which test is the best for evaluating the function of the heart? -ANSWER ECHO What are the associated symptoms of palpitations that require immediate workup? (5) -ANSWER - chest pain - diaphoresis - shortness of breath - syncope - extreme fatigue What test are ordered in a full cardiac workup? (8) -ANSWER ECG, ECHO, Holter Monitor, CBC, Chem 7, Magnesium, Troponins, Thyroid Panel Untreated peripheral artery disease may lead to (4): -ANSWER - gangrene - limb amputation - MI - CVA A differential diagnosis for PAD with a strong relationship to smoking: -ANSWER Buerger's Disease / thromboangiitis obliterans Hydrostatic edema refers to accumulation of excess interstitial fluid which results from: -ANSWER elevated capillary hydrostatic pressure Peripheral Edema may be due to (9): -ANSWER cardiovascular / lymphatic / thyroid / renal / hepatic disease, as well as trauma / infection / coagulopathy / musculoskeletal issue When peripheral edema is present, must rule out emergent: -ANSWER arterial occlusion (unilateral, acute onset) What is the most common cause of right heart failure? -ANSWER Left Heart Failure 4 signs of chronic right sided heart failure -ANSWER Jugular Venous Distention Hand/Finger Swelling Ascites Anorexia 7 signs of left sided heart failure -ANSWER Exertional Dyspnea Orthopnea Chronic Cough/Crackles/Blood-Tinged Sputum Paroxysmal Nocturnal Dyspnea Peripheral Edema Digoxin is given to patients with systolic HF due to the heart's thin, weak muscle and difficulty with -ANSWER CONTRACTION Diastolic HF is caused by -ANSWER thickening & stiffening of the left ventricle and difficulty of the muscle to relax (nitroglycerin may be prescribed) Most common causes of Heart Failure (2): -ANSWER myocardial ischemia (atherosclerosis), uncontrolled hypertension → dilated cardiomyopathy Brain Natriuretic Peptide (BNP) level diagnostic of Heart Failure -ANSWER 500 pg/mL The presence of this in the posterior, peripheral lung fields is indicative of heart failure: -ANSWER Kerley B lines ABCDE pneumonic for HF on CXR -ANSWER A - alveolar edema B - kerley B lines C - cardiomegaly D - dilated upper lobe vessels E - pleural effusion 2 main risk factors for PAD -ANSWER Age 65+ and Smoking Primary sign of PAD -ANSWER intermittent claudication initially and then pain at rest in advanced stage The 7 "P's" of Peripheral Artery Disease: -ANSWER - Pallor - Polar (cold) - Pulselessness - Pain - Paresthesia - Paralysis - Poikilothermia (inability to maintain core temperature) ABI result of _______ is diagnostic of PAD: -ANSWER ≤ 0.9 PAD represents a significant systemic atherosclerotic burden and should be considered equivalent to -ANSWER coronary artery disease Medications f