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NSG-430 Exam 2 questions with correct answers
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NSG-430 Exam 2 questions with correct answers
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NSG-430 Exam 2 questions with correctanswers
heart \failure \- \ANSWERS✔✔ \-Complex \clinical \syndrome \resulting \in \insufficient \blood \supply/oxygen \
to \tissues \and \organs
-Involves \diastolic \or \systolic \dysfunction
-Ejection \fraction \(EF) \is \amount \of \blood \pumped \by \LV \with \each \heart \beat
-Associated \with \CVDs:
-↑ \In \incidence \and \prevalence
-Better \survival \after \cardiac \events
-Aging \population
-Costly
-Most \common \cause \for \hospital \admission \in \adults \over \age \65
-Review \risk \factors
Clinical \Manifestations:
-Edema:
•Common \sign \of \HF
•It \may \occur \in \dependent \body \areas \(peripheral \edema), \liver \(hepatomegaly), \abdominal \cavity \
(ascites), \and \lungs \(pulmonary \edema \and \pleural \effusion). \
•If \the \patient \is \in \bed, \sacral \and \scrotal \edema \may \develop. \
•Pressing \the \edematous \skin \with \the \finger \may \leave \a \transient \depression \(pitting \edema). \
•The \development \of \dependent \edema \or \a \sudden \weight \gain \of \more \than \3 \lb \(1.4 \kg) \in \2 \days \
is \often \a \sign \of \ADHF, \an \exacerbation \of \chronic \HF. \
•It \is \important \to \note \that \not \all \lower \extremity \edema \is \a \result \of \HF.
•Hypoproteinemia, \immobility, \venous \insufficiency, \and \certain \drugs \can \cause \peripheral \edema.
-Nocturia:
,•The \tendency \to \urinate \excessively \during \the \night. \•Chronic \HF \is \frequently \associated \with \poor \
renal \perfusion \and \function. \
•Patients \develop \increased \peripheral \and \systemic \edema. \•At \night \when \lying \flat, \extravascular \
fluid \is \reabsorbed \from \the \interstitial \spaces \back \into \the \circulatory \system. \
•This \results \in \increased \perfusion \to \the \kidneys. \The \increased \renal \blood \flow \results \in \diuresis. \
•The \patient \may \complain \of \having \to \urinate \frequently \throughout \the \night.
-Pleural \Effusion:
•Is \a \common \complication \in \HF. \•There \are \two \pleural \layers \or \membranes: \the \visceral \pleura \
lines \the \lungs, \whereas \the \parietal \pleura \lines \the \chest \cavity. \
•Normally \a \small \amount
left-sided \heart \failure \- \ANSWERS✔✔ \-Most \common \form \of \HF
-Left-sided \HF \results \from \left \ventricular \dysfunction.
-This \prevents \normal, \forward \blood \flow \and \causes \blood \to \back \up \into \the \left \atrium \and \
pulmonary \veins.
-The \increased \pulmonary \pressure \causes \fluid \leakage \from \the \pulmonary \capillary \bed \into \the \
interstitium \and \then \the \alveoli.
-This \manifests \as \pulmonary \congestion \and \edema.
-Results \from \inability \of \LV \to:
•Empty \adequately \during \systole
•Fill \adequately \during \diastole
-Further \classified \as:
•Systolic
•Diastolic
•Mixed \systolic \and \diastolic
-Blood \backs \up \into \left \atrium \and \pulmonary \veins
-Increased \pulmonary \pressure \causes \fluid \leakage \→→ \pulmonary \congestion \and \edema
Pathophysiology:
,-HFrEF: \HF \with \reduced \EF
-Inability \to \pump \blood \forward
-Caused \by:
•Impaired \contractile \function
•Increased \afterload
•Cardiomyopathy
•Mechanical \abnormalities
-Decreased \LV \ejection \fraction \(EF)
right-sided \heart \failure \- \ANSWERS✔✔ \-Right-sided \HF \occurs \when \the \right \ventricle \(RV) \fails \to \
pump \effectively.
-When \the \RV \fails, \fluid \backs \up \into \the \venous \system.
-This \causes \movement \of \fluid \into \the \tissues \and \organs \(e.g., \peripheral \edema, \abdominal \ascites, \
hepatomegaly, \jugular \venous \distention).
-The \most \common \cause \of \right-sided \HF \is \left-sided \HF.
-As \the \LV \fails, \fluid \backs \up \into \the \pulmonary \system, \causing \increased \pressures \in \the \lungs.
-The \RV \has \to \work \harder \to \push \blood \to \the \pulmonary \system.
-Over \time, \this \increased \workload \weakens \the \RV \and \gradually \it \fails.
-Other \causes \of \right-sided \HF \(independent \of \the \function \of \the \LV) \include \RV \infarction, \
pulmonary \embolism, \and \cor \pulmonale \(RV \dilation \and \hypertrophy \caused \by \pulmonary \disease).
acute \decompensated \heart \failure \(ADHF) \- \ANSWERS✔✔ \-Mechanisms \can \no \longer \maintain \
adequate \CO \and \inadequate \tissue \perfusion \results.
-Sudden \onset \of \signs \and \symptoms \of \HF
-Requires \urgent \medical \care
-Life \threatening \condition, \both \of \the \ventricles \are \failing, \end \organ \perfusion \is \greatly \impacted
-Pulmonary \and \systemic \congestion \due \to \↑ \left-sided \and \right-sided \filling \pressures \(universal \
finding)
Clinical \Manifestations:
, -In \acute \decompensated \HF \(ADHF), \the \pulmonary \venous \pressure \increases \caused \by \failure \of \the
\LV. \This \results \in \engorgement \of \the \pulmonary \vascular \system. \
-As \a \result, \the \lungs \become \less \compliant, \and \there \is \increased \resistance \in \the \small \airways. \
To \help \compensate, \the \lymphatic \system \increases \its \flow \to \help \maintain \a \constant \volume \of \
the \pulmonary \extravascular \fluid.
-This \early \stage \is \clinically \associated \with \a \mild \increase \in \the \respiratory \rate \and \a \decrease \in \
partial \pressure \of \oxygen \in \arterial \blood \(Pao2).
-If \pulmonary \venous \pressure \continues \to \increase, \the \increase \in \intravascular \pressure \causes \
more \fluid \to \move \into \the \interstitial \space \than \the \lymphatics \can \remove. \Interstitial \edema \occurs
\at \this \point.
•Tachypnea \develops \and \the \patient \becomes \symptomatic \(e.g., \short \of \breath).
-If \the \pulmonary \venous \pressure \increases \further, \the \alveoli \lining \cells \are \disrupted \and \a \fluid \
containing \red \blood \cells \(RBCs) \moves \into \the \alveoli \(alveolar \edema). \
-As \the \disruption \becomes \worse \from \further \increases \in \the \pulmonary \venous \pressure, \the \
alveoli \and \airways \are \flooded \with \fluid.
-This \is \accompanied \by \a \worsening \of \the \arterial \blood \gas \values \(i.e., \lower \Pao2 \and \possible \
increased \partial \pressure \of \carbon \dioxide \in \arterial \blood \[Paco2] \and \progressive \respiratory \
acidemia).
-Based \on \hemodynamic \and \clinical \status, \patients \can \be \c
heart \transplantation \- \ANSWERS✔✔ \-The \transfer \of \a \healthy \donor \heart \to \a \patient \with \a \
diseased \heart. \This \surgery \is \used \to \treat \a \variety \of \terminal \or \end-stage \heart \conditions.
-Treatment \of \choice \for \patients \with \refractory \end-stage \HF, \inoperable \CAD, \and \cardiomyopathy
-3,000 \on \list; \average \2,000 \available
-Survival \rate \of \85%-90% \at \1year; \75% \at \3
-Selection \process \identifies \patients \who \would \most \benefit \from \a \new \heart
-The \United \Network \for \Organ \Sharing \(UNOS) \is \in \charge \of \a \system \that \gives \organs \fairly \to \
people.
-Once \a \person \meets \the \criteria \for \heart \transplantation, \a \complete \physical \examination \and \
diagnostic \workup \are \done. \
-In \addition, \the \patient \and \caregiver \undergo \a \comprehensive \psychologic \evaluation. \
-This \includes \assessing \coping \skills, \support \systems, \and \commitment \to \follow \the \rigorous \
regimen \that \is \essential \to \a \successful \transplantation. \
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