PNII Module 6 Exam Key Concepts
Pharmacologic management, collaborative management, planning and implementation of
interventions, assessment with
... [Show More] clinical manifestations, nursing diagnoses, diagnostic tests
Congestive Heart Failure
- Aka left sided heart failure
- Ejection fraction falls below 40% with ventricular dilation in systolic.
- Fatigue; weakness; oliguria at day, nocturia at night; angina; confusion, restlessness;
tachycardia palpitations; pallor; weak peripheral pulses; cool extremities; hacking
cough worse at night; dyspnea; breathlessness; crackles or wheezes in lungs; frothy
pink tinged sputum; tachypnea; s3/s4 summation gallop
- Electrolytes; elevated BNP; creatinine; hemoglobin; hematocrit; urinalysis for protein
levels; ABGs; X-ray for left ventricular failure; echocardiogram; radionuclide studies;
Multigated blood pool scans.
Aortic/mitral/pulmonary stenosis
- Aortic
o Dyspnea on exertion; angina; syncope on exertion; fatigue; orthopnea;
paroxysmal nocturnal dyspnea; harsh, systolic crescendo-decrescendo
murmur
o Most common cardiac valve problem. Often considered disease of wear and
tear; left ventricular outflow obstructed during systole. Results in ventricular
hypertrophy. Eventually output becomes fixed and cannot speed up to meet
the demands which leads to symptoms.
- Mitral
o Fatigue; dyspnea on exertion; orthopnea; paroxysmal nocturnal dyspnea;
hemoptysis; hepatomegaly; neck vein distention; pitting edema; atrial
fibrillation; rumbling apical diastolic murmur.
o Usually results from rheumatic carditis; valve thickening by fibrosis and
calcification; most commonly caused by rheumatic fever. Notify provider
immediately of irregularly irregular heart rhythm.
- Pulmonary
o Heart murmur; fatigue; shortness of breath on exertion; angina; loss of
consciousness
- Often follows endocarditis in IV drug abusers. Tri valve not affected.
- Echocardiography to visualize structure and movement of the heart. Exercise
tolerance test along with stress echocardiography to evaluate symptomatic response
and assess functional capacity.
- Diuretics; beta blockers; ACE inhibitors; digoxin; oxygen to improve symptoms of HF.
Nitrates administered cautiously due to potential for syncope. Calcium channel [Show Less]