Galen NUR 242 Streb Unit 9 With 100% correct answers 2025-2026 already graded A+

Perform a complete cardiovascular assessment. As HTN is a risk of CAD, assess

BP in both arms

Check for all major pulses as well as capillary refill and temperature of

lower extremities

Prolonged capillary refill (>3 seconds in young to middle-aged adults;>5 seconds in older adults) indicates

poor circulation

Listen with a stethoscope or use a Doppler to assess for a bruit, which is heard as a

swishing sound as blood attempts to push through a narrowed artery

Bruits often occur in the

carotid, aortic, femoral, and popliteal arteries

Obtain information about family history and modifiable risk factors, including

eating habits, lifestyle, and physical activity levels. Ask about a history of smoking and how much alcohol is consumed each day. Assess body mass index (BMI) and weight

Dysrhythmias are disorders of the

electrical conduction of the heart that results in disturbances in the heart rate and/or heart rhythm

Dysrhythmias may alter blood flow and lead to

hemodynamic changes

Dysrhythmias: Sinus bradycardia has a heart rate less than 60 bpm. Rates < 45 bpm cause

syncope, dizziness, weakness, confusion, diaphoresis, SOB, and angina.

Dysrhythmias: The treatment of choice is atropine but an

external pacemaker may be needed. Patient must avoid strenuous physical activity following placement o pace maker to allow time to settle. Nurses should withhold beta blockers.

Ventricular fibrillation (VF), a life-threatening dysrhythmia, is the leading cause of

sudden cardiac death

A patient in VF has no cardiac output and must receive intervention promptly. This rhythm is fatal if not successfully treated in

3 to 5 minutes. Begin CPR, defibrillate as soon as possible, and administer antidhysrhthmics.

Ventricular tachycardia (VT/V-Tach) is a life-threatening dysrhythmia that occurs when an irritable ectopic takes over as

the pacemaker. If a pulse is present and no changes in LOC, synchronized cardioversion may be needed to restore NSR, if the patient in VT does not have a pulse, treat as v-fib and defibrillate.

Heart failure usually begins with failure of the

left ventricle and progresses to failure of both

Causes of left-sided heart failure (LHF) include

hypertension, coronary artery disease, and mitral or aortic valve disorders. Patients experience tachypnea, muscle weakness, and fatigue. A cough is usually noted due to fluid being trapped in the lungs. Bibasilar crackles may be noted when auscultating the lungs.

Right-sided heart failure may be caused by

left ventricular failure, right ventricular MI, or pulmonary hypertension

RHF usually results due to

COPD, pulmonary hypertension, or ARDS. Fluid is retained, resulting in edema of the extremities. Jugular vein distention may also be present.

The diagnosis of heart failure is based on the health history data and presenting manifestations as well as diagnostic test results. A B-type natriuretic peptide (BNP) level will be ordered. The BNP is a

protein produced and released by the ventricles when the patient has fluid overload as a result of HF.

Instruct the patient to weigh daily and that 1 kg (2.2Ibs) of weight gain is equal to

1 liter of retained or lost fluid. The same scale should be used every morning before breakfast for the most accurate assessment of weight. Instruct patients to call their primary care provider if they gain 2 to 3 pounds in 1 day or 5 to 7 pounds in one week.

Heart Failure: Teach the patient energy conservation techniques, such as

eating small meals and resting afterward, as well as spacing out ADLs and activities to conserve oxygen and avoid excessive fatigue

The primary cause of CAD is

inflammation and lipid disposition in the wall of the artery

Arteriosclerosis is a

thickening, or hardening, of the arterial wall that is often associated with aging

Non-modifiable risk factors for CAD include

age, gender, family history, and ethnic background. The more factors a person has the greater the risk of CAD.

Laboratory tests to diagnosis CAD include a

lipid panel where total cholesterol, HDL, LDL, and triglycerides are measured. Elevated cholesterol levels are confirmed by HDL and LDL measurements. Cholesterol management focuses on an LDL < 100 mg/dl and an HDL > 40.

Procedures to open vessels are performed in the cardiac catheterization laboratory which includes

high-resolution fluoroscopy (patients may experience feeling of heat when dye is injected) and x-ray. These procedures include angioplasty, atherectomy, stents, and revascularization.

Coronary artery bypass graft (CABG) surgery involves the bypass of

a blockage in one or more of the coronary arteries using the saphenous veins, mammary artery, or radial artery as conduits or replacement vessels

Arteriosclerosis can occur when

arteries grow thick and stiff and restrict blood flow to organs and tissue in the body. This gradual process weakens arteries and can develop in various organs, most commonly the heart.

As arteriosclerosis progresses, clogged arteries can trigger a heart attack or stroke, with the following symptoms

angina, arm or leg weakness or numbness, difficulty speaking, loss of vision in one eye, high blood pressure, and kidney failure

Early diagnosis is critical for managing arteriosclerosis. Arteriosclerosis can be diagnosed by performing a

physical exam, blood test and EKG, and other diagnostic procedures.

Ischemia occurs when oxygen supplied is not sufficient to meet the requirements of the myocardium and is referred to as

Angina

Ischemia that occurs with angina is limited in duration and does not cause

permanent damage of myocardial tissue

Atherosclerosis, a type of arteriosclerosis, involves the formation of plaque within the arterial wall and is the leading risk factor for

cardiovascular disease

Atherosclerosis is a progressive disease that begins

early in life and develops in the coronary arteries, causing them to become narrowed or blocked. When blood flow through the coronary arteries is partially or completely blocked, ischemia and infarction of the myocardium may result.

Stable angina is

chest discomfort that occurs with moderate to prolonged exertion in a pattern that is familiar to the patient. The frequency, duration, and intensity of symptoms remain the same over several months. Stable angina results in only slight limitation of activity and is usually associated with a fixed atherosclerotic plaque.

Unstable angina is considered a

Acute Coronary syndrome, which also includes myocardial infarction

Primary HTN, idiopathic hypertension, includes over 90% of all HTN cases and develops gradually over many years. It is associated with

multiple factors, but one single cause cannot be identified.

Secondary HTN is directly related to a single factor, and if it is eliminated, the HTN will likely resolve. Factors that cause secondary HTN

include kidney abnormalities, tumors, acute stress, illegal drugs, and prescription medications.

Non-modifiable risk factors for hypertension include

family history, age, gender, and ethnicity.

Education for patients with HTN focuses on

lifestyle modifications and compliance with the treatment plan. Weight reduction and sodium restriction are the most important lifestyle.

Patient education should also include instructions on how to monitor

BP at home as well as target BP goals. Make sure patients know to record BP readings and take discuss with their healthcare provider. Sever hypertension (i.e. 200/150) requires immediate medical intervention.

To reduce the risk of injury, caution patients about sudden movement or position changes when taking

antihypertensive drugs. Bradycardia is associated with beta blockers and potassium depletion is common with loop diuretics, causing heart palpitations. Report any adverse reactions to the primary health care provider.

Peripheral vascular disease (PVD) includes disorders of the

arterial and venous systems of the peripheral circulation. The term PVD is used to describe peripheral arterial disease. PVD is increasingly common and has the potential to cause loss of limb or, occasionally, life.

Peripheral artery disease is a common disorder that usually affects

men over age 50. Physical assessment often reveals a loss of hair on the lower calf, and dry, scaly, pale skin.

PVD: People are at higher risk if they have a history of

abnormal cholesterol, diabetes, coronary artery disease, hypertension, kidney disease involving dialysis, smoking, or cerebrovascular disease.

Noninvasive testing for arterial disease provides information about

the arterial system with minimal risk. Duplex ultrasound exams of the extremities are prescribed. The femoral, popliteal, dorsalis pedis, and posterior tibial arteries are evaluated in the lower extremities. The axillary, brachial, ulnar, and radial arteries are evaluated in the arms.

Peripheral arterial occlusive diseases are primarily caused by

atherosclerosis, which gradually progresses to complete occlusion of medium and large arteries, especially the ones affecting the lower legs and feet.

Arteries can be occluded acutely from

embolism, thrombosis, trauma, vasospasm, or edema.

Atherosclerosis deprives the tissues of oxygenated blood which can injure

nerves and other tissues. The walls of the arteries also become stiffer and cannot dilate to allow greater blood flow when needed. This occurs slowly and progressively. The arteries that supply blood to the internal organs, arms, and legs are usually involved.

Acute Peripheral Occlusion: Diagnostic studies will include

serum cholesterol levels. Imaging studies include arteriography of the lower extremities, which may be done if stenting of the narrowed vessel is planned or to determine the exact amount of narrowing or occlusion before peripheral bypass surgery

Acute Peripheral Occlusion: Femoral bypass surgery is associated with serious risks including

hemorrhage, thrombosis, embolus, loss of limb, and death. Coolness of the affected extremity may indicate loss of blood supply.

Buerger's disease is also called thromboangiitis obliterans. It is an

inflammatory disease of the small and medium-sized arteries and veins of the extremities. It is often seen in men and appears to be directly related to smoking.

Buerger's Disease: Ulcers and pain are common. Pain is the outstanding clinical manifestation, especially while

walking. Weak lower extremities pulses, changes in nails and the skin, and edema of lower extremities are also seen.

Buerger's Disease: Various types of lower extremity paresthesias may occur. In advanced cases,

the extremities may be abnormally red or cyanotic, particularly when dependent. Ulceration and gangrene are frequent complications and may occur early in the course of the disease.

Buerger's Disease: Avoiding

cold and smoking cessation are essential

Raynaud's syndrome causes classic color changes in the

hands from spasm of the digital arteries, which results in pallor. The fingers look cyanotic, and rubor eventually develops when arterial spasms stop completely.

Raynaud's is exacerbated by things that normally cause vasoconstriction, such as

stress, caffeine, nicotine, cold, and chocolate

Raynaud's Disease: It is essential to keep hands and feet

warm and dry, protect all parts of the body from cold exposure to prevent reflex sympathetic vasoconstriction of the digits, and terminate tobacco use. Biofeedback has been of help to some patients.

Raynaud's Disease: Diagnostic studies will include

serum cholesterol levels. Imaging studies include arteriography of the lower extremities. This procedure involves injecting contrast medium into the arterial system and is associated with serious risks including hemorrhage, thrombosis, embolus, and death.

Treatment of Raynaud's includes medication when attacks interfere with the patient's ability to

work or to perform activities of daily living. Nifedipine is the drugs of first choice because they have been shown to decrease the frequency, duration, and intensity. Individuals who rarely go out in the cold weather may take medications prophylactically 1 to 2 hours before exposure to the cold.

Thrombus formation is attributed to venous stasis, hypercoagulability, and injury to the venous wall. Conditions that may cause stasis are

>40 years, surgery, immobility, phlebitis, prolonged travel, stroke, obesity, pregnancy, paralysis, heart disease, and heart failure. Some of the highest risk patients are those who have orthopedic surgery.

Clots can form in superficial veins and in deep veins. Blood clots with inflammation in superficial veins rarely cause serious problems. But clots in deep veins (DVT) require

immediate medical care, as they can dislodge and become a life threatening emboli.

The severity and location of the pain of intermittent claudication vary. The most common location of intermittent claudication is the

calf muscle. The pain in the calf muscle occurs only during exercise.

Elevation of the legs also decreases venous pressure, which in turn reduces

edema and pain. Elevate the foot of the bed 6 inches with a slight knee bend to prevent popliteal pressure. The veins of the legs should be level with the right atrium.

The head of the bed may be raised to facilitate eating and bathing. If compression stockings are prescribed, they must be fitted correctly and removed for a

short time every day. Bathe the legs and inspect them closely for manifestations of skin breakdown while the stockings are off.

Venous insufficiency results from

obstruction of the venous valves in the legs or a reflux of blood back through the valves. Superficial and deep leg veins can be involved. Resultant venous hypertension can occur whenever there has been a prolonged increase in venous pressure.

Edema, altered pigmentation, pain, stasis dermatitis, dilated superficial veins, and stasis ulcers are evidence of

venous insufficiency

Management is directed at reducing venous stasis and preventing ulceration. The nursing management aimed at treating chronic venous insufficiency

includes decreasing edema and promoting venous return by elevating the leg, compression of superficial veins with elastic compression stockings, walking, avoid crossing legs, avoid clothes that restrict blood flow, protect skin from trauma, and keeping it clean, dry and soft.

Protruding veins that are darkened/tortuous and caused by

weak vein walls, increased venous pressure & incompetent valves

Varicose veins: Common in patients that

stand for long periods, pregnant, obese, or have systemic problems such as heart disease

Varicose Veins: Assessment findings reveal

aching pain in leg, with fatigue and heaviness, statis dermatitis, feelings of heat in the leg, visibly dilated veins, discolored skin above the ankles, and increased incidence of PE and thrombophlebitis

Varicose Veins: Nursing interventions should focus on assessing

circulation, elevating legs, and performing active ROM

Varicose Veins: Patient teaching will include avoidance of

venous stasis, wearing compression stockings, performing lower extremity exercises when sitting for prolonged periods of time, and elevating the legs

Amputations: After surgery, the patient will have a soft dressing or a rigid dressing. Assess the surgical dressing for integrity and drainage. Elevate the stump for the first 24 to 48 hours. Move and turn the patient gently and slowly to prevent severe muscle spasms. Reposition the patient every 2 hours, turning the patient from side to side and prone, if possible. Lying prone helps reduce

hip flexion contractures. Avoid placing pillows between the patient's legs or under the back.

Amputations: Provide stump care as prescribed, and assess the stump for signs and symptoms of

infection and skin irritation or breakdown. Assess the color, temperature, and most proximal pulse on the stump before rewrapping it, comparing findings to the contralateral extremity.

Phantom sensations are feelings that the amputated part is still

present. The client may describe sensations of warmth, cold, itching, or pain, especially in amputated fingers or toes.

Phantom sensations are caused by

intact peripheral nerves proximal to the amputation site that carried messages between the brain and the now amputated part

Interventions that may reduce phantom pain include

range-of-motion exercises, visual imaging, nerve-stabilizing medications, and other interventions for chronic pain