NURS 6501 Knowledge Check: Cardiovascular and Respiratory Disorders
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Scenario 1: Myocardial Infarction CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.” HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10. Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl His diagnosis is an acute inferior wall myocardial infarction.  NURS 6501 Knowledge Check Cardiovascular and Respiratory Disorders Question: Which cholesterol is considered the “good” cholesterol and what does it do? |
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Question 2
Scenario 1: Myocardial Infarction
CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”
HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with
NURS 6501 Knowledge Check Cardiovascular and Respiratory Disorders
a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.
Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
Question:
1. How does inflammation contribute to the development of atherosclerosis?
Selected Answer: Atherosclerosis is thte the cause of myocardial infaraction,stroke,and ischemic gagrene.Inflammation is part of body’s defence mechanism and it plays a major in the healing process. Inflammation plays a major in all phases of artherosclerosis . Artherosclerosis is the thicking or hardening of the artery. It is caused by a buildup of plaque in the inner lining. They stable plaques characterizs by inflammatory infiltrates. Vulnerable and ruptured plaques are characterized by active inflammation.Repeated cycles of inflammation can induce smooth cell muscle poliferation and form atherosclerotic .
Correct Answer: 
Inflammation in the heart muscle caused by chronic inflammatory processes leads to mitochondrial damage that results in an increased free radical production that further activates the chronic inflammatory vicious cycle.
Response Feedback: [None Given] -
Question 3Scenario 2: Pleural Friction Rub
A 35-year-old female with a positive history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 5-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
1. Because of the result of a pleural friction rub, what does the APRN recognize?
Selected Answer: Acute pericarditis is the inflammation of the pericardicia lining of the heart lining. The cause is idiopathic. Retrosternal pain is from the inflammation of the pericardium .Pleural friction rub is the result a pleuritis, The pleual rub sound is the movement of the inflammed and rough surface against each. which can also has effusion
Correct Answer: The inflammation of the pericardium, due to either the underlying autoimmune disease or a post viral syndrome, causes roughening of the pericardium. The roughening of the pericardium causes the classic “rub” which can best be heard at the apex of the heart and left sternal border.
Response Feedback: [None Given] -
Question 4
Scenario 4: Deep Venous Thrombosis (DVT)
A 81-year-old obese female patient who 48 hours post-op left total hip replacement. The patient has had severe nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).
Question:
1. Given the history of the patient explain what contributed to the development of a deep venous thrombosis (DVT)
Selected Answer: Thrombous is combination of blood cells and finbrin, is blood clot is attached to the endothelia lining of the bloodvessel it can develop either in ihe arterial or venous systems. .it can obstruct or block blood supply to vital organs, resulting in ischaemia. Venous clot formation is known to occur commonly in the deep veins of the leg . The contributory factors are Obesity, Age, Dehydration from nausea and vomiting, Post surgery complication.
Correct Answer: Virchow’s Triad caused damage to the walls of the vessels. When there is injury to the intimal layer of the vessel, antiplatelet substances such as nitric oxide and prostacyclin, along with the expression of collagen on the vessel wall, causes adherence of the platelets to the vessel wall. The platelets become activated then aggregate forming clots. Venous stasis because of obesity, patient’s advanced age and inability to go to physical therapy.
Response Feedback: [None Given] -
Question 5
Scenario 5: COPD
A 66-year-old female with a 50 pack/year history of cigarette smoking had a CT scan and was diagnosed with emphysema. He asks if this means he has chronic obstructive pulmonary disease (COPD).
Question:
1. There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD.
Selected Answer: Emphysema is one of the preventable lung disease, is as a result of prolong smoking. other causes can be pollution,and genetic, which occur as a result of alpha-1 anttrypsin deficiency . The aveoli of the lungs is affected, there is permanent enlargement and destruction of bronchial and aveoli structure reducing the surface area and decrease in elastic recoil,that leads to decrease airflow and gas exchange . Chronic obstructive disease is the obstruction of airflow due to destruction or inflammation of large central airways,small pheripheral airways and the lung parenchyma. Both emphysema and COPD have the same causes but affect different part of the lungs Chronic bronchitis and emphysema are the most common form of COPD
Correct Answer: Emphysema is a disease of the airways that causes permanent enlargement of the gas exchange airways. It is accompanied by destruction of the alveolar walls do not appear to be fibrotic. Chronic exposure to irritants recruit neutrophils, macrophages, and lymphocytes to the lung resulting in progressive damage from inflammatory oxidative stress. Emphysema is characterized by destruction of alveoli leading to decreased surface area for gas exchange that causes significant ventilation/perfusion mismatch.
Response Feedback: [None Given] Scenario 4: Deep Venous Thrombosis (DVT) A 81-year-old obese female patient who 48 hours post-op left total hip replacement. The patient has had severe nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).
Question:
1. Given the history of the patient explain what contributed to the development of a deep venous thrombosis (DVT)
Selected Answer: given patient history factors that may contribute to her developing deep vein thrombosis, age, surgery, immobility, and dehydration Correct Answer: Virchow’s Triad caused damage to the walls of the vessels. When there is injury to the intimal layer of the vessel, antiplatelet substances such as nitric oxide and prostacyclin, along with the expression of collagen on the vessel wall, causes adherence of the platelets to the vessel wall. The platelets become activated then aggregate forming clots. Venous stasis because of obesity, patient’s advanced age and inability to go to physical therapy. Response Feedback: [None Given] · Question 5
4 out of 4 points
Scenario 5: COPD A 66-year-old female with a 50 pack/year history of cigarette smoking had a CT scan and was diagnosed with emphysema. He asks if this means he has chronic obstructive pulmonary disease (COPD).
Question:
1. There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD.
Selected Answer: Emphysema is one of the lung conditions included in the term COPD. Normal lung tissue resembles a sponge; however, the lungs of people with emphysema look like an old used sponge, with large holes in them and a limited ability to “spring-back” into shape. Emphysema is a progressive disease, that usually starts slowly with small holes between the alveoli, which eventually collapse to form larger air spaces. Old air gets trapped in these air spaces, which makes it difficult for people to inhale fresh air. Blood flow through the alveoli is also impaired meaning that people with emphysema not only struggle to breathe but have trouble receiving enough oxygen.
Cigarette smoking is by far the biggest cause of emphysema, but also the most preventable. Emphysema is more common with age and in males, and it tends to run in families. Other causes include air pollution, airway reactivity, and a deficiency of alpha-1-antitrypsin.
The main difference between emphysema and COPD is that emphysema is a progressive lung disease caused by over-inflation of the alveoli and COPD is an umbrella term used to describe a group of lung conditions emphysema is one of them. A person with emphysema has COPD; however, not everybody with COPD has emphysema.
Correct Answer: Emphysema is a disease of the airways that causes permanent enlargement of the gas exchange airways. It is accompanied by destruction of the alveolar walls do not appear to be fibrotic. Chronic exposure to irritants recruit neutrophils, macrophages, and lymphocytes to the lung resulting in progressive damage from inflammatory oxidative stress. Emphysema is characterized by destruction of alveoli leading to decreased surface area for gas exchange that causes significant ventilation/perfusion mismatch. Response Feedback: [None Given]