Lab 9-pre-talk

Please see chapter 20 and your lecture notes on hypertension and congestive heart failure.

Table (below). Relationship between dietary profile hypertension and a sequela of hypertension (i.e. congestive heart failure). Congestive heart failure can also feature hypertension and other pro-atherosclerotic features given below including a pro-atherosclerotic diet prior to post-onset management of congestive heart failure. Please refer to the lab 8 pre-talk as a pro-atherosclerotic diet leads atherosclerosis leading to hypertension which leads to myocardial infarction which can lead to congestive heart failure.

Heart rate / Stroke volume / Cardiac output / Total peripheral resistance
Diet-reduced atherosclerotic profile risk diet / Normal / Normal / Normal / Normal
Diet-pro-atherosclerotic profile risk diet / Higher* / Higher / Higher / Lower*
Plasma triglycerides
Normal
Elevated (pro-atherosclerotic) / Normal
Higher / Normal
Higher / Normal
Higher / Normal
Lower
Plasma HDL-cholesterol
Normal
Low (pro-atherosclerotic) / Normal
Higher / Normal
Higher / Normal
Higher / Normal
Lower
Plasma LDL-cholesterol
Normal
Elevated (pro-atherosclerotic) / Normal
Higher / Normal
Higher / Normal
Higher / Normal
Lower
Plasma LDL size (angstroms)
Normal
Low (pro-atherosclerotic) / Normal
Higher / Normal
Higher / Normal
Higher / Normal
Lower
Plasma Lp(a)
Normal
Elevated (pro-atherosclerotic) / Normal
Higher / Normal
Higher / Normal
Higher / Normal
Lower
Plasma VLDL-triglyceride
Normal
Elevated (pro-atherosclerotic) / Normal
Higher / Normal
Higher / Normal
Higher / Normal
Lower
Plasma chylomicrons-triglyceride clearance
fractional clearance rate
Normal
Low (pro-atherosclerotic) / Normal
Higher / Normal
Higher / Normal
Higher / Normal
Lower
BMI
Normal
Elevated (pro-atherosclerotic) / Normal
Higher / Normal
Higher / Normal
Higher / Normal
Lower
Waist circumference
Normal
Elevated (pro-atherosclerotic) / Normal
Higher / Normal
Higher / Normal
Higher / Normal
Lower
Bleeding time
Normal
Low (pro-atherosclerotic) / Normal
Higher / Normal
Higher / Normal
Higher / Normal
Lower

*Please note that higher and lower are relative to normal in terms of heart rate, stroke volume, cardiac output, and total peripheral resistance.

NCLEX STYLE QUESTIONS

HYPERTENSION

Page 263-question 41: Which topic should the nurse determine is most appropriate when presenting health related instructions to clients from an African-American (or African Canadian/African Nova Scotian) community?

a) osteoporosis

b) hypertension

c) uterine cancer

d) thyroid disorders

a) African-American (or African Canadians/Africans Nova Scotians) have approximately 50 % less risk for osteoporosis than do American or Canadian Caucasians

b) Among African-American (or African Canadians/Africans Nova Scotians), hypertension is 78 % more prevalent than among American or Canadian Causcasians

c)American or Canadian Caucasian females are 30 % more likely to be diagnosed with uterine cancer than African- American/-Canadian/-Nova Scotian women

d) statistics indicate that African-American (or African Canadians/Africans Nova Scotians) are less likely to develop thyroid cancers than Caucasian Americans/Canadians

Page 275-Q 201- A nurse provides dietary teaching about a low sodium diet for a client with hypertension. Which nutrient selected by the client indicates an understanding about foods that are low in natural sodium?

a) milk

b) meat

c) fruits

d) vegetables

a) milk-higher in natural sodium than fruits

b) meat- higher in natural sodium than fruits

c) fruits-less natural sodium than do other foods

d) vegetables- higher in natural sodium than fruits

Congestive heart failure

Page 266-question 76- A client admitted to the hospital has oedematous ankles. What should the nurse do to best reduce oedema of the lower extremities?

a) restrict fluids

b) elevate the legs

c) apply elastic bandages

d) do range of motion exercises

a) this is a dependent function of the nurse

b) elevation of the extremities promotes venous and lymphatic drainage by gravity

c) this is a dependent function of the nurse

d) this procedure has little effect on oedema

in question 76- what electrolyte may contribute to the oedema?

CACHEXIA- wasting -skeletal muscle and adipose tissue atrophy resulting in progressive weight loss

Page 275-q 196-A nurse is caring for a client who is cachetic. What information about the function of adipose tissue in fat metabolism is necessary to better address the needs of this client?

a) releases glucose for energy

b) regulates cholesterol production

c) uses lipoproteins for fat transport

d) stores triglycerides for energy reserves

a) releases glucose for energy-this is not a main function of adipose tissue- main function of adipose tissue is storage of triglycerides

b) regulates cholesterol production-not a function of adipose tissue-cholesterol is synthesised in the liver

c) uses lipoproteins for fat transport-not a function of adipose tissue- lipoproteins are used to transport fat in the water portion of the blood

d) stores triglycerides for energy reserves-when energy is required, fatty acids mobilised from triglycerides in fat tissue; fatty acids are used for fuel. The nurse needs to consider that a client who is cachetic will have limited reserves to meet energy needs.