312 LEC PRELIM EXAMINATION Flashcards by KYLE ANGEL ESPEJON

Assessment shows client had Post-MI syndrome (Dressler’s syndrome). Where patient experiences fever, pericardial & pleural effusion 1-12 weeks after Myocardial Infarction. This disorder is called?

Pericarditis

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Inflammation of the pericardium caused by Infective organisms (bacteria, viruses, fungi)

Pericarditis

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fibrous thickening of the pericardium

“Chronic Constrictive Pericarditis

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Patients verbalize pain radiating to the neck, shoulder & back. The pain is aggravated by inspiration, coughing & swallowing and feels worst in supine position. Thus, pain is relieved by sitting up & leaning forward.

Pericarditis

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Assessment found scratchy high pitch sound called “Friction rub”, increase WBC count, and Atrial fibrillation/irregular and often very rapid heart rhythm

Pericarditis

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A patient with pericarditis who undergo Echocardiography and CT scan will have a finding of _ of pericardium

thickening

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Intervention for patient with uremic pericarditis

Hemodialysis

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Intervention for patient with chronic constrictive pericarditis

Pericardiectomy

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complications to monitor in patient with pericarditis

pericardial effusion

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buildup of too much fluid in the double-layered, saclike structure around the heart (pericardium). The space between these layers typically contains a thin layer of fluid.

pericardial effusion

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medical emergency that takes place when abnormal amounts of fluid accumulate in the pericardial sac compressing the heart leads to increased pressure, impairing ventricular filling and, and leading to a decrease in cardiac output and shock

cardiac tamponade

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Patient assessment findings show Jugular distention/bulging of the major veins in your neck and muffled heart sounds

pericardial effusion 🡪 cardiac tamponade

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Patient assessment findings show an abnormal drop in systolic blood pressure during inspiration. This means there is a decrease in cardiac output and a possible circulatory collapse

pericardial effusion 🡪 cardiac tamponade

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Drainage procedures or surgery or emergency care to treat pericardial effusion

pericardiocentesis

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A patient with pericardial effusion has a paradoxical pulse of systolic BP higher or more on expiration than on inspiration. How many mmHg?

10mmHg

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the buildup of excess fluid between the layers of the pleura outside your lungs.

pleural effusion

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buildup of fluid in the space around your heart.

pericardial effusion

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A build-up of blood or other fluid in the pericardial sac puts pressure on the heart, which may prevent it from pumping effectively.

cardiac tamponade

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Assessment found elevated WBC count, c-reactive protein (CRP), and cardiac isoenzymes

myocarditis

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bulimic patients/eating disorder (bulimia) are taking what to facilitate purging that causes myocardial damage

ipecac syrup

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this condition is caused by Viral, bacterial, fungal & parasitic infection,
Radiation therapy, and
Autoimmune disorders/immune system attacks own healthy tissues

Myocarditis

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patients who induced in Chronic alcohol & cocaine abuse might develop what condition

myocarditis

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Bulimic patients taking ipecac syrup to facilitate purging excessively may cause damage leading to

Myocarditis

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due to inflammation, abnormal function includes ⭣ cardiac output, impaired blood circulation, and predispose client to Congestive Heart Failure (CHF). this condition is

Myocarditis

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Myocarditis can occur because of ischemia/inadequate blood supply to an organ or part of the body. Myocarditis due to ischemia can cause

tachycardia, dysrhythmias

aside from Congestive Heart Failure (CHF), myocarditis can be associated to a chronic disease of the heart muscle known as

Cardiomyopathy

patient's assessment findings show PAIN, Fever, Tachycardia, Dysrhythmias, Dyspnea, Malaise, Fatigue, Anorexia, Pale or cyanotic skin, signs of RSHF

Myocarditis

Echocardiography and CT scan used in assessment of pericarditis. in myocarditis, abnormal result is found using

chest radiography and echocardiography

Aside from antibiotic given as Treatment of underlying cause of Myocarditis. what other drugs are prescribed used to treat congestive heart failure (CHF) and heart rhythm problems (atrial arrhythmias)

cardiotonic drugs (digitalis)

aside from cardiopulmonary status (vs, dependent edema, etc), what complication is monitored to a patient with myocarditis

CHF, dysrhythmias

Sodium/Na+-restricted diet for patients with what condition

Myocarditis

A systemic inflammatory disease that usually develops after an URTI

Rheumatic Fever

bacteria causing Rheumatic fever

group A ß-hemolytic streptococci

patient assessment show major symptoms including Carditis, Polyarthritis, Subcutaneous nodules, and Erythema marginatum

Rheumatic Carditis/ Endocarditis

Endocarditis or Rheumatic Carditis is associated with Sydenham’s chorea also known as

St. Vitu’s dance

this major/classic symptom of endocarditis is Characterized by formation of Aschoff’s bodies, Murmur (valve damage), pericardial friction rub (pericarditis), and CHF

Carditis

this major/classic symptom of endocarditis is Characterized by Swelling of several joints (knees, ankle, hips, shoulders) that is warm, red and painful

Polyarthritis

this major/classic symptom of endocarditis is Characterized by Involuntary grimacing & inability to use skeletal muscles in a coordinated manner and Involvement of central nervous system

Chorea (Sydenham’s chorea, St. Vitu’s dance)

this major/classic symptom of endocarditis is Characterized by Sometimes marble-sized nodules appear around the joints

Subcutaneous nodules

this major/classic symptom of endocarditis is Characterized by Red, spotty rashes on the trunk that disappears rapidly leaving irregular circles on the skin

Erythema marginatum

this minor symptom of endocarditis is Characterized by pain in one or more joints without evidence of inflammation, tenderness, or limited movement

Arthralgia

a history of Rheumatic Fever or evidence of pre-existing rheumatic heart disease is a minor symptom of

Rheumatic Carditis/ Endocarditis

a fever of __ is a minor symptom of endocarditis

38.9 - 40°C or 101 - 104°F

a patient with Endocarditis will have ECG changes result of

prolonged P-R interval

Diagnostic tests shows 🡩 in erythrocyte sedimentation rate (ESR) and ASO titer (antibodies have been found. This means that you may have had a recent strep infection), and (+) C- reactive protein

Rheumatic Carditis/ Endocarditis

Rheumatic Carditis/ Endocarditis is Diagnosed clinically through the use of the

JONES criteria

JONES criteria must show presence of

2 major manifestation or 1 major + 2 minors with supporting evidence of a recent streptococcal infection

patient is experiencing 38.9 - 40°C or 101 - 104°F fever accompanied with chills, sudden on sent of sore throat, and diffuse redness of throat with exudates on oropharynx

streptococcal pharyngitis

a child patient complaint having Abdominal pain, has Enlarge & tender lymph nodes, and Acute sinusitis & acute otitis media

streptococcal pharyngitis

Infectious Disorders

Pericarditis, Myocarditis, Endocarditis, RHD

adequate treatment of streptococcal infection would prevent rheumatic carditis. this bacteria is known as

streptococcal pharyngitis

to control blood clot formation around the valves in endocarditis, what medication is given

Aspirin

for fever in endocarditis, what management is given

antipyretics, hydration

to prevent recurrence in endocarditis, what medication is given

Antibiotic prophylaxis

An infection of the innermost layers of the heart. It may occur in people with congenital and valvular diseases.

Endocarditis

Inflammatory symptoms = induced by antibodies originally formed to destroy the group A beta-hemolytic streptococcal microorganisms. INSTEAD the antibodies mistakenly cross-react against the proteins in the connective tissue of the heart, joints, skin and nervous system cross reaction causes = valvular damage OR a condition where there is an inflammation of the entire heart: the pericardium, myocardium, and endocardium.

Pancarditis

A child was assessed and findings found a major symptom of Polyarthritis (client complain of warm, red, and painful knees) and minor symptom of Arthralgia (pain in shoulders without evidence of inflammation)

Rheumatic Carditis/Endocarditis

inadequacy of the heart to pump blood throughout the body

Pump failure

accumulation of blood & fluid in organs & tissues due to impaired circulation

Congestive Heart Failure

This condition might be a result of a damage to muscular wall (M.I.) due to heart attack, Cardiomyopathy (Any disorder that affects the heart muscle), Coronary artery disease (CAD), or Valvular defects

Congestive Heart Failure

Types of Heart Failure

◼ Left-sided heart failure ◼ Right-sided heart failure

What condition indicates if diagnostic findings are: Chest x-rays reveals cardiomegaly (hypertrophy) ECG reveals ventricular hypertrophy and dysrhythmias Echocardiography reveals cardiac valvular changes and chamber enlargement

Heart Failure

Multigraded angiographic (MUGA) scans shows information about ejection fraction. The condition could be?

Heart Failure

A patient with heart failure is given what diet

Low-sodium diet, fluid restriction

loss of apetite, nausea and vomiting, rapid, slow, irregular heart rate, disturbance in color vision are signs of

DIGITALIS toxicity

Digitalis, Diuretics, Vasodilators, ACE inhibitors, are medications given to patient with what condition

Heart Failure

Dopamine and Dobutamine exert positive inotropic effects in patients with

heart failure

Digoxin (Lanoxin) is an Inotropic Agent that decreases: A) contractility B) heart rate C) conduction D) it increases all

decreases: A) contractility B) heart rate C) conduction

Which of the following statements about Digoxin is true? A) It has negative sympa. Activity B) It has positive parasympa. Activity C) It has negative positive sympa. Activity D) It is the generic name for Lanoxin. E) It is a Digitalis

A) It has negative sympa. Activity B) It has positive parasympa. Activity D) It is the generic name for Lanoxin. E) It is a Digitalis.

Which of the following medications is a Diuretic? - Furosemide (Lasix) - Digoxin (Lanoxin) - Chlorothiazide (Diuril) - Nitroglycerin - Captopril

- Furosemide (Lasix) - Chlorothiazide (Diuril)

assessment in patient with heart failure can be done by thinking __ are similar to what you hear when blowing back through a straw in a can of soda because Fluid backs up into here.

Lung sounds

Heart sounds of a patient in __ will resemble that of a Galloping Horse and feel like they are drowning

CHF

Congestion of Peripheral Tissues -> Dependent edema and action GI tract congestion -> Anorexia, GI distress, weight loss Liver congestion -> signs related to impair liver function are complications associated with what type of heart failure

RIGHT-SIDED HEART FAILURE

Decreased cardiac output -> activity intolerance and signs of decreased tissue perfusion Pulmonary congestion -> impaired gas exchange -> cyanosis and signs of hypoxia -> Pulmonary Edema -> Cough with frothy sputum, Orthopnea, Paroxysmal Nocturnal Dyspnea are complications associated with what type of heart failure

LEFT-SIDED HEART FAILURE

three main forms of arteriosclerosis

Atherosclerosis, Mönckeberg's arteriosclerosis/medial calcific sclerosis, Arteriolar sclerosis/arteriolosclerosis

the most common type of arteriosclerosis which is the leading contributor to coronary artery and cerebrovascular disease

Atherosclerosis

a specific type of arteriosclerosis in which plaques (chiefly composed of cholesterol) of fatty deposits form in the inner layer (tunica intima) of the arteries w/c can restrict blood flow

atherosclerosis

type of arteriosclerosis, in which there is an involvement of the middle layer (tunica media) of the arteries, where there is destruction of muscle and elastic fibers and formation of calcium deposits

Mönckeberg's arteriosclerosis/medial calcific sclerosis

type of arteriosclerosis which is marked by thickening of the walls of arterioles/hardening of the arterial wall

Arteriolar sclerosis/arteriolosclerosis

The process of Atherosclerosis begins with Damage to the vascular system -> Fatty Streak development in the __ layer -> Plaque formation, leading to partial or complete occlusion of blood flow

intimal

partial or complete occlusion of blood flow because of plaque can lead to which complications

* Calcifications * Ulceration * Thrombosis

what forms of arteriosclerosis the male gender is at risk of having

atherosclerosis

a client with “type A” personality, Postmenopausal Estrogen Deficiency, has High Carbohydrate Intake is at risk of

atherosclerosis

a client with atherosclerosis might experience Hyperlipidemia hypolipidemia Hypertension hypotension Lipoprotein Lp(a)

Lipoprotein Lp(a) Hardened (trans)unsaturated fat intake Hyperlipidemia Hypertension

The nicotinic acid in tobacco triggers the release of __, which raise the heart rate and blood pressure. Nicotinic acid can also cause the coronary arteries to constrict. Smokers have an increased risk of CAD and sudden cardiac death. The increase in _ may be a factor in sudden cardiac death.

catecholamines

Which of the following substances in tobacco triggers the release of catecholamines? A. Nicotine B. Nicotinic acid C. Carbon monoxide D. Tar

Nicotinic acid

What effect does the increased blood carbon monoxide level, due to cigarette smoking, have on hemoglobin? A. Decreases the amount of oxygen that hemoglobin can carry. B. Increases the amount of oxygen that hemoglobin can carry. C. Has no effect on the amount of oxygen that hemoglobin can carry. D. Enhances the ability of the heart to pump blood.

Decreases the amount of oxygen that hemoglobin can carry, may decrease the heart’s ability to pump.

* Use of __ adversely affects the vascular endothelium, resulting in increased platelet adhesion and leading to a higher probability of thrombus formation.

tobacco

High blood pressure whether it is genetic or caused by bad eating habits can cause heart disease. A high intake of _ leads to hypertension which allows plaque to stick to the insides of arteries.

sodium

Diabetes can cause __ because it causes increased amount of blood sugar which leads to premature cell death and slowed blood flow.

atherosclerosis

Alcohol consumption: You have probably heard that an occasional glass of red wine is “good for the heart”. This is true if it is done in moderation and small amounts. However, too much of wine, or any other alcoholic beverage can cause LDL levels to increase by as much as _%. This also leads to plaque buildup in arteries.

40%

What effects do estrogen deficiency have on metabolic syndrome in postmenopausal women? A. Hypertriglyceridemia, reduced HDL, and increased small dense LDL particles, insulin resistance, hypertension, increased central fat, reduction in lean body mass, and reduction in lean body mass. B. Hypertriglyceridemia, increased HDL, and increased large LDL particles, insulin resistance, hypertension, increased central fat, and reduction in lean body mass. C. Normal triglyceride levels, increased HDL, normal or slightly increased LDL levels, increased insulin sensitivity, normal blood pressure, increased peripheral fat, and increased lean body mass.

A. Hypertriglyceridemia (high blood triglyceride levels), reduced HDL (high-density lipoprotein, or 'good' cholesterol), and increased small dense LDL (low-density lipoprotein, or 'bad' cholesterol) particles, insulin resistance, hypertension (high blood pressure), increased central fat (fat deposited around the abdomen) and reduction in lean body mass (loss of muscle tissue) are all effects of estrogen deficiency in postmenopausal women.

many features of the metabolic syndrome exhibit Hypertension, Dyslipidemia, Insulin resistance, Increased central fat and reduction in lean body mass, and Increased hypercoagulability and pro-inflammatory state. shown in which kind of patients

postmenopausal women with estrogen deficiency

hypertriglyceridemia (too many triglycerides/fat in your blood), reduced HDL, and increased small dense LDL particles are under what condition where one has unhealthy levels of one or more kinds of lipid (fat) in blood.

Dyslipidemia

What conditions are used to assess the risk of developing atherosclerosis? A. Hypertension, high cholesterol and triglycerides, abdominal obesity, elevated fasting blood sugar (FBS), and elevated homocysteine. B. Low blood pressure, low cholesterol and triglycerides, peripheral obesity (fat deposited around the hips, buttocks, and thighs), low fasting blood sugar, and low homocysteine. C. Optimal blood pressure, normal cholesterol and triglycerides, excess peripheral fat, optimal fasting blood sugar, and optimal homocysteine.

A. Hypertension (high blood pressure), high cholesterol and triglycerides, abdominal obesity, elevated fasting blood sugar, and elevated homocysteine are all used as risk factors to assess the likelihood of developing atherosclerosis.

Elevated homocysteine levels can have which of the following effects on the endothelium? a. increase the production of nitric oxide b. block the production of nitric oxide c. have no effect on the production of nitric oxide d. promote the breakdown of nitric oxide

blocks the production of nitric oxide on the endothelium making cell wall less elastic & permitting plaque to build up

Based on the homocysteine test result, what is the borderline risk? a. levels between 9-12 mol/L b. levels between 12 and 15 mol/L c. levels greater than 15 mol/L

levels between 12 and 15 mol/L

to lower homocysteine level, a diet of what is recommended

B-complex vitamin rich diet (folic acid)

Cholesterol screening, Smoking cessation, and HMG-CoA reductase inhibitors “Statins” are medical interventions for?

atherosclerosis

What is the role of cholesterol in the formation of arterial plaques? - Cholesterol is converted into chylomicrons by the liver and then reprocessed by the gastrointestinal tract as lipoproteins. - Cholesterol is converted into chylomicrons by the gastrointestinal tract and then reprocessed by the liver as lipoproteins.

Cholesterol is converted into chylomicrons by the gastrointestinal tract and then reprocessed by the liver as lipoproteins.

supplies blood and oxygen to heart muscle

coronary artery

bacteria associated with atherosclerosis

chlamydia pneumoniae

In postmenopausal women, many features of the metabolic syndrome emerge with estrogen deficiency. It exhibit a condition that refers to unhealthy levels of one or more kinds of lipid (fat) in your blood

Dyslipidemia

Elevated __ blocks the production of nitric oxide on the endothelium making cell wall less elastic & permitting plaque to build up

homocysteine

high density lipoproteins are what kind of cholesterol

good cholesterol

low density lipoproteins are what kind of cholesterol

bad cholesterol

Cholesterol is processed by the gastrointestinal tract into lipoprotein globules called

chylomicrons

Cholesterol is processed by the gastrointestinal tract into lipoprotein globules called chylomicrons. These are reprocessed by the liver as

lipoproteins

patient's assessment found Elevated cholesterol & triglycerides, Elevated FBS, and Elevated homocysteine. patient has

ATHEROSCLEROSIS

patient assessment findings shows hypertension, abdominal obesity and homocysteine test results are interpreted as greater than 15 mol/L. patient has signs of

ATHEROSCLEROSIS

aside from alcohol, another unhealthy habit is a major risk factor for atherosclerosis

cigarette smoking

the excess of lipids or fats in your blood also known as high cholesterol

hyperlipidemia

Hardened (trans)unsaturated fat intake, obesity, diabetes, and high carbohydrate intake are risk factors for which condition

atherosclerosis

Lipoprotein(a), or Lp(a), is an established and genetically determined risk factor for

atherosclerosis

Use of tobacco adversely affects the vascular endothelium, resulting in increased platelet adhesion and leading to a higher probability of __. A person at increased risk for heart disease is encouraged to stop tobacco use through any means possible: educational programs, counseling, consistent motivation and reinforcement messages, support groups, and medications.

thrombus formation

ANGINA PECTORIS of cardiac origin

“Chest pain”

Sudden coronary obstruction caused by thrombus formation over a ruptured or ulcerated plaque

MYOCARDIAL INFARCTION

most common clinical manifestation of myocardial ischemia

ANGINA PECTORIS

the cause is insufficient coronary blood flow, resulting in a decreased oxygen supply when there is increased myocardial demand for oxygen in response to physical exertion or emotional stress. ‘the need for oxygen exceeds the supply’.

ANGINA PECTORIS

occurs as a result of sustained ischemia, causing irreversible cellular damage.

MYOCARDIAL INFARCTION

Types of Angina

Stable, Unstable, Variant (Prinzmetal’s)

type of angina which 75% coronary occlusion accompanies exertion, Elevated HR or BP, and pt Eating a large meal

Stable Angina

type of angina with Arterial spasm in normal or diseased coronary artery

Variant (Prinzmetal’s)

Unstable Angina is the Progressive worsening of stable angina with __% coronary occlusion

>90%

type of angina where Chest pain of increased frequency, severity & duration poorly relieved by rest or oral nitrates

Unstable Angina

Stable Angina has Similar pain severity, frequency & duration with each episode. Chest pain may radiate for how long

15mins or less

Variant Angina chest pain occurs at rest usually between what time

12am & 8am

chest pain that occurs at rest (usually bet. 12am & 8am), sporadic over _ mos & diminishes over time (ECG: ST – elevation)

3-6

supply ischemia

unstable angina and printzmetal's variant angina

demand ischemia

chronic stable angina

PRIMARY FACTOR of Myocardial Infarction

Atherosclerosis

Modifiable risk factors of ? * Elevated serum cholesterol levels * CIGARETTE SMOKING!!! * Hypertension * Hypotension * Impaired glucose tolerance * Obesity * Physical inactivity * Stress

Myocardial Infarction

an area of the myocardium is permanently destroyed, typically because plaque rupture and subsequent thrombus formation result in complete occlusion of the artery.

MYOCARDIAL INFARCTION

Condition where Pain varies from a feeling of indigestion to a choking or heavy sensation in the upper chest ranging from discomfort to agonizing pain.

ANGINA PECTORIS

In __, Discomfort is poorly localized and may radiate to the aspect of the left upper arms

Angina Pectoris

The pain in Angina Pectoris is usually retrosternal, deep in the chest behind the

upper or middle third of the sternum

A feeling of weakness or numbness in the arms, wrists, and hands, as well as shortness of breath, pallor, diaphoresis, dizziness or lightheadedness, and nausea and vomiting, may accompany the pain. Anxiety may also occur.

ANGINA PECTORIS

An important characteristic of anginal pain is that it subsides when the precipitating cause is removed or with __.

nitroglycerin

Positioning for Myocardial Infarction

semi Fowler’s

Oxygen must be given to patient with Myocardial Infarction by _/min through nasal cannula

2-4L/min

Diagnosis of this condition shows Elevated myoglobin Lactate dehydrogenase (LDH) , aspartate aminotransferase (AST), WBC, and erythrocyte sedimentation rate (ESR) .

MYOCARDIAL INFARCTION

In myocardial infarction, Troponin I increases __ the onset of pain.

7-14 hrs after

In myocardial infarction, Troponin T increases within __ the onset of pain.

3-6 hrs after

Elevated serum creatine kinase isoenzyme (CK-MB) is primarily found in cardiac muscle in Myocardial Infarction. Which increase how many hours after the onset of chest pain

3-6 hrs

What changes occur in the ECG readings of a patient experiencing a myocardial infarction, in what order do these changes occur? a) Changes occur first in the ST segment then the T wave and finally the Q wave. As the myocardium heals the ST and T waves return to normal but the Q wave changes persist. b) Changes occur first in the T segment then the ST wave and finally the Q wave. As the myocardium heals the ST and T waves return to normal but the Q wave changes persist.

a) Changes occur first in the ST segment then the T wave and finally the Q wave. As the myocardium heals the ST and T waves return to normal but the Q wave changes persist.

involves the entire thickness of the myocardium

Transmural MI

damage has not penetrated through the entire thickness

Subendocardial MI

the plaque rupture and thrombus formation causes partial occlusion to the vessel that results in injury and infarct to the subendocardial myocardium

NSTEMI

characterized by complete occlusion of the blood vessel lumen. resulting in transmural injury and infarct to the myocardium, which is reflected by ECG changes and a rise in troponins

STEMI

thrombus angina also known as supply ischemia

Unstable angina

Fixed stenosis also known as demand ischemia

stable angina

The objectives of the medical management of angina a) to increase the oxygen demand of the myocardium and to increase the oxygen supply. b) to decrease the oxygen demand of the myocardium and to increase the oxygen supply.

b) to decrease the oxygen demand of the myocardium and to increase the oxygen supply.

what is the result after Sudden coronary obstruction caused by thrombus formation over a ruptured or ulcerated plaque

acute coronary syndrome

The pain in __ is usually retrosternal, deep in the chest behind the upper or middle third of the sternum

Angina Pectoris

An important characteristic of __ is that it subsides when the precipitating cause is removed or with nitroglycerin

anginal pain

primarily found in cardiac muscle in Myocardial Infarction

Elevated serum creatine kinase isoenzyme (CK-MB)

Patient is given Nitrates, Beta Blockers, Calcium Channel Blockers, Thrombolytics/ Fibrinolytics. The condition patient has

Myocardial Infarction

For pain management of Myocardial Infarction, patient is given MONA which means

Morphine, Oxygen, Nitroglycerin, Aspirin

For pain management of Myocardial Infarction, patient is given how many mg of Morphine

2- to 10-mg IV q

For pain management of Myocardial Infarction, patient is given 2- to 10-mg IV Morphine for how many minutes

q 5-15 minutes

Ischemia causes inversion of the __ because of altered repolarization

T wave

cardiac muscle injury causes elevation of the

ST segment

__ waves develop because of the absence of depolarization current from the necrotic issues and opposing current from other parts of the heart

Q waves

chest pain or discomfort not relieved by rest or nitroglycerin palpitations is a sign of

myocardial infarction

heart sounds include S3, S4 and new onset of a murmur is a sign of

myocardial infarction

fear with feeling of impending doom or denial that anything is wrong and increased jugular venous distention may be seen if the __ has caused heart failure

myocardial infarction

a cardiovascular sign where in addition to st-segment and t-wave changes, ECG may show tachycardia, bradycardia, or other dysrhythmias

myocardial infarction

shortness of breath, dyspnea, tachypnea, pulmonary edema, and crackles if myocardial infarction has caused what condition

pulmonary congestion

decreased urinary output and cool, clammy, diaphoretic, and pale appearance due to pathetic stimulation in myocardial infraction may indicate

cardiogenic shock

aside to cardiogenic shock - anxiety, restlessness, and lightheadness may indicate a) increased sympathetic stimulation or a decrease in contractility and cerebral oxygenation b) decrease sympathetic stimulation or a increase in contractility and cerebral oxygenation

a) increased sympathetic stimulation or a decrease in contractility and cerebral oxygenation

most patients with angina pectoris must self administer what on an as-needed basis

nitroglycerin

in taking sublingual nitroglycerin instruct the patient to i. make sure the mouth is dry i.i make sure the mouth is moist ii. the tongue is still iii. saliva is not swallowed until the nitroglycerin tablet dissolves iv. if pain is severe, patient can crush the tablet between the teeth iv.o if pain is severe, patient can not crush the tablet between the teeth v. carried in original container (capped dark glass bottle) vi. tablets should never be moved and stored in metal/plastic pillboxes

i.i make sure the mouth is moist ii. the tongue is still iii. saliva is not swallowed until the nitroglycerin tablet dissolves iv. if pain is severe, patient can crush the tablet between the teeth v. carried in original container (capped dark glass bottle) vi. tablets should never be moved and stored in metal/plastic pillboxes

explain to patient that nitroglycerin is volatile and is inactivated by heat moisture air light & time. instruct the pt to renew the nitroglycerin supply every

6 months

in taking sublingual nurse must i. inform the pt that medication should be taken in anticipation of any activity that may produce pain because nitroglycerin increases tolerance for exercise & stress when taken prophylactically ii. advise pt if pain persists after taking 3 sublingual tablets at 5 minutes, emergency medical service should be called iii. discuss possible side effects: flushing, throbbing headache, tachycardia iii. advise pt to sit down to avoid hypertension & syncope iv. advise pt to sit down to avoid hypotension & syncope

i. inform the pt that medication should be taken in anticipation of any activity that may produce pain because nitroglycerin increases tolerance for exercise & stress when taken prophylactically ii. advise pt if pain persists after taking 3 sublingual tablets at 5 minutes, emergency medical service should be called iii. discuss possible side effects: flushing, throbbing headache, hypotension, tachycardia iv. advise pt to sit down to avoid hypotension & syncope

cardiogenic shock, pulmonary edema, mitral regurgitation, left ventricular failure, right ventricular failure, pulmonary emboli, papillary muscle rupture, systemic emboli, dysrhythmias, cardiac rupture, pericarditis, septal rupture, and mural thrombi are complications of

myocardial infarction

COPD A group of chronic (obstructive) lung diseases includes:

Emphysema Chronic Bronchitis

Chronic Airflow Limitations (CAL)

COPD, Bronchial Asthma, Bronchiectasis

Most important risk factor for COPD

SMOKING!!!

Tobacco smoke triggers the release of EXCESSIVE amounts of __ that breaks down elastin which is a major component of alveoli o Impairs & inhibits the action of cilia

elastase protease

ACTIVE smokers – 100% PASSIVE smokers –

80%

Clinical Manifestations -General appearance -Cyanosis, Clubbing of fingers -Presence of “Barrel chest” -Manifestations of RSHF/right sided heart failure (dependent edema)

COPD

RR of COPD patient

40-50 breaths/min

Laboratory assessment o Abnormal ABG results in COPD patient

hypoxemia, hypercarbia

COPD Airway maintenance: o Keep the client’s - in alignment

head, neck and chest

assisst clients with __ to liquefy secretions and clear the airway

COPD

COPD Airway maintenance: Controlled coughing o advise client to cough on

arising on the morning, before mealtimes, before bedtimes

Proper instruction for **Controlled coughing**. the client sits in a chair or on the side of a bed with feet placed firmly on the floor. to cough effectively, Instruct the client to turn the shoulders __ and to bend the head slightly downward hugging a pillow against the stomach.

inward

to do Controlled coughing for patients with COPD Insturct the patient that After the _ deep breath/pursed-lip breathing, the client will **bend forward slowly**

3rd to 5th

O2 Therapy COPD o Assess COPD client at least q2° o Assess COPD client at least q4° o usually, 2-4 L/min or even 1-2 L/min via nasal cannula o usually, 3-4 L/min or even 1-2 L/min via nasal cannula o up to 30% via venturi mask o up to 40% via venturi mask

o Assess COPD client at least q2° o usually, 2-4 L/min or even 1-2 L/min via nasal cannula o up to 40% via venturi mask

COPD client’s primary drive for breathing

Low-flow O2/low arterial oxygen level

mucolytics such as acetylcysteine (Mucomyst) and Guaifenesin are drug therapy for

COPD

o one of the most common complications of COPD

PNEUMONIA

Teach clients to avoid large crowds and stress the importance of receiving a pneumonia vaccination and a yearly influenza vaccine

“flu shot”

o Hypoxemia & acidosis o Respiratory Infections o Cardiac Dysrhythmias o Cor Pulmonale are complications of

COPD

due to impaired exchange of gases

Hypoxemia & acidosis

respiratory infection is a complication of COPD due to ⭡ mucus & poor oxygenation. most common bacteria are S. pneumoniae, H. influenzae, and

Moraxella catarrhalis

due to _, COPD manifestations worsens due to increasing inflammation & mucus production

Respiratory Infections

results from ⭡O2 supply to the ⭡, other cardiac disease, drug effects, or acidosis

Cardiac Dysrhythmias

RSHF caused by pulmonary disease

Cor Pulmonale

A chronic disease characterized by loss of lung elasticity & hyperinflation of the lung

Emphysema

most common COPD

Emphysema

Emphysema Major cause:

Smoking

risks of these conditions involved smoking, alpha antitrypsin deficiency (AAT), and air pollution

Emphysema

Alpha1 – Antitrypsin Deficiency (AAT) is made by the _ and is normally present in the lungs

liver

regulates proteases from working on lung structures

Alpha1 – Antitrypsin Deficiency (AAT)

If _ is deficient, COPD develops even if the person is not exposed to cigarette smoke or other irritants

Alpha1 – Antitrypsin Deficiency (AAT)

emphysema classification destruction of the entire alveolus uniformly; diffuse & more severe in the lower lung areas

Panlobar or panacinar

emphysema classification openings occur in the bronchioles and allow spaces to develop as tissue walls breakdown; upper lung sections

Centrilobular or centriacinar

emphysema classification only the alveolar ducts and alveolar sacs are affected; upper half of the lung

Paraseptal or distal acinar

1st symptom Emphysema shortness of breath with minimal activity

Exertional dyspnea

o Chronic productive cough with mucopurulent sputum o Decreased breath sounds, wheezing, crackles o “Barrel shaped chest” o Use of accessory muscle of respiration o Toxic CO2 levels⭡ Lethargy, stupor, coma (carbon dioxide narcosis)

Emphysema

Meds: Bronchodilators, mucolytics, antibiotics, corticosteroids (limited basis to assist with broncho dilation & removal of secretions)

Emphysema

Emphysema Administer O2 via nasal cannula (_ L/min)

2-3

Prolonged inflammation of the bronchi accompanied by a chronic cough & excessive production of mucus for at least 3 months each year for 2 consecutive years

Chronic Bronchitis

Etiology: o CIGARETTE SMOKING o Long history of bronchial asthma, RTI, air pollution

Chronic Bronchitis

thick white mucus (earliest symptom) ⭡ yellow, purulent, copious, blood streaked sputum

Chronic productive cough

Bronchospasm, Acute respiratory infections, cyanosis, DOE (dyspnea on exertion), RSHF (cor pulmonale)

Chronic Bronchitis

Medical Management SMOKING CESSATION Bronchodilators, ⭡fluid intake, Well-balanced diet, Postural drainage, Steroid therapy, Antibiotic therapy

Chronic Bronchitis

Chronic Bronchitis Focus: educating clients in managing their disease Smoking cessation, occupational counseling, monitoring air quality & pollution levels, avoiding cold air & wind exposure (triggers

bronchospasm)

Typically begins as an URTI (viruses, bacteria) H. influenzae, S. pneumoniae, M. pneumoniae o Chemical irritants (noxious fumes, gases, air contaminants)

Acute Bronchitis

Assessment Findings: o Fever, chills, malaise, headache, dry irritating nonproductive cough (initial) ⭡ mucopurulent sputum

Acute Bronchitis

Medical Management: o Usually self-limiting o Bedrest, antipyretics, expectorants, antitussives, ⭡fluids, humidifiers, antibiotics

Acute Bronchitis

Intermittent & reversible airflow obstruction affecting the lower airway.

Bronchial Asthma

Obstruction is due to: Inflammation Airway hyper-responsiveness (bronchospasm) Constriction of bronchial smooth muscle due to stimulation of the nerve fibers

Bronchial Asthma

Etiology: allergens, cold air, dry air, airborne particles, microorganism, aspirin ⭡ inflammation exercise, upper respiratory illness (viruses), unknown reasons ⭡ bronchospasm

Bronchial Asthma

Physical assessment findings: Audible wheezing & ⭡RR (acute episode) Wheezing is louder during exhalation Dyspnea, cough, use of accessory muscle of respiration, barrel chest (chronic severe asthma) Cyanosis, poor O2 saturation (pulse oximetry) Change of LOC & tachycardia due to hypoxemia

Bronchial Asthma

most accurate test for asthma

PuLmOnArY fUnCtiOn teSts

volume of air exhaled from full inhalation to full exhalation

Forced Vital Capacity (FVC)

volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest full inhalation

Forced Expiratory Volume (FEV1

fastest airflow rate reached at any time during exhalation

Peak Expiratory Rate Flow (PERF)

Methacholine is inhaled (induces bronchospasm) & then FVC, FEV1 & PERF is measured then brochodilators will be given ⭡ an ⭡ 12% of values:

asthma

Normal (effortless breathing), volume of air inspired and expired with each breath during normal breathing

Tidal Volume

500 mL

how much can be exhaled

Vital Capacity

(about 4,800)

Total Lung Capacity

up to 6,000

how much remains in the lungs after exhalation (about 1, 200)

Residual volume

Bronchial Asthma Client Education Guide Use bronchodilator __ exercise to prevent or reduce exercise-induced asthma

30 minutes before

Albuterol (Ventolin), Bitolterol, Pirbuterol, Salmeterol, Formoterol

β2 agonist Bronchodilators:

Theophylline, Aminophylline, Oxtriphylline]

Methylxanthines

Cholinergic antagonist

Ipratropium (Atrovent)

Bronchial Asthma Anti-inflammatory Agents:

Corticosteroids Mast cell stabilizer Monoclonal antibodies

helps prevent atopic asthma attacks (prevent mast cell membranes from opening when an allergen binds to IgE) but are not useful during an acute episode

Cromolyn sodium (Intal)

binds to IgE receptor sites on mast cells & basophils preventing the release of chemical mediators for inflammation

Omalizumab (Xolair)

Accumulation of air in the pleural space it can lead to partial or complete collapse of the lung

Pneumothorax

Most common type of closed pneumothorax

Spontaneous pneumothorax

Air accumulates within the pleural space without an obvious cause (no antecedent trauma to thorax)

Spontaneous pneumothorax

Rupture of a small bleb on the visceral pleura most frequently produces this type of pneumothorax

Spontaneous pneumothorax

usually caused by stabbing or gunshot wound

Spontaneous pneumothorax

● causes ⭣ intra- thoracic pressure & shifting of the mediastinal contents to the unaffected side (mediastinal shift)

tension pneumothorax

pressure in the pleural space is POSITIVE throughout the respiratory cycle

Tension pneumothorax

occurs in mechanical ventilation or resuscitation

Tension pneumothorax

air enters the pleural space with each inspiration but cannot escape

Tension pneumothorax

● causes ⭣ intra- thoracic pressure & shifting of the mediastinal contents to the unaffected side (mediastinal shift)

Tension pneumothorax

Accumulation of BLOOD in the pleural space

Hemothorax

frequently found w/ an open pneumothorax resulting in a hemopneumothorax

Hemothorax

Assessment findings: * PAIN, Dyspnea * Diminished/absent breath sounds on affected side * ⭣respiratory excursion on affected side * Hyper resonance on percussion

Pneumothorax/ Hemothorax

* Tracheal shift to the opposite side (tension pneumothorax accompanied by mediastinal shift) * Weak, rapid pulse; anxiety; diaphoresis

Pneumothorax/ Hemothorax

● Microcytic, Hypochromic anemia caused by: ● Inadequate intake of iron ● Decreased absorption of iron in GIT ● Excessive loss of iron (excessive bleeding or blood loss)

Iron Deficiency Anemia

● Assessment Findings: ● Reduced energy, Cold sensitivity, Fatigue, DOE ● ⭣HR even at rest ● decreased CBC, Hgb, Hct, serum Fe ● Blood smear reveals microcytic & hypochromic RBCs

Iron Deficiency Anemia

● Oral iron supplements for mild iron losses (FeSO4) ● prophylactic use:

300-325mg

● Oral iron supplements for mild iron losses (FeSO4) therapeutic use __mg daily in divided dose

600-1200mg

● Use the - technique to prevent leakage into tissues

Z-track injection

foods high in iron ● Liver especially - ● Red meat, Organ meats, Kidney beans ● Whole-wheat breads and cereals ● Leafy green vegetables ● Carrots, Egg yolk, Raisins

pork & lamb

Encourage ingestion of - and increase fluid intake to prevent constipation if oral iron preparations are being taken

roughage

best source of iron

red meat

● Caused by a deficiency of intrinsic factor (substance normally secreted by the gastric mucosa) ● Intrinsic Factor is necessary for absorption of Vitamin B12 ● Vitamin B12 is needed for the maturation of erythrocytes

Pernicious Anemia

without Vitamin - ● precursor cells undergo improper DNA synthesis (few are released from the bone marrow) ● increased in size: MEGALOBLASTIC or MACROCYTIC cells ● Paresthesia: Vitamin - is needed for normal nerve function

B12

● Usually seen in elderly (production of intrinsic factor decreases with age & gastric mucosal atrophy) & in clients w/ history of surgical removal of stomach, bowel resection (ileum) ● Stomatitis, glossitis (a smooth, beefy-red tongue) ● Pallor, fatigue, Dyspnea on exertion

Pernicious Anemia

severe case of this anemia can cause jaundice, irritability, confusion Numbness & tingling in the arms & legs & difficulty with gait (walking) or balance (neurologic involvement)

Pernicious Anemia

● measures absorption of radioactive Vitamin B 12 before and after parenteral administration of intrinsic factor ● Definitive test for pernicious anemia ● used to detect lack of intrinsic factor

Schilling test

The Schilling test is performed by administering __Co-labeled __ and collecting urine for 24 h and is dependent upon normal renal and bladder function. As a consequence, __ absorption may be abnormal in Pernicious anemia

58, cobalamin

The - is performed to evaluate vitamin B12 absorption.

Schilling test

- helps in the formation of red blood cells, the maintenance of the central nervous system, and is important for metabolism.

B12

● Medical Management: ● Administration of Vitamin B12 (IM) weekly & monthly for maintenance ● Nursing Management: ● Provide a Vitamin B12-rich diet ● Liver, Organ meats, Dried beans, Nuts, Green leafy vegetables, Citrus fruit, Brewer’s yeast

Pernicious Anemia

Avoid highly seasoned, coarse, or very hot foods if client has

stomatitis & glossitis

Dilated tortuous veins

Varicose Veins (Varicosities)

commonly affected in Varicose Veins (Varicosities)

saphenous leg veins

commonly affected: ● saphenous leg veins (lack support from surrounding muscles) ● also occurs in ● Rectum Hemorrhoids ● Esophagus Esophageal varices

Varicose Veins (Varicosities)

constricts or interferes with venous return (venous congestion or pooling) ● prolonged standing, obesity, pregnancy, abdominal tumor

Varicose Veins (Varicosities)

etiology: Thrombophlebitis (a condition that causes a blood clot to form and block one or more veins, often in the legs)

Varicose Veins (Varicosities)

● ASSESSMENT FINDINGS: ● Legs feel heavy & tired particularly after prolonged standing (patient will say that activity or elevation of the legs relieves the discomfort) ● Leg veins look distended & tortuous seen under the skin as dark blue or purple, snakelike elevations ● Feet, ankles, legs may appear swollen

Varicose Veins (Varicosities)

● client lie flat & elevates the affected leg to empty veins, tourniquet is then applied to the upper thigh, & the client is ask to stand

Brodie-Trendelenburg test

● if blood flows from upper part of the leg into the superficial veins while doing Brodie-Trendelenburg test it indicates

INCOMPETENT valves

DIAGNOSTIC FINDINGS: ● Brodie-Trendelenburg test ● Ultrasonography ● Venography

Varicose Veins (Varicosities)

if blood flows from upper part of the leg into the superficial veins

INCOMPETENT valves

MEDICAL MANAGEMENT: ● exercise (walking, swimming) ● losing weight ● wearing elastic support stockings ● avoidance of prolonged sitting & standing

MILD varicose veins

MEDICAL MANAGEMENT: ● Surgery -Vein ligation -Vein stripping

Varicose Veins (Varicosities)

type of surgery for severe or multiple varicose veins where veins are tied off above & below the area of incompetent valves, but the dysfunctional vein remains

Vein ligation

type of surgery for varicose veins where ligated veins are severed & removed

Vein stripping

assess for skin, distal circulation ( flow of blood occurring in the areas furthest away from the central body), peripheral edema (swelling in your lower legs or hands) NURSING MANAGEMENT for __

Varicose Veins (Varicosities)

post operative period nursing management for patient with varicosities nurse elevates the foot of the bed to aid venous circulation to the heart & reminds the client to alternately __ the lower leg muscles

contract & relax

● Deficiency of circulating RBCs usually accompanied by leukopenia & thrombocytopenia

Aplastic Anemia

There is PANCYTOPENIA (lower-than-normal number of red and white blood cells and platelets in the blood) in

aplastic anemia

Failure of the bone marrow to produce cells

(pluripotent stem cell injury)

(pluripotent stem cell injury) ● Long-term exposure to toxic agents (drugs, chemical) ● ionizing radiation ● viral infection ● autoimmune ● 50% of cases UNKNOWN???

Aplastic Anemia

Weakness & fatigue (typical for any type of

anemia

● Frequent opportunistic infections ● Coagulation abnormalities (unusual bleeding, petechiae & ecchymoses “bruises”) ● Splenomegaly

Aplastic Anemia

● accumulation of client’s blood cells destroyed by lymphocytes that failed to recognize them as normal cells

Splenomegaly

● BM aspiration/ biopsy =definitive test ; Result: Low primitive cells Most Common Site: Iliac Crest

Aplastic Anemia

● New classification(2003) “Normal adult BP”:

● <120mmHg systolic ● <80mmHg diastolic

Prehypertension:

● 120-139/80-89mmHg

Stage 1 hypertension:

140-159/90-99mmHg

Stage 2 hypertension:

>160/>100mmHg

● most clients have no symptoms; however, they may experience headaches, dizziness, fainting

Hypertension

decrease in BP of 20mmHg systolic &/or 10mmHg diastolic when the client changes position from lying to sitting in 2 minutes interval

Orthostatic hypotension

Hypertension Interventions: Lifestyle modifications ● Sodium restriction – ↓ sodium intake from the average of 150mEq/L to

<100mEq/L

depress Na+ reabsorption in the ascending loop of henle & promote K+ excretion (ex; Lasix)

Loop (high-ceiling) diuretics

prevent Na+ & water reabsorption in the distal tubules while promoting K+ excretion

● Thiazide (low-ceiling) diuretics

inhibits reabsorption of Na+ in DCT in exchange for K+, thereby retaining K+ [Spironolactone (aldactone)]

K+-sparing diuretics

Lower Bp by interfering with transmembrane flux of Ca++ ion resulting to vasodilation & subsequent ↓ in BP (Verapamil, Amlodipine, Diltiazem)

Calcium channel blocking agents

inhibits conversion of angiotensin I to II, one of the most powerful vasoconstrictors in the body (Captopril, Enalapril, Lisinopril)

ACE inhibitors

(Candesartan, Losartan, Telmisartan)

Angiotensin II receptor blockers

DOC for hypertensive clients with ischemic heart disease because the heart is the most common target of end-organ damage w/ hypertension

Beta blockers

Hypertension Interventions: Drug therapy

Calcium channel blocking agents ACE inhibitors Angiotensin II receptor blockers Aldosterone receptor antagonist Beta blockers

chronic partial or total arterial occlusion resulting from systemic - leading to deprivation of O2 & nutrients

atherosclerosis

chronic partial or total ARTERIAL OCCLUSION resulting from systemic atherosclerosis (thickening or hardening of the arteries) leading to deprivation of O2 & nutrients

Peripheral Arterial Disease

Peripheral Arterial Disease of lower extremities is also called

“Lower Extremity Arterial Disease” (LEAD)

involves the distal end of the aorta & the common, internal, external iliac arteries (located above the inguinal ligament)

Inflow obstruction

involves femoral, popliteal & tibial arteries (below the superficial femoral artery)

Outflow obstruction

most common cause of Peripheral Arterial Disease

Atherosclerosis

Risk factor for? hypertension hyperlipedimia DM CIGARETTE SMOKING obesity familial predisposition

Peripheral Arterial Disease

Clients with Peripheral Arterial Disease initially seek treatment for a characteristic leg pain known as - (usually they can walk only a certain distance before a cramping, burning muscle discomfort or pain forces them to stop)

intermittent claudication

presence of – numbness or burning sensation often describe as a feeling like a toothache, that is severe enough to awaken clients at night located in the distal portion of the extremities (heal, toes)

Rest Pain

discomfort in the lower back, buttocks or thighs

Inflow disease

burning or cramping in the calves, ankles, feet & toes

Outflow disease

Assessment Findings of? intermittent claudication: cramping rest Pain: numbness or burning sensation Inflow disease: lower back, buttocks or thighs Outflow disease: calves, ankles, feet & toes ● Loss of hair on the lower calf, ankle & foot thickened toenails

Peripheral Arterial Disease

dry, scaly, dusky, pale or mottled skin ● Cold extremity & cyanotic; pallor occurs when the extremity is elevated

Peripheral Arterial Disease

most sensitive & specific indicator of arterial function is the quality/absence/not palpable -

posterior tibial pulse

in Peripheral Arterial Disease, what early sign you must note

ulcer

(pedal pulse) place the fingers just lateral to the extensor tendon of the great toe

dorsalis pedis

(pedal pulse) place fingers just behind and slightly below the medial malleolus

posterior tibial

Ankle-Brachial Index an ABI of - in either leg is diagnostic of PAD (derived by dividing the ankle BP by the brachial BP)

<0.9

not commonly performed today because this procedure involves injecting contrast medium into the arterial system and can have risks which include hemorrhage, thrombosis, embolus & death

Arteriography

Done by stress test or treadmill and gives valuable information about claudication (muscle pain) without rest pain

Exercise Tolerance Testing

Normally, BP readings in the __ are higher than those in the upper extremities; with the presence of arterial disease, these pressures are LOWER than the brachial pressure

thigh and calf

people with severe rest pain, venous ulcers or gangrene should not participate in

Exercise

nicotine causes vasoconstriction (1 cigarette = - hour vasoconstriction)

↑ flexibility of RBCs; ↓ blood viscosity by inhibiting platelet aggregation & ↓ fibrinogen thus increasing blood flow to the extremities

Pentoxifylline (Trental)

Invasive procedure; arteries are dilated with a balloon catheter advanced through a cannula, which is inserted into or above an occluded or stenosed artery

Percutaneous Transluminal Angioplasty (PTA)

Reserved for clients with smaller occlusions in the distal superficial femoral, proximal popliteal & common iliac arteries

Laser-Assisted Angioplasty

most commonly performed procedure that ↑ arterial blood flow in an affected limb

Arterial revascularization

o Proper technique & correct use of metered dose inhalers for patients with

Bronchial Asthma

– reveals increased size of bronchioles, atelectasis & changes in the pulmonary tissues

CXR & bronchoscopy

– Reflection of turbulence of blood flow through the normal or abnormal valves

Murmurs

Murmur (valve damage) Assessment findings in

Carditis

Pulmonary embolism complication of

Pleural E󰇗usion

Deep Vein Thrombophlebitis/ Thrombosis (DVT) ● affects the deep vein of the lower extremities which presents a greater risk for

pulmonary embolism

complication of chest trauma occurring when 2 or more adjacent ribs are fractured at two or more sites, resulting in free-floating rib segments

Flail Chest

Invasive procedure; laser probe is advanced through a cannula similar to that used for PTA

Laser-Assisted Angioplasty

cone-shaped hollow muscular organ located in the mediastinum between the lungs

Heart

Heart Pumps about

60ml/beat or 5L/min

Pharmacologic Therapy for * Nitrates, the mainstay of therapy (nitroglycerin) * Beta-adrenergic blockers (metoprolol and atenolol) * Calcium channel blockers/calcium ion antagonists (amlodipine and diltiazem) *Antiplatelet and anticoagulant medications (aspirin, clopidogrel, heparin, glycoprotein [GP] * Oxygen therapy

ANGINA PECTORIS

Medications for _ o Nitrates -Nitroglycerine, Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur) o Beta Blockers o Calcium Channel Blockers o Thrombolytics/ Fibrinolytics

Myocardial Infarction

Medical management for o Meds: Bronchodilators, mucolytics, antibiotics, corticosteroids (limited basis to assist with broncho dilation & removal of secretions)

Emphysema

Medical Management for _ o Usually self-limiting o Bedrest, antipyretics, expectorants, antitussives, ⭡fluids, humidifiers, antibiotics

Acute Bronchitis

Bronchodilators for _ β2 agonist Methylxanthines Cholinergic antagonist

Bronchial Asthma

Medical Management for __ Drainage of purulent material from the bronchi Antibiotics Bronchodilators Mucolytics Humidification Surgery removal of bronchiectasis if confined to a small area

Bronchiectasis

Caused by vasospasm of the arterioles and arteries of the upper & lower extremities

Raynaud’s Disease

Raynaud's syndrome usually occurs with people __ years of age

older than 30

Raynaud's syndrome usually occurs with people older than 30 years of age; but can occur between the ages of __ years of age

17 & 50

Raynaud’s Disease is more common in what gender

women

Raynaud’s Phenomenon Assessment shows that as a result of vasospasm, the cutaneous vessels are constricted & __ of the extremities, followed by cyanosis

blanching

Aside from the cutaneous vessels constricting and blanching, other assessment findings of __ are Numbness, coldness, pain swelling, and ulcers

Raynaud's Phenomenon

the constriction of vessels decreases blood supply to fingers, causing them to turn pale. This is shown in what phenomenon

Raynaud's Phenomenon

Management/treatment in Raynaud's disease involves relieving or preventing the __ by drug therapy

vasoconstriction

For severe symptoms not relieved by drug in Raynaud’s Disease: __ is performed

Lumbar sympathectomy

In Disseminated Intravascular Coagulation, there is Diffuse __ deposition within arterioles and capillaries

fibrin

In Disseminated Intravascular Coagulation, there is Diffuse fibrin deposition within arterioles and capillaries with widespread coagulation all over the body and subsequent depletion of

clotting factors

this condition might cause hemorrhage in kidneys, brain, adrenals, heart, and other organs and may be linked with entry of thromboplastic substances into the blood

Disseminated Intravascular Coagulation

Assessment Findings: ● Petechiae and ecchymoses on the skin, mucous membranes, heart, lungs, and other organs

Disseminated Intravascular Coagulation

● Severe and uncontrollable hemorrhage during childbirth or surgical procedures ● Oliguria and acute renal failure ● Convulsions,coma, death

Disseminated Intravascular Coagulation

● Avoid IM injections ● Apply pressure to bleeding sites ● Provide frequent nontraumatic mouth care (soft toothbrush or gauze sponge) for patient with

Disseminated Intravascular Coagulation

wirelike devices that may be used along with the PTA to help keep the vessel open

Stents

Heat from the laser vaporizes the arteriosclerotic plaque to open the occluded or stenosed artery

Laser-Assisted Angioplasty

grafts preferred are saphenous vein, cephalic or basilic arm veins, synthetic materials such as polytetrafluoroethylene, Gore-Tex & Dacron

Bypass procedures

needed for RBC Production in Aplastic anemia

Bone marrow

diet to help reduce incidence of infection in aplastic anemia

high-protein, high-Vitamin diet

● Use a soft toothbrush and electric razor ● Avoid IM injection ● Check for occult blood in urine and stool (Hematest) ● Observe for oozing from gums, petechiae, or ecchymoses. Nursing Management for

Aplastic Anemia

needed for RBC Production in Pernicious anemia

Intrinsic factor

● Produced by gastric mucosa ● Needed for absorption of Vit B12

Pernicious anemia

● Needed for maturation of RBC ● Extrinsic facto

Folic acid

needed for the maturation of erythrocytes

Vitamin B12

Normally, ingested vitamin B12 combines with intrinsic factor, which is produced by cells in the __.

stomach

Intrinsic factor is necessary for vitamin B12 to be absorbed in the __. Certain diseases, such as pernicious anemia, can result when absorption of vitamin B12 is inadequate.

small intestine

Medical Management for Pernicious Anemia ● Administration of Vitamin B12 via weekly & monthly for maintenance

Liver, Organ meats, dried beans, Nuts, Green leafy vegetables, Citrus fruit, Brewer’s yeast, eggs, meat, poultry, shellfish, milk & milk products. diet for pt with

pernicious anemia

Take iron with or immediately after a meal to avoid GI upset ● Take with __ (⭣ absorption) ● Use straw (elixir preparations) to prevent staining of teeth

orange juice or vitamin C source

● Expect iron to color stool __ ● Causes constipation

dark green or black

● Liver especially pork & lamb ● Red meat, Organ meats, Kidney beans ● Whole-wheat breads and cereals ● Leafy green vegetables ● Carrots, Egg yolk, Raisins diet for pt with

Iron Deficiency Anemia

primary/essential: genetic & lifestyle above 60 excess cal inactivity hyperlipidemia (high choles) african-american high intake of caffeine/salt reduce intake of k/potassium, Calcium, Mg obesity smoling stress are primary causes of

hypertension

tachycardia, sweating & pallor in hypertension suggest a

pheochromocytoma or adrenal medulla tumor

more than 1 once of ethanol and less than 100meq/L sodium intake is a lifestyle modification for

hypertension

medication for hypertensive clients who have asthma, chronic airway limitation (CAL) & chronic renal disease

DIURETICS

most common target of end-organ damage w/ hypertension

heart

An umbrella term for hypoxemic, respiratory failure; acute respiratory distress syndrome is a severe form of acute lung injury

Acute lung injury

nonspecific pulmonary response to a variety of pulmonary and nonpulmonary insults to the lung; characterized by interstitial infiltrates, alveolar hemorrhage, atelectasis, decreased compliance, and refractory hypoxemia.

Acute respiratory distress syndrome

-thorancntesis -sunction -ctt * Provide relief/control of pain. – Administer narcotics/ analgesics/ sedatives as ordered and monitor effects – Position client in high-Fowler’s position. for patient with

Pneumothorax/ Hemothorax

Aims to restore negative pressure of the pleural cavity and drain collected fluid/blood

CHEST TUBES AND DRAINAGE SYSTEM

Components of CHEST TUBES AND DRAINAGE SYSTEM

■ Suction control chamber ■ Water seal chamber ■ Closed collection chamber

Serum lipids

Cholesterol, Triglycerides, High density lipoprotein, low density lipoprotein

(⭣40-160⭣35-135mg/dl)

triglycerides

(122-200mg/dl),

Cholesterol

low density lipoprotein

(⭣⭣60-180mg/dl)

high density lipoprotein

(⭣45-50 ⭣55-60mg/dl),

HDL:p LDL ratio

(3:1)

C-Reactive Protein

(<1.0mg/dl)

Determine the size, silhouette & position of the heart

Chest radiography

● Invasive procedure involving fluoroscopy & the use of contrast media The beating heart and its surrounding blood vessels can be watched and recorded in extraordinary detail as a catheter injects a contrast dye into a patient's coronary arteries

Angiography (arteriography)

● Most definitive, most invasive test used in the diagnosis of heart disease

Cardiac catheterization

– Technique is the same for left-sided heart catheterization – Complications: MI, Stroke, Arterial bleeding, Thromboembolism, Lethal dysrhythmias, Death

Coronary arteriography

– Catheter with miniature transducer (soundwaves) at the distal tip to visualize the coronary arteries

● Intravascular ultrasonography (IVUS)

– graphically measures & records the electrical current traveling through the conduction system generated by the heart – measured by electrodes placed on the skin & connected to an amplifier & strip chart recorder – in a standard 12-lead ECG: ● five electrodes attached to the arms, legs, & chest ● measures electrical current from 12 different views or leads

Electrocardiography (ECG)

Bipolar limb leads

– Lead I – Lead II – Lead III

– aVR – aVL – aVF

Unipolar augmented leads

– V1 – V2 – V3 – V4 – V5 – V6

Unipolar precordial leads

additional sounds generated by turbulent blood flow in the heart and blood vessels. Murmurs may be systolic, diastolic or continuous.

MURMUR

The most common types of murmurs in children and based on their timing within systole, they are classified into:

Systolic Murmurs

(SEM, crescendo- decrescendo) result from turbulent blood flow due to obstruction (actual or relative) across the semilunar valves, outflow tracts or arteries. The murmur is heard shortly after S1 (pulse).

a) Systolic ejection murmurs

start at the beginning of S1 (pulse) and continue to S2. Examples: ventricular septal defect (VSD), mitral and tricuspid valve regurgitation.

Holosystolic (regurgitant) murmurs

is a subtype of holosystolic murmur that may be heard in patients with small VSDs. In the latter part of systole, the small VSD may close or become so small to not allow discernible flow through and the murmur is no longer audible.

Decrescendo systolic murmur

murmurs immediately follow S2. Examples: aortic and pulmonary regurgitation.

Early diastolic murmurs

(rumble) are due to increased flow (relative stenosis) through the mitral (VSD) or the tricuspid valves (ASD).

Mid-diastolic murmurs

due to pathological narrowing of the AV valves. Example: rheumatic mitral stenosis. Tricuspid stenosis is very rare in children.

Late diastolic murmurs

Usually abnormal, and may be early, mid or late diastolic.

Diastolic Murmurs

Heard during both systole and diastole. They occur when there is a constant shunt between a high and low pressure blood vessel.

Continuous Murmurs

Common in children and have the following characteristics:  Grade III or less in intensity  An otherwise a normal cardiac examination and normal heart sounds  No associated cardiac symptoms  Change in intensity with body position (e.g. louder in supine position)

Innocent Murmurs

Electrocardiogram (ECG) Strip: each small block measures 1 mm in height & width  Standard Speed:

25mm/sec

Represents atrial depolarization

P WAVE

Represents the time required for the impulse to travel through the AV node, where it is delayed, and through the Bundle of His, Bundle branches, & Purkinje fiber network, just before ventricular depolarization

PR SEGMENT

 Represents the time required for atrial depolarization as well as impulse travel through the conduction system and Purkinje fiber network, inclusive of the P wave and PR segment  It is measured from the beginning of the P wave to the end of the PR segment (0.12- 0.20 sec)

PR INTERVAL

 Represents ventricular depolarization and is measured from the beginning of the Q (or R) wave to the end of the S wave (0.04 - 0.10 sec)

QRS COMPLEX

 Represents early ventricular repolarization

ST SEGMENT

 Represents ventricular repolarization

T WAVE

 Represents late ventricular repolarization

U WAVE

 Represents the total time required for ventricular depolarization and repolarization and is measured from the beginning of the QRS complex to the end of the T wave

QT INTERVAL

60-100 bpm

found BEFORE the QRS complex

P waves

Adhering to the epicardium

Visceral Pericardium

 Enveloping the visceral pericardium  A tough fibrous tissue that attaches to the great vessels, diaphragm, sternum, and vertebral column and supports the heart in the mediastinum

Parietal Pericardium

(0-5 mmHg)

Right atrium

(25 mmHg)

Right Ventricle

 (Also known as blood thinners.) o Decreases the clotting (coagulating) ability of the blood.

Anticoagulants

o Keeps blood clots from forming by preventing blood platelets from sticking together.

Antiplatelet Agents & Dual Antiplatelet Therapy (DAPT)

o Lowers blood pressure by widening blood vessels. This reduces the workload of the heart. o Reason for medication o Used to treat or improve symptoms of cardiovascular conditions including high blood pressure and heart failure. o They also provide health benefit

Angiotensin-Converting Enzyme (ACE) Inhibitors

o Slows the heart rate and force of contraction, which lowers blood pressure and makes the heart beat more slowly and with less force.

Beta Blockers

o Amlodipine (Norvasc) o Diltiazem (Cardizem, Tiazac) o Felodipine (Plendil) o Nifedipine (Adalat, Procardia) o Nimodipine (Nimotop) o Nisoldipine (Sular) o Verapamil (Calan, Verelan)

Calcium Channel Blockers

 Also known as water pills o Causes the body to rid itself of excess fluids and sodium through urination.

Diuretics

Non-steroidal anti-inflammatory drugs (NSAIDs) for PAIN – if not infectious: Corticosteroids – Antibiotics: for bacterial infection – Radiation or chemotherapy if caused by malignancy (cancerous cells)

PERICARDITIS

Intervention: – Treatment of underlying cause (antibiotic) – Na+-restricted diet: Too much salt can cause fluid to build up around the heart -cardiotonic drugs (digitalis): to remove excess extracellular fluid

MYOCARDITIS

Intervention: – Antibiotic: DOC – penicillin: bacterial infections – Aspirin (control blood clot formation around the valves) – Steroids (ANTI INFLAMMATORY:suppresses inflammation) – Fever (antipyretics, hydration) – Antibiotic prophylaxis to prevent recurrence

Rheumatic Carditis/ Endocarditis

Intervention: >> Inotropic agents change the force of your heart's contractions – Digitalis~! to treat congestive heart failure (CHF) BUT too much digitalis: DIGITALIS TOXICITY -> loss of apetite N&V rapid or slow/irregular heart rate disturbance in color vision DDD: fail A. Digoxin (Lanoxin) : di la decrease everything ⭣ contractility, ⭣ HR, ⭣ conduction (AV node) (-) sympa. activity, (+) parasympa. Activity B. Dopamine (Intropin): do in(side) C. Dobutamine (Dobutrex):dodo >> Diuretics flx FL CD help reduce fluid buildup in the body A. Furosemide (Lasix) B. Chlorothiazide (Diuril) >> Vasodilators enhance blood flow NA A. Nitroglycerin B. ACE inhibitors (pril) april ace

HEART FAILURE/Rheumatic heart disease

Intervention: HMG-CoA reductase inhibitors “Statins” reduces cholesterol production

ATHEROSCLEROSIS

Intervention: 1.Nitrates, the mainstay of therapy (nitroglycerin) 2.Beta-adrenergic blockers metoprolol atenolol 3. Calcium channel blockers/calcium ion antagonists diltiazem amlodipine 4. Antiplatelet and anticoagulant medications clopidogrel heparin glycoprotein [GP] aspirin

ANGINA PECTORIS

Intervention: Pain management: MONA Morphine: 2- to 10-mg IV q 5-15 minutes. AE: respiratory depression, hypotension, bradycardia, severe vomiting. Antidote: Naloxone (Narcan) 0.2 – 0.8 mg IV Oxygen: 2-4L/min by nasal cannula Nitroglycerin Aspirin o Nitrates (NII) -Nitroglycerine -Isosorbide dinitrate (Isordil) -Isosorbide mononitrate (Imdur) o Beta Blockers o Calcium Channel Blockers o Thrombolytics/ Fibrinolytics

Myocardial Infarction

Intervention: 2-4 L/min or even 1-2 L/min via nasal cannula or up to 40% via venturi mask oLow-flow O2 because low arterial oxygen level is the COPD client’s primary drive for breathing mucolytics acetylcysteine (Mucomyst) Guaifenesin

COPD

Intervention: o Meds: Bronchodilators mucolytics antibiotics corticosteroids (limited basis to assist with broncho dilation & removal of secretions) o Administer O2 via nasal cannula (2-3 L/min)

Emphysema

Intervention: Bronchodilators: β2 agonist: Albuterol (Ventolin), Bitolterol, Pirbuterol, Salmeterol, Formoterol Methylxanthines: Theophylline, Aminophylline, Oxtriphylline Monitor for SE: excessive cardiac & CNS stimulation (check pulse & BP) Cholinergic antagonist Ipratropium (Atrovent) Anti-inflammatory Agents: Corticosteroids oral – Prednisolone, Prednisone inhaler – Budesonide, Fluticasone, Beclomethasone, Triamcinolone, Flunisolide Mast cell stabilizer Cromolyn sodium (Intal); helps prevent atopic asthma attacks (prevent mast cell membranes from opening when an allergen binds to IgE) but are not useful during an acute episode Monoclonal antibodies Omalizumab (Xolair), approved in 2003 only – binds to IgE receptor sites on mast cells & basophils preventing the release of chemical mediators for inflammation

Bronchial Asthma

Intervention: Drainage of purulent material from the bronchi Antibiotics Bronchodilators Mucolytics Humidification Surgery removal of bronchiectasis if confined to a smal

Bronchiectasis

Involves placing a hollow plastic tube between the ribs and into the chest to drain fluid or air from around the lungs. The tube is often hooked up to a suction machine to help with drainage.

CHEST TUBE THORACOSTOMY (CTT)

Measure lung volumes, ventilator function, and mechanics of breathing,diffusion, and gas exchange

Pulmonary Function Test

Checks respiratory function in terms of oxygenating the blood and maintaining acid- base balance.

Arterial Blood Gas Analysis

Checks the causative agent for infectious lung disease ■ STERILE container is used for culture

Sputum Analysis/Culture

■ (+) consent form ■ NPO for 6 hrs before the procedure ■ Remove dentures/oral prosthesis ■ Topical anesthetic (lidocaine) spray to suppress cough reflex ■ NPO post-procedure until gag reflex returns

Bronchoscopy

Non-invasive device that estimates a client’s arterial blood oxygen saturation and pulsations

Pulse Oximeter

0.12-0.20 secs

PR Interval

0.08-0.10s

pwave

0.06-0.10

QRS

Use to assess the volume & pressure of blood in the heart & vascular system by means of a surgically inserted catheter

Hemodynamic Monitoring