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7th Semester > 400 Exam 4 > Flashcards

400 Exam 4 Flashcards

1
Q

Common Sequence of Events That Occur in Cardiac Patients:

A

Coronary Heart Disease

Angina Pectoris

Acute Coronary Syndrome

Acute Myocardial Infarction

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2
Q

• Don’t do anything until ___% blocked

A

70%

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3
Q

• Refers to the development and progression of plaque accumulation in the coronary arteries

A

CAD

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4
Q

3 stages of CAD

A

stable angina
unstable
MI

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5
Q

enough blood flow still

A

stable angina

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6
Q

not enough blood flow.

increased demand can cause this

A

unstable angina

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7
Q

with stable angina there is damage to the _____ by some type of trauma or irritant

A

endothelium

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8
Q

what could cause damage to the endothelium with stable angina

A

o Elevated cholesterol
o Hypertension
o High levels of nicotine
o Diabetes (high glucose level)

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9
Q

cholesterol sticks to damaged areas of artery walls; made of cholesterol, macrophages & other things; starts swelling and plaques form up

A

Fatty streak—

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10
Q

what disorders increase risk for CAD

A

hepatitis
H. pylori
cytomegaly virus (HIV)

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11
Q

what causes chest pain

A

not enough O2 –> anaerobic metabolism –> increase in lactic acid

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12
Q

sx of CAD

A

chest pain
SOB
anxiety

HTN
elevated glucose

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13
Q

other presentations with CAD

A

jaw pain
arm pain
back pain

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14
Q

goal for chest pain

A

0/10 because 1/10 means chest is still not ok.

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15
Q

causes of chest pain

A 
activity
stress
casino
cold
eating a heavy meal
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16
Q

complications of CAD and MI

A

heart failure
dysrhythmias
pericarditis

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17
Q

—inflammation of pericardial lining of heart

A

o Pericarditis

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18
Q

risk factors for CAD

A 
genetics!
older age
males
diabetes
cholesterol
HTN
tobacco
diet
physical inactivity
obesity
metabolic syndrome
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19
Q

group of d/o put together (must have @ least 3 of the following);

A

metabolic disorder

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20
Q

5 categories of metabolic disorder

A 
central obesity
high BP
high triglycerides
low HDL
insulin resistance
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21
Q

dx of CAD

A

stress test
coronary angiogram
cholesterol levels

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22
Q

• If they fail stress test = ____ result

A

positive

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23
Q

if they get a positive stress test, they will take them to?

A

do heart cath

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24
Q

LDL cholesterol level

A

<100 mg/dL

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25
Q

total cholesterol level

A

<200 mg/dL

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26
Q

HDL cholesterol level for men

A

> 40

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27
Q

HDL for women

A

> 50

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28
Q

triglyceride level

A

<150 mg/dL

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29
Q

nursing management for heart cath

A

allergies to iodine or dye??

bleeding risk!!!

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30
Q

o If you come in with chest pain?

A

EKG to diagnose MI – will show ST segment elevation

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31
Q

• Complementary Therapies for CAD

A

fish oil
garlic
b vitamins (Niacin)
one glass of wine

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32
Q

5 types of engine pectoris

A 
stable
unstable
intractable
variant (Prinzmetal's)
silent ischemia
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33
Q

o (STABLE, PREDICTABLE PATTERN)

♣ Occurs with a predictable amount of activity or stress and is relieved by rest and/or nitroglycerin

♣ Stop and sit down – chest pain goes away

A

stable angina

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34
Q

o (CAN OCCUR AT REST)
♣ Occurs with increasing frequency and severity – may occur at times unrelated to activity or stress; may not be relieved with rest and/or nitro

A

unstable angina

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35
Q

o Severe incapacitating chest pain; usually caused by atherosclerotic disease

A

o Intractable or Refractory Angina

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36
Q

♣ Only type of angina not necessarily r/t CHD–develops d/t coronary artery spasm; pain at rest with reversible ST-segment elevation

A

o Variant (Prinzmetal’s) angina

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37
Q

o (Never known they had a heart attack)

♣ Refers to the objective evidence of ischemia (such as ECG changes with a stress test), but patient reports no pain

A

Silent ischemia

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38
Q

sx of angina

A 
pain--deep in chest
choking or strangling sensation
dyspnea
sweating
tachycardia
anxiety
pallor
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39
Q

• ALWAYS ASSESS ____ FIRST WITH CHEST PAIN

A

Vitals

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40
Q

atypical sx of angina

A

indigestion
N/V
upper back pain
GI cocktail

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41
Q

if the GI cocktail fixes the chest pain?

A

it’s not cardiac

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42
Q

precipitating factors for angina

A 
exercise/activity
strong emotion
stress
exposure to cold
eating a heavy meal
metal (lead poisoning)
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43
Q

old people typically have what type of angina??

A

silent ischemia

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44
Q

DX of CHD/acute coronary syndrome/MI

A 
12 lead ECG
Blood testing
stress testing
echocardiogram
radionuclide testing
coronary angiography
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45
Q

ex of blood testing

A

troponin 1
creatine kinase (CK)
CK-MB
Myoglobin

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46
Q

• Increase in ____ can be detected within a few hours during an acute MI

A

troponin

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47
Q

• Increases only when there has been damage to cardiac cells

A

creatinine kinase (CK)

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48
Q

is specific to cardiac tissue)

A

MB

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49
Q
  • Level starts to increase within 1-3 hours and peaks within 12 hours after onset of symptoms
  • Increase in this is not very specific in indicating an acute cardiac event
A

myoglobin

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50
Q

– treadmill or stationary bike, arm crank; increases oxygen demand to see if heart is meeting increased oxygen demand

A

• Stress testing

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51
Q

inject dye into coronary arteries to see if there are any blockages

A

• Coronary angiography –

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52
Q

what to worry about with • Coronary angiography –

A

bleeding!

pedal pulses!

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53
Q

= hallmark sign of MI

A

• ST Elevation

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54
Q

ischemia

A

• ST Depression =

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55
Q

means damage from MI went through all 3 heart muscles (will show up on ECG’s forever)

A

• Q WAVE MI –

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56
Q

non STEMI MI results?

A

EKG is normal but cardiac enzymes are increased

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57
Q

meds to treat angina

A 
nitrates
BB
CCB
antiplatelets
anticoagulants
heparin
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58
Q

o Usually drug of choice – DILATES PRIMARY VEINS to decrease the workload of the heart

A

nitrates

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59
Q

how are nitrates administered?

A

sublingual
oral capsule
topical agent
IV

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60
Q

how to admin sublingual nitro?

A

under the tongue or in the cheek every 2-3 minutes up to 15 minutes.

(only up to 3)

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61
Q

do not admin nitro if systolic BP is _____.

A

< 90 mm/Hg

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62
Q

side effects of nitro

A

flushing
hypotension
throbbing HA
tachycardia

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63
Q

what happens if patient takes 3 nitro’s and they still have pain medicine?

A

go to ER

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64
Q

Beta blockers end in?

A

-LOL

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65
Q

beta blockers decrease what 4 things?

A

HR
BP
contractility
conduction of the impulses

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66
Q

Beta blockers cause bronchoconstriction so they should not be given to patients with?

A

asthma

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67
Q

o Reduce myocardial oxygen demand/blood supply

A

Calcium Channel Blockers

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68
Q

CCBs can also?

A

lower the HR and decrease the strength of the myocardial contraction

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69
Q

o Thins the blood prevents platelet aggregation and reduces the incidence of MI

A

antiplatelets

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70
Q

o May be on a low-molecular weight heparin ______.

(problem is that it’s very expensive);

A

lovenox

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71
Q

don’t give livens if platelets are below ?

A

100,000

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72
Q

guidelines for management of stable angina:

A

ABCDE

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73
Q

A

A

aspirin and antianginals (nitro)

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74
Q

B

A

beta-blocker and blood pressure

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75
Q

C

A

cholestrol and cigarettes

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76
Q

D

A

diet and diabetes

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77
Q

E

A

education and exercise

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78
Q

MONA stands for?

A

morphine
oxygen
nitro
aspirin

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79
Q

MONA is used to treat ____ ____.

A

unstable angina

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80
Q

• called this because it’s the Coronary Arteries that are affected

A

ACUTE CORONARY SYNDROME

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81
Q

• Heart can stay stable as long as it’s blocked less than ____%

A

70%

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82
Q

plaque build up causes

A

acute coronary syndrome

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83
Q

usually what kills patient before actual tissue damage

A

dysrhythmias

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84
Q

o Entire wall of heart muscle has been infracted all the way through

A

Q-wave infarctions

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85
Q

how to dx acute coronary syndrome (MI)

A

ECG (T wave inversion, ST segment elevation, abnormal Q wave)

cardiac biomarkers

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86
Q

meds for acute coronary syndrome (MI)

A 
aspirin
Nitro
Morphine
IV BB
Heparin
Lovenox
Thromboytics
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87
Q

complications of MI

A 
dysrhythmias
pump failure
cardiogenic shock
infart extension
structural defects
pericarditis
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88
Q

o Acute MI pts are at risk for?

A

heart failure

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89
Q

what is the worst type of MI

A

Q wave MI (goes through all layers of heart muscle)

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90
Q

patient education on valvular heart disorders?

A

education on diagnosis, the progressive nature of valvular heart disease, and treatment plan

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91
Q

o Education regarding damaged heart valve is more susceptible to bacterium which can lead to ____ _____.

A

infectious endocarditis

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92
Q

priority with valvular disorders?

A

measure HR, BP, RR and compare with previous date and note changes

listen to heart and lung sounds

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93
Q

s/sx of heart failure?

A 
SOB when lying flat
dizziness
increased weakness
chest pain
PND
dysrhythmias
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94
Q

PND means?

A

paroxysmal nocturnal dyspnea

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95
Q

who is more likely to have dysrhythmias?

A

mitral valve prolapse

mitral stenosis

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96
Q

Heart failure patients should report what amount of weight gain?

A

3 lbs in a day

5 lbs in a week

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97
Q

with HF they may also be on ______ to let the heart rest and ___ _____ to prevent progression to HF.

A

Beta Blockers;

ACE inhibitors

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98
Q

CORRECTION OF STRUCTURAL DEFECTS USUALLY NOT TREATED UNTIL THEY START SHOWING SYMPTOMS OF?

A

Heart Failure

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99
Q

what 3 ways to correct structural defects:

A

valve repair
valve replacement
ross procedure

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100
Q

valve repair AKA

A

valvuloplasty

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101
Q

important about valvuloplastys:

A

higher survival rate

fewer cardiac
complications

lower operative mortality rate

potential improvement in L ventricular function

reduced need for anticoagulant and lower cost

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102
Q

important about valve replacement

A

carries significant operative risk and mortality

risks increase in patients over 70 y/o

BLOOD CLOTS – need anticoagulants

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103
Q

• uses the patient’s own pulmonary valve

o Used for YOUNGER PATIENTS; they have better outcomes, especially children

A

ross procedure

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104
Q

2 types of valves

A

mechanical valves

tissue (biologic) valves

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105
Q

♣ More durable; usually don’t wear out

♣ NEED ANTICOAGULATION IS THE DOWNSIDE

♣ Will hear a distinct “clicking” upon auscultation

A

mechanical valves

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106
Q

3 types of tissue (biologic) valves

A

xenographs
homografts
autografts

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107
Q

Comes from a different species

A

♣ Xenographs

108
Q

Comes from Human Cadavers

A

♣ Homografts

109
Q

important about tissue (biologic) valves:

A

women of child bearing age et this

they last 10-15 years

110
Q

PRIORITY for valvuloplasty and replacement:

A

: ASSESS FOR S/S OF HF, EMBOLI, AND BLEEDING

111
Q

• Listens for any changes in heart sounds every ___ hrs post op valvuloplasty and replacement

A

q 4

112
Q

admitted to ICU if they have surgical _____

A

valvuloplasty

113
Q

care in the ICU=

A

frequent monitoring of euro

cardiovascular, renal, and respiratory functioning monitoring

114
Q

patients will be on ___ therapy after valvuloplasty and valve repair

A

anticoagulant

115
Q

it’s important to prevent infective endocarditis by ?

A

ATB before dental procedures or any other major procedures

116
Q

• Heart Muscle Disease associated with Cardiac Dysfunction

A

cardiomyopathy

117
Q

cardiomyopathy can lead to

A

heart failure

118
Q

cardiomyopathy is Classified according to _____ and _____ abnormalities of the heart muscle

A

structural and functional

119
Q

Most common type of cardiomyopathy

A

dilated

120
Q

sx of cardiomyopathy

A 
o	PND
o	Cough
o	Orthopnea
o	Fluid Retention
o	Peripheral Edema
o	Nausea caused by poor perfusion of the GI Tract
o	Chest Pain
o	Palpitations
o	Dizziness
o	Syncope with Exertion
o	Could cause Cardiac Arrest
121
Q

dx of cardiomyopathy

A

echocardiogram (quickest diagnosis)

122
Q

indicates that the heart is not pumping out correctly and can lead to shock and death

A

v. tach and v. fib

123
Q

a. systole means

A

you’re dead

124
Q

medical management of cardiomyopathy

A 
id underlying cause
BB
lasix
anti-coagulants
low sodium diet
exercise/rest regimen
controlling dysrhythmias
125
Q

how do you control dysrhythmias with cardiomyopathy?

A

pacemaker
or
implanted defibrillator

126
Q

INFECTIOUS DISEASES OF THE HEART:

A
  • Rheumatic Endocarditis
  • Infectious Endocarditis
  • Myocarditis
  • Pericarditis
127
Q
  • May occur after an episode of group A beta-hemolytic streptococcal pharyngitis (strep throat)
  • Diagnosing and treating streptococcal pharyngitis can prevent rheumatic fever which can cause rheumatic endocarditis
A

rheumatic endocarditis

128
Q

sx of rheumatic heart disease

A

new heart murmur
cardiomegaly
pericarditis
HF

129
Q

what can prevent endocarditis

A

promt tx of “strep” throat with ATB

130
Q

• Involves the endocardium, most often the heart valves

A

infective endocarditis

131
Q

—can occur rapidly and progress to death in days if untreated

A

• Acute infective endocarditis

132
Q

individuals at high risk for infective endocarditis:

A 
IV drug users
HIV patients
patients with catheters
long term corticosteroids
long term ATB
invasive procedures

any heart disease
chlamydia

133
Q

leading risk factor for infective endocarditis

A

mitral valve prolapse

134
Q

o The infection most frequently results in platelets, fibrin, blood cells, and microorganisms that cluster as vegetations on the endocardium. The vegetations may embolize to other tissues throughout the body

A

infective endocarditis:

135
Q

dx of infective endocarditis?

A

TEE

136
Q

myocarditis results from?

A 
viral
bacterial
fungal 
parasitic
immune related
137
Q

symptoms of myocarditis

A

may be asymptomatic
“flu-like” sxs
palpitations
chest discomfort

138
Q

myocarditis may result in

A

heart failure or sudden cardiac death

139
Q

dx of myocarditis

A

o Can be hard to diagnosis
o Cardiac MRI with contrast
o Endocardial biopsies
o Monitor for Dysrhythmias

140
Q

• Prevention of infectious diseases through?

A

appropriate immunizations (ex. flu and pneumonia) and early treatment appear to be important in decreasing the incidence

141
Q

• Management of symptoms of myocarditis?

A

o Initially bed rest to decrease the cardiac workload, then limited physical activity for months; not fixed quickly

142
Q

• Nursing management of myocarditis?

A

o Careful assessment for resolution of tachycardia, fever, and other clinical manifestations (anorexia, N&V, flu-like symptoms.)

143
Q

• NURSE ALERT: PATIENTS WITH MYOCARDITIS ARE SENSITIVE TO

A

DIGITALIS.

144
Q

NURSES MUST CLOSELY MONITOR THESE PATIENTS FOR DIGITALIS TOXICITY, WHICH IS EVIDENCED BY

A 
DYSRHYTHMIAS, 
ANOREXIA, 
NAUSEA, 
VOMITING, 
HEADACHE, AND 
MALAISE
HALOS IN VISION
145
Q

digitalis levels?

A

0.8-2.0

or

0.5-2.0

146
Q

• Inflammatory process of the Pericardium; causing a Pericardial Friction Rub

A

PERICARDITIS

147
Q

causes of pericarditis

A

o Bacterial (rare), Viral (most common), or Fungal Infection

o Disorders of Connective Tissue (Ex. RA, Lupus)

o Sarcoidosis

o Hypersensitivity States

o Disorders of Adjacent Structures (Ex. MI, aneurysms)

o Neoplastic Disease (Ex. lung or breast cancer)

o Radiation therapy of chest and upper torso (peak occurrence 5-9 months after treatment)

o Renal Failure, uremia

o TB

o After major trauma

o Can occur after an acute MI (10 days-2 months after)

148
Q

sx of pericarditis

A 
asymptomatic
chest pain
fever
leukocytosis
elevated ESR
tachycardia
149
Q

with pericarditis you will hear a ___ ___ ____

A

pericardial friction rub

150
Q

potential complications with pericarditis?

A

pericardial effusion

cardiac tamponade

151
Q

fluid will increase from the inflammation and this will compress the heart causing:

A

♣ PERICARDIAL EFFUSION

152
Q

(compression on heart so that heart can’t pump effectively)

A

• CARDIAC TAMPONADE

153
Q

with CARDIAC TAMPONADE they will do a _________ to remove the fluid

A

pericardiocentesis

154
Q

o Beck’s triad Classic 3 Terms heard for symptoms of Cardiac Tamponade—medical emergency

A

hypotension
JVD
muffled heart sounds

155
Q

dx of pericarditis

A

CT/MRI

Echocardiogram

156
Q

pericarditis has a ____ pulse pressure

A

narrowed

157
Q

tube left in for a few days to remove fluid periodically (@ risk for infection)

A

o Pericardial window

158
Q

what’s the difference between pericarditis and MI?

A

ST segment elevation with MI

BP is low with pericarditis

159
Q

– pain caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients and oxygen during exercise

A

o Intermittent claudication

160
Q

persistent pain in the forefoot when the patient is resting

A

o Rest pain –

161
Q

“hardening of the arteries”; thickening of the walls of the arteries

A

• Arteriosclerosis:

162
Q

accumulations of atheromas or plaque in the arteries

A

• Atherosclerosis:

163
Q

Atherosclerosis and Arteriosclerosis are both caused by?

A

lack of blood flow d/t blockages

164
Q

• Atherosclerotic plaque formation causes thickening of the artery resulting in partial or complete obstruction of the vessel lumen

A

Atherosclerosis/Arteriosclerosis

165
Q

; most plaque accumulates at

A

bifurcations

166
Q

the body compensates by doing what with Atherosclerosis/Arteriosclerosis

A

vasodilating and developing collateral circulation

167
Q

sx of Atherosclerosis/Arteriosclerosis

A

intermittent claudication
rest ischemia
ulcers

168
Q

o pain caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients and oxygen during exercise.

A

intermittent claudication

169
Q

♣ Muscular cramping pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by _____ with Atherosclerosis/Arteriosclerosis

A

rest

170
Q

—dye highlights arteries and shows blockages

A

• Peripheral angiogram

171
Q

Involves the progressive narrowing, degeneration, and eventual obstruction of the arteries of the peripheral vascular system (aorta, iliac arteries, femoral, popliteal, and Tibial arteries)

A

PERIPHERAL ARTERIAL DISEASE OR PERIPHERAL VASCULAR DISEASE

172
Q

o Smoking is the biggest risk factor d/t causing vasoconstriction and plaque build up with?

A

PAD or PVD

173
Q

risk factors for PAD or PVD

A 
♣	Gender (Males)
♣	Increases with Age
♣	Positive Family History
♣	Smoking
♣	Diet
♣	HTN
♣	Diabetes mellitus
♣	Obesity
♣	Stress
♣	Sedentary lifestyle 
♣	Hyperhomocyteinemia
♣	Elevated cholesterol 
♣	Elevate C-reactive Protein
♣	Elevated Homosysteine Levels
174
Q

prevention of PAD/PVD

A

stop smoking
diabetes control
HTN control

175
Q

diagnostic tests for PAD/PVD

A

ankle-brachial index (ABI)

♣	Stress testing
♣	Doppler ultrasound
♣	Transcutaneous oximetry
♣	Peripheral Angiography
♣	MRI
♣	Computed tomography
♣	Air plethysmography
♣	Contrast phlebography (venography)
♣	Lymphangiography
176
Q

• Stick going down (retrograde stick)—hold pressure differently than if the catheter would be going up hold pressure below the site instead of above the site—use two hands and hold above and below if you’re not sure what kind of angiogram was done

A

♣ Peripheral Angiography

177
Q

• Do BP measurements on legs and arms—should be similar

A

ankle-brachial index (ABI)

178
Q

normal ABI

A

1

179
Q

an ABI of 1 means?

A

the BP in the legs and arms are similar

180
Q

those with PVD will have an ABI of?

A

<0.5

less circulation in legs than arms

181
Q
  • Provides a way of detecting lymph node involvement

* Use a contrast agent

A

lymphangiography

182
Q

diagnostic tests for PVD/PAD

A

inflow and outflow procedures

183
Q

Improve blood supply from the aorta into the femoral artery; described with diseases of the aorta

A

♣ Inflow Procedure

184
Q

Provide blood supply to vessels below the femoral artery; described with peripheral arterial occlusive disease

A

♣ Outflow Procedures

185
Q

radiologic interventions for PAD/PVD

A

percutaneous transluminal angioplasty (PTA)

186
Q

go in with balloon, open blockage and put a stent in place

A

♣ Percutaneous Transluminal Angioplasty (PTA)—

187
Q

meds for PVD/PAD

A 
trentile
aspirin
pletal
persanteen
ticlid
188
Q

PERIPHERAL ARTERIAL OCCULSIVE DISEASE sx

A

intermittent claudication
fatigue
decreased ability to walk
sleep with legs in dependent position

189
Q

assessment findings with Peripheral Arterial Occlusive Disease

A

coolness
weak pulse
painful (if complete occlusions)
ulcers (punched out look; circular; inside will be pale)

190
Q

what do the ulcers look like with Peripheral Arterial Occlusive Disease??

A

punched out look
circular
inside will be pale

191
Q

surgery for Peripheral Arterial Occlusive Disease?

A

stents first

192
Q

• Important to monitor ______ to that extremity after surgery

A

circulation

193
Q

• Do a bypass graft with peripheral arterial occlusive disease and may see it as a ___-___ ______.

A

Fem-Pop bypass

194
Q

post op education for fem-pop bypass?

A

long-term anti platelets

195
Q

nursing management with Fem-Pop bypass?

A 
o	Tell them to walk
o	Weight reduction
o	Tobacco cessation 
o	Maintaining circulation 
o	Monitor and manage potential complications
o	Promote home and community based care
196
Q

monitor for complications after fem-pop for?

A

every 8 hrs for 24 hrs

197
Q

is an obstructive vascular disorder caused by segmental inflammation in the arteries and veins; believed to be an autoimmune response triggered by nicotine in susceptible persons—want them to stop smoking

A

• Buerger’s disease

198
Q

single most significant cause with burger’s disease

A

SMOKING

199
Q

• Buerger’s disease typically occurs in?

A

young men (20-35) who use tobacco

200
Q

• Manifestations of Buerger’s disease

A

o Sensation diminished and extreme pain where occlusion is

o Extremities pale and cyanotic

o Diminished pulses

o Cool or cold to touch

o Usually fingers or toes

201
Q

management for Buerger’s disease?

A

o STOP SMOKING

o Keep extremities warm—prevents vasoconstriction and spasm

o Keep extremities in dependent position

o Prevent injury

o Promote regular exercise

o If severe, amputation may be necessary

202
Q

• When iliac arteries become narrowed or blocked

A

AORTOILIAC DISEASE

203
Q

sx of AORTOILIAC DISEASE

A

o may be asymptomatic, or they may complain of buttock or low back discomfort associated with walking

o Men may experience impotence

o May have decreased or absent femoral pulses

204
Q

tx for AORTOILIAC DISEASE

A

o Surgical treatment = aortobifemoral graft

205
Q

nursing management for AORTOILIAC DISEASE

A

o Same as peripheral arterial disease

o Monitor peripheral pulses, temperature, sensations

o Monitor urine output—should be more than 30ml/hr

May have a paralytic ileus

206
Q

• Localized sac or dilation formed at a weak portion in the wall of the artery.

A

Aneurysm

207
Q

most common aneurysm due to atherosclerotic changes in the aorta

A

abdominal aortic aneurysm.

208
Q

causes of aneurysms

A 
congenital
mechanical (hemodynamic)
inflammatory (noninfectious)
infectious (mycotic)
pregnancy
209
Q

primary connective tissue disorders (Marfan’s syndrome) and other diseases

A

o Congenital –

210
Q

poststenotic and arteriovenous fistula and amputation related

accident–wreck

A

o Mechanical (hemodynamic) –

211
Q

associated w/ arteritis (lupus, Kawasaki syndrome) and periarterial inflammation (pancreatitis)

A

o Inflammatory (noninfectious) –

212
Q

bacterial, fungal, spirochete infections

A

o Infectious (mycotic) –

213
Q

aneurysm patients have a high risk for?

A

MI or stroke

214
Q

when a break/tear in the tunica intimia and media allows blood to invade or dissect the layers of the vessel

o MEDICAL EMERGENCY Rupture is possible

A

• Dissecting aneurysms:

215
Q

Locations of Aneurysms

A
  • Thoracic Aortic Aneurysms
  • Abdominal Aortic Aneurysms
  • Popliteal and Femoral Aneurysms
  • Aortic Dissections
216
Q

type of aneurysm that is a medical emergency because of risk for rupture

A

aortic dissections

217
Q
  • Most caused by atherosclerosis or HTN; 10% are aortic aneurism—weakening in aortic wall
  • May be congenital d/o
  • Occur most frequently in MEN
A

thoracic aortic aneurysm

218
Q

1/3 of thoracic aortic aneurysm patients die due to?

A

rupture

219
Q

sx of thoracic aortic aneurysms

A

asymptomatic

pain as it gets larger

220
Q

if the thoracic aortic aneurysm is pushing on the esophagus they will have what symptoms?

A 
brassy cough
hoarseness
stridor
complete loss of voice
dysphagia
221
Q

medical management of thoracic aortic aneurysm that is asymptomatic?

A

leave it alone

222
Q

if thoracic aortic aneurysm is symptomatic worry about it _____.

A

dissecting

223
Q

surgery for thoracic aortic aneurysm

A

stent graft or surgery

224
Q
  • Most common cause is atherosclerosis
  • Occur most commonly in men over 65
  • Frequently occur below the renal arteries
  • After aneurysm develops, it tends to enlarge
A

Abdominal Aortic Aneurysm

225
Q

sx of AAA

A

asymptomatic
pulsating mass during an assessment
may hear a bruit

226
Q

turbulent blood flow

A

bruit

227
Q

if the AAA is ___-___ cm they will do surgery because the risk of rupture is too high

A

5.5-6cm

228
Q

• A tear in the intima or the media (the lining) of the artery can occur in the diseased aorta (see video posted)

A

Dissecting Aorta

229
Q

sx of Dissecting Aorta

A

o Severe and persistent pain described as tearing or ripping; may be mistaken for MI

o S/S of Rupture: Pale, Diaphoretic, Changes in BP, Low BP, significant BP differences between the right and left arms (20mmhg difference)—main indicator!

230
Q

Dissecting Aorta Tx

A

immediate surgery to repair

231
Q

______ ______ arise most commonly from thrombi that develop in the chambers of the heart as a result of atrial fibrillation, MI, infective endocarditis (vegetation that grows on the valve,), or chronic heart failure d/t being at risk for atrial fib; also from an arterial aneurysm (blood sluggish and clots develop)

A

• Arterial emboli

232
Q

• Arterial emboli

usually the immediate effect is ?

A

cessation of distal blood flow

233
Q

Cerebral=

A

(they will have a stroke),

234
Q

mesenteric, renal

A

(they will go in to renal failure),

235
Q

and coronary arteries are often involved

A

(MI);

236
Q

If go into lungs

A

pulmonary embolism

237
Q

• Emergency embolectomy if in extremity that is _____ _____.

A

completely blocked

238
Q

• Contraincidated with anyone with trauma and bleeding, history of bleeding, pregnancy, recent major surgery, risk of cerebral vascular hemorrhage

A

thrombolytics

239
Q

thrombolytics example:

A

TPA
activase
altaplace
streptokinase

240
Q

if they are on thrombolytic therapy where will they be?

A

ICU

241
Q

if they are on a heparin drip?

A

they can stay on the floor

242
Q

ϖ Intense vasospasms in the small arteries and arterioles, usually only effects women

ϖ Episodes can last minutes to hours

A

raynaud’s disease

243
Q

with raynaud’s vasospasm is confined to the ____

A

digits

244
Q

ϖ Classic tricolor changes with raynaud’s:

A

pallor,
cyanosis, and
rubor (extreme blood flow coming back) of one or more digits

245
Q

with raynaud’s you want to protect the hands and feet from ____ and ____

A

cold and trauma

246
Q

meds for raynaud’s

A

CCB
Vasodilators
smooth muscle relaxers

247
Q

A blood clot forms on the wall of a vein, accompanied by inflammation of the vein wall and some degree of obstructed venous blood flow;

A

VENUS THROMBOSIS

248
Q

if the thrombi form in the deep veins

A

deep vein thrombosis

249
Q

risk factors for venus thrombosis

A 
post op ortho
prolonged sitting
trauma
women >40
bedridden
PG
obesity
IV lines
oral contraceptives
smoking
250
Q

sx of venus thrombosis

A

o Tenderness
o Unilateral Leg Pain
o Most will have a Negative Homan’s Sign
o Verchow’s Triad

251
Q

____% of the patients don’t know they have venus thrombosis

A

50

252
Q

verchow’s triad:

A

stasis of blood flow,
vessel wall injury,
hypercoagulability

253
Q

dx of venus thrombosis

A

venogram

D-dimer test

254
Q

If it’s positive that means there is some sort of clotting going on

A

o D-dimer test

255
Q

prophylaxis for thrombosis

A

lovenox

256
Q

hold lovenox is Platelets are below

A

100,000

257
Q

meds for venus thrombosis

A

anticoagulants

anti-inflammatory agents

258
Q

tx of venus thrombus

A

relieve sx and reduce inflammation

warm compresses

rest

avoid tight fitting garments

avoid prolonged sitting/standing

259
Q

o Get them walking within ???? if they are on anti-coagulant therapy

A

a day

260
Q

NO ____ medications for venus thrombosis

A

IM injections

261
Q

♣ A disorder of inadequate venous return over a prolonged period
• DVT most frequent cause

A

CHRONIC VENOUS INSUFFICIENCY

262
Q

manifestions for chronic venous insufficiency

A

lower egg edema
itching
discomfort of affected extremity

263
Q

with chronic venous insufficiency they have recurrent stasis ulcers where?

A

above the ankle

264
Q

what to do with extremities with chronic venous insufficiency

A

o Elevate the extremity to decrease the swelling and increase blood return to the heart

265
Q

used to get rid of the dead tissue so viable tissue can function

A

• Debridement;

266
Q

♣ Cover every single edge

♣ Do not wet it to take it out easier, it defeats the purpose of removing the dead skin

A

o Wet-dry dressings

7th Semester (14 decks)

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