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
2
Q
• Don’t do anything until ___% blocked
A
70%
3
Q
• Refers to the development and progression of plaque accumulation in the coronary arteries
A
CAD
4
Q
3 stages of CAD
A
stable angina
unstable
MI
5
Q
enough blood flow still
A
stable angina
6
Q
not enough blood flow.
increased demand can cause this
A
unstable angina
7
Q
with stable angina there is damage to the _____ by some type of trauma or irritant
A
endothelium
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)
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—
10
Q
what disorders increase risk for CAD
A
hepatitis
H. pylori
cytomegaly virus (HIV)
11
Q
what causes chest pain
A
not enough O2 –> anaerobic metabolism –> increase in lactic acid
12
Q
sx of CAD
A
chest pain
SOB
anxiety
HTN
elevated glucose
13
Q
other presentations with CAD
A
jaw pain
arm pain
back pain
14
Q
goal for chest pain
A
0/10 because 1/10 means chest is still not ok.
15
Q
causes of chest pain
A
activity stress casino cold eating a heavy meal
16
Q
complications of CAD and MI
A
heart failure
dysrhythmias
pericarditis
17
Q
—inflammation of pericardial lining of heart
A
o Pericarditis
18
Q
risk factors for CAD
A
genetics! older age males diabetes cholesterol HTN tobacco diet physical inactivity obesity metabolic syndrome
19
Q
group of d/o put together (must have @ least 3 of the following);
A
metabolic disorder
20
Q
5 categories of metabolic disorder
A
central obesity high BP high triglycerides low HDL insulin resistance
21
Q
dx of CAD
A
stress test
coronary angiogram
cholesterol levels
22
Q
• If they fail stress test = ____ result
A
positive
23
Q
if they get a positive stress test, they will take them to?
A
do heart cath
24
Q
LDL cholesterol level
A
<100 mg/dL
25
total cholesterol level
<200 mg/dL
26
HDL cholesterol level for men
>40
27
HDL for women
>50
28
triglyceride level
<150 mg/dL
29
nursing management for heart cath
allergies to iodine or dye??
| bleeding risk!!!
30
o If you come in with chest pain?
EKG to diagnose MI – will show ST segment elevation
31
• Complementary Therapies for CAD
fish oil
garlic
b vitamins (Niacin)
one glass of wine
32
5 types of engine pectoris
```
stable
unstable
intractable
variant (Prinzmetal's)
silent ischemia
```
33
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
stable angina
34
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
unstable angina
35
o Severe incapacitating chest pain; usually caused by atherosclerotic disease
o Intractable or Refractory Angina
36
♣ Only type of angina not necessarily r/t CHD–develops d/t coronary artery spasm; pain at rest with reversible ST-segment elevation
o Variant (Prinzmetal’s) angina
37
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
Silent ischemia
38
sx of angina
```
pain--deep in chest
choking or strangling sensation
dyspnea
sweating
tachycardia
anxiety
pallor
```
39
• ALWAYS ASSESS ____ FIRST WITH CHEST PAIN
Vitals
40
atypical sx of angina
indigestion
N/V
upper back pain
GI cocktail
41
if the GI cocktail fixes the chest pain?
it's not cardiac
42
precipitating factors for angina
```
exercise/activity
strong emotion
stress
exposure to cold
eating a heavy meal
metal (lead poisoning)
```
43
old people typically have what type of angina??
silent ischemia
44
DX of CHD/acute coronary syndrome/MI
```
12 lead ECG
Blood testing
stress testing
echocardiogram
radionuclide testing
coronary angiography
```
45
ex of blood testing
troponin 1
creatine kinase (CK)
CK-MB
Myoglobin
46
• Increase in ____ can be detected within a few hours during an acute MI
troponin
47
• Increases only when there has been damage to cardiac cells
creatinine kinase (CK)
48
is specific to cardiac tissue)
MB
49
* 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
myoglobin
50
– treadmill or stationary bike, arm crank; increases oxygen demand to see if heart is meeting increased oxygen demand
• Stress testing
51
inject dye into coronary arteries to see if there are any blockages
• Coronary angiography –
52
what to worry about with • Coronary angiography –
bleeding!
| pedal pulses!
53
= hallmark sign of MI
• ST Elevation
54
ischemia
• ST Depression =
55
means damage from MI went through all 3 heart muscles (will show up on ECG’s forever)
• Q WAVE MI –
56
non STEMI MI results?
EKG is normal but cardiac enzymes are increased
57
meds to treat angina
```
nitrates
BB
CCB
antiplatelets
anticoagulants
heparin
```
58
o Usually drug of choice – DILATES PRIMARY VEINS to decrease the workload of the heart
nitrates
59
how are nitrates administered?
sublingual
oral capsule
topical agent
IV
60
how to admin sublingual nitro?
under the tongue or in the cheek every 2-3 minutes up to 15 minutes.
(only up to 3)
61
do not admin nitro if systolic BP is _____.
< 90 mm/Hg
62
side effects of nitro
flushing
hypotension
throbbing HA
tachycardia
63
what happens if patient takes 3 nitro's and they still have pain medicine?
go to ER
64
Beta blockers end in?
-LOL
65
beta blockers decrease what 4 things?
HR
BP
contractility
conduction of the impulses
66
Beta blockers cause bronchoconstriction so they should not be given to patients with?
asthma
67
o Reduce myocardial oxygen demand/blood supply
Calcium Channel Blockers
68
CCBs can also?
lower the HR and decrease the strength of the myocardial contraction
69
o Thins the blood prevents platelet aggregation and reduces the incidence of MI
antiplatelets
70
o May be on a low-molecular weight heparin ______.
(problem is that it’s very expensive);
lovenox
71
don't give livens if platelets are below ?
100,000
72
guidelines for management of stable angina:
ABCDE
73
A
aspirin and antianginals (nitro)
74
B
beta-blocker and blood pressure
75
C
cholestrol and cigarettes
76
D
diet and diabetes
77
E
education and exercise
78
MONA stands for?
morphine
oxygen
nitro
aspirin
79
MONA is used to treat ____ ____.
unstable angina
80
• called this because it’s the Coronary Arteries that are affected
ACUTE CORONARY SYNDROME
81
• Heart can stay stable as long as it’s blocked less than ____%
70%
82
plaque build up causes
acute coronary syndrome
83
usually what kills patient before actual tissue damage
dysrhythmias
84
o Entire wall of heart muscle has been infracted all the way through
Q-wave infarctions
85
how to dx acute coronary syndrome (MI)
ECG (T wave inversion, ST segment elevation, abnormal Q wave)
cardiac biomarkers
86
meds for acute coronary syndrome (MI)
```
aspirin
Nitro
Morphine
IV BB
Heparin
Lovenox
Thromboytics
```
87
complications of MI
```
dysrhythmias
pump failure
cardiogenic shock
infart extension
structural defects
pericarditis
```
88
o Acute MI pts are at risk for?
heart failure
89
what is the worst type of MI
Q wave MI (goes through all layers of heart muscle)
90
patient education on valvular heart disorders?
education on diagnosis, the progressive nature of valvular heart disease, and treatment plan
91
o Education regarding damaged heart valve is more susceptible to bacterium which can lead to ____ _____.
infectious endocarditis
92
priority with valvular disorders?
measure HR, BP, RR and compare with previous date and note changes
listen to heart and lung sounds
93
s/sx of heart failure?
```
SOB when lying flat
dizziness
increased weakness
chest pain
PND
dysrhythmias
```
94
PND means?
paroxysmal nocturnal dyspnea
95
who is more likely to have dysrhythmias?
mitral valve prolapse
| mitral stenosis
96
Heart failure patients should report what amount of weight gain?
3 lbs in a day
5 lbs in a week
97
with HF they may also be on ______ to let the heart rest and ___ _____ to prevent progression to HF.
Beta Blockers;
| ACE inhibitors
98
CORRECTION OF STRUCTURAL DEFECTS USUALLY NOT TREATED UNTIL THEY START SHOWING SYMPTOMS OF?
Heart Failure
99
what 3 ways to correct structural defects:
valve repair
valve replacement
ross procedure
100
valve repair AKA
valvuloplasty
101
important about valvuloplastys:
higher survival rate
fewer cardiac
complications
lower operative mortality rate
potential improvement in L ventricular function
reduced need for anticoagulant and lower cost
102
important about valve replacement
carries significant operative risk and mortality
risks increase in patients over 70 y/o
BLOOD CLOTS -- need anticoagulants
103
• uses the patient’s own pulmonary valve
o Used for YOUNGER PATIENTS; they have better outcomes, especially children
ross procedure
104
2 types of valves
mechanical valves
tissue (biologic) valves
105
♣ More durable; usually don’t wear out
♣ NEED ANTICOAGULATION IS THE DOWNSIDE
♣ Will hear a distinct “clicking” upon auscultation
mechanical valves
106
3 types of tissue (biologic) valves
xenographs
homografts
autografts
107
Comes from a different species
♣ Xenographs
108
Comes from Human Cadavers
♣ Homografts
109
important about tissue (biologic) valves:
women of child bearing age et this
they last 10-15 years
110
PRIORITY for valvuloplasty and replacement:
: ASSESS FOR S/S OF HF, EMBOLI, AND BLEEDING
111
• Listens for any changes in heart sounds every ___ hrs post op valvuloplasty and replacement
q 4
112
admitted to ICU if they have surgical _____
valvuloplasty
113
care in the ICU=
frequent monitoring of euro
cardiovascular, renal, and respiratory functioning monitoring
114
patients will be on ___ therapy after valvuloplasty and valve repair
anticoagulant
115
it's important to prevent infective endocarditis by ?
ATB before dental procedures or any other major procedures
116
• Heart Muscle Disease associated with Cardiac Dysfunction
cardiomyopathy
117
cardiomyopathy can lead to
heart failure
118
cardiomyopathy is Classified according to _____ and _____ abnormalities of the heart muscle
structural and functional
119
Most common type of cardiomyopathy
dilated
120
sx of cardiomyopathy
```
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
dx of cardiomyopathy
echocardiogram (quickest diagnosis)
122
indicates that the heart is not pumping out correctly and can lead to shock and death
v. tach and v. fib
123
a. systole means
you're dead
124
medical management of cardiomyopathy
```
id underlying cause
BB
lasix
anti-coagulants
low sodium diet
exercise/rest regimen
controlling dysrhythmias
```
125
how do you control dysrhythmias with cardiomyopathy?
pacemaker
or
implanted defibrillator
126
INFECTIOUS DISEASES OF THE HEART:
* Rheumatic Endocarditis
* Infectious Endocarditis
* Myocarditis
* Pericarditis
127
* 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
rheumatic endocarditis
128
sx of rheumatic heart disease
new heart murmur
cardiomegaly
pericarditis
HF
129
what can prevent endocarditis
promt tx of "strep" throat with ATB
130
• Involves the endocardium, most often the heart valves
infective endocarditis
131
—can occur rapidly and progress to death in days if untreated
• Acute infective endocarditis
132
individuals at high risk for infective endocarditis:
```
IV drug users
HIV patients
patients with catheters
long term corticosteroids
long term ATB
invasive procedures
```
any heart disease
chlamydia
133
leading risk factor for infective endocarditis
mitral valve prolapse
134
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
infective endocarditis:
135
dx of infective endocarditis?
TEE
136
myocarditis results from?
```
viral
bacterial
fungal
parasitic
immune related
```
137
symptoms of myocarditis
may be asymptomatic
"flu-like" sxs
palpitations
chest discomfort
138
myocarditis may result in
heart failure or sudden cardiac death
139
dx of myocarditis
o Can be hard to diagnosis
o Cardiac MRI with contrast
o Endocardial biopsies
o Monitor for Dysrhythmias
140
• Prevention of infectious diseases through?
appropriate immunizations (ex. flu and pneumonia) and early treatment appear to be important in decreasing the incidence
141
• Management of symptoms of myocarditis?
o Initially bed rest to decrease the cardiac workload, then limited physical activity for months; not fixed quickly
142
• Nursing management of myocarditis?
o Careful assessment for resolution of tachycardia, fever, and other clinical manifestations (anorexia, N&V, flu-like symptoms.)
143
• NURSE ALERT: PATIENTS WITH MYOCARDITIS ARE SENSITIVE TO
DIGITALIS.
144
NURSES MUST CLOSELY MONITOR THESE PATIENTS FOR DIGITALIS TOXICITY, WHICH IS EVIDENCED BY
```
DYSRHYTHMIAS,
ANOREXIA,
NAUSEA,
VOMITING,
HEADACHE, AND
MALAISE
HALOS IN VISION
```
145
digitalis levels?
0.8-2.0
or
0.5-2.0
146
• Inflammatory process of the Pericardium; causing a Pericardial Friction Rub
PERICARDITIS
147
causes of pericarditis
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
sx of pericarditis
```
asymptomatic
chest pain
fever
leukocytosis
elevated ESR
tachycardia
```
149
with pericarditis you will hear a ___ ___ ____
pericardial friction rub
150
potential complications with pericarditis?
pericardial effusion
| cardiac tamponade
151
fluid will increase from the inflammation and this will compress the heart causing:
♣ PERICARDIAL EFFUSION
152
(compression on heart so that heart can’t pump effectively)
• CARDIAC TAMPONADE
153
with CARDIAC TAMPONADE they will do a _________ to remove the fluid
pericardiocentesis
154
o Beck’s triad Classic 3 Terms heard for symptoms of Cardiac Tamponade—medical emergency
hypotension
JVD
muffled heart sounds
155
dx of pericarditis
CT/MRI
| Echocardiogram
156
pericarditis has a ____ pulse pressure
narrowed
157
tube left in for a few days to remove fluid periodically (@ risk for infection)
o Pericardial window
158
what's the difference between pericarditis and MI?
ST segment elevation with MI
BP is low with pericarditis
159
– 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
o Intermittent claudication
160
persistent pain in the forefoot when the patient is resting
o Rest pain –
161
“hardening of the arteries”; thickening of the walls of the arteries
• Arteriosclerosis:
162
accumulations of atheromas or plaque in the arteries
• Atherosclerosis:
163
Atherosclerosis and Arteriosclerosis are both caused by?
lack of blood flow d/t blockages
164
• Atherosclerotic plaque formation causes thickening of the artery resulting in partial or complete obstruction of the vessel lumen
Atherosclerosis/Arteriosclerosis
165
; most plaque accumulates at
bifurcations
166
the body compensates by doing what with Atherosclerosis/Arteriosclerosis
vasodilating and developing collateral circulation
167
sx of Atherosclerosis/Arteriosclerosis
intermittent claudication
rest ischemia
ulcers
168
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.
intermittent claudication
169
♣ Muscular cramping pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by _____ with Atherosclerosis/Arteriosclerosis
rest
170
—dye highlights arteries and shows blockages
• Peripheral angiogram
171
Involves the progressive narrowing, degeneration, and eventual obstruction of the arteries of the peripheral vascular system (aorta, iliac arteries, femoral, popliteal, and Tibial arteries)
PERIPHERAL ARTERIAL DISEASE OR PERIPHERAL VASCULAR DISEASE
172
o Smoking is the biggest risk factor d/t causing vasoconstriction and plaque build up with?
PAD or PVD
173
risk factors for PAD or PVD
```
♣ 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
prevention of PAD/PVD
stop smoking
diabetes control
HTN control
175
diagnostic tests for PAD/PVD
ankle-brachial index (ABI)
```
♣ Stress testing
♣ Doppler ultrasound
♣ Transcutaneous oximetry
♣ Peripheral Angiography
♣ MRI
♣ Computed tomography
♣ Air plethysmography
♣ Contrast phlebography (venography)
♣ Lymphangiography
```
176
• 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
♣ Peripheral Angiography
177
• Do BP measurements on legs and arms—should be similar
ankle-brachial index (ABI)
178
normal ABI
1
179
an ABI of 1 means?
the BP in the legs and arms are similar
180
those with PVD will have an ABI of?
<0.5
| less circulation in legs than arms
181
* Provides a way of detecting lymph node involvement
| * Use a contrast agent
lymphangiography
182
diagnostic tests for PVD/PAD
inflow and outflow procedures
183
Improve blood supply from the aorta into the femoral artery; described with diseases of the aorta
♣ Inflow Procedure
184
Provide blood supply to vessels below the femoral artery; described with peripheral arterial occlusive disease
♣ Outflow Procedures
185
radiologic interventions for PAD/PVD
percutaneous transluminal angioplasty (PTA)
186
go in with balloon, open blockage and put a stent in place
♣ Percutaneous Transluminal Angioplasty (PTA)—
187
meds for PVD/PAD
```
trentile
aspirin
pletal
persanteen
ticlid
```
188
PERIPHERAL ARTERIAL OCCULSIVE DISEASE sx
intermittent claudication
fatigue
decreased ability to walk
sleep with legs in dependent position
189
assessment findings with Peripheral Arterial Occlusive Disease
coolness
weak pulse
painful (if complete occlusions)
ulcers (punched out look; circular; inside will be pale)
190
what do the ulcers look like with Peripheral Arterial Occlusive Disease??
punched out look
circular
inside will be pale
191
surgery for Peripheral Arterial Occlusive Disease?
stents first
192
• Important to monitor ______ to that extremity after surgery
circulation
193
• Do a bypass graft with peripheral arterial occlusive disease and may see it as a ___-___ ______.
Fem-Pop bypass
194
post op education for fem-pop bypass?
long-term anti platelets
195
nursing management with Fem-Pop bypass?
```
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
monitor for complications after fem-pop for?
every 8 hrs for 24 hrs
197
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
• Buerger’s disease
198
single most significant cause with burger's disease
SMOKING
199
• Buerger’s disease typically occurs in?
young men (20-35) who use tobacco
200
• Manifestations of Buerger’s disease
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
management for Buerger's disease?
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
• When iliac arteries become narrowed or blocked
AORTOILIAC DISEASE
203
sx of AORTOILIAC DISEASE
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
tx for AORTOILIAC DISEASE
o Surgical treatment = aortobifemoral graft
205
nursing management for AORTOILIAC DISEASE
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
• Localized sac or dilation formed at a weak portion in the wall of the artery.
Aneurysm
207
most common aneurysm due to atherosclerotic changes in the aorta
abdominal aortic aneurysm.
208
causes of aneurysms
```
congenital
mechanical (hemodynamic)
inflammatory (noninfectious)
infectious (mycotic)
pregnancy
```
209
primary connective tissue disorders (Marfan’s syndrome) and other diseases
o Congenital –
210
poststenotic and arteriovenous fistula and amputation related
accident--wreck
o Mechanical (hemodynamic) –
211
associated w/ arteritis (lupus, Kawasaki syndrome) and periarterial inflammation (pancreatitis)
o Inflammatory (noninfectious) –
212
bacterial, fungal, spirochete infections
o Infectious (mycotic) –
213
aneurysm patients have a high risk for?
MI or stroke
214
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
• Dissecting aneurysms:
215
Locations of Aneurysms
* Thoracic Aortic Aneurysms
* Abdominal Aortic Aneurysms
* Popliteal and Femoral Aneurysms
* Aortic Dissections
216
type of aneurysm that is a medical emergency because of risk for rupture
aortic dissections
217
* Most caused by atherosclerosis or HTN; 10% are aortic aneurism—weakening in aortic wall
* May be congenital d/o
* Occur most frequently in MEN
thoracic aortic aneurysm
218
1/3 of thoracic aortic aneurysm patients die due to?
rupture
219
sx of thoracic aortic aneurysms
asymptomatic
| pain as it gets larger
220
if the thoracic aortic aneurysm is pushing on the esophagus they will have what symptoms?
```
brassy cough
hoarseness
stridor
complete loss of voice
dysphagia
```
221
medical management of thoracic aortic aneurysm that is asymptomatic?
leave it alone
222
if thoracic aortic aneurysm is symptomatic worry about it _____.
dissecting
223
surgery for thoracic aortic aneurysm
stent graft or surgery
224
* 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
Abdominal Aortic Aneurysm
225
sx of AAA
asymptomatic
pulsating mass during an assessment
may hear a bruit
226
turbulent blood flow
bruit
227
if the AAA is ___-___ cm they will do surgery because the risk of rupture is too high
5.5-6cm
228
• A tear in the intima or the media (the lining) of the artery can occur in the diseased aorta (see video posted)
Dissecting Aorta
229
sx of Dissecting Aorta
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
Dissecting Aorta Tx
immediate surgery to repair
231
______ ______ 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)
• Arterial emboli
232
• Arterial emboli
usually the immediate effect is ?
cessation of distal blood flow
233
Cerebral=
(they will have a stroke),
234
mesenteric, renal
(they will go in to renal failure),
235
and coronary arteries are often involved
(MI);
236
If go into lungs
pulmonary embolism
237
• Emergency embolectomy if in extremity that is _____ _____.
completely blocked
238
• Contraincidated with anyone with trauma and bleeding, history of bleeding, pregnancy, recent major surgery, risk of cerebral vascular hemorrhage
thrombolytics
239
thrombolytics example:
TPA
activase
altaplace
streptokinase
240
if they are on thrombolytic therapy where will they be?
ICU
241
if they are on a heparin drip?
they can stay on the floor
242
ϖ Intense vasospasms in the small arteries and arterioles, usually only effects women
ϖ Episodes can last minutes to hours
raynaud's disease
243
with raynaud's vasospasm is confined to the ____
digits
244
ϖ Classic tricolor changes with raynaud's:
pallor,
cyanosis, and
rubor (extreme blood flow coming back) of one or more digits
245
with raynaud's you want to protect the hands and feet from ____ and ____
cold and trauma
246
meds for raynaud's
CCB
Vasodilators
smooth muscle relaxers
247
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;
VENUS THROMBOSIS
248
if the thrombi form in the deep veins
deep vein thrombosis
249
risk factors for venus thrombosis
```
post op ortho
prolonged sitting
trauma
women >40
bedridden
PG
obesity
IV lines
oral contraceptives
smoking
```
250
sx of venus thrombosis
o Tenderness
o Unilateral Leg Pain
o Most will have a Negative Homan’s Sign
o Verchow’s Triad
251
____% of the patients don’t know they have venus thrombosis
50
252
verchow's triad:
stasis of blood flow,
vessel wall injury,
hypercoagulability
253
dx of venus thrombosis
venogram
| D-dimer test
254
If it’s positive that means there is some sort of clotting going on
o D-dimer test
255
prophylaxis for thrombosis
lovenox
256
hold lovenox is Platelets are below
100,000
257
meds for venus thrombosis
anticoagulants
| anti-inflammatory agents
258
tx of venus thrombus
relieve sx and reduce inflammation
warm compresses
rest
avoid tight fitting garments
avoid prolonged sitting/standing
259
o Get them walking within ???? if they are on anti-coagulant therapy
a day
260
NO ____ medications for venus thrombosis
IM injections
261
♣ A disorder of inadequate venous return over a prolonged period
• DVT most frequent cause
CHRONIC VENOUS INSUFFICIENCY
262
manifestions for chronic venous insufficiency
lower egg edema
itching
discomfort of affected extremity
263
with chronic venous insufficiency they have recurrent stasis ulcers where?
above the ankle
264
what to do with extremities with chronic venous insufficiency
o Elevate the extremity to decrease the swelling and increase blood return to the heart
265
used to get rid of the dead tissue so viable tissue can function
• Debridement;
266
♣ Cover every single edge
♣ Do not wet it to take it out easier, it defeats the purpose of removing the dead skin
o Wet-dry dressings
