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adult 2 exam 2 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

preload

A

how stretched the LV cardiac muscle is after the end of diastole.

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2
Q

afterload

A

amount of resistance the LV is ejecting against the aorta

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3
Q

stroke volume

A

amount of blood ejected with each heartbeat

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4
Q

cardiac output

A

amount of blood pumped out of LV each min!

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5
Q

how to calculate cardiac output

A

to calculate the amount of blood ejected in each MIN
you have to multiple SV(amount of blood ejected each heart beat) and heart rate(heart beats per minute)

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6
Q

what are we looking at when we look at a 12-EKG

A

its a ONE TIME THING we want to see the rhythm
that there has to be a P before every QRS
R to R distance is the same
QRS and T should be same direction
HEIGHTS DONT MATTER
hor: time
ver: amplitude
with hor and ver = you can calculate the heart rate.

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7
Q

what does it mean if the T wave is downwards and QRS is upwards

A

heart disease

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8
Q

what does each part of EKG mean

A

P: atrial depolarization
QRS: v depolarization and unseen atrical repolarization
T: v depolarization
U: you shouldn’t see this wave. if you do this is bad because its disease. its the Purkinje fibers contracting.

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9
Q

what does it mean if R to R and if there is P wave mean

A

normal sinus rhythm.
impulse is from SA node or pace maker

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10
Q

normal sinus rhythm

A

heart rate 60 to 100 bpm
reg rhythem
P wave before QRS
same R to R distance

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11
Q

sinus brady

A

less than 60
regular
p before QRS
same R to R distance

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12
Q

sinus tachy

A

more than 100
regular
p before QRS
same R to R distance

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13
Q

what is a fib

A

uncoordinated electrical activity. atrial muscle is twitching its NOT contracting to push blood into the ventricle. this is bad

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14
Q

how can we see a fib on EKG

A

no P before QRS
R to R distance don’t match

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15
Q

how can we treat afib

A

warfarin: for high risk for clots
metoprolol for HR and BP

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16
Q

how is a fib different from a flutter

A

its more organized whereas a fib is more chaotic and faster HR.
but there is not P wave. R to R waves are like saw tooth-like baby shark

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17
Q

what does ST elevation indicate

A

patient has chest pain so if they have ST elevation: plaque is building up and the patient is not getting oxygen.
there is ischemia: MI
pericarditis
HYPERkalemia

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18
Q

ST depression

A

valve disease
HYPOkalemia: digoxin

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19
Q

coronary atherosclerosis patho

A

coronary arteries give oxygen to heart muscles.
atherosclerosis is when cholesterol and lipids are building up and turning into a plaque(atheroma) to obstruct circulation.
THROWBACK: fatty streak starts to happen as a kid. but not all of them turn into lesions so it depends on their genetics or smoking or HTN. the lesions will trigger an inflammatory where monocytes(WBC) and platelets gather up. the smooth muscle starts to grow. the smooth muscle has a fibrous cap that covers the inflammation and lipids that is unstable. at some point its going to rupture. when this ruptures, more platelets/clotting factors causing blood to POOL. obstruction will cause an MI!!!

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20
Q

atheroma

A

walls of the arteries will start to accumulate lipids and scar tissue to make plaque.

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21
Q

signs and symptoms of coronary atherosclerosis

A

ASYMPTOMATIC
chest pain: no oxygen to heart
older patients: SOB, weakness and NO ANGINA because of neuropathy from DM
women: SOB, nausea, weaknes “GI problems”
signs and symptoms depend on where the plaque obstruction is

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22
Q

coronary atherosclerosis risk factors

A

Non-Modifiable: Age: men 45 women 55 Gender: men but women after 55 Race: AA Modifiable: HTN DM Diet Exercise.

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23
Q

what lab for coronary athero

A

FLP to see

cholesterol

tri

LDL

HDL

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24
Q

how often should patients get FLP

A
  • over 20? every 5 years
  • MI, CABG, Heart catheter? within few months of discharge, every 6 weeks then we check 4 to 6 months for maintenance
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25
Q

educate your parent with hyperlipidemia on diet

A
  • MEDI DIET: veggies and fish and only red meat 2 a twice
  • watch cholesterol should be less than 200mg PER DAY
  • sat fat should be 7 percent of the calories
  • fat should be between 25 to 35 percent of total calories(total calories depends on your weight) most fat should come from mono fats (20 percent) whereas poly is 10
  • carb is 50 to 60 percent
  • protein is 15 percent
  • fiber is 20 to 30 percent
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26
Q

educate hyperlipidemia parent on exercise

A

work out 30 mins a day but make sure you are able to talk while you exercise. exercising is good because this will get your blood circulating and lower the triglycerides in your blood.

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27
Q

educate your hyperlipidemia patient on smoking

A

smoking is bad because it can 1. activate your sympathetic NS and this causes an increase in HR and BP vasoconstriction which does not allow blood passage. 2. damages your BV so you increase in platelet aggregation. if the platelets stick together then clots can happen. 3. also hemoglobin will bind to CO2 instead of O2

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28
Q

what meds should we give to a patient with hyperlipidemia?

A

Statins and fibs restrict lipoproteins

Ezetimibe decreases cholesterol absorption

Chole (Bile) removes lipoprotein

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29
Q

when should we give statins and with what

A

food and at night because thats when most of the cholesterol is being made

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30
Q

angina patho

A

when the heart muscle is not getting enough oxygen.

stable angina: relieved by rest and nitro

unstable angina: NOT relieved by rest or angina STEMI BBY

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31
Q

patient is experiencing chest pain what should we tell them to do

A

sit down and rest so the pain can go away then take the nitro. dont just give them morphine give them O2 for oxygen

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32
Q

why do patients give chest pain

A

exercise

stress increases heart workload

cold weather bc vasoconstriction and body is using energy to warm up

heavy meal because all the blood goes to the GI tract for digestion

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33
Q

how do patients describe chest pain and ASK WHAT?

A

choking sensation

elephant on chest

indigestion

chest pain: neck, jaw, shoulder, left arm

SOB

DM patients: numbness in arms but watch out they might not feel anything at all

ASK: WHAT WERE YOU DOING THAT CAUSED THIS CHEST PAIN

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34
Q

what assessment do we need for chest pain

A

12 lead EKG

Troponin: draw 3 times 6 hours apart

Chest X-ray to rule out pulmonary issues

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35
Q

chest x-ray preparation

A
  1. No preggo
  2. no metals
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36
Q

Angina Drugs

A
  • nitro
  • beta blocker
  • calcium (amlodipine)
  • antiplatelet: ASA and Plavis
  • Anticoag: Heparin and Enoxaparin
  • O2
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37
Q

Nitro

What does it do?

Check what?

How many?

S/E?

route

DRUG INTERACTION

A

decreases preload and afterload

check BP

give nitro 3 times 5 mins apart NO WATER

HA and hypotension

tabs treat patches prevent

VIAGRA

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38
Q

nitro patch

patient (3)

nurse (1)

A

you can swim

take it off at night time

you can put it on chest, left arm, shoulder, or BACK

date time initial

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39
Q

beta blockers

assess what

educate patient about what?

contraindiacted in which patients

A

HR and BP bc blocks sympathetic NS

wean off to prevent rebound HTN and check blood sugars because it can mask hypoglycemia (shaking, sweating, sleepy, dizzy)

patients with asthma. CALL DR if patient has wheezes, crackles, or SOB

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40
Q

calcium channel blockers

what does it do

check what

A

prevent or reduce vasospasm which can be good especially during heart cath because that can cause vasospasms

BP

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41
Q

anti-platelet

max ASA

check what

avoid what

A

325 mg

check BP and HR(compensatory) H and H, Vitals, GI BLEEDS and BLEEDING

AVOID IM injections, frequent BP checks, drawing blood, starting IV sites. PUT PRESSURE IF PATIENT IS BLEEDING

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42
Q

anticoag

indications:

heparin

check what?

a/e

enoxparin

NURSE DO WHAT?

A

DVT

aptt(45 to 75) if IV

antidote: protamine sulfate

HIT

give the prefilled syringe with the airbubble to seal the med in the tissue

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43
Q

oxygen toxicity

A

N

V

nasal stuffiness

coughing

substernal pain

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44
Q

cardiac stress test

  1. what should the patient do before the test?
  2. what should the nurse do before the EKG
  3. why do we do this test?
  4. how do we do this test?
  5. what side effects can the vasodilators cause?
  6. how long does it take?
  7. max HR?
  8. what should the patient avoid?
  9. does the patient have a NPO status. if so, how many hours?
  10. what meds should we hold?
  11. when should we stop the test?
  12. what is a positive test?
  13. what should the nurse start and monitor?
  14. what should the patient do and should not do AFTER test?
A
  1. signed consent for CABG in case patient has heart attack and wear comfy shoes and clothes. make sure they do NOT work out three hours before this stress test
  2. baseline vitals
  3. stressing the heart to see how well the coronary arteries work. we want get 80 to 90 percent of HR
  4. arm cramp, treadmill, vasodilators
  5. flushing, HA, dizzy(annoying izzy is blushing)
  6. 1-3 hours
  7. max HR= 220- age
  8. alc, tobacco, caf
  9. yes, 4 hours NPO
  10. beta blockers because it drops the HR
  11. patient compains of chest pain, dizziness, fatigue, cramping.
  12. Pt complains EKG or vital changes STOP its a positive test
  13. IV SITE in case patient has a heart attack. Monitor the vital signs via telemetry and cold and clammy
  14. no baths after 1-2 hours after stress test because their vessels are dilated from the vasodilator or exercise.
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45
Q

Nursing Process for ANGINA

ASSESS

DX

Plan

NI

Eval

A
  • ASSESS
    • COLDSPA
    • Risk factors
    • what were you doing before
    • level of understanding
    • Physical assessment: Vitals, Aus Heart Lungs, Abdomen, Pulses, Edema
  • DX
    • Ineffective tissue perfusion
    • anxiety
    • deficient knowledge
  • Planning and Goals
    • Perserve heart muscles
  • NI
    • SIT DOWN
    • High-Fowlers
    • O2
    • Get vitals
    • EKG
    • Nitro
    • ANXIETY MANAGEMENT
    • balance activity and rest
    • educate their patient
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46
Q

REVIEW CASEE STUDY

A

REVIEW CASE STUDY

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47
Q

how good is nitro good for and how should the patient store it

A

6 months and patient should store it in a dark glass bottle

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48
Q

what diet should patients with angina be on if they have a lot of weight gain like 8 pounds in a week(should no more than 5 pounds)

A

sodium restriction: 2g

fluid restriction: 2L

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49
Q

MI is an acute coronary syndrome that includes

A

STEMI nonSTEMI and unstable angina

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50
Q

what is the GOAL of MI

A

we want to perserve cardiac muscle that isnt dead

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51
Q

what are signs and symptoms of MI

A

chest pain

SOB

N

anxiety

Indigestion

Cold, pale, moist, sweating skin

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52
Q

what is the FIRST med we should give to patient with MI since CP not relieved by nitro

A

nitro IV drip

morphine IV push

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53
Q

how can we diagnose patient with patient with MI

A

EKG: Read within 10 mins

Troponin: 3 times 6 hours apart

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54
Q

What other meds do we give with MI

A
  • Nitro
  • MORPHINE
  • Ace(DIREUTIC)
  • Beta
  • tPA
  • Anti-platelet
  • Anti-coag
  • CARDIAC REHAB
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55
Q

morphine

check what

A

RR

urine output: myoglobin?

SOB

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56
Q

ACE

check what

what does it do

A

check BP

diuretic because inhibits a1 converting and a2 and a2 stimulates aldosterone. now if you block aldosterone you will prevent the reabsorption of water and sodium retention.

remodels the heart muscles

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57
Q

tpa

given within?

indication

contraindicated?

A

6 hours

declots PICC lines or central lines

h. stroke, surgery in 3. weeks

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58
Q

why can’t we give patients with h stroke tpa

A

because it get rid of those protective clots

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59
Q

Nursing Process for MI

A
  • Assess
    • Baseline vitals
    • Aus Heart, Lung, Abdomen
    • COLDSPA
    • UO(could have AKI)
    • IV site(bc they can have another MI)
    • EKG reading
    • Assess for post MI
      • pulmonary edema
      • HF
      • Cardiogenic shock
  • NI
    • High Fowlers
    • VS every 4 hrs
    • BED REST
    • POST MI COMPLICATIONS
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60
Q

POST MI COMPLICATIONS

A

Cardiogenic shock

pulmonary embolism (NOTIFY DR IF THEY HAVE EDEMA OR CRACKLES)

heart failure

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61
Q

what should do you do if patient has positive stress test

A

Cardiac Cath

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62
Q

remember after troponin and EKG you do

A

cardiac stress test.

positive? cardiac cath

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63
Q

three types of perc. coronary interventions

A
  • perc trans luminal coronary angioplasty
  • coronary artery stent

atherectomy

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64
Q

PERCUTANEOUS CORONARY INTERVENTIONS

  1. what should patient do before
  2. what meds will the patient be on
  3. is this treatment GOLD
  4. what is this procedure
  5. what is stenosis
  6. What should the nurse assess before
  7. patient might feel:
  8. Is the patient NPO, if so how long?
  9. What should the nurse do for RIGHT after cath lab?
  10. how frequent should we take vital signs?
  11. What should the nurse ASSESS for?
  12. how should the nurse assess?
  13. Patient should be in what position
  14. How long should the patient should be in that position?
  15. Why is the patient in pain after cath lab?
A
  1. signed consent because patient can have ANOTHER MI so we gotta do CABG
  2. plavix and aspirin
  3. HELL YEAH GOLD STANDARD
  4. PCI: this procedure checks how bad the CAD is and stenosis. CAN USE WITH DYE so the doc is gonna go into via groin area into the femoral artery ALLL way to the coronary artery with a balloon tipped catheter to where the plaque is. The ballloon will INFLATE to crack that plaque and deflate and remove the balloon. 60 min procedure. CAS: Coronary artery stent: same shit but when balloon is up. a MESH STENT will be up there for structural SUPPORT. sometimes the doctor will coat the STENT with ASA. Atherectomy: shave that plaque
  5. narrowing of CORONARY blood vessels
  6. Assess renal function (UO), allergies,
  7. warm, flushed feelings
  8. yes, 8 hours
  9. VITAL SIGNS
  10. over 6 hours, every 15 mins in first hour, second hour 30 times 2, every hour times 4
  11. ASSESS GROIN FOR HEMATOMA (it should be soft. bad if its hard because hematoma is painful and its basically blood trapped under skin. Patient is going to be sleeping so they won’t know. Assess pedal pulses.
  12. Use a doppler for pedal pulses and marker it.
  13. supine.
  14. 6 hours
  15. BACK PAIN and HEMATOMA(BAD)
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65
Q

now why would we do a CABG

A

cardiac cath didn’t work

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66
Q

CABG

  1. what should the patient do before?
  2. nurse should get what before this procedure
  3. what is this procedure?
  4. what incisions will the patient have
  5. what meds can the doc stop and why?
  6. What should we assess for after the procedure when they come back 2 days after ICU
  7. what should the patient do after 48 hours? should they rest in bed after a CABG
  8. if they should ambulate, how many feet
  9. What labs should the nurse monitor
A
  1. signed consent
  2. baseline vitals and INCENTIVE SPIROMETRY
  3. this procedure is when a vessel from the leg is chosen and grafted to the occulded site to let more blood flow.
  4. check the small one on leg and big one chest
  5. stop the anti coags and platelets because of BLEEDING
  6. VS, UO (kidney damage), LOC, Aus Lungs Heart & Abdodmen, Tele
  7. NO REST. SIT in chair get. that blood moving to prevent lung collapse and DVT.
  8. yes AMBULATE. 25 to 100 feet
  9. infection (WBC, CBC) UO (AKI)
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67
Q

hypertension patho

A

BP=COxPR

cardiac output=amount of blood ejected per min

PR: peripheral resistance

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68
Q

why is hypertension is a silent killerr

A

asymptomatic. but it can damage your heart(MI) brain(stroke) eyes(vision loss), and kidneys(CKD). ⅓ of patients have it and they dont even know.

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69
Q

primary HTN

A

95 percent patients have this and its because of no IDENTIFIED cause

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70
Q

secondary HTN

A

Renal

Preggo

NSAIDs(fluid retention)

Tumor

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71
Q

HTN Expected findings

A

HA

dizziness

vision loss

fainting

but for the most part: no symptoms

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72
Q

How do we dx patient with HTN

A

2 or more readings on bare arms at heart level and patient is sitting.

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73
Q

when a patient has HTN was should we monitor

A

I and Os; UO BUN and Creat because HTN can ruin kidneys

HLD: hyperlipidemia is a risk factor

DM: glucose levels

EKG

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74
Q

HTN meds

A
  • DIURETICS
    • thiazide
    • loop
    • potassium sparing (amiloride)
    • spironolactone
    • beta
    • ACE
    • ARBs
    • Clonidine
    • Calcium channel
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75
Q

thiazide assess and do what

A

give this med with food because GI upset

assess K because K loss

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76
Q

loop

A

monitor BP because hypotension

HR idk why

get K too because K loss

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77
Q

why is clonidine given

A

for uncontrolled HTN

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78
Q

what should you do if your patient has hypotension

A

LAY YO HEAD ON MY PILLOW

lay their head so the blood can go to the brain

elevate legs 15 to 30 degrees

Trendelenburg

FLUID BOLUS

79
Q

HTN nursing process

A
  • assess
    • BP
    • heart, kidneys, eyes, brain check
    • aus lungs why? because fluid retention. secondary HTN can be from NSAIDs, kidney problems.
    • SES
  • NI
    • educate on noncompliance
    • older patients and orthostatic hypotension and involve their family because they can forget
80
Q

one drink of alc

A

12 oz of beer

5 oz of wine

1.5 oz of a shot

81
Q

pre HTN

A

120-139/80-89

82
Q

stage 1

A

140-159/90-99

83
Q

stage 2

A

more than 160/100

84
Q

hypertensive emergency

value?

treatment?

organ damage?

goal?

nursing care?

how often should we check the BP?

A
  1. 220/140
  2. IV sodium nitroprusside and nicardipine HCl
  3. YES
  4. bed rest and reduce MAP by 25 percent; next 6 hours 160/100 not too fast because it might mess up perfusion to organs
  5. automatic BP machine and check labs: BUN and Creat EKG!
  6. every 5 mins then 15-30 mins after stabilization
85
Q

hypertensive urgency

treatment

organ damage?

signs?

nursing care?

A
  1. PO
    1. beta
    2. ace
    3. clonidine
  2. NO
  3. HA nosebleeds anxiety
  4. heart, lungs, peripheral pulses, kidneys
86
Q

AAA main cause

A

atherosclerosis; the plaque is basically a weakended wall. so remember there are a lot of platelets so the platelets are probably pooling and creating like this bulge.

87
Q

AAA RISK FACTOR

A

elderly white men in 60s and 90s

88
Q

AAA risk factor

A

genes

smoking

HTN

89
Q

AAA sign

A

NO SYMPTOMS besides the pulsation of the abdomen. but you can hear a bruit SOMETIMES

90
Q

AAA patho

A

damage to media layer

trauma

genetics

91
Q

AAA diagnosis

A

CT scan

Ultrasound

92
Q

what size is okay for AAA

A

5.5 cm and smaller

93
Q

what do you do if the AAA is small and whats the goal

A
  1. monitor it for 6 months and check with the CT scan
  2. control the BP
  3. GOAL 100-120
94
Q

what do you do if the AAA is big bigger than what

A
  1. bigger than 5.5 cm, open surgical repair and endovascular grafting
95
Q

WHAT IS THE SIGN OF IMPENDING RUPTURE FOR AAA

and

WHY

A

SEVERE BACK PAIN

that AAA IS PRESSING ON THE LUMBAR NERVES

96
Q

how will a ruptured AAA affect vitals and labs

A

H and H drop

BP and HR rise

because of bleeding

97
Q

what is open surgical repair for

and where is the incision

A

AAA

surgeons will open up that vessel and place a graft (a man made tube) to replace the weakened vessel wall AFTER IT RUPTURED

incision: midline abdomen

98
Q

what is endovascular grafting

where is that incision

A

similar to cath lab.

surgeon will thread his way to the weakened vessel and put a stent there to get rid of that built up blood pressure.

GROIN

99
Q

how do you check endovascular grafting post op

A

SAME AS CARDIAC CATH

SO PLEASE LOOK AT THOSE

100
Q

hypovolemic shock

A

when your blood cant pump anymore because there is just too much fluid or blood loss

101
Q

what do you do if the AAA ruptures

A

doctor will want to do surgery but you start the IVs because we got to get that fluid(normal saline) and and blood transfusions running. thats your job as a nurse when vitals are tanking (comp mechanism)

102
Q

AAA post op directions

A

cath lab directions

pain assignment

vitals

aus heart lungs and abdomen listen for bruit

nutrition for healing

peripheral pulses, skin

I and O: HTN can affect the kidneys

ALSO TEACH THE PATIENT HOW TO DO DRESSINGS!

103
Q

Heart Failure Left sided

A
  • SOB
  • Low O2
  • S3 heart sound(V gallop so your LV is passively filling)
  • crackles
  • Cough
  • Frothy sputum
  • Altered mental status
  • fatigue
104
Q

Right Sided HR

A
  • peripheral and GI problems
  • JVD
  • edema
  • Ascites
  • Large Liver
  • Anoxeria
  • Nausea(stasis in the GI)
  • Weakness(losing blood)
  • WEIGHT GAIN so what DAILY WEIGHTS
105
Q

HF diagnostic procedure

A

BNP 0-100 pg/ml

echo

106
Q

(neurohormone that regulates fluid volume and blood pressure)

A

BNP

107
Q

BNP value

A

100 pg/ml

108
Q

echo ejection fraction

A

55 to 65 percent

109
Q

what is the echo if the patient askes

A

lay on the left side while patient is lying still. dr will take pictures of the heart it takes like an hour

110
Q

what is ejection fraction

A

the percent of blood pumped out of the LV

111
Q

lifestyle recs of HF

A
  • no more than 2g of salt
  • fluid restriction no more than 2L
  • empty bladder same clothes daily weights
112
Q

what medications can you give HF patients

A
  • ACE
  • Diuretics ( Lasix)
  • Beta-blockers
  • DIGOXIN
  • ARBs
  • Hydralazine
  • Isosorbide Dinitrate
113
Q

what does digoxin

A
  • treats HF and heart rhythm by increasing the myocardial contraction and contractility to RESTORE that rhythm.
  • reduces heart rate
  • decreases the workload of the heart
114
Q

what is the range for digoxin

A

0.8 to 2.0

115
Q

what should you do before you give digoxin

A
  1. apical heart rate(listen with stethoscope for ONE minute) and palpate the pulse.
  2. make sure both pulses match bilaterrally. we don’t want unequal heart rates.
  3. assess K levels because digoxin and K will compete for sodium and potassium channels.
116
Q

when giving digoxin what does more calcium mean

A

more contractility

117
Q

what are signs and symptoms

A
  • anorexia
  • N
  • V
  • Visual disturbances
    • halo
    • photophobia
    • blurred vision
    • double vission
  • Depression
  • brady
  • dysrthymia
  • fatigue
  • weakness
118
Q

how do you know digoxin is getting toxic

A

GI problems

Visual problems

HR problems (bradycardia)

119
Q

VESSEL

Various positions for arterial and venous disease

A
  1. Various positions that alleviate pain
    1. Arterial: pain is alleviated dangling(elevation makes pain because ischemia and blood flow is impeded). With arterial blood goes down not up
    2. Venous pain is elevated with an elevation of the legs because it helps decrease swelling and blood flow. Dangling hurts and makes edema worse
120
Q

VESSEL

explain the pain

A
  • Arterial Pain feels:
    • sharp WORST at night when RESTING
    • patients wake up from sleep from the pain
    • intermittent claudication: activity while severe pain because of activity uses up oxygen so it goes away when they rest it. (feel like leg day) calves, butt, thighs
  • Venous
    • heavy, dull, throbbing, and aching
    • blood is worse with standing and sitting(dangling)
121
Q

VESSEL

Skin of lower extremity

A
  • Arterial: issue with perfusion
    • Cool to touch
    • thin
    • dry/scaly
    • hairless
    • thick toenails
    • Dr. EP
    • dangle=red
    • elevate =pale
  • Venous
    • thick, tough skin
    • brownish
    • swollen from edema
122
Q

Strength of pulse in lower extremity

VESSEL

A
  • Arterial
    • Poor/Absent
    • GET DOPPLER
  • Venous
  • Present pulses
123
Q

VESSEL

Edema

A
  • Arterial
    • no edema
  • Venous
    • edema
124
Q

VESSEL

lesions(ulcers)

A
  • Arterial
    • end of toes
    • top of feet
    • lateral ankle region
    • little drainage
    • no tissue granulation (pink) or (necrotic)
    • punched out skin
  • Venous
    • medical parts of the lower legs
    • medial ankle
    • swollen with drainage
    • granulation deep pink to red
    • edges IRREGULAR
    • shallow
125
Q

what is PAD lower extremeties

A

it involves the narrowing and degeneration of the arteries in the neck, abdomen, and extremities.

126
Q

what is the main culprit behind PAD

A

atherosclerosis

127
Q

what age is mostly affected by PAD

A

60s and 80s

128
Q

what are risk factors for PAD

A
  • smoking
  • DM
  • HTN
  • hyperlipidmia
129
Q

what arteries are involved in PAD

PPTAF

A
  • Popliteal
  • Peroneal
  • Tibial
  • Aortoiliac
  • Femoral
130
Q

why does PAD experience paresthesia

A

nerves need oxygen too so you can have numbness, tingling, and pain.

injuries go unnoticed

131
Q

what are the complications of PAD

A
  • think of ariel and her tail is green
  • MOST SERIOUS
  • nonhealing
  • gangrene
  • amputation and infection
    • delayed wound healing
    • atrophy of skin and muscles
    • infection
    • necrosis
132
Q

why does everything die in PAD

A

NO BLOOD AND O2

133
Q

how to diagnose PAD

A

Doppler

Ankle-brachial index

Duplex

Angiography

MRA

134
Q

how can we diagnose PAD through doppler

A
  • in a normal person, BP is higher in the leg then upper extremities.
  • PAD is its the OPPOSITE
  • if the drop is greater than 30 in the doppler then the patient has PAD
135
Q

how can we diagnose PAD with ankle brachial index

A

also uses a doppler on ANKLE

the number is calculated when the patient is SUPINE. brachial and dorasalis pedis.

normal is 1.0-1.4

less than 0.91

less than 0.5 SEVERE

136
Q

duplex imaging

A

color doppler and it color codes the artherosclerosis

137
Q

angiography for PAD

A

visualizes the inside of the BV

138
Q

MRangiography

A

picture of BV with radiowave energy

139
Q

Drug therapy for PAD

A
  • Aspirin 325 MAX
  • Plavix
  • ACE inhibitor
    • vasodilators so lets blood flow happen. patient can walk more.
  • DRUGS for PAD
    • Cilo: vasodilates and walk more
    • Pento: makes blood less thicker
140
Q

PAD exercise therapy

A
  • 30 to 60 mins 3 to 5 times for 3 to 6 months
  • walk until pain rest then walk again
141
Q

PAD nutrition

A
  • BMI less than 25
  • waist
    • Men <40 inches
    • Women <35 inches
  • Cholesterol <200 mg
  • less than 2g
  • low fat, high veggies, and whole grain
142
Q

How to care for limb ischemia

A
  • Infection control
  • Revascularization
  • Trauma protection
  • Angiogenesis: gene therapy
  • Hyperbaric oxygen therapy
  • Pain management
  • Treat risk factors
143
Q

For Severe PAD: why would you do a percutaneous transluminal balloon angioplasty

A

cath lab

144
Q

what is the peripheral artery bypass

A
  • similar to CABG
  • where is synthetic femoral-popliteal artery graft is put is placed in
145
Q

what is last resort for PAD

A

amputation

146
Q

PAD Assess

A
  • Smoking
  • DM
  • Hyperlipidemia
  • HTN
  • Obesity
  • Exercise intolerance
  • Check the lower extremeties for loss of hair or thick toe nails.
  • do they have pulses?
    • ABSENT=EMERGENCY=could mean AMPUTATION
147
Q

Nursing Implementation

A
  • Diet
    • low sodium
    • low sat fat
    • high veggies
  • Proper foot care
  • Avoid injuries because numbness and delayed wound healing
  • TELL THEM TO AVOID knee flex position except for exercise
  • Turn and position 2x
  • AVOID tight clothes
148
Q

Thromboangities

Burgers Disease

A

Guys like SMOKED Burgers and RUN to get them

  • Young men < 40
  • Smokers
  • NO OTHER RISK FACTORS
  • Intermittent claudication
149
Q

how can we do atherectomy

A

use a rotating diamond tip, cutting, laser

150
Q

how can you treat burgers disease

A

sympathectomy: destroy sym. NV nerves for blood flow

151
Q

Raynaud’s phenoemnon

what is it

who is affected by it

what are the signs and symptoms

what are triggers

A
  1. young women who are 15 to 45
  2. vasospasms induced color change of finger, toe, ear, nose.
  3. coldness, numbness, throbbing, aching pain, tinging, swelling
  4. exposure to cold, emotions, tobacco, caffiene
152
Q

what colors does raynauds change to

A

white to blue

black to red

153
Q

Raynauds diseases

A
  • loose warm clothes
  • gloves
  • avoid extreme temps
  • immerse water in warm water
  • avoid caf, drugs that vasoconstrict like sudafed
  • reduce stress
154
Q

Raynauds

A

Calcium channel

Symphatehtacmy

155
Q

Virchows triad

A
  1. Venous stasis
  2. Endothelial damage
  3. hypercoagulability of blood
156
Q

venous stasis

A

veins valves don’t work so blood can back blow

157
Q

virchows triad

the reason behind venous thrombosis

A
  1. venous stasis
  2. endothelial damage
  3. hypercoag
158
Q

venous stasis

A

vein valves don’t work so blood can back flow

159
Q

endothelial damage

A

platelet activation

coagulation activation

160
Q

hypercoagulability of blood

A

smoking

oral BC

hormone replacement

build up of platelets and RBCs

161
Q

SVT

A

caused by a swollen IV port

162
Q

what should the nurse do when we have a SVT(thromplebitis)

A
  1. remove IV
  2. elevate arm to reverse edema and pain
  3. warm and most heat can help relieve their pain
163
Q

SVT signs and symptoms

A
  • red
  • swollen
  • warm
  • tender
  • WBC UP
164
Q

how should you treat SVT

A

warfarin

Lovenox

NSAIDS

compression stockings

exercise

NSAIDs BUT DONT GIVE WITH WARFARIN> BLEEDING RISK

165
Q

VTW (DVT)

venous thromboembolism

A

unilateral edema, pain, paresthesia, erythema, fever

166
Q

what are complications of DVT

A

PE

CVI

Phlegmasia

167
Q

how do diagnose VTE

A

aPTT INR

H and H

platelet

D-dimer

Ultrasound

168
Q

D-dimer normal value

A

less than 250 ng/ml

169
Q

what does the d-dimer tell you

A

theres a CLOT

170
Q

nonpharm preventions for DVT

A

mobilization

compression stocking

SCDs

171
Q

when should you wear compression can be worn

A

ACTIVE CLOT

172
Q

when should you wear the SCDs stocking

A

NO ACTIVE CLOT AND WEAR IT AT ALL TIMES

173
Q

why cant you wear SCDs when you have a clot

A

it will dislodge the clot and can cause PE or stroke

174
Q

what is the drug therapy for DVT

A
  • warrfarn
  • heparin
  • enoxparin
  • apixaban
  • tpa
  • direct thrombin inhibitor HIRUDIN
175
Q

Heparin IV

A

normal 20 to 39 seconds

therapeutic 50 to 100 seconds

176
Q

what should the patient wear if they are on anticoag

A

bracelet!

177
Q

what meds should patients AVOID with anticoags

A

Ginkgo and ginseng

Allopurinol

Cimetidine

Phenotyoin

Corticos

Oral hypoglycemic

NSAIDs

Saliculiates

Sulfonamides

178
Q

what is the surgerry. for DVT

A

open. venous thrombectomy

179
Q

what is the open venous thrombectomy

A
  • you cut the vein and remove the clot using a greenfield stainless steel filter. to prevent PE.
180
Q

inferior vena cava interruption

A

greenfield stainless steel filter to prevent pulmonary embolism. you have to CATCH the clot before it can turn into a pulmonary embolism

181
Q

ambulatory care for VTE

A

WEAR SOCKS FOR 2 YEARS

182
Q

what should you educate the patient

A

wear socks for two years

stop smoking

no tight clothes

INR

NO BIRTH CONTROL OR HORMONE THERAPY

don’t stand or sit too long

183
Q

pulmonary embolisms

A

Chest pain

SOB

BLOOD IN SPUTUM

184
Q

what cant you do if the patient has a PE

A

homans sign

SCD

185
Q

varicose veins patho

A

valves cant close properly so blood is backflowing

186
Q

varciose veins risk factors

A
  • pregnancy
  • female
  • age
  • constipation STANDING
  • job
  • obesity
  • chronic cough
  • family history
    *
187
Q

varicose veins signs

A
  • tortuous veins
  • heavy, aching feeling or pain after standing
  • pressure, itching,burning or cramplike sensation (think of how you feel when you do dishes)
  • swelling, noctural craamp
188
Q

varicose vein complications

A

SVT(supervein vein thrombosis)

rupture

skin ulcers

189
Q

varicose veins dx

A

appearance

duplex ultrasound

190
Q

varicose veins collab

A
  • rest with limb elevation
  • graduated compression stockings
  • SCLEROTHERAPY
191
Q

sclerotherapy

A

special agent to shrink the vessel

192
Q

complications of varicose veins sclerotherapy

A

hyperpigmentation

pain

itching blistering

193
Q

CVI patho

A

valve problems

194
Q

CVI ucler care

A

high protein

wound care: moist environmental steril saline with gauze. leave a dressing on for 3 to 5 days

adult 2 exam 2 (3 decks)

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