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Illness and Patho 1 > Cardiac > Flashcards

Cardiac Flashcards

0
Q

What controls the modulation of BNP?

A

Calcium

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1
Q

Peptide secreted by ventricles of the heart in response to excessive stretching of the heart muscles

A

Brain Natriuretic Peptide

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2
Q

In a heart failure patient, what would the BNP levels look like?

A

Elevated

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3
Q

System that regulates blood pressure and water balance

A

Renin Angiotension Aldosterone System

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4
Q

The volumetric fraction of blood pumped out of the ventricle with each heartbeat or cardiac cycle

A

Ejection Fraction

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5
Q

What is a normal ejection fraction?

A

70%

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6
Q

What is the danger level of ejection fraction?

A

<55%

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7
Q

The volume of blood pumped from one ventricle with each beat

A

Stroke volume

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8
Q

The stoke volume of the heart increases in response to an increase in the volume of blood filling the heart when all other factors remain constant

A

Starling’s Law

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10
Q

The intrinsic ability of the heart to squeeze; the potential of the myocyte to contract

A

Contractility

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11
Q

What is the most accurate measure of how a heart patient is doing?

A

Ejection fraction

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12
Q

Pressure needed to open the aortic valve

A

Impedance

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13
Q

Myocardial fiber stretch, determined by the amount of blood at the end of diastole and by the pulmonary system

A

Preload

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14
Q

The resistance against which the left ventricle must eject its load

A

Afterload

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15
Q

High density lipoproteins that enable the transportation of lipids such as cholesterol

A

HDL

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16
Q

Low density lipoproteins that enable the transportation of lipids such as cholesterol

A

LDL

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17
Q

Stretching the heart too much will cause it to explode

A

Starling’s Law

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18
Q

What is the good cholesterol?

A

HDL

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19
Q

What should the HDL levels be?

A

Greater than 40

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20
Q

What should the LDL levels be?

A

Less than 100

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21
Q

Occurs when the kidneys leak small amounts of albumin in the urine indicating protein breakdown and heart disease?

A

Microalbuminuria

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22
Q

Glycerol and a three fatty acid chain that help enable the bidirectional transference of adipose fat and blood glucose from the liver

A

Triglycerides

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23
Q

What should triglyceride levels be?

A

Lower than 150

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24
Q

Protein produced by the liver that rises when there is inflammation throughout the body, especially in the heart

A

C-Reactive protein

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25
Q

A non-protein amino acid which high levels of are linked to cardiovascular disease

A

Homocysteine

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26
Q

What is the left atrial valve?

A

Mitral

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27
Q

What is the normal stroke volume?

A

50 mL/contraction

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28
Q

What is the formula for cardiac output?

A

CO = HR x SV

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29
Q

What is the normal cardiac output?

A

4-7 L/min

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30
Q

What factors affect preload?

A

Blood volume, muscle fiber length, and tension

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31
Q

As preload increases, what also increases?

A

Oxygen demand

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32
Q

What is the right atrial valve?

A

Tricuspid

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33
Q

What factors affect after load?

A

Blood pressure and the diameter of the blood vessels

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34
Q

As after load increases, what decreases?

A

Cardiac Output

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35
Q

What factors influence impedance?

A

Blood viscosity, arterial constriction, and aortic compliance

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36
Q

What are the two major divisions of the circulatory system?

A

The systemic division and the pulmonary division

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37
Q

What are the semilunar valves?

A

Aortic and pulmonic

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38
Q

What does cold air do to systemic vascular resistance?

A

Increases it

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39
Q

What are the non-modifiable risk factors for cardiac disease?

A

Family history, diabetes mellitus, gender, and age

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40
Q

Which gender is at the biggest risk for cardiac disease?

A

Men until women reach menopause, then it equals out

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41
Q

Why do women with cardiac disease fair worse then men?

A

They have less collateral circulation

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42
Q

What is the dominant artery in females?

A

The right anterior decending

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43
Q

Why do older patients with coronary artery disease fair better than younger patients?

A

They have developed better collateral circulation

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44
Q

What values indicate metabolic syndrome?

A

Fasting glucose > 100, low HDLs, triglycerides > 150, BP >130/85, and waist circumference > 35” (F) or 40” (M)

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45
Q

What causes hyperurecemia and gout?

A

Increased uric acid produced by and excess of meats and alcohol

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46
Q

What diseases that occur during pregnancy increase the risk of cardiovascular disease later in life?

A

Preeclampsia and gestational diabetes

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47
Q

What does heavy alcohol intake increase the risk of?

A

Hypertension, arrhythmias, and heart disease

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48
Q

What cardiovascular problems does cocaine cause?

A

Spasms of the coronary arteries, atherosclerosis, and thrombosis

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49
Q

What cardiovascular problems do amphetamines cause?

A

Acute hypertension, arrhythmias, myocardial infarctions, and cardiomyopathy

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50
Q

What history should a patient with dyspnea be asked?

A

When did you first notice it, what brings it on, how is it relieved, and if they are taking any meds for it

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51
Q

What history should a patient with orthopnea be asked?

A

Number of pillows to sleep and the onset of the symptoms

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52
Q

What history should a patient with paroxysmal nocturnal dyspnea be asked?

A

Ask about sudden onset and termination

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53
Q

What history should a patient with a cough be asked?

A

When was it first noticed, is it productive, is it dry or moist, when did it first occur

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54
Q

What does a dry cough indicate?

A

Cardiac related without heart failure

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55
Q

What does a moist cough indicate?

A

Respiratory causes

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56
Q

What does a night cough indicate?

A

Cardiac related

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57
Q

What history should a patient with fatigue be asked?

A

What activities can no longer be performed, how often do you need to rest, and do you nap during the day

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58
Q

What history should a patient with chest discomfort be asked?

A

Type, location, how often, what precipitates it, and what alleviates it

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59
Q

What does a weight increase in a cardiac patient indicate?

A

Fluid increase

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60
Q

What is the most common symptom that brings patients with cardiac problems to the doctor?

A

Fatigue

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61
Q

What is an appropriate BMI range?

A

18.5 kg/m2 and 24.9 kg/m2

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62
Q

Why is BMI not alway accurate?

A

It doesn’t take the weight of muscles into account

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63
Q

What does a BMI of over 25 indicate?

A

The patient is overweight

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64
Q

What does a BMI of over 30 indicate?

A

The patient is obese

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65
Q

What does waist circumference indicate?

A

Central obesity

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66
Q

What should a patient’s head and neck be evaluated for?

A

Carotid bruits, JVD, and xanthomas

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67
Q

What is an early sign of CHF?

A

S3 heart sound

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68
Q

What does an S4 heart sound indicate?

A

Hypertension

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69
Q

What would a dissecting aorta present as?

A

Searing, unrelenting back pain

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70
Q

What are the mitral and aortic changes related to calcification that occur normally with age?

A

Murmurs, valve changes, and possibly rhythm changes

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71
Q

Fatty deposits around the eyes

A

Xanthomas

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72
Q

What do the decreased number of pacemaker cells that occur with advancing age cause?

A

Dysrhythmias and a slower heart rate

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73
Q

As people age, conduction time increases and what occurs?

A

PVCs

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74
Q

The increase of fat and fibrous tissue in the SA node that occurs with age results in what?

A

A loss of inherent rhythm

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75
Q

What do xanthomas indicate?

A

Elevated cholesterol levels

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76
Q

As people age, how does the left ventricle change?

A

Increases in size, stiffens, and undergoes fibrotic changes, undergoes hypertrophy

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77
Q

What do the changes that occur in the left ventricle with age result in?

A

Decreased ejection fraction, activity intolerance, and a decrease in diastolic filling

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78
Q

As people age, how do the aorta and arteries change?

A

They thicken and stiffen

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79
Q

What do the changes that occur in the aorta and arteries with age result in?

A

Hypertension, increased SVR, and there is a risk of target organ damage

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80
Q

As people age, what happens to their baroreceptors?

A

They become less sensitive

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81
Q

What does the decrease in sensitivity of the baroreceptors cause?

A

Orthostatic hypothension

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82
Q

As people age, what changes does the SA node undergo?

A

Increases in fat and fibrous tissue

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83
Q

What does the lipid panel measure?

A

Cholesterol, lipoproteins, and triglycerides

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84
Q

What causes an increase in lipid panel measurements?

A

Atherosclerosis

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85
Q

What is the emerging risk factor and indicator of metabolic syndrome?

A

Triglycerides

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86
Q

What should a patient’s total cholesterol be?

A

Less than 200 mg/dL

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87
Q

What should be Lp(a) levels be?

A

Less than 30 mg/dL

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88
Q

What is a lipoprotein-a?

A

A modified LDL

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89
Q

What c-reactive protein level is normal?

A

1 mg/dL

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90
Q

What c-reactive protein level indicates risk for heart disease?

A

> 3 mg/dL

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91
Q

Elevated c-reactive protein levels in patients over 60 indicate which type of drug therapy?

A

Statins

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92
Q

What do high levels of homocysteine cause?

A

Cell walls become vulnerable to plaque buildup

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93
Q

What are high levels of homocysteine treated with?

A

Dietary sources of B vitamins

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94
Q

What does a fasting blood glucose test for?

A

Metabolic syndrome and diabetes

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95
Q

What does creatinine test for?

A

Chronic renal insufficiency

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96
Q

What are ECGs used to evaluate?

A

Left ventricular hypertrophy

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97
Q

What does left ventricular hypertrophy indicate?

A

Longstanding hypertension

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98
Q

What does a patient undergoing an Exercise Treadmill Test have to be watched for?

A

Rebound effect

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99
Q

Why is Chantix a preferred smoking cessation treatment?

A

It doesn’t have nicotine in it

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100
Q

How to you know that you are exercising at an appropriate level?

A

The patient is in a target heart rate and has no chest pain

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101
Q

Why is the “Heart Healthy Diet” no longer recommended?

A

It is too high in sugar

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102
Q

Why are soluble fibers good for your diet?

A

Binds fat in the intestine and helps to lower cholesterol levels

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103
Q

Drugs used to lower LDL and triglyceride levels when diet isn’t enough

A

Statins

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104
Q

How much does statins lower total cholesterol levels by?

A

20%

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105
Q

Name the statins

A

Zocor, mevacor, lipitor, crestor, and pravachol

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106
Q

What is the action of statins?

A

They reduce cholesterol synthesis in the liver and increase clearance of LDL from the blood

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107
Q

What symptom indicates that statins should be stopped?

A

Muscle pain

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108
Q

In what patients are statins contraindicated?

A

Patients with liver disease, pregnancy, rhabdomyolysis, and cholestasis

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109
Q

What needs to be monitored for patients on statins?

A

Liver enzymes, total cholesterol levels, CPK levels, and PT

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110
Q

When should statins be taken?

A

In the evening

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111
Q

What needs to be avoided by a patient on statins?

A

Grapefruit

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112
Q

Ezetimibe, used in place of or with statins to inhibit absorption of cholesterol through small intestines

A

Zetia

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113
Q

Combo of ezetimibe and simvastatin

A

Vytorin

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114
Q

Lowers LDL and VLDL and increases HDL

A

Niacin

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115
Q

What side effect is associated with niacin?

A

Flushing

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116
Q

What needs to be monitored when a patient is on niacin?

A

Liver enzymes

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117
Q

Combines niacin and lovastatin

A

Advicor

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118
Q

Reduce triglycerides and decreases plaque, inflammation, and clots

A

Omega-3 Fatty Acids

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119
Q

A chronic disease of the arterial system including abnormal thickening and hardening of the vessel walls

A

Arteriosclerosis

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120
Q

What causes the stiffening of arteries in arteriosclerosis?

A

Smooth muscle cells and collagen fibers migrate to the tunica intima

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121
Q

What molecules affect arteriosclerosis?

A

Cholesterol, lipids, and phospholipids

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122
Q

What are the modifiable risk factors for arteriosclerosis?

A

Obesity, sedentary lifestyle, smoking and stress

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123
Q

What diseases exacerbate arteriosclerosis?

A

Hypertension or poor tissue perfusion

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124
Q

What is the leading cause of coronary and cerebrovascular heart disease?

A

Atherosclerosis

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125
Q

How does atherosclerosis occur?

A

Soft deposits of intra-arterial fat and fibrin in vessel walls harden over time

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126
Q

At what point will a patient realize they have atherosclerosis?

A

Only when a complication occurs

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127
Q

How does arteriosclerosis occur?

A

The artery gets damaged, setting off an inflammatory response and leading to cholesterol flooding the vessel, making it sticky

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128
Q

Why does an injured vessel get sticky?

A

Injured cells produce lower amounts of antithrombic and vasodilating cytokines

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129
Q

What are the causes of injuries to arteries that lead to arteriosclerosis?

A

Elevated blood sugars and hypertension

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130
Q

How is a foam cell formed?

A

LDL is engulfed by macrophages

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131
Q

What is the pathophysiology of arteriosclerosis?

A

Injury, cellular proliferation, macrophage migration, LDL oxidation, foam cell formation, foam cell accumulation leads to a fatty streak, fibrous plaque, and complicated plaque

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132
Q

What are the clinical manifestations of arteriosclerosis?

A

Inadequate tissue perfusion, TIA, superimposed thrombus formation, and tissue infarction

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133
Q

What are TIAs associated with?

A

Exertion, exercise, or stress

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134
Q

What is the goal for patients with arteriosclerosis?

A

Restore tissue perfusion

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135
Q

Measure of force applied to walls of the arteries as the heart pumps blood throughout the body

A

Blood pressure

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136
Q

What factors determine blood pressure?

A

Strength of the contraction, amount of blood pumped into the arteries, viscosity of blood and size and flexibility of arteries

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137
Q

Who has smaller arteries?

A

Women

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138
Q

Elevated systolic and/or diastolic blood pressure

A

Hypertension

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139
Q

If a patient has heart disease or diabetes, what is the recommended blood pressure?

A

<130/90

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140
Q

What is the recommended blood pressure for average patients?

A

<120/80

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141
Q

What does an increased blood pressure do to the workload of the heart?

A

Increases it

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142
Q

What does an increased blood pressure do to the physiology of the heart?

A

Causes it to enlarge and weaken

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143
Q

What population in the US is at higher risk for hypertension?

A

Male african americans and people with diabetes

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144
Q

What are the parameters for prehypertension?

A

120-139/80-89

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145
Q

What part of the nervous system regulates blood pressure?

A

Autonomic nervous system

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146
Q

What aspects of blood pressure are controlled by the autonomic nervous system?

A

Controls vessel diameter and peripheral vascular resistance

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147
Q

Which hormones of the autonomic nervous system regulates blood pressure?

A

Epinephrine and Norepinephrine

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148
Q

What does the sympathetic nervous system do in response to lowered blood pressure?

A

Increases heart rate, speed of conduction, contractility and peripheral vasoconstriction

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149
Q

What does the parasympathetic do in response to increased blood pressure?

A

Decreases heart rate, contractility and conductivity

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150
Q

Which hormone controls the parasympathetic nervous system’s response to increased blood pressure?

A

Acetylcholine

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151
Q

What do chemoreceptors respond to changes in?

A

PaO2, PaCO2, and pH

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152
Q

What do chemoreceptors do?

A

Stimulate vasomotor center in the medulla controlling vasoconstriction and vasodilation

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153
Q

Where are the baroreceptors located?

A

Carotid sinus, aorta, and left ventricular wall

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154
Q

What are the parameters for Stage 1 hypertension

A

140-159/90-99

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155
Q

What do baroreceptors respond to changes in?

A

Arterial pressure

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156
Q

How do the baroreceptors counteract a rise in arterial pressure?

A

Through the vagus nerve

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157
Q

What do the baroreceptors do?

A

They slow pulse and cause vasodilation

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158
Q

What causes baroreceptors to fail?

A

Hypertension

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159
Q

How does the amount of fluid in the ECF regulate blood pressure?

A

The increase in Na causes increased blood return to the heart, increased cardiac output, and diuresis

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160
Q

What changes does ADH undergo in response to blood volume?

A

Decreases in response to increased volume, increases in response to decreased volume

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161
Q

How does the R-A-A-S regulate blood pressure?

A

A rise in cardiac output produces diuresis, and stimulates Angiotensin 2 and aldosterone to constrict vessels and promote water retention

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162
Q

What are the parameters for Stage 2 hypertension?

A

> 160/>100

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163
Q

What does inappropriate secretion of renin increase?

A

PVR in essential hypertension

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164
Q

When blood pressure increases, what should renin do?

A

Fall

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165
Q

Idiopathic hypertension with no known cause

A

Primary or essential hypertension

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166
Q

How many of the cases of hypertension does primary hypertension account for?

A

92-95%

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167
Q

Hypertension caused by a systemic disease process that raises peripheral vascular resistance or cardiac output?

A

Secondary hypertension

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168
Q

Rapidly progressing elevation of blood pressure to >200/>130

A

Malignant hypertension

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169
Q

What are the symptoms of malignant hypertension?

A

Blurred vision, headaches, dyspnea, and uremia

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170
Q

Increased waste products in blood signifying a renal problem

A

Uremia

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171
Q

As we age, which is a better indicator for heart disease and stroke, systolic or diastolic blood pressure?

A

Systolic Blood Pressure

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172
Q

What is the most common form of hypertension in older adults?

A

Isolated systolic hypertension

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173
Q

What type of hypertension does white coat syndrome cause?

A

Isolated systolic hypertension

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174
Q

What diseases cause secondary hypertension?

A

Renal dysfunction, dysfunction of the adrenal medulla or cortex, primary aldosteronism, pheochromocytoma, Cushing’s syndrome, coarctation of the aorta, neurogenic disturbances, and medications

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175
Q

Why does a pheochromocytoma cause hypertension?

A

Excretes lots of epinephrine

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176
Q

What does aldosterone do to blood pressure and how?

A

It promotes sodium and therefore water retention, raising blood pressure

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177
Q

What is coarctation of the aorta?

A

Narrowing of the aorta

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178
Q

Chronic hypertensive damage to the walls of systemic blood vessels

A

Complicated hypertension

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179
Q

What accompanies complicated hypertension?

A

Target organ damage

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180
Q

What happens to the vasculature in patients with complicated hypertension?

A

Formation, dissection, rupture of aneurysms, occlusion, and edema

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181
Q

What happens to the renal system in patients with complicated hypertension?

A

Nephrosclerosis, renal arteriosclerosis, and renal insufficiency and failure

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182
Q

What is an early sign of renal damage caused by hypertension?

A

Protein in urine

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183
Q

What happens to the retinas of patients with complicated hypertension?

A

Impaired vision, retinal vascular stenosis, hemorrhage, and exudation

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184
Q

What happens to the brain of patients with complicated hypertension?

A

TIA, stroke, cerebral thrombosis, aneurysm, hemorrhage, and cognitive decline in the elderly

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185
Q

How is primary hypertension treated?

A

Diuretics, beta blockers, and ACE inhibitors

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186
Q

What do beta blockers or ACE inhibitors treat in patients with primary hypertension?

A

Overstimulation of sympathetic neural fibers in the heart and great vessels

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187
Q

What do diuretics treat in patients with primary hypertension?

A

Increased blood volume, water and sodium retention, and the hormonal inhibition of Na-K transport across cell walls

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188
Q

What diuretic should patients with primary hypertension be on?

A

Spironalactone

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189
Q

What should patients with primary hypertension try first for treatment?

A

Life style modification

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190
Q

What diagnostic workups should be done for patients with hypertension?

A

ECG, urinalysis, blood glucose, Hct, lipid panel, serum K, Ca, creatinine, and BUN

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191
Q

What would an ECG show to diagnose hypertension?

A

Evidence of left atrial and ventricular hypertrophy

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192
Q

Why is an urinalysis obtained in patients with hypertension?

A

To indicate whether there is renal damage from that hypertension

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193
Q

What diuretics can be given to patients with hypertension?

A

HCTZ, Lasix, Bumex, or Aldactone

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194
Q

What do calcium channel blockers do?

A

Interfere with membrane transfer of Ca leading to vasodilation

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195
Q

What are the calcium channel blockers?

A

Amlodipine and Cardizem

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196
Q

What do ACE inhibitors do?

A

Inhibit the enzyme that converts Angiotensin 1 to Angiotensin 2, preventing vasoconstriction

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197
Q

What are the ACE inhibitors?

A

Enalapril, captopril, and prinivil

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198
Q

What is a side effect of ACE inhibitors?

A

Dry, hacking cough, and fluid trapped in lower extremities

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199
Q

What do ARBs do?

A

Block Angiotensin 2 from binding to its receptor, thereby blocking vasoconstriction

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200
Q

What are the ARBs?

A

Losartan, candesartan, and telmesartan

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201
Q

What do the aldosterone receptor antagonists do?

A

Block aldosterone binding at receptor sites in the kidney, heart, blood vessels, and brain, thereby inhibiting water and sodium retention, reducing total plasma volume

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202
Q

What are the aldosterone receptor antagonists?

A

Inspra

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203
Q

What do beta blockers do?

A

Decrease contractility and heart rate, decreasing cardiac output

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204
Q

What are the beta blockers?

A

Metoprolol, atenolol, Coreg, Zebeta

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205
Q

What needs to be checked before administering a beta blocker?

A

Heart rate and blood pressure

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206
Q

What do central alpha agonists do?

A

Prevent uptake of norepinephrine, thereby decreasing vascular resistance

207
Q

What are the central alpha agonists?

A

Clonidine

208
Q

What do alpha adrenergic agonists do?

A

Dilate arterioles and veins, decreasing PVR

209
Q

What are the alpha adrenergic agonists?

A

Minipress

210
Q

What do renin inhibitors do?

A

Inhibit vasoconstriction and aldosterone production, reducing Na reabsorption and fluid retention

211
Q

What are the renin inhibitors?

A

Aliskiren

212
Q

What is the best medication for patients with heart disease?

A

Beta blockers

213
Q

What needs to be monitored when a patient is on antihypertensives?

A

Vital signs, orthostatic blood pressures, and electrolytes, especially potassium

214
Q

In general, when would you hold an antihypertensive medication?

A

Systolic < 90, diastolic <60

215
Q

How long should nicotine and caffeine be withheld after administering an antihypertensive?

A

1 hour

216
Q

What activities should be avoided for patients on antihypertensive medications?

A

Hot tubs, saunas, alcohol, and exercise

217
Q

How often should home blood pressures be taken?

A

Once a week

218
Q

What does a patient on antihypertensive meds need to be taught?

A

Lifetime therapy, orthostatics, sodium restriction, water restriction, and relaxation techniques

219
Q

When does a hypertensive crisis occur?

A

When patient’s hypertension has been poorly controlled, undiagnosed, or if they have abruptly stopped taking their medications

220
Q

What is the treatment for a hypertensive crisis?

A

IV antihypertensives

221
Q

What are the IV antihypertensives used in a hypertensive crisis?

A

Nipride, Cardene, and normodyne

222
Q

What types of drugs are the IV antihypertensives?

A

Potent beta blockers

223
Q

What do IV antihypertensives need to be protected from?

A

Light

224
Q

How often should the blood pressure of a patient in a hypertensive crisis be monitored?

A

Every 5 minutes

225
Q

Who is most at risk for heart failure?

A

African Americans

226
Q

Why is heart failure a major cause of death and disability after a MI?

A

Because the heart muscle is destroyed

227
Q

General term used to describe several types of cardiac dysfunction that results in inadequate perfusion of tissues with blood borne nutrients

A

Heart failure

228
Q

What are the types of heart failure?

A

Left sided, right sided, and high output heart failures

229
Q

What proceeds 75% of heart failure cases?

A

Hypertension

230
Q

What disease causes heart failure because of pulmonary and aortic stenosis?

A

Rheumatic heart disease

231
Q

What population is most at risk for endocarditis?

A

Drug abusers

232
Q

What is the most common dysrhythmia?

A

Atrial fibrillation

233
Q

Which type of drug attacks the heart muscle?

A

Mycins

234
Q

What are the causes of heart failure?

A

Hypertension, CAD, cardiomyopathy, alcohol and drug abuse, valve disease, congenital defects, cardiac infections, dysrhythmias, diabetes mellitus, smoking, family history, hyperthyroidism, and chemotherapy

235
Q

What is the most common type of heart failure?

A

Left sided heart failure

236
Q

What are the causes of left sided heart failure?

A

Hypertension, CAD, and valvular disease

237
Q

What are the clinical manifestations of left sided heart failure?

A

Decreased CO and severe pulmonary congestion

238
Q

Is systolic or diastolic heart failure more common?

A

Systolic

239
Q

With systolic heart failure, what happens to preload, after load, ejection fraction, and tissue perfusion?

A

Preload increases, after load increases, ejection fraction decreases and tissue perfusion decreases

240
Q

Left ventricle can’t relax enough during diastole, preventing inadequate filling

A

Diastolic heart failure

241
Q

What happens to the ventricles during diastolic heart failure?

A

They stiffen

242
Q

With diastolic heart failure, what happens to stroke volume, CO, and ejection fraction?

A

All remain normal

243
Q

Decreased contractility of the heart, causing the heart to not be able to eject adequate blood

A

Systolic heart failure

244
Q

What is the sign of systolic heart failure?

A

Increase pulmonary blood, so crackles in the lungs

245
Q

Who is more at risk for diastolic heart failure?

A

Older adults and women post MIs

246
Q

What is the sign of diastolic heart failure?

A

Crackles in the lungs

247
Q

What happens to the coronary vessels of patients with diastolic heart failure?

A

They don’t get perfusion and adequate filling, causing a buildup of lactic acidosis

248
Q

What are the symptoms of left sided heart failure?

A

Fatigue, weakness, activity intolerance, oliguria, confusion, restlessness, dizziness, tachycardia, palpitations, chest discomfort, arrhythmia, S3 gallop, pallor, pulmonary congestion, dyspnea, orthopnea, tachypnea, cough, and paroxysmal nocturnal dyspnea

249
Q

What arrhythmias are common in patients with left sided heart failure?

A

Atrial fibrillation, PACs, and PVCs

250
Q

What are the early signs of left sided heart failure?

A

Coughing at night and S3 gallop

251
Q

Where would adventitious lung sounds be heard in patients with left sided heart failure?

A

Crackles and wheezes heard from the bases up

252
Q

When would frothy pink-tinged sputum be seen in patient with left sided heart failure?

A

As it progresses to include pulmonary edema

253
Q

Why does pulmonary pressure increase in patients with left sided heart failure?

A

The left ventricle fails to eject sufficient blood

254
Q

What are the signs of pulmonary edema?

A

Crackles, dyspnea at rest, anxiousness, tachycardia, disorientation, and confusion

255
Q

What are the signs of worsening pulmonary edema?

A

Pink, frothy sputum, cold and clammy, and cyanosis

256
Q

The right ventricle is unable to empty completely, causing increased volume and pressure in the systemic veins

A

Right sided heart failure

257
Q

What is the most common cause of right sided heart failure?

A

Diffuse hypoxic pulmonary disease

258
Q

What are the signs of right sided heart failure?

A

Peripheral edema, JVD, hepatomegaly, splenomegaly, distended abdomen, increases abdominal girth, ascites, nocturnal polyuria, weight gain, anorexia, and nausea

259
Q

Where would peripheral edema be seen in patients with right sided heart failure?

A

From the lower legs and ascending

260
Q

What causes the anorexia and nausea seen in patients with right sided heart failure?

A

Liver engorgement

261
Q

Physical changes in the heart that occur with heart failure

A

Remodeling

262
Q

What are the causes of right sided heart failure?

A

LV failure, RV MI, pulmonary hypertension, and increased left ventricular filling pressure

263
Q

What remodeling occurs in patients with heart failure?

A

Enlargement and thinning of the left ventricle, causing contractile dysfunction and mitral valve regurgitation

264
Q

What happens to the use of oxygen, ejection fraction, and CO in patients with remodeling?

A

Increased use of oxygen, decreased ejection fraction, and reduced CO

265
Q

What hormone contributes to remodeling in patients with heart failure?

A

Angiotensin 2

266
Q

Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms

A

Stage B

267
Q

What are the compensatory mechanisms for heart failure?

A

Increase in catecholamines, increase in CO, tachycardia, increase in oxygen demand, increased stroke volume, increased venous return, more forceful contractions, and arterial vasoconstriction

268
Q

Heart failure patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion

A

Class 2

269
Q

What are the catecholamines?

A

Epinephrine and norepinepherine

270
Q

Patients with current or prior symptoms of heart failure

A

Stage C

271
Q

What does the increase in catecholamines do for patients with heart failure?

A

Increases heart rate and blood pressure

272
Q

Heart failure patients with no limitations of activity, they suffer no symptoms from ordinary activities

A

Class 1

273
Q

What system in activated in patients with heart failure due to reduced blood flow to kidneys with decreased CO?

A

R-A-A-S

274
Q

What does the R-A-A-S do for patients with heart failure?

A

Vasoconstriction, aldosterone secretion, increase in preload and after load, and ventricular remodeling

275
Q

Patients at high risk for developing heart failure

A

Stage A

276
Q

What is the immune response to heart muscle injury?

A

Release of cytokine, interleukins, and endothelin

277
Q

What does endothelin do for patient with heart failure?

A

Increases peripheral resistance and hypertension, actually worsening the heart failure

278
Q

Patients with refractory end-stage heart failure

A

Stage D

279
Q

Thickening of the heart muscle to compensate for low output

A

Hypertrophy of the myocardium

280
Q

Heart failure patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest

A

Class 4

281
Q

Potent vasoconstrictor that is released with stretching of myocardial fibers

A

Endothelin

282
Q

What does myocardial hypertrophy do for patients with heart failure?

A

Increases the force of the contraction

283
Q

Tumor necrosis factor that contributes to ventricular remodeling

A

Cytokine

284
Q

What is a symptom of myocardial hypertrophy?

A

Loss of appetite

285
Q

Heart failure patients with marked limitation of activity; they are comfortable only at rest

A

Class 3

286
Q

Produced by ventricles with fluid overload from heart failure

A

BNP

287
Q

What system does BNP counteract?

A

R-A-A-S

288
Q

What does BNP promote?

A

Vasodilation and diuresis

289
Q

Which sex has a higher concentration of BNP?

A

Women

290
Q

Secreted by the posterior pituitary as a result of lower cerebral perfusion from low cardiac output

A

ADH

291
Q

What does ADH do?

A

Causes vasoconstriction and fluid retention

292
Q

What does ADH do for heart failure?

A

Worsens it

293
Q

What are the diagnostic tests for heart failure?

A

Electrolytes, BUN, creatinine, urinalysis, microalbuminuria, Hb, Hct, BNP, ABG, SCG, echocardiogram, chest xray, and a MUGA scan

294
Q

Why are Hb and Hct taken for patients with heart failure?

A

To see if the heart failure is a result of anemia

295
Q

What type of heart failure would BNP be especially elevated in?

A

Diastolic failure

296
Q

What are normal levels of BNP?

A

<100

297
Q

Why is a BNP taken for patients with heart failure?

A

To differentiate between respiratory symptoms of cardiac versus pulmonary nature

298
Q

Why is an ABG taken for patients with heart failure?

A

To reveal hypoxia and blood oxygenation

299
Q

What does an ECG reveal for patients with heart failure?

A

Ischemia, injury to heart, dysrhythmias, and hypertrophy

300
Q

What does an echocardiogram reveal in patients with heart failure?

A

Ejection fraction, hypertrophy, chamber enlargement, and valvular function

301
Q

What does a MUGA scan reveal in patients with heart failure?

A

MUGA scans calculate LV ejection fraction and velocity

302
Q

What extra test is done for patients with heart failure who are in critical care?

A

Pulmonary artery catheter measurements of pressure

303
Q

What do pulmonary artery catheter measurements of pressure show?

A

Ventricle end diastolic pressures

304
Q

What do chest X-rays reveal for patients with heart failure?

A

Show shape, size and location of the heart

305
Q

What is the goal of treatment for patients with heart failure?

A

Reduce after load, reduce preload and improve cardiac contractility

306
Q

What types of drugs reduce after load?

A

ACE inhibitors, ARBs, and B-type natriuretic peptides

307
Q

What types of drugs reduce preload?

A

Sodium restriction, fluid restriction, diuretics, and venous vasodilators

308
Q

Which drugs improve cardiac contractility?

A

Positive inotropic meds, vasodilators, and beta blockers

309
Q

Which population are ARBs less effective in?

A

African Americans

310
Q

What patients are ARBs good for?

A

Patients with the cough from ACE inhibitors and those at risk for hyperkalemia

311
Q

What type of diet should patients with heart failure be on?

A

2-3 grams of sodium/day, 2 L of fluid/day

312
Q

What do patients with heart failure need to monitor closely?

A

Weight and electrolyte levels

313
Q

How long do loop diuretics take to work?

A

5 minutes

314
Q

What is a side effect of rapid administration of Lasix?

A

Ototoxicity

315
Q

How does aldactone spare potassium?

A

Inhibits reabsorption of sodium in distal tubules in exchange for potassium

316
Q

What is the sign of hyperkalemia?

A

Peaked T waves

317
Q

Drug used for patients with acute heart failure with dyspnea

A

Nitrates

318
Q

What do nitrates do for patients with heart failure?

A

Reverses vasoconstriction, decreases volume of blood returning to the right ventricle, and improves left ventricular function

319
Q

How do nitrates improve left ventricular function?

A

They increase coronary arteriole blood flow

320
Q

What is the side effect of nitrates?

A

Head ache

321
Q

Drugs given to decrease preload and after load, reduce anxiety, and slow respirations in patients with heart failure

A

Morphine sulfate

322
Q

How are morphine sulfates given to patients with heart failure?

A

IV, in 1-2 mg increments

323
Q

What do beta blockers do for patients with heart failure?

A

Improves morbidity, mortality, quality of life, and increases ejection fraction

324
Q

How should beta blockers be administered?

A

Initial doses are low, started slowly and titrated up

325
Q

What do cardiac glycosides do?

A

Improve cardiac contractility and decrease heart rate

326
Q

Name the cardiac glycosides

A

Digoxin and digitalis

327
Q

Why are cardiac glycosides used less often?

A

They increase myocardial oxygen demand

328
Q

What patients are cardiac glycosides used for?

A

Those in either sinus rhythm or atrial fibrillation with class 3 or 4 heart failure

329
Q

How is IV digoxin given?

A

Over at least 5 minutes

330
Q

What needs to be assessed before giving IV digoxin?

A

Apical pulse

331
Q

What teaching needs to take place for patients taking digoxin?

A

Don’t take with antacids, look for hypokalemia, how to take pulse and assess rhythm

332
Q

Why would hypokalemia be very bad for patients on digoxin?

A

It increases the risk of dig toxicity

333
Q

What are the signs of dig toxicity?

A

Bradycardia, halo vision, seeing red and yellow lights, dysrhythmias, anorexia, mental status changes, vomiting, and fatigue

334
Q

What is the antidote for digoxin?

A

Digubine

335
Q

Beta-adrenergic agonist given IV for short-term treatment of acute heart failure to improve contractility and increase cardiac output

A

Dobutrex

336
Q

Inotropic and vasodilator, phosphodiestrerase inhibitor given IV that enhance calcium entry into heart cells and increases contractility

A

Milrinone (Primacor)

337
Q

What is the therapeutic range of digoxin?

A

0.8-2.0 mg/mL

338
Q

How often should a pulse ox be taken on a patient with heart failure?

A

Every 1-4 hours

339
Q

At what level should oxygen sats be maintained in patients with heart failure?

A

> 90%

340
Q

How often should patients with heart failure do deep breath and cough exercises?

A

Every 2 hours

341
Q

How often should breath sounds be assessed on patients with heart failure?

A

Every 4 hours

342
Q

In what position should patients with heart failure be in?

A

High Fowlers

343
Q

What are the goals for patients with heart failure?

A

Improve tissue perfusion, improve gas exchange, and increase activity tolerance

344
Q

What are the nursing implications for increasing activity tolerance in patients with heart failure?

A

Assess cardiovascular response to activity, assess vital signs, alternate periods of rest and activity, avoid activity immediately after meals, teach patients how to minimize oxygen consumption

345
Q

What indicates activity is too much for patients with heart failure?

A

Any dramatic change in vital signs

346
Q

What is a dramatic change in vital signs?

A

Change of blood pressure of 20 mmHg or more or increase in heart rate of 20 beats/minute or more

347
Q

How can patients with heart failure minimize oxygen consumption?

A

Cluster activities to avoid using all of their oxygen reserve

348
Q

What health teaching is needed for patients with heart failure?

A

Fluid restriction; daily weights and reporting gains of 2-3 pounds or more; sodium restriction; small, frequent meals; report edema and cough; and how to take pulse and blood pressure

349
Q

Acute condition associated with severe heart failure in which the pressure in the lounge is increased from accumulation of blood

A

Pulmonary Edema

350
Q

Why are patients with pulmonary edema placed in High Fowlers with their legs down?

A

To decrease venous return

351
Q

How is pulmonary edema treated?

A

High flow oxygen through a non-rebreather at 10 L, give nitro, diuretics, and morphine

352
Q

What is the side effect of HCTZ?

A

Decrease in male libido

353
Q

What causes the dry, persistent cough associated with ACE Inhibitors?

A

Accumulation of kinins in the respiratory tract

354
Q

What do patients taking aldosterone receptor antagonists need to be taught?

A

Avoid extra potassium, don’t use salt substitutes

355
Q

What are the side effects of aldosterone receptor antagonists?

A

Gynecomastia and progesterone stimulation

356
Q

What do central alpha agonists do?

A

Decrease systolic and diastolic blood pressure and heart rate

357
Q

What are the side effects of central alpha agonists?

A

Postural hypotension, sedation, and impotence

358
Q

What is the largest affect of alpha adrenergic agonists on?

A

Diastolic pressure

359
Q

What diseases, besides heart disease, are alpha adrenergic agonists used for?

A

Raynaud’s disease and BPH

360
Q

What do patients on renin inhibitors need to be monitored for?

A

Angioedema

361
Q

How is the filling volume and pressure on the right side of the heart assessed?

A

Jugular venous pressure

362
Q

How are pack-years determined?

A

Number of packs per day multiplied by the number of years the patient has smoked

363
Q

S3 is what kind of gallop?

A

Ventricular

364
Q

Which types of ulcers are more common?

A

Venous

365
Q

Which types of ulcers are more severe?

A

Arterial

366
Q

Atherosclerotic disease of arteries that perfuse the limbs

A

Peripheral vascular disease

367
Q

How often does peripheral vascular disease occur in patients over 70?

A

12-20%

368
Q

What is generally the end result of peripheral vascular disease?

A

Limb amputation

369
Q

S4 is what kind of gallop?

A

Atrial

370
Q

What are the symptoms of peripheral vascular disease often mistaken for?

A

Aging or peripheral neuropathy

371
Q

Distal end of aorta and iliac arteries

A

Inflow

372
Q

Where do patients with inflow occlusion complain of pain?

A

Lower back, buttocks, or thighs

373
Q

Intra-inguinal artery segments, below the superficial popliteal

A

Outflow

374
Q

Where do patients with outflow occlusion complain of pain?

A

Calves, ankles, and feet

375
Q

Which type of occlusion causes significant damage?

A

Outflow

376
Q

Where is tissue perfusion altered in patients with occlusions?

A

Below the level of occlusions

377
Q

What is usually the first symptom of PAD?

A

Intermittent Claudication

378
Q

What percentage of patients with PAD have intermittent claudication?

A

15-40%

379
Q

Pain that occurs even while at rest; numbness and burring in the distal portion of extremities that is relieved with dependent position

A

Rest pain

380
Q

Ulcers; blacked tissue on toes, forefoot, heel with a gangrenous odor

A

Gangrene/necrosis

381
Q

Where do patients with PAD lose hair?

A

Lower calf, ankle, and foot

382
Q

Pain, cramping, burning in the legs, usually at calf with ambulation or exercise that subsides at rest

A

Intermittent Claudication

383
Q

What does the skin of patients with PAD look like?

A

Dry, scaly, mottled and thickened toenails

384
Q

What color is the skin of patients with PAD?

A

Cold, gray-blue, or darkened, pallor when elevated and rub or when lowered

385
Q

Painful ulcers on or between toes at pressure points with deep, pale, even edges that won’t heal or heal slowly

A

Arterial ulcers

386
Q

What is Buerger’s test?

A

Capillary refill is greater than 15 seconds, indicating vascular compromise

387
Q

Line of demarcation that will not spread to healthy tissue; causes affected area to wither and die

A

Dry gangrene

388
Q

Soft tissue swelling due to infection of strep or staph, causing the tissue to die

A

Wet gangrene

389
Q

Where are arterial (ischemic) ulcers frequently seen?

A

On the dorsum of the foot

390
Q

What color are arterial ulcers?

A

Pale, gray, or yellow, possibly with eschar

391
Q

What would the segmental systolic blood pressures of patients with PAD reveal?

A

Leg pressures are lower than in the upper extremities

392
Q

Where are segmental systolic blood pressure taken?

A

Thigh, calf, and ankle

393
Q

What would an exercise tolerance test show in patients with PAD?

A

After 5 minutes on the treadmill, the able pulse pressure will drop and claudication will occur

394
Q

Graphs of arterial flow that detect changes in the volume of an organ, limb, or body by measuring the flow of blood through its veins and arteries

A

Plethysmography

395
Q

How is the ankle-brachial index determined?

A

Divide the ankle pressure by the branchial pressure

396
Q

What is a normal ankle-brachial index?

A

0.9-1.0

397
Q

What test is used to diagnose PAD in diabetics?

A

Toe-brachial index

398
Q

What ankle-brachial index indicates severe PAD?

A

0.5-0.75

399
Q

What is the most frequent test done to diagnose PAD?

A

Dopplers

400
Q

What ankle-brachial index indicates moderate PAD?

A

0.75-0.9

401
Q

What is the nonsurgical management of PAD?

A

Exercise, positioning, promoting vasodilation, avoidance of cold, adequate fluids, and drug therapy

402
Q

Test using two forms of ultrasound to show the structure of the blood vessels and the movement of the RBCs through the vessels

A

Dopplers

403
Q

What ankle-brachial index indicates life-threatening PAD?

A

Below 0.5

404
Q

What position needs to be avoided in patients with PAD?

A

Crossed legs

405
Q

How is vasodilation promoted in patients with PAD?

A

Warmth and avoidance of nicotine and alcohol

406
Q

What do Doppler studies reveal?

A

Obstruction, speed, and direction of flow in the blood vessels

407
Q

What drugs are used for antiplatelet therapy?

A

Aspirin or Plavix

408
Q

Suppresses platelet aggregation and acts as a direct arterial vasodilator

A

Pletal

409
Q

What does pletal treat?

A

Claudication and improves skin temperature

410
Q

In what patients is pletal contraindicated?

A

Patients with CHF

411
Q

Dilates the arteries with a balloon catheter; may use a stent to maintain patency

A

Percutaneous Transluminal Angioplasty

412
Q

What types of of occlusions are percutaneous transluminal angioplasty useful for?

A

Arterial occlusions that are accessible with the catheter and in patients who are poor surgical risks

413
Q

When should patients with PAD avoid exercise?

A

If they have rest pain, venous ulcers, or gangrene

414
Q

What is the general care for arterial revascularization?

A

Check pulses, check for bleeding or occlusion/collapse, don’t take blood pressures in the area, know baseline vitals and monitor them, site should be pink and warm, mark the site of the pulse and Doppler, and monitor for pain

415
Q

What type of pain indicates an occlusion in patients with PAD?

A

Throbbing or burning

416
Q

In what vessels can stents be placed in patients with PAD?

A

Common Iliac or external iliac arteries

417
Q

What does stent duration in patients with PAD depend on?

A

Blood viscosity and compliance

418
Q

Heat from laser vaporizes the plaque in arterial occlusions

A

Laser-assisted Angioplasty

419
Q

What types of occlusions is laser-assisted angioplasty used for?

A

Small arterial ones

420
Q

Metal burr abrades occlusion to fine particles

A

Artherectomy

421
Q

What is the risk with any procedure that accesses an artery?

A

Bleeding and stroke

422
Q

What needs to be monitored with procedures that access arteries?

A

Bleeding, vitals, H&H, and pulses

423
Q

What are the surgical treatments for inflow occlusions in patients with PAD?

A

Aortoiliac, aortafemoral, and axillogemoral bypasses

424
Q

What are the surgical treatments for outflow occlusions in patients with PAD?

A

Femoropopliteal and femorotibial bypasses

425
Q

Which surgeries are generally more successful and have less instance of reocclusion?

A

Inflow

426
Q

What remains even after outflow surgeries in patients with PAD?

A

Pain

427
Q

What graphs can be used to treat patients with PAD?

A

Autogenous, saphenous vein, cephalic, basilic vein or synthetic grafts

428
Q

Surgical removal of the plaque from the artery

A

Endartectomy

429
Q

What does the success of endartectomies depend on?

A

Location and extent of arterial blockage

430
Q

Where is the incision of endartectomies?

A

Inner lining of the diseased artery

431
Q

When do graft occlusions occur after surgical treatment of patients with PAD?

A

Within the first 24 hours

432
Q

How often do grafts have to be assessed post-op in patients with PAD?

A

Q15 minutes for 1 hour and then hourly

433
Q

What do normal grafts look like post-op in patients with PAD?

A

Warm, red, and edema

434
Q

How long do patients with PAD need to be on bed rest post-op?

A

24 hours

435
Q

What is used for thrombolytic therapy?

A

t-PA, Integrilin, and Aggrastat

436
Q

How often do platelets need to be monitored after platelet inhibitors are used?

A

3, 6, and 12 hours after surgery

437
Q

What is the platelet inhibiting drug?

A

ReoPro

438
Q

Increased tissue pressure within confined space, leading to tissue ischemia and necrosis

A

Compartment Syndrome

439
Q

Where is the most common site for compartment syndrome?

A

Forearm or lower leg

440
Q

What is the earliest sign of compartment syndrome?

A

Progressive pain distal to the injury that is not relieved by analgesics

441
Q

What are the signs of compartment syndrome?

A

Pain with passive movement, inability to move digits, numbness, tingling, loss of function, pallor, coolness, diminished or absent peripheral pulses

442
Q

What can result from untreated compartment syndrome?

A

Myoglobinuria and renal failure

443
Q

What is the treatment for compartment syndrome?

A

Fasciotomy or amputation

444
Q

What is the most common cause of PAD occlusions?

A

Embolus

445
Q

What are the six p’s in assessing for PAD occlusions?

A

Pain, Pallor, Pulselessnes, Paresthenia, Paralysis, and Poiklothermia

446
Q

What drugs are used to treat PAD occlusions?

A

Activase, t-PA, ReoPro, and Heparin

447
Q

What is the surgical treatment for PAD occlusions?

A

Arteriotomy, thrombectomy or embolectomy

448
Q

Inflammatory disease of the peripheral arteries resulting in the formation of nonatherosclerotic lesions

A

Buerger’s Disease

449
Q

Where do the nonatherosclerotic lesions of Buerger’s Disease occur?

A

Digital, tibial, plantar, ulnar, and palmar arteries

450
Q

What occludes or obliterates arteries in Buerger’s disease?

A

Thrombi and vasospasm

451
Q

Who does Buerger’s disease occur in most?

A

Young men who are heavy smokers

452
Q

What causes the symptoms of Buerger’s disease?

A

Slow, sluggish blood flow

453
Q

What are the symptoms of Buerger’s disease?

A

Pain, tenderness, hair loss, rubor, cyanosis, cold sensation, diminished pulses, sharply defined lesions leading to gangrenous lesions

454
Q

How is Buerger’s disease treated?

A

Quit smoking, vasodilators, and sympathectomy

455
Q

Episodic vasospasm in arteries and arterioles of the upper and lower extremities

A

Raynaud’s disease/phenomenon

456
Q

What are the primary diseases of Raynaud phenomenon?

A

Scleroderma, smoking, pulmonary hypertension, myxedema, or environmental factors

457
Q

What are the signs of Raynaud?

A

Pallor, numbness, and cold sensation

458
Q

What are the changes in skin color and sensation in Raynaud due to?

A

Ischemia

459
Q

What is the drug therapy for Raynaud?

A

Procardia or Dibenzyline

460
Q

Clot of fibrin attached to vessel wall

A

Thrombus

461
Q

Bolus of matter that is circulating in the blood stream

A

Embolus

462
Q

Clot of platelets and fibrin formed under high flow

A

Arterial thrombus

463
Q

Clot of red blood cells and large amounts of fibrin formed under low flow

A

Venous thrombus

464
Q

What can be an embolus?

A

Thrombus, air bubble, amniotic fluid, aggregate of fat, bacteria, cancer cells or a foreign substance

465
Q

Previously circulating matter that has lodged and obstructed blood flow, causing ischemia

A

Lodged embolus

466
Q

Where is a superficial venous thromboembolism located?

A

Below the knee

467
Q

Where is a deep venous thromboembolism located?

A

Above the knee

468
Q

What is the main complication of venous thromboemboli?

A

Pulmonary Emboli

469
Q

What does a superficial VTE look like?

A

Red streak along the vein coarse that is warm and tender, possibly with edema

470
Q

How is a superficial VTE treated?

A

Elevate the extremity, moist heat, and NSAIDs

471
Q

When do DVTs occur?

A

After hip, knee or prostate surgery, with pregnancy, heart failure, immobility, or ulcerative colitis

472
Q

What are the symptoms of a DVT?

A

Pain with walking, pain in the foot, leg edema, and pressure

473
Q

What are the factors for a DVT?

A

Virchow’s triad - Alterations in blood flow, venous endothelial damage, and hyper coagulable state

474
Q

What can cause alterations in blood flow?

A

Stasis, turbulence, and varicose veins

475
Q

What can cause venous endothelial damage?

A

Hypertension or shear stress

476
Q

What can cause a hyper coagulable state?

A

Hyperviscosity, age, smoking, obesity, pregnancy, trauma, burns, or cancer

477
Q

What are the signs of a DVT?

A

Calf or groin tenderness or pain, sudden onset of unilateral swelling, Homans’ sign, and localized edema and warmth

478
Q

Test to measure fibrin and degradation products to diagnose DVTs or PEs

A

D-dimer test

479
Q

What are the venous flow studies?

A

Doppler, ultrasounds, venography, and MRI

480
Q

How accurate are venous flow studies in diagnosing DVTs?

A

95%

481
Q

How are DVTs managed?

A

Rest and elevation, warm, moist socks and drug therapy

482
Q

What are the signs of a PE?

A

Dyspnea and chest pain

483
Q

What is the drug therapy for DVTs?

A

Anticoagulants Heparin and then warfarin and thrombolytics

484
Q

What does Heparin do for DVTs?

A

Inhibits fibrin formation

485
Q

What are the types of Heparin?

A

Unfractioned and low molecular weight

486
Q

When on heparin, what needs to be monitored?

A

PTT

487
Q

What is the therapeutic level of heparin?

A

1.5-2X normal control

488
Q

What is the heparin antidote?

A

Protamine Sulfate

489
Q

When on Coumadin, what needs to be monitored?

A

PT and INR

490
Q

What is the therapeutic PT/INR?

A

1.5-2X the control or 12-15 seconds

491
Q

What is the antidote for Coumadin?

A

Vitamin K

492
Q

What are the types of low molecular weight Heparin?

A

Lovenox or Fragmin

493
Q

What is different between low molecular weight and unfractioned heparin?

A

Low molecular weight does not require constant coagulation monitoring

494
Q

When a patient is on Coumadin, how often does their PT need checked?

A

Every 1-4 weeks

495
Q

How long do thrombolytics take to work?

A

24 hours

496
Q

How can DVTs be prevented?

A

Smoking cessation, avoid oral contraceptives, adequate hydration, increased mobility, early ambition, leg exercises, and compression stockings

497
Q

Result of prolonged venous hypertension, stretching veins and damaging valves

A

Venous Insufficiency

498
Q

What are the risk factors for venous insufficiency?

A

Prolonged standing, obesity, and pregnancy

499
Q

What is the hallmark of venous insufficiency?

A

Hemosiderin deposits

500
Q

Wood-like hard deposits of fibrin in dermis and fat from chronic venous disease that has the appearance of an inverted bottle

A

Lipodermatosclerosis

501
Q

What do venous ulcers look like?

A

Irregular boarders and a large, shallow base with heavy drainage and only mild pain

502
Q

Where do venous ulcers appear?

A

In the gaiter region - medial malleolus and lateral malleolus

503
Q

What are the symptoms of venous ulcers?

A

Leg aches, heaviness, cramps, itchiness and edema

504
Q

What are the goals of managing venous ulcers?

A

Reduce edema, promote venous return, and prevent stasis

505
Q

Dressings for venous ulcers to assist in return of pooled blood to circulation

A

Compression dressings

506
Q

Dressing for venous ulcers to control the wound environment and deliver some growth factors for healing

A

Active Dressings

507
Q

Occlusive dressings for venous ulcers that provide moisture

A

Interactive dressings

508
Q

What antibiotic is used to treat venous ulcers?

A

Silvadene

509
Q

How can the edema associated with venous ulcers be managed?

A

Elevation of the leg above the heart, bed rest, and compression stockings

510
Q

Distended, protruding veins that appear darkened and tortuous

A

Varicose Veins

511
Q

How are varicose veins managed?

A

Elastic stockings, elevation, sclerotherapy, surgical removal, and radio frequency to heat the veins

512
Q

Broad spectrum antibiotic that lowers bacterial load to levels acceptable for wound closure without causing pain

A

Silvadene

513
Q

What is the most sensitive indicator of PAD?

A

Quality of the posterior tibial pulse

Illness and Patho 1 (12 decks)

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