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Cardiac Flashcards

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1
Q

Normal blood flow thru ♡

A

superior and inferior vena cava (deoxygenate blood) → RA → tricuspid valve → RV → pulmonary artery → lungs → pulmonary veins (oxygenated blood) → LA → mitral/bicuspid valve → LV → aorta → body systems

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2
Q

Preload

A

amount of blood returning to right side of heart and muscle stretch that the volume causes — (ANP released during stretch)

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3
Q

Afterload
• what is it?
• w/ HTN = more ____ = lead to what? because HIGH afterload = ↓ CO and ↓ forward flow (wears your heart out)

A
  • pressure/”resistance” in aorta and peripheral arteries that LV has to pump against to get blood out
  • HTN = more RESISTANCE = lead to HF and pulmonary edema (HIGH afterload = ↓ CO and ↓ forward flow — wears your heart out)
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4
Q

Stroke Volume

A

amount of blood pumped out of ventricles w/ each beat

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5
Q

Cardiac Output
• formula?
• ____ is dependent on adequate CO
• Cardiac output changes according to body’s ____

A
  • CO = HR x SV
  • Tissue perfusion
  • body’s needs
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6
Q

Factors that affect Cardiac Output

• what 3 things? examples?

A
  1. HR and certain arrhythmias
  2. Blood volume
    - -less volume = ↓ CO
    - -more volume = ↑ CO
  3. Decreased contractility
    - -MI, meds, cardiac muscle disease
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7
Q 
Patho of ↓ CO
• will you perfuse properly?
a. Brain: LOC?
b. heart?
c. lungs?
d. skin?
e. kidneys?
f. peripheral pulses?

• ____ are no big deal UNTIL they affect your Cardiac Output

A

• NO

a. LOC ↓
b. chest pain
c. wet lung sounds; SOB
d. cold and clammy
e. UO ↓
f. weaker pulses

• Arrhythmias

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8
Q

3 Arrhythmias that are always a big deal

A
  • V-fib
  • Pulseless V-tach
  • Asystole
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9
Q

Medications Effects on CO

Preload - vasodilate/diurese to ↓ preload

A
  1. Diuretics (furosemide)

2. Nitrates (nitroglycerin)

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10
Q

Medications Effects on CO

Afterload - vasodilate to ↓ afterload

A
  1. ACE inhibitors (enalapril, fosinopril, captopril)
  2. ARBs (losartan, irbesartan)
  3. Hydralazine
  4. Nitrates
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11
Q

Medications Effects on CO

Improve Contractility

A
  1. Inotropes (dopamine, dobutamine, milrinone)
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12
Q

Medications Effects on CO

Rate control

A
  1. Beta blockers (propranolol, metoprolol, atenolol, carvedilol)
  2. Calcium Channel Blockers (diltiazem, verapamil, amlodipine)
  3. Digoxin
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13
Q

Medications Effects on CO

Rhythm control

A
  1. Antiarrhythmics (Amiodarone)
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14
Q

Coronary Artery Disease (CAD)

• most common type of cardiovascular disease: broad term for _____ and _____

A

• chronic stable angina and acute coronary syndrome

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15
Q

Chronic Stable Angina Patho

  1. Intermittent ↓ blood flow to myocardium leads to? and then can lead to temporary what?
  2. what brings this pain? ____ O2 usually d/t ____
  3. What relieves the pain?
A
  1. ISCHEMIA; pain/pressure in chest
  2. LOW O2 d/t EXERTION
  3. rest and/or nitroglycerin SL
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16
Q 
Nitroglycerin (Nitrostat): Sublingual
• causes what? then causes ↓ \_\_\_\_ and \_\_\_\_; also causes what to increase blood flow to myocardium?
• take 1 every \_\_\_\_ min x \_\_\_\_ doses
• okay to swallow?
• keep inside what? in what environment?
• burn or fizz?
• will get a what?
• renew how often? spray?
• after taking nitro, what to expect for BP to do?
A
  • venous and arterial DILATION; ↓ PRELOAD and AFTERLOAD; also causes DILATION of CORONARY ARTERIES
  • take 1 every 5 MINUTES x 3 DOSES
  • DO NOT SWALLOW –needs to dissolve
  • keep in DARK, GLASS BOTTLE; dry, cool
  • burn or fizz –MAY OR MAY NOT HAPPEN
  • will get a HEADACHE
  • renew EVERY 6 MONTHS —-spray: 2 YEARS
  • BP ↓
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17
Q

Algorithm for NItroglycerin

A

take 1 NTG SL –after 5 mins if chest pain/discomfort is unimproved/worsened – CALL 911!

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18
Q 
Beta-Blockers for Prevention of Angina
• examples?
• what BBs do to BP, Pulse, myocardial contractility?
• what BBs do to workload of heart?
• what BBs block?
• what happens to CO?
A
  • propranolol (Inderal), metoprolol (Lopressor/Toprol XL), atenolol (Tenormin), carvedilol (Coreg)
  • DECREASE BP, Pulse, myocardial contractility
  • ↓ workload of heart
  • block beta cells (receptor sites for catecholamines – epi, norepi)
  • ↓ CO
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19
Q 
Calcium Channel Blockers for Prevention of Angina
• examples?
• what CCB do to BP?
• cause what in arterial system?
• dilate \_\_\_\_ \_\_\_\_
• 2 benefits of CCB?
A
  • nifedipine (Procardia XL), verapamil (Calan), amlodipine (Norvasc), diltiazem (Cardizem)
  • ↓ BP
  • vasodilation
  • coronary arteries
  • ↓ afterload and ↑ O2 to heart muscle
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20
Q 
Acetylsalicylic acid (Aspirin)
typical dose?
A

81 mg - 325 mg

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21
Q 
Chronic Stable Angina Education
• rest?
• nutrition: avoid \_\_\_\_, eat what?
• what to avoid that ↑ HR?
• wait how long after eating to exercise?
• what to wear in cold weather? why?
• take \_\_\_\_ prophylactically
• \_\_\_\_ cessation
• lose \_\_\_\_
• avoid \_\_\_\_ exercise
• reduce \_\_\_\_
A
  • rest FREQUENTLY
  • nutrition: avoid OVEREATING, eat LOW-FAT, HIGH FIBER
  • EXCESS CAFFEINE OR ANY DRUGS that ↑ HR
  • wait 2 HOURS after eating to exercise?
  • DRESS WARMLY in cold weather? TEMP EXTREMES PRECIPITATE ATTACK
  • take NITROGLYCERIN prophylactically
  • SMOKING cessation
  • lose WEIGHT
  • avoid ISOMETRIC exercise (NO LIFTING WEIGHTS)
  • reduce STRESS
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22
Q 
Cardiac Catheterization 
Pre-procedure
• ask if allergic to what? why?
• check kidney function why?
• what do PHP prescribe if client has kidney problems? why? what should the client expect when getting this?
A
  • shellfish or iodine — iodine-based dye is used
  • b/c dye is excreted thru kidneys
  • acetylcysteine (Mucomyst) —helps protect kidneys — hot shot and palpitations
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23
Q 
Cardiac Catheterization 
Post-procedure
• monitor \_\_\_\_
• watch puncture site for what?
• assess 5 Ps?
• bed rest, flat, extremity straight for how many hours?
• report \_\_\_\_ ASAP
• IF client is on metformin (Glucophage) -- what to do with this med post procedure? we are worried of what?
A
  • monitor VS
  • bleeding and hematoma formation
  • Pulselessness, Pallor, Pain, Paresthesia, Paralysis
  • 4-6 hours
  • Pain
  • hold metformin for 48 hours post procedure — worried about kidneys
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24
Q

Unstable chronic angina = Impending ______

A

MI

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25
Q

Acute Coronary Syndrome/MI/Unstable Angina
PATHO
• Decreased blood flow to ____ → ____ and ____
• does the client have to be doing anything to bring this pain on?
• will rest or nitroglycerin (Nitrostat) relieve this pain?

A
  • Decreased blood flow to MYOCARDIUM → ISCHEMIA and NECROSIS
  • no
  • no
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26
Q 
Acute Coronary Syndrome/MI/Unstable Angina 
S/SX
• pain described as?
• women present with what s/sx?
• #1 sign of MI in elderly?
• skin? BP?
• CO?
• ECG changes?
• Vomiting?
A
  • pain as CRUSHING, elephant sitting on chest, pressure radiating to left arm and left jaw, N/V, pain between shoulder blades
  • women - GI s/sx – epigastric discomfort, pain between shoulders, aching jaw or choking sensation
  • SOB
  • cold and clammy; BP ↓
  • CO ↓
  • ECG changes –lots of PVCs
  • Yes, stimulation of vagus nerve
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27
Q

Triad of Symptoms in Women

A
  1. indigestion or feeling of fullness
  2. unsual fatigue
  3. inability to catch one’s breath
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28
Q

STEMI?
NSTEMI?

***WORRY ABOUT WHICH CLIENT?

A

STEMI
– ST-segment elevation MI – client is having a HEART ATTACK – goal is to get client to cath lab for PCI in <90 minutes!!

STEMI
Non-ST segment elevation MI – less worrisome

WORRY ABOUT STEMI CLIENT

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29
Q 
MI Lab work
- CPK-MB
• Cardiac specific \_\_\_\_
• \_\_\_\_ w/ damage to cardiac cells
• elevates within \_\_\_\_ hours; peaks in \_\_\_\_ hours
  • TROPONIN
    • ____ specificity to myocardial damage
    • elevates within ____ hours; remains elevated up to ____ weeks
  • MYOGLOBIN
    • Increases within ____ hour; peaks in ____ hours
    • ____ results are a good thing
  • which cardiac biomarker is the most sensitive indicator for an MI?
  • which enzymes or biomarkers are most helpful when the client delays seeking care?
A
  • biomarker
  • INCREASE
  • elevates within 3-6 HOURS —- peak: 12-24 HOURS
  • HIGHLY specific cardiac biomarker
  • elevates within 3-4 HOURS — elevates up to 3 WEEKS
  • 1 HOUR; peak: 12 HOURS
  • negative
  • troponin
  • troponin
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30
Q

MAJOR ARRHYTHMIAS
• what untreated arrhythmias will put client at risk for SUDDEN DEATH?

  • tx for V-Fib?
  • if defib doesn’t work, what’s 1 st med or vasopressor to give?
  • what’s an antiarrhythmic and is used when V-fib and pulseless VT are resistant to treatment, also for fast arrhythmias
  • antiarrhythmic drugs given to prevent a second episode of V-fib?
  • Lidocaine toxicity: any ____ changes
  • 1sst antiarrhythmic of choice? important SE? why?
A

• Pulseless V-tach, V-Fib, Asystole

  • Defibrillation “Defib the V-fib!”
  • EPI
  • amiodarone (Cordarone)
  • Amiodarone or Lidocaine
  • NEURO changes
  • amiodarone (Cordarone); hypotension; lead to further arrhythmias
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31
Q

MI Treatment
• MONA?
• postition? why?

A
  • oxygen, chewable aspirin, nitro, morphine (2mg at a time)

* head up — ↓ workload on heart and ↑ CO

32
Q

Thrombolytics
• goal?

  • medications examples?
  • how soon after onset of myocardial pain should these drugs be administered? within ____ HOURS
  • Stroke: _____ IS BRAIN
  • major complication?
  • obtain what history?
  • contraindications?
  • during and after administration we take _____ precautions
  • draw blood when starting IV’s to decrease what?
  • what about ABGs? why?
A

• DISSOLVE CLOT that’s blocking blood flow to heart muscle = ↓ size of infarction

  • alteplase (t-PA), tenecteplase (TNKase, one time push), reteplase (Retavase), streptokinase
  • within 6 - 8 HOURS
  • TIME IS BRAIN
  • BLEEDING
  • bleeding hx
  • intracranial neoplasm, intracranial bleed, suspected aortic dissection, internal bleeding (= CAUSE MASSIVE HEMORRHAGE)
  • bleeding precautions
  • number of puncture sites
  • no; artery is going to BLEED
33
Q

Bleeding Precautions
• watch for?
• use what?

A
  • Watch for bleeding gums, hematuria, black stools

* use electric razor, soft toothbrush, no IMs

34
Q

MEDS REQUIRING BLEEDING PRECAUTIONS

A

ALL ANTICOAGULANTS!!!
abciximab, acetaminophen, acetylsalicylic acid, apixaban, clopidrogel, dabigatran, enoxaparin sodium, eptifibatide, heparin rivaroxaban, warfarin

35
Q

PCI (PERCUTANEOUS CORONARY INTERVENTIONS)
• including interventions such as?
• major complication of angioplasty?
• if any problems occur → go to ____
• chest pain after procedure–what to do?

• anti-platelet meds?

A 
• PTCA (percutaneous transluminal coronary angioplasty)
and stents
• MI
• go to SURGERY
• call PHP bc REOCCLUDING!
• acetylsalicylic acid (Aspirin);
clopidogrel (Plavix);
prasugrel (Effient);
abciximab (ReoPro IV);
eptifibatide (Integrilin IV)
36
Q 
CABG (Coronary Artery Bypass Graft)
• what is it?
• scheduled or emergency procedure?
• used for?
• the \_\_\_\_ main coronary artery supplies the entire left ventricle
• \_\_\_\_main coronary artery occlusion...
Think: \_\_\_\_ or Widow Maker
A
  • open heart surgery
  • both
  • multiple vessel disease or left main coronary artery occlusion
  • left
  • left; sudden death
37
Q 
Cardiac Rehab
• \_\_\_\_ cessation
• activity?
• diet changes?
• exercises to avoid?
• valsalva? straining? suppository? docusate (Colace)?
• when can sex be resumed?
• safest time of day for sex?
• best exercise for MI client?
• teach s/sx of HF, which are?
A

• SMOKING cessation
• activity? INCREASE GRADUALLY
• diet changes? LOW FAT, LOW SALT, LOW CHOLESTEROL
• exercises to avoid? NO ISOMETRIC EXERCISES (↑ workload of heart)
• valsalva? straining? suppository? docusate (Colace)? NO TO ALL OF IT
• when can sex be resumed? clients w/o complications – 1 WEEK TO 10 DAYS; or can walk/go upstair w/o SOB
• safest time of day for sex? IN THE MORNING (8-9 AM)
• best exercise for MI client? WALKING
• teach s/sx of HF, which are?
–weight gain, ankle edema, SOB, confusion

38
Q

HF causes

A

result from cardiomyopathy, valvular heart disease, endocarditis, acute MI, HTN

39
Q

Left-sided HF
• blood is not moving ____ into aorta and out to body….goes backward into the ____
• s/sx

A 
• forward; lungs
• pulmonary congestion
dyspnea
cough
blood tinged frothy sputum
restlessness -- hypoxia 1st sign
tachycardia
S3 (ventricular gallop, lub-dub-dub)
orthopnea
nocturnal dyspnea
40
Q

Right-sided HF
• blood is not moving ____ into the ____….goes backward into the _____ system
• s/sx

A 
• forward; lungs... venous system
• distended neck veins
edema
enlarged organs
weight gain
ascites
41
Q

Systolic HF

A

heart can’t contract and eject

42
Q

Diastolic HF

A

ventricles can’t relax and fill

43
Q

HF Diagnosis
a. BNP
• secreted by ____ in heart when what are increased
• ____ indicator
• can be ____ for HF when CXR does not indicate a problem
• if client is on nesiritide (Natreco), what to do with before drawing a BNP?

b. CXR
enlarged ____, pulmonary ____

c. Echocardiogram
looks at what of the heart? give info about?

d. NY Heart Association Functional Classification of Persons w/ HF:
Class 1-4 — which is the WORST?

A 
a. BNP
• ventricular tissues in heart when ventricular volumes and pressure ↑
• sensitive
• positive
• turn it off 2 hours prior

b. CXR
enlarged HEART, pulmonary INFILTRATES

c. Echocardiogram
pumping action or ejection fraction of heart —backflow and valve disease

d. class 4 is the worst!

44
Q

Swan-Ganz (Pulmonary Artery) catheter

A

floated into the right side of heart and pulmonary artery–provides hemodynamic pressures, CO, and access to mixed venous blood sampling

45
Q

Arterial lines
• most common site?
• provides what? allows for repeated collection of what?

A
  • radial artery

* provides continuous intra-arterial BP; repeated ABGs (prevent injury to client)

46
Q 
HF Treatment: ACE Inhibitors
• these are the \_\_\_\_ for HF
• suppress what?
• prevent conversion of?
• results in?
A
  • drug of choice for HF
  • Renin Angiotensin System (RAS)
  • Angiotensin I to Angiotensin II
  • arterial vasodilation and ↑ SV
47
Q

HF Treatment: ARBs
• block what?
• cause a ______ in arterial resistance and ____ BP

A
  • Angiotensin II receptors

* ↓ arterial resistance, ↓ BP

48
Q

HF Treatment: Beta Blockers
• considered as? prescribed in additon to?
• relax the? and decreases what?
• ACE inhibitors and ARBs block _____ = we lose _____ and _____ and retain ____
• why a client w/ HF will be sent home on ACE inhibitors–why?

A
  • first-line therapy; ACE inhibitors
  • vessels; ↓BP, ↓ afterload, ↓ workload on heart
  • block aldosterone; lose sodium and water; retain potassium
  • these drugs ↓ workload on heart by preventing vasoconstriction (↓ afterload) = ↑ CO and keep blood moving forward
49
Q 
HF Treatment: Digoxin (Lanoxin)
ACTIONS
• monitor for \_\_\_ in elderly
• uses?
• often given in combination with what meds?
• contraction?
• HR?
• CO?
• kidney perfusion?
A
  • drug toxicity
  • SINUS RHYTHM or A-Fib and has chronic HF
  • ACE inhibitors, ARBs, Beta Blocker, Diuretics
  • contraction IMPROVES (STRONGER)
  • HR lower
  • CO ↑
  • kidney perfusion ↑
50
Q 
HF Treatment: Digoxin (Lanoxin)
NURSING CONSIDERATIONS
• would diuresis be a good thing or bad thing?
• digitalizing dose mean?
• how do you know it's working?

• s/sx of toxicity–early? late?

  • before administering, do what? hold if?
  • Monitor ____

• what electrolyte when it’s low cause the most trouble? why?

A
  • good thing!
  • loading dose
  • CO ↑

• early – anorexia, N/V
late – arrhythmias and vision changes (yellow halo

• check apical pulse (hold if <60 bpm)

  • electrolytes
  • POTASSIUM — hypokalemia + digoxin = DRUG TOXICITY
51
Q

HF Treatment: Diuretics
• med examples
• action
• when do you give diuretics?

A
  • furosemide (Lasix), hydrochlorthiazide (HCTZ), bumetanide (Bumex), hydrochlorothiazide/triamterene (Dyazide), spironolactone (Aldactone)
  • decreases preload
  • morning
52
Q

HF Treatment: IV Inotropes

examples?

A

• milrinone (Primacor), dobutamine

53
Q

HF Treatment: Vasodilators

examples?

A

• nitroprusside (Nipride), neseritide (Natrecor)

54
Q

HF Treatment: Non-med
• what diet? decreases what? helps with?
• watch for?
• what can contain a lot of sodium?

  • elevate ____
  • weigh daily and report a gain of ______
  • Report s/sx of recurring ______
A
  • low sodium diet; ↓ fluid retention; helps ↓ preload
  • salt substitutes (has lots of potassium!)
  • canned/processed foods and OTC meds
  • elevate HOB
  • 2-3 lbs (1-2 kgs)
  • failure
55
Q

Fluid retention - think _____ problems first

A

heart

56
Q

Pacemakers
• what’s your “natural” pacemaker called? it sends out what?
• if HR drops 60 or below = CO?
• what is pacemaker used for?

A
  • SA node or sinus node; sends out impulses that makes heart contract
  • ↓ CO
  • increase HR w/ symptomatic bradycardia
57
Q

Pacemaker may be temporary or permanent?
• always worry if HR drop below the _______
• what maintain a certain minimal HR depending on settings?

  • a ____ pacemaker kicks in only when the client needs it
  • _____ rate pacemakers fire at a ____ rate constantly
  • it’s okay for rate to increase but never _____
  • always worry if the rate _____ below the set rate
A

BOTH; temporary (invasive or non-invasive) and permanent

  • set rate
  • set rate
  • demand pacemaker
  • fixed
  • decrease
  • drops
58
Q

Post-procedure care (permanent pacemakers)
• monitor the?
• most common complication?
• immobilize the ____
• how to prevent frozen shoulder?
• kee the client from raising arm higher than what?

A
  • incision and ECG for malfunction
  • Electrode displacement (wires pull out)
  • arm
  • assisted passive ROM
  • keep client from raising the arm higher than shoulder height
59
Q

Pacemakers: S/SX of Malfunction
• is it possible that no contraction will follow the stimulus? called what?

  • is it possible for pacemaker to fire at inappropriate times? called what?
  • what can cause any malfunction?
  • -pacemaker may not be ______ correctly
  • -electrodes can _____
  • -battery may be ____

• watch for any sign of what?

A
  • loss of capture
  • failure to sense
  • programmed; dislodged; depleted
  • ↓ CO or ↓ rate
60
Q 
Pacemaker Client Education/Teaching
• Check \_\_\_ daily
• wear what?
• Avoid \_\_\_\_\_\_\_ fields
• Avoid what dx procedure?
A
  • pulse
  • ID card or bracelet
  • electromagnetic fields (cell phones, large motors)
  • MRI
61
Q 
Pulmonary Edema Risks
Any person:
• receiving IVFs really \_\_\_\_
• very \_\_\_ and very \_\_\_\_
• history of what diseases?
A
  • FAST
  • young, old
  • heart or kidney
62
Q

Pulmonary Edema Patho
• fluid is backing up into ____ — heart is unable to move the volume ____
• usually occurs when?

A
  • lungs; forward

* at night when client goes to bed

63
Q

Pulmonary Edema S/SX

A
  • sudden onset
  • breathless
  • restless/anxious (think hypoxia)
  • SEVERE HYPOXIA
  • productive cough (pink frothy sputum)
64
Q

Pulmonary Edema Treatment:
• Non-med
• position? improves what? promotes ____ of blood in lower extremities
• prevention – check what and avoid what?

A

• Oxygen (high flow O2) – monitor O2 sat and keep
>90%
• Upright position; legs down — improves CO —- promotes POOLING of blood
• check lung sounds and avoid FVE

65
Q

Pulmonary Edema Treatment: Diuretics
• furosemide: causes what? dose? to prevent?
• bumetanide: given how? dose?

A
  • diuresis and vasodilation = reduces preload — 40 mg IV push SLOWLY over 1-2 minutes to prevent HYPOTENSION and OTOTOXICITY
  • given IV push or continuous IV infusion to provide rapid fluid removal —- 1-2 mg IV push given over 1-2 minutes
66
Q

Pulmonary Edema Treatment: Nitroglycerin IV
• Vasodilation = ____ afterload
• _____ afterload = ____ CO because why?

A
  • ↓ afterload

* ↓ afterload = ↑ CO — heart is pumping against less pressure and more blood can move forward

67
Q

Pulmonary Edema Treatment: Morphine

• dose? decrease what?

A

• 2 mg IV push for vasodilation; ↓ preload and afterload

68
Q 
Pulmonary Edema Treatment: Nesiritide (Natrecor)
• synthetic version of?
• route? short or long term?
• not be given more than \_\_\_\_ hours
• action?
A
  • synthetic BNP
  • IV infusion; short term therapy
  • 48 hours
  • vasodilates veins and arteries and has a diuretic effect
69
Q

Cardiac tamponade
Patho
• blood, fluid, or exudates have leaked into _____ resulting in what?
• causes?

A
  • pericardial sac; compression of heart

* MV collision, RV biopsy, MI, pericarditis, hemorrhage post CABG

70
Q 
Cardiac tamponade
S/SX
• CO
• CVP
• BP
• heart sounds
• neck veins
• pressures in all 4 chamber are \_\_\_\_\_\_\_\_
• shock?
• \_\_\_\_\_ pulse pressure
A
  • CO ↓ (LV being squeezed)
  • CVP ↑
  • BP ↓ (CO is dropping)
  • heart sounds – MUFFLED/DISTANT
  • neck veins DISTENDED
  • pressures in all 4 chamber are THE SAME
  • shock? YES
  • NARROWED pulse pressure
71
Q

Cardiac tamponade
Treatment
• To remove blood from around the heart?
• procedure? monitor what after?

A
  • Pericardiocentesis — insert needle into pericardial sac and remove fluid
  • Surgery — monitor UO
72
Q 
Arterial Disorders 
Patho
• if you have \_\_\_\_\_ in one place, you have it everywhere
• medical emergency if you have what?
• client will report what?
• extremity temp?
• no \_\_\_\_\_ pulse
• more symptomatic where?
• what's the hallmark sign? what is it?
• arterial blood isn't getting to the \_\_\_\_\_\_ →
 what sx?
• paint rest means what?

Treatment
• If you elevate the extremity, would pain increase or decrease?
• treated with what?

A

• if you have ATHEROSCLEROSIS in one place, you have it everywhere
• medical emergency - ACUTE ARTERIAL OCCLUSION
• client will report NUMBNESS and PAIN
• extremity temp? COLD
• no PALPABLE pulse
• more symptomatic where? LOWER EXTREMITIES
• what’s the hallmark sign? what is it? INTERMITTENT CLAUDICATION; pain when walking
• arterial blood isn’t getting to the TISSUES →
coldness, skin/nail changes, ulcerations
• paint rest means SEVERE OCCLUSION

tx
• increase — we DANGLE ARTERIES
• angioplasty or endarterectomy

73
Q 
Venous Disorders
• arteries carry \_\_\_\_ blood; veins carry \_\_\_\_ blood
• what can occur?
• could develop what?
• tx?
A
  • oxygenated; deoxygenated
  • inflammation and chronic ulcers
  • DVT
  • absorbent dressing on wound; compression
74
Q

we _____ veins

we ____ arteries

A

we ELEVATE veins

we DANGLE arteries

75
Q 
Chronic Arterial Insufficiency Symptoms
• Pain
• Pulses
• Color
• Temp
• Edema
• Skin changes
• Ulceration
• Gangrene
• Compression
A
  • Pain — INTERMITTENT CLAUDICATION
  • Pulses — ↓ or ABSENT
  • Color — PALE WHEN ELEVATED; RED W/ LOWERING OF LEG
  • Temp — COOL
  • Edema — ABSENT OR MILD
  • Skin changes — THIN, SHINY, LOSS OF HAIR OVER FOOT/TOES, NAIL THICKENING
  • Ulceration — IF PRESENT, WILL INVOLVE TOES OR AREAS OF TRAUMA ON FEET (PAINFUL)
  • Gangrene — MAY DEVELOP
  • Compression — NOT USED
76
Q 
Chronic Venous Insufficiency Symptoms
• Pain
• Pulses
• Color
• Temp
• Edema
• Skin changes
• Ulceration
• Gangrene
• Compression
A
  • Pain — NONE TO ACHING PAIN, depending on dependency of area
  • Pulses — NORMAL (may be difficult to palpate d/t edema)
  • Color — NORMAL (may see petechiae or brown pigmentation with chronic condition)
  • Temp — NORMAL
  • Edema — PRESENT
  • Skin changes — BROWN PIGMENTATION AROUND ANKLES, POSSIBLE THICKENING OF SKIN, SCARRING MAY DEVELOP
  • Ulceration — IF PRESENT, WILL BE ON SIDES OF ANKLES
  • Gangrene — DOES NOT DEVELOP
  • Compression — USED

NCLEX (24 decks)

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