Cardio Exam 2 Study Guide Flashcards
Which labs are monitored in the client receiving heparin therapy?
aPTT, platelet counts.
Discuss possible food interactions while undergoing heparin therapy.
vegetables high in vitamin K
Why is Benadryl used in clients receiving a transfusion?
For mild allergies during or up to 24 hours after transfusion. Findings include itching, urticaria, and flushing.
List three nursing interventions for preventing venous stasis.
Elevate limb, wear pressure stockings, ROM. Rest.
List the signs and symptoms of folic acid deficiency.
pallor, progressive weakness and fatigue, SOB, glossitis, cheilosis, and diarrhea.
Discuss the function of erythrocytes, granulocytes, thrombocytes and lymphocytes.
Erythrocytes: Red Blood Cell’s. Contain hemoglobin and these transport oxygen and carbon dioxide to and from the tissues.
Granulocytes: WBC with secretory granites in its cytoplasm. “basophil”. Function is to fight off pathogens such as bacteria and fungi.
Thrombocytes: Platelets. Function is to stop bleeding by clumping and clotting blood vessel injuries.
Lymphocytes: WBC that function as part of the immune system. Properly respond to foreign invaders in the body.
State the normal range for neutrophils.
The percent of neutrophils consists of the segmented (fully mature) neutrophils) + the bands (almost mature neutrophils). The normal range for the ANC = 1.5 to 8.0 (1,500 to 8,000/mm3).
Describe the location of the mitral valve.
Between the Left Atrium and Left Ventricle
Define pernicious anemia.
Vitamin B12 deficiency. Lack of intrinsic factor.
Discuss the relationship of red blood cell count and blood viscosity.
RBCs contribute thickness (viscosity) to the blood.
List the risk factors for deep vein thrombosis.
Hip surgery, total knee arthroplasty, open prostate surgery (prolonged immobility)
Heart failure, immobility, pregnancy, contraceptives.
Discuss the teaching for the client discharged on iron preparations.
have hemoglobin checked q4-6 weeks.
vitamin C can increase oral absorption.
instruct to take supplements between meals to increase absorption.
list the effects of thrombolytic therapy
for the medication to dissolve a clot or clear blocked blood vessels
Describe the nursing interventions for suspected phlebitis at an IV site.
Monitor for: ven induration (hard), redness, pain or burning, discomfort, warmth, edema, red streaks, fever.
Observe site q2h, non tunneled catheters require intact sterile dressing. use smallest gauge needle in largest vein possible. clean site and change sites per facility protocol.
Discuss the expected lab findings for the client with disseminated intravascular coagulation (DIC).
low platelet count, low fibrinogen count
PT and PTT. decreased clotting factors V and VIII.
positive D-dimer test
peripheral blood smear shows schistocytes
Describe two important interventions for the client with decreasing blood pressure.
lie down, start IV, oxygen, administer vasopressin.
- drink more water
- safety
- semi fowlers position
- 02
- take medications to raise
- wear compression stockings
- trendelenburg
List an adverse effect of epoetin alfa (Epogen).
Raises blood pressure. Check often.
Discuss myocarditis, its treatment and prognosis.
Myocarditis is the inflammation of the heart’s muscular walls.
Treatment includes: medication to regulate the heartbeat and improve heart function. Rare occasions will need a device such as a pacemaker.
Caused by a viral, fungal, or bacterial infection. Also Crohn’s disease.
Discuss the care of the client following a vein ligation and stripping.
Post-op:
- maintain elastic bandages on the legs
- monitor groin and leg for bleeding through the bandages
- monitor extremity for edema, warmth, color, pulses
- elevate legs above the heart
- encourage client to perform ROM in legs
- review the client instruction to elevate the legs when sitting, and avoid dangling them over the side of the bed
CHECK DRESSING. PRESSURE DRESSING.
Discuss how the client with Raynaud’s disease can prevent the onset of symptoms.
Keep warm, do not smoke, don’t stress, avoid aggravating medications, exercise regularly.
Discuss the pathophysiology of sickle cell anemia.
HbS becomes crystalized when hypoxemia occurs –> rigid, elongated RBCs that form a sickle shape –> increase blood viscosity (thickness) and hemolysis of the cell –> accumulation in the smaller blood vessels and capillaries –> vessel obstruction –> tissue death
List the signs and symptoms of disseminated intravascular coagulation (DIC)..
abnormal bleeding, petechiae, ecchymosis, epistaxis, hemoptysis, cyanosis: cold, mottled fingers and toes, severe muscle, back abdominal and chest pain, dyspnea, confusion, oliguria, shock
How should IV dextran be administered?
Parenteral iron supplement (iron dextran) are only given for severe anemia. Administer using the z-track method.
Administer doses of 2 mL or less, IV, once a day, until the calculated total amount required has been reached
How does heparin work in treating thrombophlebitis?
It works by preventing new clots and prevents enlargement of existing clots.
What is the greatest priority in the care of a client with varicose veins with edema and ulcerations.
Proper nutrition and proper wound healing
list the normal lab value ranges fro hematocrit, hemoglobin, RBC’s and platelets
Hematocrit:
F: 12 - 16
M: 14 - 18
Hemoglobin:
F: 37 - 47
M: 42 - 52
RBC: 5,000 - 10,000
Platelets: 150,000 - 400,000
Which lab test is used to confirm rheumatic endocarditis?
Blood cultures to detect bacterial infection
Throat culture to deter strep.
give the definition and example of cardiogenic shock
Condition when the heart suddenly can’t pump enough blood to meet the body’s needs.
EXAMPLES: heart attack, myocarditis, endocarditis, arrhythmias.
Describe the priority assessment of the client with an arterial occlusion of the leg.
Assess for a negative homan’s sign.
List 3 signs or symptoms of anemia.
pallor, fatigue, irritability, dyspnea.
Which labs are monitored in the client with DIC?
pT, pTT, clotting time. decreased clotting factors V and VIII
decreased serum platelet count, fibrinogen level
Positive D-dimer test (specific fibrinogen test for DIC)
Peripheral blood smear shows Schistocytes
List the priority diagnosis for the client in sickle cell crisis.
A blood test can check for hemoglobin S
List a medication used to treat a client with hemophilia A.
IV administration of cryoprecipitate or lyophilized factor VII or IX to increase clotting factor levels and permit normal hemostasis
Define and discuss the treatment of hemarthrosis.
blood in the joints.
pain, welling, tenderness, inability to walk and move.
Joint aspiration
RICE.
List 5 food sources for iron.
Beans Dark leafy greens Enriched rice Whole grains Meat
List the signs and symptoms of aplastic anemia.
fatigue, weakness, pallor and dyspnea. petechiae or ecchymosis, infection.
List 2 expected lab values for the client with polycythemia vera.
increased RBC mass and total blood volume
How is heparin-induced thrombocytopenia treated?
the drug caused the problem. Remove the underlying cause (chemo, heparin, alcohol)
blood transfusion, platelet infusion, corticosteroids, immunosuppressants, splenectomy
ADMINISTER PROTAMIN SULFATE
List the signs and symptoms of polycythemia vera.
- HTN
- Headaches, dizziness, vision and hearing disruptions
- Ruddy red color in the face, hands, feet, and mucous membranes
- Severe, painful pruritis of fingers and toes
- Hepatomegaly, splenomegaly, JVD
- Thrombosis –> stroke, angina, and PVD
Discuss the treatment for hypovolemic shock.
IV Lactated Ringers or 0.9% NaCl to increase preload and maintain adequate ventricular filling
blood transfusion
plasma expanders
surgical intervention
List 3 adverse effects of daily aspirin therapy.
Stroke caused by burst of blood vessel, GI bleeds, internal bleeding.
List the signs or symptoms of a suspected occlusion or rupture of a graft of the abdominal aorta.
flank pain, feeling that something is wrong
Discuss the pathophysiology of DIC.
Triggered by endothelial damage, release of tissue factors into circulation, or inappropriate activation of the clotting cascade by an endotoxin.
Extensive thrombin enters systemic circulation and overwhelms natural anticoagulants –> clot formation.
Widespread clotting consumes clotting factors and activates fibrinolytic processes with anticoagulant production –> hemorrhage.
List an expected finding in the physical assessment of client who has a history of mitral valve insufficiency.
frothy sputum S/S: Left side heart failure
Discuss thrombocytopenia and its treatment.
Deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury.
Platelet transfusion.
Define: thrombocytosis, leukocytosis, pernicious anemia and pancytopenia
Thrombocytosis is a disorder in which your body produces too many platelets
Leukocytosis is an increase in the number of white cells in the blood, especially during an infection.
Pernicious anemia is a condition in which the body can’t make enough healthy red blood cells because it doesn’t have enough vitamin B12.
Pancytopenia is a deficiency of all three cellular components of the blood (red cells, white cells, and platelets).
Discuss the medication that might be given for a mild allergic reaction to a blood transfusion.
administer antihistamine such as benedryl
Describe the expected treatment for the client with sickle cell crisis.
Treatments include medications, blood transfusions, and rarely a bone-marrow transplant.
List the normal range for digoxin.
If you’re receiving treatment for heart failure, the normal level of digoxin is between 0.5 and 2.0 nanograms of medication per milliliter of blood (ng/ml).
If you’re being treated for a heart arrhythmia, the normal level of the drug is between 1.5 and 2.5 ng/ml.
List the cells known for phagocytic activity.
T CELLS AND B CELLS
List two early indicators of shock.
early:
- restlessness
- hypotension
later:
- loss of consciousness
- drop in BP
List the signs and symptoms of bacteria endocarditis.
AKA Infective Endocarditis.
Findings: fever, flulike symptoms, murmur, petechiae, positive blood cultures, splinter hemorrhages.
List two possible nursing interventions for the client with peripheral vascular disease reporting cold feet.
Wear socks, move feet for adequate circulation
Discuss the teaching for the client prescribed erythropoietin (Epogen).
reinforce the importance of having hug and hit evaluated two times per week.
List instructions to provide the client who is taking supplemental iron.
have hemoglobin checked q4-6 weeks.
vitamin C can increase oral absorption.
instruct to take supplements between meals to increase absorption.
Compare and contrast a thrombus and an embolus.
Thrombus is a clot that forms in the vein.
An embolus is anything that travels through the blood vessels until it reaches a vessel that is too small to let it pass.
Discuss the etiology, diagnosis and treatment of rheumatic fever.
.
List a cause of chronic venous insufficiency.
immobility
Be able to do dosage calculation.
D/H x ml
Discuss the teaching for the client undergoing a bone marrow biopsy.
- sign informed consent
- provide accurate info and emotional support
- position prone, local anesthesia used: client will have sensation of pressure and pushing
- postural iliac crest most common site
- apply pressure post procedure 5-10 mins after
- check vitals, medicate for pain, monitor bleeding and infection.
List labs that may be elevated during the infectious process.
WBC
List an expected finding in the client with pericarditis.
Respiratory infection.
S/S pericardial friction rub, SOB, Pain received by sitting and leaning forward
Discuss the care of the client in the acute stage of bacterial endocarditis.
.
Discuss the discharge teaching for the client with aplastic anemia.
stay away from infectious people. proper nutrition. wash hands. SAFETY. AVOID PUNCTURES. ELECTRIC RAZOR, SOFT BRISTLE TOOTHBRUSH.
What should the nurse monitor in the client undergoing heparin therapy?
aPTT labs. Monitor SOB and chest pain.
List the priority assessment for the client with acute infective (bacterial) endocarditis.
Blood and throat cultures. Assess throat, vitals, and labs.
Which medications are used to treat hemophilia A.
cryoprecipitate for A and IV of factor IX for B.
fresh frozen plasma or PRBCs
List the priority of care for the client with neutropenia.
Keep the patient clean and free from any infections.
Discuss the Schilling test.
This test measures vitamin B12 absorption. Used to differentiate between malabsorption and pernicious anemia.
List the function of hemoglobin and hematocrit in the body.
decreased levels indicate anemia.
hemoglobin is a protein in RBC’s that is responsible for delivery of oxygen to tissues.
hematocrit measures the volume of RBCs compared to the total good volume.
List 3 risk factors for pernicious anemia.
- resection of the stomach or ileum
- loss of pancreatic secretions
- chronic gastritis
- alcohol
- gastric bypass
Which labs are typically drawn in the client with hemophilia?
low serum factor VIII and prolonged PTT in A
laboratory analysis reveals deficient factor IX and normal factor VIII in B
normal platelet count and bleeding time
normal PT and INR
Discuss the treatment for the client with thrombophlebitis.
Therapy must be started within 5 days after the development of the clot for therapy to be effective.
These are effective within the first 24 hours:
- abciximab (ReoPro)
- eptifibatide (Integrilin)
- Monitor for bleeding (intracerebral)
- Instruct patient about bleeding precautions. ** bladed razor, soft toothbrush
Describe the expected findings in the client with an aortic aneurysm.
Abdominal Aortis Aneurysm - the main blood vessel that delivers blood to the body, at the level of the abdomen
FINDINGS:
- constant gnawing feeling in abdomen; flank or back pain
- pulsating abdominal mass (do not palpate!)
- bruit
- elevated BP
Discuss the universal recipient and universal donor in regards to blood transfusions.
Type O blood is the universal donor
AB is the universal recipient
What stimulates the production of red blood cells?
Low numbers of oxygen levels will trigger the kidney and liver to create erythropoietin in the bone marrow.
List the expected findings in the client with fluid volume excess.
JVD peripheral edema SOB HTN Increased and labored respirations
List the signs and symptoms of polycythemia vera and thrombocytopenia.
Polycythemia - HTN, Headaches, dizziness, ruddy red color on face, hands, feet, severe, painful pruritis of fingers and toes, hepatomegaly.
Thrombocytopenia - petechiae, ecchymosis, prolonged bleeding, menorrhagia, blood in stool
List 3 nursing interventions for the client who is having fluid overload.
Provide diuretic, manage fluid, monitor daily I&O with weight.
Discuss the treatment of pernicious anemia.
vitamin B12 supplement for life
List the antidote for heparin.
protamine sulfate
Describe the position of the client to undergo a bone marrow biopsy from the iliac crest.
Prone or side lying to expose the iliac crest
List the expected findings in the client with a low platelet count.
- purpura
- petechiae
- nosebleeds
- bleeding gums
- bleeding from wounds that lasts for a - prolonged period or doesn’t stop on its own
- heavy menstrual bleeding
- bleeding from the rectum
- blood in the stools
- blood in the urine
Discuss the procedure for verifying packed red blood cells for transfusion.
- Review lab values (packed RBC’s prescribed for clients who have an Hgb of less than 8g/dl)
- verify prescription
- obtain blood samples
- ensure client has 20 gauge or larger IV
- review client date for hx of reactions
inspect blood products from the blood bank for discoloration, excessive bubbles, or cloudiness. - confirm identity, blood compatibility, and expiration time of the blood with another nurse
- provide 0.09% sodium chloride to prime the blood
- obtain baseline vitals
List the signs and symptoms of transfusion reaction. What should the nurse do first if this occurs?
Stop the transfusion immediately. Initiate saline infusion (initiated with a separate line), save blood bag to go back for testing, obtain urine specimen, notify primary provider.
