Cardiovascular Flashcards
1
Q
What are the 3 layers of the heart from inside to outside?
A
Endocardium, myocardium (contracting muscle), epicardium
2
Q
What cushions the heart and how much?
A
Pericardial space with 5-20ml of fluid
3
Q
What does the right atrium do?
A
Receives deoxygenated blood from the body through the vena cavas
4
Q
What does the right ventricle do?
A
Receives deoxygenated blood from the right atrium and then pumps the blood to the lungs through the pulmonary artery
5
Q
What does the left atrium do?
A
Receives oxygenated blood from the lungs by the pulmonary vein
6
Q
What does the left ventricle do?
A
Receives oxygenated blood from the left atrium then pumps the blood into the systemic circulation via the aorta
7
Q
What is the left ventricle?
A
The largest most muscular chamber
8
Q
Where is the tricuspid valve?
A
Top right side of heart between right atrium and right ventricle
9
Q
Where is the mitral valve?
A
Left side of heart between left atrium and left ventricle
10
Q
What do the tricuspid and mitral valves do?
A
Prevent back flow of blood by opening when the ventricles relax
11
Q
Where is the pulmonic valve?
A
Between right ventricle and pulmonary artery
12
Q
Where is the aortic valve?
A
Between the left ventricle and aortic artery
13
Q
What does the pulmonary and aortic valves do?
A
Prevent back flow of blood during relaxation by closing when the ventricles relax
14
Q
What is the S1 heart sound?
A
Heard when the Atrioventricular valve closes. “Lub” heard at apex of heart
15
Q
What is the S2 heart sound?
A
Heard when the semilunar valve closes. “Dub” heard at base of heart
16
Q
What is the S3 heart sound?
A
Heard if ventricular wall compliance is decreased or vibrating
17
Q
What can an S3 sound indicate?
A
Heart failure or valvular regurgitation. Normal is under 30yo
18
Q
What is a S4 sound?
A
Heard on atrial systole if resistance to ventricular filling is present
19
Q
What can a S4 heart sound indicate?
A
Cardiac hypertrophy to injury to ventricular wall
20
Q
What is depolarization? *
A
Mechanical activity
21
Q
What is repolarization? *
A
Rest
22
Q
The faster the HR…
A
The less time the heart has to fill. Decreases cardiac output
23
Q
What does the sympathetic nervous system do r/t the heart and when is it stimulated? *
A
Releases norepinephrine which increases the HR, conduction speed through AV nodes, atrial/ventricular contractility and peripheral vasoconstriction. Stimulated when decreased pressure is detected
24
Q
What does the parasympathetic nervous system do r/t the heart and when is it stimulated? *
A
Releases acetylcholine which decreases HR, atrial/ventricular contractility, and conductivity. Stimulated when increased pressure is detected
25
What happens if atrial pressure is increased?
HR and BP will decrease
26
What is systole?
Contraction or depolarization (stroke volume=amount of blood ejected with each heartbeat)
27
What is diastole?
Relaxation to repolarization (ventricle refill with blood)
28
What is the normal cardiac output?
4-8L/min
29
What is preload and when is it increased?
Volume of blood in ventricles at end of diastole
- hypervolemia
-regurgitation
-heart failure
30
What is afterload and what is it increased in?
Resistance left ventricle must overcome to circulate blood
-HTN
-vasoconstriction
31
What is contractility?
Ability of the heart to eject a stroke volume (SV) at each afterload and preload
32
What does an increased contractility increase the risk for?
A stroke
33
What is supraventricular tachycardia (SVT) and what do you do? *
Super fast heart beat (140-180)
- vagomaneuver
-blow through a straw
- face in cold water
-gag/cough forcefully
34
How do you calculate pulse pressure and what does it mean? *
Difference between systolic BP and diastolic BP
Decreased PP means heart failure
35
How do you calculate mean atrial pressure (MAP)? *
Systolic BP + 2 diastolic BP divided by 3
36
What are the levels of MAP?
<60 = decreased perfusion DEATH
>100= increased pressure to arteries, blood clot or HTN
37
What do you do for assessment of orthostatic hypotension if the pt is sitting and when is it abnormal? *
Have them lie down for 5 min. If dialstolic drops>20
38
What do you do for a JVD assessment? *
Sit them up at a 45 degree angle
39
How do you assess arteries? *
At the same time on both sides EXCEPT Corotid
40
What are the land marks for heart sounds?
Aortic: 2nd ICP Left
Pulmonic: 2nd ICP right
Erbs: 3rd ICP left
Tricuspid: 5th ICP left
Mitral/apical: midclavicular line 5th ICP Left
41
If a patient has chest pain what lab needs to be drawn? *
Troponin
42
What happens with a blocked artery?
Increase in BP and SVR
43
What does increases myoglobin indicate?
Muscle injury
44
What does increased Homocysteine indicate?
Increased meat=heart disease (getting it decreased will not decrease the risk of heart disease)
45
If a patient is short of breath, what diagnostic will distinguish btwn respiratory or cardiac problem? *
BNP. If normal <100 then respiratory. If >100 then heart failure
46
What do increased LDL and HDL indicate?
LDL=BAD heart disease
HDL=good normal
47
What can hypokalmeia cause r/t the heart?
Ventricular dysrythmias and digoxin toxicity
Flat T wave
U wave
ST depression
48
What can hyperkalemia cause r/t the heart?
Asystole and ventricular dysrythmias
Tall peaked T wave
Wide QRS
Prolonged PR
Flat P
49
What can hypomagnesium lead to r/t the heart?
Ventricular tachycardia and fibrilation
Tall T wave
Depressed ST
50
What can hypermagnesemia cause r/t the heart?
Muscle weakness, hypotension and bradycardia
Prolonged PR
Wide QRS
51
What does an echocardiogram measure?
Ejection fraction (how much blood is pumped from left ventricle) 55% is normal
52
What can high and low levels of central venous pressure cause? *
Normal is 3-8
High= increased blood volume and fluid overload
Low= decreased blood volume, hemorrhaging, and hemodialation
53
What do you do when your pt comes back from cath lab? *
Increased risk for clotting and bleeding so check pedal pulse every 15 min
54
What do you assess for preload and afterload?
Blood pressure
55
What is the normal pedal pulse?
2
56
What are some anticoagulants?
Heparin (Lovenox, Fragmin)
Warfarin (Coumadin)
Rivaroxaban (Xarelto)
Apixiban (Eliquis)
Dabigatrin (Pradaxa)
57
What needs to be monitored when taking Heparin?
PTT
58
What do you need to monitor when taking Lovenox and Fragmin?
PTT is not needed
59
If a patient is on a heparin drip and has a STEMI, what is it doing? *
Prevent clot from going into coronary arteries
60
What do you not do when giving Lovenox?
Do not expel air bubbles
61
What does Warafrin (Coumadin) do?
Prevents Vit K by GI tract and prevents clot formation
62
What do you monitor when giving Warafrin (Coumadin)?
PT/INR
63
Why would someone be on Coumadin and Lovenox at the same time?*
It takes 4-5 days for Coumadin to make full effect so don’t stop Lovenox until INR is at therapeutic level
64
What does Rivaroxaban (Xarelto) do?
Prevents strokes with afib, thrombphylaxis, and treats DVT/PE
65
What does Dabigatran (Pradaxa) do and what do you monitor?
Prevents strokes and thrombosis with nonvalvular afib
No monitoring is needed
66
What do you give for toxic effects of Warafrin?
Vit K (Phytonadione)
May take 36-48 hours for liver to get enough clotting factors to reverse naturally
67
What can reverse toxic effects of Heparin?
Protamine Sulfate
68
What is the patient education for all anticoagulants?
Regular lab testing
Signs of abnormal bleeding
Prevent bruising, bleeding, or injury
Medalert bracelet
Avoid foods high in vitamin K
69
What are the reversal agents of Lovenox?
Protamin Sulfate
70
What are the reversal agents of Dabigatran?
Idarucizumab
71
What are the reversal agents of Apaxiban and Rivaroxaban?
Andexanet alfa
72
What is the normal INR without Warafrin?
1.0
73
What is the normal INR with Warafrin?
2-3.5
74
What is the priority goal for all dysrhythmias? *
Maintain adequate cardiac output
75
What does the parasympathetic nervous system do to the SA and AV node?
Decreases the rate of the SA node and slows the conduction of the AV node
76
What does the sympathetic nervous system do to the SA and AV node?
Increases the rate of the SA node, increases the conduction of the AV node and increases cardiac contractility
77
What’s the normal beats/min for the SA node?
60-100
78
What’s the normal beats/min for the AV node?
40-60
79
What’s the normal beats/min for the HIS and perkinje fibers?
20-40
80
When is sinus bradycardia a normal rhythm?
In aerobic exercise and sleeping
81
What are the symptoms of sinus bradycardia?
Hypotension
Pale/cool skin
Weak
Angina
Dizzy/syncope
Confusion
SOB
82
What is used to treat sinus bradycardia?
Atropine, Pacemaker and Dopamine/epinephrine
83
What is the HR in sinus tachycardia?
101-200
84
What are the symptoms of sinus tachycardia?
Dizzy
Dyspnea
Hypotension
Angina in pt with CAD
85
What is used to treat sinus tachycardia?
Treat cause (ex. Pain)
Vagal maneuver
Beta blockers (metoprolol)
Adenosine
Calcium Channel Blockers (Diltiazem)
If unstable do a cardio version
86
What do you need to do while giving antidysrhythmia drugs?
Get potassium levels before administering and take radial pulse (notify HCP if less than 60)
87
What are some beta blockers?
Antidysrhythmias: Atenolol, Esmolol, and Metoprolol
88
What do beta blockers do?
Blocks sympathetic NS reducing transmission of impulses in the heart (HR not BP) and depresses depolarization
89
What does Adenosine do?
Antidysrhythmia: slows conduction through the AV node and may cause asystole for a few seconds
90
What are the adverse effects of antidysrhythmia drugs?
THEY CAN CAUSE DYSRHYTHMIAS
N/V, diarrhea
Dizzy
HA/ blurred vision
Prolonged QT intervals
91
What do you monitor with Coumadin?
INR
92
Which medications can you not take with grapefruit?
Amiodarone, Disopyramide, and Quinidine
93
What is a premature atrial contraction?
Contraction ectopic focus in atrium
Abnormal pathway
Stops and delays at AV node
94
What are the EKG signs of a premature atrial contraction?
P wave may be hidden in the T wave
95
What are the causes of premature atrial contractions?
Stress
Fatigue
Cafffeine
Tobacco
Alcohol
Hypoxia
F/E imbalances
96
What are the symptoms of premature atrial contractions?
Heart skips a beat and palpatations
97
What is the treatment for premature atrial contractions?
Monitor for more serious dysrythmias and give beta blockers
98
What is the priority concern of paroxysmal supraventricular tachycardia? (PSVT)*
Rate control
99
What is paroxysmal supraventricular tachycardia (PSVT)?
Repeated premature beats with no p wave or T wave with an abrupt onset and termination
100
What are the symptoms of paroxysmal supraventricular tachycardia (PSVT)?
Hypotension, dyspnea and angina
101
What is the HR and output with paroxysmal supraventricular tachycardia (PSVT)?
150-220 beats/min with decreased cardiac output and stroke volume
102
What is the treatment for paroxysmal supraventricular tachycardia (PSVT)?
Vagal stimulation
Adenosine
Amiodarone
Beta blockers (Sotalol)
Calcium channel blockers (Cardizem)
If unstable do a cardio version
103
What does Amiodarone do and what can you not take it with?
Controls ventricular dysrythmias. Digoxin and Warfarin
104
What are some of the calcium channel blockers?
Diltiazem (Cardizem) and Verapamil (Calan) Amlodipine
105
What do calcium channel blockers do and what are they used for?
Depresses depolarization and slows AV node
Used for PSVT, and rate control for Afib and Flutter
106
What is atrial flutter and the EKG changes?
Blood stays in the atria causing no P wave, irregular saw tooth pattern
107
What is the HR for atrial flutter and what can it increase the risk for?
200-350 and increase the risk for stroke
108
What is used to treat atrial flutter?
Flecainide, cardioversion and ablation
109
What is the black box warning for Flecainide and Peopafenone? *
They can increase mortality and proarrhythmic effects
Any new or advanced dysrhythmias
110
What is atrial fibrillation and the EKG changes?
Chaotic, asynchronous activity with multiple ectopic focus
Irregular, no distinct P wave, no saw tooth
111
What can atrial fibrillation increase the risk for?
Blood clots and stroke
112
What is the difference in afib and afib with RVR?
Afib HR is 60-100 with controlled ventricles
Afib with RVR HR is >100 with rapid ventricles
113
What is the goal for Afib?
Decrease ventricular response and prevent strokes
114
What is used to treat afib?
Amiodarone
Ibutilide
Anticoagulants
Cardioversion
Ablation/ cryoablation
115
If Warafrin is not started before a cardioversion what can happen? *
Clots can dislodge
116
What does Ibutilide (Corvert) treat?
Treats atrial dysrythmias
117
What is the treatment of afib with RVR?
Propranolol
Diltiazem
Digoxin
118
What patient do you need to see first if on a Cardizem drip and why? *
If HR is not slowing down you should see them first because Cardizem should slow the HR with afib and RVR
119
What is a first degree AV block and what is the treatment? *
Long PR interval >0.2 while everything else is normal
No treatment, not serious with no symptoms
120
What is a second degree AV block type 1?
Wenckebach r/t ischemia with an irregular ventricular rate and QRS will drop
121
How do you treat a second degree AV block type 1?
Atropine and a pacemaker
122
What is a second degree AV block type 2 and how do you treat it?
Progressive with an extra Pwave
Pacemaker
123
What can you not use to treat a second degree AV block type 2?
Atropine
124
What is a third degree AV block?
A complete heart block where all P waves are different
125
What is the HR with a third degree AV block?
20-60
126
How do you know its a third degree AV block by looking at a heart monitor? *
Atrial rhythm is independent of the ventricle rhythms
There is no relation between P and QRS
127
How do you treat a third degree AV block?
Pacemaker ASAP NO ATROPINE
128
What is a premature ventricular contraction (PVC)?
3 or more Vtach that are irregular with wide, distorted QRS. Not harmful in a healthy heart
129
What do you need to monitor with premature ventricular contractions (PVC)? *
Potassium levels for hypokalemia
130
How do you treat a premature ventricular contraction (PVC)?
Correct the cause
Beta blockers
Lidocaine
Amiodarone
131
When is the only time you can use lidocaine?
In ventricular dysrhythmias
132
What is ventricular tachycardia and the HR ?
Life threatening, wild and bizarre with a HR of 150-250
133
What is used to treat ventricular tachycardia?
Procainamide and Quinidine
134
What is the black box warning for Quinidine?
Can cause tornadoes de pointes with prolonged QT interval
135
What can ventricular tachycardia cause?
Decreased CO
Hypotension
Pulmonary edema
Cardiopulmonary arrest
Decreased cerebral blood flow
136
How do you treat pulseless ventricular fibrillation?
CPR, defibrillation, epinephrine, Amiodarone
137
What is given for hard to treat dysrhythmias?
Amiodarone
Dronedarone
Dofetilide
Sotalol
Ibutilide
138
If a patient had an arrhythmia and is on Amiodarone, what do you need to watch for? *
New or worse dysrhythmias
139
What do you need to do when giving Dofetilide?
Continuous EKG for 3 days
140
What is asystole and what do you do? *
No ventricular contraction. Pt is unresponsive, pulseless and apneic
Assess in more than 1 lead then do immediate CPR and flatten bed
141
How do you treat asystole?
CPR and ACLS
Epinephrine and Vasopressin
Intubate
142
What is pulseless electrical activity (PEA)?
Electrical activity is on EKG but no mechanical activity. Pt is pulseless
143
What can cause pulseless electrical activity?
Hypovolemia
Hypoxia
Hydrogen Ion (acidosis)
Hyper/ hypokalemia
Hypoglycemia
Hypothermia
Toxins
Tamponade
Thrombosis
Tension pneumothorax
Trauma
144
How do you treat pulseless electrical activity?
CPR, intubate and epinephrine
145
What do most sudden cardiac deaths (SCD) result from?
Ventricular dysrhythmias
146
What is defibrillation?
Treatment for ventricular fibrillation and tachycardia
Electrical shock to allow SA node to resume
147
What is monophonic debrillator?
Deliver energy in 1 direction
148
What is Biphasic defibrillator?
Deliver energy in 2 directions
149
What needs to be turned off with defibrillation?
Sync button
150
What is a synchronized cardioversion?
Treatment for ventricular tachycardia with a pulse and supraventricular tachycardia dysrhythmias
151
When is synchronized cardioversion used and what do you do?
Only use with R wave QRS complex
Sync button on
152
If a patient comes in pulseless during a cardioversion, what do you do?
Turn sync off and defibrillate
153
If a patient has a pacemaker and sees a tiny spike what is it? *
A paced rhythm
154
What is a transcutaneous pacing?
Bridge used in emergencies until a pacemaker can be placed. Noninvasive
155
What is ablation therapy?
Electrode catheter burns pathways or ectopic sites in atria, AV nodes and ventricles
156
What are the changes associated with myocardial ischemia?
St segment depression
T wave inversion
Isoelectric Line
157
What are the changes associated with cardiac injury?
Physiologic Q wave
ST elevation
158
What are the changes associated with infarction?
ST elevation
Pathological Q wave
T wave inversion
159
What is a vasovagal syncope?
Corotid sinus sensitivity
160
What does HTN increase the risk for?
Heart attack ,heart failure, stroke and renal disease
161
Decreased HR and CO causes
Decreased BP
162
When kidneys hold onto sodium and water, what does it do?
Increases BP
163
What is primary HTN?
Idiopathic with no known cause
164
What is secondary HTN?
Has a specific cause
165
What are the risk factors for primary HTN? *
Stress
Age
Gender
Ethnicity
Genetics
Family Hx
Lifestyle
Economic status
Obesity
Alcohol
Tobacco
Diabetes
Increases lipids and sodium
166
What does stress and increased SNS activity do?
Increases vasoconstriction (BP), HR and renin levels
167
What are some vasodialators?
Nitric oxide and Prosracyclin
168
What can nitric oxide do?
Increase insulin impairment
169
What is a vasoconstrictor?
Endothelin(ET)
170
What are the symptoms of HTN?
Fatigue
Dizzy
Palpatations
Angina
Dyspnea
171
What are the lifestyle modifications for HTN?
Calorie restrict
Physical activity 150min/week
DASH diet
Restrict sodium, alcohol and nicotine
172
What is the DASH diet?
Fruits/ veggies
Fat free milk
Whole grains
Fish/ poultry
Beans
Seed/nuts
173
What do you do first if a patient comes in with HTN that hasn’t changed? *
Ask if they are following their medication regimen
174
What do diuretics do for HTN and which are most common for HTN?
Decrease plasma and ECF, decrease preload, CO, and peripheral resistance. Thiazide
175
What are the thiazide diuretics and what do they do for HTN?
Excrete water, sodium and chloride
Hydrochlorothiazide
Metolazone
Chlorthalidone
Indapamide
176
What should a patient do when taking thiazide diuretics? *
Monitor for hypokalemia
Increase potassium foods (bananas/oranges)
Decrease fats and sodium (Eat baked chicken and almonds)
177
When should thiazide diuretics not be used?
If creatinine is less than 30-50
Normal is 125
178
What are the adverse effects of thiazide diuretics?
Dizzy, HA, blurred vision
Impotence
Jaundice, leukemia, agranulocytosis
Urticaria, Photosensitivity
Hypokalemia, hyperglycemia, hyperuricemia, alkalosis
DEHYDRATION, HYPOKALEMIA, HYPERLYCEMIA
179
What are the loop diuretics and what do they do?
Bumetanide, Furosemide, and Torsemide
Decrease fluid volume, potassium and sodium
180
When can you use loop diuretics?
Creatinine less than 25
181
What are the adverse effects of loop diuretics?
DIZZY, HA, blurred vision, tinnitus
Photosensitivity, Steven Johnson syndrome
Agranulocytosis, neutropenia, Thrombocytopenia
Hypokalemia, hyperglycemia, hyperuricemia
DEHYDRATION, HYPOKALMEIA, HYPOTENSION, OTOTOXICITY
182
When can you not use loop diuretics?
Hepatic coma
Severe electrolyte loss
Lithium and vancomycin
183
What are the potassium sparing diuretics and what do they do?
Spironolactone, Triameterene, amiloride
Excrete water and holds onto potassium
184
What are some high potassium foods that can be eaten with loop and thiazide diuretics?
Banana
Orange
Date
Apricot
Raisins
Broccoli
Green beans
Potatoes
Meat, fish
Legumes
185
What does a patient need to monitor for when taking diuretics? *
Digoxin toxicity
N/V, hyperkalemia, bradycardia, v fib and v tach
186
What are some of the adrenergic drugs for HTN?
Clonidine and Doxazosin
187
What can happen if you stop taking Clondine abruptly?
Rebound HTN
188
Why is Doxazosin rarely used?
Unwanted adverse effects
189
What are the adverse effects of adrenergic drugs?
Syncope
Bradycardia
Dry mouth
drowsy
Constipation
Depression
edema
Sexual dysfunction
190
What can beta blockers do for HTN?
Decrease HR, levels of renin, and peripheral resistance
191
What does carvedilol do for HTN ?*
Slows progression of HF and is the #1 beta blocker for HTN
192
Why do you not stop any beta blocker abruptly? *
Can cause rebound HTN
193
If a patient is NPO before surgery but is schedulaed to get metoprolol, what do you do? *
Still give it
194
What are the ACE inhibitors?
-Pril drugs Catopril is needed often and Enalopril is the only injection
195
What do ACE inhibitors do for HTN?
Decrease BP
Prevent sodium and water absorption
Decrease heart work
Prevent complications of MI
Decrease GFR and proteinuria
196
When can you not give an ACE inhibitor and why? *
If a patient potassium is greater than 6.5 because it increases potassium levels. DONT GIVE LISINOPRIL
197
Which ACE inhibitors are given to patients with liver problems?
Lisinipril and Catopril
198
What are the ARBS and what do they do for HTN?
-tan drugs, blocks vasoconstriction and aldosterone
199
What is the difference in ACE and ARBS?
ARBS do not cause a dry cough or hyperkalemia
ACE do not cause chest pain
200
What do you teach your patients when giving thiazide and loop diuretics?
Take early in day to prevent nocturia
Eat foods high in potassium
Monitor BP and weight
Signs of hypokalmeia
Get up slowly
Monitor blood sugar
Report tinnitus/ hearing loss with loop
201
What are the adverse effects of potassium sparing diuretics?
Hyperkalmeia and drowsiness
202
What do you give ACE and ARBS to prevent?
HTN, HF, post MI, diabetic neuropathy
203
What should you teach you patients when taking ACE and ARBS?
Use contraception and rise slowly
204
What should you teach your patients when taking ACE inhibitors?
Signs of angioedema, notify HCP is cough persist, avoid potassium foods
205
What do you give beta blockers to prevent?
HTN, HF, post mi, and angina
206
What is the primary use of calcium Channel blockers?
HTN and angina
Decreases peripheral smooth muscle, SVR and BP
207
What are some of the calcium channel blockers?
Amlodipine (norvasc)
Verapamil (Calan)
Diltiazem (Cardizem)
Nefedipine (Procardia)
208
What can calcium channel blockers cause?
Hypotension
Palpatations
Constipation
Dyspnea
209
What do vasodialators do and what do they treat?
Decrease SVR, after load, and peripheral vasodialation. Treat HTN crisis
210
Which vasodilator is used in HTN emergencies?
Sodium Nitroprusside
211
You cannot give vasodilators to a patient who has what?
Hypotension
Cerebral edema
Head injury
acute MI
CAD
heart failure
212
What are some of the vasodilators?
Hydralazine
Minoxidil
Nitroprusside
Sidenafil/ Tadalafil
213
What can sodium Nitroprusside cause?
Hypotension
Hypothyroidism
Methemoglobinemia
Cyanide toxicity
214
What is Sildenafil and Tadalafil used for when treating HTN?
Erectile dysfunction
215
What can aggravate low BP?
Hot tub/shower/bath
Hot weather
Prolonged sitting or standing
Exercise
alcohol
216
What is coenzyme Q10?
Found in body and it decreases with HTN and HF
217
What does fish oil do?
Prevents and manages heart disease
218
What other herbs/meds can be used to HTN?
Garlic, licorice, Vitamin D, Omega 3 and fatty acids
219
What is resistant HTN?
Failure to reach BP goal with full doses of 3 drugs including a diuretic
220
When doing a nursing assessment for HTN what needs to be checked?
Nocturia for renal disease and erectile dysfunction
221
What is the hypertensive crisis BP?
>180/>120
222
What is the difference in hypertensive urgency and emergency?
Urgency has no damage to organs
223
What can an emergency HTN crisis cause?
Encephalopathy (HA, N/V, seizure, confusion)
Renal insufficiency
Cardiac decompensation
Aortic dissection
Retinopathy
224
What is the treatment for an emergency HTN crisis and what do you do?
Nitroprusside, Nicardipine, Labetolol, Clevidipine
Keep quiet, raise HOB, O2, slowly reduce BP
225
If a patient reports syncope/ fainting, what do you assess? *
BP for orthostatic hypotension
226
What are the BP guidelines for orthostatic hypotension?
If systolic drops more than 20 or diastolic drops more than 10 within 5 min of standing
227
What meds do you give for hypotension?
Midodrine and Erythropoeitin
228
What is stage 2 HTN?
>140/ >90
229
What is coronary artery disease caused by?
Atherosclerosis and it is not curable
230
What are the nonmodifiable risk factors for coronary artery disease? *
Age (men>45, women >55)
family HX (HD before 55 in father/brother, HD before 65 in mother/sister)
Gender (white middle aged man)
Ethnicity (African and native Americans)
Genetics (Lipid metabolism)
231
What are the modifiable risk factors for Coronary artery disease? *
Hyperlipidemia
HTN
Tobacco
Inactivity
Obesity
DM
Increased Homocysteine levels
Metabolic syndrome
Stress
Alcohol/drugs
232
What are the hyperlipidemia levels that increase the risk for CAD?
Total cholesterol >200
LDL>130
HDL< 40
Triglycerides >150
233
What drugs are used for hyperlipidemia?
Statins
Niacin
Fibric acid derivatives
Bile acid sequestrants
Proprotein convertase/ Kexin 9 inhibitors
Cholesterol absorption inhibitors
234
What are the statins used for hyperlipidemia?
Atorvastatin (Lipitor) and Simvastatin (Zocor)
235
If a patient is on a statin what do you need to educate them on? *
Side effects of myopathy
Notify HCP for muscle pain not r/t activity bc it can lead to rhabdomylosis
236
When should statins be taken?
At dinner meal because body naturally makes cholesterol in evening
237
What needs to be avoided with statins?
Grapefruit and alcohol
238
What are the bile acid sequestrants used for hyperlipidemia?
Cholestyramine (Questran)
Colesevelam (Welchol)
Colestipol (Colestid)
239
When should bile acid sequestrants be taken?
1 hour before or 6 hours after other meds
240
What do bile acid sequestrants do?
Prevent absorption of bile acids which absorb calcium, so it decreases cholesterol and fat solvable vitamins (ADEK)
241
What are the adverse effects of bile acid sequestrants and what do you do?
Constipation, heartburn, nausea, belching, and bloating. Increase fiber and fluid
242
What are the adverse effects of Niacin that is used for hyperlipidemia and what do you do?
Flushing, pruitis, and GI distress, take aspirin 30 min before
243
What are the fibric acid derivatives used for hyperlipidemia?
Gemfibrozil (Lopid) and Fenofibrate (Tricor)
244
What do lab values look like with fibric acid derivatives?
Increased PTT and decreased Hgb/HcT
245
What can fibric acid derivatives cause?
GI distress, gallstones (RUQ pain), and Hepatoxicity
246
What is a cholesterol absorption inhibitor used for hyperlipidemia?
Ezetimibe (Zetia)
247
What can Ezetimide cause?
Hepatitis and Myopathy
248
What are the PSCK-9 inhibitors used for hyperlipidemia?
Alirocumab (Praluent) and Evolocumab (Repatha)
249
When can you not take garlic for CAD?
If surgery is within 2 weeks, HIV or diabetes
250
When can you not not take Flax with CAD?
If on anti diabetics or anticoagulants
251
When can you not take fish oil with CAD?
If on anticoagulants
252
You cannot give niacin to a patient with what?
Gout
253
What are the symptoms of CAD?
Ischemic cardiac cells and angina when there is a blockage
254
If a patient c/o a new onset of chest pain with CAD, what do you do first? *
EKG
255
What should you assess for chest pain before you call the HCP? *
Onset, location, duration and severity
256
What is chronic stable angina?
Intermittent chest pain with ST depression and an inverted T wave
257
How do you treat chronic stable angina?
Rest and nitrates
258
What are some of the nitrates given for chronic stable angina?
Nitroglycerin
Isorbide dinitrate (Isordil)
Isossorbide Mononitrate (Imdur, Monoket)
259
What is the therapeutic effect of Nitrates for angina? *
Decrease chest pain
260
What diagnostics are used for CAD?
Lipid, CRP, Homocysteine
Cardiac bio markers
CXR and EKG
Echo
Stress test
nuclear imaging
Cardiac cath
261
What us Ranolazine (Ranexa)?
Only for patients who have failed to benefit from other anti angina therapy
262
What can Ranolazine cause and what do you need to avoid?
Can elevate BP and avoid grapefruit
263
What do you give for angina if beta blockers dont work?
Calcium channel blockers
264
What are the adverse affects of nitrates?
HA, reflex tachycardia, postural hypotension, skin irritation and tolerance
265
What is isosorbid dinitrate?
Nitrate for angina
266
What meds cannot be given with nitroglycerin? *
Phosphodiesterase: Cialias and VIagra
267
What is the most important drug for symptoms of angina?
Nitroglycerin
268
What can you not give Ranolazine with?
Ketoconazole, Veraapamil, and digoxin
269
What can what chemicals are used in a stress test for CAD?
Adenosine, Dobutamine, Dipyridamole, and Regadenson
270
What do you need to avoid 24 hours before a stress test?
Caffeine and beta blockers
271
What is a cardiac catheter?
Gold standard for CAD that visualizes coronary arteries (Left) and pressure (right)
272
What do you asses for after a cardiac catheter? *
Pedal pulses every 15 min for 1 hour
Insertion site for hematoma and swelling
Output
273
Why do you hold metformin 48 hours before a cardiac catheter?
It can cause lactic acidosis
274
What do you do if a patient has consistent rhythm changes after a cardiac catheter? *
Call HCP
275
What is a percutaneous transluminal coronary angioplasty?
Done in cath lab to open up arteries
276
What meds do you give after a PCTA with a stent?
Heparin, Aspirin, and clopidigril for 12 mon
277
What is acute coronary syndrome and what do you do?
NSTEMI and STEMI, thrombus formation, immediately hospitalize
278
What is unstable angina?
New onset of angina that is unpredictable and it needs to be treated immedialty
279
What are the lab levels with unstable angina? *
Trope in and EKG are normal
280
What is a STEMI and what do you do?
ST segment elevated MI where artery is completely blocked. EMERGENCY, artery must be opened within 90 min
281
What is a NSTEMI and what do you do?
Non ST segment elevated MI, artery is partially blocked and a cardiac cath must be performed within 12-72 hours
282
What is the most adequate cardiac bio marker? *
Troponin
283
What are the lab levels for a STEMI?
ST elevation and increased troponin
284
What are the lab levels for a NSTEMI?
No ST elevation, increased troponin
285
What is the normal range for troponin?
0.1-0.4
4-6 hours shows
10-24 peaks
10-12 days
286
What is the immediate treatment of a MI?
Morphine
Oxygen
Nitroglycerin
ASA or plavix
287
What do you monitor on a heparin drip and the therapeutic effect? *
PTT/PT/INR
Prevent blood clots
288
What is a coronary artery bypass graft?
Bypass blocked artery
If 3 or more are blocked pt will need open heart surgery
289
What do you need to assess for 24-48 hours after a CABG?
I/O
SIgns of inadequate cardiac output: tachycardia, dim pulse, decreased LOC and cool skin
290
What are the complications of a CABG?
Renal, neuro and SIRS
291
What could a sudden stop of drainage from a chest tube indicate after a CABG? *
Obstruction, cardiac tamponade, and pleural effusion
292
If a pt who had a MI got diagnosed with pericarditis, what are expected findings? *
Friction rub sound
Hypoglycemia
Fever
Increased troponin levels
ONLY CHART
293
What makes the heart wall weak after a MI?
Neutrophils and macrophages
294
What drugs are used for acute coronary syndrome?
Antiplatelt
Nitroglycerin
Morphine
Beta blockers
ACE/ARBS
Anti dysrhythmias
Lipid lowering meds
Stool softener
295
What therapy is started ASAP for STEMI?
Reprofusion therapy
296
What can Heparin be used for ACS?
NSTEMI
297
What should you do when administering Labetolol for HTN?
Tell pt to notify when getting out of bed
298
What should you teach to a patient who survived a sudden cardiac death?
CPR to family members
299
What are the risk factors for HF?
HTN
CAP
diabetes
Smoking
300
What is systolic failure?
Inability to pump blood forward HFrEF
301
What are lab levels with systolic failure?
Decreased left ventricle ejection fraction, stroke volume, cardiac output and increased BP
302
What does systolic failure cause?
Pulmonary congestion and edema
303
What is diastolic HF?
Impaired ventricles to relax and refill, HFpEF
304
What are the lab levels with diastolic failure?
Decreased stroke volume and cardiac output
305
What is biventricle failure?
Inability of both ventricles to pump
Fluid buildup
Decrease perfusion to vital organs
306
What is dilation?
Enlargement of heart chambers, increased pressure on chambers, preload and cardiac output
307
What is hypertrophy r/t HF?
Increase muscle mass with a thick cardiac wall
308
What is compensated HF?
Normal cardiac output
309
Signs of left sided heart failure? *
Paroxysmal nocturnal dyspnea
Orthopnea
Tachycardia
Cough
Crackles/wheezes
Blood tinged speutum
Restless
Confusion
Cyanosis
Increased pulmonary/capillary pressure
310
Signs of right sided HF? *
Fatigue
Ascites
Enlarged liver/spleen
Distended JV veins
Anorexia, GI distress
Swelling in hands/fingers
Dependent edema
Increased peripheral venous pressure
311
What is early acute decompensated HF?
Increased pulmonary venous pressure with increased RR and decreased O2
312
What is late acute decompensated HF?
Interstitial edema with tachypnea
313
What is progressive acute decompensated HF?
Alveolar edema with respiratory acidosis
314
When does acute decompensated HF need immediate action? *
Sudden onset of dyspnea or orthopnea
315
What are the signs of pulmonary edema?
Anxious, pale, cyanosis
Cool/clammy skin
Dyspnea , Orthopnea, Tachypnea
Accessory muscle use
Frothy blood tinged sputum
Crackles/wheezes
Tachycardia
Abnormal s3 and s4
316
What are the categories for acute decompensated HF?
Dry warm
Dry cold
Wet warm most common
Wet cold
317
What do you do for acute decompensated HF?
Hemodynamic monitoring
O2
Mechanical ventilation
High Fowler
Ultrafiltration
IABP
VAD
318
What meds do you give for acute decompensated HF?
Diuretics
Vasodialators
Morphine
Intropin
Dobutres
Levophed
Primacor
Digoxin
319
What is a cardiac glycoside?
Digoxin. 0.6-1.2. Low potassium can increase risk for toxicity so monitor F/E
320
What are the signs of chronic HF?
Fatigue
Activity limitation
Chest congestion/cough
Edema
SOB
Nocturnal dyspnea and Orthopnea
Tachycardia
Skin changes
Weight change
Behavioral change
321
What are the complications of chronic HF?
Pleural effusion
Dysrhythmias
LV thrombus
Hepatomegaly
Rena; failure
322
What meds are used for chronic HF?
ACE/ARB
Spironalactone
Beta blockers
Vasodialators
Bidil
Digoxin
323
What do you do for chronic HF?
Low sodium diet
Fluid restrictions <2l/day
Daily weight
324
What can cause acute decompensated HF?
Blood transfusion and IV fluids
325
What are early signs of digoxin toxicity that you need to watch for when treating decompensated HF and what do you do? *
Anorexia, N/V, confusion, HA, blurred vision. Hold dose and notify HCP
326
What is a main intervention for chronic HF? *
Weigh daily at same time and report weight gain of 3 pounds in 2 days
327
What diseases increase BNP levels?
Pulmonary embolism, renal failure and CAD
328
What are the stages of infective endocarditis?
1. Bacteremia: mitral stenosis
2. Adhesion
3. Vegetation
329
What are the manifestations of infective endocarditis?
Fever/chills
Weakness
Malaise/fatigue
Anorexia
Splinter hemorrhages
Arthralgias
Myalgias
Back pain
Abdominal discomfort
Weight loss
HA
Clubbing
330
What can infective endocarditis cause?
New/worsen systolic murmur and HF
331
What are the diagnostics for infective endocarditis?
3 positive blood cultures over 1 hour period from 3 sites
CXR shows enlarged heart
Echo shows vegetation
EKG shows 1st or 2nd degree HB
332
What is the treatment for infective endocarditis?
Repeat blood cultures every 24-48 hiurs
IV ATB
Antipyretcs
Fluids/rest
333
When does a pateint have to receive prophylactic ATB for infective endocarditis?
Dental procedures
Repiratory tract incisions
Tonsillectomy/ adenoidectomy
Surgery involving infected skin, skin structures or musculoskeletal tissue
334
What is acute pericarditis?
Develops rapidly, pericardial sac is inflammed and leaks fluid
335
What is subacute pericarditis?
Occurs weeks-month after an event
336
What is the hallmark fidning for acute pericarditis?
Pericardial friction rub
337
What are the symptoms of pericarditis?
Progressive, severe, sharp chest pain
Deep inspiration when lying flat
Dyspnea
338
What are the complications of pericarditis? *
Pericardial effusion: fluid
Cardiac tamponade: fluid compresses the heart
339
What are the signs of cardiac tamponade? *
Distant heart sounds, distended JV, decreased arterial pressure
340
What are the diagnostics for peridcrditis?
Troponin elevated in acute
CBC: leukocytisis
CXR
EKG: diffused, wide ST elevation
Periocardiocentesis
341
what is the treatment for acute pericarditis?
ATB
best rest
NSAIDS
corticosteroids
manage anxiety
342
what is myocarditis?
inflammation of the heart muscle
343
what is the diagnostic for myocarditis?
endomyocardial biopsy
344
what medications are used for myocarditis?
ACE
beta blcokers
diuretics
digoxin
anticoagulants
immunosupprants
345
what are the signs of myocarditis?
cardiac signs appear 7-10 days after a viral infetion
fever
fatigue/malaise
N/V
myalgias
pharyngitis
dyspnea
lymphadenopathy
346
what can myocarditits cause in late symptoms?
HF
s3 heart sound
crackles
JVD
peripheral edema
angina
347
what is the most common cause of dilated cardiomyopathy?
results from heart dysfunction from myocarditis
348
what is the nursing managment for myocarditis?
manage s/s of HF and decrease cardiac workload:
semi fowlwer
quiet enviroment
space activity/ rest periods
349
what is rheumatic fever (RF)?
a complication 2-3 weeks after group A strep pharyngitis
350
what can RF effect?
heart, joints and CNS
351
what are the diagnostics for RF?
ECHO: valvular insufficeny and pericardial fluid
CXR: enlarged heart
EKG: delayed AV conduction, prlonged PR interval
352
what are the s/s of mitral valve stenosis?
extertional dyspnea
loud S1
murmur
fatigue
palpatations
hoarseness, hemoptysis
chest pain
seizure/stroke
353
what are the s/s of chronic mitral valve regurgitation?
asymptomatic until LV failure:
weak
fatigue
palpatations
dyspnea
peripheral edema
s3 heart sound
murmur
orthopnea
354
when does chronic mitral valve regurgitation need treatment?
needs surgery before LV failure or pulmonary HTN
355
what are the s/s of acute mitral valve regurgitation?
thready peripheral pulses
cool/clammy extremitities
356
what are the s/s of mitral valve prolapse?
many pt are asymptomatic:
dysrythmias
palpatations
dizzy/light headed
infective endocarditis with mitral regurgitation
chest pain unresponsive to nitrates
murmurs on systole
357
what do you not give for mitral valve prolapse? *
No ATB
No nitrates
avoid caffeine
excersize daily
358
what are the signs of aortic valve stenosis?
SAD: syncope, angina, dyspnea = LVF
later signs are RHF
359
what can you not give for aortic valve stenosis? *
nitroglycerin because it reduces preload
360
what are s/s of acute aortic valve regurgitation?
sever dyspnea
chest pain
hypotension
cardiogenic shock
LIFE THREATNING EMERGENCY
361
what are the s/s of chronic aortic valve regurgitation?
symptoms only occur after heart dysfunction has occured
exertional dyspnea
orthopnea
paroxysmal dyspnea
angina
water hammer pulse severe
soft/ absent s1
s3 and s4
murmur
362
what are the signs of tricuspid valve stenosis?
peripheral edema
ascites
hepatomegaly
low pitched murmur
363
what is tricuspid valve stenosis common in?
rheumatic fever and drug users
364
what are the s/s of pulmonic valve stenosis?
fatigue and loud midsystolic murmur (BORN WITH)
365
what is the treatment for all valvular heart disease?
treat underllying cause
Treat HF: Nitrates, ACE, digoxin, diuretics, betablockers
sodium restriction
anticoagulants
antidysryhtmias
percutaneous transluminal balloon valvuloplasty
366
if a pt got a percutaneous transluminal baloon valvuloplasty for a valve disease, what do you monitor? *
HIGH RISK PATIENT
bleeding and hypotension
367
what is a commissurotomy valvulotomy?
surgical valve repair for mitral stenosis
368
what is a valvuloplasty and annuloplasty?
valve repair
369
what does a mechanical valve replacement increase the risk for and what is given? *
thromboembolism and give long term anticoagulation
Biologic over mechanical because no anticoagulation is needed in pt with alzheimers
370
what is dilated cardiomyopathy? *
ventricular dilation
371
what is hypertrophic cardiomyopathy?
left ventricle and enlarged septum
372
what is restrictive cardiomyopathy? *
rigid ventricle walls least common
373
what is takotsubo cardiomyopathy?
broken heart syndrome
374
what are the s/s of dilated cardiomyopathy? *
ALL CHAMBERS ARE ENLARGED
fatigue
dyspnea on rest and nocturnal
orthopnea
dry cough
palpatations
bloating
N/V
375
what are the diagnostics for dilated cardiomyopathy? *
CXR: enlarged, pulmonary HTN, pleural effusion
EKG: tachycardia, bradycardia, dysrhytmia
increased BNP
doppler echo
heart cath
376
what is the treatment for dilated cardiomyopathy?
Nitrates and diuretics to decrease preload
ACE to reduce afterload
Beta blockers and aldosterone (spironalactone)
antidysrythmias
anticoagulation to decrease risk of embolism
heart transplant
377
what are the s/s of hypertrophic cardiomyopathy? *
asymptomatic with thick ventricular walls
exertional dysonea, fatigue, angina, syncope
378
what is the primary diagnostic for hypertrophic cardiomyopathy?
ECHO: apical pulse through chest on palpatations
379
what can you not give with hypertrophic cardiomyopathy?
NO VASODILATERS
380
what are the s/s of restrictive cardiomyopathy?
fatigue, excersize intolerance, dyspnea because heart cant increase cardiac ouput by increasing HR without compromising ventricular filling
381
what do you teach a patient with restrictive cardiopmyopathy?
avoid strenous activity and dehydration
382
whats the most important thing to assess for in mitral valve stenosis?
SOB on exertion
383
what is peripheral artery disease?
progressive narrowing and degeneration of arteries in the upper and lower extremities r/t smoking
advanced systemic atherosclerosis
384
what can peripheral artery disease lead to?
coronary artery diesease and or cerebral artery disease
385
what are the s/s of perioheral artery disease?
intermittent claudication
paresthsia
thin, shiny, tout skin
loss of hair
diminished pulses
pallor, blanching with elevation
hyperemiia and redness
pain at rest
386
what are the complications of peripheral artery disease?
atrophy
delayed healing
wound infection
necrosis
arterial ulcers
gangrene
amputation
387
what are the risk factor modifications for peripheral artery disease?
smoking cessation
exercise
BMI<25
waist circumference <40men <35women
reduce calories and salt (DASH)
HA1C<7%
388
what should you monitor with peripheral artery disease?
perfusion to extremities
proper foot wear
no constrictive socks
dont cross legs or prolong sit/stand
no heat
389
what meds are used for peripheral artery disease?
ACE/ARB
lipid management
antiplatlets (ASA or clopidogril)
use Cilostazol or Pentoxifylline for intermittent claudication
390
what does antiplatelts do for PAD?
prevent platelts adhesion at site of blood vessel injury and decreases collagen
391
what is aspirin contradicted in?
flulike symotms (Reyes)
392
what does Cilostazol do for intermittent claudication with PAD?
decreases platlet aggregation and increased vasodilation
relief of cramping
improves walking indurance in 2-4 weeks
393
what are contradictions to antiplatelts?
thrombocytopenia
active bleeding
leukemia
traumatic injury
GI ulcer
Vit K defiecney
stroke
394
what do you do for acute arterial ischemia?
assess 6 P (pulse, pain, paresthia, polar, pallor, paralysis)
thromboectomy
thrombotic therapy
anticoagulation
Heparin or remove clot
395
what do you do for thromboangitis obliterans?
“Buerger disease” inflammed clot in legs
limit cold tempretures
suprivise walking ATB for ulcers
analgesics for pain
avoid trauma
stop smoking
soft pedal pulse
vasodilators (Ventavis)
sympathectomy
amputation
396
what is raynauds pnenomenon and when is it diagnosed?
extremities suddenly experience decrease blood circulation r/t vassospasm and diagnosed 2 years after repeated episodes r/t cold, stress or smoking
397
what education do you give for raynauds phenomenon?
stress managment
wear gloves and socks
stop smoking
avoid injuries
avoid caffeien
place hands in warm water when attack begins
398
what is the treatment of raynauds phenomenon?
CCB: Nifedipine
Iioprost
Botulinum toxin A and statins
399
what are the s/s of a throacic aorta anurism (TAA)?
deep defused chest pain that radiates to neck, shoulders, and back
dyspnea
syncope
increase pulse
weakness
hoarse with difficulty swallowing
400
what are the s/s ascending aortic arch?
angina
TIA
SOB
cough
hoarse r/t compression on laryngeal nerve
401
what are the s/s of an abdominal aortic aneurysm (AAA)?
asymptomatic until ruptures
pulsatinf mass under umbillicus below renal artieries
402
what do you do for AAA and when is surgery needed?
if small (4-5.5) and asymptomatic only moniotr
if >5.5 surgery is needed
403
if a patient has a AAA and has a sudden onset of abdominal pain what do you do? *
Immediatly intervene PRIORITY PATIENT
404
what are s/s of a rupture in retroperitoneal space?
bruising, sudden sever pain
405
what are s/s of a rupture in throacic or abdominal cavity?
massive bleeding, needs ressection and CPR
406
If a patient has a thoracic aorta aneurysm (TAA) that is enlarging, what would you monitor for? *
Deep chest pain
dyspnea
syncope
increase pulse and tachycardia
hoarse with dofficult swallowing
407
what is intraabdominal HTN?
lethal complication in emergency repair of aneurysm r/t abdominal compartment syndrome
408
If a patient has intraabdominal HTN and their monitor and pressure starts increasing, what do you do? *
REPORT IMMEDIATLY PRIORITY PT
normal pressure is 12-15
409
what is the aortic surgery post op care? *
peripheral profusion
temp, color, capillary refill, semsation and movement
renal perfusion (BUN/Creatnine)
Cardiac rythm
daily weight
HOB at 45
410
If a patient has decreased ot absent pulses with cool extremeities post op aortic surgery what could it mean? *
artery occluded or clot
411
what is an aortic dissection?
result of a false lumen through blood flow, tear in aorta
Type A: emergency surgery
Type B: potential conservation treatment
412
what is a life threatning complication of an aortic dissection?
Cardiac tamponade:
hypotension
narrow pulse pressure
JVD
muffled heart sounds
pulses paradoxus
413
what are compliations of an aortic dissection?
aorta rupture
hemmorage
occlusion of arteiral supply to organs
414
what are the s/s of superficial vein thrombosis?
palpable, firm, subQ, cord like vein
itchy, painful, red and warm
temp elevation and leukocytosis
edema
415
what are the s/s of venous thromboembolism (DVT)?
unillateral edema
pain, tender with palpatation
dilated superficial veins
fullness in legs
paresthsia
warm, red skin
systemic fever >100.4
416
what can cause phlebitis and what do you do?
IV gone bad and apply warm moist compress
417
what is the most serious complication of a VTE and what do you do? *
pulmonary embolism; if new onset of dyspnea at rest apply O2 and call HCP
418
if a patient already has a VTE what can you not use?
compression stockings
419
How do you prevent a DVT?
reposition every 2 hours
ambulate 4-6 times a day
stockings with anticoagulants
420
what meds are given for a DVT?
anticoagulants:
warafarin
heparin
enoxaparin
dabigatrin
Rivaroxaban
421
what is the nursing care for a DVT? *
increase protein
compression socks
elevate legs
moist dressing
never use lotion
no smoking, alcohol or caffiene
limit prolonged stand/sit
422
what is the prevention for varicose veins?
avoid prolonged sit/stand
maintain ideal body weight
walk daily
423
what do you do after a vein ligitation surgery for varicose veins?
elevate legs to prevent edema
compression socks: remove every 8 hours for a short period
424
what is the long term management for varicose veins?
elevate legs above heart
compression socks
frequently flex/extend to change positions when prolonged standing
425
what is the drug and surgical therapies for varicose veins? *
Venoactive drugs
Sclerotherapy: iv injection
Transcutaneous laser: when sclerotheroay is contradicted
426
what is primary varicose veins?
women, weak vein walls
427
what is secondary varicose veins?
results drom direct injury, VTE of venous distention
428
what are the risk factors for lower extremitiy varicose veins?
family hx
female
weak veins
tobacco
age
obeisty
multiparity
hx of VTE
phlebitis
prolonged sit/stand
429
what can chronic venous insufficeny result in?
edema
skin changes
venous leg ulcers
430
what are the s/s of venous leg ulcers and chronic venous indufficency?
leathery skin
brown appearance
persistant edema
eczema/ itching
slow to heal and debilitating
431
what is the managment for venous leg ulcers?
elevation
wound care
moist dressing
compression
bland diet with protein
432
what is the wound care for venous leg ulcers?
Hydrocolloid, hydrogel, foam, alginates gauze and trasnparent dressing
unna boot
debridment
NS
ointments, creams and powders are harmful
