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NSG 229 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the 3 layers of the heart from inside to outside?

A

Endocardium, myocardium (contracting muscle), epicardium

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2
Q

What cushions the heart and how much?

A

Pericardial space with 5-20ml of fluid

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3
Q

What does the right atrium do?

A

Receives deoxygenated blood from the body through the vena cavas

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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

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5
Q

What does the left atrium do?

A

Receives oxygenated blood from the lungs by the pulmonary vein

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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

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7
Q

What is the left ventricle?

A

The largest most muscular chamber

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8
Q

Where is the tricuspid valve?

A

Top right side of heart between right atrium and right ventricle

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9
Q

Where is the mitral valve?

A

Left side of heart between left atrium and left ventricle

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10
Q

What do the tricuspid and mitral valves do?

A

Prevent back flow of blood by opening when the ventricles relax

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11
Q

Where is the pulmonic valve?

A

Between right ventricle and pulmonary artery

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12
Q

Where is the aortic valve?

A

Between the left ventricle and aortic artery

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13
Q

What does the pulmonary and aortic valves do?

A

Prevent back flow of blood during relaxation by closing when the ventricles relax

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14
Q

What is the S1 heart sound?

A

Heard when the Atrioventricular valve closes. “Lub” heard at apex of heart

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15
Q

What is the S2 heart sound?

A

Heard when the semilunar valve closes. “Dub” heard at base of heart

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16
Q

What is the S3 heart sound?

A

Heard if ventricular wall compliance is decreased or vibrating

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17
Q

What can an S3 sound indicate?

A

Heart failure or valvular regurgitation. Normal is under 30yo

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18
Q

What is a S4 sound?

A

Heard on atrial systole if resistance to ventricular filling is present

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19
Q

What can a S4 heart sound indicate?

A

Cardiac hypertrophy to injury to ventricular wall

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20
Q

What is depolarization? *

A

Mechanical activity

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21
Q

What is repolarization? *

A

Rest

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22
Q

The faster the HR…

A

The less time the heart has to fill. Decreases cardiac output

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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

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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

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25
Q

What happens if atrial pressure is increased?

A

HR and BP will decrease

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26
Q

What is systole?

A

Contraction or depolarization (stroke volume=amount of blood ejected with each heartbeat)

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27
Q

What is diastole?

A

Relaxation to repolarization (ventricle refill with blood)

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28
Q

What is the normal cardiac output?

A

4-8L/min

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29
Q

What is preload and when is it increased?

A

Volume of blood in ventricles at end of diastole
- hypervolemia
-regurgitation
-heart failure

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30
Q

What is afterload and what is it increased in?

A

Resistance left ventricle must overcome to circulate blood
-HTN
-vasoconstriction

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31
Q

What is contractility?

A

Ability of the heart to eject a stroke volume (SV) at each afterload and preload

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32
Q

What does an increased contractility increase the risk for?

A

A stroke

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33
Q

What is supraventricular tachycardia (SVT) and what do you do? *

A

Super fast heart beat (140-180)
- vagomaneuver
-blow through a straw
- face in cold water
-gag/cough forcefully

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34
Q

How do you calculate pulse pressure and what does it mean? *

A

Difference between systolic BP and diastolic BP
Decreased PP means heart failure

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35
Q

How do you calculate mean atrial pressure (MAP)? *

A

Systolic BP + 2 diastolic BP divided by 3

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36
Q

What are the levels of MAP?

A

<60 = decreased perfusion DEATH
>100= increased pressure to arteries, blood clot or HTN

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37
Q

What do you do for assessment of orthostatic hypotension if the pt is sitting and when is it abnormal? *

A

Have them lie down for 5 min. If dialstolic drops>20

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38
Q

What do you do for a JVD assessment? *

A

Sit them up at a 45 degree angle

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39
Q

How do you assess arteries? *

A

At the same time on both sides EXCEPT Corotid

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40
Q

What are the land marks for heart sounds?

A

Aortic: 2nd ICP Left
Pulmonic: 2nd ICP right
Erbs: 3rd ICP left
Tricuspid: 5th ICP left
Mitral/apical: midclavicular line 5th ICP Left

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41
Q

If a patient has chest pain what lab needs to be drawn? *

A

Troponin

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42
Q

What happens with a blocked artery?

A

Increase in BP and SVR

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43
Q

What does increases myoglobin indicate?

A

Muscle injury

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44
Q

What does increased Homocysteine indicate?

A

Increased meat=heart disease (getting it decreased will not decrease the risk of heart disease)

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45
Q

If a patient is short of breath, what diagnostic will distinguish btwn respiratory or cardiac problem? *

A

BNP. If normal <100 then respiratory. If >100 then heart failure

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46
Q

What do increased LDL and HDL indicate?

A

LDL=BAD heart disease
HDL=good normal

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47
Q

What can hypokalmeia cause r/t the heart?

A

Ventricular dysrythmias and digoxin toxicity
Flat T wave
U wave
ST depression

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48
Q

What can hyperkalemia cause r/t the heart?

A

Asystole and ventricular dysrythmias
Tall peaked T wave
Wide QRS
Prolonged PR
Flat P

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49
Q

What can hypomagnesium lead to r/t the heart?

A

Ventricular tachycardia and fibrilation
Tall T wave
Depressed ST

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50
Q

What can hypermagnesemia cause r/t the heart?

A

Muscle weakness, hypotension and bradycardia
Prolonged PR
Wide QRS

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51
Q

What does an echocardiogram measure?

A

Ejection fraction (how much blood is pumped from left ventricle) 55% is normal

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52
Q

What can high and low levels of central venous pressure cause? *

A

Normal is 3-8
High= increased blood volume and fluid overload
Low= decreased blood volume, hemorrhaging, and hemodialation

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53
Q

What do you do when your pt comes back from cath lab? *

A

Increased risk for clotting and bleeding so check pedal pulse every 15 min

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54
Q

What do you assess for preload and afterload?

A

Blood pressure

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55
Q

What is the normal pedal pulse?

A

2

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56
Q

What are some anticoagulants?

A

Heparin (Lovenox, Fragmin)
Warfarin (Coumadin)
Rivaroxaban (Xarelto)
Apixiban (Eliquis)
Dabigatrin (Pradaxa)

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57
Q

What needs to be monitored when taking Heparin?

A

PTT

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58
Q

What do you need to monitor when taking Lovenox and Fragmin?

A

PTT is not needed

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59
Q

If a patient is on a heparin drip and has a STEMI, what is it doing? *

A

Prevent clot from going into coronary arteries

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60
Q

What do you not do when giving Lovenox?

A

Do not expel air bubbles

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61
Q

What does Warafrin (Coumadin) do?

A

Prevents Vit K by GI tract and prevents clot formation

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62
Q

What do you monitor when giving Warafrin (Coumadin)?

A

PT/INR

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63
Q

Why would someone be on Coumadin and Lovenox at the same time?*

A

It takes 4-5 days for Coumadin to make full effect so don’t stop Lovenox until INR is at therapeutic level

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64
Q

What does Rivaroxaban (Xarelto) do?

A

Prevents strokes with afib, thrombphylaxis, and treats DVT/PE

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65
Q

What does Dabigatran (Pradaxa) do and what do you monitor?

A

Prevents strokes and thrombosis with nonvalvular afib
No monitoring is needed

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66
Q

What do you give for toxic effects of Warafrin?

A

Vit K (Phytonadione)
May take 36-48 hours for liver to get enough clotting factors to reverse naturally

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67
Q

What can reverse toxic effects of Heparin?

A

Protamine Sulfate

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68
Q

What is the patient education for all anticoagulants?

A

Regular lab testing
Signs of abnormal bleeding
Prevent bruising, bleeding, or injury
Medalert bracelet
Avoid foods high in vitamin K

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69
Q

What are the reversal agents of Lovenox?

A

Protamin Sulfate

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70
Q

What are the reversal agents of Dabigatran?

A

Idarucizumab

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71
Q

What are the reversal agents of Apaxiban and Rivaroxaban?

A

Andexanet alfa

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72
Q

What is the normal INR without Warafrin?

A

1.0

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73
Q

What is the normal INR with Warafrin?

A

2-3.5

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74
Q

What is the priority goal for all dysrhythmias? *

A

Maintain adequate cardiac output

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75
Q

What does the parasympathetic nervous system do to the SA and AV node?

A

Decreases the rate of the SA node and slows the conduction of the AV node

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76
Q

What does the sympathetic nervous system do to the SA and AV node?

A

Increases the rate of the SA node, increases the conduction of the AV node and increases cardiac contractility

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77
Q

What’s the normal beats/min for the SA node?

A

60-100

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78
Q

What’s the normal beats/min for the AV node?

A

40-60

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79
Q

What’s the normal beats/min for the HIS and perkinje fibers?

A

20-40

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80
Q

When is sinus bradycardia a normal rhythm?

A

In aerobic exercise and sleeping

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81
Q

What are the symptoms of sinus bradycardia?

A

Hypotension
Pale/cool skin
Weak
Angina
Dizzy/syncope
Confusion
SOB

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82
Q

What is used to treat sinus bradycardia?

A

Atropine, Pacemaker and Dopamine/epinephrine

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83
Q

What is the HR in sinus tachycardia?

A

101-200

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84
Q

What are the symptoms of sinus tachycardia?

A

Dizzy
Dyspnea
Hypotension
Angina in pt with CAD

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85
Q

What is used to treat sinus tachycardia?

A

Treat cause (ex. Pain)
Vagal maneuver
Beta blockers (metoprolol)
Adenosine
Calcium Channel Blockers (Diltiazem)
If unstable do a cardio version

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86
Q

What do you need to do while giving antidysrhythmia drugs?

A

Get potassium levels before administering and take radial pulse (notify HCP if less than 60)

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87
Q

What are some beta blockers?

A

Antidysrhythmias: Atenolol, Esmolol, and Metoprolol

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88
Q

What do beta blockers do?

A

Blocks sympathetic NS reducing transmission of impulses in the heart (HR not BP) and depresses depolarization

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89
Q

What does Adenosine do?

A

Antidysrhythmia: slows conduction through the AV node and may cause asystole for a few seconds

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90
Q

What are the adverse effects of antidysrhythmia drugs?

A

THEY CAN CAUSE DYSRHYTHMIAS
N/V, diarrhea
Dizzy
HA/ blurred vision
Prolonged QT intervals

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91
Q

What do you monitor with Coumadin?

A

INR

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92
Q

Which medications can you not take with grapefruit?

A

Amiodarone, Disopyramide, and Quinidine

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93
Q

What is a premature atrial contraction?

A

Contraction ectopic focus in atrium
Abnormal pathway
Stops and delays at AV node

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94
Q

What are the EKG signs of a premature atrial contraction?

A

P wave may be hidden in the T wave

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95
Q

What are the causes of premature atrial contractions?

A

Stress
Fatigue
Cafffeine
Tobacco
Alcohol
Hypoxia
F/E imbalances

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96
Q

What are the symptoms of premature atrial contractions?

A

Heart skips a beat and palpatations

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97
Q

What is the treatment for premature atrial contractions?

A

Monitor for more serious dysrythmias and give beta blockers

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98
Q

What is the priority concern of paroxysmal supraventricular tachycardia? (PSVT)*

A

Rate control

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99
Q

What is paroxysmal supraventricular tachycardia (PSVT)?

A

Repeated premature beats with no p wave or T wave with an abrupt onset and termination

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100
Q

What are the symptoms of paroxysmal supraventricular tachycardia (PSVT)?

A

Hypotension, dyspnea and angina

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101
Q

What is the HR and output with paroxysmal supraventricular tachycardia (PSVT)?

A

150-220 beats/min with decreased cardiac output and stroke volume

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102
Q

What is the treatment for paroxysmal supraventricular tachycardia (PSVT)?

A

Vagal stimulation
Adenosine
Amiodarone
Beta blockers (Sotalol)
Calcium channel blockers (Cardizem)
If unstable do a cardio version

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103
Q

What does Amiodarone do and what can you not take it with?

A

Controls ventricular dysrythmias. Digoxin and Warfarin

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104
Q

What are some of the calcium channel blockers?

A

Diltiazem (Cardizem) and Verapamil (Calan) Amlodipine

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105
Q

What do calcium channel blockers do and what are they used for?

A

Depresses depolarization and slows AV node
Used for PSVT, and rate control for Afib and Flutter

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106
Q

What is atrial flutter and the EKG changes?

A

Blood stays in the atria causing no P wave, irregular saw tooth pattern

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107
Q

What is the HR for atrial flutter and what can it increase the risk for?

A

200-350 and increase the risk for stroke

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108
Q

What is used to treat atrial flutter?

A

Flecainide, cardioversion and ablation

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109
Q

What is the black box warning for Flecainide and Peopafenone? *

A

They can increase mortality and proarrhythmic effects
Any new or advanced dysrhythmias

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110
Q

What is atrial fibrillation and the EKG changes?

A

Chaotic, asynchronous activity with multiple ectopic focus
Irregular, no distinct P wave, no saw tooth

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111
Q

What can atrial fibrillation increase the risk for?

A

Blood clots and stroke

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112
Q

What is the difference in afib and afib with RVR?

A

Afib HR is 60-100 with controlled ventricles
Afib with RVR HR is >100 with rapid ventricles

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113
Q

What is the goal for Afib?

A

Decrease ventricular response and prevent strokes

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114
Q

What is used to treat afib?

A

Amiodarone
Ibutilide
Anticoagulants
Cardioversion
Ablation/ cryoablation

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115
Q

If Warafrin is not started before a cardioversion what can happen? *

A

Clots can dislodge

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116
Q

What does Ibutilide (Corvert) treat?

A

Treats atrial dysrythmias

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117
Q

What is the treatment of afib with RVR?

A

Propranolol
Diltiazem
Digoxin

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118
Q

What patient do you need to see first if on a Cardizem drip and why? *

A

If HR is not slowing down you should see them first because Cardizem should slow the HR with afib and RVR

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119
Q

What is a first degree AV block and what is the treatment? *

A

Long PR interval >0.2 while everything else is normal
No treatment, not serious with no symptoms

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120
Q

What is a second degree AV block type 1?

A

Wenckebach r/t ischemia with an irregular ventricular rate and QRS will drop

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121
Q

How do you treat a second degree AV block type 1?

A

Atropine and a pacemaker

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122
Q

What is a second degree AV block type 2 and how do you treat it?

A

Progressive with an extra Pwave
Pacemaker

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123
Q

What can you not use to treat a second degree AV block type 2?

A

Atropine

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124
Q

What is a third degree AV block?

A

A complete heart block where all P waves are different

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125
Q

What is the HR with a third degree AV block?

A

20-60

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126
Q

How do you know its a third degree AV block by looking at a heart monitor? *

A

Atrial rhythm is independent of the ventricle rhythms
There is no relation between P and QRS

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127
Q

How do you treat a third degree AV block?

A

Pacemaker ASAP NO ATROPINE

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128
Q

What is a premature ventricular contraction (PVC)?

A

3 or more Vtach that are irregular with wide, distorted QRS. Not harmful in a healthy heart

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129
Q

What do you need to monitor with premature ventricular contractions (PVC)? *

A

Potassium levels for hypokalemia

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130
Q

How do you treat a premature ventricular contraction (PVC)?

A

Correct the cause
Beta blockers
Lidocaine
Amiodarone

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131
Q

When is the only time you can use lidocaine?

A

In ventricular dysrhythmias

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132
Q

What is ventricular tachycardia and the HR ?

A

Life threatening, wild and bizarre with a HR of 150-250

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133
Q

What is used to treat ventricular tachycardia?

A

Procainamide and Quinidine

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134
Q

What is the black box warning for Quinidine?

A

Can cause tornadoes de pointes with prolonged QT interval

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135
Q

What can ventricular tachycardia cause?

A

Decreased CO
Hypotension
Pulmonary edema
Cardiopulmonary arrest
Decreased cerebral blood flow

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136
Q

How do you treat pulseless ventricular fibrillation?

A

CPR, defibrillation, epinephrine, Amiodarone

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137
Q

What is given for hard to treat dysrhythmias?

A

Amiodarone
Dronedarone
Dofetilide
Sotalol
Ibutilide

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138
Q

If a patient had an arrhythmia and is on Amiodarone, what do you need to watch for? *

A

New or worse dysrhythmias

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139
Q

What do you need to do when giving Dofetilide?

A

Continuous EKG for 3 days

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140
Q

What is asystole and what do you do? *

A

No ventricular contraction. Pt is unresponsive, pulseless and apneic
Assess in more than 1 lead then do immediate CPR and flatten bed

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141
Q

How do you treat asystole?

A

CPR and ACLS
Epinephrine and Vasopressin
Intubate

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142
Q

What is pulseless electrical activity (PEA)?

A

Electrical activity is on EKG but no mechanical activity. Pt is pulseless

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143
Q

What can cause pulseless electrical activity?

A

Hypovolemia
Hypoxia
Hydrogen Ion (acidosis)
Hyper/ hypokalemia
Hypoglycemia
Hypothermia

Toxins
Tamponade
Thrombosis
Tension pneumothorax
Trauma

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144
Q

How do you treat pulseless electrical activity?

A

CPR, intubate and epinephrine

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145
Q

What do most sudden cardiac deaths (SCD) result from?

A

Ventricular dysrhythmias

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146
Q

What is defibrillation?

A

Treatment for ventricular fibrillation and tachycardia
Electrical shock to allow SA node to resume

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147
Q

What is monophonic debrillator?

A

Deliver energy in 1 direction

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148
Q

What is Biphasic defibrillator?

A

Deliver energy in 2 directions

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149
Q

What needs to be turned off with defibrillation?

A

Sync button

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150
Q

What is a synchronized cardioversion?

A

Treatment for ventricular tachycardia with a pulse and supraventricular tachycardia dysrhythmias

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151
Q

When is synchronized cardioversion used and what do you do?

A

Only use with R wave QRS complex
Sync button on

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152
Q

If a patient comes in pulseless during a cardioversion, what do you do?

A

Turn sync off and defibrillate

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153
Q

If a patient has a pacemaker and sees a tiny spike what is it? *

A

A paced rhythm

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154
Q

What is a transcutaneous pacing?

A

Bridge used in emergencies until a pacemaker can be placed. Noninvasive

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155
Q

What is ablation therapy?

A

Electrode catheter burns pathways or ectopic sites in atria, AV nodes and ventricles

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156
Q

What are the changes associated with myocardial ischemia?

A

St segment depression
T wave inversion
Isoelectric Line

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157
Q

What are the changes associated with cardiac injury?

A

Physiologic Q wave
ST elevation

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158
Q

What are the changes associated with infarction?

A

ST elevation
Pathological Q wave
T wave inversion

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159
Q

What is a vasovagal syncope?

A

Corotid sinus sensitivity

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160
Q

What does HTN increase the risk for?

A

Heart attack ,heart failure, stroke and renal disease

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161
Q

Decreased HR and CO causes

A

Decreased BP

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162
Q

When kidneys hold onto sodium and water, what does it do?

A

Increases BP

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163
Q

What is primary HTN?

A

Idiopathic with no known cause

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164
Q

What is secondary HTN?

A

Has a specific cause

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165
Q

What are the risk factors for primary HTN? *

A

Stress
Age
Gender
Ethnicity
Genetics
Family Hx
Lifestyle
Economic status
Obesity
Alcohol
Tobacco
Diabetes
Increases lipids and sodium

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166
Q

What does stress and increased SNS activity do?

A

Increases vasoconstriction (BP), HR and renin levels

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167
Q

What are some vasodialators?

A

Nitric oxide and Prosracyclin

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168
Q

What can nitric oxide do?

A

Increase insulin impairment

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169
Q

What is a vasoconstrictor?

A

Endothelin(ET)

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170
Q

What are the symptoms of HTN?

A

Fatigue
Dizzy
Palpatations
Angina
Dyspnea

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171
Q

What are the lifestyle modifications for HTN?

A

Calorie restrict
Physical activity 150min/week
DASH diet
Restrict sodium, alcohol and nicotine

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172
Q

What is the DASH diet?

A

Fruits/ veggies
Fat free milk
Whole grains
Fish/ poultry
Beans
Seed/nuts

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173
Q

What do you do first if a patient comes in with HTN that hasn’t changed? *

A

Ask if they are following their medication regimen

174
Q

What do diuretics do for HTN and which are most common for HTN?

A

Decrease plasma and ECF, decrease preload, CO, and peripheral resistance. Thiazide

175
Q

What are the thiazide diuretics and what do they do for HTN?

A

Excrete water, sodium and chloride
Hydrochlorothiazide
Metolazone
Chlorthalidone
Indapamide

176
Q

What should a patient do when taking thiazide diuretics? *

A

Monitor for hypokalemia
Increase potassium foods (bananas/oranges)
Decrease fats and sodium (Eat baked chicken and almonds)

177
Q

When should thiazide diuretics not be used?

A

If creatinine is less than 30-50
Normal is 125

178
Q

What are the adverse effects of thiazide diuretics?

A

Dizzy, HA, blurred vision
Impotence
Jaundice, leukemia, agranulocytosis
Urticaria, Photosensitivity
Hypokalemia, hyperglycemia, hyperuricemia, alkalosis

DEHYDRATION, HYPOKALEMIA, HYPERLYCEMIA

179
Q

What are the loop diuretics and what do they do?

A

Bumetanide, Furosemide, and Torsemide
Decrease fluid volume, potassium and sodium

180
Q

When can you use loop diuretics?

A

Creatinine less than 25

181
Q

What are the adverse effects of loop diuretics?

A

DIZZY, HA, blurred vision, tinnitus
Photosensitivity, Steven Johnson syndrome
Agranulocytosis, neutropenia, Thrombocytopenia
Hypokalemia, hyperglycemia, hyperuricemia

DEHYDRATION, HYPOKALMEIA, HYPOTENSION, OTOTOXICITY

182
Q

When can you not use loop diuretics?

A

Hepatic coma
Severe electrolyte loss
Lithium and vancomycin

183
Q

What are the potassium sparing diuretics and what do they do?

A

Spironolactone, Triameterene, amiloride
Excrete water and holds onto potassium

184
Q

What are some high potassium foods that can be eaten with loop and thiazide diuretics?

A

Banana
Orange
Date
Apricot
Raisins
Broccoli
Green beans
Potatoes
Meat, fish
Legumes

185
Q

What does a patient need to monitor for when taking diuretics? *

A

Digoxin toxicity
N/V, hyperkalemia, bradycardia, v fib and v tach

186
Q

What are some of the adrenergic drugs for HTN?

A

Clonidine and Doxazosin

187
Q

What can happen if you stop taking Clondine abruptly?

A

Rebound HTN

188
Q

Why is Doxazosin rarely used?

A

Unwanted adverse effects

189
Q

What are the adverse effects of adrenergic drugs?

A

Syncope
Bradycardia
Dry mouth
drowsy
Constipation
Depression
edema
Sexual dysfunction

190
Q

What can beta blockers do for HTN?

A

Decrease HR, levels of renin, and peripheral resistance

191
Q

What does carvedilol do for HTN ?*

A

Slows progression of HF and is the #1 beta blocker for HTN

192
Q

Why do you not stop any beta blocker abruptly? *

A

Can cause rebound HTN

193
Q

If a patient is NPO before surgery but is schedulaed to get metoprolol, what do you do? *

A

Still give it

194
Q

What are the ACE inhibitors?

A

-Pril drugs Catopril is needed often and Enalopril is the only injection

195
Q

What do ACE inhibitors do for HTN?

A

Decrease BP
Prevent sodium and water absorption
Decrease heart work
Prevent complications of MI
Decrease GFR and proteinuria

196
Q

When can you not give an ACE inhibitor and why? *

A

If a patient potassium is greater than 6.5 because it increases potassium levels. DONT GIVE LISINOPRIL

197
Q

Which ACE inhibitors are given to patients with liver problems?

A

Lisinipril and Catopril

198
Q

What are the ARBS and what do they do for HTN?

A

-tan drugs, blocks vasoconstriction and aldosterone

199
Q

What is the difference in ACE and ARBS?

A

ARBS do not cause a dry cough or hyperkalemia
ACE do not cause chest pain

200
Q

What do you teach your patients when giving thiazide and loop diuretics?

A

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
Q

What are the adverse effects of potassium sparing diuretics?

A

Hyperkalmeia and drowsiness

202
Q

What do you give ACE and ARBS to prevent?

A

HTN, HF, post MI, diabetic neuropathy

203
Q

What should you teach you patients when taking ACE and ARBS?

A

Use contraception and rise slowly

204
Q

What should you teach your patients when taking ACE inhibitors?

A

Signs of angioedema, notify HCP is cough persist, avoid potassium foods

205
Q

What do you give beta blockers to prevent?

A

HTN, HF, post mi, and angina

206
Q

What is the primary use of calcium Channel blockers?

A

HTN and angina
Decreases peripheral smooth muscle, SVR and BP

207
Q

What are some of the calcium channel blockers?

A

Amlodipine (norvasc)
Verapamil (Calan)
Diltiazem (Cardizem)
Nefedipine (Procardia)

208
Q

What can calcium channel blockers cause?

A

Hypotension
Palpatations
Constipation
Dyspnea

209
Q

What do vasodialators do and what do they treat?

A

Decrease SVR, after load, and peripheral vasodialation. Treat HTN crisis

210
Q

Which vasodilator is used in HTN emergencies?

A

Sodium Nitroprusside

211
Q

You cannot give vasodilators to a patient who has what?

A

Hypotension
Cerebral edema
Head injury
acute MI
CAD
heart failure

212
Q

What are some of the vasodilators?

A

Hydralazine
Minoxidil
Nitroprusside
Sidenafil/ Tadalafil

213
Q

What can sodium Nitroprusside cause?

A

Hypotension
Hypothyroidism
Methemoglobinemia
Cyanide toxicity

214
Q

What is Sildenafil and Tadalafil used for when treating HTN?

A

Erectile dysfunction

215
Q

What can aggravate low BP?

A

Hot tub/shower/bath
Hot weather
Prolonged sitting or standing
Exercise
alcohol

216
Q

What is coenzyme Q10?

A

Found in body and it decreases with HTN and HF

217
Q

What does fish oil do?

A

Prevents and manages heart disease

218
Q

What other herbs/meds can be used to HTN?

A

Garlic, licorice, Vitamin D, Omega 3 and fatty acids

219
Q

What is resistant HTN?

A

Failure to reach BP goal with full doses of 3 drugs including a diuretic

220
Q

When doing a nursing assessment for HTN what needs to be checked?

A

Nocturia for renal disease and erectile dysfunction

221
Q

What is the hypertensive crisis BP?

A

> 180/>120

222
Q

What is the difference in hypertensive urgency and emergency?

A

Urgency has no damage to organs

223
Q

What can an emergency HTN crisis cause?

A

Encephalopathy (HA, N/V, seizure, confusion)
Renal insufficiency
Cardiac decompensation
Aortic dissection
Retinopathy

224
Q

What is the treatment for an emergency HTN crisis and what do you do?

A

Nitroprusside, Nicardipine, Labetolol, Clevidipine
Keep quiet, raise HOB, O2, slowly reduce BP

225
Q

If a patient reports syncope/ fainting, what do you assess? *

A

BP for orthostatic hypotension

226
Q

What are the BP guidelines for orthostatic hypotension?

A

If systolic drops more than 20 or diastolic drops more than 10 within 5 min of standing

227
Q

What meds do you give for hypotension?

A

Midodrine and Erythropoeitin

228
Q

What is stage 2 HTN?

A

> 140/ >90

229
Q

What is coronary artery disease caused by?

A

Atherosclerosis and it is not curable

230
Q

What are the nonmodifiable risk factors for coronary artery disease? *

A

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
Q

What are the modifiable risk factors for Coronary artery disease? *

A

Hyperlipidemia
HTN
Tobacco
Inactivity
Obesity
DM
Increased Homocysteine levels
Metabolic syndrome
Stress
Alcohol/drugs

232
Q

What are the hyperlipidemia levels that increase the risk for CAD?

A

Total cholesterol >200
LDL>130
HDL< 40
Triglycerides >150

233
Q

What drugs are used for hyperlipidemia?

A

Statins
Niacin
Fibric acid derivatives
Bile acid sequestrants
Proprotein convertase/ Kexin 9 inhibitors
Cholesterol absorption inhibitors

234
Q

What are the statins used for hyperlipidemia?

A

Atorvastatin (Lipitor) and Simvastatin (Zocor)

235
Q

If a patient is on a statin what do you need to educate them on? *

A

Side effects of myopathy
Notify HCP for muscle pain not r/t activity bc it can lead to rhabdomylosis

236
Q

When should statins be taken?

A

At dinner meal because body naturally makes cholesterol in evening

237
Q

What needs to be avoided with statins?

A

Grapefruit and alcohol

238
Q

What are the bile acid sequestrants used for hyperlipidemia?

A

Cholestyramine (Questran)
Colesevelam (Welchol)
Colestipol (Colestid)

239
Q

When should bile acid sequestrants be taken?

A

1 hour before or 6 hours after other meds

240
Q

What do bile acid sequestrants do?

A

Prevent absorption of bile acids which absorb calcium, so it decreases cholesterol and fat solvable vitamins (ADEK)

241
Q

What are the adverse effects of bile acid sequestrants and what do you do?

A

Constipation, heartburn, nausea, belching, and bloating. Increase fiber and fluid

242
Q

What are the adverse effects of Niacin that is used for hyperlipidemia and what do you do?

A

Flushing, pruitis, and GI distress, take aspirin 30 min before

243
Q

What are the fibric acid derivatives used for hyperlipidemia?

A

Gemfibrozil (Lopid) and Fenofibrate (Tricor)

244
Q

What do lab values look like with fibric acid derivatives?

A

Increased PTT and decreased Hgb/HcT

245
Q

What can fibric acid derivatives cause?

A

GI distress, gallstones (RUQ pain), and Hepatoxicity

246
Q

What is a cholesterol absorption inhibitor used for hyperlipidemia?

A

Ezetimibe (Zetia)

247
Q

What can Ezetimide cause?

A

Hepatitis and Myopathy

248
Q

What are the PSCK-9 inhibitors used for hyperlipidemia?

A

Alirocumab (Praluent) and Evolocumab (Repatha)

249
Q

When can you not take garlic for CAD?

A

If surgery is within 2 weeks, HIV or diabetes

250
Q

When can you not not take Flax with CAD?

A

If on anti diabetics or anticoagulants

251
Q

When can you not take fish oil with CAD?

A

If on anticoagulants

252
Q

You cannot give niacin to a patient with what?

A

Gout

253
Q

What are the symptoms of CAD?

A

Ischemic cardiac cells and angina when there is a blockage

254
Q

If a patient c/o a new onset of chest pain with CAD, what do you do first? *

A

EKG

255
Q

What should you assess for chest pain before you call the HCP? *

A

Onset, location, duration and severity

256
Q

What is chronic stable angina?

A

Intermittent chest pain with ST depression and an inverted T wave

257
Q

How do you treat chronic stable angina?

A

Rest and nitrates

258
Q

What are some of the nitrates given for chronic stable angina?

A

Nitroglycerin
Isorbide dinitrate (Isordil)
Isossorbide Mononitrate (Imdur, Monoket)

259
Q

What is the therapeutic effect of Nitrates for angina? *

A

Decrease chest pain

260
Q

What diagnostics are used for CAD?

A

Lipid, CRP, Homocysteine
Cardiac bio markers
CXR and EKG
Echo
Stress test
nuclear imaging
Cardiac cath

261
Q

What us Ranolazine (Ranexa)?

A

Only for patients who have failed to benefit from other anti angina therapy

262
Q

What can Ranolazine cause and what do you need to avoid?

A

Can elevate BP and avoid grapefruit

263
Q

What do you give for angina if beta blockers dont work?

A

Calcium channel blockers

264
Q

What are the adverse affects of nitrates?

A

HA, reflex tachycardia, postural hypotension, skin irritation and tolerance

265
Q

What is isosorbid dinitrate?

A

Nitrate for angina

266
Q

What meds cannot be given with nitroglycerin? *

A

Phosphodiesterase: Cialias and VIagra

267
Q

What is the most important drug for symptoms of angina?

A

Nitroglycerin

268
Q

What can you not give Ranolazine with?

A

Ketoconazole, Veraapamil, and digoxin

269
Q

What can what chemicals are used in a stress test for CAD?

A

Adenosine, Dobutamine, Dipyridamole, and Regadenson

270
Q

What do you need to avoid 24 hours before a stress test?

A

Caffeine and beta blockers

271
Q

What is a cardiac catheter?

A

Gold standard for CAD that visualizes coronary arteries (Left) and pressure (right)

272
Q

What do you asses for after a cardiac catheter? *

A

Pedal pulses every 15 min for 1 hour
Insertion site for hematoma and swelling
Output

273
Q

Why do you hold metformin 48 hours before a cardiac catheter?

A

It can cause lactic acidosis

274
Q

What do you do if a patient has consistent rhythm changes after a cardiac catheter? *

A

Call HCP

275
Q

What is a percutaneous transluminal coronary angioplasty?

A

Done in cath lab to open up arteries

276
Q

What meds do you give after a PCTA with a stent?

A

Heparin, Aspirin, and clopidigril for 12 mon

277
Q

What is acute coronary syndrome and what do you do?

A

NSTEMI and STEMI, thrombus formation, immediately hospitalize

278
Q

What is unstable angina?

A

New onset of angina that is unpredictable and it needs to be treated immedialty

279
Q

What are the lab levels with unstable angina? *

A

Trope in and EKG are normal

280
Q

What is a STEMI and what do you do?

A

ST segment elevated MI where artery is completely blocked. EMERGENCY, artery must be opened within 90 min

281
Q

What is a NSTEMI and what do you do?

A

Non ST segment elevated MI, artery is partially blocked and a cardiac cath must be performed within 12-72 hours

282
Q

What is the most adequate cardiac bio marker? *

A

Troponin

283
Q

What are the lab levels for a STEMI?

A

ST elevation and increased troponin

284
Q

What are the lab levels for a NSTEMI?

A

No ST elevation, increased troponin

285
Q

What is the normal range for troponin?

A

0.1-0.4
4-6 hours shows
10-24 peaks
10-12 days

286
Q

What is the immediate treatment of a MI?

A

Morphine
Oxygen
Nitroglycerin
ASA or plavix

287
Q

What do you monitor on a heparin drip and the therapeutic effect? *

A

PTT/PT/INR
Prevent blood clots

288
Q

What is a coronary artery bypass graft?

A

Bypass blocked artery
If 3 or more are blocked pt will need open heart surgery

289
Q

What do you need to assess for 24-48 hours after a CABG?

A

I/O
SIgns of inadequate cardiac output: tachycardia, dim pulse, decreased LOC and cool skin

290
Q

What are the complications of a CABG?

A

Renal, neuro and SIRS

291
Q

What could a sudden stop of drainage from a chest tube indicate after a CABG? *

A

Obstruction, cardiac tamponade, and pleural effusion

292
Q

If a pt who had a MI got diagnosed with pericarditis, what are expected findings? *

A

Friction rub sound
Hypoglycemia
Fever
Increased troponin levels
ONLY CHART

293
Q

What makes the heart wall weak after a MI?

A

Neutrophils and macrophages

294
Q

What drugs are used for acute coronary syndrome?

A

Antiplatelt
Nitroglycerin
Morphine
Beta blockers
ACE/ARBS
Anti dysrhythmias
Lipid lowering meds
Stool softener

295
Q

What therapy is started ASAP for STEMI?

A

Reprofusion therapy

296
Q

What can Heparin be used for ACS?

A

NSTEMI

297
Q

What should you do when administering Labetolol for HTN?

A

Tell pt to notify when getting out of bed

298
Q

What should you teach to a patient who survived a sudden cardiac death?

A

CPR to family members

299
Q

What are the risk factors for HF?

A

HTN
CAP
diabetes
Smoking

300
Q

What is systolic failure?

A

Inability to pump blood forward HFrEF

301
Q

What are lab levels with systolic failure?

A

Decreased left ventricle ejection fraction, stroke volume, cardiac output and increased BP

302
Q

What does systolic failure cause?

A

Pulmonary congestion and edema

303
Q

What is diastolic HF?

A

Impaired ventricles to relax and refill, HFpEF

304
Q

What are the lab levels with diastolic failure?

A

Decreased stroke volume and cardiac output

305
Q

What is biventricle failure?

A

Inability of both ventricles to pump
Fluid buildup
Decrease perfusion to vital organs

306
Q

What is dilation?

A

Enlargement of heart chambers, increased pressure on chambers, preload and cardiac output

307
Q

What is hypertrophy r/t HF?

A

Increase muscle mass with a thick cardiac wall

308
Q

What is compensated HF?

A

Normal cardiac output

309
Q

Signs of left sided heart failure? *

A

Paroxysmal nocturnal dyspnea
Orthopnea
Tachycardia
Cough
Crackles/wheezes
Blood tinged speutum
Restless
Confusion
Cyanosis
Increased pulmonary/capillary pressure

310
Q

Signs of right sided HF? *

A

Fatigue
Ascites
Enlarged liver/spleen
Distended JV veins
Anorexia, GI distress
Swelling in hands/fingers
Dependent edema
Increased peripheral venous pressure

311
Q

What is early acute decompensated HF?

A

Increased pulmonary venous pressure with increased RR and decreased O2

312
Q

What is late acute decompensated HF?

A

Interstitial edema with tachypnea

313
Q

What is progressive acute decompensated HF?

A

Alveolar edema with respiratory acidosis

314
Q

When does acute decompensated HF need immediate action? *

A

Sudden onset of dyspnea or orthopnea

315
Q

What are the signs of pulmonary edema?

A

Anxious, pale, cyanosis
Cool/clammy skin
Dyspnea , Orthopnea, Tachypnea
Accessory muscle use
Frothy blood tinged sputum
Crackles/wheezes
Tachycardia
Abnormal s3 and s4

316
Q

What are the categories for acute decompensated HF?

A

Dry warm
Dry cold
Wet warm most common
Wet cold

317
Q

What do you do for acute decompensated HF?

A

Hemodynamic monitoring
O2
Mechanical ventilation
High Fowler
Ultrafiltration
IABP
VAD

318
Q

What meds do you give for acute decompensated HF?

A

Diuretics
Vasodialators
Morphine
Intropin
Dobutres
Levophed
Primacor
Digoxin

319
Q

What is a cardiac glycoside?

A

Digoxin. 0.6-1.2. Low potassium can increase risk for toxicity so monitor F/E

320
Q

What are the signs of chronic HF?

A

Fatigue
Activity limitation
Chest congestion/cough
Edema
SOB
Nocturnal dyspnea and Orthopnea
Tachycardia
Skin changes
Weight change
Behavioral change

321
Q

What are the complications of chronic HF?

A

Pleural effusion
Dysrhythmias
LV thrombus
Hepatomegaly
Rena; failure

322
Q

What meds are used for chronic HF?

A

ACE/ARB
Spironalactone
Beta blockers
Vasodialators
Bidil
Digoxin

323
Q

What do you do for chronic HF?

A

Low sodium diet
Fluid restrictions <2l/day
Daily weight

324
Q

What can cause acute decompensated HF?

A

Blood transfusion and IV fluids

325
Q

What are early signs of digoxin toxicity that you need to watch for when treating decompensated HF and what do you do? *

A

Anorexia, N/V, confusion, HA, blurred vision. Hold dose and notify HCP

326
Q

What is a main intervention for chronic HF? *

A

Weigh daily at same time and report weight gain of 3 pounds in 2 days

327
Q

What diseases increase BNP levels?

A

Pulmonary embolism, renal failure and CAD

328
Q

What are the stages of infective endocarditis?

A
  1. Bacteremia: mitral stenosis
  2. Adhesion
  3. Vegetation
329
Q

What are the manifestations of infective endocarditis?

A

Fever/chills
Weakness
Malaise/fatigue
Anorexia
Splinter hemorrhages
Arthralgias
Myalgias
Back pain
Abdominal discomfort
Weight loss
HA
Clubbing

330
Q

What can infective endocarditis cause?

A

New/worsen systolic murmur and HF

331
Q

What are the diagnostics for infective endocarditis?

A

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
Q

What is the treatment for infective endocarditis?

A

Repeat blood cultures every 24-48 hiurs
IV ATB
Antipyretcs
Fluids/rest

333
Q

When does a pateint have to receive prophylactic ATB for infective endocarditis?

A

Dental procedures
Repiratory tract incisions
Tonsillectomy/ adenoidectomy
Surgery involving infected skin, skin structures or musculoskeletal tissue

334
Q

What is acute pericarditis?

A

Develops rapidly, pericardial sac is inflammed and leaks fluid

335
Q

What is subacute pericarditis?

A

Occurs weeks-month after an event

336
Q

What is the hallmark fidning for acute pericarditis?

A

Pericardial friction rub

337
Q

What are the symptoms of pericarditis?

A

Progressive, severe, sharp chest pain
Deep inspiration when lying flat
Dyspnea

338
Q

What are the complications of pericarditis? *

A

Pericardial effusion: fluid
Cardiac tamponade: fluid compresses the heart

339
Q

What are the signs of cardiac tamponade? *

A

Distant heart sounds, distended JV, decreased arterial pressure

340
Q

What are the diagnostics for peridcrditis?

A

Troponin elevated in acute
CBC: leukocytisis
CXR
EKG: diffused, wide ST elevation
Periocardiocentesis

341
Q

what is the treatment for acute pericarditis?

A

ATB
best rest
NSAIDS
corticosteroids
manage anxiety

342
Q

what is myocarditis?

A

inflammation of the heart muscle

343
Q

what is the diagnostic for myocarditis?

A

endomyocardial biopsy

344
Q

what medications are used for myocarditis?

A

ACE
beta blcokers
diuretics
digoxin
anticoagulants
immunosupprants

345
Q

what are the signs of myocarditis?

A

cardiac signs appear 7-10 days after a viral infetion
fever
fatigue/malaise
N/V
myalgias
pharyngitis
dyspnea
lymphadenopathy

346
Q

what can myocarditits cause in late symptoms?

A

HF
s3 heart sound
crackles
JVD
peripheral edema
angina

347
Q

what is the most common cause of dilated cardiomyopathy?

A

results from heart dysfunction from myocarditis

348
Q

what is the nursing managment for myocarditis?

A

manage s/s of HF and decrease cardiac workload:
semi fowlwer
quiet enviroment
space activity/ rest periods

349
Q

what is rheumatic fever (RF)?

A

a complication 2-3 weeks after group A strep pharyngitis

350
Q

what can RF effect?

A

heart, joints and CNS

351
Q

what are the diagnostics for RF?

A

ECHO: valvular insufficeny and pericardial fluid
CXR: enlarged heart
EKG: delayed AV conduction, prlonged PR interval

352
Q

what are the s/s of mitral valve stenosis?

A

extertional dyspnea
loud S1
murmur
fatigue
palpatations
hoarseness, hemoptysis
chest pain
seizure/stroke

353
Q

what are the s/s of chronic mitral valve regurgitation?

A

asymptomatic until LV failure:
weak
fatigue
palpatations
dyspnea
peripheral edema
s3 heart sound
murmur
orthopnea

354
Q

when does chronic mitral valve regurgitation need treatment?

A

needs surgery before LV failure or pulmonary HTN

355
Q

what are the s/s of acute mitral valve regurgitation?

A

thready peripheral pulses
cool/clammy extremitities

356
Q

what are the s/s of mitral valve prolapse?

A

many pt are asymptomatic:
dysrythmias
palpatations
dizzy/light headed
infective endocarditis with mitral regurgitation
chest pain unresponsive to nitrates
murmurs on systole

357
Q

what do you not give for mitral valve prolapse? *

A

No ATB
No nitrates
avoid caffeine
excersize daily

358
Q

what are the signs of aortic valve stenosis?

A

SAD: syncope, angina, dyspnea = LVF
later signs are RHF

359
Q

what can you not give for aortic valve stenosis? *

A

nitroglycerin because it reduces preload

360
Q

what are s/s of acute aortic valve regurgitation?

A

sever dyspnea
chest pain
hypotension
cardiogenic shock
LIFE THREATNING EMERGENCY

361
Q

what are the s/s of chronic aortic valve regurgitation?

A

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
Q

what are the signs of tricuspid valve stenosis?

A

peripheral edema
ascites
hepatomegaly
low pitched murmur

363
Q

what is tricuspid valve stenosis common in?

A

rheumatic fever and drug users

364
Q

what are the s/s of pulmonic valve stenosis?

A

fatigue and loud midsystolic murmur (BORN WITH)

365
Q

what is the treatment for all valvular heart disease?

A

treat underllying cause
Treat HF: Nitrates, ACE, digoxin, diuretics, betablockers
sodium restriction
anticoagulants
antidysryhtmias
percutaneous transluminal balloon valvuloplasty

366
Q

if a pt got a percutaneous transluminal baloon valvuloplasty for a valve disease, what do you monitor? *

A

HIGH RISK PATIENT
bleeding and hypotension

367
Q

what is a commissurotomy valvulotomy?

A

surgical valve repair for mitral stenosis

368
Q

what is a valvuloplasty and annuloplasty?

A

valve repair

369
Q

what does a mechanical valve replacement increase the risk for and what is given? *

A

thromboembolism and give long term anticoagulation
Biologic over mechanical because no anticoagulation is needed in pt with alzheimers

370
Q

what is dilated cardiomyopathy? *

A

ventricular dilation

371
Q

what is hypertrophic cardiomyopathy?

A

left ventricle and enlarged septum

372
Q

what is restrictive cardiomyopathy? *

A

rigid ventricle walls least common

373
Q

what is takotsubo cardiomyopathy?

A

broken heart syndrome

374
Q

what are the s/s of dilated cardiomyopathy? *

A

ALL CHAMBERS ARE ENLARGED
fatigue
dyspnea on rest and nocturnal
orthopnea
dry cough
palpatations
bloating
N/V

375
Q

what are the diagnostics for dilated cardiomyopathy? *

A

CXR: enlarged, pulmonary HTN, pleural effusion
EKG: tachycardia, bradycardia, dysrhytmia
increased BNP
doppler echo
heart cath

376
Q

what is the treatment for dilated cardiomyopathy?

A

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
Q

what are the s/s of hypertrophic cardiomyopathy? *

A

asymptomatic with thick ventricular walls
exertional dysonea, fatigue, angina, syncope

378
Q

what is the primary diagnostic for hypertrophic cardiomyopathy?

A

ECHO: apical pulse through chest on palpatations

379
Q

what can you not give with hypertrophic cardiomyopathy?

A

NO VASODILATERS

380
Q

what are the s/s of restrictive cardiomyopathy?

A

fatigue, excersize intolerance, dyspnea because heart cant increase cardiac ouput by increasing HR without compromising ventricular filling

381
Q

what do you teach a patient with restrictive cardiopmyopathy?

A

avoid strenous activity and dehydration

382
Q

whats the most important thing to assess for in mitral valve stenosis?

A

SOB on exertion

383
Q

what is peripheral artery disease?

A

progressive narrowing and degeneration of arteries in the upper and lower extremities r/t smoking
advanced systemic atherosclerosis

384
Q

what can peripheral artery disease lead to?

A

coronary artery diesease and or cerebral artery disease

385
Q

what are the s/s of perioheral artery disease?

A

intermittent claudication
paresthsia
thin, shiny, tout skin
loss of hair
diminished pulses
pallor, blanching with elevation
hyperemiia and redness
pain at rest

386
Q

what are the complications of peripheral artery disease?

A

atrophy
delayed healing
wound infection
necrosis
arterial ulcers
gangrene
amputation

387
Q

what are the risk factor modifications for peripheral artery disease?

A

smoking cessation
exercise
BMI<25
waist circumference <40men <35women
reduce calories and salt (DASH)
HA1C<7%

388
Q

what should you monitor with peripheral artery disease?

A

perfusion to extremities
proper foot wear
no constrictive socks
dont cross legs or prolong sit/stand
no heat

389
Q

what meds are used for peripheral artery disease?

A

ACE/ARB
lipid management
antiplatlets (ASA or clopidogril)

use Cilostazol or Pentoxifylline for intermittent claudication

390
Q

what does antiplatelts do for PAD?

A

prevent platelts adhesion at site of blood vessel injury and decreases collagen

391
Q

what is aspirin contradicted in?

A

flulike symotms (Reyes)

392
Q

what does Cilostazol do for intermittent claudication with PAD?

A

decreases platlet aggregation and increased vasodilation
relief of cramping
improves walking indurance in 2-4 weeks

393
Q

what are contradictions to antiplatelts?

A

thrombocytopenia
active bleeding
leukemia
traumatic injury
GI ulcer
Vit K defiecney
stroke

394
Q

what do you do for acute arterial ischemia?

A

assess 6 P (pulse, pain, paresthia, polar, pallor, paralysis)
thromboectomy
thrombotic therapy
anticoagulation
Heparin or remove clot

395
Q

what do you do for thromboangitis obliterans?

A

“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
Q

what is raynauds pnenomenon and when is it diagnosed?

A

extremities suddenly experience decrease blood circulation r/t vassospasm and diagnosed 2 years after repeated episodes r/t cold, stress or smoking

397
Q

what education do you give for raynauds phenomenon?

A

stress managment
wear gloves and socks
stop smoking
avoid injuries
avoid caffeien
place hands in warm water when attack begins

398
Q

what is the treatment of raynauds phenomenon?

A

CCB: Nifedipine
Iioprost
Botulinum toxin A and statins

399
Q

what are the s/s of a throacic aorta anurism (TAA)?

A

deep defused chest pain that radiates to neck, shoulders, and back
dyspnea
syncope
increase pulse
weakness
hoarse with difficulty swallowing

400
Q

what are the s/s ascending aortic arch?

A

angina
TIA
SOB
cough
hoarse r/t compression on laryngeal nerve

401
Q

what are the s/s of an abdominal aortic aneurysm (AAA)?

A

asymptomatic until ruptures
pulsatinf mass under umbillicus below renal artieries

402
Q

what do you do for AAA and when is surgery needed?

A

if small (4-5.5) and asymptomatic only moniotr
if >5.5 surgery is needed

403
Q

if a patient has a AAA and has a sudden onset of abdominal pain what do you do? *

A

Immediatly intervene PRIORITY PATIENT

404
Q

what are s/s of a rupture in retroperitoneal space?

A

bruising, sudden sever pain

405
Q

what are s/s of a rupture in throacic or abdominal cavity?

A

massive bleeding, needs ressection and CPR

406
Q

If a patient has a thoracic aorta aneurysm (TAA) that is enlarging, what would you monitor for? *

A

Deep chest pain
dyspnea
syncope
increase pulse and tachycardia
hoarse with dofficult swallowing

407
Q

what is intraabdominal HTN?

A

lethal complication in emergency repair of aneurysm r/t abdominal compartment syndrome

408
Q

If a patient has intraabdominal HTN and their monitor and pressure starts increasing, what do you do? *

A

REPORT IMMEDIATLY PRIORITY PT
normal pressure is 12-15

409
Q

what is the aortic surgery post op care? *

A

peripheral profusion
temp, color, capillary refill, semsation and movement
renal perfusion (BUN/Creatnine)
Cardiac rythm
daily weight
HOB at 45

410
Q

If a patient has decreased ot absent pulses with cool extremeities post op aortic surgery what could it mean? *

A

artery occluded or clot

411
Q

what is an aortic dissection?

A

result of a false lumen through blood flow, tear in aorta
Type A: emergency surgery
Type B: potential conservation treatment

412
Q

what is a life threatning complication of an aortic dissection?

A

Cardiac tamponade:
hypotension
narrow pulse pressure
JVD
muffled heart sounds
pulses paradoxus

413
Q

what are compliations of an aortic dissection?

A

aorta rupture
hemmorage
occlusion of arteiral supply to organs

414
Q

what are the s/s of superficial vein thrombosis?

A

palpable, firm, subQ, cord like vein
itchy, painful, red and warm
temp elevation and leukocytosis
edema

415
Q

what are the s/s of venous thromboembolism (DVT)?

A

unillateral edema
pain, tender with palpatation
dilated superficial veins
fullness in legs
paresthsia
warm, red skin
systemic fever >100.4

416
Q

what can cause phlebitis and what do you do?

A

IV gone bad and apply warm moist compress

417
Q

what is the most serious complication of a VTE and what do you do? *

A

pulmonary embolism; if new onset of dyspnea at rest apply O2 and call HCP

418
Q

if a patient already has a VTE what can you not use?

A

compression stockings

419
Q

How do you prevent a DVT?

A

reposition every 2 hours
ambulate 4-6 times a day
stockings with anticoagulants

420
Q

what meds are given for a DVT?

A

anticoagulants:
warafarin
heparin
enoxaparin
dabigatrin
Rivaroxaban

421
Q

what is the nursing care for a DVT? *

A

increase protein
compression socks
elevate legs
moist dressing
never use lotion
no smoking, alcohol or caffiene
limit prolonged stand/sit

422
Q

what is the prevention for varicose veins?

A

avoid prolonged sit/stand
maintain ideal body weight
walk daily

423
Q

what do you do after a vein ligitation surgery for varicose veins?

A

elevate legs to prevent edema
compression socks: remove every 8 hours for a short period

424
Q

what is the long term management for varicose veins?

A

elevate legs above heart
compression socks
frequently flex/extend to change positions when prolonged standing

425
Q

what is the drug and surgical therapies for varicose veins? *

A

Venoactive drugs
Sclerotherapy: iv injection
Transcutaneous laser: when sclerotheroay is contradicted

426
Q

what is primary varicose veins?

A

women, weak vein walls

427
Q

what is secondary varicose veins?

A

results drom direct injury, VTE of venous distention

428
Q

what are the risk factors for lower extremitiy varicose veins?

A

family hx
female
weak veins
tobacco
age
obeisty
multiparity
hx of VTE
phlebitis
prolonged sit/stand

429
Q

what can chronic venous insufficeny result in?

A

edema
skin changes
venous leg ulcers

430
Q

what are the s/s of venous leg ulcers and chronic venous indufficency?

A

leathery skin
brown appearance
persistant edema
eczema/ itching
slow to heal and debilitating

431
Q

what is the managment for venous leg ulcers?

A

elevation
wound care
moist dressing
compression
bland diet with protein

432
Q

what is the wound care for venous leg ulcers?

A

Hydrocolloid, hydrogel, foam, alginates gauze and trasnparent dressing
unna boot
debridment
NS
ointments, creams and powders are harmful

NSG 229 (4 decks)

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