Cardiovascular Flashcards
1
Q
What measures the amount of cholesterol one has?
A
Plasma cholesterol screening
2
Q
What can you eat 12 hours before plasma cholesterol test?
A
Only sips of water to achieve accurate results
3
Q
What do you do after the application of a cast on the arm?
A
Elevate the arm for the first 24 - 48 hours to minimize swelling. It protects from pressure and flattening of the cast.
4
Q
Tredelenburg test can be used for clients with…
A
varicose veins
5
Q
Heartburn that radiates to the jaw indicates…
A
chest pain
6
Q
Patient receiving thrombolytic therapy may cause…
A
bleeding, for example with IM injections
7
Q
What does it mean if the pulse increases?
A
tissues are not being perfused correctly
8
Q
What problems does a low platelet count cause?
A
No blood clotting, allowing blood to infuse joints, putting the pt at risk for injury
9
Q
What is the most common cause of mitral valve problems?
A
A history of rheumatic fever with a subsequent complication of carditis which affects the valve.
10
Q
What does CVP readings measure?
A
the pressure in the right ventricle
11
Q
What does Swan-Ganz catheter measure?
A
the pulmonary artery wedge pressure, which is an indirect reading of the pressure in the left ventricle.
12
Q
What is a pulmonary artery catheter?
A
a multi lumen apparatus
13
Q
What can a pulmonary artery catheter measure?
A
Pulmonary artery pressure Myocardial filling pressures Cardiac output Pulmonary resistance Systemic resistance Cardiac index (the cardiac output divided by the body surface area)
14
Q
Should a nitroglycerine patch be removed prior to an MRI?
A
Yes
15
Q
What is Buerger’s disease (thromboangitis abliterans)?
A
a vascular occlusion disease of the extremities causing a decreased blood flow to the feet and legs
16
Q
What is keep-open-rate?
A
the lowest possible infusion rate (cannot be used on sickle cell patients because they need more hydration)
17
Q
Sickle cell patients should not be given aspirin because…
A
of bleeding tendencies
18
Q
What is the rate of keep-vein-open (KVO)?
A
20 ml/hr, this rate will keep access open
19
Q
Why do elderly patients have lower temperatures?
A
due to lower metabolic rate
20
Q
How is adult hypertension recognized?
A
After 2 readings taken at least 5 minutes apart
21
Q
5 things to know about sequential compression device (SCD):
A
- apply anti embolism stocking prior to applying SCD sleeves.
- stocking should be worn the entire time they’re in the hospital. Should be removed after baths and replaced after the skin is dry and before the client gets out of bed.
- the stocking is worn to prevent discomfort and increase blood flow.
- you need to be able to fit 2 fingers between the sleeve and the leg.
- SCD is used to decrease venous stasis and reduce risk of thrombus formation.
22
Q
Why is talcum powder used?
A
it allows easier application of the stocking
23
Q
Why elevate the patient’s leg before applying the stocking?
A
it prevents stagnation of blood in the lower extremities.
24
Q
When applying stockings their should be no wrinkles because…
A
it can cause irritation to the skin
25
4 things to know about DVT:
1. pt should not be ambulating, bed rest for 5 - 7 days to prevent pulmonary embolisms. Leg should be elevated with warm moist packs.
2. the affected calf is expected to be warm.
3. extremity edema is expected because of venous congestion.
4. patients need to be given anticoagulants
26
2 things to know about IV sites?
1. if tenderness and redness is noted, remove catheter and apply warm soaks to decrease swelling.
2. marking pen should not be used on IV bag. ink can penetrate the plastic and get into the solution. Labeling should be done on the bag label using a regular pen.
27
What is used to wean patients off TPN?
Hypertonic dextrose solution
28
What is extravasation?
When vesicant has filtrated.
29
What is vesicant?
a medication or IV solution that causes blisters and tissue sloughing (burning).
30
8 medications that can cause burning if infiltrated?
1. vancomycin
2. gentamycin
3. penicillin
4. dilantin
5. any antineoplastic
6. calcium
7. potassium
8. epinephrine
31
Infiltrations need cool compresses except for...
Vancomycin, which needs warm compresses
32
If hematoma or bleeding is suspected what kind of compresses are best?
Cool compresses. It constricts vessels to slow down bleeding or stop bleeding.
33
With a central venous catheter how often do you flush?
After giving meds flush with saline and then heperinized solution afterwards. Then flush every 12 hours or after meds administration.
34
Why limit manipulation of the cannula at the IV insertion site?
To prevent dislodgment.
35
Why should IV sites not be close to joints?
Because movements could cause displacement.
36
What is the correct sequence for cardiac assessment?
inspection, palpation and then auscultation
37
What is polyarteritis nodosa?
inflammation of the small arteries causing diminished blood
38
What can reverse supraventricular tachycardia (SVT)?
Valsalva's maneuvers such as having a child stick their thumb in their mouth, close it and blow.
39
What is the most frequent cause of disseminated intravascular coagulation (DIC)?
Sepsis
40
If a patient is undergoing septic shock and there is blood at the venipuncture site around and IV catheter, this is an indicator of...
Disseminated intravascular coagulation (DIC) a life-threatnening problem.
41
Septic shock causes an increase in...
capillary permeability
42
What is DIC?
Not a disease, but a sign of an underlying condition. An acquired clotting disorder from overstimulation. Hyperstimulation of coagulation pathways that eventually fails, resulting in bleeding.
43
7 things that trigger DIC:
1. Sepsis
2. Trauma
3. Cancer
4. Shock
5. Abruption placentae
6. Toxins
7. Allergic reactions
44
What happens to PT, PTT and platelet count in DIC?
PT and PTT are prolonged and platelet count is reduced.
45
What lab tests are specific for DIC?
1. Fibrin-split products (FSP)
| 2. Fibrin degradation product (FDP)
46
What are a group of soluble protein fragments that are produced by the proteolytic action of plasmin on fibrin or fibrinogen?
Fibrin degradation product (FDP)
47
How do you provide oral care for a patient with DIC?
Use oral swabs because it has the least potential cause of tissue injury in the oral cavity.
48
Patients with DIC may bleed from?
1. Mucous membrane
2. Venipuncture sites
3. GI and urinary tract
49
What symptoms do the patients have during the initial process of DIC?
No new symptoms
50
The diagnosis of DIC is established by...
1. drop in platelet count
2. an increase in PT and PTT
3. an elevation in FDP and measurements in one or more clotting factors.
51
What kind of diet is needed for a patient diagnosed with anemia?
High in protein, iron and vitamins
52
Food high in iron include?
```
Beef
Brown rice
Raisins
Green beans
Carrots
Milk
Oatmeal-raisin
```
53
What does hypothermia cause?
1. Vasoconstriction and hypertension
2. Myocardial irritability, which disrupts conduction system of the heart and causes the heart to be near the fibrillation threshold, especially ventricular fibrillation.
54
What can external re-warming technique cause in hypothermic patients?
Can cause re-warming shock and temperature after drop, which can lead to ventricular fibrillation
55
What can occur during paracentesis?
Shock, so blood pressure cuff needs to be on for monitoring.
56
Complication of paracentesis:
1. Abdominal pain
2. Rigidity and distension
3. Nausea and vomitting
57
Patient should ___________ before a paracentesis...
Void, to prevent puncture of the bladder
58
Heat can facilitate...
hypotension
59
Contraindications for a hypertensive client include...
Isometric exercises such as heavy weight-lifting and rowing
60
What do you do with a patient who has a constant nose bleed?
Pinch the nose 5 - 10 minutes with an ice cold washcloth
61
What else can be used to stop a nose bleed?
Silver nitrate applicator and gel foam
62
Defibrillation should be set at _______ joules:
200 joules, then 200 - 300 joules, then 360 joules. There are emergency treatment for ventricular fibrillation.
63
The purpose of defibrillation:
it completely depolarizes myocardial cells so SA nodes can re-establish as pacemaker.
64
The purpose of cardio-version...
To restore the normal sinus rhythm by chemical or electrical means
65
What medication must be withheld 48 hours before cardio-version? and why?
Digitalis. To prevent ventricular fibrillation after cardioversion
66
The sync button on the defibrillator is used for cardioversion to treat the following:
1. Atrial Flutter
2. A. fib
3. Supraventricular tachycardial synchronizes shock with R wave
67
Why is it important not to touch the bed when using a defibrillator?
To prevent accidental countershock
68
How often do you check for incisional bleeding and record the drainage after a total knee replacement?
Every 4 hours
69
When can a male resume sexual activity after a heart attack?
When he can tolerate climbing 2 flights of stairs or walking one block without SOB. Should not have intercourse after a heavy meal and remain supine.
70
What kind of diet for a hypertensive patient?
Low fat, low cholesterol and low sodium
71
Risk factors for CVA:
1. Being black
2. Male
3. Substance abuse
4. Diabetes
5. Obesity
6. Heart murmur
7. Oral contraceptive pills
8. Migraines
72
What can you take for the start of a migraine headache?
Ergotamines
73
What do you check after a cardiac catheterization?
Pedal pulses immediately after procedure and repeat every 15 minutes for several hours to detect changes in circulation.
74
What does elevating the leg promote?
Venous return, does not increase circulation
75
3 things to know about Raynaud's Syndrome:
1. Yoga can decrease stress that can cause vasospasms; helps increase circulation
2. It is best to keep warm
3. The color of the fingers changes from white to blue to red and is accompanied by tingling, numbness and burning pain.
76
How do you give medications ordered by IV push or bolus?
Slowly over several minutes with the use of a watch.
77
Patients with CVA need the following nursing care:
1. prevent flexion of the affected extremities
2. maintain adduction of the affected shoulder to prevent deformities
3. will need assistance to perform active ROM
4. prevent external rotation of the hip joint, prevent foot drop (plantar flexion) and place the hand in the slight supination so that the fingers are barely flexed….all to prevent deformities
78
The left hemisphere of the brain controls:
1. Speech
2. Math skills
3. Analytical thinking
79
Impulsive behavior is seen with...
right hemisphere CVA
80
Symptoms of right hemisphere CVA:
1. disoriented to time, person, place
2. has visual spatial defects
3. has proprioceptive (posture) difficulties
4. impulsive behavior
5. poor judgement
6. decreased attention span
7. lack of awareness or denial
8. neurological defects, increased risk for injury
81
3 things to know about autologous blood donation:
1. donor may give blood up to 5 weeks before surgery.
2. donor will have to begin oral iron supplements at least before the first transfusion
3. donor can give 2 - 4 units of blood
82
What symptoms may hemolytic reaction cause? What to do with blood transfusion?
lower backache, hypotension, fever, hematuria. Transfusion must be stopped.
83
What symptoms may febrile reaction cause? What to do with blood transfusion?
fever, chills, nausea and headache. Stop blood and administer aspirin
84
What symptoms may an allergic reaction cause? What to do with blood transfusion?
Urticaria (hives), pruritus, fever, wheezing, facial flushing, epiglottal edema. Stop blood, administer Benadryl and oxygen.
85
What do you do for circulatory overload during a blood transfusion?
Stop transfusion, position the patient upright and administer oxygen.
86
What happens with albumin deficit?
it decreases oncotic pressure and fluids shift from vascular to tissue
87
Best indicator of long term nutritional status?
Albumin level
88
What to do with a patient with extremely low hemoglobin level?
Provide oxygen
Give 2 units of packed red blood cells
Start IV
Place on cardiac monitor
89
4 symptoms of right sided heart failure:
1. Dependent edema
2. Liver enlargement
3. Peripheral edema
4. Congestion of gastric veins resulting in anorexia and ascities.
90
What is cor pulmonale?
the hypertrophy or failure of the right ventricle
91
3 symptoms of left sided heart failure:
1. Dyspnea
2. S3
3. Non-productive cough
92
Earliest sign of heart failure:
S3 ventricular gallop
93
Pain in the chest after coughing indicates...
irritation of the parietal pleura or pericarditis
94
What is the antidote for heparin?
Protamine sulfate
95
Is heparin transmitted in breast milk?
No
96
A ___________ can affect the placement of a permanent pacemaker.
hearing aid battery
97
Symptoms of decreased cardiac output with a pacemaker battery failure include:
Shortness of breath and dizziness
98
Instructions given to a patient with a pacemaker include:
Take their pulse everyday at the same time
99
Anytime the pulse rate drops below the present rate of the pacemaker that means….
That the pacemaker is malfunctioning. Pulse should be maintained at the minimal rate set on the pacemaker.
100
What is the primary purpose of a pacemaker?
To increase cardiac output
101
Signs and symptoms of a heat stroke?
1. Anhydrosis
2. Temperature of 105 degrees or higher
3. Confusion, bizarre behavior
4. Hypotension
102
Initial symptom of hyperthermia?
Headache
103
If when walking, a patient's leg throbs, it may be indicative of a form of ____________
Peripheral vascular disease
104
__________ is a useful guide in gauging activity tolerance in patients with decreased cardiac output.
Fatigue
105
______________ is subacute or chronic enlargement of the heart.
Cardiomyopathy
106
With hemophilia, the most frequent site of bleeding are into _______ and __________. Repeated bleeding causes change in _______ and __________.
muscles and joints
bone and muscles
107
How to administer platelet transfusion?
Administration set is particularly designed to platelet. It has a smaller filter and a shorter tubing.
108
If a patient's hematocrit increases by more than 4% in a span of two weeks, the likelihood of __________ and __________ increases.
Hypertension, seizures
109
What to do if the hematocrit increases more than 4% in two week?
Physician should be called to decrease dose of epoetin alpha (procrit)
110
5 symptoms of Epoetin Alpha (procrit)
1. flu-like symptoms
2. arthralgia (joint pain)
3. edema
4. nausea
5. reaction at injection site
111
4 things to know regarding central venous catheter (CVS) insertion:
1. patient should not deep breath during insertion, patient should be instructed to perform valsalva's maneuver to prevent air embolism
2. insertion occurs in the right side of the body, usually through the subclavian into the superior vena cave, turning the head away from the site to prevent contamination
3. skin needs to be shaved the night before
4. patient will be placed in the Trendelenburg position to dilate veins and decrease risk of embolism
112
A widening pulse pressure and bradycardia indicates...
a cardiac problem
113
What's common after an MI?
dysrhythmias, ventricular being the most serious
114
6 signs and symptoms of an MI?
1. chest pain radiating to arms, jaw and neck
2. dyspnea
3. indigestion
4. apprehension
5. low grade fever
6. elevated WCB, ESR, CK-MD, LDH
115
What is a temporary pacemaker?
an electronic device that is used for temporary cardiac pacing.
116
What happens to temporary pacemakers is second degree blocks?
only some of the impulses from the atria are conducted to ventricles; 2:1 or 3:1
117
What happens after a coronary artery bypass graft (CABG)?
the patient may see swelling in the leg used for the donor graft. Edema increases at home because the patient is usually more active
118
What do you do if while removing a PICC line a piece of the catheter breaks off?
tie a tourniquet to the upper arm to prevent the piece from moving into the right atrium
119
6 things to know about morphine:
1. decreases blood return to the right side of the heart
2. decreases peripheral resistance
3. provides relief from anxiety
4. give morphine prior to giving a pt oxygen, because is will decrease the heart's oxygen consumption
5. causes respiratory distress
6. it is contraindicated in head injury because is masks the signs of increased intracranial pressure
120
Can garlic capsules be taken for hypertension?
Yes
121
________ and ___________ are potential signs for an MI.
nausea and being diaphoretic
122
3 things to know regards to ambulatory EKG:
1. Do not bath or take showers during monitoring; sponge bath is fine
2. pt should record event in daily log
3. no need to change diet
