Cardiovascular Flashcards
Hypovolemic shock
S/S: pale, diaphoretic, restless
Nursing knowledge: patients are hypotensive, tachycardia, tachypnea
Nursing actions: give oxygen, narrowing pulse pressure
Polyarteritis Nodosa
Inflammation of the small arteries causing a diminished blood
Treatment: Cortisol
Cardiac catheterization
Inspection of pain at site, report of chest pain, lightheaded and nausea immediately following catheterization should be reported to PCP
This uses dye contrast to assess for artery obstruction. Complications include allergic reactions, lactic acidosis ( due to use of Metformin(glucophage), glucophage should be discontinued 24-48 hours prior to and exposure to dye) and kidney failure( dye increases kidney damage)
Catheter insertion
Should never be withdrawn and inserted when resistance is felt. Rather stop he insertion and ask patient to take a deep breathe— this helps relax the urethral muscles and facilitate passage through the prostate gland
Withdrawing blood from a PICC LINE
Discard 3ml-5ml of blood to prevent contamination of blood sample with iv fluid and medications
Use 10ml syringe to flush port
Apply a push -pause technique to reduce the risk of clot formation and damage to catheter
Venous insufficiency
Elevate legs not dangle
Arterial insufficiency
Dangle legs in dependent position not elevate
Beta blocker (LOL to my 4Bs: bradycardia, bronchospasm, blood sugar, blood pressure)
Never MISS !!!!!!!!!
Bradycardia ( decrease heart rate: notify PCP if HR is less than 50) Bronchospasm ( Do not give to asthmatic patients: it increases resistance of airway)
Blood pressure decreases
Blood sugar masked( hyperglycemia)
Hypertensive crisis
Notify PCP
Administer prescribe antihypertensive crisis
Elevate HOB 15-30 to prevent increase ICP
No need to administer fluid because it expands blood volume which in turns increases ICP
Atorvastatin
Huge category X, advice patient to use contraception while taking atorvastatin.
MONITOR LFT at least yearly. Follow low fat diet. Effective for everyone
ACE inhibitors- angiotensin converting enzymes inhibitors —e.g. Lisinopril, captopril
blocks the release of aldosterone and by doing that promote the retention of potassium .
Avoid food high in potassium
Common side effects of ACE inhibitors include orthostatic blood pressure(dizziness), dry cough, hyperkalemia, and angioedema( worst: report immediately)
Tartrazine (yellow food coloring)
No aspirin
Aerobic exercise( cardio exercise)
Regular aerobic exercise are usually recommended over isometric exercise ( heavy weight lifting) and rowing because they can cause a dangerous rise in blood pressure
Warfarin(Coumadin)
Question? The nurse notes that a client taking warfarin sodium ( Coumadin) has an international normalized ratio (INR) of 2.8, what should the nurse do?
The Normal INR is 1.3 to 2.0. The treatment goal of warfarin sodium is to raise the INR to an appropriate value. An INR of 2 to 3 is appropriate for most clients, although for some clients the target 🎯 INR is 3 to 4. 5.
if the INR is above the recommended range, warfarin should be ⬇️ decrease . If the INR is a 2.8, the nurse should plan to administer the same dosage as prescribe.
CONTRAINDICATIONS for WARFARIN!!!!!!
Active peptic ulcers
Alcohol 🍺 use
Recent injuries
Warfarin PT normal values is 9.6 to 11.8
Below the knee amputation
PostOp Care
>Elevate limb to minimized edema but do not elevate for more than 24 hours because of hip flexion
> During the first 24 hours, you may lie the patient prone for 30 minute 3 times per day for a short period of time
Cardio version
Administer sedatives/ hypnotic
Instruct client that medications may cause dizziness or drowsiness
Withhold digitalis 48 hours before procedure to prevent ventricular fibrillation after cardio version
Immediate Treatment for MI
Mnemonic ( MONA) M: Morphine Sulfate O: Oxygen N: Nitroglycerin A: ASA
Treatment for CHF
Mnemonics's ( UNLOAD FAST) U: sit upright N: Nitro L: lasix O: Oxygen A: aminophyline D: Digoxin
F:Fluid decrease
A: Afterload decrease
S: sodium decrease
T: tests, dig levels, ABG, K
Pack Red blood cells administration
Prime the tubing with 0.9% sodium chloride to reduce hemolysis.
Infuse one unit of red blood cell over 4 hours
Use 18-20 gauge needle
Take baseline vitals signs
Verify with another nurse
Hydralazine hydrochloride(apresoline)
Fast acting antihypertensive : helps to relax smooth muscle. S/E: headache, angina,tachycardia, palpitations, sodium retention, anorexia, and lupus erythematosus-like syndrome( sore throat, fever, muscle joint aches and rash)
Ginkgo
Is an anti-platelet, an a CNS stimulate given dementia syndrome. There is increase risk with NSAIDS
Clopidogrel ( plavix)
Anticoagulant.
Increase risk of hypertension, needs periodic blood test. Also med should be taken the same time each day
Increases risk of bleeding
Hyperkalemia
MURDER
M: muscle weakness ( metabolic acidosis)
U: urine, oliguria, Anuria
R: respiratory distress ( respiratory acidosis
D: decrease cardiac contractility
E: elevated T waves (ECG changes)
R: reflexes, hyperreflexia.
Hypokalemia,
Vomiting, use of steroids
PVC
Patient complains of a lump in the throat
Cardiac tamponade
Large amount of pericardial fluid cause the heart to be squeezed and unable to contract effectively. Heart tones become muffled, cardiac output and blood pressure drop, pulse increases and the client develops jugular vein distention, pulsus paradoxus, and narrowed pulses. 3MAIN ASSESSMENT Narrowed pulse pressure Muffled heart sounds Distended neck vein
B-type natriuretic peptide (BNP)
Are made and stored and release primary by the ventricles, they are produce in response to stretching of the ventricles due to the increase blood volume and higher level of extra fluid that accompany heart failure. Elevation of BNP >100pg/mL helps to distinguish cardiac from respiratory causes of dyspnea.
CK-MB
Specific diagnostic of myocardial infarction
Thoracic aortic aneurysm
This can put pressure on the esophagus and cause dysphasia indicating that aneurysm has increase in size and may need further intervention
Abdominal aortic aneurysm
Repair of aneurysm can be done via femoral percutaneous placement of a stent graft. PostOp priority is to monitor for graft leakage or separation. Manifestation of graft leakage include: echymosis of the groin, penis, scrotum, or perineum, increased abdominal girth, tachycardia, weak or absent peripheral pulse, decrease hematocrit and hemoglobin, increase pain in the pelvis, back or groin, and decrease urinary output( due to inadequate perfusion to the kidney leading to hypotension)
Storm bite
Non dangerous in kids, also known as salmon patch or angel kiss. Pt and parent needs teaching. Goes away after a year
PAD( peripheral artery disease)
Decrease blood flow to organs Intermittent claudication Decrease peripheral pulses Cool, dry, shinny skin Gangrene Thick brittle nails Ulcers. Teaching for PAD Smoking cessation, regular exercise, low sodium diet Tight glucose control( diabetic) Instruct patient to never apply direct heat to extremities due to the risk of a burn from decrease sensitivity. They do not feel it.
Chest drainage
Anything drainage >100ml/hr should be reported to PCP
Left sided heart failure
Pulmonary congestion(lungs congestion) : pulmonary edema, dyspnea, orthopnea, PND( paroxysmal nocturnal dyspnea) and crackles Cardiomegaly which result: displaced PMI and S3 sound
Right sided heart failure
Systemic venous congestion:
Jugular vein distention
Hepatomegaly, splenomegaly, as it’s and edema of lower extremities
Dyspnea on exertion
aPTT
Normal value is 25-35 for patient not being anticoangulated
however heparin infusion are titrated to obtain a therapeutic value of aPTT typically 1.5-2.5 times the normal value, so the expected therapeutic value for aPTT is 46-70 seconds, if higher than this, the patient is at risk for bleeding.
ECG Strips
HR( 60-100)
P waves: should be present before QRS
PR interval: 0.10-0.20 (<5 small squares)
QRS: <0.12
Prolonged PR interval indicate first degree av node block.
Ventricular tachycardia
Can be pulseless or have a pulse
A pulseless V-tach or V-fib ( defribrilate)
An unstable client in a V-tach with pulse( treat with synchronized cardioversion)
The stable client in V-tach with a pulse ( treat with amiodarone, procainamide or sotalol)
Aortic abdominal aneurysm
A bruit, swishing or buzzing sound that indicates turbulent blood flow in the aneurysm, best heard at the bell of the steothoscope. It can be heard in the periumbilical or epigastric area slightly left of the midline
D-Dimer
Order for patient with pulmonary embolism
Lower extremity DVT
Unilateral edema, calf pain or tenderness to touch, warmth, and erythema, and a low grade temperature
Poor skin turgor or skin tenting
Indicate dehydration
Central venous pressure (CVP):
a normal CVP is 2-8 mmHg. An elevated CVP indicated right ventricular failure or fluid volume overload.
Coronary arteriogram
Pt are require to be NPO prior to IV line
Dye used
Pt are require to lie flat to maintain hemostasis of the femoral artery
Contraindication for thrombolytics
Prior intracranial hemorrhage Structural cerebrovascular lesion Ischemic stroke within 3months ( except within 3hours Suspected aortic dissection Active bleeding or bleeding diathesis Significant head trauma within 3month
Transfusion reactions
If an adverse blood transfusion reaction is suspected, the first action is to stop the infusion, and infusion of normal saline through a different port for the CVC is typically started, a client assessment and notification of the HCP are also required
Heart attack in elderly women
Most often present with atypical symptoms such as nausea, vomiting, belching, indigestion, diaphoresis, dizziness and fatigue
Pulmonary edema
Dyspnea
Cough production of pink frothy sputum
Infective endocarditis (IE)
A vegetation over the valves breaks off and embolized to various organ, resulting in a life threatening complications which includes:
Stroke
Spinal cord ischemia: paralysis of both legs
Ischemia to extremities: pain, pallor, and cold foot or arm
Intestinal infarction: abdominal pain
Splenic infarction: left upper quadrant pain
Septic pulmonary emboli
Osler nodes
Splinter hemorrhage
Petechiae
