cardiovascular Flashcards
mediastinal CT
complications?
obstruction can cause fluid buildup in the pericardium causing a cardiac tamponade
CABG: post op
washing incision?
normal findings?
do not?
report?
where does the vein come from?
sign of hemorrhage?
MICABG- what is the difference?
- What to do:
- Wash incision/shower daily with soap/water and pat dry
- wear ted hose
- elevate legs when sitting
- Normal:
- Itching
- numbness and tingling around the incisions (for several weeks)
- Do NOT:
- Take tub baths= risk of infection
- Report:
- redness
- swelling
- drainage
- incision has opened
- graft harvested from great saphenous vein so brusing is expected
- hemorrhage= 100mL/hr or more of drainage into CT (PRIORITY)
- MICABG: more painful most op but shorter recovery time
when can a client resume sex w an MI?
If a client can walk 1 block or climb 2 flights of stairs w/o symptoms they can resume sex
It is safe to resume sex 7-10 days after an uncomplicated MI
troponin levels
when do they inc?
peak?
return to BL?
increase 4-6 hrs after onset
peak 10-24hrs
return to BL in 10-14 days
what is a holter monitor?
how long do you keep it on?
dos and do nots?
- Records ECG rhythm for 24-48 hrs
- Keep a diary of activities and symptoms, engage in normal activities
- do not bathe or shower during test period
Thrombotic thrombocytopenic purpura (TTP)
priority assessment?
safety measures?
any change in LOC
use electric razors, no NSAIDs (use acetaminophen instead)
Coronary arteriogram (angiogram)
eating/drinking?
post op positioning?
discharged?
XR or visualization
NPO 6-12 hours prior
lie flat for several hrs post op
discharged the same day
abdominal aortic aneurysm (AAA)
preop: what do you want to pay attention to?
signs of embolization or graft occlusion|?
what can prolonged hypotension lead to?
what is an Endovascular abdominal aortic aneurysm and what should you monitor for?
normal post op sx?
signs of graft leakage?
- Preop:
- pay attention to peripheral pulses, renal, and neuro status
- Mark dorsalis pedis and posterior tibial pulses
- embolization or graft occlusion:
- dec or absent pulse w cool, pale, mottled or painful extremity
- prolonged hypotension can lead to graft thrombosis
- Endovascular abdominal aortic aneurysm:
- do not require an abdominal incision
- monitor puncture sites for bleeding
- Post op:
- abd tenderness, nonrigid soft abd
- NG tube green bile drainage
- signs of graft leakage
- hypotension, tachycardia, inc abdominal girth, groin, back or pelvic pain, ecchymosis of scrotum/penis/groin/perineum, weak/absent peripheral pulses (pulses can be absent for 4-12 hrs after), dec H&H
rheumatic fever
what is it and what is it caused by?
symptoms?
tx?
- Inflammatory disease of the heart
- occurs 2-3 weeks after streptococcal pharyngitis (strep throat)
- sx: arthritis, carditis, SQ nodules, fever, arthralgias, inc ESR/c-reactive protein, prolonged PR interval
- Tx: penicillin
chronic venous insufficiency
Sx?
tx?
- sx:
- venous stasis
- leg ulcers/dermatitis
- edema
- warm thick skin
- brown pigmentation
- varicose veins
- tx
- elevate legs
- ambulate
- DVT prophylaxis (anti embolism stockings, SCD, SQ heparin)
R vs L sided HF causes and sx?
teaching?
interventions?
- Right (rest of body):
- causes: pulm HTN, MI
- sx: JVD, pitting edema, hepatomegaly, splenomegaly, ascites, inc abdominal girth, dilutional hyponatremia, inc CVP
- Left (lungs):
- causes: systemic HTN, MI
- sx: fatigue, SOB/dyspnea, orthopnea, pulm edema (fine crackles), cardiomegaly (displaced PMI, S3), dec CO= hypotension
- Teaching/interventions:
- daily weights
- dec Na (do not take NSAIDs, cause Na retention)
- fluid restriction
- take pulse for 1 minute if taking dig or BB
- walking w/ rest periods
- avoid extreme heat/cold
- meds: diuretics, ACEI, digoxin
- intra aortic balloon pump, AI defribrillator
cardiac tamponade?
sx?
tx procedure and position?
what can it be caused by?
- pericardial effusion buildup
- MEDICAL EMERGENCY
- sx: SOB, Narrowed PP (SBP-DBP), muffled/distant heart sounds, JVD, hypotension, pulsus parodoxus, chest pain, tachypnea, tachycardia
- tx: emergent pericardiocentesis
- supine
- can be caused by pericarditis
endocarditis/pericarditis/valvulitis?
acute pericarditis: what do we see in the EKG leads?
sx?
interventions?-meds? position?
- inflammation of heart layers
- STEMI in ALL leads (MI is only ONE lead)
- sx: inc WBC, fever, pain, dec =hypotension, pericardial friction rub
- interventions: IV abx, NSAIDs, aspirin, colchicine, sit up and lean foward to dec pain
carotid endarectomy?
monitor for?
- Removes plaque from carotid artery to improve cerebral perfusion
- Monitor for signs of altered neuro status ( risk for stroke)
- FAST
compartment syndrome
6Ps of CS
where should you place extremity?
volkamm contracture?
- Signs of CS (6 Ps):
- pain (unrelieved by repositioning or analgesics)
- pallor
- pulselessness
- paranesthesia
- poikilothermia (coolness)
- paralysis
- Place extremity at heart level
- volkamm contracture: Occurs as a result of CS associated with distal humerus fractures
- Restricting arterial blood flow
- wrist contractures and inability to extend fingers
- Medical emergency
HTN crisis
BP?
Sx?
tx?
>180/>120
sx: severe HA, confusion, n/v, seizure, blurry vision, tachycardia, tachypnea, dyspnea, cyanosis
tx: IV nitrates (vasodilators) or antiHTN meds, dec MAP by no more than 25% (maintain 110-115), check BP q5min, HOB 45 degrees
marfan syndrome?
who is most in danger if they have this?
tx?
how likely is it to give to offspring?
- what is it: CT disorder causing cardiac defects - root of the aorta is dilated/weakened = risk of aortic dissection or rupture
- sx:
- frequent aneurysms
- distinct long slender body type
- Those who are pregnant pose a high risk for maternal mortality
- Tx: BB, use reliable BC
- 50% chance of inheritance to offspring
what is cardiac ablation?
what does it treat?
post op positioning?
- Treats clients with recurrent episodes of SVT
- Cath inserted through a large artery or vein and threaded toward heart
- Must remain supine after w HOB <30 and the affected extremity straight to prevent bleeding
aortic aneurysm rupture/aortic dissection
aneurysm?
dissection?
sx?
tx?
- aneurysm: bulging of the aorta
- dissection: tearing away of aortic lining
- s/sx: chest pain that radiates to back pain (PRIORITY)
- tx:
- BP management (BB)
- interventional radiology
- surgical graft repair (assess for pre/post op AKI-oliguria)
cardiac catheterizations/PCI
angioplasty?
alteplase?
highest risk?
post cath assessments?
positioning for femoral and radial?
- angioplasty: surgical, stent etc
- alteplase: clot buster, thrombolytic
- procedure: risk for bleeding (PRIORITY) and infection
- post cath:
- neurovascular exams (cap refill, pulses, sensation/strength
- Q1 surgical site assessment
- compression stockings
- if pt is feeling wet/damp= not good= bleeding
- positioning
- femoral entry: supine 4 hrs
- radial artery: semi fowlers, affected extremity must be imobilized for 4hrs
heart sounds
S1
S2
S3
S4
S1/S2= normal lub dub
S3= extra heart sound after S2
S4= fluid overload (normal in pregnant women)
peripheral artery disease
- Sx:
- hair loss
- dec peripheral pulses
- thick brittle nails
- ulcers/gangrene
- cool/dry/shiny/taunt skin
- intermittent claudication
- position: LE below the heart when sitting/lying. Pain worsens when legs are elevated and improved when they are dependent
- tx:
- moderate exercise
- skin care (lotion), cotton between toes
- maintain mild warmth to improve blood flow (no heating pads)
- avoid tight clothing
- snug shoes
myocardial infarcation (MI)
- patho: ischemia of heart muscle
- causes: embolism, athersclerosis, vasospastic (prinzmetal angina) caused by stimualnt
- sx
- men: chest pain radiating down left arm, SOB, tachycardia, jaw pain
- women: n/v malaise, cold sweats, jaw pain
- elderly diabetic women: n/v fatigue, dyspnea, belching, indigestion, may not have chest pain
- interventions:
- M: morphine– pain and vasodilator
- O: oxygen – only if pt needs it
- N: nitroglycerin – vasodilator
- A: aspirin/clopidogrel – prevent it from getting worse
- assess VS, EKG (STEMI or NSTEMI), troponin and creatine kinase, CXR
