Cardiovascular Diseases Flashcards

Question

CHF: Types | (3)

Answer 1

1. Left-sided heart failure LT ventricle - trouble pumping into circulation > LT atrium fills > back-up into pulmonary veins (INC pressure) > fluid is going into interstitium > goes into lungs > PULMONARY EDEMA 2. Right-sided heart failure ~ **cor pulmonale** 3. Biventricular heart failure LT side failure is so bad > back-up from lungs > pulmonary artery is full (to much pressure) > RT ventricle has to much pressure to overcome > RT side heart failure = symptoms of LT + RT heart failure

Answer 2

1. LHF > DEC SV > DEC LVEDV > INC LV pressure > INC LA pressure > fluid mvmt from veins to interstitial space of lungs (excess hydrostatic pressure) > pulmonary edema 2. LHF > DEC SV > INC SNS activation **(compensatory)** > INC HR > fatigued myocardium & fail 3. DEC CO > DEC arterial blood flow > DEC perfusion to the kidneys > renal failure *BUN = blood, urea, nitrogen - will be elevated* 4. Inactivity/bed rest > mm wasting, myopathies, osteoporosis *PT role = INC functional mobility* 5. Compensated vs uncompensated - Decompensated - severe damage - S/S of CHF - Compensated - influenced by something else to get enough CO to the system 1. INC SNS activation = INC HR 2. Medications 3. Hyptertrophy of the ventricle - stronger - results in other problems 4. ** Cognizant not to push the limits of a persons (cardiac dilation) compensated HF = ACUTE heart failure requiring medical attention

Answer 3

1. Cardiac mm dysfunction 2. Cardiac dysrhythmias (altered electrical function - can affect function & exacerbate) 3. Cardiomyopathies 4. Long-term CAD 5. Hypertension *Harder for LT ventricle to pump against resistance - weaken - fail ""working in overdrive* 6. Valve Abnormalities (regurgitation of blood/ backflow) 7. Pericardial pathology - pericarditis (INC pressure against the ventricle)

Answer 4

1. Dyspnea - V/Q mismatching, INC RR 2. Fatigue - tissues have less O2 to turn into energy 3. Weakness - tissues have less O2 4. Pulmonary edema 5. Paroxysmal nocturnal dyspnea Sudden episodes of SOB @ night > **Orthopnea** = SOB in recumberant position SUPINE - fluid is at an equal level so it is going to spreal all over the lung. Surface area of fluid covered alveoli iis much greater & makes gas exchange more difficult) 6. Orthopnea - semi-fowler: ~30-90 degrees

Answer 5

1. Dyspnea 2. Fatigue 3. Weakness 4. **Jugular vein distension** - HALLMARK OF RHF 5. Peripheral edema *4-5* - Backflow of fluid. Hydrostatic pressure push fluid into periphery (systemic volume overload) > DEC SV actually signals to kidneys to retain fluid & make issues worse Heart is failing & now is getting overloaded w/ fluid 6. Pitting edema 7. Fluid weight gain 8. Ascities - excess fluid in belly area (RT & LT)

Answer 6

1. Positioning to reduce orthopnea - pillow to be in semi-fowler position (30-90 degrees) 2. Relaxed breathing exercises (ie diaphragmatic breathing) *DEC energy expenditure to breath* 3. Supplemental oxygen - low SpO2 4. Graded increased ambulation - progressively 5. Graded exercise (volume & intensity 6. Cardiac rehabilitation program

Answer 7

An abnormal accumulation of fluid in the lungs Fluid moves from the pulmonary capillaries > interstitial space > alveolar space

Answer 8

1. INC capillary membrane permeability (can change ossmotic pressure) 2. INC capillary hydrostatic pressure 3. DEC capillary osmotic pressure Move or keep fluid in - draw fluid to w/e side has the most solutes. Solutes cause the fluids to leave towards a place w/ INC osmotic pressure 4. Lymphatic insufficiency Normally drain excess fluid out - not doing a good job pulling that fluid out of intersitium = INC accumulation in the interstitium > moves into alveloar spaces

Answer 9

Cardiogenic Pulmonary Edema - **High** pressure (INC pulmonary capillary hydrostatic pressure) - Backflow of blood in the system due to kidney, heart mm, or valve damage leading to INC blood accumulation in pulmonary capillaries which INC pulmonary capillary hydrosstatic pressyre - Ex. **LHF** Non-Cardiogenic Pulmonary Edema - **LOW** pressure - INC permeability of the pulmonary capillaries & alveolar endothelium d/t trauma or toxins (altered osmotic pressure) *Draws the fluid out of the capillaries into where osmotic pressure is higher - inside the lungs* - Ex. ARDS **FLUID not secretions - mobilization techniques will not help** Not trying to loosen up anything. Suctioning may help but other techniques will not be used

Answer 10

Inspection: - Dyspnea - INC WOB - Cyanotic - hypoxaemia - DEC diffusion of O2 into the circulatory system - **Orthopnea (SOB in supine)** - **Cough with pink, frothy sputum (cardiogeniic) ** *Different from everything else we have seen & ONLY w/ cardiogenic type* - Swelling in lower extremities (gravity - dependent positions) Palpation: - Tactile fremitus: Normal or INC Percussion: - Dull Auscultation: - DEC BS - Fine inspiratory crackles - fluid - Egophoney: (-) - no consolidation or excess lung tissue ABGs: - DEC PaO2 - less O2 diffused through CXR: - Cardiomegaly (INC heart size) - Enlarged pulmonary vessels - White fluffy/hazy airspace - Kerley B lines - short, horizontal lines near pleural surface (base of lungs)

Answer 11

A blood clot that has been lodged in a pulmonary artery - Commonly associated with DVT in the lower extremities (usually in calf) - **Life-threatening** - impede BF & cause lung cell death

Answer 12

- Pulmonary embolus obstructs blood flow to an area of the lungs - If blood flow to lung tissue completely blocked, can lead to infarction & necrosis of lung tissue - Very large embolism can lead to INC pulmonary artery resistance > INC work load of right ventricle > RHF

Answer 13

1. **IMMOBILIZATION (ie post-op)** - Venous stasis 2. Secondary INC coagulation (ie oral contraceptions, cancer, polycythemia - thick blood d/t hemoglobin) 3. Other: CHF, Hx of DVT, obesity, pregnancy, stroke, trauma, varicose veins

Answer 14

Inspection: - **ACUTE onset of dyspnea** - Hallmark - INC RR - **Chest pain** - May have cough with bloody sputum (**hemoptysis**) ABGs: - DEC PaO2 - DEC PaCO2 - INC pH - **Respiratory Alkolosis** CXR: - Infarcted area of lung appears white (rare) Diagnosed using CT scan or V/Q scan

Answer 15

Prophylactic Post-Op - Anti-coagulation medications - Bed exercises - ankle pumps - NEED to get the person moving - Early mobilization - Compression stockings - preventative measure *NOT as a Tx - contraindicated once pt has a DVT > chance to disloge the clot* If PE or DVT is suspectde or confirmed: - **Discontinue exercise & mobilization until further notice** - Notify a nurse or surgeon - Document - INC anti-coagulation medications - Thrombolytic medications

Answer 16

- Refers to disorder of the blood vessels of the body (arteries & veins) - Primarily d/t to **atherosclerosis** - hardening & narrowing of vessels - Significant narrowing of vessels must occur before there is enough occulsion of blood flow to produce symptoms

Answer 17

1. Leg Pain (intermittent claudification) 2. Coldness in affected leg 3. DEC pulses in lower limb 4. DEC mobility & function of limb d/t pain 5. Possible numbness 6. Possible pain & paleness of leg with elevation (**Buerger's test**) 7. DEC hair growth (circulatory problem) 8. Skin breakdown - ulcers 9. Ulcerations (arterial & venous insufficiency ulcers) 10. Gangrene (in very severe cases that were not well managed) *Debride it - if it does not work - amputation*

Answer 18

1. Buerger's Test - Elevation Palor Pt lying in supine - lift leg up (blood wil rush out - PALE) May be painful 2. Dependent Rubor When leg is pale - sit up - put leg down level of the body (where leg is in a gravity dependent position) - becomes RED (rubor)

Answer 19

Pain or cramping that occurs in the buttock or legs (especially calves) as a result of poor circulations to the affected area - INC pain w/ INC activity d/t to increased energy demands on the muscle which has poor circulation *More anaerobic metabolism > to create ATP & as a result it going to produce a lot of LACTIC ACID = in excess, can cause PAIN* **DEMAND > SUPPLY** - DEC pain at rest (even in standing position) - Must differentiate between Intermittent Claudification & Neurogenic Claudification (spinal stenosis) **BOTH complain w/ walking** IC (vascular) vs NC (neuro) "Bicycle Test" - bend forward FLEXION while leg mm are still working Differentiate by: manipulating back position while **walking** - Stooped posture = will NOT provoke symptoms in NC - IVF is gapped open Spinal stenosis - Nerve root is getting compressed when exiting the IVF (DDD, osteophytes, narrowing of the foramen - Worse in **extension**

Answer 20

1. Progressive increase activity & aerobic exercise (may be painfuk) May stimulate the development of collateral blood vessels Graded Exercise (aerobic) = INC tolerance & stimulate the development of collateral blood vessels 2. Education on risk factors & self-management (PVD) 3. Self-assessment of skin & education on skin-care Check for ulcers or skin breakdown - infected - may lead to impaired wound healing or amputation **COMPRESSION STOCKINGS ARE CONTRAINDICATED** - Poor BF & will only compress the blood vessels further = make the BF even worse

Cardiovascular Diseases Flashcards

(44 cards)