Cardiovascular eaq Flashcards
the following flashcards are based on the cardiovascular case study for patient 1, 10 question quiz
The first question in the case study discuss about a patient who has a diagnoses of peripheral arterial disease (PAD).
I want you to answer the following select all that apply and select which ones follow PAD symptoms? (6)
- pallor of feet
- warm extremities
- ulcers on the toes
- delayed capillary refill
- thick, hardened skin
- hair loss to lower extremities
- muscle atrophy
- intermittent claudication
what is PAD mean ?
what can chronic PAD results in?
what is the most common presenting symptom of PAD?
what are the other two symptoms in this select all that apply mainly are attributed to?
additional information
what is the treatment of PAD vs PVD?
pallor, ulcers on the toes, delayed cap refill, hair loss, muscle atrophy, intermittent claudication
PAD affects arterial circulation and results in delayed and impaired circulation to the extremities
- resulting in pallor, ulcers, cool skin, long cap refill, hair loss
muscle atrophy
intermittent claudication
warm extremities and thick hardened skin are often associated with venous disease (PVD)
PAD - lower your legs down for circulation & stay active to avoid intermittent claudication
PVD - elevate your legs and wear compression socks to promote oxygenation
The following question 2 was about a patient who came into the emergency department being diagnosed with pulmonary edema. He reports having shortness of breath and frothy sputum. He was currently in tripod position and unable to fully expel a cough.
The question was asking what are clinical manifestations for a patient who has a diagnosis of pulmonary edema?
select all that apply (6)
- crackles
- coughing
- orthopnea
- yellow sputum
- anxiety
- dependent edema
- restlessness
- lethargy
what is pulmonary edema?
why is orthopnea considered a symptom of pulmonary edema?
what does yellow sputum usually indicate?
what does pulmonary edema sputum look like?
where is the edema usually occurring in the body when discussing pulmonary edema?
crackles, coughing, orthopnea, anxiety, restlessness, lethargy
pulmonary edema is when fluid moves into the pulmonary interstitial space and then into the alveoli, resulting in the symptoms
the reason why orthopnea is considered a symptom of pulmonary edema is because the patient, even when sitting upright, is still learning forward with the arms supported, to help aid maximum expansion of this lungs and prevent/limit the amount of pressure the abdominal organs against his diaphragm when breathing.
yellow sputum indicates infection
pulmonary sputum looks frothy and blood tinged
pulmonary edema is only having pulmonary edema, not dependent edema
question 3 on the NGN practice talks about a patient who is just coming back from abdominal surgery however, is presenting signs of internal bleeding with a decrease blood pressure and slowly increasing heart rate.
the question is asking, select all that apply, for symptoms that a patient with internal bleeding after abdominal surgery may exhibit? (3)
- pallor
- polyuria
- decrease mean arterial pressure ( MAP )
- bradypnea
- tachycardia
- hypertension
- increase pulse pressure
- warm skin temperature
what are the other symptoms often associated with?
why do these 3 symptoms occur when patients are having internal bleeding?
instead of polyuria, what happens when the kidneys are experiencing internal bleeding with the body ,or remember, when they dont get oxygen ?
( think of the kidneys being the princess of the body )
pallor, decreased mean arterial pressure (MAP), tachycardia
polyuria is often associated with hyperglycemic diabetes, but remember its the opposite because the kidneys are not getting oxygenated, they are the first to stop working, meaning it would be decreased urinary output. remember best way for circulation to be tested, is urinary output
bradypnea is not occurring because of the fact the body is trying to get any form of oxygen it can through increase respiration, meaning the patient is tachypnic !
hypertension wouldn’t apply to this because of the fact that he is bleeding, meaning this is hypotension related to hypovolemia ( the blood loss happening, losing all the fluids )
same things goes for increased pulse pressure, the blood pressure is tanking, meaning more than likely the circulation is decreasing and the feeling of a pulse might become thready
warm skin temperature wouldn’t occur, because he is bleeding out, meaning blood would not circulate the extremities and eventually to the rest of the body, meaning the body would be cold because of the lack of circulation, not warm.
pallor occurs as the peripheral blood vessels constrict in an effort to shunt blood to vital organs, meaning again, the body would end up being cold and pale, instead of warm and pink
during the initial stages, MAP will decrease by 5-10mm hg due to the blood pressure dropping, and the heart rate will accelerate in hemorrhage as the body attempt to increase blood flow and oxygen to body tissues.
instead of polyuria, we will have decrease urinary output, because of the hemorrhage and lack of oxygenation, they are the first to give out!
question 4 is about a patient who was diagnosed with having varicose vein’s, she has a previous history of coronary artery diesease and chronic angina that is relieved with nitroglycerin.
when assessing a client with varicose veins, which clinical manifestations would the nurse expect to find. select all that apply (3)
- presence of ankle edema
- increased leg fatigue
- diminished peripheral pulses
- report of leg fullness and pruritus
- leg pain with activity that resolves with rest
- no hair on lower extremities
- thickened toenails
- pallor to bilateral lower extremities
can you tell me why the other options were not selected for this question ?
remember to state each one and the reasoning behind it
what does varicose veins mean as well ?
what color would the skin be instead of pale when talking about PVD with varicose veins ? and why
presence of ankle edema
increased leg fatigue
report of leg fullness &
pruritus
varicose veins is due to poor venous return and increased venous pressure, meaning the lack of oxygen and the increase demand for oxygen
diminished peripheral pulses are associated with decreased arterial blood flow
intermittent claudication, as evidenced by leg pain with activity that resolves with rest occurs with decreased arterial, not venous perfusion, meaning, for PAD = leg pain from activity = rest = solved
PVD = leg pain from activity = move around and elevate = solved
brown pigmentation or skin staining, the reason is because of extravasated red blood cells in lower extremities, in other words, the red blood cells pool together then burst and thats why it ends up looking brown with PVD
The following question is talking about a patient who has heart failure and is seen into the clinic with a new onset of ankle edema, the nurse would question the client about which lifestyle factor that may have contributed to the ankle swelling?
select all that apply (5)
- intake of salty food
- increased fluid consumption
- dietary fat intake
- medication compliance
- family stress
- recent ravel
- alcohol intake
- increased physical activity
tell me why we selected the 5 options ?
tell me why we didn’t select the other options
intake salty food
increased fluid
medication
recent Travel
alcohol intake
fluid retention in heart failure may be caused by increased salt intake, with associated water retention, remember salt and water play together with how the body eliminates.
poor adherence to medication to help treat heart failure, such as ACE inhibitors and diuretics, may also lead to fluid retention
recent travel may cause fluid retention because of the changes in the environment and or possible airplane travel
increased alcohol intake, is always bad and worsen heart failure symptoms
the incorrect ones and why we didn’t choose them
increased or decreased fat intake will not cause fluid mention
stress is not a contributor to fluid retention
the client who has heart failure is encouraged to do more physical acitivyt without overdoing it, and for someone who isn’t doing that, would not contribute to fluid accumulation
the following question is talking about signs that a patient is progressing better in the hospital setting.
this was the correct answers
sinus tachycardia without any arrhythmias
few crackles noted in right lower lung field
+3 pitting edema in bilateral lower extremities
heart rate of 102bpm
blood pressure of 138/80
if you remember, we gave the patients furosemide and a nitroglycerin prior to this, however these clinical manifestations are still present, can you tell me why ?
the administration of furosemide would help decrease fluid overload, meaning it would help decrease heart rate, which is still really high at the start of 120 - however dropped down to 102
and furosemide would help decrease the amount of crackles we would hear in the patients, from being bilateral lung crackles, to now only being few in the right
furosemide would also help in lowering the edema, from +4 to now +3
the nitroglycerin would help lower the blood pressure, which it did from 152/90 to now 138/80
the following question is basic common knowledge on what to expect with someone who has an acute rheumatic fever.
what are the 5 assessment findings that are consisent
- murmur
- opening snap
- split s2
- epigastric discomfort
- joint pain
- painless nodules over elbows
- constipation
- alcohol consumption
- previous sore throat and upper respiratory infection
first to begin what is acute rheumatic fever ?
what type of pain does rhumatic fever cause instead of epigastric pain?
acute rheumatic fever is when a patient who has had a previous sore throat or scarlet fever does not get treated, which then progresses into rheumatic fever
murmur, opening snap, joint pain, nodules over elbows, previous sore throat and upper respiratory infection
a murmur or change in murmur is a common sign - indicated carditis
an opening snap is a sign of heart valve stenosis due to acute rheumatic fever
rheumatic fever causes abdominal pain, not epigastric
the following question follows back to the last flashcard of rheumatic fever, the patient is at risk for developing
- chorea
which would manifest as
- student puporseless, nonrepeitivie movements.
what is chorea?
how long can chorea last?
however we should tell patients it doesn’t impair there what?
when does chorea usually develop?
its important to note that erythema marginatum, Aschoff bodies and migrating polyarthtiris can occur, its not as common.
tell me what each of those three options mean ^
chorea again is that non repetitive moment that is uncontrolled after having rheumatic fever untreated.
from 1 week to several years, however does not permentatly impair the central nervous system
occurs after development of polyarhtitis with the joint pain and nodules on the elbow
erythema marginatum is a rash, clear in the center and not itchy
Aschoff bodies are scar nodules that form in the heart
migrating polyarthtisis is pain that migrates among large joints
the following question is still on the same patient with rheumatic fever
the nurse determines the priority needs to be
- administer the penicillin
due to
- group a beta hemolytic strep infection
why do you think we chose this instead of the other options?
the other option is an ECG should be done, why is this not selected?
why did we not choose to administer naproxen?
to treat rheumatic fever, you use penicillin G to help aid with the strep infection, to kill it off.
the reason why ECG is not selected is because the p-r interval is prolonged, not shorten or depressed
usually naproxen Is given to help with a fever, and carditis and polyarthritis, however our patient hasn’t gotten to polyarhtitis and does not have a fever
once again the following question applies to the same rheumatic fever patient.
we are required to select why we chose this for each section, tell me which we choose for each section and why we did
then tell me why we didn’t select the other one
neurologic
- administrer naproxen for development of chorea
- monitor for aimless, involuntary movements
( what drug do we use to treat Chora, and what is naproxen used for )
integumentary
- maintain hydration
- notify healthcare provider to change penicillin to iv route
( why would we ask for a change in penicillin to IV to begin with? )
cardiovascular
- ausculate for a pericardial friction rub
- encourage rest periods
for neurologic, the nurse would have to assess for any involuntary movement because that would indicate chorea, an neurological symptom of acute rheumatic fever
- chorea is also treated with central nervous depressants like phenobarbital, not naproxen
naproxen is used for fevers/ anti-inflammatory drugs
integumentary
we must maintain hydration, since the client has a fever, and is more than likely sweating and losing fluid.
we would not need to change penicillin G to IV because it is given IM
cardiovascular
we must assess for a pericardial friction rub because rheumatic fever attacks the heart, when it the heart is attacked and damaged enough, it can result in a pericardial friction rub, indicating pericarditis ( inflammation of the sac around the heart ) because of the fever, increased metabolic rate and increase demands of the heart, rest is encouraged and required to aid with the healing process
the following question is also on the same patient with rheumatic fever
however
we are given the choice to choose each function
what is the classification of penicillin?
what is the client teaching for penicillin?
why are we doing that ^
what is naproxen
what is the client teaching for naproxen?
why do we do that ^
what is an echocardiogram?
what is an electrocardiogram ?
are there food restrictions for either of those tests ^ ?
beta-lactam antimicrobal
you will be watched closely for 15mintues
- because the patient has never had penicillin, an anaphylactic reaction can occur
non steroidal anti-inflammatory medication
- you should take with food or water before administration
- the reason why we tell he patient to drink water or fluid is because we dont want them to have an upset gastrointestinal effect
echo is noninvasive and includes sound waves that are used to make images
- think of an ultrasound in a sense but like ultrasound of the heart
- no restrictions to food or water
electrocardiogram is noninvanse and just puts electrodes on the arms and legs ( outside the body )
- no restrictions to food or water
the last question is the same thing about a patient with rheumatic fever
the client understands the teaching by stating
- swollen lymph nodes
- drainage in back of throat
- sudden onset of sore throat
indicate a recurrence of streptococcal pharyngitis infection
why did we select these 3
and why did we not select
low- grade fever, small painless lymph nodes, pale throat ?
because those 3 are all following of the same condition
its important to treat it fast
in rheumatic fever, the throat is red, not pale
lymph nodes are enlarged and tender, not small and painless
the fever is also moderate and not low
additional notes that I will make for cardio are the following
examples of cephalosporins include
- cefazolin
- ceftriaxone
- cephalexin
examples of aminoglycoisdes include
- gentamicin
- neomycin
- streptomycin
- tobramycin
antibiotics must be taken for the full amount, not just until symptoms resolve, like a rash.
doxycycline is not a penicillin and can not be taken with diary products
examples of opioids include
- moprhine
- hydromoprohne
- codeine
examples of corticosteroids include
- prednisone
- cortisone
- betamethasone
- beclomethasone
examples of potassium wasting diuretics is
- furosemide and laxix
and needs potassium because of the loss in diuretic
certain statins must not be taken with grapfruit juice because it decrease effectiveness or may even cause toxicity
