Cardiovascular System Flashcards
Blood flow pathway
Heart, arteries, arterioles, capillaries, venules, veins, back to heart
_________ carry blood away from the heart, while _________ bring blood back to the heart
Arteries; veins
Membrane that surrounds and protects the heart
Pericardium
Three layers of the heart wall
Epicardium (outer), myocardium (middle), endocardium (inner)
Flow of blood through the heart
Superior/inferior vena cava, right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic valve, aorta, body
Conduction pathway of heart
SA node, AV node, bundle of his, L and R bundle branches, purkinje fibers
Relaxation of atria and ventricles allowing for filling of blood
Diastole
Contraction of atria and ventricles ejecting blood
Systole
The volume of blood in liters ejected from the left ventricle every minute
Cardiac output (HR x SV)
The number of times the heart contracts in one minute
Heart Rate (60-100 bpm)
The volume of blood in liters ejected from the ventricle with each heart beat
Stroke volume
Normal cardiac output
4-8 L/min
The percentage of blood that leaves the left ventricle each time it contracts
Left ventricular ejection fraction (LVEF)
Normal LVEF
55-70%
The volume of blood in the ventricles at the end of diastole that determines the amount of stretch placed on myocardial fibers of heart
Preload
The peripheral resistance that the left ventricle must overcome in order to push blood into systemic circulation
Afterload
Amount of pressure exerted on arterial walls during left ventricular contraction
Systolic BP
Amount of pressure exerted on arterial walls during left ventricular relaxation
Diastolic BP
Catheter inserted in a small peripheral vein in the arm or hand
Peripheral venous catheter
Most common type of IV that is 3 inches or less
Short peripheral catheter
A midline peripheral catheter is between 3 and 8 inches in length and terminates at or below the level of the _________ and distal from the _________
Axilla; shoulder
Where does the tip of a central venous catheter (CVC) terminate?
Superior vena cava right above the right atrium
Indications for CVC
Long-term antibiotic therapy, TPN, and chemotherapy
PICC lines and implantable ports are examples of
CVCs
Inflammation of the veins
Phlebitis
S/S of phlebitis
Erythema, warmth, pain, induration (hardened) vein, red streak
Nursing interventions for phlebitis
D/C IV, elevate extremity, apply warm, moist compresses
The leakage of IV fluids or medications into surrounding tissues outside the vein
Infiltration
S/S of infiltration
Swelling, coolness, dampness, slowed rate of IV infusion, leaking fluid from IV site
Nursing interventions for infiltration
D/C IV, elevate extremity, apply warm or cold compresses depending on what was infusing (warm for normal or high pH solutions, cool for low pH solutions)
Infiltration with a vesicant agent (medication that causes tissue damage)
Extravasation
S/S of Extravasation
Erythema, pain, edema, formation of blisters, necrotic tissues such as slough, ulceration
Extravasation nursing care
Stop the infusion, aspirate residual medication, administer antidote, D/C IV, elevate extremity, apply warm or cold compress depending on solution
Entrance of air into the venous system from the IV catheter
Air embolus
S/S of air embolus
Hypotension, tachycardia, tachypnea, cyanosis
Air embolism nursing interventions
Clamp the catheter, place patient in trendelenburg position, administer O2, notify provider
Fluid overload nursing interventions
Raise HOB, slow infusion rate, monitor O2 and vitals, administer diuretics as ordered by provider
Packed RBCs are infused over ___-___ hours
2-4
Fresh frozen plasma is infused between ___-___ min
15-30
Fresh frozen plasma should be administered within ___ hours of thawing
2
Platelets are infused between ___-___ mins
15-30
IV catheter gauge ideal for blood transfusions
18 gauge (20 gauge will also work)
Blood transfusion line should ONLY be primed with
0.9% NS
T or F: the nurse can administer medications through the blood transfusion line
False
If blood is not administered within ___ mins of receiving it, it needs to be sent back to the blood bank
30
Blood transfusion nursing care
Take vitals before administration of blood, stay with patient for the first 15 min of administration to make sure they do not have a reaction, take vitals again
Transfusion reaction nursing care
Stop the infusion, administer 0.9% NaCl through SEPARATE line
Itching, flushing, and urticaria are symptoms of a _________ reaction to blood transfusing
Mild allergic
Nursing interventions for mild allergic reaction to blood transfusion
Administration of diphenhydramine (Benadryl)
Wheezing, dyspnea, hypertension, and decreased oxygenation are symptoms of an _________ reaction to blood transfusion
Anaphylactic
What kind of medications are commonly given for anaphylactic allergic reactions to blood transfusions?
Epinephrine, corticosteroids
Fever, chills, hypotension, tachycardia, and tachypnea are symptoms of a _________ blood transfusion reaction
Febrile
_________ are anticipated to be ordered for patients with febrile blood transfusion reactions
Antipyretics
Fever, chills, and abdominal pain are symptoms of a _________ blood transfusion reaction
Septic
Nursing care for septic blood transfusion reaction
Collect cultures and administer antibiotics as ordered
What blood transfusion reaction may cause symptoms such as low back pain, fever, chills, tachycardia, tachypnea, and hypotension
Acute hemolytic reaction
Acute hemolytic reaction nursing interventions
Collect labs and specimen, give fluids as ordered by provider
What kind of blood transfusion reaction may cause symptoms such as dyspnea, tachycardia, tachypnea, crackles, hypertension, and distended neck veins?
Circulatory overload reaction
Cardiac enzyme released into bloodstream upon damage to cardiac muscle
CK-MB
Normal CK-MB
0%
CK-MB will be elevated ___-___ hours after damage to the heart muscle, and it will stay elevated for approximately ___-___ days
3-6; 2-3
A protein found in the heart muscle and skeletal muscle
Myoglobin
Normal myoglobin should be less than
90
Myoglobin will be elevated ___-___ hours after cardiac or skeletal muscle damage and will stay elevated for approximately ___ hours
2-3; 24
_________ is the most specific enzyme for identifying ischemia of the heart
Troponin
Troponin T should be under _____ and Troponin I should be under _____
0.1; 0.03
Troponin T and troponin I will become elevated ___-___ hours after cardiac damage occurs. Troponin ___ will stay elevated for about two weeks. Troponin ___ will stay elevated for 1 week
2-3; T; I
Total cholesterol should be less than
200
LDL should be less than
130; 100 if high risk for cardiovascular disease
HDL should be over ___ for females and ___ for males
55; 45
Normal triglycerides for males and females
Males: 40-160
Females: 35-135
Normal RBC range for females and males
Females: 4.2-5.4
Males: 4.7-6.1
Normal platelet range
150,000-400,000
Normal Hgb range for females and males
Females: 12-16
Males: 14-18
Normal Hct range for females and males
Females: 37-47%
Males: 42-52%
Normal aPTT
30-40 sec
Normal aPTT range for clients on heparin
45-80 sec (1.5-2x baseline)
Normal PT
11-13 sec
Normal PT for clients on warfarin
17-26 sec (1.5-2x baseline)
Normal INR
1
Normal INR for patients on warfarin
2-3
D-Dimer should be less than
0.4
A hormone released by the ventricles in the heart in response to fluid overload
hBNP
Normal hBNP
<100 (over 100 indicates HF)
S/S of fluid volume deficit
Hypotension, tachycardia, tachypnea, weak thready pulses, prolonged capillary refill, low UOP, flattened jugular veins
Fluid volume deficit labs
Concentrated blood (increased Hct and osmolarity), concentrated urine (increased BUN)
S/S of hypervolemia
Weight gain, edema, hypertension, bounding pulses, JVD, tachycardia, dyspnea and tachypnea, crackles in lungs
Fluid volume excess labs
Dilute blood (low Hgb, Hct, osmolarity) and dilute urine (decreased urine specific gravity)
Report weight gain of ___-___ lbs in 24 hours or ___ lbs or more in one week
1-2; 3
Extracellular electrolyte essential for fluid balance and nerve and muscle function
Sodium
Normal sodium range
135-145
S/S of hypernatremia
Thirst, agitation, muscle weakness, GI upset
Treatment for hypernatremia
Hypotonic solutions such as 0.45% NaCl, diuretics such as furosemide, restrict sodium intake, increase intake of water
It is important to SLOWLY correct a patient’s sodium balance in order to prevent
Cerebral edema or seizures
S/S of hyponatremia
Confusion, fatigue, N/V, headache
Treatment for hyponatremia
Hypertonic solutions such as 2-3% NaCl, increased sodium intake, restrict fluid intake
An electrolyte important for bone and teeth formation, nerve and muscle function, and clotting
Calcium
Normal calcium range
9-11
S/S of Hypercalcemia
Constipation, decreased DTRs, kidney stones, lethargy, weakness
Hypercalcemia treatment
0.9% NaCl, calcitonin, dialysis (severe)
S/S of hypocalcemia
Positive Chvostek sign, positive trousseau sign, muscle spasms, numbness and tingling in lips and fingers, GI upset
Hypocalcemia treatment
Calcium supplements, increased intake in calcium rich foods and vitamin D
Electrolyte important in maintaining ICF, and nerve and muscle function
Potassium
Normal potassium range
3.5-5
S/S of hyperkalemia
Dysrhythmias, muscle weakness, numbness and tingling, N/V
Hyperkalemia treatment
Diuretics such as furosemide, Kayexalate, insulin, decreased intake of potassium rich foods (bananas, potatoes, cantaloupe, etc)
S/S of hypokalemia
Dysrhythmias, muscle spasms or weakness, constipation, ileus
Hypokalemia treatment
Potassium supplements (oral or IV), encourage increased intake of potassium rich foods
Electrolyte important for many biochemical reactions in the body and is also needed for muscle and nerve function
Magnesium
Magnesium normal range
1.5-2.5
S/S of hypermagnesemia
Hypotension, lethargy, muscle weakness, decreased DTRs, respiratory and cardiac arrest
Hypermagnesemia treatment
Diuretics such as furosemide, calcium (reverse cardiac effects)
S/S of hypomagnesemia
Dysrhythmias (torsades de pointes), tachycardia, hypertension, increased DTRs, tremors, seizures
Hypomagnesemia treatment
Magnesium supplements (PO or IV), encourage intake of magnesium rich foods
Causes of hypernatremia
Excess sodium intake, Cushing’s syndrome, DI
Causes of hyponatremia
Diuretics, kidney failure, diaphoresis, SIADH, hyperglycemia, HF
Causes of Hypercalcemia
Hyperparathyroidism, corticosteroids, bone cancer
Causes of hypocalcemia
Diarrhea, vitamin D deficiency, hypoparathyroidism, thyroidectomy
Causes of hyperkalemia
DKA, metabolic acidosis, salt substitutes, kidney failure
Causes of hypokalemia
Diuretics, GI losses (vomiting, NGT suctioning), diaphoresis, Cushing’s syndrome, metabolic alkalosis
Causes of hypermagnesemia
Kidney disease, excess intake of antacids or laxatives containing magnesium
Causes of hypomagnesemia
GI losses, diuretics, malnutrition, alcohol abuse
PH > 7.45
PaCO2 < 35
Respiratory alkalosis
Causes of respiratory alkalosis
Hyperventilation (d/t fear, anxiety, etc.), salicylate toxicity, high altitude, shock, pain, trauma
S/S of respiratory alkalosis
SOB, dizziness, chest pain, numbness in hands or feet
PH < 7.35
PaCO2 > 45
Respiratory acidosis
Causes of respiratory acidosis
Hypoventilation — respiratory disorders such as ARDS, asthma, pneumonia, COPD; inadequate chest expansion; respiratory depression with certain meds such as opioids and Benzos
S/S of respiratory acidosis
Confusion, lethargy, dyspnea, pale or cyanotic skin
PH > 7.45
HCO3 > 28
Metabolic alkalosis
Causes of metabolic alkalosis
Antacid overdose, loss of body acid through vomiting or NGT suctioning
S/S of metabolic alkalosis
Dysrhythmias, muscle weakness, lethargy
PH < 7.35
HCO3 < 21
Metabolic acidosis
Causes of metabolic acidosis
DKA, kidney failure, starvation, diarrhea, dehydration
S/S of metabolic acidosis
Hypotension, tachycardia, weak pulses, dysrhythmias, kussmaul respirations, fruity breath
Metabolic acidosis treatment
Sodium bicarbonate, IV fluids and insulin for DKA, hemodialysis for kidney failure
Regular rate and rhythm but with a HR over 100 bpm
Sinus tachycardia
Causes of sinus tachycardia
Physical activity, anxiety, fever, pain, anemia, compensation for decrease BP or CO
Regular cardiac rhythm but with a HR below 60 bpm
Sinus bradycardia
Causes of sinus bradycardia
Excess vagal stimulation, cardiovascular disease, hypoxia, certain medications, athletes (normal and expected finding)
Asymptomatic bradycardia does not require treatment, but if the patient is symptomatic they may be administered
Atropine and a pacemaker
Rapid and disorganized depolarization of the atria, such that the atria will quiver rather than fully contract
Atrial fibrillation (Afib)
Afib increased the risk for
Blood clot formation
Afib interventions/treatment
Anticoagulants, cardioversion, antiarrythmics
Abnormal electrical circuit that forms in the atria and causes rapid depolarization of the atria (between 250-350 times per min) ; EKG strip reveals sawtooth waves (F waves)
Atrial flutter
Atrial flutter treatment
Antiarrythmics, cardioversion
Rapid ventricular rhythm (over 100 bpm), no P-waves, wide QRS complexes that occur regularly
Ventricular tachycardia (V-Tach)
Causes of V-Tach
Ischemic heart disease
Treatment of V-Tach WITH a pulse
Cardioversion, antiarrythmics, correction of electrolyte imbalances
Treatment for PULSELESS V-Tach
Defibrillation
Rapid, ineffective quivering of the ventricles (will not see P-waves or QRS complexes on EKG strip)
Ventricular fibrillation (Vfib)
Vfib treatment
Defibrillation
Absence of any ventricular rhythm (flat-line)
Asystole
Asystole treatment
CPR
Atrioventricular (AV) blocks are typically caused by
Heart disease, MI, certain medication such as BB or digoxin
AV block characterized by prolonged impulse conduction time between the atria to the ventricles due to a delay in the AV node; EKG strip will show a long PR interval that is consistent
First-degree AV block
AV block characterized by progressive increase in the conduction time between the atria and the ventricles until one impulse fails to conduct at all; EKG strip will show PR intervals that gradually get longer until a QRS complex drops
Second-degree type I AV block (Mobitz I)
AV block characterized by sudden failure of impulse conduction between the atria and ventricles without a progressive increase in conduction time; EKG will show a consistent PR interval (consistently long or consistently normal) followed by a dropped QRS complex
Second degree type II AV block (Mobitz II)
Treatment for Mobitz II
Pacemaker
AV block characterized by complete failure of any conduction between the atria and ventricles; EKG will show no associated between the P waves and QRS complexes
Third degree AV block
Third degree AV block treatment
Pacemaker
Examples of medications used in chemical cardioversion
Adenosine (NOTE: there may be a brief period of asystole after administration, however, this is normal and expected), procainamide
Cardioversion nursing care
Ensure patient has been on anticoagulation for several weeks preceding scheduled cardioversion (d/t risk for dislodging blood clots), ensure all staff is standing clear when shock is delivered, AFTER — maintain patent airway, monitor vitals, monitor EKG, monitor S/S dislodged clot)
Pacemaker post-op nursing care/education
Patient’s arm will be in sling, educate patient to avoid lifting their arm above shoulder to avoid displacement of leads, assess insertion site for bleeding and signs of infection, assess for consistent hiccups (indicates pacemaker is pacing diaphragm — notify provider!)
Pacemaker patient education
Carry pacemaker ID wherever you go, take pulse daily, avoid contact sports and heavy lifting for several months after surgery, pacemaker will set off airport security devices, but it is okay to use garage door opener and microwaves. MRIs are CONTRAINDICATED
S/S of left-sided HF
Dyspnea, crackles, fatigue, pink/frothy sputum
S/S of right-sided HF
Peripheral edema, ascites, JVD, hepatomegaly
An echocardiogram can be used as a diagnostic for HF by measuring
Ejection fraction
HF nursing care
Monitor I&Os, weight patient DAILY, sit patient in high-fowler’s, restrict fluid and sodium intake as order, monitor for complications such as pulmonary edema
T or F: HF will cause an increase in central venous pressure (CVC) and pulmonary artery wedge pressure (PAWP)
True
A defect or damage to one of the heart valves which can cause stenosis, prolapse (improper closure), and regurgitation
Valvular heart disease
Risk factors associated with acquired causes of valvular heart disease
HTN, older age, increased cholesterol, smoking, DM, rheumatic fever, infective endocarditis
S/S of valvular heart disease
Murmurs, extra heart sounds, dysrhythmias, dyspnea
Procedure/surgery for stenosis related to valvular heart disease
Percutaneous balloon valvuloplasty
Prosthetic valve patient education
Required antibiotics prior to any dental work, surgery, or other invasive procedures
Bacteria or fungi that adhere to the heart forming vegetative growth which can lead to necrosis of a heart valve or endocardium
Infective endocarditis
Infective endocarditis risk factors
Congenital heart disease, valvular heart disease, prosthetic valves, IV drug use
S/S of infective endocarditis
Fever, flu-like symptoms, murmurs, petechiae, splinter hemorrhages (red streaks under the nail bed)**
Infective endocarditis treatment
Antibiotics, valve repair or replacement
Inflammation of the heart following a strep throat infection which can cause long-term damage to the heart and valves
Rheumatic carditis
S/S of rheumatic carditis
Tachycardia, cardiomegaly, murmurs, friction rub, chest pain
Rheumatic carditis diagnosis
Throat culture, ASO titer
Rheumatic carditis treatment
Antibiotics, valve repair or replacement
Inflammation of the sac that surrounds the heart
Pericarditis
Pericarditis risk factors
Infection from autoimmune disorder, trauma
S/S of pericarditis
Chest pain that is worse when supine and better when sitting up leaning forward**, friction rub, fever, dysrhythmias, dyspnea
Pericarditis diagnosis
EKG shows ST or T spiking
The accumulation of fluid in the pericardia sac that puts pressure on the heart impairing blood flow and decreased cardiac output
Cardiac tamponade
S/S of cardiac tamponade
Hypotension, JVD, muffled heart sounds, paradoxical pulse (decrease in SBP of 10 mmHg or more during inspiration), electrical alternans (variation in QRS amplitude between heart beats), dyspnea, fatigue
Treatment for cardiac tamponade
Pericardiocentesis (removal of fluid from pericardial sac)
Disease of the heart muscle that can lead to pulmonary edema, dysrhythmias, and heart failure
Cardiomyopathy
What are the three types of cardiomyopathy?
Dilated (most common), hypertrophic, restrictive
Type of cardiomyopathy in which the ventricles enlarge and weaken and primarily affects systolic function
Dilated cardiomyopathy
Type of cardiomyopathy in which the ventricles and septum enlarge and thicken affecting diastolic function and restricting blood outflow
Hypertrophic cardiomyopathy
Type of cardiomyopathy in which the ventricles become stiff and rigid restricting filling during diastole
Restrictive cardiomyopathy
S/S of cardiomyopathy
SOB, fatigue, dizziness, arrhythmias, murmurs
Removal of part of the heart muscle in the septum to thin the septum
Septal myectomy
Injection of alcohol into heart septum that kills heart muscle allowing thinning of septum
Septum ablation
The build-up of plaque on the arterial walls
Atherosclerosis
Atherosclerosis risk factors
Older age, immobility, smoking, increased cholesterol, obesity, DM, stress
S/S of atherosclerosis
HTN, bruits (d/t turbulent blood flow)
Labs associated with atherosclerosis
Elevated LDLs and triglycerides
Family hx, increased sodium intake, obesity, smoking, stress, and hyperlipidemia are risk factors for __________ hypertension
Primary/essential
Kidney disease, hyperthyroidism, Cushing’s syndrome, and pheochromocytoma are risk factors for _________ hypertension
Secondary
S/S of hypertensive crisis
Headache, chest pain, SOB, dizziness
Dietary teaching for hypertension
DASH diet: increased intake of fruits, vegetables, and low-fat dairy; decreased consumption of sodium and fats (saturated and trans)
Inadequate blood flow to the extremities
Peripheral arterial disease (PAD)
What causes PAD?
Atherosclerosis
PAD risk factors
HTN, DM, smoking, obesity, hyperlipidemia
S/S of PAD
Intermittent claudication (leg pain worse with exertion, better when dangling legs in dependent position)**, delayed cap refill, decreased pedal pulses, lack of hair on calves, skin cool and shiny, pallor of extremities when elevated, dependent rubor, dry and necrotic wound on feet (particularly toes), delayed wound healing
PAD diagnostic that compares ankle BP to arm BP
Ankle Brachial Index (PAD indicated if ankle BP is greatly decreased)
PAD patient education
Stop and rest during activity until pain subsides, avoid restrictive clothing and crossing legs, maintain warm environment and wear socks, avoid nicotine and caffeine
The rerouting of blood flow around an occluded artery related to PAD
Peripheral bypass graft
Peripheral bypass graft post-procedure patient education
Keep leg straight for 24 hours after procedure
S/S of peripheral bypass graft occlusion
Pallor, decreased pedal pulses, decreased temperature, sudden increase in pain
Increased pressure inside a muscle compartment due to swelling resulting in impaired blood flow
Compartment syndrome
S/S of compartment syndrome
Numbness, severe pain even with passive movement, edema, taut skin
A balloon-like bulge in the arterial wall caused by congenital disorder, trauma, infection or disease that results in damage and weakening of the arterial wall
Aneurysm
Aneurysm risk factors
White males, older age, atherosclerosis, HTN, elevated cholesterol, smoking, Marfan’s syndrome
S/S of abdominal aortic aneurysm
Flank or back pain, pulsating abdominal mass, bruit
Abdominal aortic aneurysm nursing consideration
DO NOT palpate the area because this can rupture the aneurysm
S/S of thoracic aortic aneurysm
Severe back or chest pain, SOB, Dysphagia, cough
S/S of ruptured aneurysm
Sudden onset of severe pain, hypotension, diaphoresis, decreased LOC, oliguria, decreased pulses distal to rupture
An inflammatory condition that impairs circulation to the extremities (both arms and legs)
Buerger’s disease
What is the key risk factor for Buerger’s disease?
Smoking
Typical population affected by Buerger’s disease
Males between the ages of 20-50 who smoke
S/S of Buerger’s disease
Claudication, numbness and tingling, decreased pedal pulses, decreased temp in extremities, cyanotic extremities
Complications of Buerger’s disease
Tissue death, gangrene, amputation
A rare vascular disorder that causes vasospasming of the arteries in the finger and/or toes decreasing blood flow to these extremities
Raynaud’s
__________ Raynaud’s is Raynaud’s disease with an idiopathic cause
Primary (most common)
_________ Raynaud’s is Raynaud’s Phenomenon which is characterized by underlying connective tissue disease such as lupus or scleroderma which damages the arteries
Secondary
S/S of Raynaud’s
Upon exposure to cold or stress, fingers will become cyanotic, cold, painful and numb. After spasming, blood flow returns to area causing fingers to turn very red in color
Raynaud’s patient education
Avoid cold, caffeine, stress, and smoking
Blood clot that starts in a vein
Venous thromboembolism (VTE)
What are the two types of VTE?
DVT and PE
VTE form in a deep vein due to virchow’s triad which includes
Endothelial injury, impaired blood flow (venous stasis), hypercoagulability
VTE risk factors
Hip and knee replacement surgery, HF, immobility, pregnancy, combined oral contraceptives, family hx
S/S of DVT
Calf or thigh pain, swelling and redness on affected side
S/S of PE
SOB, dyspnea, chest pain with inspiration, tachycardia, hypotension, petechiae
VTE diagnosis
Elevated D-Dimer
VTE treatment
Anticoagulants (heparin, warfarin), thrombolytics (alteplase), thrombectomy, vena cava filter (prevents embolus from reaching lungs)
VTE nursing care
Elevate extremity, do NOT place knee gatch or pillow beneath knee, apply warm/moist compresses, do NOT massage, apply compression stockings as ordered, monitor for S/S of PE
PE nursing care
High fowlers position, administer O2 as prescribed
Condition by which the veins in the lower extremities do not transport blood back up to the heart effectively
Venous insufficiency
Venous insufficiency risk factors
Obesity, immobility, pregnancy, hx of DVT
S/S of venous insufficiency
Edema, brown discoloration of skin over lower extremities (stasis dermatitis), heavily draining wounds around ankles
Venous insufficiency nursing care
Elevate patients legs to promote blood return, apply compression stockings per orders (best in morning when swelling is reduced), monitor for complications such as cellulitis
Venous insufficiency patient education
Avoid sitting or standing for too long, avoid crossing legs or wearing restrictive clothing, apply stockings in morning before getting out of bed
Dilated, tortuous veins that occurs in the lower extremities due to pooling of blood in veins causing enlargement and weakening of veins and impaired valve function such that blood flows backwards
Varicose veins
Varicose veins risk factors
Females, prolonged standing, pregnancy, obesity, family hx
S/S of varicose veins
Distended rope-like veins, feeling of heaviness, itching, aching
Varicose veins treatment
Elevation, compression, procedures such as sclerotherapy and laser treatment
_________ shock can be caused due to blood loss associated with a trauma or with surgery, GI losses, excess fluid loss
Hypovolemic
_________ shock occurs as a result of heart pump failure from an MI, HF, valve or structural problem, and dysthymias
Cardiogenic
_________ shock is caused by a blockage of the great vessels or the heart itself (PE, tension pneumothorax, cardiac tamponade)
Obstructive
_________ shock is caused by extreme systemic vasodilation causing the patients blood pressure to plummet
Distributive
What are the three different types of distributive shock?
Septic, neurogenic, anaphylactic
Type of distributive shock in which endotoxins end up in the blood stream from an infection
Septic shock
Type of distributive shock in which there is a dysfunction of the sympathetic nervous system based on a trauma such as spinal cord injury
Neurogenic shock
Type of distributive shock caused by a reaction to an exposed allergen leading to closure of the airway and systemic vasodilation
Anaphylactic
S/S common across all types of shock
Hypotension, tachycardia, tachypnea, weak pulses, decreased urine output
Wheezing and angioedema are symptoms associated with _________ shock
Anaphylactic
Lab findings associated with shock
Elevated serum lactate, abnormal ABGs
Hemoglobin and hematocrit will be _________ with hypovolemic shock
Decreased
Treatment for shock
Treat underlying condition, administer IV fluids, blood products, colloids, vasopressors (epinephrine and norepinephrine), antibiotics (septic shock), oxygen
In the treatment of shock, which should the nurse perform first, administer vasopressors OR correct hypovolemia?
Correct hypovolemia FIRST, then administer vasopressors
Patient positioning for shock
Modified trendelenburg (supine w/ legs elevated)
Complications of shock
Multiple organ dysfunction syndrome (MODS) and disseminated intravascular coagulation (DIC)
Chest pain due to ischemic heart disease
Angina
Chest pain that occurs with exercise and is relieved with nitroglycerin or rest
Stable angina
Chest pain that occurs with exercise or with rest and over time the pain will increase in duration, frequency, or severity
Unstable angina
_________ angina is caused by spasming of the coronary artery and chest pain will occur at rest
Variant
Differentiating angina from MI
Chest pain unrelieved by rest or nitroglycerin and that lasts longer that 30 min is indicative of MI. MI may also have other symptoms such as SOB, N/V, and diaphoresis
Sudden blockage of blood flow into the heart
Myocardial infarction (MI)
S/S of MI in women
N/V, fatigue, pain in back, shoulders, or jaw
MI diagnosis
Elevated cardiac enzymes, abnormal ST elevation or depression
Medications used in the treatment of an MI
Aspirin, clopidogrel, thrombolytics, anticoagulants, Antihypertensives (BB, ACE), statins
A procedure used to open the coronary arteries indicated for treatment of MI; catheter with balloon threaded through blood vessel (usually femoral artery) up to blocked coronary artery, balloon is inflated, and stent is placed to restore blood flow to heart
Percutaneous Coronary Intervention (PCI)
PCI should be performed within ___ hours of the onset of symptoms of an MI
2
PCI post-procedure nursing care
Assess site for bleeding, check perfusion to extremity distal from insertion site
Procedure that bypasses one or more of the patients coronary arteries due to blockage or persistent ischemia
Coronary artery bypass graft (CABG)
CABG typically uses the _________ vein from patients leg
Saphenous
Post-CABG nursing care
Closely monitor BP (HTN can cause bleeding from graft site, hypotension can cause collapse of graft site), monitor temperature (post op hypothermia is a complication), monitor for bleeding (chest tube will be in place), assess LOC, fluid and electrolyte balance, cardiac rhythm, pain and neurovascular status of donor site
Blood disorder that results in decreased RBCs or decreased Hgb
Anemia
What are the three main causes of anemia?
Blood loss, insufficient RBC production, excess destruction of RBCs
What population is most at risk for iron deficiency anemia?
Pregnant women and children
Blood disorder caused by lack of intrinsic factor which inhibits absorption of B12
Pernicious anemia
S/S of anemia
SOB, pallor, fatigue, weakness, tachycardia
Autosomal recessive genetic disorder that causes chronic anemia, pain, infection and organ damage
Sickle cell anemia
Sickle cell anemia risk factors
Family hx, African Americans and middle eastern descent
S/S of sickle cell anemia
Pain, fatigue, SOB, pallor, jaundice
Sickle cell vaso-occlusive crisis results in
Severe pain and swelling in hands and feet — treatment involves around the clock administration of opioid analgesics
Sickle cell crises caused by blockage of blood flow out of the spleen causing enlargement of spleen and possible hypovolemic shock
Splenic sequestration crisis
Sickle cell crisis characterized by severe anemia typically related to a viral infection
Aplastic crisis
Sickle cell crisis where blood flow is impaired to the lungs resulting in dyspnea, fever, and cough
Acute chest syndrome
Sickle cell crisis characterized by a rapid decrease in Hgb levels
Hyperhemolytic crisis
Sickle cell anemia patient education
Encourage adequate fluid intake (avoid dehydration), avoid infection (hand hygiene, avoid crowds)
A rare blood disorder that causes an increase in RBCs
Polycythemia
S/S of polycythemia
Ruddy (red) complexion, dizziness, headache, fatigue, clubbing, enlarged spleen
A patient with polycythemia is at risk for
Clots, ischemia
Medications useful in the treatment of polycythemia
Hydroxyurea, aspirin
Nursing care for coagulation disorders
Limit venipunctures and IM injections, implement fall precautions, educate patients to use soft toothbrush, electric razor, and to seek immediate medical attention for any kind of head trauma
A rare, inherited bleeding disorder that results in a deficiency in clotting factors
Hemophilia
Autoimmune disorder that causes a decrease in the lifespan of platelets
Immune thrombocytopenic purpura (ITP)
An immune-mediated drug reaction to heparin causing a drop in platelets
Heparin-induced thrombocytopenia (HIT)
Labs associated with HIT
Low platelets, normal PT and APTT
HIT treatment
Discontinue heparin immediately, administer alternate anticoagulant, platelet transfusion
Disorder where clotting factors and platelets are depleted through the formation of micro-clots throughout the body
Disseminated intravascular coagulation (DIC)
Labs associated with DIC
Decrease in platelets, increased PT, APTT, and D-Dimer
DIC treatment
Administer clotting factors, platelet/plasma transfusion
