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NCLEX: Med Surg > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

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1
Q

Blood flow pathway

A

Heart, arteries, arterioles, capillaries, venules, veins, back to heart

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2
Q

_________ carry blood away from the heart, while _________ bring blood back to the heart

A

Arteries; veins

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3
Q

Membrane that surrounds and protects the heart

A

Pericardium

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4
Q

Three layers of the heart wall

A

Epicardium (outer), myocardium (middle), endocardium (inner)

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5
Q

Flow of blood through the heart

A

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

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6
Q

Conduction pathway of heart

A

SA node, AV node, bundle of his, L and R bundle branches, purkinje fibers

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7
Q

Relaxation of atria and ventricles allowing for filling of blood

A

Diastole

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8
Q

Contraction of atria and ventricles ejecting blood

A

Systole

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9
Q

The volume of blood in liters ejected from the left ventricle every minute

A

Cardiac output (HR x SV)

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10
Q

The number of times the heart contracts in one minute

A

Heart Rate (60-100 bpm)

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11
Q

The volume of blood in liters ejected from the ventricle with each heart beat

A

Stroke volume

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12
Q

Normal cardiac output

A

4-8 L/min

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13
Q

The percentage of blood that leaves the left ventricle each time it contracts

A

Left ventricular ejection fraction (LVEF)

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14
Q

Normal LVEF

A

55-70%

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15
Q

The volume of blood in the ventricles at the end of diastole that determines the amount of stretch placed on myocardial fibers of heart

A

Preload

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16
Q

The peripheral resistance that the left ventricle must overcome in order to push blood into systemic circulation

A

Afterload

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17
Q

Amount of pressure exerted on arterial walls during left ventricular contraction

A

Systolic BP

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18
Q

Amount of pressure exerted on arterial walls during left ventricular relaxation

A

Diastolic BP

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19
Q

Catheter inserted in a small peripheral vein in the arm or hand

A

Peripheral venous catheter

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20
Q

Most common type of IV that is 3 inches or less

A

Short peripheral catheter

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21
Q

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 _________

A

Axilla; shoulder

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22
Q

Where does that tip of a central venous catheter (CVC) terminate?

A

Superior vena cava right above the right atrium

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23
Q

Indications for CVC

A

Long-term antibiotic therapy, TPN, and chemotherapy

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24
Q

PICC lines and implantable ports are examples of

A

CVCs

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25
Q

Inflammation of the veins

A

Phlebitis

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26
Q

S/S of phlebitis

A

Erythema, warmth, pain, induration (hardened) vein, red streak

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27
Q

Nursing interventions for phlebitis

A

D/C IV, elevated extremity, apply warm, moist compresses

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28
Q

The leakage of IV fluids or medications into surrounding tissues outside the vein

A

Infiltration

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29
Q

S/S of infiltration

A

Swelling, coolness, dampness, slowed rate of IV infusion, leaking fluid from IV site

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30
Q

Nursing interventions for infiltration

A

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)

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31
Q

Infiltration with a vesicant agent (medication that causes tissue damage)

A

Extravasation

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32
Q

S/S of Extravasation

A

Erythema, pain, edema, formation of blisters, necrotic tissues such as slough, ulceration

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33
Q

Extravasation nursing care

A

Stop the infusion, aspirate residual medication, administer antidote, D/C IV, elevate extremity, apply warm or cold compress depending on solution

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34
Q

Entrance of air into the venous system from the IV catheter

A

Air embolus

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35
Q

S/S of air embolus

A

Hypotension, tachycardia, tachypnea, cyanosis

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36
Q

Air embolism nursing interventions

A

Clamp the catheter, place patient in trendelenburg position, administer O2, notify provider

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37
Q

Fluid overload nursing interventions

A

Raise HOB, slow infusion rate, monitor O2 and vitals, administer diuretics as ordered by provider

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38
Q

Packed RBCs are infused over ___-___ hours

A

2-4

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39
Q

Fresh frozen plasma is infused between ___-___ min

A

15-30

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40
Q

Fresh frozen plasma should be administered within ___ hours of thawing

A

2

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41
Q

Platelets are infused between ___-___ mins

A

15-30

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42
Q

IV catheter gauge ideal for blood transfusions

A

18 gauge (20 gauge will also work)

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43
Q

Blood transfusion line should ONLY be primed with

A

0.9% NS

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44
Q

T or F: the nurse can administer medications through the blood transfusion line

A

False

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45
Q

If blood is not administered within ___ mins of receiving it, it needs to be sent back to the blood bank

A

30

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46
Q

Blood transfusion nursing care

A

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

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47
Q

Transfusion reaction nursing care

A

Stop the infusion, administer 0.9% NaCl through SEPARATE line

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48
Q

Itching, flushing, and urticaria are symptoms of a _________ reaction to blood transfusing

A

Mild allergic

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49
Q

Nursing interventions for mild allergic reaction to blood transfusion

A

Administration of diphenhydramine (Benadryl)

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50
Q

Wheezing, dyspnea, hypertension, and decreased oxygenation are symptoms of an _________ reaction to blood transfusion

A

Anaphylactic

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51
Q

What can of medications are commonly given for anaphylactic allergic reactions to blood transfusions?

A

Epinephrine, corticosteroids

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52
Q

Fever, chills, hypotension, tachycardia, and tachypnea are symptoms of a _________ blood transfusion reaction

A

Febrile

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53
Q

_________ are anticipated to be order for patients with febrile blood transfusion reactions

A

Antipyretics

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54
Q

Fever, chills, and abdominal pain are symptoms of a _________ blood transfusion reaction

A

Septic

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55
Q

Nursing care for septic blood transfusion reaction

A

Collect cultures and administer antibiotics as ordered

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56
Q

What blood transfusion reaction may cause symptoms such as low back pain, fever, chills, tachycardia, tachypnea, and hypotension

A

Acute hemolytic reaction

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57
Q

Acute hemolytic reaction nursing interventions

A

Collect labs and specimen, give fluids as ordered by provider

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58
Q

What kind of blood transfusion reaction may cause symptoms such as dyspnea, tachycardia, tachypnea, crackles, hypertension, and distended neck veins?

A

Circulatory overload reaction

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59
Q

Cardiac enzyme released into bloodstream upon damage to cardiac muscle

A

CK-MB

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60
Q

Normal CK-MB

A

0%

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61
Q

CK-MB will be elevated ___-___ hours after damage to the heart muscle, and it will stay elevated for approximately ___-___ days

A

3-6; 2-3

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62
Q

A protein found in the heart muscle and skeletal muscle

A

Myoglobin

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63
Q

Normal myoglobin should be less than

A

90

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64
Q

Myoglobin will be elevated ___-___ hours after cardiac or skeletal muscle damage and will stay elevated for approximately ___ hours

A

2-3; 24

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65
Q

_________ is the most specific enzyme for identifying ischemia of the heart

A

Troponin

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66
Q

Troponin T should be under _____ and Troponin I should be under _____

A

0.1; 0.03

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67
Q

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

A

2-3; T; I

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68
Q

Total cholesterol should be less than

A

200

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69
Q

LDL should be less than

A

130; 100 if high risk for cardiovascular disease

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70
Q

HDL should be over ___ for females and ___ for males

A

55; 45

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71
Q

Normal triglycerides for males and females

A

Males: 40-160
Females: 35-135

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72
Q

Normal RBC range for females and males

A

Females: 4.2-5.4
Males: 4.7-6.1

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73
Q

Normal platelet range

A

150,000-400,000

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74
Q

Normal Hgb range for females and males

A

Females: 12-16
Males: 14-18

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75
Q

Normal Hct range for females and males

A

Females: 37-47%
Males: 42-52%

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76
Q

Normal aPTT

A

30-40 sec

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77
Q

Normal aPTT range for clients on heparin

A

45-80 sec (1.5-2x baseline)

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78
Q

Normal PT

A

11-13 sec

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79
Q

Normal PT for clients on warfarin

A

17-26 sec (1.5-2x baseline)

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80
Q

Normal INR

A

1

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81
Q

Normal INR for patients on warfarin

A

2-3

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82
Q

D-Dimer should be less than

A

0.4

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83
Q

A hormone released by the ventricles in the heart in response to fluid overload

A

hBNP

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84
Q

Normal hBNP

A

<100 (over 100 indicates HF)

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85
Q

S/S of fluid volume defective

A

Hypotension, tachycardia, tachypnea, weak thready pulses, prolonged capillary refill, low UOP, flattened jugular veins

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86
Q

Fluid volume deficit labs

A

Concentrated blood (increased Hct and osmolarity), concentrated urine (increased BUN)

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87
Q

S/S of hypervolemia

A

Weight gain, edema, hypertension, bounding pulses, JVD, tachycardia, dyspnea and tachypnea, crackles in lungs

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88
Q

Fluid volume excess labs

A

Dilute blood (low Hgb, Hct, osmolarity) and dilute urine (decreased urine specific gravity)

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89
Q

Report weight gain of ___-___ lbs in 24 hours or ___ lbs or more in one week

A

1-2; 3

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90
Q

Extracellular electrolyte essential for fluid balance and nerve and muscle function

A

Sodium

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91
Q

Normal sodium range

A

135-145

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92
Q

S/S of hypernatremia

A

Thirst, agitation, muscle weakness, GI upset

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93
Q

Treatment for hypernatremia

A

Hypotonic solutions such as 0.45% NaCl, diuretics such as furosemide, restrict sodium intake, increase intake of water

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94
Q

It is important to SLOWLY correct a patient’s sodium balance in order to prevent

A

Cerebral edema or seizures

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95
Q

S/S of hyponatremia

A

Confusion, fatigue, N/V, headache

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96
Q

Treatment for hyponatremia

A

Hypertonic solutions such as 2-3% NaCl, increased sodium intake, restrict fluid intake

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97
Q

An electrolyte important for bone and teeth formation, nerve and muscle function, and clotting

A

Calcium

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98
Q

Normal calcium range

A

9-11

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99
Q

S/S of Hypercalcemia

A

Constipation, decreased DTRs, kidney stones, lethargy, weakness

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100
Q

Hypercalcemia treatment

A

0.9% NaCl, calcitonin, dialysis (severe)

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101
Q

S/S of hypocalcemia

A

Positive Chvostek sign, positive trousseau sign, muscle spasms, numbness and tingling in lips and fingers, GI upset

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102
Q

Hypocalcemia treatment

A

Calcium supplements, increased intake in calcium rich foods and vitamin D

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103
Q

Electrolyte important in maintaining ICF, and nerve and muscle function

A

Potassium

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104
Q

Normal potassium range

A

3.5-5

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105
Q

S/S of hyperkalemia

A

Dysrhythmias, muscle weakness, numbness and tingling, N/V

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106
Q

Hyperkalemia treatment

A

Diuretics such as furosemide, Kayexalate, insulin, decreased intake of potassium rich foods (bananas, potatoes, cantaloupe, etc)

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107
Q

S/S of hypokalemia

A

Dysrhythmias, muscle spasms or weakness, constipation, ileus

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108
Q

Hypokalemia treatment

A

Potassium supplements (oral or IV), encourage increased intake of potassium rich foods

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109
Q

Electrolyte important for many biochemical reactions in the body and is also needed for muscle and nerve function

A

Magnesium

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110
Q

Magnesium normal range

A

1.5-2.5

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111
Q

S/S of hypermagnesemia

A

Hypotension, lethargy, muscle weakness, decreased DTRs, respiratory and cardiac arrest

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112
Q

Hypermagnesemia treatment

A

Diuretics such as furosemide, calcium (reverse cardiac effects)

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113
Q

S/S of hypomagnesemia

A

Dysrhythmias (torsades de pointes), tachycardia, hypertension, increased DTRs, tremors, seizures

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114
Q

Hypomagnesemia treatment

A

Magnesium supplements (PO or IV), encourage intake of magnesium rich foods

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115
Q

Causes of hypernatremia

A

Excess sodium intake, Cushing’s syndrome, DI

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116
Q

Causes of hyponatremia

A

Diuretics, kidney failure, diaphoresis, SIADH, hyperglycemia, HF

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117
Q

Causes of Hypercalcemia

A

Hyperparathyroidism, corticosteroids, bone cancer

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118
Q

Causes of hypocalcemia

A

Diarrhea, vitamin D deficiency, hypoparathyroidism, thyroidectomy

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119
Q

Causes of hyperkalemia

A

DKA, metabolic acidosis, salt substitutes, kidney failure

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120
Q

Causes of hypokalemia

A

Diuretics, GI losses (vomiting, NGT suctioning), diaphoresis, Cushing’s syndrome, metabolic alkalosis

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121
Q

Causes of hypermagnesemia

A

Kidney disease, excess intake of antacids or laxatives containing magnesium

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122
Q

Causes of hypomagnesemia

A

GI losses, diuretics, malnutrition, alcohol abuse

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123
Q

PH > 7.45
PaCO2 < 35

A

Respiratory alkalosis

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124
Q

Causes of respiratory alkalosis

A

Hyperventilation (d/t fear, anxiety, etc.), salicylate toxicity, high altitude, shock, pain, trauma

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125
Q

S/S of respiratory alkalosis

A

SOB, dizziness, chest pain, numbness in hands or feet

126
Q

PH < 7.35
PaCO2 > 45

A

Respiratory acidosis

127
Q

Causes of respiratory acidosis

A

Hypoventilation — respiratory disorders such as ARDS, asthma, pneumonia, COPD; inadequate chest expansion; respiratory depression with certain meds such as opioids and Benzos

128
Q

S/S of respiratory acidosis

A

Confusion, lethargy, dyspnea, pale or cyanotic skin

129
Q

PH > 7.45
HCO3 > 28

A

Metabolic alkalosis

130
Q

Causes of metabolic alkalosis

A

Antacid overdose, loss of body acid through vomiting or NGT suctioning

131
Q

S/S of metabolic alkalosis

A

Dysrhythmias, muscle weakness, lethargy

132
Q

PH < 7.35
HCO3 < 21

A

Metabolic acidosis

133
Q

Causes of metabolic acidosis

A

DKA, kidney failure, starvation, diarrhea, dehydration

134
Q

S/S of metabolic acidosis

A

Hypotension, tachycardia, weak pulses, dysrhythmias, kussmaul respirations, fruity breath

135
Q

Metabolic acidosis treatment

A

Sodium bicarbonate, IV fluids and insulin for DKA, hemodialysis for kidney failure

136
Q

Regular rate and rhythm but with a HR over 100 bpm

A

Sinus tachycardia

137
Q

Causes of sinus tachycardia

A

Physical activity, anxiety, fever, pain, anemia, compensation for decrease BP or CO

138
Q

Regular cardiac rhythm but with a HR below 60 bpm

A

Sinus bradycardia

139
Q

Causes of sinus bradycardia

A

Excess vagal stimulation, cardiovascular disease, hypoxia, certain medications, athletes (normal and expected finding)

140
Q

Asymptomatic bradycardia does not require treatment, but if the patient is symptomatic they may be administered

A

Atropine and a pacemaker

141
Q

Rapid and disorganized depolarization of the atria, such that the atria will quiver rather than fully contract

A

Atrial fibrillation (Afib)

142
Q

Afib increased the risk for

A

Blood clot formation

143
Q

Afib interventions/treatment

A

Anticoagulants, cardioversion, antiarrythmics

144
Q

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)

A

Atrial flutter

145
Q

Atrial flutter treatment

A

Antiarrythmics, cardioversion

146
Q

Rapid ventricular rhythm (over 100 bpm), no P-waves, wide QRS complexes that occur regularly

A

Ventricular tachycardia (V-Tach)

147
Q

Causes of V-Tach

A

Ischemic heart disease

148
Q

Treatment of V-Tach WITH a pulse

A

Cardioversion, antiarrythmics, correction of electrolyte imbalances

149
Q

Treatment for PULSELESS V-Tach

A

Defibrillation

150
Q

Rapid, ineffective quivering of the ventricles (will not see P-waves or QRS complexes on EKG strip)

A

Ventricular fibrillation (Vfib)

151
Q

Vfib treatment

A

Defibrillation

152
Q

Absence of any ventricular rhythm (flat-line)

A

Asystole

153
Q

Asystole treatment

A

CPR

154
Q

Atrioventricular (AV) blocks are typically caused by

A

Heart disease, MI, certain medication such as BB or digoxin

155
Q

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

A

First-degree AV block

156
Q

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

A

Second-degree type I AV block (Mobitz I)

157
Q

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

A

Second degree type II AV block (Mobitz II)

158
Q

Treatment for Mobitz II

A

Pacemaker

159
Q

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

A

Third degree AV block

160
Q

Third degree AV block treatment

A

Pacemaker

161
Q

Examples of medications used in chemical cardioversion

A

Adenosine (NOTE: there may be a brief period of asystole after administration, however, this is normal and expected), procainamide

162
Q

Cardioversion nursing care

A

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)

163
Q

Pacemaker post-op nursing care/education

A

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!)

164
Q

Pacemaker patient education

A

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

165
Q

S/S of left-sided HF

A

Dyspnea, crackles, fatigue, pink/frothy sputum

166
Q

S/S of right-sided HF

A

Peripheral edema, ascites, JVD, hepatomegaly

167
Q

An echocardiogram can be used as a diagnostic for HF by measuring

A

Ejection fraction

168
Q

HF nursing care

A

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

169
Q

T or F: HF will cause an increase in central venous pressure (CVC) and pulmonary artery wedge pressure (PAWP)

A

True

170
Q

A defect or damage to one of the heart valves which can cause stenosis, prolapse (improper closure), and regurgitation

A

Valvular heart disease

171
Q

Risk factors associated with acquired causes of valvular heart disease

A

HTN, older age, increased cholesterol, smoking, DM, rheumatic fever, infective endocarditis

172
Q

S/S of valvular heart disease

A

Murmurs, extra heart sounds, dysrhythmias, dyspnea

173
Q

Procedure/surgery for stenosis related to valvular heart disease

A

Percutaneous balloon valvuloplasty

174
Q

Prosthetic valve patient education

A

Required antibiotics prior to any dental work, surgery, or other invasive procedures

175
Q

Bacteria or fungi that adhere to the heart forming vegetative growth which can lead to necrosis of a heart valve or endocardium

A

Infective endocarditis

176
Q

Infective endocarditis risk factors

A

Congenital heart disease, valvular heart disease, prosthetic valves, IV drug use

177
Q

S/S of infective endocarditis

A

Fever, flu-like symptoms, murmurs, petechiae, splinter hemorrhages (red streaks under the nail bed)**

178
Q

Infective endocarditis treatment

A

Antibiotics, valve repair or replacement

179
Q

Inflammation of the heart following a strep throat infection which can cause long-term damage to the heart and valves

A

Rheumatic carditis

180
Q

S/S of rheumatic carditis

A

Tachycardia, cardiomegaly, murmurs, friction rub, chest pain

181
Q

Rheumatic carditis diagnosis

A

Throat culture, ASO titer

182
Q

Rheumatic carditis treatment

A

Antibiotics, valve repair or replacement

183
Q

Inflammation of the sac that surrounds the heart

A

Pericarditis

184
Q

Pericarditis risk factors

A

Infection from autoimmune disorder, trauma

185
Q

S/S of pericarditis

A

Chest pain that is worse when supine and better when sitting up leaning forward**, friction rub, fever, dysrhythmias, dyspnea

186
Q

Pericarditis diagnosis

A

EKG shows ST or T spiking

187
Q

The accumulation of fluid in the pericardia sac that puts pressure on the heart impairing blood flow and decreased cardiac output

A

Cardiac tamponade

188
Q

S/S of cardiac tamponade

A

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

189
Q

Treatment for cardiac tamponade

A

Pericardiocentesis (removal of fluid from pericardial sac)

190
Q

Disease of the heart muscle that can lead to pulmonary edema, dysrhythmias, and heart failure

A

Cardiomyopathy

191
Q

What are the three types of cardiomyopathy?

A

Dilated (most common), hypertrophic, restrictive

192
Q

Type of cardiomyopathy in which the ventricles enlarge and weaken and primarily affects systolic function

A

Dilated cardiomyopathy

193
Q

Type of cardiomyopathy in which the ventricles and septum enlarge and thicken affecting diastolic function and restricting blood outflow

A

Hypertrophic cardiomyopathy

194
Q

Type of cardiomyopathy in which the ventricles become stiff and rigid restricting filling during diastole

A

Restrictive cardiomyopathy

195
Q

S/S of cardiomyopathy

A

SOB, fatigue, dizziness, arrhythmias, murmurs

196
Q

Removal of part of the heart muscle in the septum to thin the septum

A

Septal myectomy

197
Q

Injection of alcohol into heart septum that kills heart muscle allowing thinning of septum

A

Septum ablation

198
Q

The build-up of plaque on the arterial walls

A

Atherosclerosis

199
Q

Atherosclerosis risk factors

A

Older age, immobility, smoking, increased cholesterol, obesity, DM, stress

200
Q

S/S of atherosclerosis

A

HTN, bruits (d/t turbulent blood flow)

201
Q

Labs associated with atherosclerosis

A

Elevated LDLs and triglycerides

202
Q

Family hx, increased sodium intake, obesity, smoking, stress, and hyperlipidemia are risk factors for __________ hypertension

A

Primary/essential

203
Q

Kidney disease, hyperthyroidism, Cushing’s syndrome, and pheochromocytoma are risk factors for _________ hypertension

A

Secondary

204
Q

S/S of hypertensive crisis

A

Headache, chest pain, SOB, dizziness

205
Q

Dietary teaching for hypertension

A

DASH diet: increased intake of fruits, vegetables, and low-fat dairy; decreased consumption of sodium and fats (saturated and trans)

206
Q

Inadequate blood flow to the extremities

A

Peripheral arterial disease (PAD)

207
Q

What causes PAD?

A

Atherosclerosis

208
Q

PAD risk factors

A

HTN, DM, smoking, obesity, hyperlipidemia

209
Q

S/S of PAD

A

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

210
Q

PAD diagnostic that compares ankle BP to arm BP

A

Ankle Brachial Index (PAD indicated if ankle BP is greatly decreased)

211
Q

PAD patient education

A

Stop and rest during activity until pain subsides, avoid restrictive clothing and crossing legs, maintain warm environment and wear socks, avoid nicotine and caffeine

212
Q

The rerouting of blood flow around an occluded artery related to PAD

A

Peripheral bypass graft

213
Q

Peripheral bypass graft post-procedure patient education

A

Keep leg straight for 24 hours after procedure

214
Q

S/S of peripheral bypass graft occlusion

A

Pallor, decreased pedal pulses, decreased temperature, sudden increase in pain

215
Q

Increased pressure inside a muscle compartment due to swelling resulting in impaired blood flow

A

Compartment syndrome

216
Q

S/S of compartment syndrome

A

Numbness, severe pain even with passive movement, edema, taut skin

217
Q

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

A

Aneurysm

218
Q

Aneurysm risk factors

A

White males, older age, atherosclerosis, HTN, elevated cholesterol, smoking, Marfan’s syndrome

219
Q

S/S of abdominal aortic aneurysm

A

Flank or back pain, pulsating abdominal mass, bruit

220
Q

Abdominal aortic aneurysm nursing consideration

A

DO NOT palpate the area because this can rupture the aneurysm

221
Q

S/S of thoracic aortic aneurysm

A

Severe back or chest pain, SOB, Dysphagia, cough

222
Q

S/S of ruptured aneurysm

A

Sudden onset of severe pain, hypotension, diaphoresis, decreased LOC, Liguria, decreased pulses distal to rupture

223
Q

An inflammatory condition that impairs circulation to the extremities (both arms and legs)

A

Buerger’s disease

224
Q

What is the key risk factor for Buerger’s disease?

A

Smoking

225
Q

Typical population affected by Buerger’s disease

A

Males between the ages of 20-50 who smoke

226
Q

S/S of Buerger’s disease

A

Claudication, numbness and tingling, decreased pedal pulses, decreased temp in extremities, cyanotic extremities

227
Q

Complications of Buerger’s disease

A

Tissue death, gangrene, amputation

228
Q

A rare vascular disorder that causes vasospasming of the arteries in the finger and/or toes decreasing blood flow to these extremities

A

Raynaud’s

229
Q

__________ Raynaud’s is Raynaud’s disease with an idiopathic cause

A

Primary (most common)

230
Q

_________ Raynaud’s is Raynaud’s Phenomenon which is characterized by underlying connective tissue disease such as lupus or scleroderma which damages the arteries

A

Secondary

231
Q

S/S of Raynaud’s

A

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

232
Q

Raynaud’s patient education

A

Avoid cold, caffeine, stress, and smoking

233
Q

Blood clot that starts in a vein

A

Venous thromboembolism (VTE)

234
Q

What are the two types of VTE?

A

DVT and PE

235
Q

VTE form in a deep being due to virchow’s triad which includes

A

Endothelial injury, impaired blood flow (venous stasis), hypercoagulability

236
Q

VTE risk factors

A

Hip and knee replacement surgery, HF, immobility, pregnancy, combined oral contraceptives, family hx

237
Q

S/S of DVT

A

Calf or thigh pain, swelling and redness on affected side

238
Q

S/S of PE

A

SOB, dyspnea, chest pain with inspiration, tachycardia, hypotension, petechiae

239
Q

VTE diagnosis

A

Elevated D-Dimer

240
Q

VTE treatment

A

Anticoagulants (heparin, warfarin), thrombocytes (alteplase), thrombectomy, vena cava filter (prevents embolus from reaching lungs)

241
Q

VTE nursing care

A

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

242
Q

PE nursing care

A

High fowlers position, administer O2 as prescribed

243
Q

Condition by which the veins in the lower extremities do not transport blood back up to the heart effectively

A

Venous insufficiency

244
Q

Venous insufficiency risk factors

A

Obesity, immobility, pregnancy, hx of DVT

245
Q

S/S of venous insufficiency

A

Edema, brown discoloration of skin over lower extremities (stasis dermatitis), heavily draining wounds around ankles

246
Q

Venous insufficiency nursing care

A

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

247
Q

Venous insufficiency patient education

A

Avoid sitting or standing for too long, avoid crossing legs or wearing restrictive clothing, apply stockings in morning bedroom getting out of bed

248
Q

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

A

Varicose veins

249
Q

Varicose veins risk factors

A

Females, prolonged standing, pregnancy, obesity, family hx

250
Q

S/S of varicose veins

A

Distended rope-like veins, feeling of heaviness, itching, aching

251
Q

Varicose veins treatment

A

Elevation, compression, procedures such as sclerotherapy and laser treatment

252
Q

_________ shock can be caused due to blood loss associated with a trauma or with surgery, GI losses, excess fluid loss

A

Hypovolemic

253
Q

_________ shock occurs as a result of heart pump failure from an MI, HF, valve or structural problem, and dysthymias

A

Cardiogenic

254
Q

_________ shock is caused by a blockage of the great vessels or the heart itself (PE, tension pneumothorax, cardiac tamponade)

A

Obstructive

255
Q

_________ shock is caused by extreme systemic vasodilation causing the patients blood pressure to plummet

A

Distributive

256
Q

What are the three different types of distributive shock?

A

Septic, neurogenic, anaphylactic

257
Q

Type of distributive shock in which endotoxins end up in the blood stream from an infection

A

Septic shock

258
Q

Type of distributive shock in which there is a dysfunction of the sympathetic nervous system based on a trauma such as spinal cord injury

A

Neurogenic shock

259
Q

Type of distribute shock caused by a reaction to an exposed allergen leading to closure of the airway and systemic vasodilation

A

Anaphylactic

260
Q

S/S common across all types of shock

A

Hypotension, tachycardia, tachypnea, weak pulses, decreased urine output

261
Q

Wheezing and angioedema are symptoms associated with _________ shock

A

Anaphylactic

262
Q

Lab findings associated with shock

A

Elevated serum lactate, abnormal ABGs

263
Q

Hemoglobin and hematocrit will be _________ with hypovolemic shock

A

Decreased

264
Q

Treatment for shock

A

Treat underlying condition, administer IV fluids, blood products, colloids, vasopressors (epinephrine and norepinephrine), antibiotics (septic shock), oxygen

265
Q

In the treatment of shock, which should the nurse perform first, administer vasopressors OR correct hypovolemia?

A

Correct hypovolemia FIRST, then administer vasopressors

266
Q

Patient positioning for shock

A

Modified trendelenburg (supine w/ legs elevated)

267
Q

Complications of shock

A

Multiple organ dysfunction syndrome (MODS) and disseminated intravascular coagulation (DIC)

268
Q

Chest pain due to ischemic heart disease

A

Angina

269
Q

Chest pain that occurs with exercise and is relieved with nitroglycerin or rest

A

Stable angina

270
Q

Chest pain that occurs with exercise or with rest and over time the pain will increase in duration, frequency, or severity

A

Unstable angina

271
Q

_________ angina is caused by spasming of the coronary artery and chest pain will occur at rest

A

Variant

272
Q

Differentiating angina from MI

A

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

273
Q

Differentiating angina from MI

A

Chest pain unrelieved by rest or nitroglycerin and that lasts longer that 30 min is indicative of MI

274
Q

Sudden blockage of blood flow into the heart

A

Myocardial infarction (MI)

275
Q

S/S of MI in women

A

N/V, fatigue, pain in back, shoulders, or jaw

276
Q

MI diagnosis

A

Elevated cardiac enzymes, abnormal ST elevation or depression

277
Q

Medications used in the treatment of an MI

A

Aspirin, clopidogrel, thrombolytics, anticoagulants, Antihypertensives (BB, ACE), statins

278
Q

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

A

Percutaneous Coronary Intervention (PCI)

279
Q

PCI should be performed within ___ hours of the onset of symptoms of an MI

A

2

280
Q

PCI post-procedure nursing care

A

Assess site for bleeding, check perfusion to extremity distal from insertion site

281
Q

Procedure that bypasses one or more of the patients coronary arteries due to blockage or persistent ischemia

A

Coronary artery bypass graft (CABG)

282
Q

CABG typically uses the _________ vein from patients leg

A

Saphenous

283
Q

Post-CABG nursing care

A

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

284
Q

Blood disorder that results in decreased RBCs or decreased Hgb

A

Anemia

285
Q

What are the three main causes of anemia?

A

Blood loss, insufficient RBC production, excess destruction of RBCs

286
Q

What population is most at risk for iron deficiency anemia?

A

Pregnant women and children

287
Q

Blood disorder caused by lack of intrinsic factor which inhibits absorption of B12

A

Pernicious anemia

288
Q

S/S of anemia

A

SOB, pallor, fatigue, weakness, tachycardia

289
Q

Autosomal recessive genetic disorder that causes chronic anemia, pain, infection and organ damage

A

Sickle cell anemia

290
Q

Sickle cell anemia risk factors

A

Family hx, African Americans and middle eastern descent

291
Q

Sickle cell anemia risk factors

A

Family hx, African Americans and middle eastern descent

292
Q

S/S of sickle cell anemia

A

Pain, fatigue, SOB, pallor, jaundice

293
Q

Sickle cell vaso-occlusive crisis results in

A

Severe pain and swelling in hands and feet — treatment involves around the clock administration of opioid analgesics

294
Q

Sickle cell crises caused by blockage of blood flow out of the spleen causing enlargement of spleen and possible hypovolemic shock

A

Splenic sequestration crisis

295
Q

Sickle cell crisis characterized by severe anemia typically related to a viral infection

A

Aplastic crisis

296
Q

Sickle cell crisis where blood flow is impaired to the lungs resulting in dyspnea, fever, and cough

A

Acute chest syndrome

297
Q

Sickle cell crisis characterized by a rapid decrease in Hgb levels

A

Hyperhemolytic crisis

298
Q

Sickle cell anemia patient education

A

Encourage adequate fluid intake (avoid dehydration), avoid infection (hand hygiene, avoid crowds)

299
Q

A rare blood disorder that causes an increase in RBCs

A

Polycythemia

300
Q

S/S of polycythemia

A

Ruddy (red) complexion, dizziness, headache, fatigue, clubbing, enlarged spleen

301
Q

A patient with polycythemia is at risk for

A

Clots, ischemia

302
Q

Medications useful in the treatment of polycythemia

A

Hydroxyurea, aspirin

303
Q

Nursing care for coagulation disorders

A

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

304
Q

A rare, inherited bleeding disorder that results in a deficiency in clotting factors

A

Hemophilia

305
Q

Autoimmune disorder that causes a decrease in the lifespan of platelets

A

Immune thrombocytopenic purpura (ITP)

306
Q

An immune-mediated drug reaction to heparin causing a drop in platelets

A

Heparin-induced thrombocytopenia (HIT)

307
Q

Labs associated with HIT

A

Low platelets, normal PT and APTT

308
Q

HIT treatment

A

Discontinue heparin immediately, administer alternate anticoagulant, platelet transfusion

309
Q

Disorder where clotting factors and platelets are depleted through the formation of micro-clots throughout the body

A

Disseminated intravascular coagulation (DIC)

310
Q

Labs associated with DIC

A

Decrease in platelets, increased PT, APTT, and D-Dimer

311
Q

DIC treatment

A

Administer clotting factors, platelet/plasma transfusion

NCLEX: Med Surg (5 decks)

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