CARDIOVASCULAR SYSTEM Flashcards
58 - Peripherally inserted centra catheter (PICC line) \+ What is it for? \+ Where is the tip? \+ How long can it sty in? \+ Nursing care of PICC line
Implanted port: What is it for and how to access it?
PICC: Used for long-term administration of IV antibiotics, TPN, chemotherapy. Tip positioned in lower 1/3 of superior vena cava. Can stay in place for up to 12 months.
NURSING CARE OF PICC:
+ Assess site every 8 hours.
+ USE 10 ML (OR LARGER) SYRINGE TO FLUSH LINE).
+ Flush w/10mL of 0.9% NaCl before, between, and after medications.
+ Blood draws: withdrawal 10 mL blood and discard, withdrawal 10 mL blood for sample; flush w/20mL NaCl (or per facility policy)
+ NO BP on arm with PICC line.
IMPLANTED PORT: For long-term (>=1 year) vascular access; common with chemotherapy. ACCESS WITH NON-CORING (HUBER) NEEDLE.
59 - IV complications
+ Symptoms and Nursing care for: Phlebitis, Infiltration, Air Embolism
PHLEBITIS:
+ S/S: erythema, pain, warmth, edema, indurated or cordlike veins, red streak.
+ Care: Discontinue IV, warm compress.
INFILTRATION:
+ S/S: edema, coolness taut skin
+ Care: Discontinue IV, cool compress, elevation.
AIR EMBOLISM:
+ S/S: shortness of breath
+ Care: place in Trendelenburg position on left side, give oxygen, notify provider.
60 - Dysrhythmias
+ Medications and electrical interventions for: Bradycardia, AFIB, SVT, Ventricular tachycardia with/without pulse, Ventricular fibrillation
BRADYCARDIA (HR<60 BPM): If symptomatic, administer atropine.
+ Electrical intervention: pacemaker.
AFIB, SVT, VENTRICULAR TACHYCARDIA WITH PULSE: Administer anti-arrhythmic medication (ex: amiodarone, adenosine, verapamil).
+ Electrical intervention: cardio-version.
+ Nursing care for cardio-version:
++ Patient must be on anticoagulation for 4-6 weeks before cardio-version.
++ Staff needs to stand clear of patient when shock is delivered.
++ After procedure: assess airway, monitor VS, obtain EKG. Monitor for S/S of dislodged clot (PE, stroke, MI).
VENTRICULAR TACHYCARDIA WITHOUT PULSE, VENTRICULAR FIBRILLATION: Administer anti-arrhythmic medication (ex: amiodarone, lidocaine, epinephrine).
+ Electrical intervention: Defibrillation.
67 - Myocardial Infarction (MI)
+ Risk factors, Signs & Symptoms, Labs, EKG Changs, Medications, Complications
MI RISK FACTORS: Male gender, post-menopausal women, hypertension, smoking, hyperlipidemia, diabetes, stress, inactivity.
S/S: Anxiety, chest pain, nausea, diaphoresis, cold/clammy skin, pallor, tachycardia.
LABS: Elevated cardiac enzymes (CK-MB, Troponin I, Troponin T, Myoglobin).
EKG CHANGES: ST depression or elevation, T wave inversion, abnormal Q wave.
MEDICATIONS: Nitroglycerin, analgesics, beta blockers, thrombolytic meds, antiplatelet meds, anticoagulants.
COMPLICATIONS: Heart failure, cardiogenic shock (symptoms: tachycardia, hypotension, de erased urinary output, altered LOC, respiratory, decreased peripheral pulses, chest pain).
66 - Angina
+ Three kinds of angina
+ Angina vs. Myocardial Infarction (MI)
STABLE ANGINA: Occurs with exercise, relieved by rest (or nitroglycerin).
UNSTABLE ANGINA: Occurs with exercise or at rest. Increase in duration, occurrence, or severity over time.
VARIANT ANGINA: Related to coronary artery spasm, occurs during rest.
ANGINA VS. MI: Pain unrelieved by rest or nitroglycerin and lasts more than 30 minutes is indicative of an MI (vs. angina). MI’s (unlike angina) often have other symptoms, such as: nausea, epigastric discomfort, diaphoresis, dyspnea.
68 - Heart Failure \+ What is it? \+ Left vs. Right Sided HF \+ Labs \+ Diagnosis
HEART FAILURE: Heart muscle does not pump effectively, resulting in decreased cardiac output.
+ LEFT SIDED HF: Results in pulmonary congestion (pulmonary edema). Key symptoms: DYSPNEA, CRACKLES, ORTHOPNEA, FATIGUE, PINK/FROTHY SPUTUM.
+ RIGHT SIDED HF: Results in systemic congestion. Key symptoms: JUGULAR VEIN DISTENTION, PERIPHERAL EDEMA, ASCITES, HEPATOMEGALY.
LABS: hBNP ELEVATED (>100 pg/mL)
DIAGNOSIS:
+ Hemodynamic monitoring: increasd cvp, pawp; decreased co
+ Echocardiogram: reduced ejection fraction (normal: left 55-70%, right 45-60%)
69 - Heart Failure
+ Nursing Care
+ Meds
NURSING CARE FOR HF: \+ Monitor daily weight, I&Os \+ Position patient in high-Fowlers \+ Administer O2 \+ Restricted fluid and sodium intake
MEDICATIONS FOR HF: \+ Diuretics \+ Afterload-reducing meds (ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers) \+ Inotropic agents (Digoxin) \+ Beta Blockers \+ Vasocilators (Nitroglycerin) \+ Human B-type natriuretic peptides (hBNP) \+ Anticoagulants
74 - Peripheral Arterial Disease (PAD)
+ What is it?
+ Risk factors
+ Symptoms
PAD: Inadequate blood flow to lower extremities due to atherosclerosis.
RISK FACTORS: hypertension, diabetes, smoking, obesity, hyperlipidemia.
SYMPTOMS: \+ PAIN IN LEGS DURING EXERCISE (RELIEVED BY PLACING LEGS IN DEPENDENT POSITION - I.E. DANGLING THEM) \+ Decreased capillary refill of toes \+ Decreased pedal pulses \+ LACK OF HAIR ON CALVES \+ Thick toenails \+ PALLOR W/ELEVATION, DEPENDENT RUBOR \+_ Ulcers/gangrene on toes
75 - Peripheral Arterial Disease (PAD) \+ Patient Teaching \+ Medications \+ Surgeries \+ Complications
Patient teaching with PAD:
+ Walk until point of pain, stop and rest, then walk a little more.
+ Avoid crossing legs and restrictive garments
+ Maintain warm environment, wear insulated socks
+ Avoid cold, stress, caffeine, nicotine - which can lead to vasoconstriction.
MEDS: Antiplatelet medications (aspirin, clopidogrel) to reduce blood viscosity, statins.
SURGERIES: Angioplasty (balloon, stent), peripheral bypass graft.
COMPLICATIONS: Graft occlusion (sx: reduced pedal pulses, increased pain, pallor, cold), compartment syndrome (sx: numbness, pain w/passive movement, edema.).
76 - Peripheral Venous Disorder
+ What is it?
+ Three kinds
PERIPHERAL VENOUS DISORDER: Issue with adequate blood return from the extremities. 3 kinds:
1) VENOUS THROMBOEMBOLISM (VTE): Blood clot.
2) VENOUS INSUFFICIENCY: Caused by incompetent valve in the deeper veins. This can lead to swelling, venous ulcers, and cellulitis.
3) VARICOSE VEINS: Enlarged superficial veins
77 - Venous Thromboembolism \+ Risk factors \+ Symptoms \+ Diagnosis \+ Nursing Care \+ Meds
RISK FACTORS: VIRCHOW’S TRIAD (IMPAIRED BLOOD FLOW, HYPERCOAGULABILITY, ENDOTHELIAL INJRY), hip and knee replacement surgery, heart failure, immobility, pregnancy, oral contraceptives.
SYMPTOMS: Calf/groin pain, edema in extremity, warmth/hardness over blood vessel, SHORTNESS OF BREATH (PE).
DIAGNOSIS: Positive d-dimer, venous duplex ultrasonography.
NURSING CARE: Elevation of extremity (no pillow or knee gatch under knees), warm/moist compresses, NO massaging limb, compression stockings, watch for S/S of pulmonary embolism (PE).
MEDS: anticoagulants, thrombolytics.
78 - Venous Insufficiency
+ Risk factors
+ Symptoms
+ Nursing care
RISK FACTORS: Sitting/standing in one place for a long time, obesity, pregnancy
SYMPTOMS: Aching pain and feeling of heaviness in legs, brown discoloration of legs (stasis dermatitis), BLE edema, venous stasis ulcers (usually around ankles)
NURSING CARE: Elevate legs, avoid crossing legs or restrictive clothing, compression stockings (apply in morning when swelling is reduced).
79 - Varicose Veins
+ Risk factors
+ Symptoms
+ Therapeutic procedures
VARICOSE VEIN RISK FACTORS: Female, jobs that required prolonged standing, pregnancy, obesity, family history.
SYMPTOMS: Distended/tortuous veins just below the skin surface, aching, pruritus.
THERAPEUTIC PROCEDURES: Sclerotherapy (chemical solution is injected into varicose vein to close off the vein), vein-stripping, laser treatment, radio frequency.
80 - Hypertension
+ Primary vs. secondary hypertension
+ Risk factors (primary and secondary hypertension)
+ Symptoms
PRIMARY HYPERTENSION: No known cause.
SECONDARY HYPERTENSION: Caused by disease or medications.
RISK FACTORS:
+ Primary: family history, excess sodium intake, inactivity, obesity, smoking, stress, hyperlipidemia, race (African American).
+ Secondary: Kidney disease, Cushing’s syndrome, pheochromocytoma
SYMPTOMS: Headache, dizziness, visual issues; OR patients may not have ANY symptoms.
81 - Hypertension \+ BP levels for: Pre-hypertension, Stage I, Stage II, Hypertensive crisis \+ Medications \+ Patient Teaching \+ Complications
BP LEVELS:
+ Prehypertension: SBP 120-139; DBP 80-89
+ Stage I: SBP 140-159; DBP 90-99
+ Stage II: SBP >=160; DBP >= 100
+ Hypertensive Crisis: SBP > 240; DBP >120
MEDS: Diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists, aldosterone receptor antagonists, beta blockers.
PATIENT TEACHING: Take BP regularly, limit alcohol intake, DASH diet (HIGH in fruits, veggies, low-fat dairy; LOW in salt and fat), reduce weight, reduce stress, stop smoking.
COMPLICATIONS: Hypertensive crisis (symptoms: severe headache, blurred vision).
