CARDIOVASCULAR SYSTEM Flashcards

1
Q
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?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

59 - IV complications

+ Symptoms and Nursing care for: Phlebitis, Infiltration, Air Embolism

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

60 - Dysrhythmias
+ Medications and electrical interventions for: Bradycardia, AFIB, SVT, Ventricular tachycardia with/without pulse, Ventricular fibrillation

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

67 - Myocardial Infarction (MI)

+ Risk factors, Signs & Symptoms, Labs, EKG Changs, Medications, Complications

A

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).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

66 - Angina
+ Three kinds of angina
+ Angina vs. Myocardial Infarction (MI)

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
68 - Heart Failure
\+ What is it?
\+ Left vs. Right Sided HF
\+ Labs
\+ Diagnosis
A

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%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

69 - Heart Failure
+ Nursing Care
+ Meds

A
NURSING CARE FOR HF:  
\+ Monitor daily weight, I&amp;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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

74 - Peripheral Arterial Disease (PAD)
+ What is it?
+ Risk factors
+ Symptoms

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
75 - Peripheral Arterial Disease (PAD)
\+ Patient Teaching
\+ Medications
\+ Surgeries
\+ Complications
A

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.).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

76 - Peripheral Venous Disorder
+ What is it?
+ Three kinds

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
77 - Venous Thromboembolism
\+ Risk factors
\+ Symptoms
\+ Diagnosis
\+ Nursing Care
\+ Meds
A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

78 - Venous Insufficiency
+ Risk factors
+ Symptoms
+ Nursing care

A

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).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

79 - Varicose Veins
+ Risk factors
+ Symptoms
+ Therapeutic procedures

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

80 - Hypertension
+ Primary vs. secondary hypertension
+ Risk factors (primary and secondary hypertension)
+ Symptoms

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
81 - Hypertension
\+ BP levels for:  Pre-hypertension, Stage I, Stage II, Hypertensive crisis
\+ Medications
\+ Patient Teaching
\+ Complications
A

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).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

83 - Hemodynamic Shock

Symptoms, Labs, Nursing care, Medications, Complications

A

SYMPTOMS: Hypoxia, tachypnea, hypotension, tachycardia, weak pulses, decreased urine output; wheezing, angioedema, rash with anaphylactic shock.

LABS: Increased serum lactic acid, abnormal ABGs, increased cardiac enzymes w/cardiogenic shock, decreased Hct/Hgb w/hypovolemic shock, positive blood culture with septic shock.

NURSING CARE: Administer O2, prepare for intubation, place patient flat w/legs elevated for hypotension.

MEDS: Dobutamine, vasopressin, epinephrine, colloids for hypovolemic shock (REPLACE VOLUME FIRST), antibiotics for septic shock.

COMPLICATIONS: MODS, DIC

17
Q

82 - Type of Hemodynamic Shock

Cardiogenic, Hypovolemic, Obstructive, Distributive (Septic, Neurogenic, Anaphylactic)

A

CARDIOGENIC: Cardiac pump failure due to heart failure, MI, dysrhythmias.

HYPOVOLEMIC: Blood loss due to trauma, surgery, burns or fluid loss due to GI losses, diuresis.

OBSTRUCTIVE: Blockage of great vessels (ex: PE, tension pneumothorax, cardiac tamponade).

DISTRIBUTIVE: Extreme vasodilation. Thress kinds:
+ SEPTIC: Endotoxins in blood stream from infection (most commonly gram negative bacteria)
+ NEUROGENIC: Loss of sympathetic tone due to trauma or spinal shock.
+ ANAPHYLACTIC: Antigen-antibody reaction due to exposure to allergens.

18
Q

54 - Cardiac Enzymes

+ Expected ranges, duration of elevated levels

A

CARIDAC ENZYMES: Released in bloodstream in response to ischemia in heart muscle. TROPONIN IS MOST SPECIFIC!
+ CK-MB: More specific to heart than CK. Should be 0%. Elevated for 2-3 days.

+ TROPONIN T: Should be less than 0.1 ng/L. Elevated for 10-14 days.

+TROPONING I: Should be less than 0.03ng/L. Elevated for 7-10 days.

+ MYOGLOBIN: Can be elevated due to heart damage OR skeletal muscle damage. Should be <90 mcg/L, Elevaged for 24 hours.

19
Q

55 - Cholesterol Levels
+ Different kinds, Expected ranges

Hemodynamic Monitoring
+ Expected ranges for: CVP, PAWP, CO
+ Nursing care during arterial line insertion

A

CHOLESTEROL LEVELS:
+ Total Cholesterol: < 200 mg/dL
+ HDL (H) = “Happy”): >55 mg/dL (women), >45 mg/dL (men)
+ LDL (L = “Lousy”): <130 mg/dL
+ Triglycerides: Between 35-135 mg/dL (women), between 40-160 mg/dL (men)

HEMODYNAMIC MONITORING:
+ CVP (Central Venous Pressure): 2-6 mmHg
+ PAWP (Pulmonary Artery Wedge Pressure): 6-15 mmHg
+ CO (Cardiac Output): 3-6 L/min

NURSING CARE DURING ARTERIAL LINE INSERTION: LEVEL TRANSDUCER WITH PHLEBOSTATIC AXIS (4TH INTERCOSTAL SPACE, MID-AXILLARY LINE), zero system, confirm placement w/x-ray.

20
Q

56 - Coronary Angiogram
+ What is it?
+ Pre-procedure and post-procedure nursing care

A
CORONARY ANGIOGRAM (I.E. CARDIAC CATH):  Invasive procedure used to determine if patient has coronary artery blockages or narrowing.  Catheter inserted into femoral artery and threaded up to heart.
\+ PRE-PROCEDURE:  NPO 8 hours prior to procedure.  Assess for allergy to iodine or shellfish.  Assess kidney function (BUN, creatinine) to determine if kidneys can excrete the dye.
\+ POST-PROCEDURE:  Check insertion site for bleeding, check extremity distal to puncture site (pulses, capillary refill, temperature, colors).  Take VS every 15 minutes x 4, every 30 minutes x 2, every hour x 4.  Patient lies flat in bed for 4-6 hours after procedure.
21
Q

57 - Cardiac Tamponade
+ What is it?
+ S/S, Diagnosis, Treatment

A

CARDIAC TAMPONADE: Accumulation of fluid in pericardial sac.

S/S: Hypotension, MUFFLED HEART SOUNDS, distended jugular veins, PARADOXICAL PULSE (variance of 10 mmHg or more in SBP between inspiration and expiration).

DIAGNOSIS: Chest x-ray, echocardiogram

TREATMENT: Pericardiocentesis (removal of fluid form pericardial sac).