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Complex 1 > Complex Test 2: Perfusion > Flashcards

Complex Test 2: Perfusion Flashcards

1
Q

CAD modifiable risk factors

A

smoking, sedentary lifestyle, atherogenic diet, oral contraceptives (women), hormone replacement therapy (women only), obesity, HTN, stress, anxiety, high cholesterol, hyperlipidemia, diabetes mellitus,

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2
Q

CAD non-modifiable risk factors

A

genetics, race, age (men at or older than 45 and women at or greater than 55), sex

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3
Q

CAD Assessment

A

fatigue, dyspnea, chest pain radiating to shoulder and jaw for men, back pain and N/V more common in women, angina

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4
Q

What usually causes CAD?

A

accumulation of atherosclerotic plaques in the coronary artery is the usual cause

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5
Q

CAD Patient Education

A
  • take sublingual nitro if chest pain occurs, can take up to 3 doses 5 minutes apart. make sure to stay seated b/c orthostatic hypotension
  • nutrition: low fat, low cholesterol, high fiber, low calorie diet, Eat lean meats, no red meats, brown rice.
  • exercise
  • remove fat from meat, steamed veggies
  • decrease alcohol intake, moderation; 2 drinks for men and one for women
  • decrease saturated fat
  • surgery
  • angioplasty with contrast and Coronary artery bypass grafting (CABG)
  • smoking cessation
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6
Q

CAD labs and diagnostics:

A
  • History and physical to see what other diseases they may have
  • Probably has hyperlipidemia so cholesterol levels are going to be high. Normal levels: HDL greater than 60, LDL less than 100, Cholesterol less than 200
  • Cardiac catherization: need to know if PT has allergy to iodine or shellfish b/c dye. If they are, give diphenhydramine before
  • echocardiography stress test
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7
Q

CAD Treatment/Nursing Interventions:

A
  • monitor kidneys after cardiac catherization for excretion of dye
  • Statins (#1 for cholesterol): atorvostatin, take at night; rhabdomyalysis, muscle cramps/weakness, monitor liver function
  • nitrates: vasodilators, so orthostatic hypotension, headache is common side effect. Nitrate patches long term
  • monitor HR and BP with beta blockers
  • calcium channel blockers
  • antiplatelets for stent placement
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8
Q

CAD Complications

A

Chest pain (angina), MI, HF, abnormal heart rhythm (arrhythmia)

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9
Q

Angina general/normal S/S

A
  • crushing, severe, pressure, heaviness, squeezing feeling

- dyspnea, pallor, tachycardia, anxiety, and fear

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10
Q

Angina Types: Stable

A
  • relieved when you lay down
  • brought on by activity, exposure to cold, or stress
  • sit down!!! especially if taking a nitro for relief
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11
Q

Angina Types: Unstable

A
  • At risk for Acute MI
  • increasing frequency, severity, and duration; pain is unpredictable, occurs with decreasing levels of activity or stress, and may occur at rest
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12
Q

Angina Types: Variant

A
  • may occur at night or any other time- may not even have a blockage
  • spasmic
  • may result from hyperactive sns responses, altered calcium flow, or reduced prostaglandins
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13
Q

Angina S/S women

A

present w/atypical symptoms such as indigestion, N/V, fatigue, and upper back pain

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14
Q

DVT risk factors

A
  • Virchows triad- for VTE. 1) venous stasis, 2) endothelial damage, 3) hyper coagulability of blood
  • inheriting a blood clotting disorder
  • immobility
  • injury or surgery; hip surgery, total knee replacement, open prostate surgery
  • pregnancy
  • obesity
  • smoking
  • HF
  • active cancer
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15
Q

DVT assessment:

A
  • can be asymptomatic
  • calf or groin pain, tenderness, sudden onset edema
  • warmth, edema, induration, hardness
  • increased circumference of right and left calf/thigh over time
  • SOB/chest pain indicate embolus moved to lungs (can indicate a PE)
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16
Q

DVT Patient Education

A
  • bed rest
  • elevate extremity higher than heart level
  • warm moist compress (NOT UNDER HEEL)
  • do NOT massage limb
  • thigh high compression or anti-embolism stockings
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17
Q

DVT Pharm Interventions: anticoags

A

Anticoagulants: Unfractioned Heparin, low-molecular weight heparin, Warfarin

Low Molecular weight Heparin: give SQ and is based on PT weight. Take heparin in hospital and start warfarin a few days prior to DC and PT will go home on Warfarin.

Warfarin: therapeutic effect takes 3-4 days to develop, so administration of med while the PT still on heparin.

  • Monitor PT and INR.
  • ensure Vitamin K (antidote for warfarin) is available in case of excessive bleeding
  • instruct PT about food sources of vitamin K (green leafy veggies) and to avoid fluctuations in the amount and frequency of consumption
  • Get to therapeutic level
18
Q

DVT Pharm Interventions: thrombolytic therapy

A
  • dissolves clots that have already developed
  • to be effective, therapy must be started within 5 days after the development of the clot
  • Abciximab and eptifibatide can be effective in dissolving a clot or preventing new clots during the first 24 hours.
  • monitor for bleeding
  • PT should be instructed about bleeding precautions that should be taken (use electric instead of bladed razor and brush teeth with a soft toothbrush)
19
Q

DVT Treatment/Nursing Intervention

A
  • unfractioned Heparin: monitor PTT, antidote is protamine sulfate
  • low molecular weight Heparin (enoxaparin)
  • Warfarin: monitor PT/INR, vitamin K antidote, takes 3-5 days to develop therapeutic effect
20
Q

DVT Complications S/S

A
  • Ulcer formation: form over medial malleolus
  • PE: sudden onset dyspnea, chest pain, restless, apprehension, cough, feel impending doom**, hemoptysis (throw up blood), increased HR, crackles, increased RR, diaphoresis, decreased O2 saturation
21
Q

Left Sided Heart Failure Risk Factors

A
  • HTN
  • Coronary artery disease, angina, MI
  • Valvular Disease (mitral and aortic)
22
Q

Left sided heart failure expected findings

A
  • dyspnea, orthopnea (SOB while lying down), nocturnal dyspnea
  • fatigue
  • displaced apical pulse (hypertrophy)
  • S3 heart sound (gallop)
  • pulmonary congestion (dyspnea, cough, bibasilar crackles)
  • frothy sputum (can be blood-tinged)
  • AMS
  • manifestations of organ failure, such as oliguria (decreased urine output)
  • MORE FLUID IN LUNGS
23
Q

Right sided HF

A
  • left sided heart (ventricular) failure
  • right ventricular MI
  • pulmonary problems (COPD, pulmonary fibrosis)
24
Q

Right Sided HF Expected Findings

A
  • JVD
  • ascending dependent edema (legs, ankles, sacrum)
  • abdominal distention, ascites
  • fatigue, weakness
  • nausea and anorexia
  • polyuria at rest (nocturnal)
  • liver enlargement (hepatomegaly)and tenderness
  • weight gain
  • MORE FLUID IN BODY
25
Q

HF lab tests

A

Human B-type natriuretic peptides (hBNP): clients who have dyspnea, elevated hBNP confirms a diagnosis of heart failure rather than a problem originating in the respiratory system

  • Less than 100 pg/mL indicates NO HF
  • 100 to 300 pg/mL suggests HF is present
  • Greater than 300 pg/mL indicates MILD HF
  • Greater than 600 pg/mL indicates MODERATE HF
  • Greater than 900 pg/mL indicates SEVERE HF
26
Q

HF Medications: Diuretics

A

Diuretics: Loop diuretics (furosemide and bumetanide), thiazide diuretics (hydrochlorothiazide), potassium-sparing diuretics (spironolactone)
-Teach PT taking loop or thiazide diuretics to ingest foods and drinks that are high in K+ to counter the effects hypokalemia

27
Q

HF Meds: after load reducing agents

A

Afterload-reducing agents: help the heart pump more easily by altering the resistance to contraction

  • Angiotensin converting enzyme (ACE) inhibitors: enalapril and captopril
  • Angiotensin receptor II blockers: losartan
  • Calcium channel blockers: ditalizem and nifedipine
  • Phosphodiesterase-3 inhibitors: milrinone
28
Q

HF Meds: Inotropic agents

A
  • such as digoxin, dopamine, dobutamine, and milrinone are used to increase contractility and thereby improve cardiac output
  • Digoxin- take the apical heart rate for 1 minute and hold med if apical pulse is less than 60/min and notify provider. Take digoxin at the same time each day. Do not take digoxin at the same time as antacids, separate the two medications by at least 2 hours.
29
Q

HF Meds: beta blockers

A
  • Carvedilol and metoprolol
  • Monitor BP, HR
  • check orthostatic blood pressure readings
  • do not give if HR less than 60
30
Q

HF Meds: Vasodilators

A

Nitroglycerin and isosorbide mononitrate

  • given to treat angina and help control Bp
  • can cause orthostatic hypotension
  • headache is a common side effect of this medication
31
Q

HF Meds: Anticoags

A

warfarin, monitor bleeding times: PT, aPTT, INR, and CBC

-contraindications: active bleeding, PUD, history of cerebrovascular accident and recent trauma

32
Q

HF Med categories general

A

-diuretics, afterload-reducing agents, inotropic agents, beta blockers, vasodilators, anticoagulants

33
Q

HF Nutrition

A

small frequent meals, promote low sodium, and low saturated fat food choices

34
Q

HF Nursing Care

A
  • monitor daily weights, and I&O’s
  • assess for SOB and dyspnea on exertion
  • administer oxygen as prescribed
  • Position PT in high fowler’s to maximize ventilation
  • assess for S/S med toxicity (esp. digoxin)
  • encourage energy conservation by assisting with care and ADLs
  • maintain dietary restrictions as prescribed (restricted fluid intake, restricted sodium intake)
35
Q

HF Diagnostic Procedures

A

Transesophageal echocardiography (TEE)

36
Q

HF Complicatoins

A

acute PE, cariogenic shock, pericardial tamponade

37
Q

HF Health Promotion and Disease Prevention

A
  • maintain an exercise routine to remain physically active, and consult with the provider before starting any exercise regimen
  • consume a diet low in sodium, along with fluid restrictions, and consult with the provider regarding diet specifications
  • refrain from smoking
  • follow medication regimen, and follow up with the provider as needed
38
Q

HTN Health Promotion and disease prevention

A
  • maintain BMI of less than 30
  • PT with diabetes mellitus should keep blood glucose within a recommended reference range
  • use stress management technique during times of stress
  • limit caffeine and alcohol intake
  • NO SMOKING. Nicotine patches or engaging in a smoking cessation class are potential strategies
  • engage in exercise that provides aerobic benefits least 3 times a week
  • limit sodium and fat intake
39
Q

HTN Risk Factors: Essential HTN

A
  • positive family history
  • excessive sodium intake
  • sedentary lifestyle
  • obesity
  • high alcohol consumption
  • African American
  • Smoking
  • Hyperlipidemia
  • stress
  • age greater than 60 or postmenopausal
40
Q

HTN Risk Factors: Secondary HTN

A
  • kidney disease
  • cushing’s disease (excessive glucocorticoid secretion)
  • primary aldosteronism (causes HTN and hypokalemia)
  • Pheochormocytoma (excessive catecholamine release)
  • brain tumors, encephalitis
  • Medications such as estrogen, steroids, and sympathomimetics
  • pregnancy
41
Q

HTN expected findings

A
  • headaches, particularly in the AM
  • facial flushing
  • dizziness
  • fainting
  • retinal changes, visual disturbances (pupils smaller)
  • nocturia
42
Q

Levels of HTN

A

Prehypertension: systolic 120 to 139 mm Hg; 80 to 89 mm Hg
Stage I hypertension: systolic 140 to 159 mm Hg; diastolic 90 to 99 mm Hg
Stage II HTN: systolic greater than or equal to 160 mm Hg; diastolic greater than or equal to 100 mm Hg

Complex 1 (3 decks)

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