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Clients with Health Challenges - N3600 > CV - things in red > Flashcards

CV - things in red Flashcards

1
Q

Conduction system: the ____ node is the _________ of the heart, which conducts to the ____ node, through the bundle of his, to the lt and rt bundles branches, diffuses through the ventricle walls via the Purkinje fibers; takes all of _____.

A

SA - sinoatrial - pacemaker
AV - atrioventricular node
0.12 seconds

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2
Q

HTN:
- systolic BP ?
- DBP?
How many measurements?

A

systolic 140 or higher
diastolic 90 or higher
either or for HTN
Need more than one measurement

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3
Q

Dietary HTN management?

A

DASH - dietary approaches to stop HTN - low fat dairy and lots of fruits and veggies - recommended to combine with low sodium too

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4
Q

Effects of aging on the heart:

  • Amount of _____ in the heart increases and the amount of ______ decreases
  • Decreased ______ and heart rate
  • cardiac valves become _____ and _____ due to _____ accumulation, valve incompetence or stenosis = _____
  • number of pacemaker cells in the ___ node decreases causing?
  • decreased ________ NS control of CV system
  • Arterial blood vessels thicken and become less elastic causing an increase in _____.
A

collagen ↑; elastin ↓
contractility ↓
thicker, stiffer - lipid accumulation
valve incompetence and stenosis = murmur
SA pacemakers ↓ –> bradycardia, heart block
↓sympathetic input
↑BP - arterial walls thicken and become less elastic

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5
Q

Congenital heart defects:

Survival rate - ___% of infants born with complex heart defects reached adulthood

A

90%

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6
Q

Pericarditis - Dx

- Symptoms - most important one?

A

Pain decreases when patient leans forward

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7
Q

Women and CAD:

  • Heart disease kills more Canadian women than all forms of _____ combined
  • It is the #__ cause of death in women over ___
  • _____ deaths in women than men
  • Women manifest CAD __ years later than men due to the cardioprotective effects of natural ______, which are lost after ______
  • higher mortality and complications with CABG surgery, because they have ______ arteries, are ______, and are referred ______
  • These three things are powerful predictors of CAD in wome
A 
cancer
1, >55
more
10, estrogen, menopause
smaller, older, later
diabetes, smoking, decreased estrogen levels
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8
Q

Risk factors for CAD

  • Modifiable:
    • Smoking -?
    • Blood pressure?
    • Cholesterol?

Non-modifiable
- what are the three?

A

smoking 1+ packs a day
BP - >160
cholesterol - >240

non-modifiable

  • family Hx of heart disease
  • Age
  • Gender (men > women til age 60)
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9
Q

Angina pectoris

Stable angina - no permanent damage is done to the heart muscle. Predictable and typically relieved with ______

A

rest

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10
Q

Medications for angina pectoris:

Anticoagulants/Antiplatelet - prevent platelet aggregation - benefit is what?

A

Improves blood flow

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11
Q

Acute coronary syndrome (MI)

- Severe, _______ chest pain not relieved by rest or nitrates

A

immobilizing

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12
Q

MI Assessment

  • GI - ?
  • Integument?
  • Neuro?
  • Psychological
A

GI - will VOMIT and be NAUSEOUS - if there is food, they will vomit

Integumentary - pale, cool, clammy, DIAPHORETIC - sweating buckets

Neuro - ANXIOUS

Psychogolical - FEELING OF IMPENDING DOOM

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13
Q

Diagnostic studies - non-invasive
- Albumin cobalt - binding test
Blood studies (name):
- cardiospecific enzyme >3-5% indicates MI
- Contractile proteins released following MI
- cholsterol, TGs, lipoproteins

A

Cobalt binds to damaged tissue and confirms location of infarct

CK-MB
Troponin T and I (i)
Serum lipids

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14
Q

MI treatment acronym?

A 
MONA
M - morphine for pain
O - oxygen per nasal cannula 2-4L/min
N - nitrates
A - aspirin
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15
Q

MI treatment - real important one?

A

Cardiac catheterization

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16
Q

What is required after cardiac catheterization?

A

Pressure dressing

Bed rest post-procedure

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17
Q

What effect on a client and their family’s QOL would symptoms of CHF have?

A

Very high level of stress for the patient and family

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18
Q

Interprofessional treatment for CHF:

  • Acute:
  • -Drugs - number one drug for heart failure patients?

Chronic:
- Diet??

A

Digitalis - Digoxin

Sodium restricted diet

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19
Q

A cardiac glycoside, slows and strengthens the heart

A

Digoxin

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20
Q

When is digoxin held?

A

If pulse < 50

21
Q

What are signs and symptoms of digitalis toxicity?

A

Bradycardia/tachycardia, pulse deficit, dysrhythmias

NV, diarrhea and abdominal pain

22
Q

What is a cardinal sign of pulmonary edema?

A

Pink, frothy sputum

23
Q

Life-threatening arrythmia, Dx when there is a run of 3 or more PVCs. Decreased CO and can carry on the this.

A

Vtac –> Vfib

24
Q

Treatment of VTAC?

A

Drug therapy (e.g. IV lidocaine), CARDIOVERSION

25
Q

VFIb treatment?

A

CARDIOVERSION, CPR, drug therapy (IV epi)

26
Q

Describe whether left or right sided heart failure:

A:

  • SOBOE
  • Orthopnea
  • Dry congested cough
  • Bibasilar crackles
  • Oligouria

B:

  • JVD
  • Edema (dependent)
  • Hepatomegaly
  • Ascites
  • Anorexia
A

A - left

B - right

27
Q

A client with heart failure is concerned about decreased urinary output. What would you tell the client regarding the cause of their decreased output?

A - You are dying so your body is shutting down.
B - Your chest pain caused a negative feedback loop to your bladder to tell it to stop producing urine.
C - Decreased cardiac output which results in decreased urinary output.
D - I’m sure if you tried hard enough you could have a better urine output.

A

C

28
Q

Frothy blood-tinged sputum would indicate which of the following?

A - Spinal cord trauma
B - Fat embolism
C - Right sided heart failure
D - Left sided heart failure

A

D - specifically pulmonary edema

29
Q

Progressive narrowing and degeneration of the arteries of neck, abdomen or extremities.

A

PAD

30
Q

What is the major cause of PAD?

A

Atherosclerosis

31
Q

PAD:

  • __ years of age or older; earlier age with ____
  • Clinical manifestations occur when there is between __-___% vessel occlusion
A

50+; DM

60-75%

32
Q

Risk factors for PAD:

  • Non-modifiable?
  • Modifiable?
A

non-mod - age, gender, genetics

Modifiable - smoking (nicotine), HTN, diet, obesity, sedentary lifestyle, stress, DM

33
Q

Arterial leg ulcer characteristics:

  • Painful - _______ _______
  • ABPI?
A

intermittent claudication

ABPI < 0.8 - if <0.4 - critical ischemia

34
Q

How is ABPI calculated?

A

Ankle systolic / greatest systolic pressure in arm

35
Q

Aneurysms:

  • Outpouchings or _____ of the blood vessel wall
  • ______ most common vessel
  • usually caused by ______ and ______
  • AAA major risk factors are ____, age over ___, and _____ use
  • classified as _____ or ______
  • Sign - pulsating swelling that produces a blowing ____ on auscultation (______)
A 
dilations
aorta
HTN, atherosclerosis
males, 65+, tobacco
true, false
murmur (bruit)
36
Q

Where is an AAA located?

What is the treatment?

A

Location: below the kidneys, above femoral artery bifurcation
Surgeon puts pt on heart-lung machine and completes a bifurcation graft

37
Q

Buerger’s disease:

  • Rare, non-atherosclerotic, segmental ________ disorder
  • Cause?
A

inflammatory

TOBACCO SMOKE

38
Q

Episodic vasospastic disorder of small cutaneous arteries.

A

Raynaud’s phenomenon

39
Q

Raynaud;s phenomenon

  • cause?
  • Primarily affects this demographic
  • Association with ______ diseases (e.g. RA, SLE)
  • Colour change of fingers and toes, ears, nose to this
  • Attacks brought on by _____ or ______ stimuli
A 
cause unknown
women 15-40 yrs
collagen
white, blue, red
cold, emotional
40
Q

What is the treatment for Raynaud’s phenomenon?

A

Loose, WARM clothing, no nicotine, caffeine or vasoconstrictive drugs
Calcium channel blockers

41
Q

What is the recipe for disaster for developing DVT called?

A

Virchow’s triad:

  • Venous stasis
  • Damaged endothelium of vein
  • Hypercoagulability of blood
42
Q

DVT:

- Women at greater risk due to this?

A

If on estrogen, smoke and over 35 y.o.

43
Q

Describe varicose veins

A

Valves become dysfunctional in the perforating vein - get backflow and tortuous, extended veins

44
Q

Venous insufficiency pathology:

  • _________ which blocks outflow. DVT
  • _______ incompetence, permitting retrograde backflow
  • _______ muscle pump failure, which results in incomplete emptying
A

obstruction
valvulvar
calf

45
Q

Differentiate venous vs. arterial ulcers:

A

Arterial:

  • painful, mostly toes and malleolus
  • skin shiny, taut, lack of hair
  • cold
  • ABPI < 0.8
  • punched out

Venous:

  • normal ABPI
  • often painless
  • large, irregular shape, often in gaiter area (above ankle, below knee)
  • inverted champagne bottle (lipodermatosclerosis)
  • buckets of exudate
46
Q

Most important thing for management of venous ulcers?

A

COMPRESSION

  • cornerstone of prevention
  • NEVER use without doing ABPI first
47
Q

Compression bandaging precautions

- always document this?

A

PATIENT TEACHING PROVIDED TO PT AND FAMILY

48
Q

Support/Compression stockings:

  • For ________
  • ordered once ______ is controlled
  • mild to high compression
  • prescribed by?
  • replaced at this frequency
  • removed at _____ and reapplied in the _____
A 
prevention
edema
MD, NP, ET, WCS
q3-6 months
bedtime, morning

Clients with Health Challenges - N3600 (22 decks)

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