CVPV/Anemia/Blood products Flashcards
the amount of blood pumped in 1 minute
-the lower, the poorer the perfusion to organs and other extremities
cardiac output
the force opposing movement of blood within the vessels
-as arteries narrow, resistance to blood flow increases
systemic vascular resistance
the force exerted by the blood against the walls for the vessel
blood pressure
what’s the consideration systolic and diastolic of hypertension?
140/90
what are the risk factors of hypertension?
age
inactive lifestyle
high lipids
what causes hypertension?
fluid overload
vasoconstricting (narrowing)
not related to another disease or condition
primary hypertension
what are the risk factors for primary hypertension?
age
inactivity
high lipids
what is secondary hypertension
a result of other disorder or condition, once condition is treated the hypertension can be fixed
what are the risk factors of secondary hypertension?
cardiovascular disorders
renal disorders
endocrine system disorders
pregnancy
medications
sleep apena**
thyroid disorder
what is suspected on people who suddenly develop hypertension?
primary hypertension
how does hypertension affect the vessels?
hypertrophy
hyperplasia
cells that get larger/working harder
hypertrophy
damage in cells and the cells start to replicate, inflammatory response
hyperplasia
early stages of disease have no clinical manifestation other than elevated blood pressure reading
silent killer
what are the signs and symptoms of early hypertension?
asymptomatic
what are the signs and symptoms of hypertension later in life?
headaches
visual disturbances
chest pain
dyspnea
dizziness
fatigue
sustained hypertension that has effects beyond hemodynamics
complicated hypertension
what are the two major mechanisms of tissue damage with complicated hypertension?
ischemia
edema
not enough oxygen going where it needs to be
ischemia
fluid buildup in the tissue
edema
what age does accumulation start happening for hypertension?
20s-30s
what age does atherosclerosis begin with complicated hypertension?
30s-40s
at what are is their irreversabile damage because of hypertension?
40s
what are nonmodifiable
age
race
genetics
gender
what are modifiable
smoking
drinking
sedentary lifestyle
poor diet habit
which organs does complicated hypertension affect?
heart
kidneys
brain
eyes
what are the evaluations for hypertension?
history
sedentary lifestyle
neuro
pulses
lung sounds (crackles=heart failure)
what is the most accurate to check for hypertension?
auscultation
sit quietly at least 5 minutes
arm at heart level
appropriate size cuff
what is the treatment goal for patients with hypertension?
to have bp of 130/80
what is are the recommendations for people with hypertension?
DASH Diet
exercise
moderate alcohol consumption
what is the DASH diet?
low in dietary sodium
saturated fats
dairy, total fats, carbs
red meats, and sweets
rich in fiber and potassium
includes veggies, fruits
increase in full grains products, fish, poultry, nuts
what are the medications you can take for hypertension?
adrenergic blockers
ace inhibitors
angiotensin receptor blockers
beta blockers
calcium channel blockers
diuretics
inhibit vasoconstriction
adrenergic blockers
-clonidine
-methyldopa
prevent peripheral vasoconstriction
ace inhibitors (-pril)
-benazepril
-captopril
-enalapril
-liniopril
prevent peripheral vasoconstriction as well as ace inhibitors
angiotensin receptor blockers (-sartans)
-losartan
-valsartan
decrease cardiac output, hr, bp, and cardiac workload
beta blockers (-olol)
-atenolol
-metoprolol
-carveidolol
-propanolol
who should be monitored if taking beta blockers
asthma patients
diabetic patients
increase blood flow to the extremities; good for vasospasm?
calcium channel blockers
-amlodipine
-diltiazem
-verapamil
increase blood flow to the extremities; good for vasospasm as well as calcium channel blockers?
alpha adrenergic blockers (-zosin)
-doxazosin
-prazosin
-terazosin
promote Na+ and H2O excretion, K+ retension
spironolactone
inhibit Na and CL reabsorption from the loop of henele
will be on K+ supplements
furosemide/bumetanide
increase Na+ and H2O excretion by inhibiting sodium reabsorption (specifically for hypertension)
thiazides
-chlorothiazide
-metolazone
-hydrochlorothiazide
what is the hypertension nursing care?
daily weights
i&o
urine output
response of bp
electrolytes
take pulses
ischemic episodes
complications of 4C’s
-CAD
-CRF
-CVA
-CHF
drop of 20mmHg or greater systolic or 10mmHg or greater diastolic
-decrease in both systolic and diastolic BP upon standing
orthostatic hypotension
what can cause acute hypotension?
-altered electrolytes
-drug action
-prolonged immobility
-starvation
-physical exhaustion
-volume depletion
-venous pooling (sat for to long)
-postprandial**
what can cause chronic hypotension?
-secondary to specific disease
-endocrine
-metabolic disorders
-CNS
-PNS
what is idiopathic hypotension?
-no known cause
what is the diagnostic for orthostatic hypotension?
lying/sitting/standing
tilt table test
what is the nursing priority for orthostatic hypotension?
safety
-fall risk
what are the treatments for orthostatic hypotension?
-adjust meds
-give volume
-replace electrolytes
-assist with frequent repositioning
vasoconstriction leads to increased blood pressure readings? true or false
true
accumulation of lipid, or fatty substances in vessel walls
-inflammation process
-ischemia
-platelets
atherosclerosis
where is atherosclerosis most common?
coronary arteries
what are the non-modifiable risk factors of CAD?
-age
-gender
-family hx
-ethnicity
what are the modifiable risk factors of CAD?
-high cholesterol
-smoking
-hypertension
-hyperglycemia
-obesity
-physical activity
-stress
which cholesterol do pts want high?
HDL
decrease supply of blood flow/oxygen, increased demand for flow/oxygen
myocardial ischemia
what can myocardial ischemia cause?
atherosclerosis
thrombus formation
vasoconstriction
within 10 seconds you will start having what?
ischemia
how long are cardiac cells viable?
20 minutes
chest pain caused by myocardial ischemia
-insufficient coronary blood flow results in decrease oxygen supply to meet the myocardial demand for O2
angina pectoris
what factors can cause anginal pain
-physical exertion
-exposure to cold
-eating a heavy meal
-stress or emotional situation
predictable pain on exertion
-stops after 3-5 minutes after doing activites
stable
unpredictable (variant or vasospatic)
caused by vasospasm
prinzmetal
what medication can help with prinzmetal?
calcium channel blockers
EKG changes but no reported symptoms
silent ischemia
occurs at rest or during minimal activity; increasing severity or frequency
unstable (preinfarction)
what are will women complain of with angina?
fatigue
what do elderly pts complain of with angina?
SOB
what are some preventions for angina?
-dash diet
-exercise
-med
-tabacco cessation
-managing htn
-controlling dm
-managing stress
how to evaluate of chest pain?
-physical assessment (ausculation)
-EKG
-lab
-stress test
-echo
-coronary angiography
what are the signs and symptoms of angina?
-indigestion
-chocking or heavy pressure in sternum
-radiate to neck, jaw, shoulders, arms, usually left arm
-weakness or numbness in arms, wrists, and hands
-sob, pallor, diaphoresis
-dizziness, N/V
What EKG assessment is ischemia?
ST depression
Which EKG assessment is injury/MI?
ST elevation
How many minutes have to pass to have injury/MI and you will have permanent damage to the heart?
21 minutes
Which lab shows cardiac injury?
troponin
Around which amount do we want HDLs?
> 40-50
what do LDLs do?
transport cholesterol into the cell
what do HDLs do?
cholesterol goes into the liver and out of the body
what are the medications for cholesterol?
lipid lowering agents
(-statins) Atravastatin
B-vitamin increase HDLs
niacin
lower cholesterol synthesis; watch liver enzymes
fibrates(gemfibrozil)
what should you monitor when taking statins?
liver function test
when should monitor liver enzymes?
every 6 weeks then every 6 months
how do they perform the stress test?
exercise/dye/MRI
how do they perform echo?
they evaluate wall motion, valve function, blood flow
how to they perform angiography?
contrast/coronary vessels/occlusion
what is the primary aim in therapy for myocardial ischemia and angina in reducing myocardial oxygen consumption?
decrease bp
decrease hr
assist contractility
decrease left ventricular volume
what are the nursing intervention in chest pain?
-oxygen
-pain assessment (position, quality, radiation/relief) severity, timing
-vital signs
-monitor respiratory status
-12 lead EKG
-nitroglycerin
what medication helps decrease preload and in higher doses decrease the afterload, they also reduce myocardial O2 consumption and decreases ischemia and relieves pain
nitroglycerin
what medication should not being taken within 4 hours of erectile dysfunction med?
nitroglycerin
how should nitroglycerin be stored?
brown/glass vile protected from the sun
how do you know if nitroglycerin is expired?
it doesn’t sting/burn
how do you take nitroglycerin?
sublingual
how many times can you take nitroglycerin if pain is persitant?
3 tabs and 5 minute intervals
what are the side effects of nitroglycerin?
headache**
flushing
decrease bp
tachycardia
reduce myocardial O2 consumption blocking beta-adrenergic sympathetic stimulation
-reduces HR
-reduces bp
-reduces contractility
beta blockers
what can beta blockers cause in people with asthma?
bronchospasms
what can beta blockers cause in people with diabetes?
masks signs of hypoglycemia
can you abruptly stop beta blockers?
no, it’ll cause rebound hypertension
what are nursing interventions when taking beta blockers?
monitor hr
check bp
monitor for bronchospasm
monitor glucose levels
helps slow down the impulse of the SA node, decrease HR, decrease BP, relax the blood vessels
calcium channel blockers
what medication is not recommended to take with grapefuit juice or grapefruit?
calcium channel blocker
what are the side effects of calcium channel blocker?
dizziness, decrease bp
prevents platelet activation
aspirin
platelet aggregate
can be used with aspirin or alone
clopidogrel (plavex)
what should you monitor on patients taking aspirin and clopidogrel (plavex)
increase chance for bleeding
how should you manage angina at home?
-reduce activities that cause chest pain or SOB
-avoid extreme temperatures
-maintain regular bp
-avoid otc meds that can increase bp
-stop smoking
-take prescribed meds
-keep nitroglycerin
abruptly deprived of oxygen, the longer the vessels are occluded the more damage
myocardial infarction
what are the signs and symptoms of a myocardial infarction?
-sudden chest pain
-no to rest or medication
-SOB, dyspnea, tachypnea
-n/v
-decrease urinary output
-cool, clammy, diaphoretic pale skin
-anxiety, restlessness, fear
how much should the urinary output be?
30ml/hr
what is the nursing care for MI?
-bed rest
-stool softner
eduction on
-diet
-caffeine
-smoking cessation
-exercise
-s/s of recurrent MI
mona
morphine-decrease preload, decrease workload
oxygen
nitrates
aspirin
what medication can you take for MI?
ace inhibitors-decrease bp & cardiac workload
beta blockers
what is the goal for pts with MI?
cardiac rehab
return client to work and pre-illness lifestyle
looks for blockages
NPO (8-12hours)
CCCA
cardiac catheterization and coronary angiography
what should patient be asked before going in for a CCCA?
if they’re allergic to dye, shellfish
what medication should be stopped 48 hours before going in for a CCCA?
metformin
what are the nursing interventions for post op on a CCCA?
-assess catheter site for bleeding or hematoma
-check peripheral pulses, color, temp, pain, or numbness
-monitor for dysrhythmias
-bed rest 2-6 hours
-keep affected extremity straight
-HOB no higher than 30º
-encourage fluids to flush out dye
- ensure safety
what are patients at great risk post op of CCCA?
bleeding
opens a blockage w/stent or balloon
stents are medicated antiplatelet medication
PCI/PTCA
reroute the blood flow with bypass
coronary artery bypass
leaflets of the mitral valve billow upward into the atrium
mitral valve prolapse
control the blood flow through the heart
heart valves
what are the signs and symptoms of mitral valve prolapse?
often asymptomatic
palpatations
tachycardia
fatigue
weakness
chest tightness
anxiety
depression
chest pain
what is the diagnostic for mitral valve prolapse?
echocardiogram
what should be avoided when having mitral valve prolapse?
hypovolemia
the valve orifice is constricted or narrowed, blood can’t flow through efficiently, pressure in chamber builds up and can lead to hypertrophy
stenosis
valves don’t completely shut all the way, blood flows freely on its own. increase volume the heart has to pump, increase workload
regurgitation
what are the signs and symptoms of a valve disorder?
dyspnea
weakness/fatigue
murmurs
chest pain
what medications can be used for valve disorders?
diuretics
cardiac glycosides
b-blockers
prophylactic antibiotics
will make a click sound/more durable, is used more in younger patients
mechanical valve
less likely to cause thrombus, replaced more frequently
tissue valves
used from a pig or cow
xenografts
human cadaver or tissue donation
homografts
patient’s own valve
autografts
which valve replacement will need to be on long term anticoagulation
mechanical valve
is most often caused by CAD, HTN, or valve disorders
heart failure
what are some systemic conditions of heart failure?
-fever
-hypoxia and anemai
-dysrhythmias
-electrolyte abnormalities
-renal failure
-thyroid problem
what are the symptoms of left heart failure?
-cough will start dry then it will progress to a pink frothy sputum
-dyspnea on exertion
-orthopnea
-paroxysmal nocturnal dyspnea
-oliguria
-confusion, anxiety, restlessness
-cyanosis
is pulmonary edema part of left heart failure or right heart failure?
left heart failure
what are the early stages of pulmonary edema?
-dry, hacking cough
-fatigue
-wt gain
-worsening edema
-degree of dyspnea
what is the key to pulmonary edema?
prevention
what are the signs and symptoms of right heart failure?
JVD
dependent edema (LE)
hepatomegaly
ascites
weakness, anoerxia, wt gain
what is the hallmark sign of right heart failure?
edema (feet, ankles, legs)
what are the diagnostics for heart failure?
B-type natriuretic peptide-BNP
what is the priority nursing assessment when having edema?
skin assessment
what is the nursing management for heart failure in hospital setting?
i&o
daily weight
lung assessment
assess for JVD
assess and evaluate dependent edema
close monitor VS (O2**)
skin turgor
s/s fluid overload
electrolyte monitoring
turn patient frequently to shift fluid
what should patients be taught to do when going home with heart failure?
daily weight
same time
same scale
how does medications help with heat failure?
reduce workload by reducing preload and afterload
what medications are used for heart failure?
ace inhibitors (captopril)
arbs (losartan)
beta blockers
alpha/beta blockers
promote vasodilation and diuresis
excrete Na+ & retain K+
ace inhibitors
what is a warning sign that the medication ace inhibitor isn’t working properly?
dry persistent cough
what medication can cause birth defects?
ace inhibitors
arbs
what are the side effects of ace inbibitors?
dizziness
orthostatic hypotension
cardiac glycoside used for systolic heart failure, a-fib, and flutter
digoxin
what medication increases myocardial contraction and decreases ventricular rate
-promotes diuresis
digoxin
what are the signs and symptoms of digoxin toxicity?
fatigue
depression
malaise
n/v, anorexia
changes in heart rhythm
what lab should you monitor with digoxin?
potassium
what is the antidote for digoxin?
digibind
what are the medical management of heart failure?
diuretics
anticoagulants
low sodium diet
treating congestive heart failure
upright position
nitrates
lasix
oxygen
ace inhibitors
digoxin
fluids (decrease)
afterload (decrease)
sodium restriction
test
what tips for physical activity?
warm up-exercise
avoid extreme heat, cold, humid weather
should be able to talk during exercise
wait 2 hours after eating to exercise
stop activity if sob, pain, or dizziness
cool down period
build up of atherosclerosis or fatty substances lipids and plaque in the peripheral vessels
peripheral vascular disease
pain in extremities with exercise; well relieved by rest
intermittent claudication
-skin and temp changes
-cool and pale
-white or blanched appearance when elevated
-rubor
-cyanosis
-gangrenous changes
-loss of hair
-brittle nails
-dry,shiny,scaly skin
-bruits
peripheral arterial disease
nursing assessment of peripheral arterial disease
pulse changes
-presence or absense
-0 to 4+ scale
-droppler to detect flow
what are the risk factors for PAD?
-nicotine use
-hyperlipidemia
-hypertension
-diabetes
-stress
-sedentary lifestyle/obesity
what are nursing intervensions for arterial insufficiency?
-lower extremity to increase perfusion
-no constrictive clothing; no crossing legs
-protective shoes; foot care; meticulous hygiene
what are medications for peripheral vascular disease?
antiplatelets (clopidogrel and aspirin)
diabetes medication
lipid lowering agents
what are the surgical interventions for peripheral vascular disease?
aorto-iliac
aorto-femoral
femoral-popliteal
what are the nursing considerations for patients after peripheral vascular surgery?
no crossing let
check pulse
temperature
color
check pulse every hour for the first hours
then every 4 hours for the remainder of the 24 hours
chronic venous stasis
edema
brownish discoloration
pain
venous insufficiency
what are the nursing management of venous insufficiency?
-elevate extemities
-foot pumping
-avoid crossing legs
-avoid constrictive clothing
-compression stockings
intermittent claudication pain
no edema
no pulse or weak pulse
no drainage
round smooth sores
black eschar
location of sores: toes and feet
arterial
dull, achy pain
lower leg edema
pulse present, drainage
sores with irregular borders
yellow slough or ruddy skin
location of sores: ankles
venous
venous stasis
vessel wall injury
altered blood coagulation
DVT
what are the signs of DVT?
lower extremity
limb pain
heaviness
swelling, redness, warmth
tenderness
difference in leg circumference
what are the risk factors to DVT?
immobility
major surgery
fracture pelvis
prostate surgery
bed rest
oral contraceptives
what medication can cause DVT?
oral contraceptives
what is the diagnostic for DVT?
venous doppler
how to prevent DVT?
elastic compression stocking
active and passive leg exercise
early ambulation
TCDB
enoxaparin
what are treatments for DVT?
heparin
warfarin
enoxaparin
what lab is used for heparin?
anti-xa every 6 hours
what is the lab used for coumadin/warfarin?
pt & inr
what is the antidote for heparin?
prodamine sulfate
what is the antidote for warfarin/coumadin?
vitamin k
ffp
what do you monitor for enoxaparin?
platelets
how often are labs required for people on coumadin/warfarin?
every week
heparin induced?
thrombocytopenia
what should you avoid if taking antiplatelets?
nsaids
what are patients at higher risk when taking antiplatelets/anticoagulants?
bleeding
what are some patient eduction when taking anticoagulants?
avoid alcohol
do not stop unless directed
consider wearing an ID band
decrease amount of red blood cells or hemoglobin in the body
decrease hemoglobin=decrease O2
anemia
what are the common causes of anemia?
-acute blood loss (trauma, sudden blood loss)
-decreased or faulty RBC
-destruction of RBC
destruction of red blood cells
hemolysis
what labs check for anemia?
h&h (cbc)
iron
what are the chronic types of anemia?
Cancer
Immunodeficiency Syndrome
Renal disease
Liver disease
Autoimmune conditions
what are the risk factors of acute anemia?
-surgical patient
-active bleeding-trauma
-immunocompromised patient
what are the nutritional deficiency?
iron
folate
vit b
what is the hereditary anemia?
sickle cell
thalassemia
what are the symptoms of anemia?
-fatigue
-dyspnea
-disrythmeias
-chest pain
-cold extremities
what can people with anemia crave?
-dirt
-clay
-ice
what are the treatments of anemia?
administer blood products
hematopoiteic drug
encourage diet rich in the deficient nutrient
control the source of acute bleeding
what is considered anemic
<10
what is absorbed better by the body?
animal based products
what does the body use to make hemoglobin?
iron
how should iron supplements be taken?
on an empty stomach
w/vitamin c or orange juice
what should be avoided while on iron supplements?
milk
calcium
what foods are rich in iron?
Oysters Canned Tomatoes
White Beans Beef
Dark Chocolate Potatoes
Beef Liver Cashews
Lentils Fortified Breakfast Cereal
Eggs
Spinach
Tofu
Kidney Beans
Sardines
Chickpeas
inadequate intake of b12
or lack of absorption
macrocytic anemia
deficiency of intrinsic factor
pernicious anemia
what is the assessment for b12 deficiency?
severe pallor
fatigue
wt loss
smooth, beefy red tongue
absorb iron and folate from the diet in?
proximal small intestine
what color are red blood cells?
red
what color are platelets?
yellow
how much plasma?
55%
how much of the buffy coat?
1%
how much of the red blood cells?
45%
what is in the plasma?
water
salts/minerals
proteins
what is in the buffy coat?
wbc
platelets
what is in the red blood cells?
red blood cells
why is plasma given?
for volume
how much does a whole bag of whole blood hold?
+/-500cc
what are rbc’s most important job in the body?
transporting O2, perfusion
what should always be done before administering RBCs?
cross and match
what color is plasma?
yellow
how is ffp stored?
usually frozen and thawed to give
how much does the bag of ffp hold?
150-200cc
how much does a bag of platelets hold?
50cc
when hypertension causes damage to other organs?
complicated hypertension
which part of the heart pushes blood out to the rest of the body?
left ventricle
what is the diet that includes veggies, low in dairy, total carbs, and fats?
dash diet
places besides a saltshaker that you find Na+
processed canned foods
what side effect included orthostatic hypotension, sexual dysfunction, vertigo, tachyardia?
alpha blockers
monitor K+ level with what med?
furosemide
what diuretic that is primary used for HTN?
hydrocholorthiazide
what is it called when you have a decrease in BP systolic 20mmHg or greater or diastolic 10mmHg
orthostatic hypotension
primary nursing intervention for orthostatic hypotension?
safety
fall risk
true or false vasoconstriction leave to HTN
true
what is it called when you have accumulation of lipid, fatty substances in the vessel walls?
athrosclerosis
what are age, gender, ethnicity
non modifable
the cholesterol that we what high?
HDL
what do we call inadequte blood flow or o2 content?
ischemia
which angina is predictable chest pain on exertion?
stable
how many doses of nitro can be taken?
how many minutes apart?
what kind of container?
how to know if its expired?
3tabs
5min
dark/glass
doesn’t burn or sting
what med cannot be given within 4 hours of erectile dysfunction med?
nitroglycerin
what major side effect for nitroglycerin?
headache
this is indicated injury or infarction on EKG?
ST elevation
what the specific lab to identify heart injury?
troponin
what is the lab to identify heart failure
BNP
what diagnostic test is used to look at heart wall, motion, valve function?
echocardiogran
what lab is monitored when administering enoxaparin?
platelets
acronym of MI
mona
why is aspirin given?
flowing of blood
what should urine output be?
30ml/hr
when heart valve never completly closes and blood continues to flow even when flow should be shut?
regurgitation
what is vitamin k antidote?
warfarin/coumidin
signs of SOB, wheezing
left sided heart failure
classic assessment finding right side heart failure
edema
astha patients shouldnt take
beta blockers
DC pt goes home what should nurse teach about fluid balance?
same scale
same time everydat
leg pain induced by walking and subsides upon rest
intermittent claudication
use of this med puts individuals at risk for DVT
oral contraceptives
