CVPV Exam Flashcards
what are the risk factors for Hypertension
family history increasing age cigarette smoking obesity heavy alcohol consumption Black race Men (early to mid adulthood) women (over 50s) high dietary sodium intake low dietary intake of K, Ca, Mg glucose intolerance
what doe the AHA recommend for alcohol
2 drinks a day for men
1 drink a day for women
what is considered moderate alcohol consumption a week
2-3 drinks per weekw
what is known as the silent killer
hypertension
why is hypertension known as the silent killer
early stages of disease have no clinical manifestations other than elevated blood pressure readings
what are S/S of hypertension
asymptomatic HA visual disturbances chest pain flushed face epistaxis diziness
what are the two major mechanisms of tissue damage
ischemia and edema
how does hypertension cause edema
vessels get torn up and fluids start to seep outside the vessel
what begins to get complicated with HTN
heart and kidneys
kidneys are _____ structures and the _____ pressure will tear the kidneys apart
small; high
a hypertensive heart thickens the walls of the…
ventricles
HTN can cause
stroke
arteriosclerosis
heart attack
kidney failure
hypertension could be caused by taking meds that cause it or could be because they have
kidney disease that cause high BP
an irregular heart beat is not picked up on bp machine so what should you do
manually auscultate BP
what is white coat syndrome
BP increases when pt goes to the doctors office… take BP at home and log it
what lab test shows us kidney function
urine test, BUN and creatinine
what labs predisposes pt to hypertension
K, Ca, Mg
what are the treatment goals of hypertension
focus on systolic
<140/90 mmHg
preexisting conditons (diabetes, renal disease, heart disease)
how do you find pulse pressure
subtracting diastolic from systolic
what are 4 treatment options for hypertension
lifestyle modifications
Dash Diet
Exercise
Moderate alcohol consumption
what consists of the dash diet
desirable to soncume no more than 1500mg of sodium daily, eliminate soups, ready made dinners, processed meats, no added salt
what is always important in the success of treatment
pt compliance
once a pt receives a dx of hypertension they should be evaluated every _____ until their goal is reached, then about every ____ months
month; 3-6 months
what are S/S of orthostatic hypotension
Dizziness
blurring or loss of vision
syncope and fainting
orthostatic hypertension is very common after a _____ in _____ adults
meal; older
how should we monitor orthostatic BP
lying/sitting/standing BP (3-4xday)
a decrease of more than 20 systolic and 10 diastolic
tilt table test
what is the treatment of orthostatic hypotension
eliminate any known cause
assist pt when sitting/standing
supportive devices
fall precautions
what is the prevention/treatment of atherosclerosis/coronary artery disease
Diet exercise medications tobacco cessation Managing HTN controlling DM managing stress
what is a vasoconstrictor
nicotine
what are the 3 evaluations of chest pain
physical assessment
EKG
Lab
when assessing chest pain what do we ask ourselves
do we hear muffled, strange or extra heart beats
are they having chest pain and where is it locates
head to toe assessment
what are the S/S of angina
feeling of indigestion
choking or heavy pressure in sternum
may radiate to neck, jaw shoulders, arms, usually left arm
weakness or numbness in arms, wrists and hands
shortness of breath, pallor, diaphoresis, dizziness, nauseam and vomiting
why will pain sometimes radiate to left arm
because heart is slightly shifted to the left in our chest
if pt have any history of cardiac event we will treat it as cardiac until
it is ruled out
what will chest pain be described as on an EKG
ST depression and ST elevation
represents cardiac ischemia
ST depression
what is ischemia
lack of oxygen
what is infarction
cell death
represents infarction
ST elevation
what does STEMI stand for
ST elevation, Myocardial Infarction
first hump on EKG
P wave
Spike on EKG
QRS
p wave=
atrial contraction
QRS wave=
ventricular contraction
everything from the S on is
relaxation of the ventricle and thats when the heart gets filled with blood
what are the serum markers of Acute Coronary Syndrome
CK & CKMB
Troponin
Myoglobin
shows up within 4-6 hrs and peaks within 12-24 hours
CK & CKMB
what is the only problem with CK & CKMB
they also can be elevated with other muscle damage
what is the most specific lab for cardiac event and is rarely high in a non cardiac even
troponin
shows up in 3-5 hrs and remains elevated for 1-3 wks
troponin
shows up in 1-3hrs and then goes away
myoglobin
very good to see if a person is having a cardiac event at that time
myoglobin
what are more evaluations of chest pain
Echo and Coronary Angiography/Cardiac Cath
when would you never do an exercised stress test
in a pt having active chest pain
what is an echo gram good for
to look at wall motion and valve function because of that they are going to be a very good assessment of heart failure
what does a lexican do
gets heart rate up to mimic exercise and they insert radiopaque dye to show reduced blood flow
what is the primary aim of therapy for myocardial ischemia and angina is to
reduce myocardial oxygen consuption
what is the treatment of angina
decrease BP
decrease heart rate
assist contractility
decrease left ventricular volume
what medications help the heart take a good strong beat
beta blockers and cardiac glycoside (digoxin)
what should you always initiate at the onset of chest pain
OXYGEN
what are the 7 nursing interventions of chest pain
get pt to rest oxygen quick assessment vital signs monitor resp. status 12 leak EKG nitroglycerin
what does the PQRST stand for in the assessment of angina/chest pain
position quality Radiation/relief Severity Timing
how can pt manage angina at home
reduce activities avoid temp extremes maintain normal BP avoid OTC meds that raise BP stop smoking take ASA & BBLockers carry nitro
the cold
vasocontricts
the heat
wears a person out
what are S/S of MI
SUDDEN onset of chest pain no response to rest or meds SOB, dyspnea, tachypnea N/V decreased urinary output cool, clammy pale skin anxiety, restlessness, fear
the s/s of _____ are more sudden and more severe. almost the same s/s of _____ but acts faster
MI; angina
poor cardiac output does not get to the organs like it should and decreases
urinary output, causes N/V, cool clammy skin
what is the nursing care for MI
bed rest
stool softeners
education
why do you want to give stool softeners to MI pt
because we do not want them to strain and have a vagal response
what is the first phase of cardiac rehab
low level activities and education (usually started in the hospital after stabilization)
what is the second phase of cardiac rehab
4-6wks after discharge and focuses on lifestyle modifications and risk factor reduction
what is the third phase of cardiac rehab
maintenance of cardiovascular stability (something to do at home and have regular exercise, watch their diet)
when can a pt resume sexual activity
when they can walk 3-4 mph without SOB or 2-3 flights of stairs before SOB
what are surgical interventions for CAD
cardiac cath & coronary angiography, percutaneous coronary interventions, coronary artery bypass
when there is an obstruction what is the goal
to open up the blocked vessel
inject dye to visualize the vessels and look for blockage
cardiac cath
if a blockage is seen then what is done
PCI is done- open up the vessel either an angioplasty or stent
if the PCI does not work what is done next
coronary artery bypass
NPO is recommended ______ before a scheduled procedure
8-12 hrs
what is given to pt to be able to verbalize when chest pain gets worse
versed
how will the pt feel when dye is injected
very warm flushed feeling
after a cardiac cath or angioplasty what should we do
assess cath site for bleeding
check peripheral pulses, color, temp, pain or numbness, monitor dysrhythmias, bed rest for 2-6hrs, affected extremity straight, HOB no higher than 30 degrees (can’t put pressure on leg), encourage fluid to flush dye out, ensure safety
when should we instruct the pt to notify us
if they feel anything “pop”, warmness, dampness
if there is bleeding at the site what should we do
hold pressure and call doc
what is an angioplasty
balloon, idea is to push or crack that plaque to open up the vessel, there is a vacuum at the end to catch the plaque breaking off
what is a stent
opens up the vessel with the balloon and place a wire mesh in there and helps hole the vessel open
surgery in which a blood vessel form another part of the body is grafted to the occluded coronary artery so that blood can glow beyond the occlusion
coronary artery bypass graft
what is the most common vein for heart bypass
the greater saphenous vein
what is the BEST graph to use for the heart bypass
left internal mammary artery
what are the S/S of valve disorders
dyspnea
weakness/fatigue
murmurs
chest pain
what are the 2 valve disorders
stenosis and regurgitation
what is the coronary artery disease big problem
blood is not going where it needs to go and so we need to fix it
valve disease and heart failures big problem is
have too much volume, weak heart, stretched out heart and that makes it an ineffective heart and not a good pump
what medications are given for the management of valve disorders
diuretics, cardiac glycosides, B blockers, prophylactic antiobiotics
since heart is not being an effective pump we are giving ____ so extra fluid is not put in
diuretics
_____ will help the heart take a strong beat and slows the heart rate down
digoxin
when admin dioxin what should be done
apical pulse for one minute
a procedure to improve blood flow through a narrow valve. a catheter is threaded to the valve through a hole temporarily created in the septal wall and inflated
valvuloplasty
what is done for a stenotic valve
commiserautomy
a surgical procedure performed to open a stenotic calce. a stenotic valve restricts the flow of blood. a scalpel incision widens the valve
commissurotomy
what is an annuloplasty ring done on
a valve that has regurgitation
what are the two types of valve replacements
mechanical and tissue valves
the pt will need LIFELONG anticoagulation with this valve replacement and why?
mechanical; blood platelets, etc like to stick to anything foreign
which valve replacement is less likely to generate clots, great for childbearing women, older age and lasts 7-10 years
tissue valve
what should you watch closely for after valve replacement surgery
development of Heart Failure
what are the main two S/S of mitral valve prolapse and very common in
systolic heart murmur
mid systolic click; younger women
mitral valve prolapse could progress to
regurgitation
mitral valve prolapse pt are not supposed to
donate blood
volume of blood in ventricles at end of diastole
preload
resistance left ventricle must overcome to circulate blood
afterload
left heart failure affects the
lungs (pulmonary congestion)
left heart failure S/S
dyspnea on exertion orthopnea paroxysmal nocturnal dyspnea oliguria confusion, anxiety and restlessness
pulmonary congestion consists of
cough, crackles, wheezes, blood sputum, tachypnea
alveoli become filled with fluid
pulmonary edema
pulmonary edema recognition of early stages
dry, hacking cough fatigue weight gain worsening edema degree of dyspnea
S/S of right hear failure
jugular vein distension dependent edema-feet, ankles,legs hepatomegaly-liver ascites- fluid in peritoneal cavity (has a gut) weakness, anorexia, weight gain
what side heart failure is systemic and has MASSIVE weight gain
right sided heart failure
what is the most common cause of right sided heart failure
left sided heart failure
what is class 1 of heart failure
client exhibits no more symptoms with activity than a healthy client would
what is class 2 of heart failure
client has symptoms with ordinary exertion
what is class 3 of heart failure
symptoms with minimal exertion
what is class 4 of heart failure
symptoms at rest
what are the 3 major nursing management of heart failure
I&Os
daily weight assessment
lung assessment
if pt gains 2-3 lb within a day they need to
notify physician
how should HF patient weigh themselves
same scale same time everyday
how can we reduce preload
diuretics, fluid restriction, sodium
how can we reduce after load
avoid cold or heat, BP meds, quit smoking
heart skips a beat is
PVCs pre mature ventricular contractions
where is a pacemaker placed
pocket in left subclavian area
why are pt not supposed to get the placemaker site wet for 7 days
great place for infection to set in
pacemaker pt should be up at least 30 degrees and keep arm still for
24-48 hrs
what is peripheral arterial disease: intermittent claudication
pain in extremities with exercise; relieved by rest
pain of int. claud. occurs…
one joint space below disease process
lower extremity of peripheral arterial disease because
increases perfusion and much less painful
what are the 5 signs of peripheral arterial disease (PAD)
loss of hair brittle nails dry, shiny, scaly skin ulcerations bruits
turbulent blood flow =
bruits
what are risk factors of PAD
nicotine use, hyperlipidemia, hypertension, diabetes, stress, sedentary lifestyle/obesity
what are nursing interventions for arterial insufficiency
lower extremity to increase perfusion exercise program avoid extreme cold no nicotine avoid stress proper nutrition
what are management of peripheral vascular disease
exercise program
weight reduction
smoking cessation
surgical interventions for PVD
surgical bypass grafts
after peripheral artery bypass surgery watch pulses and carefully doc every
hour for the first , then 4 hour pulse checks with doppler, keep legs elevated because we don’t want pressure on leg
what are signs of venous insufficiency
chronic venous stasis (blood stays put)
edema
brownish discoloration
pain
what is the management of venous insufficiency
elevating extremities, foot pumping, avoid crossing legs, avoid constrictive clothing, compression stockings,
what are signs of DVT
limb pain heaviness swelling, reddness, warmth tenderness diff in leg circumference venous doppler
DVT is
clot in vein
what is the gold standard for DVT dx
venous doppler
why is the pulse normal in a DVT
because its a venous problem not an arterial problem
what is the prevention of DVTs
elastic compressions active and passive leg exercises early ambulation TCDB enoxaparin
what is the treatment of DVT
bed rest, elevation, compression stockings, analgesics
why is the DVT pt on bedrest
don’t want clot moving
for arterial problem we _______ legs, for venous problem we ________legs
dangle; elevate
what meds are used in treatment of DVT
anticoagulant and thrombolytic therapy
traps blood clot as they travel up the vena cava preventing them from reaching the lungs
inferior vena cava filter
ppl at risk for dvt usually will get this device
inferior vena cava filter
