Exam 2 Flashcards
What is heart failure?
Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.
Systolic dysfunction is
problem with contraction of the heart
Diastolic dysfunction is
problem with filling the heart
What is “Left-Sided” heart failure?
When the left ventricular cannot pump blood out efficiently into the aorta and the systemic circulation.
this leads to pulmonary congestion
What is “right-Sided” heart failure?
When the right ventricle fails and cannot eject blood or accommodate all the blood flowing in from VC.
What is the pathway that leads to HF?
-Systolic HF (not enough blood going out to body)
-sympathetic NS stimulated epinephrine and norepinephrine
-Decrease in kidney perfusions stimulates RASS system to increase BP and retain fluid
-Reduction on contractility of muscle fibers in heart due to increased work load
-Heart compensates for increased workload which increased thickness of heart muscle.
What are different things that can cause HF?
-Coronary artery disease (atherosclerosis)
-Ischema
-Cardiomyopathy
-Systemic or pulmonary hypertension
-Valvular heart disease
What are the manifestations of “Left-sided” heart failure?
-Dyspnea (SOB)
-Cough - dry nonproductive
-Crackles
-Low oxygen levels
What are the manifestations of “right-sided” heart failure?
-Edema
-Peripheral
-JVD
-Enlargement of the liver (due to venous engorgement)
-GI distress (due to build-up of fluid and extra pressure)
-Loss of appetite due to engorgement of GI organs.
How is HF diagnosed?
ECG
Chest Xray
Sonograms
Stress test
PET scan
Cardiac catherterization
What labs are being asses with HF?
-Liver enzymes
-Cardiac drug levels (Digoxin)
-Bleeding / clotting times
-Electrolytes
-Pulse oximetry
-ABGs
-BUN/Creatinine
-Serum albumin
-CBC
-ESR
-Thyroid studies
What are medications used to treat HF
-RAAS inhibitors (ACEi, ARB, Aldosterone, Reinin inhibitors)
-Beta Blockers
-Calcium Channel Blockers
-Diuretics
-Dilators
-Digoxin
CAN therapies for HF
-Restrict Sodium
-Supplemental Oxygen
-CRT (pacemaker)
-Ultrafiltration (for pts with severe fluid overlaod)
-Cardiac transplant
How should a nurse assess for HF?
-Auscultate lung sounds
-Auscultate for S3 heart sounds
-Assess for JVD
-LOC
-Liver for hepatojugular reflux
-Measure I/O
-daily weight
What is Hypertension?
Any BP over 140/90
***based on average of 2 or more accurate BP measurements during 2+ consultations with the provider.
What is a Normal BP
Systolic: >120
Diastolic: >80
What is prehypertension / elevated BP range
Systolic: 120-129
Diastolic: >80
What is Stage 1 Hypertension?
Systolic: 130-139
Diastolic: 80-89
What is Stage 2 Hyptertension?
Systolic: 140 or higher
Diastolic: 90 or higher
What is Hypertensive Crisis?
Systolic: higher than 180
Diastolic: Higher than 120
What are different factors / causes for hypertension?
-Excess sodium (increased body to hold onto water)
-Obesity
-Genetic Alteration
-Increase in sympathetic NS
-Increase in renal reabsorption
-Increase in RAAS
-Decreased vasodilation (due to damage)
How does hypertension manifest?
-headache (Oxygen is not getting to the brain)
-Dizziness (Oxygen is not getting to the brain)
-Chest Pain (decreased Oxygen)
-Blurred vision (too much constriction of blood vessels in the eye)
What are some client education on how to prevent hypertension?
-Weight Reduction
-DASH diet (heavy in fruits and veggies and l ow in fat dairy)
-Reduce salt
-increase physical activity
-reduce alcohol to no more than 2 drinks per day (men) 1 (women)
What can hypertension lead to?
-Heart failure
-MI
-Impaired vision
-Renal failure
What medications are used to treat hypertension
a lot of the same meds that are used to treat HF
-Ace i, angiotension i, ARBs, CCBs, Reinin i
-Thiazide Diuretics
What is Angina Pectoris?
Chest pain
What causes angina?
insufficient blood flow to heart muscles
What are the different types of angina?
Stable
Unstable
Intractable or refactory
Variant
Silent
What is stable angina?
Predictable and consistent pain, but is relieved by nitroglycerin
What is unstable angina?
symptoms increase in frequency and severity, and may or may not be relieved by nitro
What is intractable or refractory angina?
Severe incapacitating chest pain
What is variant angina?
pain while at rest with reversible ST-segment elevation and may be caused by coronary artery vasospasm
What is silent ischemia?
objective evidence of ischemia, but no pain
What is common pathophysiology for angina?
Atherosclerotic disease
Major coronary artery obstruction
Oxygen demands are not met
Increase of oxygen required goes up, but can’t be met
-Ischemia (blockage in a coronary artery)
What are common causes for angina?
Physical exertion (increase need for O2)
Exposure to cold (vasoconstriction with elevated BP)
Eating a heavy meal (increased blood flow to digestion and takes away from heart)
Stress
How does angina manifest?
Chest pain felts deep in chest behind the sternums that may radiate to neck, jaw, and shoulders!
Numbness, weakness in arms, wrist and hands
SOB
Pallor - due to inadequate blood supply
What are gerontological considerations regarding angina?
-May not exhibit typical pain profile due to diminished responses of neurotransmitters
-Dyspnea
-Silent angina is common
-encourage them to recognize chest pain symptoms like weakness
What are complications that result from angina?
MI (This happens if angina is left untreated)
Cardiac arrest (heart pumps more and more blood to compensate, and cardiac muscle fails)
Cardiogenic shock (MI predisposes them to this)
How do we diagnose angina?
ECG
24 hr ECG (Holter)
Exercise or pharm stress electrocardiography
Cardiac enzymes
Chest Xray
Pco2, potassium, myocardial lactate
Serum lipids
Nuclear imaging
MUGA
Cardiac cath w/ angiography
What are the different types of therapies that can be used to treat angina?
Oxygen
Nitro
Beta Blockers
Calcium channel blockers
antiplatelet meds
anticoagulants
What is atherosclerosis?
Artery wall thickens as a result of fatty material build up (cholesterol LDL and Triglycerides)
How do triglycerides affect the arteries?
cause inflammation of arterio-vascular endothelium
Why is atherosclerosis hard to diagnose?
Many people are unaware they have it since arteries are not always blocked completely. They will not know they have it until they get an MI or stroke.
What is PAD/PVD
Venous insufficiency (Venus is return of blood to the heart
What are things that can lead to PAD/PVD
Damaged Vein valves
Accumulation of blood in damaged veins
Formation of clot
How does PAD manifest?
-leg pain, aching or cramping
-burning or itching in skin
-leg or ankle swelling
-“heavy” legs
-skin discoloration/texture changes
-open wounds or sores
-restless legs
-varicose veins
What puts individuals more at risk for developing PAD?
Gender
age
heredity
pregnancy
standing occupation
obesity
prior injury or surgery
sedentary life
What is ABI
Ankle Brachial Index
-Used to diagnose PAD and prevent progression.
How is ABI calculated?
Divide blood pressure in artery of ankle by blood pressure in arm.
How should pts manage PAD/PVD?
-increase activity
-compression socks
-pneumatic compression
What is DVT?
Deep vein thrombosis - when a blood clot (thrombus) forms in one or more of the deep veins in the body (usually the legs)
Why is DVT so serious?
The clot can break loose and travel through the bloodstream into the lungs which would block blood flow.
What is the pathophysiology of DVT?
-Reduced blood flow
-damage to lining of blood vessels
-phlebitis
-platelet aggregation
-Tail - can flow or propagate in direction of blood flow
-Fragmentation
What are different causes for DVT?
-Direct Trauma
-Blood coagulability
-Oral contraceptives
-Pregnancy
-Repetitive motions
How does DVT manifest?
-Edema
-Phlegmasia cerulea dolens (massive iliofemoral venous thrombosis - entire extremity becomes massively swollen, tense, painful and cool to touch)
-Tenderness
-Pulmonary embolus
How can DVT be prevented?
Graduated compression stockings
Pneumatic compression device
Leg exercises
What types of medications are used for DVT?
-Heparin
-Warfarin
-Aspirin
-Factor Xa inhibitor
Thrombolytic therapy
-Low molecular weight heparin
What are two major diuretics?
Furosemide
HCTZ
What are two major Antihypertensives?
Metoprolol
Lisinopril
What is a main antilipidemic
Atorvastatin
What are the major anticoagulants?
Heparin
Warfarin
Enoxaparin sodium
What are the different types of anemia?
Iron Deficiency
B12
Sickle Cell
What is Thrombophilia?
Blood has an increased tendency to form clots
What do RBCs do?
Transport Oxygen through the body to the tissues
What does Hemoglobin do?
molecule that is part of RBC that the O2 attached to so it can be carried throughout the body
What is a hematocrit?
measures the % of cells in the whole body
What is Erythropoietin?
A hormone secreted by the kidneys to increase the production of red blood cells created by the body
What is Epoetin alfa (Epogen)?
This is synthesized from erythropoietin to stimulate RBC production from bone marrow.
What is Anemia?
Condition where hemoglobin concentration is lower.
What is Aplastic Anemia (hypoproliferative anemia)
marrow cannot produce adequate number of RBC
What is hemolytic anemias?
There is a premature destruction of RBCs that result in liberation of hemoglobin from RBCs into plasma. Then the released hemoglobin is converted into bilirubin
How does hyperproliferative anemia manifest?
Decreased hemoglobin (levels between 9-11)
Fatigue
tachycardia
dyspnea
pallor
How can someone prevent hyperproliferative anemia?
Iron rich diet
Iron supplements
What can hyperproliferative anemia lead to?
HF
Paresthesia (muscles don’t get enough Oxygen)
Delirium
What is iron deficiency anemia?
When the body stores of iron drops
What are causes of iron deficiency anemia?
diet
hemorrhage
malabsorption
Iron-Refractory iron deficiency anemia (IRIDA)
Iron deficiency manifestations
Fatigue
Difficulty focusing
crazy sore muscles
apathy
brittle nails
pale skin
pink or red urine
frequent infections
trouble doing normal workout
breathlessness
below average body weight
anorexia (loss of appetite)
growth retardation
listlessness (lethargic / out of it)
What are foods rich in Iron?
Dark leafy greens
broccoli
liver
Egg yolk
Beef, Pork, chicken
shrimp, clams
Rasins
Potato’s with skin
What is B-12 Deficiency
Pernicious anemia
Lack of B12 and Folate for RBCs to form
-Diet deficiency
-Malabsorption
-GI disturbances
-Alcohol
What is Sickle Cell anemia?
Severe hemolytic anemia
RBCs are moon shaped
Both parents must have the gene, and kids will have 25% chance of getting it. 50% chance of becoming carriers
What is the BIG danger with sickle cell anemia?
Sickle cells do not flow smoothly through blood and can get stick together forming clots
What are causes for sickle cells to clot
cold temp (aggravates the sickling process due to vacosonstriction slowing blood flow
-Tissue hypoxia (hypoxia and necrosis causes sickle crisis)
-Human parvovirus (Aplasic crisis - results from HP virus)
-Splenic infaction (Sequestration crisis) - organs pool the sickeled cells, like the spleen)
Infhow does sickle cell anemia manifest?
Anemia is always present (7-10 hemoglobin levels)
-jaundice
-Dysrhythmias
-Enlargement of bones
What are major complications of sickle cell anemia?
Infection
stroke
rental failure
Hf
Is sickle cell anemia painful?
Yes!!
Chronic pain and substance abuse needs to be emphasized in nursing plan
What is Thalassemia?
Autosomal recessive
Affects: alpha and beta
Mutation causes incomplete formation of hemoglobin which limits O2 binding capacity
Who is more at risk for Thalassemia?
Mediterranean
African
SE Asian
(1/3 of ppl in SE Asia)
How does Thalassemia manifest?
Anemia
fatigue
pallor
Irritability
Anorexia
What is medical management for Thalassemia?
Splenectomy
Transfusion
Bone Marrow Transplant
Diet
Antipyretics
Antihistamines
chelating agents
corticosteroids
antibacterial comibinations
vitamines
vaccines
What are the different bleeding disorders?
-Hemopheliia (A & B)
-Von Willebrad disease
-Antiphospholipid antibody syndrome
-Disseminated intravascular coagulation
-Polycythemia vera
What is Hemophilia A?
X-linked, recessive disease
-deficiency factor VII (8)
What is Hemophilia B?
X-linked, recessive disease
-deficiency factor IX (9)
What is Hemophilia c?
Autosomal Recessive
-Deficiency of factor XI (11)
-RARE
What is Von Willibrand Disease?
Autosomal dominant trait
-Deficiency of VW factor
Who is Ryan White?
Had Hemophilia A and developed HIV due to a blood transfusion. He started the process to better screen blood.
How does Hemophilia manifest?
-Hematuria
-general symptoms (weakness, orthostasis may occur)
-musculoskeletal (tingling, cracking, warmth, pain, stiffness)
-CNS (headache, stiff neck, N/V, Lethargy, irritability, spinal cord syndromes)
-Genitourinary (painless, or hepatic/splenic tenderness and peritoneal signs_
What is medical management for hemophilia?
Gene Therapy
Surgery/labor and delivery
-make sure to have factors available
What are nursing interventions for hemophilia?
-Relieve pain
-Maintain optimal physical motility
-Assist in coping
-Prevent bleeding
-Prevent injury
What is Thrombophilias?
-Factor V Leiden
-Antiphospholipid antibody syndrome
-Disseminated intravascular coagulation
-Polycythemia vera
What is Factor V LEiden?
Gene mutation
-causes excessive clotting ability
-Risk for DVT & Pulmonary Embolism
What are treatment options for Factor V Leiden?
Warfarin
Eliquis
Heparin
ASA
What are risk factors for Factor V Leiden?
-Two faulty Genes: One from each parent
-Immobility (extended periods from sitting to long or a long flight)
-Estrogen (oral contraceptives)
-Surgeries or Injuries
-Non-O blood type
What is Antiphospholipid antibody syndrome?
Autoimmune disorder where antibodies affect certain proteins in the blood.
Risks and treatments are similar to Leiden V.
What is DIC
Disseminated Intravascular Coagulation
-Clotting factors are exhausted which results in massive hemorrhage.
-Can be caused by trauma or infection (sepsis)
What medication can be used to treat DIC?
Heparin…. yes, heparin!
What is Polycythemia Vera?
A form of cancer
-Excessive RBX
-Causes excessive clotting
-Risks and treatment are similar to other clotting problems
What are the different blood products for transfustion?
Whole
PRBCs
Platelets
FFP
Albumin
Granulocytes
When is whole blood indicated for transfustion?
Pts who need both increased oxygen carrying capacity and restoration of blood volume when there is no time to prepare or obtain the specific blood components needed.
Transfused over 2-4 hours
Does Whole blood require ABO typing and crossmatch?
Yes
When is PRBCs indicated for transfusion?
This is the most commonly transfused blood.
Transfused over 2-4 hours
Does PRBCs require ABO typing and crossmatch?
Yes
When are platelets indicated for blood transfusion?
When platelet levels are depleted
-These assist with clotting
-Given a lot to cancer patients
-Can be transfused as fast as possible
Do platelets require ABO typing and crossmatch?
Yes
When are FFP indicated?
Used for volume expansion when fluids alone are insufficient
-Contains clotting factors
-Can be transfused as fast as possible
Does FFP require ABO typing and crossmatch?
Yes
When is Albumin indicated for transfusion
Used for fluid expansion & hypoalbuminemia
-Primary protein of whole blood
-Can be transfused as fast as possible
When are granulocytes indicated for blood transfusion ?
Neutropenic Patients
Similar risks as other transfusions
Do Granulocytes require ABO type and crossmatch?
Yes
What are the S/S for Allergic reaction to blood transfusion ?
Flushing
Rash
Hives
pruritus’
Laryngeal edema, difficulty breathing
What are the S/S for Febrile reaction to blood transfusion ?
Sudden chills and fever
flushing
headache
anxiety
What are the S/S for Septic reaction to blood transfusion ?
Rapid onset of chills
vomiting
marked hypotension
high fever
What are the S/S for circulatory overload caused by blood transfusion ?
rise in venous pressure
dyspnea
crackles or rales
distend neck veins
cough
elevated BP
What are the Hemolytic reaction to blood transfusion ?
lower back pain
chills
feeling of fullness
tachycardia
flushing
tachypnea
hypotension
bleeding
vascular collapse
acute renal failure
What are S/S of volume excess
-Abnormal breath sounds: crackles
-Altered electrolytes
-Anxiety
-Azotemia
-BP changes
-Change in mental status
-Change in resp pattern
-Decreased Hgb or Hct
-Edema
-Increased central venous pressure
-intake exceeds output
-JVD
-Restlessness
-Oliguria
-Change in specific gravity
-SOB
-Tachycardia
-3rd heart sound S3
What are S/S of volume deficient
-Altered mental state
-Pt complains of weakness
-excess thirst
-tachycardia
-weak pulse
-weight loss
-concentrated urine
-decreased urine output (under 30 ml / hr in 2 hrs)
-dry mucous membranes, sunken eyeballs
-decreased skin turgor
-decreased BP
-postural hypotension
What are nursing interventions for excess fluid?
-Limit salt
-monitor fluid intake
-administer diuretics
-elevate edematous extremities
-Administer iv fluids through infusion pump
-semi fowlers
-reposition every 2 hours
-educate
What are nursing interventions for excess deficit
-Encourage oral fluids
-Monitor hypovolemia
-Start IV
-Administer fluids
-Adminiser blood (if needed)
-maintain flow rate
-Monitor I/O
-provide measures to prevent excessive electrolytes
-advance diet in volume and composition once ongoing fluid
-educate
What is Normal Range for Sodium?
136 - 145
What is Normal Range for Potassium?
3.5 - 5.0
What is Normal Range for Chloride
98 - 106
What is Normal Range for Total calcium?
9-10.5
What is Normal Range for Magnesium?
1.3 - 2.1
What is Normal Range for Phosphorus?
3 - 4.5
How long does the preoperative phase last ?
From the time the client is admitted in the surgical unit, to the time they are prepared physically, psychosocially, spiritually, and legally for procedure, until they are transported into operating room.
What needs to be prepared before surgury?
-skin
-full bath to remove microorganisms
-Prep GI tract
-NPO
-Preparing for anesthesia
-No Alcohol or smoking 24 hours before
-promote rest and sleep
-Administer sedatives
How long does post operative last?
From the time a client is admitted to the recovery room to when they are transported back to surgical unit, discharged from hospital, until the follow-up care.
What are the goals of post op?
-Maintain adequate body system functions
-Restore homeostasis
-Alleviate pain / discomfort
-Prevent postoerative complications
-Ensure adequate discharge planning and teaching
What happens during admission to the PACU?
-Promote safe recovery from anesthesia
-administer O2
-Continuos monitoring for ECG, pulse ox, and BP
-Assess surgical site and dressing
-check patency of catheter, drains and tubes
-measure body temp
-provide warming blanket
-control shivering (Meperidine *Demerol)
-VS every 5-15 minutes
What are the different types of anesthesia?
Local
Regional
General
Conscious Sedation
What is local anesthesia?
-cause loss of following sensation: temp, touch, proprioception, skeletal muscle tone
-Never bockers
-cause temporary interruption of production and conduction of nerve impulses
Examples of local anesthisia
Lidocaine
marcaine
Novocain
benzocaine
cocaine
When is local anesthesia indicated?
infiltration anesthesia
peripheral ad sympathetic nerve blocks
central nerve blocks
spinal and caudal anesthesia
topical anesthetic
When is local anesthesia contraindicated or must be used with caution?
-Allergy
-Heart block
-shock
-decreased plasma esterase
-pregnancy, lactation
