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Adult health 2 > Exam 2: Cardiac > Flashcards

Exam 2: Cardiac Flashcards

1
Q

When a thrombus becomes dislodged and travels what is our biggest life threatening concern

A

that it will travel to the right side of the heart and become a pulmonary embolus – life threatening

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2
Q

What is a DVT

A

thrombi developed from platelets, fibrin, RBC, WBC in areas where blood flow is slow or turbulent

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3
Q

What 3 things are involved with the etiology virchow’s triad

A

Blood: hyper-coagulability
Vessel: vascular damage
Flow: coagulatory stasis

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4
Q

What are risk factors for deep venous thrombosis

A

heart disease
dehydration
immobility (BR for more than 72 hours, air travel for longer than 4 hours)
paralysis
incompetent vein valves
obesity
pregnancy
surgery
age over 40
female

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5
Q

Risk factors for vessel wall injury

A

trauma (fracture–long bones and pelvis, burns)
infection
venipuncture
intravenous infusion of irritant solutions
central and peripheral intravenous cath
history of DVT or varicose veins
previous major surgery

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6
Q

Risk factors of hypercoagulability

A

alterations in hemostatic mechanisms (hemolytic anemias, increased viscosity, inherited coagulation disorders)
trauma or surgery
malignancy
oral contraceptives use
dehydration

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7
Q

Clinical manifestations of the DVT

A

local pain or tenderness
unilateral edema or swelling
may be bilateral if DVT is located in vena cava
local warmth, redness
mild fever
tender, palpable venous cord in popliteal fossa
positive homan’s signs

no symptoms in 50% of patients

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8
Q

How do we diagnose a DVT…

Noninvasive:
Invasive:
Other exams:

A

Noninvasive: doppler studies, impedance plethysmography

invasive: venogram

Other: D-dimer, radio labeled fibrinogen scan

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9
Q

Prevention of a DVT

A

pharm prophylaxis of anticoagulant

mechanical prophylaxis: reduce risk factors as appropriate–immobility, hydration, use of pneumatic devices

Lifestyle modifications: avoid oral contraceptives and smoking

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10
Q

Indications for enoxaparin (lovenox)

A

total hip arthroplasty
hip fracture
total knee arthroplasty

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11
Q

Indications for danaparoid (Orgaran)

A

total hip arthroplasty

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12
Q

Indications for Dalteparin (Fragmin)

A

total hip arthroplasty

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13
Q

Indication for ardeparin (Normiflo)

A

total knee arthroplasty

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14
Q

Anticoagulant therapy will _________

A

prevent further clot development

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15
Q

What to know about heparin

A

SQ or IV

Monitor PTT, H/H, platelets

Assess for bleeding

Initiate bleeding precautions–avoid IM injections, use of razors, soft toothbrushes

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16
Q

Antidote for heparin

A

protamine sulfate

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17
Q

Indications coumadin (Warfarin)

A

PO–Initiate concurrently with Heparin therapy

Monitor PT/INR, H/H

teach patient long term implications, dietary considerations, medic alert ID, bleeding precautions

Monitor for signs of bleeding

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18
Q

Antidote for Warfarin

A

Vitamin K

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19
Q

_______ is a highly selective direct thrombin inhibitor

A

Bivalirudin (Angiomax)

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20
Q

Thrombolytic therapy

A

Activate the conversion of plasminogen to plasmin which actively dissolves the clot

We get worried for bleeding

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21
Q

Additional treatments of DVT’s

A

possible bedrest

pain management

monitor for complications of DVT: PE, Vena cava interruptions/filter

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22
Q

Pulmonary embolisms present with

A

change in LOC, dyspnea, SOB, productive cough, tachycardia, decreased oxygen saturation

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23
Q

What are indications for vena cava filter placement

A

recurrent thromboembolisms despite anticoagulation

confirmed deep venous thrombosis or thromboembolism with a contraindication to anticoagulation therapy

complication of anticoagulation requiring discontinuation of therapy

recurrent pulmonary embolism with associated pulmonary hypertension and cor pulmonale

free-floating thrombus

postpulmonary embolectomy

prophylaxis in high risk patients

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24
Q

Varicose veins are

A

prominent, torturous dilated veins effecting the lower extremities, gravity on venous pressure, valvular incompetence

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25
Q

epidemiology of varicose veins

A

women in multi pregnancies, increase incidence in women-elderly

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26
Q

Etiology of varicose veins

A

hereditary factors, obesity, prolonged standing, chronic disease

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27
Q

Symptoms of varicose veins

A

possibly asymptomatic or swelling, heaviness, pressure, discomfort, nocturnal cramps

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28
Q

Diagnosis of varicose veins

A

Noninvasive trendelenburg’s test

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29
Q

Treatment of varicose veins

A

dependent on the severity of varicosities

–> elastic stockings, decrease prolonged standing, lifestyle modifications, avoid tight fitting clothes

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30
Q

Treatment options of varicose veins

A

sclerotherapy
laser ablation therapy
ligation and stripping surgical procedure

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31
Q

What is sclerotherapy

A

injection of an irritating solution which leads to fibrosis and obliteration of the vein lumen

outpatient, elastic compression stocking are worn

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32
Q

What is laser ablation therapy

A

nonsurgical approach using laser fiber contact inside the vein that seals the vein, outpatient compression stockings

33
Q

Venous ulcers

A

chronic venous insufficiency (common in legs)

34
Q

Etiology of venous ulcers

A

DM, RA, venous stasis, trauma, pressure

35
Q

Pathophysiology of venous ulcers

A

leg veins and valves fail to keep blood moving forward, resulting in ambulatory venous htn

serious fluid and RBCs leak from the capillaries and venules into the tissue. This produces edema and chronic inflammatory changes

Enzyme’s in the tissue break down RBCs causing the release of hemosiderin. This causes the brownish skin discoloration.

Skin and subcutaneous tissue around the ankle are replaced by fibrous tissue, resulting in thick, hardened, and contracted skin

36
Q

Wound management includes

A

Compression: Unna’s boot

Debridement

Topical therapy: hydrogels, calcium alginate

wound dressing: wet to dry, duoderm

vacuum assisted closure

hyperbaric oxygenation

grafting

37
Q

PVD: ______ extremities are most often involved

A

lower

38
Q

PVD pathophysiology

A

The most common cause of PVD is atherosclerosis. This is the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs. It decreases the oxygen and nutrients sent to the tissue. Blood clots may form on the artery walls. This makes the inner size of the blood vessels even smaller and blocks off major arteries

39
Q

Complications of PVD

A

Infection, ulceration, occlusion ischemia, ulcerations, gangrene, amputation

40
Q

Risk factors of PVD

A

male
increasing age
smoking
HTN
atherosclerosis
obesity
DM
stress
family history
sedentary lifestyle
hyperlipidemia

41
Q

Clinical manifestations of occlusive arterial disease

A

Intermittent claudication

rest pain in advanced disease

diminished hair growth on affected extremities

thick, brittle, slow-growing nails

Shiny, thin, fragile, taut skin

dry, scaly skin

cool skin temperature

diminished or absent pulses

pale, blanched appearance w/ extremities elevation

red coloration w/ extremities in dependent position

decreased motor function

ulcer formation with advanced disease

ankle brachial index of 0.5-0.95

42
Q

What does ankle brachial index measure

what is the normal and abnormal value

A

difference in upper extremities and lower extremities blood pressures

normal: 1
arterial insufficiency: 0.5-0.95
ischemic rest pain: 0.5 or less (ultrasound, exercise testing, and arteriography)

43
Q

Management of the patient with PVD

A

lifestyle modifications/positioning

interventional radiologic procedures

surgical management: bypass grafting

44
Q

complications of PVD

A

re thrombosis, embolism, vasospasm, bleeding

45
Q

Complications with management of arterial ulceration

treatment

A

intermittent claudication

small, circular, deep ulcerations–gangrene

toes, web spaces between toes, medial side of foot

treatment: see venous ulcer care, possible amputation

46
Q

What is the goal with a patient that is going to undergo amputation

A

preserve as much functioning as possible, while removing infected or necrotic tissue

47
Q

Amputation: elevate the stump for

A

first 24 hours

48
Q

Crutch walking: an accurate measurement of the client for crutches is important because

what is it

A

an incorrect measurement could damage the brachial plexus

the distance between the axilla and the arm pieces on the crutches should be two finger widths in the axilla space

the elbow should be slightly flexed 20 to 30 degrees when walking

49
Q

Crutch walking: when ambulating with the client, stand on the

A

affected side

50
Q

Crutch walking: instruct the client to never rest

A

on the axilla of the axillary bars

51
Q

Crutch walking: instruct the client to look

A

up and outward when ambulating

52
Q

Crutch walking: upstairs

A

walk close to the first stair and hold onto the stair rail

hold onto the rail with one hand and the crutch with the other

push down on the stair rail and the crutch and step up with the good leg

If not allowed to place weight on the “bad” leg, hop up with the “good” leg
If able to place weight, bring the “bad” leg and the crutch up beside the good leg

Lead with good leg

53
Q

Crutch walking: down stairs

A

walk to the edge of the stairs in the same way

place the “bad” leg and the crutch down on the step below; support weight by leaning on the crutches and the stair rail

bring the “good” leg down

remember the “bad” leg goes down first and the crutch moves with the “bad leg”

54
Q

What is buerger’s disease (thromboangiitis obliterans)

A

obstructive vascular disorder caused by inflammation in the arteries and veins

55
Q

What is the etiology of buerger’s disease (thromboangiitis obliterans)

A

Men 20 to 40 years of age, increase in middle east, asia and jewish heritage

56
Q

buerger’s disease (thromboangiitis obliterans) disease only occurs in ______________

A

SMOKERS

57
Q

buerger’s disease (thromboangiitis obliterans) predominantly effects

A

the lower extremities

58
Q

buerger’s disease (thromboangiitis obliterans): pathophysiology

A

effects small and medium arteries and veins –> progressive claudication, cyanosis, coldness, rest pain

59
Q

buerger’s disease (thromboangiitis obliterans): management goal

A

arrest disease process and prevent amputation

60
Q

buerger’s disease (thromboangiitis obliterans): treatment

A

smoking cessation

calcium channel blockers

Iloprost

thrombolytics

possible amputation

patient/family teaching

61
Q

Raynaud’s disease

A

episodic vasospasm involving the arteries of the fingers and toes

62
Q

Raynaud’s disease: etiology

A

women

exposure to stress, tobacco, caffiene, cold, vibration

63
Q

Raynaud’s disease: characteristics

A

symmetrical/bilateral

ischemic phase-cold, pale, numb

hyperemic phase redness, swelling, throbbing pain

lasts minutes–may persist for hours

64
Q

Raynaud’s disease: Complications

A

ulceration, gangrene

65
Q

Raynaud’s disease: management

A

mild–no treatment necessary to avoid precipitating factors

drugs: CCB, vascular smooth muscle relaxant, vasodilators, iloprost

sympathectomy

patient/family teaching

66
Q

Acute arterial occlusive disease: pathophysiology

A

Acute arterial occlusion, also known as acute limb ischemia, is a medical emergency that occurs when a peripheral artery is suddenly blocked, preventing blood flow to a limb

67
Q

Acute arterial occlusive disease: complications

A

necrosis, gangrene, amputation

68
Q

Acute arterial occlusive disease: 6 P’s

A

pain
pallor
pulselessness
paresthesia
poikilothermia
paralysis

69
Q

Acute arterial occlusive disease: diagnosis

A

physical exam, ultrasound, angiography

70
Q

Acute arterial occlusive disease: management

A

anticoagulants, thrombolytics, CCB, pain medication

endovascular procedures-balloon angioplasty

surgical treatment-embolectomy

71
Q

Acute arterial occlusion: guidelines for safe practice

A

monitor the affected limb for any change in circulatory status

monitor temp, color, sensation, and pain

monitor peripheral pulses

keep the extremities warm, but don’t apply direct heat

avoid chilling

maintain BR unless activity is specifically ordered

keep the extremities flat or in slightly dependent position to promote perfusion

use an overbed cradle to protect a painful extremity from the pressure of linens

use a sheepskin and 4-in foam mattress beneath the extremity

do not elevate the bed at the knee; no crossing legs

keep the head of the bed low to support circulation to the lower extremities

72
Q

Aneurysms

A

weakness, out pouching or dilation of an artery

73
Q

Aneurysms commonly occur in

A

aortic-thoracic or abdominal

74
Q

Aneurysms etiology

A

men 50 to 70

atherosclerotic disease, trauma, syphilis, congenital, infection

smoking, HTN, PVD, hyperlipidemia, genetic disposition

75
Q

Types of aneurysms: fusiform

A

entire circumferential segment of the vessel–> diffuse dilated lesion

76
Q

Types of aneurysms: saccular

A

Involve only a portion of the circumference of the vessel, appears to have an out pouching

77
Q

Types of aneurysms: myctotic

A

rare; infectious aneurysms of the aorta caused by…

staph
strep
salmonellae

78
Q

Types of aneurysms: pseudoaneurysms

A

adventitia is dilated, although the media and intimal layers are unaffected –> clots can mimick this

79
Q

Aneurysms: characteristics

A

Adult health 2 (10 decks)

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