Final Flashcards
Cardiac Output
4-8 L/min
Amount of blood pumped from left ventricle in 1 minute
SV x HR
Cardiac Index
2.2 - 4 < 1.5 = grave prognosis 1.5 - 2.0 = cardiogenic shock more accurate cardiac output based on body surface area
Central Venous Pressure (CVP)
2-6 mm Hg
preload for right side of heart
fluid volume status
low CVP indicates the patient is hypovolemic
high CVP indicates the patient is hypervolemic
Pulmonary Artery Pressure (PAP)
15/5
25/15
Pulmonary Artery Wedge Pressure (PAWP)
4-12 mm Hg
indicates left ventricle preload
PAD pressure equivalent when no pulmonary disease is present
Systemic Vascular Resistance (SVR)
afterload for left ventricle
800 - 1400 dynes/sec
Pulmonary Vascular Resistance (PVR)
afterload for right ventricle
100 - 250 dynes/sec
Cardiogenic Shock
initial stage
Decreased cardiac output S/S: systolic BP <90 decreased LOC pale, cool, moist skin decreased urine output chest pain (not absolute)
Cardiogenic Shock
compensatory phase
SNS initiated S/S: tachycardia tachypnea crackles (LV failure) s3 and s4 (LV failure) peripheral edema (RV failure) JVD (RV failure)
Cardiogenic Shock
Progressive stage
Continued myocardial ischemia -dysrrhythmias -chest pain respiratory distress -metabolic and respiratory acidosis -hypoxia neurologic deterioration -decreased LOC
Medical Management of Cardiogenic Shock
Medical management treat underlying cause pharmacologic agents angioplasty enhance effectiveness of pump increase oxygen supply decrease oxygen demand improve tissue perfusion IAPB VAD
Intra-aortic balloon pump
use
improves coronary artery perfusion
inflated during diastole
decreases after load
used for heart failure, cardiomyopathy
When caring for a patient in cardiogenic shock your first nursing priority would be:
to administer IV fluids and (positive) inotropic agents
positive inotropic agents improve cardiac contractility. ex: digoxin, milritrone, and dobutamine
Adenosine (Adenocard)
antidysrhythmic to treat paroxysmal supraventricular tachycardia (PSVT)
slows conduction through AV node, interrupts dysrhythmia producing re-entry pathways and can restore NSR
cardiac monitoring and vital signs
S/E: hypotension, dysrhythmias, short period of asystole following injection
Push FAST!
Verapamil (Calan, Isoptin)
antidysrhythmic to treat supraventricular tachydysrhythmias (SVT)
calcium channel blocker (negative chronotropic and inotropic) also used to treat angina
monitor HR and BP
S/E:
headache, bradycardia and hypotension
Diltiazem (Cardizem, Dilacor XR)
antidysrhythmic to treate PSVT, A fib/flutter (with increased rate)
calcium channel blocker (negative chronotropic and inotropic agent) also used to treat angina
Monitor BP and HR
S/E:
myocardial depression, bradycardia and can increase digoxin levels
Lidocaine
Antidysrhytmic to treat ventricular dysrhythmias
a fast sodium channel blocker, class 1B
local anesthetic effect on heart; decreased myocardial inability
monitor cardiac and assess for s/s of toxicity (confusion, drowsiness, hearing impairment, conduction defects, myocardial depression, muscle
metabolized in the liver
P Wave
First wave in cardiac cycle
denotes depolarization of atria
measures: no more than 0.11 sec long and 0.2 - 0.3 v in height
upright = normal depolarization from atria
inverted = coming from AV node
During physical assessment of patient with the nurse would suspect A fib when palpation of the radial pulse reveals:
an irregular pulse rhythm
A fib = irregularly, irregular pulse
no regularity to rhythm
Stroke volume
amount of blood ejected per heartbeat
A client who is hemorrhaging has decreased preload. What physiologic event will follow?
Decreased cardiac output
Normal ejection fraction
50-70
percentage of blood ejected with systole
Which of the following discharge instructions should the nurse stress to a patient with stable angina?
sit or lie down when taking sublingual nitroglycerin (NTG)
coronary vasodilator, also dilates vessels in brain, can cause dizziness, risk for falling
If on patch, patch on 12 and off 12
If pain not controlled after first dose, call 9-1-1 and take second dose
PR Interval (PRI)
P wave with adjoining straight, flat line
Denotes time from SA node to AV node
measures 0.12 - 0.20
QRS Complex
Depolarization of the ventricles
measures <0.10
ST segment
early phase of ventricular depolarization
measures 0.12 seconds or less
T wave is actual ventricular repolarization phase
T wave measures: 0.20 seconds or less
QT Interval
Ventricular depolarization through ventricular depolarization
Mesures: 0.36 - 0.44 seconds
EKG Time and Measurements
small squares = 0.04 seconds
large squares = 0.20 seconds
5 small squares = 1 large square
To calculate the rate with EKG
# of R to R intervals in 6 second strip and multiply by 10 # of large boxes between 2 QRS complexes and divide by 300 # small boxes between 2 QRS complexes and divide by 1500
Premature Ventricular Contractions (PVC)
ectopic (irritable) foci in ventricular myocardium
initiates depolarization from cell to cell, not via a pathway
etiology: hypoxia, ischemia, electrolyte imbalance, acid - base imbalance
Ventricular Tachycardia
Etiology:
same as PVCs
allowed to repeatedly occur
Ventricular Fibrillation
Etiology:
multiple foci independently causing separate sections of ventricular myocardium to contract in unorganized fashion
VT frequently proceeds to V fib
Asystole
lack of electrical activity
“flat line”
may masquerade as fine v-fib
verify in two separate leads
The best indicator of fluid balance is:
weight
2.2 lb = 1 kg = 1 L of fluid
Heart failure
inability of the heart to work effectively as a pump
On initial assessment of a patient with acute myocardial infarction (AMI), the nurse would most likely find:
hypertension
cardiac arrhythmias
sympathetic nervous system kicks in and causes HTN and tachycardia
Left Sided Heart Failure
AKA congestive heart failure
typically caused by: hypertensive, coronary arter, valvular disease
2 types: systolic and diastolic
Right-Sided Heart Failure
Causes: left ventricular failure, right ventricular MI, pulmonary hypertension
Right ventricle cannot empty completely
Increased volume and pressure in venous system and peripheral edema
When teaching a patient about complications of A fib, the nurse understands that the complications can be caused by:
statsis of blood in the atria
In planning care for a patient with acure myocardial infarction (AMI), the nurse identifies the highest priority goal of care as:
relief of pain
pain indicates ischemia to the heart muscle
The nurse recognizes second-degree AV block, type II (Mobitz II) and intervenes appropriately when s/he:
prepares for temporary pacemaker insertion
Atropine can also be used for this patient while waiting on pacemaker
A common abnormality associated with the development of peripheral vascular disease (PVD) is:
High serum lipids
atherosclerosis clogs your vessels
arteriosclerosis
thickening or hardening of arterial wall often associated with aging
Atherosclerosis
Type of arteriosclerosis involving formation of palque within arterial wall
Atherosclerosis
Physical assessment/Clinical Manifestations
Monitor BP
Palpate pulses in all major sites of the body
assess for prolonged capillary refill
assess for bruit
Atherosclerosis
Lab assessment
lipid level, including cholesterol and triglycerides, elevated
HDL and LDL
High serum levels of homocysteine can allow cell walls to become vulnerable to plaque buildup
The client admitted with PVD (peripheral vascular disease) asks the nurse why her legs hurt when she walks. The nurse bases a response on the knowledge that the main characteristic of PVD is:
Decreased blood flow
to muscle; O2 demand greater than O2 supply
This is called intermittant claudication
The nurse is assessing the lower extremeties of the client with PVD. The nurse would expect to find:
Mottled skin
d/t decreased blood flow
TX: vasodilators, plavix, eventually surgery
Atherosclerosis
Interventions
Evaluate total serum cholesterol levels and lifestyle changes nutrition therapy drug therapy smoking cessation exercise complementary and alternative therapies
Six P’s of arterial insufficiency
Pain Pallor Pulselessness Paresthesia Paralysis Poikilothermia (coolness)
Acute Peripheral Arterial Occlusion
Embolus - most common cause of occlusions, although local thrombus may be cause
May affect upper extremities but most common in lower extremities
Drug therapy
Surgical therapy
Nursing care
Aneurysms of the Peripheral Arteries
Femoral and popliteal aneurysms
S/S: limb ischemia, diminished or absent pulses, cool to cold skin, pain
TX: surgery
Post Op care: monitor for pain
The nurse should instruct a patient who has been diagnosed with Raynaud’s disease to:
wear gloves when handling ice or frozen foods
What is a positive result of using PEEP in the treatment of ARDS?
Alveoli remain open
A patient states that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse explains that tidal volume is the amount of air:
Exhaled normally after a normal inspiration
Amount of air you are breathing in and out
Patient with chest tube and nurse notes that the fluid in the water seal column is fluctuating with each breath that the client takes. What is the significance of this fluctuation?
The chest tube system is functioning properly (tidaling).
[The suction chamber should have continuous bubbling]
What condition can place a patient at increased risk for ARDS?
Septic Shock
also acute pancreatitis, pneumonia
ARDS is also known as:
ALI (acute lung injury)
Normal ABG levels:
pH 7.35 - 7.45
PaCO2 35 - 45
HCO3 21 - 28
Quick method draw arrow up or down for pH. up indicates alkalosis, down acidosis.
next look at resp (PCO), draw an arrow high or low. If arrows in opposite direction problem is respiratory in nature. Next look at HCO if arrow in same direction problem is metabolic in nature
Chest Tube Chambers:
Chamber 1: collects fluid draining from patient
Chamber 2: water seal prevents air from re-entering patient’t pleural space
Chamber 3: suction control of system
Iron Deficiency Anemia
Microcytic
common type of anemia resulting from blood loss, poor intestinal absorption or inadequate diet
if mild - s/s of weakness and pallor
evaluate adult patients for abnormal bleeding, esp from GI tract
TX: increase oral inteake of iron from food sources, oral iron supplements or IM iron solutions
What process is initiated between oxygen and hemoglobin as body temperature increases?
Oxygen unloading is enhanced
Vitamin B12 Deficiency Anemia
Macrocytic
lack of B12 causes improper DNA synthesis of RBCs
Causes: poor intake of foods containing B12, small bowel resection, tapeworm, overgrowth of intestinal bacteria
Pernicious Anemia
Anemia resulting from failure to absorb vitamin B12
Caused by a deficiency of intrinsic factor
Folic Acid Deficiency Anemia
Manifestation similar to those of vitamin B12 deficiency, but nervous system function remains normal
common causes - poor nutrition, malabsorption and drugs
Serum Electrolyte Levels
Sodium
135 - 145
Serum Electrolyte Levels
Potassium
3.5 - 5
Serum Electrolyte Levels
Calcium
8.5 - 10.2
Aplastic Anemia
dificiency of circulating RBCs because of failure of bone marrow to produce these cells
pancytopenia common
TX: blood transfusions
immunosuppressant therapy
splenectomy
Pancytopenia
Deficiency of RBC, WBCs and platelets
Thrombotic Thrombocytopenia Purpura (TTP)
rare disorder; platelets clump together abnormally in capillaries, and too few platelets remain in circulation
inappropriate clotting, yet blood fails to clot properly when trauma occurs
TX: plasmapheresis, fresh frozen plasma, aspirin, alprostadil, plicamycin, and immunosupressive therapy
Heparin Induced Thrombocytopenia (HIT)
serious immune-medicated clotting disorder that features an explained platelet count after Heparin administration
increasing because of the increased use of Heparin
can occur in any patient that receives Heparin therapy:
- unfractioned heparin
- low molecule weight heparin
Disseminated Intravascular Coagulation (DIC)
forms thousands of small clots in the tiny capillaries of the liver, kidneys, brain, spleen and heart
reduces oxygenation and decreases o2 saturation causing hypoxemia and ischemia
the clots use clotting factors and fibrinogen faster than they can be produced
occurs with septic shock
with continued capillary leak, the bleeding causes hypovolemia and a drastic decrease in cardiac output, blood pressure and pulse pressures
When caring for a patient with CREST syndrome associated with scleroderma, the nurse teaches the patient to:
Encourage small frequent meals in upright position
difficulty swallowing with scleroderma due to esohphageal dysmotility and decreased peristalsis
During the emergent phase of burn management, what diagnostic test resutl should the nurse expect to find?
increased H&H decreased serum albumin increased serum potassium increased BUN decreased serum sodium
Parkland Formula
4 ml x patient wt in kg x % of body burned = total fluid replacement for 24 hours.
give 1/2 in first 8 hours and other 1/2 over the next 16 hours
if patient came to ER 1 hour ago, give first 1/2
Treatment of Psoriasis
Corticosteroids Tar preparations other topical therapies ultraviolet light therapy systemic therapy emotional support
A patient with a major burn is receiving silver sulfadiazine (Silvadene) to treat the burns. What nursing action should be implemented when using this medication?
Monitor WBC count daily
Silvadene causes transient leukopenia
For a patient with a major burn, which evaluation criteria indicate that fluid resuscitation is effective during the first 24 hours of care?
Urine output of 30 - 50 ml/h
What is the complication of systemic lupus erythematosus (SLE) that is most common and the leading cause of death?
Nephritis
over 50% of SLE pts develop renal disease
In assessing a female patient with moderate anemia, the nurse would expect to find which of the following?
Complaints of shortness of breath with exercise (or feeling tired all the time)
anemia is usually developed slowly over time
Management of Skin Cancer
surgical: cryosurgery, curettage and electrodesiccation, excision, Mohs’ surgery, wide excision
non surgical: drug therapy and radiation therapy
Lupus Erythematosus
chronic, progressive, inflammatory connective tissue disorder
can cause major body organs/systems to fail
spontaneous remissions and exacerbations
autoimmune process
some degree of kidney involvement
Lupus clincial manifestations
skin involvement: -butterfly rash polyarthritis osteonecrosis muscle atrophy fever and fatigue Renal invovement pleural effusions Raynaud's phenonmenon neurologic manifestations serositis
Scleroderma
chronic, inflammatory, autoimmune connective tissue disease not always progressive hardening of the skin classifications: -diffuse cutaneous -limited cutaneous
CREST Syndrome
C = calcinosis R = Raynaud's phenomenon E = esophageal dysmotility S = sclerodactyly (localized thickening and tightness of the skin of the fingers or toes) T = telangiectasia (spidery, red appearance of capillaries)
**hands and forearm edema with bilateral carpal tunnel syndrome usually first symptoms to occur
Scleroderma Clinical Manifestations
arthralgia
renal and cardiac system involvement
problems with GI tract
lung involvement
