L2 Heart Flashcards
Arterial insufficiency and ulcer
Pain: contant and sharp pain to claudication
Pulse : diminish
Skin: dry shiny skin
Arterial ulcer
Location: tip of toes
Pain: very pain
Appearancew: black and dry
No or minimal edema
Venous insufficiency
Pain: achy and cramp
Pulse: have but weak
Skin: reddish blue, dermatitis
Venous ulcer:
Location: ankle
Pain: little
Location: not specific
Assesment to patient w/ peripheral arterial sufficiency
Health history
Risk factors
s/s of arterial insufficiency
Claudication
Pain
Skin change
Diagnosis for arterial insufficiency
• Altered peripheral tissue perfusion
• Chronic pain
• Risk for impaired skin integrity
• Knowledge deficient
Plannign for arterial sufficiency
Protection of extremities
Low fat diet
Weight reduction
Intervention to improve arterial circulation
Exercise like walk
Positioning strategies—> rise up lower extremities
No smoke
Stress reduction
Elastic socks
Avoid prolonged sitting
Varicose vein- preventive measures
Avoid socks that are too tight
Elevste leg above heart
Weight loss
Pulmonary edema patho+s/s
Accumulation of fluid
Patho:
1. left ventricle blood overload
2. Pressure increase in pulmonary system
3. Water move out of cappilary to interstitial space of alveoli
4. Hypoxemia
S/s : restlessness, anxiety, dyspnea, cool skin, increased sputum, less consciousness
Nursing management of pulmonary edema
Positioning- to reduce venous return to heart
Medication- provide diuretic
Inspect Jugular venous pressure
At semi-fowler
Vein not visible- right side of heart normal functioning👌🏼
Visible:
Congestive heart failure
Pulmonary embolism
IV fluid overflow
Treatment of Acute Myocardial Infarction
Medication: aspirin, morphine, beta-blocker
Oxygen therapy
Bed rest for 12-24hrs
Thrombolytic therapy 溶栓治療
通波仔英文+definition
Percutaneous coronary intervention
Surgery that a catheter is placed inside a coronary artery
搭橋手術英文+definition
Coronary artery bypass graft
Blood vessel is grafted to a distal part to bypass lesion or obstructed section
Postoperative care for cardiac surgical patient
Neurological test
1. Lvl of responsiveness
2. Pupil
3. Pain
4. Movement
Skin colour/ temperature
Tu
NG tube to avoid stomach compress
Diagnosis of ACS patient
Acute pain related to increased myocardial oxygen demand
Risk of cardiac tissue perfussion
Risk of imbalanced fluid volume
Anxiety
Planning for ACS
Relief of pain
Maintain adequate tissue perfusion
Prevention of myocardial damage
Reduce anxiety
Patient’s adherence to self-care program
Nursing management for ACS/ MI
Oxygen and medication therapy
Bed rest with rising bed head
Pain relief to reduce heart workload
Monitor I/O chart
Frequent postioning
3 valvular disorder
Regurtitation 倒流
Valve not properly closed-> blood backflow
Stenosis 收窄
Valve nit completely open hence blood flow reduced
Valve prolapse 垂鬆
Stretch of valve
Nursing management for valvular disorder
Monitor of complications
(Heart failure)
(Dysrhymias)
Monitor weight gain
Activity with rest period
Sleep with rised head
Assesment of vascular/ lymphatic disorder
Health history
Physical assesment
Peripheral pulse
(Popliteal artery 膝頭後面
Posterior tibial artery腳眼後面
Dorsalis pedis腳背
Location of pain
