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Nursing > Maegan's Test #4 - Circulation > Flashcards

Maegan's Test #4 - Circulation Flashcards

1
Q

What is the leading cause of morbidity and mortality in the US?

A

Cardiovascular Disease

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2
Q

There are often other diseases that co-exist with cardiovascular disease, What are a few examples?

A

Diabetes

Mellitus

Obesity

Hyperlipidemia

Tobacco and/or alcohol abuse

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3
Q

What is the amount of force exerted on the arterial walls by the blood flowing within the vessels?

A

Blood Pressure

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4
Q

What are the normal ranges for Systolic and Diastolic Blood Pressure?

A

Systolic 100-120 mmHg

Diastolic 60-80 mmHg

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5
Q

What are the components of Blood Pressure?

A

Pump

Fluid Volume

Vascular Bed

(Heart Rate and Force of Contraction)

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6
Q

The ULTIMATE GOAL of Blood Pressure is that it adjusts to maintain _______ Perfusion.

A

Blood Pressure is adjusted to maintain TISSUE Perfusion

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7
Q

What is the amount of blood pumped by the ventricles in 1 minute?

A

Cardiac Output

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8
Q

How do you Calculate Cardiac output?

A

Heart Rate X Stroke Volume (~70mL for healthy adult)

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9
Q

The Venus pressure is ____ _____ to adequately return blood to the heart.

A

The Venus pressure is TOO LOW to adequately return blood to the heart.

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10
Q

What are some of the Assistive mechanisms that help the Venous return?

A

Respiratory Pump

Muscular Pump
(Pushes blood toward heart)

Venous Valves
(Prevents backward flow of blood)

(Draws blood toward heart with deep breath)

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11
Q

What are the three types of Diseases/Disorders of the Cardiovascular system?

A

Congenital (Born with) VS Acquired

Structural VS Functional

Acute VS Chronic

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12
Q

What is the primary problem with a cardiovascular disease?

A

Impaired Tissue Perfusion

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13
Q

What are 3 risk factors for cardiovascular disease?

A

Heredity

Age
(As you get older you are at higher risk)

Gender
(Before menopause men are at higher risk, After Menopause it evens itself out)

(At higher risk if it runs in the family)

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14
Q

What are some of the Modifiable risk factors for cardiovascular disease? (Things that can be changed by client)

A

Elevated Lipid Levels

Hypertension

Cigarette Smoking

Diabetes Mellitus
(High Levels of Glucose damages blood vessels)

Obesity
(Not just the volume of weight but where they carry that weight-Apple shaped at higher risk than Pear)

Waist Circumference

Sedentary Lifestyle

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15
Q

What are some Lab tests you would do to check for cardiovascular problems? (3 tests)

A

Lipid & cholesterol Levels Homocysteine Levels

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16
Q

What are some cardiovascular focused assessments you would do?

A

Level of Consciousness (LOC) Orientation Skin Color, temp, moisture & turgor P,R, BP (Do both arms within 10 mmHg) Apical Pulse (Just know rate/Rhythm) Heart Sounds (Rhythm & if murmur) Peripheral Pulse (Do both at same time and know presence, rate, rhythm, strength and equality) (0-No Pulse 1-Weak 2-Normal 3-Bounding) Edema Tilt test (Test for Orthostatic hypertension)

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17
Q

When performing a tilt test, what would change in blood pressure and pulse to provide a positive tilt test result?

A

Blood Pressure Systolic- decrease 20mm Dystolic- decrease 10mm Pulse Increase by 15-30 bpm

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18
Q

What are some nursing problems/diagnosis for decreased cardiac output?

A

Decreased heart rate or force of contraction Increased heart rate (>150) Decreased fluid volume or hemorrhage Arrhythmias Incompetent valves Myocardial Ischemia (heart not getting enough oxygen)

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19
Q

What is the main Nursing Goal for decreased cardiac output?

A

Maintain & restore cardiac output

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20
Q

What is the main goal for tissue perfusion?

A

Maintain or Improve tissue perfusion

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21
Q

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport ____________ & _____________ to tissues

A

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport OXYGEN & NUTRIENTS to tissues

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22
Q

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport ______ ______ & ______ _______ from tissues for elimination

A

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport WASTE PRODUCTS & CARBON DIOXIDE from tissues for elimination

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23
Q

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport _________ & _____________ to target organs.

A

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport HORMONES & MEDICATIONS to target organs.

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24
Q

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport ______ ________ _______ & ____________ to points of inflammation or infection.

A

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport WHITE BLOOD CELLS & ANTIBODIES to points of inflammation or infection.

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25
Q

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport _____________ & __________ _____________ to points of injury.

A

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport PLATLETS& CLOTTING FACTORS to points of injury

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26
Q

The Cardiovascular system is responsible for regulating what items? (There are 3)

A

Body Temperature

pH (Regulates this)

Fluid & Electrolyte status
(Filtering through Kidney & Producing urine)

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27
Q

What is the electrical & mechanical activity that results in one heartbeat?

A

Cardiac Cycle

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28
Q

There are two phases to the cardiac cycle, what are they?

A

Contraction

Relaxation
(Diastole - Ventribles refil with blood)

(Systole - Blood ejected from heart)

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29
Q

What is it when the atria contract at end of diastole, adding additional volume to the ventricles?

A

Atrial Kick

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30
Q

Cardiac Output is adjusted to meet tissue needs, by adjusting your heart rate & the force of contraction. What are the two effects for those?

A

Chronotropic Effect
Increace Heart Rate

Inotropic Effect
Increase in how hard it thumps

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31
Q

What are some risk factors for Metabollic syndrom? (There are 5)

A

Central Obesity

Elevated Triglycerides

Lower HDL Cholesterol

Hypertension

Increased fasting glucose

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32
Q

What are 3 Diagnostic/Lab testsyou could do to check the Cardiovascular system?

A

12 Lead Electrocardiogram (EKG)
Identifies rhythm & diagnose acute events

24 Hour Holter Moniter
Catch “Intermittent” events

Telemetry/Bedside Monitoring
Monitor rhythm continuously

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33
Q

What are some nursing implications you could do for Electrophysiological studies (EKG, Telemetry)?

A

Observe electrical activity

No NPO or prep involved

Jelly filled electrodes applied to chest or limbs

May need to clip hair, dry skin, or abrade skin

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34
Q

If there is a change on the monitors what is the 1ST PRIORITY?

A

ASSESS THE CLIENT
Don’t assume since it shows no heart rate that the client is dead

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35
Q

What are 3 types of Imaging studies you can do to chekc on the cardiovascular system?

A

Echocardiogram

Doppler study
(Arterial or Venous blood flow)

CT or MRI
(Structural Anomalies)

(Structure and motion of the heart)

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36
Q

What are some nursing implications for Imaging Studies?

A

Painless but ultrasound jelly may be unpleasant

Client needs to lie still & follow tech’s instructions

Place client in gown

Some echo’s & doppler’s done at bedside

CT or MRI may include contrast
Assess for allergies and keep client NPO

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37
Q

What are some Bloodwork tests that can be ran to test the Cardiovascular system? There are 5

A

Lipid & Cholesterol Levels

Homocysteine Levels

Cardiac Enzymes (Troponin, CPK, LDH)
 (3 enzymes, 1 test - ordered for specific heart issues)

Anemia
(Compromises ability to carry oxygen to tissue)

Electrolyte Imbalance
(Fluid helps contract & relax)

(Common Prractice)

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38
Q

What are some nursing implications for bloodwork?

A

Some tests require NPO status

Responsible for notifying PCP of critical values
(When at risk for complication)

(Lipid & Cholesterol / Homocysteine Levels)

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39
Q

What are some assessment items you would ask when assessing the history on a client with cardiovascular issues?

A

Medical Hx - Cardio, Respiratory, Diabetes

Family Hx

Smoking Hx

Diet - Especially fat, salt, alcohol & caffeine

Exercise - Amount & type

Medications - Heart, BP, Circulation, cholesterol;
INCLUDE HERBALS

Lifestyle - Stressors, support, & coping Method

Symptoms - Pain, SOB, fatigue, palpations, cough, fainting

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40
Q

What are some physical assesments you would do when focused on cardivascular?

A

LOC
Level of Consciousness

Orientation

Skin - Turgor, color, temp, moisture

P, R, BP (Both arms within 10mmHg)

Apical pulse - JUST rate & rhythm

Heart Sounds - Know normal & mumur

Peripheral Pulses - Presence, rate, rhythm, strength, equality

Edema

Tilt Test

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41
Q

When assessing rhythm of pulse there are 4 stages, what are they?

A

0 - No pulse

1 - Weak

2 - Normal

3 - Bounding

42
Q

What are some Nursing Problems/Diagnosis for Decreased Cardiac Output?
There are 6

A

Decreased Heart rate or force of Contraction

Increased Heart Rate - >150
(Overall Cardiac output will diminish)

Decreased fluid volume or hemorrhage

Arrhythmias

Incompetent Valves

Myocardiao Ischemia
(Muscle not getting adequate oxygen)

43
Q

What are some signs & symptoms of decreased cardiac output?

A

Angina
Not getting enough oxygen to blood

SOB/Dyspnea(Painful Breathing)

Dizziness or lightheadedness

Nausea

diaphoresis

Decreased BP

Weak or Irreg pulses

Cool skin

Pale, ashy, dusky, or cyanotic skin

weakness

Fatigue

44
Q

What is the MAIN goal for decreased cardiac output?

A

Maintain or restore Cardiac Output

45
Q

What are 3 MAIN interventions for decreased cardiac output?

A

Place on Monitor

Provide Oxygen

SLN (To be able to give fluids and meds)

46
Q

What are two interventions you would do for a decreased heart rate or force of contraction when relating to decreased cardiac output?

A

Provide inotropic &/or chronotropic med
DIGOXIN

Pacemaker
Internal or External

47
Q

What are 4 interventions you would do if the heart rate was increased to over 150 bpm when relating to decreased cardiac output?

A

Correct fluid volume deficit FIRST

Provide medication to decrease heart rate

may require cardioversion

Stimulate Vagal Response

48
Q

What are 2 interventions for decreased fluid volume or hemmorhage when relating to decreased cardiac output?

A

Stop the bleeding

Provide IV fluids &/or blood transfusion

49
Q

What are 2 interventions for Arrhythmias when pertaining to decreased cardiac output?

A

Provide Medications

May require cardioversion
Unless Chronic

50
Q

What is the MAIN GOAL for impaired tissue perfusion?

A

Maintain or improve tissue perfusion

51
Q

What is an intervention for incompetent valves when pertaining to decreased cardiac output?

A

May require surgical replacement

52
Q

What are 4 interventions for Myocardial Ischemia when pertaining to decreased cardiac output?

A

Provide Notrostat SL to dilate coronary arteries

Provide additional meds & support as ordered
(Ex- ASA, Beta Blocker, BP support, etc)

Remain calm & supportive

Order EKG & Lab to Confirm

53
Q

What are the 2 things you evaluate when it comes to Decreased cardiac Output?

A

Were the interventions effective?

Was the goal attained?

54
Q

What are the 2 problems/diagnosis for IMPAIRED TISSUE PERFUSION?

A

Decreased Cardiac Output

Impaired Blood Flow

  • Thrombus - Clot @ that location
  • Embolus - Clot or piece of plaque brok look from origin & traveled somewhere else)
  • Constrictive/Pressure Issue (Ex: Immobility or compartment Syndrome

(5 Etiologies - Doesn’t include fluid)

55
Q

What are some assessments you would do for decreased cardiac output when pertaining to impaired tissue perfusion?

A

All signs and symptoms of decreased cardiac output

Organ Specific Assessments:

Brain: Confusion, LOC, seizure, weakness, paresthesia, & paralysis

Lungs: SOB, dyspnea, tachypnea, cyanosis, anxiety, pain in chest

Heart: angina, impending doom, arrhythmias, brady or tachycardia

Kidneys: Urine output, fluid volume overload, K level

Peripheral: Unequal pulses, isolated color changes, cool skin, edema, hair pattern, positional color changes, non-healing wounds,&/or ulcers, parasthesias, pains/aches

56
Q

What are some interventions for impaired blood flow when talkng about impaired tissue perfusion?

A

Place client in Tredelenburg

Place client on bedrest

provide anticoagulant and or antiplatelet aggregator as ordered

provide thrombolytic if ordered

Relieve Constriction

Turn client every 2 hours

57
Q

The best approach to a tissue perfusion problem is to ________ __________

A

The best approach to a tissue perfusion problem is to PREVENT OCCURENCE

58
Q

What are some ways to prevent tissue perfusion problems?

A

Leg & Feet Exercises

TED Hose
(tight to divert blood flow to main veins)

SCD’s
(Sequential Compression Devices)

Foot Pumps
(Compress veins on bottom of foot)

Early Ambulation

(Movement promotes venous return)

59
Q

What are 2 items you evaluate when it comes to impaired tissue perfusion?

A

Did we restore blood flow to tissue?

Were our interventions effective?

60
Q

There are 5 drug classes for cardiovascular problems?

A

Antihypertensives

Anticoagulants
(Helps to reduce clotting)

Antiplatelet Aggregators
(Keep platletts from forming clot)

Lipid-Lowering Agents

Antiarrhythmics
(Helps heart beat @ normal rhythm)

(Lower BP)

61
Q

What medication is an antiarrhythmic, increases the force of the contraction and slows condution through the AV node, Comes in oral & IV form, and has the side effect of Bradycardia & Nausea?

A

DIGOXIN (LANOXIN)

62
Q

What are some Nursing implications for Digoxin?

A

Check Apical pulse for 1 minute prior to administering - Hold if <60 & Notify PCP

Monitore Digoxin Level
TERAPEUTIC = 0.5-2.0 ng/ml

Suspec Toxicity & notify PCP if:
Anorexia
Nausea, Vomitting, Diarrhea
visual disturbances (Halo, Blurred, and diplopia)

GINSENG MAY INTENSIFY OR INTERFERE WITH MED!!!

63
Q

Ativan (Lorazepam) is a Benzodiazepine, what are 2 therapeutic uses?

A

Anxiolytic & Sedative-hypnotic

64
Q

What are some side effects of Ativan (Lorazepam)?
Bold is most common
ALL CAPS is what will kill you

A

Bold is most common

Central Nervous System:
Drowsiness, sedation, dizziness, weakness

Cardiovascular:
Hyper/Hypotension, Blurred Vision

GI:
Nausea & Vomitting, abdominal discomfort, anorexia

65
Q

What are some Medication or Food Interactions with Ativan (Lorazepam)?

A

CENTRAL NERVOUS SYSTEM DEPRESSANTS

ANTICONVULSANTS

CIMETIDINE

ALCOHOL

KAVA

Phenytoin levels

66
Q

What are some nursing interventions for Ativan (Lorazepam)?

A

Supervise Ambulation in older patients

Lab tests if patient is on long term therapy:
CBC (Complete Blood Count) & LFT (Liver Function Test)

Supervise for suicide risk

67
Q

What are some teachings for Ativan (Lorazepam)?

A

Do not drive or engage in hazardous activities for 24-48 hours

Do not consume alcohol for at least 24-48 hours

Notify PC if datime psychomotor function is impaired

Terminate use slowly over several days

Discuss termination of trying to get pregnant

68
Q

Valium (Diazepam) is a Benzodiazepine, what are some therapeutic uses?

A

Anticonvulsant

Antianxiety

Skeletal muscle relaxant

Alcohol Withdrawal

69
Q

What are some side effects for Valium (Diazepam)?

A

Dizziness

Drowsiness

Tachycardia

Cardiovascular Collapse

Laryngospasm

ECG Changes

RESPIRATORY DEPRESSION

Throat/Chest Pain

Fatigue

Blurred Vision

Urinary Retention

Ataxia

70
Q

What are some medication or food interactions with Valium (Diazepam)?

A

Alcohol - Causes increased Central Nervous System Depression

Kava(Herbal Supp) - Causes increased sedation

Smoking - Decreases sedation & anxiety effect

71
Q

What are some nursing interventions for Valium (Diazepam)?

A

Monitor I&O

Supervise ambulation

Suicidal tendencies

Monitor for adverse effects

72
Q

What are some teachings you should do for Valium (Diazepam)?

A

AVOID ALCOHOL & CNS DEPRESSANTS

Do not drive

Take as prescribed

73
Q

Xanax (Alprazolam) is a Benzodiazepine, what are some therapeutic uses?

A

Antianxiety

Sedative-hypnotic

74
Q

What are some side effects of Xanax (Alprazolam)?

A

Drowsiness

Sedation

Confusion

Insomnia

Headache

Fatigue

Tachycardia

Hypotension

ECG Changes

Dyspnea

75
Q

What are some of the medication/food interactions with Xanax (Alprazolam)?

A

Alcohol

Cimetidine

Disulfiram

Fluoxetine

KAVA

ST JOHNS WART

Valerian

Antihistamine’s

76
Q

What are some nursing interventions for Xanax (Alprazolam)?

A

Monitor for Signs and Symptoms of drowsiness & Sedation

Elderly may need help with ADL’s & Ambulation

Continued therapy needs periodic lab tests

77
Q

What are some teachings for Xanax (Alprazolam)?

A

Make position changes slowly

No alcohol use or OTC meds for allergies or sleep

No driving

TAPER OFF!!!

78
Q

Buspar (Buspirone Hydrochloride) is NOT related to other benzodiaepines or barbituates, What is a therapeutic use?

A

Antianxiety

79
Q

What are some Side effects for Buspar (Buspirone HCI)?

A

Dizziness

Headache

Drowsiness

Nausea

Tachycardia

Palpitation

Blurred Vision

Urinary Frequency

Hyperventilation/SOB

80
Q

What are some medication or food interactions withBuspar (Buspirone HCI)?

A

MAOI INHIBITORS

TRAZADONE

GRAPEFRUIT JUICE

ST JOHNS WORT

Haloperiod Serum Levels

81
Q

What are some interventions for Buspar (Buspirone HCI)?

A

Monitor Therapeutic effectiveness in 7-10 days

Reinforce importance of continuing treatment plan

Monitor Dystonia (Abnormal Muscle spasms)

Observe and report adema, decreased urinary output, jaundice, Nausea & Vomitting, and itching

82
Q

What are some teachings for Buspar (Buspirone HCI)?

A

Report any changes immediately

Do not use OTC drugs

Do not drive until you know how dose effects you

Discuss limits of alcohol intake

83
Q

Benzodiazepines are Anti-anxiety, Sedative-Hypnotics, and Anti-Convulsants, what are some side effects?

A

Sedating

Muscle Relaxing

Hypotension

CNS Suppressant

84
Q

What are some medication or food interactions with Benzodiazepines?

A

Alcohol increases it’s effects

85
Q

Digoxin (Lanoxin) increases the force of contraction & Slows conduction through AV node which is a negative chronotropic effect, what are some of the therapeutic uses?

A

Inotropic antidysrhythmic

Cardiac glycoside

86
Q

What are some side effects from Digoxin (Lanoxin)?

A

***Bradycardia

***Nausea

DYSRHYTHMIAS

HYPOTENSION

AV BLOCK

Drowsiness

Apathy

Confusion

Bradycardia

87
Q

What are some medication or food interactions with Digoxin (Lanoxin)?

A

GINSENG
May intensify or interfere with med

88
Q

Proventil (Albuterol) is a Bronchodilator & Beta-Adrenergic Agonist, What are some side effects?

A

Tremor

Anxiety

Nervousness

Weakness

Hypertension

Muscle Cramps

89
Q

What are some medication/food interactions with Proventil (Albuterol)?

A

EPINEPHRINE

OTHER SYMPATHOMIMETIC BRONCHODILATORS

MAOI INHIBITORS

TRICLIC

ANTIDEPRESSANT

BETA ADRENERGIC BLOCKERS

90
Q

What are some nursing interventions for Proventil (Albuterol)?

A

Monitor for effectiveness
Signifigant improvement of pumonary function within 60-90 min

Signs & Symptoms of:
Tremors, Tachycardia, Hyperactivity, Pulse OX

91
Q

What are some teachings you would do for Proventil (Albuterol)?

A

Review directions and proper administration

Avoid contact with eyes

Do not increase dosage

Notify if fails to provide relief

Causes vertigo & dizziness

Do not use OTC drugs(Cold Remedies)

92
Q

Nitro-Dur (Nitroglycerin) is a Nitrate vasodilator & antianginal, what is it given for?

A

ANGINA
*Repeat every 5 minutes - No more than 3 times

93
Q

What are some therapeutic uses for Nitro-Dur (Nitroglycerin)?

A

Decreases Peripheral in vascular resistance

Decreases blood pressure

Decreases Venous Return

94
Q

What are some side effects of Nitro-Dur (Nitroglycerin)?

A

Headache

POSTURAL HYPOTENSION

CIRCULATORY COLLAPSE

95
Q

What are some medication/food interactions with Nitro-Dur (Nitroglycerin)?

A

ALCOHOL

ANTIHYPERTENSIVE AGENTS

Heparin

96
Q

What are some nursing interventions for Nitro-Dur (Nitroglycerin)?

A

CHECK BP EACH DOSE
Hold if BP is less than 100!!

97
Q

What are some teachings for Nitro-Dur (Nitroglycerin)?

A

Store in original DARK container

Sit or lie down when taking, Relax 15-20 min after taking to prevent dizziness

Report if no relief is achieved or if an increase in frequency or severity (CALL EMS)

Keep records of attacks

Replace every 6 months

98
Q

What lung sound is this…

A

Course Crackles

99
Q

What lung sound is this?

100
Q

What is this lung sound?

101
Q

What is this lung sound?

Nursing (20 decks)

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