Med surge exam 3 Flashcards
arrhythmia
irregular heartbeat
bruit
a humming is heard that is caused by the turbulent blood flow through the vessel
claudication
pain in the legs with activity
clubbing
this occurs from oxygen deficiency over time
it is often caused by congenital heart defects or long term use of tobacco
hyperkalemia
high potassium level
healthy is 3.5 to 5
hypomagnesemia
low level of magnesium
ischemic
in areas of decreased arterial blood flow, the ischemic area feels cooler than the rest of the body
murmur
prolonged swishing sound
pericardial friction rub occurs from
inflammation of the pericardium
poikilothermy
the area becomes the temperature of the environment.
because of the absence of sufficient arterial blood flow,
point of maximum impulse
the thorax can be palpated at this point.
If palpable a thrust is felt when the ventricle contracts
(an enlarged heart may shift the PMI to the left of the midclavicular line)
preload
pressure is stretching the ventricle of the heart from fluid that is returned to it.
pulse deficit
if there are fewer radial beats than apical beats
This should be reported to the HCP
sternotomy
closed with wires through the sternum.
thrill
in an abnormal vessel that has a bulging or narrowed wall, a vibration is felt.
location of the heart
located in the mediastinum within the thoracic cavity
the structure of the heart.
the walls of the four chambers of the heart are made of cardiac muscle (myocardium) and are lined with endocardium
epithelium also covers the valve of the heart and continues into blood vessels, at which point its called
endothelium
during exercise, venous return increases and stretches the ventricular myocardium, which in response contracts more forcefully. this is called
starlings law
this results in increase stroke volume
arteries and arterioles carry blood from the heart to
capillaries
these carry blood from arterioles to venules and form extensive networks in most tissues
capillaries
decreased blood pressure stimulates kidneys to secrete renin. which initiates the
renin-angiotensin-aldosterone mechanism
which raises blood pressure
atherosclerosis
the deposition of lipids in the walls of arteries over a period of years
if blood pressure has a different reading in both arms
report to the health care provider(hcp)
cardiac output
amount of blood pumped out each minute
essential hypertension (primary hypertension)
chronic high BP from an unknown cause
hypertension
high blood pressure
hypertensive emergency
risk for progression of target organ dysfunction
hypertensive urgency
high blood pressure without organ dysfunction progression
peripheral vascular resistance
is the ability of the vessels to stretch
primary hypertension
unknown cause
secondary hypertension
the cause is known
viscosity
thickness of the blood
processes that influence blood pressure
nervous system regulation, arterial baroreceptors, chemoreceptors, the renin-angiotensin-aldosterone mechanism, and balance of body fluids
hypercalcemia could be hazardous to a patient on
digoxin
if a pt needs to be on loop diuretics it is contraindicated if they are
allergic to sulfonamides
allograft
a human cadaveric or living donor
annuloplasty
the repair or reconstruction of the valve flaps or annulus
autograft
self donor
beta-hemolytic streptococci
causes rheumatic fever
bio-prosthesis
tissue valves
cardiac tamponade
life-threatening compression of the heart by fluid accumulated in the pericardial sac.
cardiomegaly
abnormal enlargement of the heart
cardiomyopathy
an abnormality and enlargement of the heart muscle that leads to ineffective pumping of the blood.
chorea
brief rapid, uncontrolled movements
commissurotomy
repairs a stenosed valve
which is most commonly the mitral valve
Dressler syndrome
autoimmune response
emboli
results from the stasis of blood in the left atrium that may cause stroke
homograft
another term for allograft
living donor
infective endocarditis
an infection of the endocardium
mostly occurs in hearts with artificial or damaged valves or pacemakers
international normalized ratio
measures the effectiveness of warfarin therapy using a standardized testing reagent
myectomy
procedure to remove heart muscle
myocarditis
inflammation of the myocardium.
the amount of muscle destroyed with myocarditis determines the extent of damage to the heart
pericardial effusion
build up of fluid in pericardial space
pericardial friction rub
grating, scratching, high pitched sound that is the result of friction from the inflamed pericardial and epicardial layers rubbing together as the heart fills and contracts.
what is treated with a pericardiectomy?
chronic constrictive pericarditis
pericardiocentesis
the pericardium is punctured with a needle and excess fluid in the pericardial sac is removed.
pericarditis
an acute or chronic inflammation of the pericardium
petechiae
tiny red or purple flat spots
regurgitation
if a valve does not close completely, blood backs up
rheumatic fever
autoimmune reaction 2 to 3 weeks after an upper respiratory infection due to a group A beta-hemolytic streptococci infection.
thrombophlebitis
formation of clot followed by inflammation within the vein
valvotomy
expansion of a balloon to open the mitral valve
valvuloplasty
a balloon dilates the stenosed heart valve
xenograft
tissue valves that com from cow(bovine) or pig (porcine)
the two types of valvular dysfunction
stenosis and insufficiency
thickening of the mitral valve flaps and shortening of the chordae tendineae, causing narrowing of the mitral valve opening.
mitral stenosis
post cardiac catherization care
Firm pressure to the insertion site for several minutes to prevent hemorrhage or hematoma formation.
A pressure dressing/sandbag may be applied to the site when bleeding stops.
Vital signs
which cardiac biomarker indicates an MI
troponin
blood test
who is at the highest risk for death related to cardiovascular disease?
the elderly
the rate for the SA node
AV Node
The ventricular rate
75 to 100
40 to 60
20 to 35
interventions for pulse deficit
have the pt rest and have another hcp check the apical while you check the radial pulse
Contact The HCP.
holter monitoring
heart monitor
normal blood pressure reading supposed to be
120/80
what test do you perform if potassium level is out of range
EKG
under inspection
what is brown discoloration and
purple skin?
may be seen in the presence of venous flow problems.
interventions and rational for ineffective health management of hypertension
- Identify patient’s modifiable risk factors and lifestyle modifications needs.
- Develop plan to overcome identified barriers to patient adhering to therapy.
- Make referrals as needed
- Teach patient to take medications as prescribed and not to skip dosages.
- Teach pt. to change positions slowly to prevent falls.
follow up time frames for different blood pressures
For those with normal B P • 3 to 5 years For those over the age of 39 or with increased risk • Annually
who is at high risk for hypertension
nonmodifiable and modifiable
Nonmodifiable family history of hypertension age race and ethnicity Modifiable weight control diet increase physical activity glucose control
explain another explanation of hypertensive emergency
systolic bp higher than 180 mm Hg or diastolic BP higher than 120 occurs
what are the therapeutic measures for hypertension?
Lifestyle changes. L- limit salt, caffeine, and alcohol. I-Include daily potassium and calcium F- Fight fat and cholesterol E-Exercise regularly S-Stay on your BP regime T-Try to quit smoking Y-Your medication is to be taken daily L-Lose weight E- End-stage complications will be avoided. consideration of antihypertensive medications.
what medication will be prescribed for stage 1 hypertension?
Thiazide-like diuretic
Angiotensin-converting enzyme (A C E) inhibitor
Angiotensin Two receptor blocker
Calcium channel blocker
a non pharmacological intervention
call the physician
do not hold unless she instructs it.
a non pharmacological intervention
call the hcp
what are the safety measures for coumadin use
monitor INR and monitor for bleeding (teach patient to report bleeding)
who is the highest risk for mitral valve prolapse?
ischemic heart disease
cardiomyopathy
infection damaging the mitral valve and
hereditary collagen tissue disorder
interventions for aortic regurgitation
Digitalis
Diuretics
Vasodilators
Valve replacement
antidotes for coumadin and heparin
antidote for coumadin is vitamin k
antidote for heparin is protamine sulfate
interventions and rationales for a nursing diagnosis of decreased cardiac output related to post op cardiac surgery
For patients with increased preload, limit fluids and sodium as ordered.
Closely monitor fluid intake, including IV lines. Maintain fluid restriction if ordered.
Place on a cardiac monitor; monitor for dysrhythmias, especially atrial fibrillation.
causes of ineffective endocarditis
- Most commonly bacteria but possibly fungi or other organisms.
- Entry of organism into bloodstream
what is angina?
chest pain due to not enough blood or oxygen
what is dilated cardiomyopathy ?
- Size of the heart chambers increase
- The wall of the heart become thin
- Cardiac output is reduced
- Blood moves more slowly from the left ventricle
- This often results in blood clot formation
who is at risk for DVT?
hospitalized patients who are immobile after surgery
What are the complications of aortic stenosis?
- Heart failure
- Arrhythmias
- Emboli
- Endocarditis
- Sudden cardiac death
pericarditis summary
s/s chest pain, cough, edema, low-grade fever, and pericardial friction rub
therapeutic measures
treat underlying causes
Anti-inflammatory medication, corticosteroids, pericardiocentesis, and percardiectomy
data collection for thrombophlebitis
dimer and coagulation tests compression ultrasonography contrast venography MRI CT scan
what are some complications of a DVT?
Pulmonary embolism (Life-threatening emergency)
• Chronic venous insufficiency
• Varicose veins
• Recurrent D V T
what are the s/s peripheral vascular disease?
numbness, tingling, or weakness
what are the 6 P’s of PVD
pain paresthesia( decreased sensation) pallor pulselessness paralysis poikilothermia (assumes temperature of the environment)
What are the therapeutic measures for a DVT?
compression socks
blood thinners
ambulation every two hours
thrombophlebitis therapeutic measures
Superficial veins ‒ Warm, moist heat ‒ Analgesics ‒ N S A I D’s ‒ Elastic compression stockings D V T (if uncomplicated) ‒ Low-molecular weight heparin/heparin ‒ Warfarin (coumadin) ‒ Monitor appropriate lab values ‒ Bedrest (elevate extremity above heart level) ‒ Warm, moist heat ‒ Compression stocking therapy ‒ Thrombolytic therapy thrombectomy
