Medsurg Exam 1: Vascular Disease + Endocarditis

Question 1

Vascular Diseases

Answer 1

Diseases of the vasculature

Question 2

Arteriosclerosis

Answer 2

thickening of the arterial wall

Question 3

Atherosclerosis

Answer 3

(a type of arteriosclerosis )

Question 4

Prevention is the goal

Answer 4

healthy BP, physical exercise, weight reduction, DASH Diet which emphasizes vegetables, fruits, whole grains, eat low fat diary, poultry, fish, legumes

Question 5

DASH Diet

Answer 5

Dietary approaches to stop HTN
Emphasize vegetables, fruits whole grains
Eat low fat diary, poultry, fish, legumes, non tropical vegetable oils and nuts
Limit sweets, sugar sweetened beverages red meats

Question 6

Causes of Atherosclerosis

Answer 6

HTN
Coronary artery disease
Cerebrovascular disease
Peripheral artery disease

Question 7

contributing factors of Atherosclerosis

Answer 7

age, smoking, high lipid levels

Question 8

Interventions for Atherosclerosis

Answer 8

May place a stent
Balloon percutaneous transluminal angioplasty (PTA)
Rotational Atherectomy
Bypass revascularization

Question 9

Medications for Atherosclerosis

Answer 9

Medications to decrease platelet aggregation = 
aspirin and clopidogrel 

Lipid and cholesterol lowering agent = want to raise HDLS, lower LDLS, lower TGs
Statins = lovastatin and numerous others (NO grapefruit with these)
Bile acid sequestrants
Nicotinic acid
Fibric acids

Question 10

PAD/PVD

Answer 10

Slow progressive disorders of circulation
Can involve arteries, veins, or lymphatics
Result of systemic atherosclerosis
Changes the flow → cant get adequate flow to tissues as result
Inflow versus outflow
Inflow not as much significant damage
Outflow is when you start to see more significant damage

Question 11

Findings with PAD

Answer 11

Intermittent claudication 
Pain, numbness, aching, heaviness of the muscle
Weak or absent distal pulses distally 
Decreased hair on legs and toes 
Poor nail growth
Decreased temperature in one leg 
Wounds that do not heal well 
Erectile dysfunction

Question 12

acute limb ischemia

Answer 12

sudden decrease in blood flow to an extremity often due to embolism especially from heart s/p MI or atrial fibrillation = I MMEDIATE INTERVENTION
Heparin therapy and medications can be ordered
Surgical thrombectomy
Severe pain or rapid onset → Six Ps

Question 13

What are the 6 p’s

Answer 13

Pain, pallor, pulselessness, paresthesias, paralysis, poikilothermia

Question 14

Risk Factors of DVT

Answer 14

Prolonged sitting
Bed rest
Dehydration
Post partum (6 months) = due to hypercoagulability after giving birth
Use of estrogens/ bc pills = in the past due to heavy dose estrogens
pelvic/ hip surgery
Trauma

Question 15

DVT Manifestations

Answer 15

Leg pain unilaterally = see it on one side typically
Swelling extremity
Low grade fever
Homan’s sign (not diagnostic) = pressing on the foot back towards the leg and if there is pain = does not rule it in and does not rule it out

Question 16

Diagnosis of DVT

Answer 16

clinical presentation, history, and doppler ultrasound → the best thing to do is prevention → Lovenox sq or heparin sq (safe), hydration and moving asap
Acute Treatment = bedrest and anticoagulation
Heparin IV bolus followed by heparin IV drip
Coumadin po after Heparin IV drip

Question 17

Chronic Treatment of DVT

Answer 17

greenfield filter (surgery) = significant risk of pulmonary embolism 
Prevention is the best course of action = thinking how to do in the hospital

Question 18

What is endocarditis?

Answer 18

Inflammation of the inner lining of heart
Usually infectious process (bacterial endocarditis, not always infection (can be fungal virus ect)
Papillary muscles, chordae tendineae, valves can be involved
Sterile variety seen in cancer pts = inflammation, but no infections
Mortality rate %25 rate - even if we do everything right

Question 19

What are risk factors of endocarditis?

Answer 19

any port to entry of blood stream , Drug users, Central Line, Previous valvular surgery, Congential heart defect, systemic infection from any source (urosepsis), IV placement (poor technique), Skin rashes, lesions, abscess, dental work (mouth is extremely vascular)

Question 20

s/s of endocarditis?

Answer 20

Fatigue
Fever = all infections
Murmur (systolic murmurs because of regurgitations)
Paleness
Red, painless spots on the palms and soles (Janeway lesions - more common in peds)
SOB with activity
Swelling of the feet, legs, abdomen (heart failure)
Weakness
Weight loss ~ Anorexia
Embolic complications = vegetation can break from leaflets and travel anywhere (Brain, kidneys, spleen = more infection)
With Heart Failure Symptoms = weight gain

Question 21

3 Goals of Endocarditis?

Answer 21

DESTROY the infection
Repair or Replace the valves if needed (this is a goal, but not while person is infected)
Treat complications

Question 22

Diagnosis of Endocarditis

Answer 22

Clinical examination (New murmur (pain attention), fever, signs of heart failure)
Blood cultures are positive = generally more than one set and from more than one site 
Positive - infection 
CBC = WBC is high 
CXR = chest X-tray, = pulmonary edema, cardiomegaly 
Echocardiogram = verifies evidence of damage to the valves

Question 23

Treatment of Endocarditis

Answer 23

Rest in bed until improved
Nursing care: like that for heart failure patients (O2)
Long term IV antibiotics = 4-8 weeks (IV around the block, may be more than one)
Valve replacement may be necessary = replacement of fixing, once infection is good

Heart failure is secondary to endocarditis