Medsurg hesi 4 cardiac Flashcards
Left-sided heart (ventricular) failure results in inadequate left ventricle (cardiac) output and
consequently in inadequate
tissue perfusion
Right-sided heart (ventricular) failure results in inadequate right ventricle output and systemic
venous congestion (peripheral edema)
Pulmonary problems (COPD, pulmonary fibrosis) are risk factors for __ sided HF
right sided
orthopnea is symptom of __ sided HF
left
left or right HF: Displaced apical pulse (hypertrophy)
left
left or right HF: S3 heart sound (gallop)
left
left or right HF: Pulmonary congestion (dyspnea, cough, bibasilar crackles)
left
left or right HF: Frothy sputum (can be blood-tinged)
left
left or right HF: Manifestations of organ failure, such as oliguria
left
left or right HF: Jugular vein distention
right
left or right HF: Abdominal distention, ascites
right
left or right HF: Nausea and anorexia
right
left or right HF: Polyuria at rest (nocturnal)
right
left or right HF: Liver enlargement (hepatomegaly) and tenderness
right
Human B-type natriuretic peptides (hBNP): Elevated in ___ ___
heart failure
In clients who have dyspnea, elevated ___ confirms a diagnosis of heart failure rather than a problem originating in the respiratory system
hBNP
uses a transducer placed in the esophagus behind the heart to obtain a detailed view of cardiac structures
Transesophageal echocardiography (TEE)
Administer furosemide IV no faster than __ mg/min.
20
Monitor clients taking ACE inhibitors for ____ following the initial dose.
hypotension
ACE inhibitors: Monitor for increased levels of _____
potassium
Inotropic agents, such as digoxin are used to
increase contractility and thereby improve cardiac output
For a client taking digoxin, take the apical heart rate for 1 min. Hold the medication if apical pulse is less than
60/min
Teach clients who are self-administering digoxin to: count
pulse for 1 min (if it’s irregular or anything, don’t take the meds)
Do not take digoxin at the same time as ___
antacids
Vasodilators: Remind the client that a ____ is a common side effect of this medication
headache
hBNPs, such as nesiritide (Natrecor), are used to treat acute heart failure by causing
natriuresis (loss of sodium and vasodilation)
a mechanical pump that assists a heart that is too weak to pump blood through the body
Ventricular assist device (VAD)
Heart ____ is the treatment of choice for clients who have severe dilated cardiomyopathy
transplant
pink, frothy sputum (cardinal sign of ___ ___)
pulmonary Edemamama
Finding of pulmonary edema patient: __ heart sound (gallop)
S3 heart sound (gallop)
pulmonary edema: Position the client in high-Fowler’s position with
feet and legs dependent or sitting on the side of the bed to decrease preload.
pulmonary edema: Administer oxygen using a high-flow ___ mask
rebreather (bipap or intubation may become necessary too)
This is a serious complication of pump failure that occurs commonly following an MI and injury to greater than 40% of the left ventricle.
Cardiogenic shock
Valvular heart disease: Narrowed opening that impedes blood moving forward
Stenosis
Valvular heart disease: Improper closure
regurgitation – some blood flows backward
Acquired valvular heart disease: Due to damage over time from mechanical stress. The most common cause is hypertension.
Degenerative disease
Acquired valvular heart disease: Gradual fibrotic changes, calcification of valve cusps. The mitral valve is most commonly affected.
Rheumatic disease
Acquired valvular heart disease: Infectious organisms destroy the valve. Streptococcal infections are a common cause.
Infective endocarditis
heard with turbulent blood flow
murmur
_____ therapy is used for clients who have a mechanical valve replacement, atrial fibrillation, or severe left ventricle dysfunction.
Anticoagulation
This procedure can open aortic or mitral valves affected by stenosis
Percutaneous balloon valvuloplasty
Prosthetic valves: Mechanical valves last longer but require ____
anticoagulation
Valvular heart disease: biggest complication
HF
inflammatory disorder: Can be due to a myocardial infarction
Pericarditis
inflammatory disorder: Findings include chest pressure/pain, friction rub auscultated in the lungs, shortness of breath, and pain relieved when sitting and leaning forward
Pericarditis
inflammatory disorder: Can be due to a viral, fungal, or bacterial infection, or a systemic inflammatory disease (Crohn’s disease
Myocarditis
inflammatory disorder: Findings include tachycardia, murmur, friction rub auscultated in the lungs, cardiomegaly, chest pain, and dysrhythmias
Myocarditis
inflammatory disorder: An infection of the endocardium due to streptococcal bacteria
Rheumatic endocarditis
inflammatory disorder: Produces lesions in the heart
Rheumatic endocarditis
inflammatory disorder: Also known as bacterial endocarditis
Infective endocarditis
inflammatory disorder: Most common in IV drug users or clients who have cardiac malformations
Infective endocarditis
Valve debridement, draining of abscess, and repairing congenital shunts are procedures
involved with infective _____
endocarditis
PAD results from _____ that occurs in the arteries
atherosclerosis
PAD results from atherosclerosis that usually occurs in the arteries of the
lower extremities and is characterized by inadequate flow of blood.
Buerger’s disease, subclavian steal syndrome, thoracic outlet syndrome, Raynaud’s disease and Raynaud’s phenomenon, and popliteal entrapment are examples of
PADs
PAD pain is relieved by placing legs at rest in
a dependent position
Numbness or burning pain primarily in the feet when in bed
PAD
PAD bruit over ___ and ___ arteries
femoral and aortic arteries
PAD color of leg
pallor when elevated, red when dependent
involves arterial injection of contrast medium to visualize areas of decreased arterial flow on an x-ray
Arteriography
PAD test: It is usually done only to determine isolated areas of occlusion that can be treated during the procedure with percutaneous transluminal angioplasty and possible stent placement
Arteriography
used to determine the variations of blood passing through an artery, thus identifying abnormal arterial flow in the affected limb.
Plethysmography
In the absence of peripheral arterial disease, pressures in the lower extremities are ____ than those of the upper extremities.
higher
With arterial disease, the pressures in the thigh, calf, and ankle are
lower
PAD: tell the client to refrain from wearing
restrictive garments
PAD: Tell the client to elevate the legs to reduce swelling, but not to
elevate them above the level of the heart (that’s too high)
PAD: Have the client wear insulated ___
socks
PAD: best way to prevent vasoconstriction
stop smoking
may be given to specifically treat intermittent claudication experienced by clients who have PAD.
Pentoxifylline (Pento)
besides Pentoxifylline (Pento), medication that can relieve intermittent claudication
statins
Invasive intra-arterial procedure using a balloon and stent to open and help maintain the patency of the vessel
Percutaneous transluminal angioplasty
Surgical intervention for PAD: Anticoagulant therapy is used during the operative procedure, followed by
antiplatelet therapy for 1 to 3 months
used with clients who have severe claudication and/or limb pain at rest, or with clients who are at risk for losing a limb due to poor arterial circulation
Arterial revascularization surgery
After PAD bypass surgery, Hypotension may result in an increased risk of
clotting or graft collapse
After PAD bypass surgery, hypertension increases the risk for
bleeding from sutures
After PAD bypass surgery, Instruct the client to limit bending of the
hip and knee to decrease the risk of clot formation
a brown discoloration along the ankles that extends up the calf relative to
the level of insufficiency.
Stasis dermatitis (finding of venous insufficiency)
finding of venous insufficiency: stasis ulcers found on the
ankles
What kind of venous problem: Clients often report muscle cramping and aches, pain after sitting, and pruritus.
Varicose veins
Varicose veins: Clients often report pain after
sitting, and pruritus
____ test measures fibrin degradation products present in the blood produced from fibrinolysis. A positive test indicates that thrombus formation has possibly occurred.
D-dimer
Impedance plethysmography can be used to determine the variations of
blood passing through a vein
Place the client in a supine position with legs elevated. When the client sits up, the veins will fill from the proximal end if varicosities are present
(veins normally fill from the distal end).
Trendenlenburg Test for varicose veins
DVT and thrombophlebitis tx: Administer intermittent or continuous
warm moist compresses
DVT and thrombophlebitis tx: provide
thigh-high compression or antiembolism stockings
Venous insufficiency: Elevate feet approximately 6 inches at
night
Venous insufficiency: Instruct client to wear elastic compression stockings and apply them after
the legs have been elevated and when swelling is at a minimum
heparin has significant adverse effects and must be given in the
facility
Warfarin effect takes
3 to 4 days
Warfarin is started while
client is still on heparin (because it takes a little while to start working)
Warfarin antidote
vitamin K
Thrombolytic therapy must be started within _ days after the development of the clot for the therapy to be effective
5
irritating chemical solution is injected into the varicose vein to produce localized inflammation, which will, close the lumen of the vessel over time
sclerotherapy for Varicose veins
sclerotherapy: Pressure dressings are applied for approximately 1 week after each procedure to keep the vessel
free of blood
the removal of large varicose veins that cannot be treated with less-invasive procedures.
Vein stripping
Vein stripping, post op: Instruct the client to elevate the legs when sitting, and avoid
dangling them over the side of the bed
Venous stasis ulcers: Apply oxygen-permeable ____ films to superficial ulcers.
polyethylene
Venous stasis ulcers: Apply occlusive, ____ dressings on deeper ulcers
hydrocolloid
Venous stasis ulcers: Apply occlusive, hydrocolloid dressings on deeper ulcers to promote
granulation tissue and reepithelialization.
sudden onset dyspnea
PE
HTN tx: Instruct the client to avoid grapefruit juice, which ____ the medication’s effects
increases
ACE inhibitors should be stopped if client has
persistant cough
HTN: amount of alcohol that’s OK
2 drinks for men, 1 for women
Risk Factors for ___ shock: cardiac pump failure due to MI, heart failure, cardiomyopathy, dysrhythmias, and valvular rupture or stenosis
Cardiogenic
Risk Factors for ___ shock: excessive fluid loss from diuresis or vomiting/diarrhea, or blood loss secondary to
surgery, trauma, gynecologic/obstetric causes, burns, and diabetic ketoacidosis.
Hypovolemic
Risk Factors for ___ shock: blockage of great vessels, pulmonary artery stenosis, pulmonary embolism, cardiac tamponade, tension pneumothorax, and aortic dissection are among the causes
Obstructive
serum glucose can ____ during shock
increase
Cardiogenic and obstructive shock: Assess for ECG changes associated with
MI and dysrhythmias
Shock: Place the client on high-flow oxygen, such as a 100% _____ face mask.
nonrebreather
Shock: If the client has COPD, insert a
2 L/min nasal cannula and increase the oxygen flow as needed.
INOTROPIC actions
Strengthens cardiac contraction and increases cardiac output
VASOPRESSORS (like dobu) should be given through a
central line to prevent irritation
Epinephrine can cause ___ if infiltrates tissue.
sloughing
what IV fluids are given for hypovolemic shock
NS or LR
Vasodilators are used to treat ___ shock
cardiogenic
Vasodilators need to be protected from
light
DIC
Disseminated Intravascular Coagulation
Disseminated Intravascular Coagulation (DIC) is a complication of ___ shock
septic
Thousands of small clots form within organ capillaries (liver, kidney, heart, brain), creating hypoxia and anaerobic metabolism
Disseminated Intravascular Coagulation (DIC)
Disseminated Intravascular Coagulation (DIC): As a result of multiple clot formation, platelets and other clotting factors such as fibrinogen are depleted and the client is at increased risk for
hemorrhage
Disseminated Intravascular Coagulation (DIC): risk for
hemorrhage
A weakness in a section of a dilated artery that causes a widening or ballooning in the wall of the blood vessel is called an
aneurysm
Seventy-five percent of aneurysms are ___ ___ aneurysms.
abdominal aortic
can occur when blood accumulates within the artery wall (hematoma) following a tear in the lining of the artery
Dissecting aneurysm
Dissecting aneurysm can occur when blood accumulates within the artery wall (hematoma) following a tear in the lining of the artery. It’s usually due to
HTN
Abdominal aortic aneurysm: subjective
Constant gnawing feeling in abdomen; flank or back pain
Aortic dissections (often associated with ___ syndrome)
Marfan’s
the priority in an emergency aneurysm
decrease BP
Hematologic assessment and diagnostic procedures evaluate _____ function
blood function
Bone marrow Biopsy: Postprocedure discomfort is usually relieved by __ analgesics.
mild (but avoid aspirin since it causes bleeding)
Bone marrow Biopsy: Teach the client to check the biopsy site
daily
Autologous transfusions: Clients may donate blood 5 weeks in advance up to
72 hr prior to surgery.
blood tx of Coagulation factor deficiencies such as hemophilia
– fresh frozen plasma
blood tx of Anemia or Kidney failure
packed RBCs
Obtain blood products from the blood bank. Inspect the blood for excessive
bubbles
transfusion: Prime the blood administration set with
NS
transfusion: Never add ____ to blood products.
medications
Dispose of the blood-administration in
biohazard bags
Hgb levels should rise by approximately __ g/dL with each unit transfused.
1
transfusion reaction: onset: Acute hemolytic
immediately
transfusion reaction: onset: Febrile
30minto6hr after transfusion
transfusion reaction: onset: Mild allergic
During or up to 24 hr after transfusion
transfusion reaction: onset: Anaphylactic
immediately
transfusion reaction: Use WBC filter. Administer antipyretics.
Febrile reaction
transfusion reaction: This reaction may cause cardiovascular collapse, kidney failure, disseminated intravascular coagulation, shock, and death.
Acute hemolytic
Mild allergic transfusion reaction: Administer
antihistamines
transfusion reaction: Maintain airway; administer oxygen, IV fluids, antihistamines, corticosteroids, and vasopressors.
Anaphylactic
transfusion reaction: stop the infusion and Initiate an infusion of NS. The infusion should be
initiated with a separate line, so as not to infuse more blood from the transfusion tubing.
After a transfusion reaction: save the
Save the blood bag with the remaining blood (for testing)
If disseminated intravascular coagulation (DIC) occurs: Administer ___ in the early phase
anticoagulants
If disseminated intravascular coagulation (DIC) occurs: Administer ___ ___ and ___ ___ during the late phase
clotting factors and blood products
