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Midterm > Midterm Medsurge > Flashcards

Midterm Medsurge Flashcards

1
Q

VENOUS DISORDERS

A


Venous Thrombosis, Deep Vein Thrombosis (DVT),
Thrombophlebitis, and Phlebothrombosis

Chronic Venous Insufficiency

Leg Ulcers

Varicose Veins

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2
Q

Venous thrombosis

A

is a blood clot (thrombus) that forms within a vein

can occur in any vein; common lower extremities.

superficial and deep veins of the extremities may be affected

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3
Q

Is associated with inflammation

Frequently deep vein lower extremities

A

Thrombophlebitis

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4
Q

More serious that superficial thrombophlebitis, ↑risk pulmonary embolism

A

Deep vein thrombophlebitis (DVT)

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5
Q

Thrombus without inflammation

Result of stasis or hypercoagulability

A

Phlethrombosis

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6
Q

Vein inflammation.

Associated with invasive procedures (IV therapy)

A

Phlebitis

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7
Q

Stasis of blood

Endothelial injury / vessel wall injury

Hypercoagulability / altered blood coagulation

A

Virchow’s triad

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8
Q

are aggregates of platelets attached to the vein wall, along with a tail-like appendage containing fibrin, WBCs , and RBCs

A

Venous thrombi

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9
Q

Clinical manifestations DVT

A

Asymptomatic

Calf or groin tenderness

Unilateral swelling

Phlegmasia cerulea dolens

Functional impairment

↑ temperature

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10
Q

Positive homan’s sign

A

Pain in calf on dorsiflexion of the foot

Very poor predictive value, not advised

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11
Q

Treatment thrombosis superficial veins

A

Bed rest

Elevation of legs

Analgesics

Anti-inflammatory medication

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12
Q

Diagnostic test (Thrombosis)

A

Contrast venography

Duplex ultrasonography

Doppler flow studies

Impedance plethysmography

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13
Q

Example Anticoagulant therapy (DVT)

A

Unfractionated Heparin

Low molecular weight heparin

Warfarin

IV unfractionated heparin (low-molecular weight heparin) followed by oral warfarin

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14
Q

Anticoagulant low molecular weight heparin

A

Route: Subcutaneous

enoxaparin(Lovenox) dalteparin(Fragmin) ardeparin(Normiflo)

Monitor INR and stools daily for occult blood

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15
Q

Antidote for warfarin

A

Vitamin K

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16
Q

Health teaching warfarin

A

Do not change eating habits unless indicated

Food with Vitamin K may alter warfarin

Do not eat cranberry products

Do not take aspirin unless indicated

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17
Q

Contraindication thrombolytic therapy

A

Postoperatively

During pregnancy

After trauma

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18
Q

Filter traps large emboli and prevents pulmonary emboli

A

Inferior vena caval interruption

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19
Q

Removal of thrombosis

A

Thrombectomy

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20
Q

Antidote, reverse effects of heparin

A

Protamine Sulfate

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21
Q

At risk of heparin-induced thrombocytopenia

A

Recieved heparin for >5 days

No readmission after brief interruption of heparin therapy

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22
Q

Platelet count heparin-induced thrombocytopenia

A

< 100,000/mL

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23
Q

is also affected by high-fat and vitamin K-rich foods, such as cabbage, cauliflower, broccoli, asparagus, turnips, spinach, kale, fish, and liver.

A

The action of warfarin

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24
Q

Patient education (anticoagulant medication)

A

Avoid alcohol

Avoid food fad, crash diet, or marked changes in eating habits

Don’t take warfarin unless indicated

When seeking treatment inform provider of taking anticoagulant

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25
Q

Obstruction of venous valves in legs or a reflux of blood back through valves

A

Venous insufficiency

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26
Q

chronic venous stasis, resulting in edema, altered pigmentation, pain, and stasis dermatitis

Stasis ulceration

A

Post-thrombotic syndrome

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27
Q

Types of debridement

fastest method

can be performed by a physician, skilled advanced practice nurse, or certified wound care nurse in collaboration with the physician.

A

Sharp surgical debridement

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28
Q

Type of debridement

Apply isotonic saline dressings of fine-mesh gauze to the ulcer. When the dressing dries, it is removed (dry), along with the debris adhering to the gauze.

Need pain management

A

Nonselective debridement

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29
Q

Wound dressing.

promote granulation tissue and reepithelialization.

provide a barrier for protection because they adhere to the wound bed and surrounding tissue.

Not for deep wounds and infected wounds

A

Hydrocolloids (eg, Comfeel, DuoDermCGF, Restore, Tegasorb)

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30
Q

Stimulated healing

Tissue-engineered human skin equivalent along with therapeutic compression

a skin product cultured from human dermal fibroblasts and keratinocytes.

Application is not difficult, no suturing is involved, and the procedure is painless

A

Apligraf

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31
Q

are abnormally dilated, tortuous, superficial veins caused by incompetent venous valves

Most commonly occurs in lower extremities, saphenous veins, or lower trunk; can occur elsewhere in body (ex: esophageal varices)

occur in up to 60% of adult population in US

increased incidence correlated with increased age

A

Varicose veins (varicosities)

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32
Q

Management varicose veins

A

Ligation and stripping
Endovenous Laser Treatment
Radiofrequency Ablation Sclerotherapy

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33
Q

an infection of the deep layer of skin (dermis) and the layer of fat and tissues just under the skin (the subcutaneous tissues).

most common infectious cause of limb swelling

can occur as a single isolated event or a series of recurrent events.

often misdiagnosed, usually as recurrent thrombophlebitis or chronic venous insufficiency

A

Cellulitis

34
Q

an acute inflammation of the lymphatic channels.

arises most commonly from a focus of infection in an extremity.

Cause: hemolytic Streptococcus

groin, axilla, or cervical region: Nodes most often involved

A

Lymphangitis

35
Q

Most common primary type

caused by hypoplasia of the lymphatic system of the lower extremity.

usually seen in women and first appears between ages 15 and 25

A

congenital lymphedema (lymphedema preacox)

36
Q

most common cause worldwide the direct infestation of lymph nodes by the parasite Wuchereria bancrofti

A

Filariasis

37
Q

A (fibrous) ringlike structure, or any body part that is shaped like a ring

A

Annulus

38
Q

A site of union of corresponding parts; specifically, the sites of junction between adjacent cusps of the heart valves

A

Commissure

39
Q

thread-like bands of fibrous tissue that attach on one end to the edges of the tricuspid and mitral valves of the heart and on the other end to the papillary muscles

A

Chordae tendineae

40
Q

small muscle within the heart that anchors the heart valves

A

Papillary muscles

41
Q

DISORDERS OF THE MITRAL VALVE

A

mitral valve prolapse
mitral regurgitation
mitral stenosis

42
Q

DISORDERS OF THE AORTIC VALVE

A

aortic regurgitation
aortic stenosis

43
Q

Surgical management (valve)

A

Valvuloplasty

Closed Mitral commissurotomy or valvotomy Open mitral commissurotomy or valvotomy
- to open or rupture the fused commissures of the mitral valve.

Percutaneous transluminal valvuloplasty / Balloon valvuloplasty

Mitral valve replacement

44
Q

a high-pitched, blowing sound at the apex.

heard best at the apex and radiates to the axilla and usually accompanied by a thrill

a heart murmur occurring throughout systole

A

Holosystolic or pansystolic murmur

45
Q

CHF Management

A

Digitalis
Diuretic
Vasodilators
Diet
Anticoagulants

46
Q

Surgical intervention (valve)

A

Mitral valve replacement

Valvuloplasty (annuloplasty)

47
Q

murmur also reflected to mitral area which may give a false impression of a mitral regurgitation

A

Gallavardin phenomenon

48
Q

Palpated over base of heart/ 2nd RICS caused by turbulent blood flow across the narrowed valve orifice

A

Thrill/Vibration

49
Q

Clinical manifestations (Regurgitation)

A

Diastolic murmur
Austin flint murmur
Corrigan’s pulse
Watson’s water hammer pulse Widened pulse pressure
Hill’s sign

50
Q

low pitched diastolic rumble similar to mitral stenosis; indicates moderate to severe insufficiency

a mid-diastolic or presystolic murmur low-pitched rumbling murmur which is best heard at the cardiac apex.

A murmur due to aortic regurgitation, originating at the mitral valve when blood enters simultaneously from both the aorta and the left atrium.

A

Austin flint murmur

51
Q

AKA: collapsing pulse, cannonball pulse is the medical sign which describes a pulse that is bounding and forceful, as if it were the hitting of a water hammer that was causing the pulse.

PA: radial pulse of a supine patient with arm at side is firmly palpated with slight pressure until the pulse is obscured. The arm is then raised over the patient’s head, with the arm perpendicular to the supine patient

A

Watson’s water hammer pulse

52
Q

anterior chest that overlies the heart and great vessels

A

precordium

53
Q

large veins and arteries leading directly to and away from heart

A

Great vessels

54
Q

large veins and arteries leading directly to and away from heart

A

Great vessels

55
Q

at exit of each ventricle at beginning of great vessels

A

semilunar valves

56
Q

Normal Adult CO is

A

5 to 6 L/min

57
Q

SV from L ventricle is usually

A

70 ml

58
Q

Orthopnea (the inability to breathe while supine) and nocturia may indicate

A

Heart failure

59
Q

40% of patients admitted to the hospital with the condition die or are readmitted within 1 year

A

Heart failure

60
Q

Atherosclerosis of the coronary arteries is the primary cause (60%)

A

heart failure

61
Q

(Heart failure) Signs and symptoms are related to pulmonary congestion and include:

A

Wheezing (cardiac asthma)
Third heart sound
Clubbing
Hypokalemia (increase level of aldosterone)
Polycythemia
Reduced urine output
Elevated PAP, PCWP, LVEDP

62
Q

a hormone secreted by the heart at high levels when it’s injured or overworked.

One of the most specific for heart failure

A

brain natriuretic peptide (BNP)

63
Q

Medical management heart failure (4D’s)

A

Digitalis
Diuretic
VasoDilators
Diet

64
Q

Major treatment in HF

Positive inotropic, negative chronotropic & dromotropic effects

Monitor HR & K+

A

Digoxin

65
Q

Can be used in patients with heart failure and atrial fibrillation to slow conduction through the atrioventricular node, which increases left ventricular function and results in increased diuresis , and to increase the force of myocardial contration

A

Digoxin

66
Q

Example of inotropes

A

Dopamine

Dobutamine

67
Q

To decrease cardiac workload by reducing circulating volume and thereby reduce preload

A

Diuretic therapy

68
Q

added to pharmacologic therapy if EF is less than 35% and adequate ACE inhibitor therapy.

are approved for NYHA Classes III and IV and must be used cautiously, acknowledging renal function and potassium level.

been shown to decrease hospital admissions for heart failure and also increase survival when added to existing therapy.

A

Aldosterone antagonist

69
Q

Example Vasodilator

A

Ace Inhibitors - First line
Nitroprusside
Hydralazine

70
Q

To decrease afterload by decreasing resistance to ventricular emptying

A

Vasodilators

71
Q

The foundation of heart failure treatment is the ACE inhibitor

A

Unless contraindicated, EF of less than 40% should receive an ACE inhibitor

has been shown to improve ventricular function and patient well-being, reduce hospitalization, and increase survival.

If intolerant to ACE inhibitor, an ARB should be initiated

72
Q

Unless contraindicated or not tolerated, should be started for every HF patient with an EF of less than 40% due to the mortality benefits

A

Beta-Blockers

73
Q

may be added as an alternative to an ACE inhibitor or ARB if the patient is intolerant to both drugs or it may be added to existing therapy if symptoms continue to progress

A

Hydralazine / isosorbide

74
Q

Fluid Limit (heart Failure)

A

< 1.2 L/day

75
Q

Warning sign for I&O, weight (heart failure)

A

(a 2- to 3-pound [0.9- to 1.4-kg] gain in a day or a 5pound [2.3 kg] gain in a week indicates trouble)

76
Q

Bland, low calorie, low-residue with vitamin supplement during the acute phase

Small frequent feedings

A

Nursing Management Diet (heart failure)

77
Q

recommended for NYHA Class III or Class IV with a QRS prolongation of greater than 120 ms who continue to experience symptoms despite adequate pharmacologic therapy

A

cardiac resynchronization therapy

78
Q

placed to prevent sudden cardiac death caused by symptomatic and asymptomatic arrhythmias, which are seen frequently in patients with heart failure

a primary prevention to reduce mortality for patients with an EF of less than 35%

a secondary prevention for patients who survived a ventricular tachycardic event.

A

Implantable cardioverter defibrillator (ICD)

79
Q

at discharge when left ventricular EF is less than 40%, indicating systolic dysfunction

A

an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB)

80
Q

anticoagulant

A

if the patient has chronic or recurrent atrial fibrillation

81
Q

optional beta-blocker therapy

A

at discharge for stabilized patients with left ventricular systolic dysfunction without contraindications.

82
Q

Data have shown that 20% to 60% of patients with heart failure

A

don’t adhere to their prescribed treatment plan

Midterm (3 decks)

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