misc Flashcards
With myocardial muscle function, Sodium is necessary?
help maintain fluid balance.
When does ESR decrease with MI and Infective Endocarditis?
When healing begins
What focuses on the body’s balance of sodium, potassium, calcium, and magnesium?
Serum Electrolytes tests
True or False, Sodium, potassium, calcium, and magnesium are necessary for myocardial muscle function?
T
True or False, Coagulation studies are not needed if an MI is diagnosed in case fibrinolytics are needed to dissolve the thrombus.
False. The coagulation studies, PT-INR-PTT are needed.
True or False, When the ESR is elevated with MI and Infective Endocarditis?
T
True or False, PET is able to accurately detect coronary artery disease, noninvasively, in an asymptomatic patient, prompting early intervention that can salvage potentially ischemic myocardium?
T
What is Cardioversion?
The restoration of the heart’s normal sinus rhythm by delivery of a synchronized electric shock through two metal paddles placed on the patients chest
What is Myocardial Infarction
A heart attack.
Occurs because of plaque in the coronary arteries (CAD) leads to ischemia (lack of blood flow to the heart)
What are Coagulation studies useful in?
monitoring patients receiving anticoagulant drug therapy,
is prescribed for patients with myocardial infarction (MI)
True or False, Chronic Hypoxemia is often noted in HF?
T
What does a low hemoglobin indicate?
Decrease inability to carry oxygen to the cells and anemia
What does an elevated red blood cell (erythrocyte) count indicate?
The body is compensating for chronic hypoxemia
an abnormal deficiency of oxygen in the arterial blood
What lab test detects growth of bacteria in the blood that is crucial in the diagnosis of Infective Endocarditis?
Blood Cultures.
What is Thallium Scanning?
The radio-isotope is injected IV while patient exercises on a treadmill or while using Rx stressor meds
Thallium 201 is an intracellular ion that is transported into normal cells.
Tissues with inadequate perfusion appear as dark areas on scanning.
In patient who cannot tolerate physical activity, what medication given prior to the thallium to physiologically simulate exercise-induce stress.
Dipyrodamole
What is Echocardiography used for?
to detect pericardial effusion
(collection of blood or other fluid in the pericardial sac),
Ventricular function,
Cardiac chamber size and shape,
Ventricular muscle and septal motion and thickness,
Cardiac output (ejection fraction),
Cardiac tumors,
Valvular function, and congenital heart disorder.
True or False, PETs ability to distinguish between viable and nonviable myocardial tissue allows physicians to identify the most appropriate candidates for bypass surgery or angioplasty?
T
What is PET used for?
dementia, stroke, epilepsy, tumors. *Has proven merit in the diagnosis and treatment of cardiac disease.
What is Position Emission Tomography (PET)?
computerized radiographic technique that uses radioactive substances to examine the metabolic activity of various body structures.
What does the “QRS” complex represent?
depolarization of the ventricles.
What does the “T” represent?
repolarization of the ventricles.
What does the “P” represent?
depolarization of the atria.
What is Repolarization?
when the heart is in the relaxation phase.
What are the post nursing interventions for Cardiac Catheterization and Angiography?
1) Assess circulation to the extremity
2) Check peripheral pulses, color, and sensation of the extremity every 15 minutes for 1 hour then with decreasing frequency.
3) Observe the puncture site for hematoma and bleeding.
4) Monitor vital signs.
5) Assess for abnormal heart rate, dysrhythmias, and signs of pulmonary emboli (respiratory difficulty)
6) Lay the patient supine for a designated period
7) Apply a compression device over the pressure dressing at the insertion site to prevent hemorrhage.
How is the Cardiac Catheterization done?
- It is performed under sterile surgical conditions
- Its invasive nature requires a prior signed consent.
- Contrast dye may be injected to allow better heart and vessel visualization (angiography)
- Determine sensitivity to iodine to avoid an allergic reaction to dye
What is the purpose of a Cardiac Catheterization?
aids in the diagnosis of cardiac conditions, and in eval /treatment of the critically ill.
used to measure
1) pressure within the heart and
2) blood volume relationship to cardiac competence.
Vulvar defects, arterial occlusion and congenital anomalies are determined.
Blood samples are taken
What is a Cardiac Monitor?
displays information on the electrical activity of the heart
transferred via conductive electrodes place on the chest.
What is a Holter Monitor and why is it used
portable recorder is attached to the patient by leads, with a 2-pound tape recorder carried on a belt or shoulder strap.
The monitor operates continuously to record the patterns and rhythms of the patient’s heartbeat. In conjunction with the diary, the physician can note various events, times, and medications peaks that affect or precipitate dysrhythmias.
True or False. Each ECG has five distinct waves or deflections.
False. Each ECG has THREE distinct waves or deflections.
- The “P” wave
- The “QRS” complex
- The “T” wave
What is Depolarization?
The name for the electrical activity when the heart contracts.
Does Atrial repolarization occur and can it be traced on an ECG?
Yes, it is covered by the large QRS complex and cannot be seen on the ECG tracing.
True or False. There are Ambulatory ECG and Exercise Stress Test ECGs that require position variation?
T
How many electrodes does and ECG have and where is it attached to measure the total electric activity of the heart?
There are 12 ECG electrode and are attached to the surface of the skin.
What do radiographic examinations of the chest provide?
A film record of the heart size, shape, and position/outline of the shadows.
True or False, Lung congestion cannot be seen with a radiographic examination film?
False. It can be seen, Indicating possible early stage HF and Pleural effusion may be noted in left-sided HF.
What is a Flouroscopy?
The action-picture radiograph that allows observation of movement.
It is valuable in pacemaker or intracardial catheter placement.
What is the nurses responsibility in Cardiovascular function laboratory and diagnostic examinations?
To physically prepare the patient for diagnostic procedure and explain the examination to the patient
Blood is pumped from the Right atrium to the _______ where it leaves the heart to travel via the Right pulmonary artery to the lungs.
The Right Ventricle
True or False. The heart is a hollow organ?
T
The heart is divided into a right and left half by a muscular partition called?
Septum
What are the four chambers of the heart?
Right Atrium, Left Atrium, Right Ventricle, Left Ventricle
What is the purpose of the Right Atrium?
It receives deoxygenated blood from the entire body.
What is the purpose of the Superior Vena Cava?
It returns deoxygenated blood from the head, the neck, and the arms.
What is the purpose of the Inferior Vena Cava?
It returns deoxygenated blood from the lower body.
What is the endocardium?
innermost layer of the heart.
composed of a thin layer of connective tissue.
What is myocardium?
thickest and strongest layer of the heart.
It is compose of cardiac muscle tissue.
Contraction of this tissue is responsible for pumping of the blood.
What is pericardium?
The outer most layer of the heart.
a two-layered, serous membrane that covers the entire structure.
Between the two thin membranes is a serous fluid that allows friction-free movement of the heart as it contracts and relaxes.
True or False. The heart is composed mainly of muscle tissues and one way valves?
T
What is the purpose of the Coronary Vein?
It returns deoxygenated blood from the heart muscle to the coronary sinus.
What is the Vena Cava?.
One of two largest veins returning blood from the peripheral circulation to the right atrium of the heart
What is the blood flow sequence after the capillaries?
The blood proceeds to the tiny venules, then to
Larger veins, and finally returns to the
Right Atrium via the largest vein, the Vena Cava
What part of the body does the Superior Vena Cava returns deoxygenated blood from?
Upper extremities.
How many heart valves are there and what are their purpose?
There are four heart valves. They keep the blood flow moving and prevent backflow.
Where are the valves located?
The two Atrioventricular (AV) valves are in the upper chambers are located between the atrium and ventricles.
What is Automaticity and Irritability?
2 characteristics that affect the functions of the conduction system
What is Irritability?
The ability to respond to stimuli.
What is Automaticity?
The ability of the heart to start and maintain rhythmic activity without the use of the nervous system
What happens when the left ventricle contract?
the blood is forces into the aorta
and the aortic semilunar valve closes.
What is Sinoatrial node (SA node)?
known as the hearts Pacemaker. where the heartbeat is initially started and regulated.
What is the impulse pattern for the conduction system?
SA node to the AV node,
to the Bundle of His,
to the Right and Left Branches of AV bundle,
to the Purkinje Fibers
What is the function of the Bundle of His?
sends impulses to the right and left ventricles via the purkinje fibers
Where is the Sinoatrial node (SA node) located?
upper part of the right atrium.
Does the heart function as two separate pumps and if so, why?
Yes. The right side receives deoxygenated blood and pumps it to the lungs. The left side receives oxygenated blood from the lungs and pumps it throughout the body
What is the purpose of the left Ventricles?
pumps the oxygenated blood out through the aorta to all parts of the body.
What is the purpose of the Left Atrium?
It receives oxygenated blood from the lungs via the Pulmonary Veins.
What is the purpose of the Right Ventricle?
pumps blood to lungs via the Pulmonary Artery to release carbon dioxide and receive oxygen.
Bruit
An abnormal sound of venous or arterial origin heard on auscultation
The nurse is caring for a patient diagnosed with peripheral artery disease. Which signs or symptoms does the nurse expect to assess in this patient’s extremities? -
Paresthesia
- Paralysis
- Pulselessness
When planning a home care program for the patient with peripheral vascular disease, which suggestion by the LPN/LVN would be most helpful to the patient if approved by the physician?
begin an exercise program of walking or swiming
The nurse is assessing a patient who is 2 days postoperative from hip replacement surgery. During the assessment, which signs and symptoms would alert the nurse to the possibility that the patient has developed thrombophlebitis in the right calf?
The patient has swelling, redness, and warmth of the affected extremity.
The patient has recently been diagnosed with varicose veins and states, “I really don’t understand what varicose veins are.” Which response by the nurse most accurately describes varicose veins?
“Varicose veins are veins that are enlarged and engorged with blood.”
A patient with varicose veins wears elastic support hose. The purpose of these stockings is to
promote venous returen
The patient asks the nurse what might have caused her varicose veins. The nurse is correct with which response?
- “Prolonged sitting or standing
- “Having family members with varicose veins
- “A history of DVT
- “Pregnancy
A patient has been diagnosed with mild hypertension. Which intervention(s) will likely be included in his plan of care?
controlling stress
Restricting sodium intake in his diet
Controlling his weight
Incorporating exercise into his daily routine
Which of these complaints, if made by a 58-year-old man, reflects a symptom of hypertension?
“My vision is a little blurry.”
What would be contraindicated for patients with vascular occlusive disease?
Smoking
Vigorous exercise
Plane trips
A patient complains of burning and numbness in her hands and states that “they turn really red” if she is in an air-conditioned environment for too long. What are her symptoms suggestive of?
Raynaud’s disease
The student nurse is reviewing the patient’s chart and notes that the patient experiences intermittent claudication. When is the patient most likely to experience this disorder?
Following exercise
The patient who has just been prescribed a thiazide diuretic for the treatment of hypertension asks the nurse how this drug will help her blood pressure. Which response by the nurse is most accurate? “
These drugs increase the excretion of water, sodium, potassium, and chloride, which will help lower your blood pressure.”
Elderly individuals receiving antihypertensive drugs should be assessed for which side effect?
dizziness
To assist patients who are to lower their intake of sodium, which of these suggestions is appropriate?
“Use fresh or frozen fruits as snacks.”
Embolus
A clot or plug of material (usually from a thrombus) carried by blood flow that lodges in a vessel and obstructs blood flow
Rubor
A dusky red color seen in patients with arterial insufficiency
Scleropathy
The injection of a solution that causes the vessel to dry up and disintegrate
Thrombus
A blood clot that obstructs a blood vessel or a cavity of the heart
Varicose Veins
Enlarged and tortuous veins in which the distorted shape is the result of accumulations of pooled blood
Intermittent Claudication
Cramping pain in the muscles of the lower extremities brought on by exercise and relieved by rest.
Hypertension Persistently high blood pressure; in adults, a systolic pressure equal to or greater than
and a diastolic pressure equal to or greater than
140
90 mm Hg
A 54 y.o. man complains of pain when walking and numbness of his lower extremities. ON examination, the nurse notes that both extremities are pale and cool to tough. The highest priority nursing diagnosis would be…
Ineffective peripheral tissue perfusion
A patient with peripheral arterial disease is prescribed a daily dose of aspirin. The nurse accurately explains the prescription by stating…
Aspirin helps prevent formation of clots
The nurse promotes lifestyle modifications to a 39 y.o. man who is diagnosed with prehypertension. Which lifestyle modification should be recommended?
- Smoking cessation
- Exercise 30 minutes per day most days of the week
- Limit alcohol intake to two drinks per day
- Low-fat diet
- Stress Reduction Measures
A 46-year-old patient has been diagnosed with hypertension. His resting BP is 180/100 mm Hg. His physician has ordered an ECG, chest x-ray, urinalysis, and renal function studies. He asks the nurse, “Why are all these tests necessary?” The best response is:
“These tests can determine changes in your kidneys, which can cause hypertension.”
When reviewing the laboratory results for a patient with hypertension and atherosclerosis, the nurse would expect to find high levels of:
cholesterol
Thrombophlebitis
An inflammation of a vein related to formation of a blood clot within the vessel
A 40 y.o. woman complains of leg pains that are associated with fullness during walking. She describes itching on the lower leg and on inspection has a twisted appearing swelling in her legs. The patient most likely will be treated for…
Varicose Veins
The nurse is reinforcing the physician’s instructions to an elderly woman who is newly diagnosed with hypertension. The patient does not speak the nurses language and is legally blind. What is the best nursing action?
Recruit a translator to provide instructions
The nurse is receiving a patient who had femoropopliteal bypass surgery. Which nursing intervention would take priority in the immediate postoperative period?
Monitoring for signs of bleeding
The nurse reinforces discharge instructions to a patient who is diagnosed with chronic venous insufficiency. Which instructions should be included? -
Take a low dose aspirin every day
- Consider swimming for exercise
- Avoid wearing tight clothing
- Reapply elastic wraps in the afternoon
- Elevate the legs above the level of the heart as much as possible
If a patient complains of intermittent claudication, the nurse would expect which clinical finding?
Rubor when legs are dependent
A patient diagnosed with a venous disorder asks, “What is sclerotherapy?” An accurate explanation would be…
An injection of a medication that shrinks in the vein
A patient is started on antihypertensive medications. Which patient statement indicates effectiveness of teaching?
“Sudden changes in position may cause dizziness”
The most important factor in regulating the caliber of blood vessels, which determines resistance to flow, is:
The sympathetic nervous system The sympathetic nervous system
Which are probable clinical findings in a person with an acute lower extremity VTE (select all that apply)?
may or may not have:
unilateral leg edema,
extremity pain,
a sense of fullness in the thigh or calf,
paresthesias,
warm skin,
erythema, or a systemic temperature greater than 100.4 F (38 C). If the calf is involved, it may be tender to palpation.
The patient with lower extremity venous thromboembolism (VTE) may or may not have
unilateral leg edema,
extremity pain,
a sense of fullness in the thigh or calf,
paresthesias,
warm skin, erythema, or a systemic temperature greater than 100.4 F (38 C).
If the calf is involved, it may be tender to palpation.
Buerger’s disease is NOT characterized by
Lipid deposits in the arteries
A significant cause of venous thrombosis is:
a. Altered blood coagulation
b. Stasis of blood
c. Vessel wall injury
When caring for a patient who has started anticoagulant therapy with warfarin (Coumadin), the nurse knows not to expect therapeutic benefits for:
2-3 days
Intravenous heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit?
protamine sulfate
and should be readily available for use if excessive bleeding or hemorrhage should occur
A client who has been receiving heparin therapy also is started on warfarin sodium (coumadin). The client asks the nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin sodium:
.
Inhibits synthesis of specific clotting factors in the liver, and it takes 3 to 4 days for this medication to exert an anticoagulation effect.
Warfarin sodium works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited.
A nurse has an order to begin administering warfarin sodium (coumadin) to a client. While implementing this order, the nurse ensures that which of the following medications is available on the nursing unit as the antidote for Coumadin?
Vitamin K
A 24-year old man seeks medical attention for complaints of claudication in the arch of the foot. A nurse also notes superficial thrombophlebitis of the lower leg. The nurse would next assess the client for:
smoking history
Mike, a 43-year old construction worker, has a history of hypertension. He smokes two packs of cigarettes a day, is nervous about the possibility of being unemployed, and has difficulty coping with stress. His current concern is calf pain during minimal exercise that decreased with rest. The nurse assesses Mike’s symptoms as being associated with peripheral arterial occlusive disease. The nursing diagnosis is probably:
Alteration in tissue perfusion related to compromised circulation
With peripheral arterial insufficiency, leg pain during rest can be reduced by:
Lowering the limb so it is dependent
The patient at highest risk for venous thromboembolism (VTE)
The 32-year-old woman has the highest risk: long trips without adequate exercise (venous stasis), tobacco use, and use of oral contraceptives. Note: The likelihood of hypercoagulability of blood is increased in women older than 35 years who use tobacco.
A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. Which signs and symptoms would suggest that his aneurysm has ruptured?
b.Sudden, severe low back pain and bruising along his flank
The clinical manifestations of a ruptured abdominal aortic aneurysm include severe back pain, back or flank ecchymosis (Grey Turner’s sign), and hypovolemic shock (tachycardia, hypotension, pale clammy skin, decreased urine output, altered level of consciousness, and abdominal tenderness).
Which clinical manifestations are seen in patients with either Buerger’s disease or Raynaud’s phenomenon (select all that apply)?
b. Sensitivity to cold temperatures
c. Gangrenous ulcers on fingertips
d. Color changes of fingers and toes
Both Buerger’s disease and Raynaud’s phenomenon have the following clinical manifestations in common: cold sensitivity, ischemic and gangrenous ulcers on fingertips, and color changes of the distal extremity (fingers or toes).
The clinical manifestations of a ruptured abdominal aortic aneurysm include
severe back pain, back or flank ecchymosis (Grey Turner’s sign), and hypovolemic shock (tachycardia, hypotension, pale clammy skin, decreased urine output, altered level of consciousness, and abdominal tenderness).
A nurse is caring for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse would inspect the surgical site most closely for signs of:
bleeding and infection
After inferior vena cava insertion, the nurse inspects the surgical site for bleeding and signs and symptoms of infection. Otherwise, care is the same as for any post-op client.
A 50-year-old woman weighs 95 kg and has a history of tobacco use, high blood pressure, high sodium intake, and sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral artery disease (PAD) that need to be modified are
tobacco use and high blood pressure
Significant risk factors for peripheral artery disease include tobacco use, hyperlipidemia, elevated levels of high-sensitivity C-reactive protein, diabetes mellitus, and uncontrolled hypertension; the most important is tobacco use. Other risk factors include family history, hypertriglyceridemia, hyperuricemia, increasing age, obesity, sedentary lifestyle, and stress.
A nurse is assessing a client with an abdominal aortic aneurysm. Which of the following assessment findings by the nurse is probably unrelated to the aneurysm?
Hyperactive bowel sounds in that area
Which technique is considered the gold standard for diagnosing DVT?
venography
Varicose veins can cause changes in what component of Virchow’s triad?
blood flow
A nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status is:
Normal because of the increased blood flow through the leg
In preparation for discharge of a client with arterial insufficiency and Raynaud’s disease, client teaching instructions should include:
Keeping the heat up so that the environment is warm
The client’s instructions should include keeping the environment warm to prevent vasoconstriction. Wearing gloves, warm clothes, and socks will also be useful when preventing vasoconstriction, but TED hose would not be therapeutic. Walking would most likely increase pain.
A client comes to the outpatient clinic and tells the nurse that he has had legs pains that begin when he walks but cease when he stops walking. Which of the following conditions would the nurse assess for?
Peripheral vascular problems in both legs
Intermittent claudication is a condition that indicates vascular deficiencies in the peripheral vascular system. If an obstruction were present, the leg pain would persist when the client stops walking. Low calcium levels may cause leg cramps but would not necessarily be related to walking.
Which of the following characteristics is typical of the pain associated with DVT?
Sudden onset
DVT is associated with deep leg pain of sudden onset, which occurs secondary to the occlusion. A dull ache is more commonly associated with varicose veins. A tingling sensation is associated with an alteration in arterial blood flow. If the thrombus is large enough, it will cause pain.
A client is admitted with a venous stasis leg ulcer. A nurse assesses the ulcer, expecting to note that the ulcer:
Has brown pigmentation around it.
Venous leg ulcers, also called stasis ulcers, tend to be more superficial than arterial ulcers, and the ulcer bed is pink. The edges of the ulcer are uneven, and granulation tissue is evident. The skin has a brown pigmentation from accumulation of metabolic waste products resulting from venous stasis. The client also exhibits peripheral edema.
Cancer can cause changes in what component of Virchow’s triad?
Blood coagulability
