Module 1: Perfusion and Teaching & Counseling Flashcards
Red Blood Cells Normal Range
3.6-6.1 million/mcL
S/S of Low RBC Count
anemia, paleness, cyanosis, weakness, fatigue, poor circulation
What causes low RBC count?
iron deficiency anemia
What does Hemoglobin levels measure?
hemoglobin measures the protein (called hemoglobin) that carries oxygen in red blood cells
Hemoglobin Normal Range
11.1 - 15.3 g/dL
S/S of Low Hemoglobin Count
excessive bruising in pts with low platelets, cyanosis, tired, pale, increased HR, SOB, weakness
Causes of low hemoglobin
anemia or blood loss
Hematocrit Normal Levels
33.7 - 46%
What does Hematocrit measure?
portion of RBCs in blood
S/S of low level of hematocrit
cyanosis, tired, pale, increased irregular HR, SOB, weakness
S/S of high level of hematocrit
dehydration (leads to increase Hct)
What causes changes in hematocrit?
fluid balance
Platelets Normal Range
150-450 billion/L
S/S of low value platelets
BLEEDING, fatigue, nose bleeds, bl in stool, BRUISING, pallor, low blood pressure, tachycardia, weak pulse
S/S of high value platelets
more likely to clot
What causes changes in platelet count?
iron deficiency, cancer, trauma
Prothrombin Time Normal Range
11-13.5 sec
low level of prothrombin time
more likely to clot
high level of prothrombin time
more likely to bleed
What causes changes in prothrombin time?
vitamin K, drug and herb interactions
International Normalized Ratio Normal Range
0.8 - 1.3 sec
What do both INR and PT and PTT measure?
how long bl takes to clot
Low levels of INR
more likely to clot
High levels of INR
more likely to bleed
What causes changes in INR?
vitamin K, drug and herb interactions
Partial Prothrombin Time Normal Range
25-35 sec
Low value PTT
more likely to clot
High value PTT
more likely to bleed
What causes changes of PTT?
vitamin K deficiency, liver disease
Ejection Fraction Normal Range
50-70%
Low value ejection fraction
fatigue, weakness
What causes low ejection fraction
heart failure
Brain Natriuretic Peptide (BNP) normal range
less than 100 pg/mL
What does BNP measure?
levels of BNP protein made by heart and bl vessels
low BNP
know they don’t have heart failure
high BNP
worse severity of heart failure
Total Cholesterol normal range
less than 200 mg/ dL
HDL normal range
more than 40 mg/dL
GOOD CHOLESTEROL
LDL normal range
less than 100 mg/dL
S/S of low ranges of cholesterol
no s/s but increase risk of CV disease (HDL)
no s/s for other two
s/s of high ranges of cholesterol
cardiac disease
decreased circulation
increased BP
atherosclerosis
Erythrocyte Sedimentation Rate (ESR) normal range
0-20 mm/hr
What does ESR measure
detects inflammation
high levels of ESR
infection
heart attack
Albumin Normal Range
3.4 - 5.4 g/dL
What does albumin measure?
protein in bl plasma, keeps bl in vasculature
low levels of albumin
swelling (increased protein diet needed)
White Blood Cell normal range
5-10 billion/L
low and high level of WBC
s/s of infection
Electrical conduction pathway of the heart
SA node (pacemaker) (atria charge)
AV node (atria contract)
Bundle of HIS (ventricles charge)
Purkinje fibers (ventricles contract)
How do you assess the adequacy of circulation and perfusion?
skin color assessment
pulse strength
cap refill
S/S of poor tissue perfusion/poor circulation
pallor
weak pulses
slow cap refill >3 sec
S/S of Anemia
tachycardia
fatigue
pallor
confusion
diminished pulses
Left-sided heart failure interventions
assess lung sounds for crackles
daily weight checks
fluid restriction
assess the patient for confusion
allow for frequent breaks and rest periods
check SPO2
raise HOB (high fowlers)
ambulating
decrease Na diet (heart healthy diet)
deep breathing exercises (incentive spirometer)
I & O
elevate/compress legs
diuretic
Hypertension complications
glaucoma
kidney disease
cardiomyopathy
aortic aneurysm (weakening in lining of blood vessel)
heart failure
myocardial infarction
Heart Failure S/S
dyspnea
anasarca (swelling of the whole body)
heart murmur
confusion
fatigue
Factors that affect cardiovascular function
age
stress
allergic reaction
altitude
pregnancy
nutrition
obesity
exercise
tobacco
substance abuse
medications
Cardiac Arrest vs MI
cessation of cardiac function
blood supply to the heart muscle is blocked
Dysrhythmia/arrhythmia
alterations in heart rate or rhythm; arrhythmia
Cardiomyopathy
heart enlargement; impaired cardiac contractility
Valve stenosis
narrowing; blood flows through a narrow, constricted opening
Unstable angina
ischemic chest pain that has worsened and isn’t relieved by usual measures; if untreated can lead to MI
Cardiac Ischemia
oxygen requirements of the heart aren’t met; if prolonged, leads to MI as the heart begins to necrose from inadequate O2
Coronary Artery Disease (CAD)
plaque builds up inside coronary arteries; reduces blood flow to the heart muscle; clots can form
Valve incompetence
incomplete closure of a valve resulting in regurgitation of blood into the chamber from which it came
Angina Pectoris
transient chest pain due to myocardial ischemia; tissue becomes injured but doesn’t necrose
Stable Angina
a predictable pattern of ischemic chest pain that is precipitated by know triggers; alleviated by rest and medication
Main Risk Factors of Heart Failure
uncontrolled hypertension and myocardial infarctions
Right-Sided Heart Failure S/S
peripheral edema/ jugular vein distension (JVD)
abdominal distension/pain
murmurs
full feeling in stomach
urgency to urinate
nausea/vomiting
increased BP
anorexia
Right-Sided Heart Failure Interventions
diuretic
measure urine output
check edema
ambulate
increase protein diet and decrease Na intake (heart healthy diet)
raise HOB
I & O (output should be the same as or greater than input)
Priorities and Nursing Considerations for Right-Sided Heart Failure
ABCs
heart sounds (S3 and murmurs)
peripheral assessment/cap refill
skin assessment
A & O x4
Left-Sided Heart Failure S/S
crackles
SOB
productive cough (frothy/pink)
PE
dyspnea
decreased SPO2
increased RR, HR, BP
cardiomyopathy
edema
weight gain
cyanosis/pallor
confusion
bounding pulses
fatigue
cool to touch/wet skin
Priorities and Nursing Considerations for Left-Sided Heart Failure
ABCs (especially breathing)/ lung sounds
heart sounds (S3/murmurs)
peripheral assessment / cap refill
skin assessment
A & O x4
S/S for both types of Heart Failure
cardiomyopathy
decreased CO (cardiac output)
increased BNP (over 100)
S3 sounds
decreased Ejection Fraction (30% = heart failure)
Causes of venous insufficiency
obstruction
valves not working
calf muscle dysfunction
S/S for Venous Insufficiency
erythema/ “ruddy”
swelling/edema/oozy
warmth
painful (esp when extremity is dependent [hanging down])
wounds w/ drainage
Interventions for Venous Insufficiency
elevate legs
compression socks
IPCs
ice therapy
wound cleaning and keep them dry
encourage ambulation
leg exercises
S/S of Arterial Insufficiency
pallor/cyanotic/necrotic (black)
cool to touch
diminished/weak/absent pulses
slow cap refill
wounds (dry/necrotic)
loss of hair
pain upon activity (intermittent claudication)
Interventions for Arterial Insufficiency
heat therapy
legs down
frequent breaks w/ ambulation
short activity sessions
keep wounds moist
Assessments for both venous and arterial insufficiency
peripheral vascular assessment (cap refill/pulses)
skin assessment
neurovascular assessment (pain and sensations)
Vasodilator action
dilate blood vessels and ease cardiac workload
What do vasodilators end in?
-pril
Example of vasodilator
nitroglycerin
Assessment for vasodilators
systolic above 100
AP above 60
Beta-Adrenergic blockers action
reduce workload of heart and reduce oxygen consumption
relax heart
What do beta-adrenergic blockers end in?
-olol
Assessment for beta-adrenergic blockers
systolic above 100
AP above 60
Positive inotropic agents action
improve effectiveness of heart’s pumping action without excess workload or oxygen demands
decreases heart rate
for heart failure
Example of a Positive inotropic agent
digoxin
Assessment for Positive inotropic agents
AP above 60
systolic above 100
Diuretic action
reduce the volume of circulating blood
prevent accumulation of fluid in pulmonary circulation and body tissues
give to pts in heart failure
Example of diuretic
furosemide
Assessment for diuretics
AP above 60
systolic above 100
Potassium level (DO NOT GIVE WHEN K = LOW)
Anticoagulants action
blood thinner (prevents clots)
Examples of anticoagulants
heparin, enoxaparin
DO NOT GIVE WITH ASPIRIN
What do you need to monitor for pt on anticoagulant?
bleeding
RBCs
Hgb/Hct
PLATELETS (hold if less than 100)
Cholesterol / Lipid Profile
indicates risk for cardiovascular disease in the long term
Echocardiogram
ultrasound evaluation of the heart that examines function and blood flow
determines ejection fraction
Hemoglobin
measures oxygen carrying capacity of the blood
Electrocardiogram
electrode placed to evaluate electrical activity of the heart
checks electrical pathway in heart
Doppler Ultrasound
detects abnormalities of blood flow in vessels (DVT)
Venography
dye and x-rays used to identify blood clots or narrowing of the blood flow (DVT)
MI: pathophysiology, etiology, S/S, complications
caused by lack of oxygen-rich blood to the heart muscles
could be caused by hypertension, high cholesterol, atherosclerosis
chest pain, SOB; pain in arm, neck, back, shoulder; nausea, light-headedness, fatigue
arrhythmias, mechanical errors, inflammatory response, heart failure
HTN: etiology, S/S, complications
unhealthy lifestyle (exercise, smoking, diet), diabetes, obesity
blurry or double vision, dizziness, fatigue, headache, heart palpitations, nosebleeds, SOB, N/V
arterial stiffness, MI, stroke, aneurysm, heart failure, kidney problems, eye problems, dementia, changes with memory or understanding
PAD: etiology, S/S, complications
buildup of fatty, cholesterol-containing deposits (plaques) on artery walls [atherosclerosis]
coldness in lower leg or foot, leg numbness or weakness, no pulse or weak pulse, cramping after activities (walking, climbing stairs), shiny skin on leg
MI, stroke, death, coronary artery disease, cerebrovascular disease
Anemia/blood loss: etiology, S/S, complications
decrease in # of RBCs/blood loss, lack of RBC production, high rates of RBC destruction
fatigue, weakness, confusion, pallor, irregular heartbeat, SOB, dizziness, chest pain, cold hands and feet (drop in Hgb, drop in RBCs)
fatigue, pregnancy complications, heart problems, death
S/S of poor tissue perfusion/poor circulation
pallor, weak pulses, slow cap refill
Assessments for adequate circulation and perfusion
skin color, warmth, pulse strength, cap refill
TEACH acronym
tune into the pt
edit pt info
act on every teaching moment
clarify often
honor the pt as partner in education process
Steps of teaching-learning process
summary of learning needed
plan
implementation of plan
evaluation of results
Factors that affect pt learning
age and developmental level
family support networks
financial resources
cultural influences
language deficits
health literacy level
Teaching Strategies
lecture
discussion
panel discussion
demonstration
discovery
role playing
audiovisual materials
printed materials
programmed instruction
web-based instruction and technology
LET THEM KNOW WHAT IS IN IT FOR THEM
Cognitive domain for learning
storing and recalling of new knowledge in the brain
lecture, panel, discovery, written materials
Psychomotor domain for learning
learning a physical skill
demonstration, discovery, printed materials
Affective domain for learning
changing attitudes, values, and feelings; encouraging
role modeling, discussion, audiovisual materials
Common Teaching Mistakes
ignoring restrictions of the pt’s environment
failing to accept that pt’s have the right to change their mind
using medical jargon
failing to negotiate goals
duplicating teaching that other team members have done
overloading the pt with information
choosing the wrong time for teaching
not evaluating what the pt has learned
not reviewing educational media, or relying exclusively on media
failing to document pt teaching and plan for follow up or teaching reinforcement
What VS and mineral can diuretics affect?
can drop blood pressure
drop potassium
Should you give a diuretic to a pt with low blood pressure and low potassium level?
no
Anticoagulant labs to watch
PLATELETS!!!!!
RBC count
PTT (heparin)
PT and INR (non-heparin meds)
If there is blockage in the electrical conduction of the heart what would happen?
an irregular rhythm
If a heart valve isn’t working correctly, what could happen?
enlarged ventricles, murmur
If the SA node was damaged, then what node would become the start of electrical conduction?
AV node
What does vasoconstriction do to your blood pressure
increases it
Promoting circulation and decrease the risk of thromboemboli
ambulation
exercise
move legs
elevating legs
TED hose
IPCs
What medication do you give for edema?
diuretic
What OTC med would you question giving to a pt who is taking an anticoagulant?
aspirin
