Module 1: Perfusion and Teaching & Counseling Flashcards
1
Q
Red Blood Cells Normal Range
A
3.6-6.1 million/mcL
2
Q
S/S of Low RBC Count
A
anemia, paleness, cyanosis, weakness, fatigue, poor circulation
3
Q
What causes low RBC count?
A
iron deficiency anemia
4
Q
What does Hemoglobin levels measure?
A
hemoglobin measures the protein (called hemoglobin) that carries oxygen in red blood cells
5
Q
Hemoglobin Normal Range
A
11.1 - 15.3 g/dL
6
Q
S/S of Low Hemoglobin Count
A
excessive bruising in pts with low platelets, cyanosis, tired, pale, increased HR, SOB, weakness
7
Q
Causes of low hemoglobin
A
anemia or blood loss
8
Q
Hematocrit Normal Levels
A
33.7 - 46%
9
Q
What does Hematocrit measure?
A
portion of RBCs in blood
10
Q
S/S of low level of hematocrit
A
cyanosis, tired, pale, increased irregular HR, SOB, weakness
11
Q
S/S of high level of hematocrit
A
dehydration (leads to increase Hct)
12
Q
What causes changes in hematocrit?
A
fluid balance
13
Q
Platelets Normal Range
A
150-450 billion/L
14
Q
S/S of low value platelets
A
BLEEDING, fatigue, nose bleeds, bl in stool, BRUISING, pallor, low blood pressure, tachycardia, weak pulse
15
Q
S/S of high value platelets
A
more likely to clot
16
Q
What causes changes in platelet count?
A
iron deficiency, cancer, trauma
17
Q
Prothrombin Time Normal Range
A
11-13.5 sec
18
Q
low level of prothrombin time
A
more likely to clot
19
Q
high level of prothrombin time
A
more likely to bleed
20
Q
What causes changes in prothrombin time?
A
vitamin K, drug and herb interactions
21
Q
International Normalized Ratio Normal Range
A
0.8 - 1.3 sec
22
Q
What do both INR and PT and PTT measure?
A
how long bl takes to clot
23
Q
Low levels of INR
A
more likely to clot
24
Q
High levels of INR
A
more likely to bleed
25
What causes changes in INR?
vitamin K, drug and herb interactions
26
Partial Prothrombin Time Normal Range
25-35 sec
27
Low value PTT
more likely to clot
28
High value PTT
more likely to bleed
29
What causes changes of PTT?
vitamin K deficiency, liver disease
30
Ejection Fraction Normal Range
50-70%
31
Low value ejection fraction
fatigue, weakness
32
What causes low ejection fraction
heart failure
33
Brain Natriuretic Peptide (BNP) normal range
less than 100 pg/mL
34
What does BNP measure?
levels of BNP protein made by heart and bl vessels
35
low BNP
know they don't have heart failure
36
high BNP
worse severity of heart failure
37
Total Cholesterol normal range
less than 200 mg/ dL
38
HDL normal range
more than 40 mg/dL
GOOD CHOLESTEROL
39
LDL normal range
less than 100 mg/dL
40
S/S of low ranges of cholesterol
no s/s but increase risk of CV disease (HDL)
no s/s for other two
41
s/s of high ranges of cholesterol
cardiac disease
decreased circulation
increased BP
atherosclerosis
42
Erythrocyte Sedimentation Rate (ESR) normal range
0-20 mm/hr
43
What does ESR measure
detects inflammation
44
high levels of ESR
infection
heart attack
45
Albumin Normal Range
3.4 - 5.4 g/dL
46
What does albumin measure?
protein in bl plasma, keeps bl in vasculature
47
low levels of albumin
swelling (increased protein diet needed)
48
White Blood Cell normal range
5-10 billion/L
49
low and high level of WBC
s/s of infection
50
Electrical conduction pathway of the heart
SA node (pacemaker) (atria charge)
AV node (atria contract)
Bundle of HIS (ventricles charge)
Purkinje fibers (ventricles contract)
51
How do you assess the adequacy of circulation and perfusion?
skin color assessment
pulse strength
cap refill
52
S/S of poor tissue perfusion/poor circulation
pallor
weak pulses
slow cap refill >3 sec
53
S/S of Anemia
tachycardia
fatigue
pallor
confusion
diminished pulses
54
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
55
Hypertension complications
glaucoma
kidney disease
cardiomyopathy
aortic aneurysm (weakening in lining of blood vessel)
heart failure
myocardial infarction
56
Heart Failure S/S
dyspnea
anasarca (swelling of the whole body)
heart murmur
confusion
fatigue
57
Factors that affect cardiovascular function
age
stress
allergic reaction
altitude
pregnancy
nutrition
obesity
exercise
tobacco
substance abuse
medications
58
Cardiac Arrest vs MI
cessation of cardiac function
blood supply to the heart muscle is blocked
59
Dysrhythmia/arrhythmia
alterations in heart rate or rhythm; arrhythmia
60
Cardiomyopathy
heart enlargement; impaired cardiac contractility
61
Valve stenosis
narrowing; blood flows through a narrow, constricted opening
62
Unstable angina
ischemic chest pain that has worsened and isn't relieved by usual measures; if untreated can lead to MI
63
Cardiac Ischemia
oxygen requirements of the heart aren't met; if prolonged, leads to MI as the heart begins to necrose from inadequate O2
64
Coronary Artery Disease (CAD)
plaque builds up inside coronary arteries; reduces blood flow to the heart muscle; clots can form
65
Valve incompetence
incomplete closure of a valve resulting in regurgitation of blood into the chamber from which it came
66
Angina Pectoris
transient chest pain due to myocardial ischemia; tissue becomes injured but doesn't necrose
67
Stable Angina
a predictable pattern of ischemic chest pain that is precipitated by know triggers; alleviated by rest and medication
68
Main Risk Factors of Heart Failure
uncontrolled hypertension and myocardial infarctions
69
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
70
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)
71
Priorities and Nursing Considerations for Right-Sided Heart Failure
ABCs
heart sounds (S3 and murmurs)
peripheral assessment/cap refill
skin assessment
A & O x4
72
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
73
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
74
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)
75
Causes of venous insufficiency
obstruction
valves not working
calf muscle dysfunction
76
S/S for Venous Insufficiency
erythema/ "ruddy"
swelling/edema/oozy
warmth
painful (esp when extremity is dependent [hanging down])
wounds w/ drainage
77
Interventions for Venous Insufficiency
elevate legs
compression socks
IPCs
ice therapy
wound cleaning and keep them dry
encourage ambulation
leg exercises
78
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)
79
Interventions for Arterial Insufficiency
heat therapy
legs down
frequent breaks w/ ambulation
short activity sessions
keep wounds moist
80
Assessments for both venous and arterial insufficiency
peripheral vascular assessment (cap refill/pulses)
skin assessment
neurovascular assessment (pain and sensations)
81
Vasodilator action
dilate blood vessels and ease cardiac workload
82
What do vasodilators end in?
-pril
83
Example of vasodilator
nitroglycerin
84
Assessment for vasodilators
systolic above 100
AP above 60
85
Beta-Adrenergic blockers action
reduce workload of heart and reduce oxygen consumption
relax heart
86
What do beta-adrenergic blockers end in?
-olol
87
Assessment for beta-adrenergic blockers
systolic above 100
AP above 60
88
Positive inotropic agents action
improve effectiveness of heart's pumping action without excess workload or oxygen demands
decreases heart rate
for heart failure
89
Example of a Positive inotropic agent
digoxin
90
Assessment for Positive inotropic agents
AP above 60
systolic above 100
91
Diuretic action
reduce the volume of circulating blood
prevent accumulation of fluid in pulmonary circulation and body tissues
give to pts in heart failure
92
Example of diuretic
furosemide
93
Assessment for diuretics
AP above 60
systolic above 100
Potassium level (DO NOT GIVE WHEN K = LOW)
94
Anticoagulants action
blood thinner (prevents clots)
95
Examples of anticoagulants
heparin, enoxaparin
DO NOT GIVE WITH ASPIRIN
96
What do you need to monitor for pt on anticoagulant?
bleeding
RBCs
Hgb/Hct
PLATELETS (hold if less than 100)
97
Cholesterol / Lipid Profile
indicates risk for cardiovascular disease in the long term
98
Echocardiogram
ultrasound evaluation of the heart that examines function and blood flow
determines ejection fraction
99
Hemoglobin
measures oxygen carrying capacity of the blood
100
Electrocardiogram
electrode placed to evaluate electrical activity of the heart
checks electrical pathway in heart
101
Doppler Ultrasound
detects abnormalities of blood flow in vessels (DVT)
102
Venography
dye and x-rays used to identify blood clots or narrowing of the blood flow (DVT)
103
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
104
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
105
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
106
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
107
S/S of poor tissue perfusion/poor circulation
pallor, weak pulses, slow cap refill
108
Assessments for adequate circulation and perfusion
skin color, warmth, pulse strength, cap refill
109
TEACH acronym
tune into the pt
edit pt info
act on every teaching moment
clarify often
honor the pt as partner in education process
110
Steps of teaching-learning process
summary of learning needed
plan
implementation of plan
evaluation of results
111
Factors that affect pt learning
age and developmental level
family support networks
financial resources
cultural influences
language deficits
health literacy level
112
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
113
Cognitive domain for learning
storing and recalling of new knowledge in the brain
lecture, panel, discovery, written materials
114
Psychomotor domain for learning
learning a physical skill
demonstration, discovery, printed materials
115
Affective domain for learning
changing attitudes, values, and feelings; encouraging
role modeling, discussion, audiovisual materials
116
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
117
What VS and mineral can diuretics affect?
can drop blood pressure
drop potassium
118
Should you give a diuretic to a pt with low blood pressure and low potassium level?
no
119
Anticoagulant labs to watch
PLATELETS!!!!!
RBC count
PTT (heparin)
PT and INR (non-heparin meds)
120
If there is blockage in the electrical conduction of the heart what would happen?
an irregular rhythm
121
If a heart valve isn't working correctly, what could happen?
enlarged ventricles, murmur
122
If the SA node was damaged, then what node would become the start of electrical conduction?
AV node
123
What does vasoconstriction do to your blood pressure
increases it
124
Promoting circulation and decrease the risk of thromboemboli
ambulation
exercise
move legs
elevating legs
TED hose
IPCs
125
What medication do you give for edema?
diuretic
126
What OTC med would you question giving to a pt who is taking an anticoagulant?
aspirin
