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Concepts ll > Module 2 : Perfusion > Flashcards

Module 2 : Perfusion Flashcards

1
Q

What is an EKG Review ?

A

EKGs are graphic representations of electrical activity within the heart.

EKGs reflect electrical activity, not mechanical activity. To evaluate mechanical function, assess blood pressure and peripheral pulses.

When electrical impulses stimulate mechanical cells to contract, the heart is expected to contract and pump blood, thus producing a pulse.

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2
Q

what is an isoletric Line ?

A

Flatline that occurs:

-when no electrical activity is occuring

-when pulses are to weak to be detected

  • used a baseline to identify changing electrical movement
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3
Q

EKG Components

A

P-wave – atrial depolarization

PR interval – time between atrial depolarization and beginning of ventricular depolarization

QRS complex – ventricular depolarization

ST-segment – time between end of ventricular depolarization and beginning ventricular repolarization

T-wave – ventricular repolarization (recharge)

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4
Q

EKG components

A

Depolarization is the discharge of energy that transfer electrical charges across the cell membrane.

Repolarization is the return of electrical charges to their original state.

Isoelectric

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5
Q

What are normal electrical Conduction pathways ?

A

Atrium

SA node (generates electrical impulse)

P wave (EKG strip) :Natural Rate 60-100 bpm

Internodal pathway

Junction

Atrial tissue

AV node

PR interval (EKG strip)

Natural Rate 20-40 bpm

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6
Q

What are normal Electrical Conduction Pathway

A

Ventricle

Bundle of his

Right & Left bundle branches

**Purkinje fibers **

QRS complex (EKG strip)

ST segment (EKG strip)

T wave (EKG strip)

QT interval (EKG strip)

Natural Rate 20-40 bpm

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7
Q

What is Perfusion?

A

Perfusion refers to the passage of oxygenated capillary blood through body tissues. Adequate perfusion depends on normal functioning of both the respiratory and cardiac systems. The nurse encounters potential and actual alterations in perfusion in all types of clients and must detect problems and intervene early to prevent life-threatening complications.

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8
Q

Peripheral perfusion

A

leg extremities

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9
Q

Perfusion affects what ?

A

nutrition
oxygenation
pain

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10
Q

what is peripheral Artery Disease ?

A

Peripheral blood vessels that are diseased in the lower extremities

Arterial blood flow is impaired, preventing distal extremities from receiving adequate perfusion

Results in ischemia and necrosis (cell death).

Possible thrombus(clot) that can migrate

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11
Q

Signs of PAD ?

A

Claudication

Rest Pain

Necrosis

Gangrene

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12
Q

How to access the P’s of Artery Disease?

A

Check the P’s
Pain

Pallor

Pulselessness

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13
Q

PAD Diagnostic Test ( Blood Test)

A

cholesterol
triglycerides
LDL
checking build up of fatty

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14
Q

PAD Diagnostics Test

A

Arteriography ( used to look for changes in a blood vessel)

Doppler Ultrasound

Magnetic resonance angiography (MRA) ( x-ray used to check blood vessels)

Ankle-Brachial index

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15
Q

PAD Self-management

A

Patient Education:

Follow Smoking Cessation

Maintaining dietary restrictions

Participating in exercise regimen

Foot Care

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16
Q

What is a Thrombus ?

A

Blood clot
-DVT ( A pool of blood clots)
-VTE ( Venous thrombus embolism) ( a clot that has broken off )

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17
Q

How does a thrombus form?

A

Forms by :

Stasis of blood flow

Endothelial injury

Hyper coagulability

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18
Q

What are common causes of DVT/VTE?

A

Hip surgery

Total knee replacement

Oral contraceptives

Immobility

Prolonged bedrest

Prolonged Sitting

History of DVT

History of Atrial Fibrillation

Peripheral vascular disease

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19
Q

Where are your assessment finding of DVT/ VTE?

A

Calf or groin tenderness/pain

Sudden onset of unilateral swelling in legs

Localized edema

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20
Q

Diagnostic for DVT/ VTE

A

Venography

Doppler ultrasound

D-Dimer ( a protein fragment that your body makes when a blood clot dissolves)

Deep vein MRI

Venous duplex ultrasonography (preferred)

Possible Complication DIC (Disseminated intravascular coagulation) - a rare disorder that causes abnormal blood clotting

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21
Q

Thrombolytic Therapy

A

Tissue plasminogen activator (TPA)

Dissolves thrombus quickly

Prevents further venous insufficiency

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22
Q

What are Nursing Care for DVT/ VTE ( Prevention)

A

Early ambulation

Adequate hydration

Intermittent pneumatic compression {sequential compression devices (SCDs}

Venous plexus foot pump

Anticoagulant therapy

The Patient Receiving Anticoagulant Therapy (Box)

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23
Q

What do the Joint Commision recommend for VTE Core Measure?

A

VTE Prophylaxis

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24
Q

DVT/ VTE ( Nursing Care)

A

Monitor aPTT to adjust Heparin dosage (per protocol)

Ensure antidote for Heparin is available (Protamine Sulfate)

Monitor PT/INR for Warfarin (1.5-2.0)

Ensure antidote for Warfarin is available (Vitamin K)

Monitor for signs and symptoms of bleeding

Bedrest/Elevation

Avoid massaging area

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25
Q

What are DVT/ VTE desired outcomes?

A

Prevent Pulmonary Embolus (PE)

Prevent further thrombus formation

Decrease size of existing thrombus

Avoid complications of anticoagulant therapy

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26
Q

What is Angina ( Chest pain) ?

A

Perfusion:

blockage or spasm of a coronary artery leading to diminished blood supply

Oxygenation

Lack of oxygen to the myocardial results in tissue hypoxia

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27
Q

What is Ischemia ?

A

Injury
necrosis ( Infarction)

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28
Q

What is Chronic Stable Angina?

A

Predictable

Oxygen Supply does not meet Myocardial Demand

Typically exercise-induced

Pain relieved by rest/sublingual nitroglycerin (vasodilator)

Pharmacological Management

Sublingual Nitroglycerin (NTG)

Aspirin 325mg

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29
Q

PT Education for Chronic Stable Angina ( self-management)

A

Wheezing or difficulty breathing

Weight gain of 3 pounds in 1 week or 1 to 2 pounds overnight

Severe chest or epigastric discomfort with weakness or nausea

Dizziness, faintness, or shortness of breath with activity

Place one nitroglycerin tablet or spray under your tongue, allowing the tablet to dissolve.

30
Q

PT Education - Chronic Stable Angina ( Self-management)

A

Unstable Angina:

Increased nitroglycerin use

Chest discomfort that does not improve after 5 minutes or 3 sublingual NTG tablet or spray

Call 911 for transportation to a health care facility.

31
Q

What are medical Management for chronic stable angina ?

A

Rest

Pain Management

Antiplatelet

Vasodilators

32
Q

What are the desired outcomes for stable angina?

A

Relief of Chest Pain

Coronary Dilation

Increased Tissue Perfusion

Decreased Anxiety

No Acute Dysrhythmias

Maintain Central Perfusion

33
Q

What is Unstable Angina Injury

A

-Change in previously predicted pattern of angina ( no longer can predict onset)

-Part of continuum of ACS

-Indicative of plaque instability

-Not relieved by Nitroglycerin (vasodilator)

-Change requires immediate medical evaluation

-ST or T wave changes on EKG

34
Q

What are Physical Presentation of Unstable Angina ( Injury)

A

Severe chest pain

Nausea

Vomiting

Diaphoresis

Dizziness

Weakness

Palpitations

Shortness of breath

35
Q

How to Interpret CAD ( Blood Test)

A

Lipids

Total Cholesterol greater than 200 mg/dL

LDL (Bad) Cholesterol) ↑

HDL (Good) Cholesterol) ↓

C- Reactive Protein ↑

B-type natriuretic peptide (BNP) ↑

36
Q

CAD Interpreting ( Central Perfusion)

A

Cardiac Markers:

Troponin ( type of protein found in the heart)

Creatine kinase-MB

37
Q

Drug therapy for PAD

A

HMG-CoA reductase inhibitors (statins) :

Simvastatin (Zocor)

Atorvastatin (Lipitor)

Antiplatelet :

Aspirin

Clopidogrel (Plavix)

38
Q

Nursing Care for PAD

A

monitor bp
assess tissue perfusion

39
Q

Purpose of Anticoagulation Therapy for ( DVT/ VTE)

A

Anticoagulant Therapy:

Unfractionated Heparin (UFH)

Continuous IV drip (based on body weight)

Prevents formation of new clots and enlargement of existing clot

39
Q

Purpose of Anticoagulation Therapy for ( DVT/ VTE)

A

Anticoagulant Therapy:

Unfractionated Heparin (UFH)

Continuous IV drip (based on body weight)

Prevents formation of new clots and enlargement of existing clot

40
Q

DVT / VTE prevention

A

Heparin 5,000 units subcutaneous (SQ)

Low-Molecular Weight Heparin Enoxaparin (Lovenox)

41
Q

Description of chest pain ( Noticing)

A

Heartburn

Indigestion

Dull

Squeezing

Gnawing

Aching

Tightness

Pressure

Get a 12-Lead EKG

42
Q

Percutaneous Coronary Interventions ( PCI)

A

Uses a diagnostic coronary angiography to identify occluded coronary artery

Reopens occluded coronary arteries: Stent

Restores perfusion

Should be performed within 90 minutes of arrival to hospital

43
Q

PCI Nursing interventions

A

Acute Pain:Pain Management

Risk for bleeding:

Watch for signs and symptoms of bleeding

Back pain (retroperitoneal bleeding)

Assess insertion site

44
Q

PCI interventions

A

Risk for injury :

Watch for increased chest pain

Monitor EKG for ST elevation

Maintain hydration (acute kidney injury)

Monitor for acute closure of the vessel

Inquire about shellfish allergy

45
Q

PCI Interventions

A

Risk for ineffective peripheral tissue perfusion

Continuous assessment of affected extremity

Instruct patient to keep limb straight/minimize movement

Head of bed should be less than 30 degrees

Monitor distal pulses frequently

Assess color, sensation, and temperature in involved extremity

46
Q

Vasodilators - What are they ?

A

Nitroglycerin

Is a vasodilator

Helps preload and afterload

Myocardial oxygen supply

Route is based on patient symptoms

Nitroglycerin (nitrostat)

Isosorbide dinitrate (isordil)

Nitrolingual spray

Nitroglycerin patch

47
Q

What are indication for a CABG ?

A

Severe occluded coronary artery

Unstable angina with severe vessel disease

Ischemia with heart failure

Acute MI with cardiogenic shock

Signs of ischemia after PCI

48
Q

What is Heart failure?

A

The inability of the heart to pump effectively
-left-sided heart failure
-right-sided heart failure

49
Q

What are the 2 types of Left-sided heart failure?

A

Systolic heart failure
Diastolic Heart failure

50
Q

Causes of left -sided heart failure

A

Hypertension

Coronary artery disease

Valvular disease (mitral & aortic)

Myocardial Infarction (MI) ( Heart attack) happens when one or more parts of the heart do not receive oxygen

51
Q

Clinical Signs and Symptoms of Heart Failure

A

Weakness

Fatigue

Dizziness

Confusion

Dyspnea

Pulmonary Congestion

52
Q

Right Sided Heart Failure Causes

A

Left ventricular failure,

Myocardial Infarction (MI)

Pulmonary HTN

COPD

Cardiomyopathy

53
Q

signs and symptoms of right-sided heart failure

A

Distended neck veins

Increased abdominal girth

Hepatomegaly (liver engorgement)

Ascites ( accumulation of fluid in the peritoneal cavity

Dependent edema

Weight—the most reliable indicator of fluid gain or loss

Peripheral pitting edema

54
Q

Blood test for HF Diagnostics

A

B-type Natriuretic peptide ( bnp) -measure the amount of bnp protein in the blood, if the heart work harder more bnp is produced
electrolytes
Hematocrit and hemoglobin

55
Q

What Imaging are used to diagnose HR ?

A

Chest X-ray

Echocardiography (best diagnostic tool)

Decreased Ejection Fraction (EF)

EKG

Pulmonary artery catheter (Swan-Ganz)

56
Q

Name some Priority Problems for Heart failure

A

Priority problems:

Impaired gas exchange

Decreased cardiac output

Fatigue/weakness ( heart not contracting )

Activity intolerance

Potential for pulmonary edema ( too much fluid in the lung pt can not breathe)

Excess Fluid Volume

Decrease peripheral tissue perfusion ( Most common in right sided)

57
Q

Patient Outcomes for Heart Failure

A

The Patient Will:

Have improved gas exchange ( increase oxygen to 95%)

Have improved cardiac effectiveness (cardiac output) (

Tolerate Activity

Have improved respiratory rate/pattern

Maintain oxygen saturation greater than 95%

Have decreased net volume (output>intake) ( nurse goal: wants pt to have increase output)

Increased peripheral tissue perfusion ( check pulses as a goal)

58
Q

Preload - Drug Therapy for Heart failure

A

Diuretics:

Furosemide (lasix)

Aldactone (spironolactone)

Thiazide (HCTZ)

Nitrates : ( helps dilate)
Nitroglycerin (nitrostat)

Isosorbide dinitrate (isordil)

59
Q

Afterload Drug Therapy for Heart Failure ( drugs that help push blood out the heart)

A

ACE Inhibitors

Enalapril (vasotec)

Angiotensin Receptor Blockers (ARB)

Nitrates

60
Q

Heart Failure Drug therapy “ Contractility”

A

Cardiac Glycoside:

Lanoxin (digoxin)

-Increases contractility

-Reduces heart rate (HR)

-Slows conduction through atrioventricular node

61
Q

Drug therapy for Heart Failure Drug Therapy “ Contractility”

A

Beta Blockers

Inotropic drugs (milrinone)

62
Q

What are the therapeutic range and toxic range for Lanoxin ( Digoxin)

A

Therapeutic level 0.5-2.0 ng/ml
Toxicity >2.0 ng/ml

63
Q

What is everything you know about Lanoxin ( Digoxin)

A

Indications:

CHF, atrial fibrillation /flutter

Digoxin Toxicity (Signs and Systems):

Anorexia, *nausea (toxicity), vertigo, muscle weakness, *confusion (elderly), halos and vision changes

Labs associated with Dig toxicity:

↓K, Mg and ↑ Ca

Check apical pulse for 1 min

hold meds if pulse is less than 60

64
Q

Adjunt Therapy ( another form of trx used with the primary treatment

A

Beta Blockers: -lol HMG- CoA:- statin
Atenolol Atorvastatin
Metoprolol Simvastatin
Carvedilol
check bp, hr

ACE Inhibitors: -pril Statins reduce cholesterol in liver
Enalapril Contraind: pt w/ liver disease
linsinopril Pt Teach: avoid grape juice w/ statin
ARBs: -sartan
Losartan
Valsartan

65
Q

Cardiac Key Drugs

A
66
Q

Non- Surgical Management for Heart Failure

A

Non-Surgical

Continuous positive airway pressure (CPAP) is a respiratory treatment that improves obstructive sleep apnea

Cardiac resynchronization therapy (CRT) - help your heart beat with the right rhythm

Surgical:

Heart transplantation

Ventricular Assist Device (VAD)- helps pump blood from the lower chambers of your heart to the rest of the body

67
Q

What should the nurse do for Heart Failure patients

A

Monitor vitals signs

Monitor electrolytes

Monitor for early signs of pulmonary edema (review chart)

Implement Medical Regimen

68
Q

What could you teach a patient who has Heart Failure?

A

MADDL

Medications and Compliance

Activity

Daily weights

Diet

Limit Fluids

Signs of heart failure exacerbations

Prevent Readmissions

69
Q

What are signs of Heart Failure Exacerbation ( Increase/ severity of a problem)?

A

rapid weight gain
dyspnea
decrease in exercise tolerance
cold-like symptoms
increase in edema in feet, ankles, hands
increase in BNP levels
- THE FAILURE TO RESCUE-

70
Q

What is the joint commission Heart FAilure core measure:

A

provide discharge instruction
evaluation of left ventricular systolic function
ACE/ ARB for left ventricular systolic dysfunction
Adult smoking cessation

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