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NURS321 > Module 5: Cardiovascular And Pain > Flashcards

Module 5: Cardiovascular And Pain Flashcards

1
Q

What to look for when doing a lower extremity evaluation?

A
  1. Vascularity and Color (lower extremities tend to have less circulation)
  2. Inspect for Open areas or Ulcers
  3. Identify varicosities and assess location
  4. Inspect for pitting or non-pitting edema
  5. presence or not of hair on lower extremities
  6. Check for tenderness, pain, and erythema
  7. CMS
  8. Capillary refill in toes (brisk in 3 second return)
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2
Q

When looking at lower extremity open areas and ulcers, what should you check for?

A

Location, time being there, wounds, and bad perfusion leading to not even noticing its there

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3
Q

TED Stockings

A

compression stockings that prevent blood clots and aid in cardiovascular/peripheral vascular disease and varicosities

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4
Q

Anti Embolic Stockings

A

prevent pooling in lower extremities

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5
Q

When is the best time to put on compression stockings?

A

When the feet have been up for 30 minutes / when they wake up before leaving bed

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6
Q

NEVER use TED Stockings on …

A

patients with PAD (Peripheral Arterial Disease)

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7
Q

Pitting Edema

A

pushing down on an edem and seeing how long the indentation lasts - then rated on severity

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8
Q

No hair on lower extremities indicates?

A

poor circulation, and shiny skin indicated atrophy of the skin there

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9
Q

Deep vein thrombosis

A

in lower extremity area, can be palpated for warmth and swelling, and pain/inflammation/redness

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10
Q

CMS

A

“Circulation, Movement, Sensation”

Check for capillary refill in 3 seconds, can they move their toes, can they ID what toe you touch

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11
Q

Cardiovascular System

A

the heart and peripheral extremities - pump for circulation to and from the heart throughout the body through veins and arteries

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12
Q

Pericardium

A

tough, loose fitting, fiber sac that attaches to the great vessel and surrounds the OUTERmost layer and surrounds the heart

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13
Q

Epicardium

A

thin OUTERmost layer of the heart

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14
Q

Myocardium

A

thick muscular MIDDLE layer of the heart

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15
Q

Endocardium

A

thin layer of endothelial tissue that forms the INNER most layer of the heart

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16
Q

How many chambers are in the heart?

A

4

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17
Q

Two upper heart chambers

A
  • left and right atria at the base of the heart
  • earlike shape
  • thin walled, reservoirs for returning blood from the veins
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18
Q

Two lower heart chambers

A
  • right and left ventricles, at the apex

- thick walled and pumps the blood to the lungs and throughout the body

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19
Q

Which chamber pumps blood into the body?

A

Left Ventricle

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20
Q

Left Heart

A

the left atrium and ventricle

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21
Q

Right Heart

A

right atrium and ventricle

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22
Q

Cardiac Septum

A

tight partition dividing the left and right hearts

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23
Q

1 Way Valves

A
  • directs the flow of blood

- AV and Semilunar Valves

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24
Q

Atrioventricular Valves (AV)

A
  • Tricuspid (right; 3 cusp) and Mitral (left; 2 cusp; bicuspid) Valves
  • between atrium and ventricles
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25
Q

Semilunar Valves

A
  • Pulmonic and Aortic Valves

- between ventricles and great vessel / organ system

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26
Q

Arteries

A

carries oxygenated blood from the heart to the body

carries blood AWAY from the heart

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27
Q

Veins

A

carries deoxygenated blood TOWARDS the heart

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28
Q

Pulmonary circulation

A

Right heart pumps deoxygenated blood to the lungs

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29
Q

Systematic Circulation

A

Left heart pumps oxygenated blood to rest of the body

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30
Q

Direction of Blood Flow

A

Vena Cava –> R Atrium –> Tricuspid Valve –> R Ventricle –> Pulmonic Valve –> Pulmonary Arteries –> Lungs –> Pulmonary Veins –> L Atrium –> Mitral Valve –> L Ventricle –> Aortic Valve –> Aorta –> Body Systems –> repeat

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31
Q

Sinoatrial Node (SA Node)

A
  • hearts “pacemaker”
  • generates electricity and travels through the cardiac circuit
  • in R atrium near the superior vena cava
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32
Q

Atrioventricular Node

A
  • R atrium near the AV valve
  • delays passage of electrical impulses from SA node to the ventricles to make sure the atria have ejected all the blood to the ventricles before ventricles contract
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33
Q

Bundle of HIS

A

passes electrical impulses from AV node to Purkinje fibers that then move back up the heart

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34
Q

Flow of Heart Conduction

A

SA node –> AV node – > Bundle of His –> Purkinje fibers

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35
Q

ECG

A

composite recording of all actions and cells of the myocardium (waves and segments of the heart)

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36
Q

P Wave

A

SA node fires and depolarizes when atria are full. Atrial contractions start 100 msec after, represented by P-Q waves

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37
Q

Q Wave

A

depolarization occurance

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38
Q

R Wave

A

wave from ventricle contraction

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39
Q

S Wave

A

repolarization occurrence; plateau in action potential when ventricles contract

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40
Q

T Wave

A

ventricular repolarization right before this wave

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41
Q

Systole

A
  • contraction / work phase
  • semilunar valves open
  • AV valves closed
  • S1 best heard at APEX “LUB”
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42
Q

Diastole

A
  • relaxation phase
  • when blood fills the ventricles
  • AV Valves open
  • Aortic valve closed
  • S2 Best heart at the BASE “DUB”
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43
Q

Where on the heart is S1 best heard?

A

at the apex (5th intercostal)

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44
Q

Where on the heart is S2 best heard?

A

at the base

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45
Q

When taking the subjective part of the cardiovascular health history, make sure to ask the …

A

Chief complaint

ex:
pain - COLDSPA
dyspnea on exertion or at rest
palpitations
dizziness
medications
edema
nocturia
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46
Q

When looking at the health assessment of a cardiovascular health history you must gather?

A

Chief complaints
Personal/Lifestyle Health practices
Past (personal) medical history
Risk factors

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47
Q

Men have higher cardiovascular issue rates until when…

A

when women are post-menopause

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48
Q

Hypernatremia

A

high sodium levels

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49
Q

High lipid levels are linked to

A

increased likelihood of cardiac event

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50
Q

Order of Physical Exam Techniques used in Cardiovascular Assessment?

A
  1. Inspection
  2. Palpation
  3. Auscultation
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51
Q

Cardiovascular Inspection

A
  • move cephalocaudally in 3 positions
  • look for pallor, cyanosis, vital signs, HR, heaves, smell, cough, edema, varicosities, symmetry, deformities, pulsations
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52
Q

3 Positions to do Physical Cardiovascular Assessment?

A
  1. Sitting
  2. Supine (30-45 degree angle)
  3. Left Lateral Recumbent
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53
Q

5 Important Areas of the Heart

A 
Aortic (ALL)
Pulmonic (PEOPLE)
Erbs Point (ENJOY)
Tricuspid (TIME)
Mitral (MAGAZINE)
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54
Q

PMI

A

point of maximal impulse/apical impulse (mitral area)

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55
Q

Where might you be most likely to see a visible impulse on the chest?

A

5th intercostal or medial space (left side) (especially in thin people)

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56
Q

Aortic Area location

A

2nd ICS, right Sternal Border

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57
Q

Pulmonic Area Location

A

2nd ICS, left sternal border

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58
Q

Erbs Point Location

A

3rd ICS, left sternal border

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59
Q

Tricuspid Area Location

A

5th ICS (4th in children), left sternal border

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60
Q

Mitral Area Location

A

Mid-clavicular, left side, 5th ICS - maximal impulse

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61
Q

Main points of Cardiovascular Palpation

A
  1. FOCUS on inspection areas
  2. FEEL pulsations, vibrations, heaves, thrills, PMI
  3. PALPATE the 5 areas and epigastric region
62
Q

What other area do we check with palpation?

A

the epigastric region (and peripheral pulses)

63
Q

Diaphragm hears…

A

high pitched noises

64
Q

When auscultating cardiovascular, listen for…

A

S1S2 (LUBDUB)

65
Q

S1

A

LUB

Closure of AV valves, starting ventricular systole, best heard at the APEX, mitral, and tricuspid valves

66
Q

S2

A

DUB

closure of semilunar valves after systole is complete, start of diastole, best heard at BASE, aortic and pulmonary valves

67
Q

Note what when auscultating the cardiovascular system?

A

Rate Rhythm Strength

68
Q

How long must the apical pulse be counted for during the cardiovascular physical assessment?

A

60 seconds

69
Q

S3/S4

A

(S3 not uncommon sounds like KENTUCKYKENTUCKY, and normal in children and pregnancy - but concerning if new for someone)

S4 sounds like TENNASEETENASSEE and is very concerning

70
Q

What does S4 indicate

A

that the thick left ventricle is sticking

71
Q

Aortic Stenosis

A

harsh or high pitched sound when auscultating the heart

72
Q

Splits, rubs, Pericardial Rubs, Murmurs

A

sounds abnormal of the heart when the valves are not closing well and there is a swishing/turbulent sound

73
Q

Hypotension

A

low BP may not perfuse organ systems adequately

74
Q

Hypertension

A

BP > 140/90 3X

75
Q

Murmurs

A

blowing sounds turbulence in blood flow

76
Q

Myocardial Infarction (MI)

A

occlusion of arterial blood flow causing tissue damage (heart attack)

77
Q

Congestive heart Failure (CHF)

A

congestion in pulmonary and or systemic circulation related to inadequate pumping

78
Q

Thrombus

A

blood clot

79
Q

Hypovolemia

A

fluid volume deficit

80
Q

Hypervolemia

A

fluid volume excess

81
Q

Cardiovascular Tests

A
  1. EKG (chest pain to check for hearts long lasting effects)
  2. CBC (cholesterol levels)
  3. Electrolyte lab values
  4. Troponin
  5. Heart Catheterization ( make sure IV is working)
  6. CHEM7
82
Q

Examples of Cardiovascular Nursing Diagnoses

A 
Decreased Cardiac Output
Ineffective health Maintenance
Readiness for enhanced self - health management
Risk for falls
Constipation
Deficient knowledge
Sexual dysfunction related to fear, adverse effects of antihypertensive medications
Anxiety
Risk for infection
Ineffective Coping
Hyper/Hypo Volemia
83
Q

Heart Base

A

Top of the heart

84
Q

Apex

A

bottom of the heart

85
Q

What is pain?

A
  • whatever the person says it is

- an unpleasant sensation caused by noxious stimulation of sensory nerve endings as a result of disease or injury

86
Q

Pain is ____

A

Subjective (it is whatever the experiencing person says it is)

87
Q

According to HP2020, Pain affects ____ and ____

A

quality of life and wellbeing (well being is a relative state of maximizing aspects of health)

88
Q

Origins of Pain

A

Referred
Nociceptive (Somatic/Visceral)
Neuropathic
Psychogenic

89
Q

Referred Pain

A

pain perceived in the area is not necessarily its point of origin

90
Q

Nociceptive Pain

A

pain at the site of origin ( receptors transfer pain signals to the brain and spinal cord)

91
Q

2 Types of Nociceptive Pain

A

Somatic and Visceral

92
Q

Somatic pain

A

Nociceptive pain from the skin and deep tissues

93
Q

Visceral pain

A

Nociceptive pain from the internal organs

94
Q

Neuropathic pain

A

pain from injury to CNS, or a neuropathic disease

can be burning, stabbing, short, or long term

95
Q

Psychogenic Pain

A

no physical cause for the pain can be found

96
Q

Phantom Limb Pain is what type?

A

Neuropathic pain

97
Q

Descriptors and Sources of Pain

A 
Cutaneous - skin
Visceral - abdominal/organ
Deep Somatic - ligaments/tendons/bones
Radiating - pain moves outward
Referred
Phantom - neuropathic
Nociceptive
Inflammatory
98
Q

3 responses to Pain

A
  1. Physiologic
  2. Behavioral
  3. Affective
99
Q

Examples of Physiologic Responses to Pain

A 
Anxiety
Fear
Hopelessness
Sleeplessness
Thoughts of Suicide
A focus on pain
Reports of pain
Cries and Moans
Frowns and Facial Grimaces
Decrease in cognitive function
Mental confusion
Altered Temperament
High Somatization
Dilated Pupils
Increased heart Rate
Peripheral, Systemic, coronary Vascular resistance
BP Increase
Increased resp rate and sputum retention resulting in Infection  and atelectasis
Decreased urinary output
Fluid Overload
Depression of all immune systems
Decreased Gastric and Intestinal Motility
Increased ADH, EP, NEP, aldosterone, glucagon's, insulin, testosterone
Hyperglycemia
Glucose Intolerance
Insulin Resistance
Protein Catabolism
Muscle Spasm resulting in impaired muscle function and immobility
Perspiration
100
Q

7 Dimensions of Pain

A 
Physical
Sensory
Behavioral
Sociocultural
Cognitive
Affective
Spiritual

(These 7 physiologic and psychosocial phenomena affect display and perception of pain)

101
Q

Acute Pain

A

recent injury leading to protective disposition

102
Q

Chronic Pain

A

associated with injury lasting more than 6 months, and pain is intractable (not responding to any interventions)

103
Q

Malignant v Nonmalignant Pain

A

Chronic Pain

Malignant is associated with cancer

104
Q

Despite increases in pain treatment and success, pain is …

A

still undertreated and still able to have room for improvement

105
Q

The Pain Process Steps

A
  1. transduction
  2. transmission
  3. perception
  4. modulation
106
Q

Transduction (pain)

A

First stage of the pain process where pain receptors are activated by painful stimuli of chemical, mechanical, or thermal origin

electrical impulses converted from the pain stimuli travel to the spinal cord at the dorsal horn

107
Q

Sensory part of the spinal cord

A

dorsal horn

108
Q

Transmission (pain)

A

second phase of the pain process where pain sensations are conducted along pathways to the dorsal horn (if they stay there its a reflex)

109
Q

Perception (Pain)

A

third phase of the pain process involving the sensory process that occurs when a stimulus for pain is present

this is when the brain works and perceives pain and sets up the emotional status that effects the perception of the pain

110
Q

Pain Threshold

A

the LOWEST intensity when one perceives a stimulus that recognizes the pain

can change based on perception/emotion

111
Q

Modulation

A

the final phase of the pain process where neuromodulators alter and temper the perception of pain through endorphins and enkephalins

this is the phase where the body can help out in pain

112
Q

Gate Control Theory of Pain

A

The body creating good feelings (endorphins) can control pain, so it suggests pain impulses can be blocked by a gate between impulses and the dorsal horn by flooding it with modulating (not eliminating) substances

ex: Moist heating pad on back pain as a means of modulating pain

113
Q

Factors that influence the pain experience?

A 
Culture
Ethnic Variables
Family
Gender (ex: estrogen may lower pain tolerance)
Age
Religious Beliefs
Environment and Support People
Anxiety and other Stressors
Past Pain Experiences
114
Q

Joint Health Commission on Pain

A

Standards made to improve pain management:

policies and procedures that address pain, treatment or referral for treatment, and reassessment for patients as it designates is needed by an accredited institution

115
Q

Examples of JCAHO Standards

A

Clinical Leadership team for pain

Actively engaging med staff in improving pain assessment and management including strategies to decrease opioid use and minimize risks associated with use

Provide at least one non-pharma pain treatment modality

Facilitate access to prescription drug monitoring programs

improve pain assessment by concentrating on how pain influences physical function

engage patients in treatment and decisions on pain management

address patient education and engagement

facilitate referral of patients addicted to opioids to treatment programs

116
Q

What brought about the JCAHO standards?

A

the opioid addiction crisis rising

117
Q

Misconceptions of joint commission pain standards?

A
  1. Pain as a vital sign - no, the healthcare institution decides that
  2. requires pain treatment until pain reaches zero - no, reassessment needed but not need reach 0
118
Q

Role of a Nurse with Good Fundamental Beliefs on Pain

A
  • Advocate for the patient (do not be judgmental)

Acknowledge THAT PAIN IS REAL
Establish A TRUSTING RELATIONSHIP
Demonstrate COMPETENCE IN ASSESSING

119
Q

Barriers/Roadblocks to Pain Management in Geriatric Patients

A
  • Might feel its a punishment for past actions
  • Might feel is an inevitable and unavoidable part of aging
  • might feel its indicative that death is near
  • Elders fear the detection of a serious illness and may not want to continue tests
120
Q

Important factors to keep in mind when assessing pain?

A

Type
Etiology
Behavioral, physiologic, Affective Response
Other factors

COLDSPA: Character, Onset, Location, Duration, Severity, Pattern, Associated Factors

GET A DETAILED PICTURE

121
Q

Things to consider about the patient when doing a pain assessment?

A

Culture/Ethnicity
Age
Cognition / Cognitive Ability

122
Q

Hierarchy of Pain Assessment Techniques

A

Self Report > Observe Client Behaviors > Surrogate Reporting

123
Q

Examples of Pain Scales

A 
Visual Analog Scale (VAS)
Numeric Rating Scale (NRS)
Numeric pain Intensity Scale (NPI)
Verbal Descriptor Scale
Simple Descriptive Pain Intensity Scale
Graphic Rating Scale
Verbal rating Scale
Faces Pain scale
NPASS
PQRST
FLACC
124
Q

NIPS

A

Neonatal infant pain scale

scale giving points based on observation of infants that cannot explain pain

125
Q

PAINAD

A

Pain Assessment in Advanced Dementia Scale

Scale for cognitive level considerations since dementia has pain but may not be able to describe the information

126
Q

Use the right ___ for the right population/person when assessing pain

A

scale/tool

127
Q

Specific populations that have unique pain scales

A

Elders
Pediatrics
Individuals w Developmental/Cognitive Issues
Individuals with Addictions
Geographic Differences (Culture religion, rural (may not mention pain since they need to work) v urban, availability of services)

128
Q

Pharma Pain Relief Measures

A

NSAIDS (non opioid analgesics)
Opioid (Narcotic) Analgesics
Adjuvant Drugs (help in augmentation of pain)

129
Q

examples of NSAIDS

A

aspirin, tylenol/acetominophen

130
Q

examples of Opioid Analgesics

A

morphine, codeine, oxycodone, dilaudid, fentanyl, stadol, methadone

131
Q

examples of Adjuvant Drugs

A

corticosteroids, antidepressants, anticonvulsants

132
Q

Opioids should only be used in ____ cases

A

Severe

133
Q

PCA

A

Patient controlled Analgesia

Patient has a bolus with a button to receive medicine, and it is secured, but only the patient may touch the bolus button

could cause respiratory depression

134
Q

Epidural Analgesia

A

anesthesiologist inserts a catheter into the mid lumbar region into the epidural space (needs reassessment for moving sequentially afterwards)

135
Q

Local Analgesia

A

applied topically to skin or mucus membranes, or injected into the body to provide temporary loss of sensation

also called nerve Blocks

136
Q

Non-Pharma Pain Relief Measures

A 
Distraction
Music
Relaxation Therapy / Guided Imagery
TENS Unit
Acupuncture / Acupressure
Hypnosis
Therapeutic Touch

All of these work on endorphin level to modify pain interpretation according to gate theory

137
Q

What is the primary reason for ineffective pain treatment?

A

fear of causing addiction

138
Q

Addiction

A

a pattern of compulsive opioid use for means other than pain control

139
Q

Physical Dependence

A

phenomenon in which the body becomes physiologically accustomed to the opioid and suffers from withdrawal symptoms

140
Q

Tolerance

A

occurs when the body becomes accustomed to the opioid and needs a larger dose each time for pain relief

141
Q

12.7% of new illicit drug users began with…

A

prescription pain relievers

142
Q

Things a person can be addicted to?

A

Prescription / Illicit Drugs
Alcohol
Tobacco

143
Q

Cost of Substance Abuse?

A

740 billion annually in costs related to crime, lost work productivity, and health care

144
Q

Why is older age a specific consideration in regard to prescription medicine addiction?

A

Older adults tend to have polypharmacy with multiple meds they take causing addiction and synergistic effects, which increases their substance abuse risk

145
Q

What gender is more apt to use illicit drugs?

A

Male

146
Q

What gender is more likely to abuse prescription pain meds?

A

Female

147
Q

Women are more likely to do what in regard to analgesics that men are not as likely to do, even with equal pain levels?

A

take prescription opioids without a prescription in order to cope

148
Q

Why are women more likely to misuse opioids?

A

to self treat for other problems like anxiety or tension

149
Q

What gender and age group are most likely to die from prescription pain reliever overdose?

A

Women between 45 and 54

150
Q

Information on Military members and Analgesic Addiction

A

14.3% report using prescriptions with opioids, and females are more likely to use sedatives/opioids/antidepressants

151
Q

Historically, African Americans report what in regard to pain?

A

higher levels of pain but lower rates of prescription, but in 2000-2015 the prescription levels evened out to other populations (a bad thing)

NURS321 (18 decks)

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