PE And Cardiomyopathies

Question 0

What is the most frequent cause of a pulmonary embolism?

Answer 0

DVT that develop in the venous system or right side of the heart.

Question 1

What is a pulmonary embolism?

Answer 1

Obstruction of blood flow in part of the pulmonary vascular system by an embolus.

Question 2

What is the most common nonthrombotic pulmonary emboli?

Answer 2

Fat emboli

Question 3

What arethe risk factors for PE?

Answer 3

Stasis of Venous blood, vessel wall damage and altered blood coagulation. 
Prolonged immobility
Trauma
Surgery
MI and HF 
Women who use oral contraceptives
Smoking

Question 4

Is the nurse is unable to prevent, what is the plan of care?

Answer 4

Support
Oxygen
Analgesics
Pulmonary artery and wedge pressures are monitored

Question 5

What are the common clinical manifestations of PE?

Answer 5

Dyspnea and SOB
Chest pain
Anxiety and apprehension
Cough
Tachycardia and tachypnea
Crackles
Low grade fever (inflammation)

Question 6

What are less common clinical manifestations of PE?

Answer 6

Diaphoresis
Hemoptysis
Syncope
Cyanosis
S3 and S4 gallop

Question 7

What is the primary goal in treating PE?

Answer 7

Prevention because DVT may not be recognized until the actual PE occurs

Question 8

What does a plasma D-dimmer monitor for?

Answer 8

The presence of a thrombus. D-dimmer is a fragment of fibrin formed during a lysis of a blood clot. Elevated blood levels indicate a thrombus

Question 9

What does a chest CT indicate?

Answer 9

Principle test used to diagnose a PE.

Question 10

What does a lung scan indicate?

Answer 10

Radio tagged albumin is injected intravenously, the area in the lung in which the isotope cannot be detected is suggestive of occluded blood flow and PE.

Question 11

What does a pulmonary angiography indicate?

Answer 11

Definitive test when other less invasive tests are in conclusive. They are used to detect very very small emboli

Question 12

What is the ECG indicated for?

Answer 12

To rule out an MI.

Question 13

What does an ABG indicate!

Answer 13

Shows hypoxemia and often respiratory alkalosis.

Question 14

What does an ETCO2 indicate?

Answer 14

A measurement of the co2 exhaled.

Question 15

What therapy is used to prevent PE?

Answer 15

Anticoagulant therapy

Question 16

What is the dosage of heparin for a patient with a PE?

Answer 16

IV bonus of 5,000 to 10,000 units followed by a continuous infusion at a rate of 1,000 to 1,500 units/hr.

Question 17

How long do we continue heparin therapy?

Answer 17

We take heparin and Coumadin and the same time for 5 days and then discontinue the heparin and just take Coumadin.

Question 18

What is fibrinolytic therapy?

Answer 18

Treats a massive PE and hypotension,

Question 19

What are examples of Fibrinolytics?

Answer 19

Tpa, streptokinase, and alteplase

Question 20

What is the use of fibrinolytics contraindicated in?

Answer 20

Intracranial disease, recent stroke, active bleeding disorder, severe hypertension, trauma, surgery, or any invasive procedures.

Question 21

What is dilated cardiomyopathy?

Answer 21

Dilation of the heart chamber impairs ventricular contraction.

Question 22

What is the most common cardiomyopathy?

Answer 22

Dilated

Question 23

What does dilated cardiomyopathy commonly cause?

Answer 23

HF

Question 24

What causes dilated cardiomyopathy?

Answer 24

Usually idiopathic, may be secondary to chronic alcoholism or myocarditis.

Question 25

What are the clinical manifestations of dilated cardiomyopathy?

Answer 25

HF
Cardiomegaly
S3 and S4 gallop
Dyspnea, angina, and syncope
Fibrosis and necrotic myocardial cells

Question 26

What is the management for dilated cardiomyopathy?

Answer 26

Surgery (cardiac transplantation)

ICD

Question 27

What is hypertrophic cardiomyopathy?

Answer 27

Left ventricular hypertrophy and decreased compliance. Septal hypertrophy

Question 28

What is the cause of hypertrophic cardiomyopathy?

Answer 28

Hereditary, may be secondary to chronic hypertension

Question 29

What are the clinical manifestations of hypertrophic cardiomyopathy?

Answer 29

Left ventricular hypertrophy, Dysthymias, loud S4, sudden death.

Question 30

How do you manage hypertrophic cardiomyopathy?

Answer 30

Beta blockers
Antidysrhytmics
Calcium channel blockers
ICD
Surgical excision of part of septum

Question 31

What is restrictive cardiomyopathy?

Answer 31

Rigid ventricular walls that impair diastolic filling.

Question 32

What causes restrictive cardiomyopathy?

Answer 32

Secondary to amyloidosis, radiation, or myocardial fibrosis.

Question 33

What are the clinical manifestations of restrictive cardiomyopathy?

Answer 33

Dyspnea, fatigue, right sided heart failure, Cardiomegaly, S3 and S4, mitral regurgitation murmur.

Question 34

How do you manage restrictive cardiomyopathy?

Answer 34

Management if HF

Exercise restriction.

Question 35

What are the diagnostic tests for Cardiomyopathies?

Answer 35

ECCHO
ECG
Chest x ray
Hemodynamics studies
Radionuclear scans 
Myocardial biopsy 
Cardiac catheterization and coronary angiography

Question 36

What drugs are used for restrictive and dilated?

Answer 36

ACEI, vasodilators, and digitalis.