T2: PAD, PVD, Acute MI, Cardiac Tamponade, Pericardium Flashcards
buildup of fats, cholesterol and other substances in and on the artery walls
arthosclerosis
systemic atherosclerosis; partial or total blockage decreasing perfusion to extremities
Peripheral artery disease
Peripheral artery disease in legs is called
Lower extremity arterial disease (LEAD)
Peripheral artery disease inflow:
Obstruction ____ end of aorta and _____, ______, _____ iliac arteries; pain at __, ___, or _____
-distal end of aorta
-common, internal, and external iliac arteries
-pain at low back, buttocks, or thighs
Most inflow PAD patients seek medical attention due to
leg pain
(intermittent claudication)
When pulse is not palpable, use:
doppler ultrasound
Peripheral artery disease outflow:
Burning or cramping in the ____, _____, _____, and _____; pain at instep or foot discomfort =
-calves, ankles, feet, and toes
-obstruction below the politely artery
PAD outflow pain level:
experience pain after walking approx. 5 blocks
mild
PAD outflow pain level:
experience pain after walking 2 blocks
moderate
PAD outflow pain level:
experience pain after walking 1 block or less or pain at rest
severe
PAD outflow S/S (4)
-hair loss on lower calf, ankle, and foot
-dry scaly, dusky, pale, or mottled skin
-thickened toenails
-severe-cold and cyanotic or darkened
PAD interventions used to increase arterial flow to the affected leg (s) (6)
-exercise
-positioning
-promoting vasodilation
drug therapy
-invasive nonsurgical procedures
-percutaneous vascular intervention
-bypassing arterial occlusions avocet the superficial femoral arteries (SFAs)
Hemorheologic agent that increases the flexibility of red blood cells
Pentoxifylline
PAD interventions: medications (2)
-hemorrheologic agents
-anti-platelet agents
PAD stage:
-No claudication is present
-Bruit or aneurysm may be present
-Pedal pulse are decreased or absent
Stage I: asymptomatic
PAD stage:
-Muscle pain, cramping, or burning occurs with exercise and is relieved with rest
-Symptoms are reproducible with exercise
Stage II: Claudication
PAD stage:
-Pain while resting commonly awakens the patient at night
-Pain is described as numbness, burning, toothache-type pain
-Pain usually occurs in the distal part of the extremity (toes, arch, forefoot, or heel), rarely in the calf or ankle
-Pain is relieved by placing the extremity in a dependent position
Stage III: Rest Pain
PAD stage:
-Ulcers and blackened tissue occur on the toes, forefoot, and heel
-Distinctive gangrenous odor is present
Stage IV: Necrosis/Gangrene
Peripheral Venous disease includes both _____ and _____ complications
thrombus and embolus
Peripheral venous disease:
altered immunity
-inflammation occurs around the clot
-vein wall thickens
-possible embolization (PE is most common)
Most common type of thrombophlebitis
deep vein thrombosis (DVT)
DVT are most often in ___ but can occur in ______ due to central venous devices
-legs
-upper arms
interventions to prevent DVT (8)
-Patient education
-Leg exercises
-Early ambulation
-Adequate hydration
-Graduated compression stockings
-Intermittent pneumatic compression, such as sequential compression devices (SCDs)
-Venous plexus foot pump
-Anticoagulant therapy
PVD nursing consideration:
notify the health care provider if:
-aPTT value is greater that 70 seconds
PVD nursing consideration: assess patient for S/S of bleeding which includes: (6)
-hematuria
-frank/occult blood in stool
-ecchymosis (bruising)
-petechiae
-altered level of consciousness
-pain
PVD nursing consideration:
if bleeding occurs:
stop the anticoagulant immediately and call the health care provider or call Rapid Response Team
chest pain caused by a temporary imbalance between the coronary arteries’ ability to supply oxygen and the cardiac muscle’s demand for oxgygen
angina pectoris
two types of angina pectoris
-Chronic stable
-Unstable
Characteristics of Chronic Stable Angina pectoris (3)
-chest discomfort occurring with moderate to prolonged exertion in a familiar pattern to the client
-Frequency, duration, and intensity of the symptoms do not change over several months
-usually relieved by nitroglycerin
unstable angina or ________ = acute coronary syndrome
acute myocardial infarction
rupture of atherosclerotic plaque in the coronary artery ruptures
Acute coronary syndrome
Characteristics of Acute Coronary Syndrome (3)
-Platelete aggregation “clumping”
-Thrombus (clot) formation
-Vasoconstriction
ACS: the amount of plaque disruption determines:
the degree of the artery blockage and specific disease process
ACS:
_____% occlusion of artery = impaired blood flow = ______ when the myocardial demand is increased
50%
myocardia ischemia
chest pain/discomfort that occurs at rest of within exertion causing severe activity limitation
unstable angina
unstable angina
-may last longer than ______
-______ relieved by nitroglycerin
-15 minutes
-poorly
Myocardial tissue is abrupt ly and severely deprived of oxygen
Acute Myocardial INfarction
Acute MI:
_______% reduction in blood flow causing ischemia
80-90%
injury and necrosis of myocardial tissue if oxygenation not restored
ischemia
Have an ST segment and T-wave changes seen on ECG showing myocardial ischemia
Non-ST-segment elevation myocardial infarction (NSTEMI)
NSTEMI characteristics (3)
-ST depression
-T-wave inversion
-May haver elevated tropic indicating cell death or necrosis
NSTEMI causes (3)
-Coronary vasospasm
-Spontaneous dissection
-Sluggish blood flow (narrowing of the coronary artery)
Acute MI typical S/S
-chest discomfort
-SOA
-Nausea
-Sweating
Acute MI female/older adult S/S
-Neck, Jaw, Shoulder, upper back, upper abdominal discomfort
-SOA, nausea, vomiting
-heartburn
-Pain in both arms
ST-elevation myocardial infarction (STEMI) characteristics (3)
-indicates MI/necrosis
-Rupture of the fibrous atherosclerotic plaque
-Thrombus formation
STEMI:
the thrombus causes an abrupt ______% occlusion to the coronary artery; this is a ____________ and requires immediate:
-100%
-Medical Emergency
-Revisualization of the blocked coronary artery
Acute MI treatment was: (4)
MONA
-Morphine
-Oxygen
-Nitroglycerin
-Aspirin
Acute MI treatment now is: (10)
THRMOBINSS
-Thienopyridines
-Heparin/enoxaparin
-Reninangiotensin System Blockers
-Oxygen
-Morphine
-Beta blockers
-Intervention
-Nitroglycerin
-Statin
-Salicylate
Acute MI treatment note: Thienopyridines include (3)
-Clopidogrel
-Prasugrel (unless hx of stroke or TIA)
-Ticagrelor
Acute MI treatment note: oxygen
oxygen applied if SpO2 is <90%
Acute MI treatment note: Beta-blockers (7)
Contraindications
-Older than 70 years old
-Systolic BP < 120
-HR >110 or <60
-Pulmonary edema- HF
-Active asthma or RAD
-PR interval >0.24 sec
-2nd or 3rd heart block without a pacemaker
Actue MI treatment note: nitroglycerin
make sure client is sitting down prior to administering
Tests used to diagnose MI (9)
-Troponin T and I
-Chest x-ray
-CT
-64-clice computed tomography coronary angiography (CTCA)
-THallium scans
-Contrast-enhanced cardiovascular magnetic resonance (CMR) imaging
-Twelve-lead ECG
-Cardiac catheterization
-Angiography
assess for ischemia or necrosis; radioisotopes cannot reach areas with decreased or absent perfusion and they appear as “cold spots:
Thallium scans
can result from fluid accumulation in the pericardial sac
Cardiac tamponade
Cardiac tamponade S/S (4)
-Hypotension
-Jugular venous distention
-muffled heart sounds
-paradoxical pulse (variance of 10 mmHg or more in systolic blood pressure between expiration and inspiration
If cardiac tamponade S/s are observed in patient, nurse should: (4)
-notify provider immediately
-administer fluids to combat hypotension as prescribed
-expect provider to order chest x-ray or echocardiogram
-prepare client for pericardiocentesis if ordered
preparing client for pericardiocentesis (3)
- informed consent
-gather materials
-administer prescribed medications
during/after pericardiocentesis (3)
-monitor hemodynamic pressures
-monitor heart rhythm
-monitor for reoccurrence of s/s after the procedure
inflammation of the pericardium; can be caused by an MI
Pericarditis
Pericarditis s/s (4)
-chest pressure/pain
-friction rub auscultated int eh lungs
-shortness of air
-pain relived when sitting and leaning forward
