TEST 3- Part 1 Flashcards
DEFINE:
VIRUS that impairs the functioning of a person’s immune system.
Human Immunodeficiency Virus (HIV)
How does HIV impaire our immune system?
The virus impairs/destroys CD4+ T cells
What is the primary function of CD4+ T cells in the immune system?
A) They produce antibodies to neutralize pathogens.
B) They directly destroy infected cells.
C) They alert the body’s immune system to the presence of an infection.
D) They enhance the activity of phagocytes.
C) They alert the body’s immune system to the presence of an infection.
Note: They don’t necessarily actively fight infections in the body, but the play a critical role in signaling and activating other parts of the immune system when an infection is present.
What actually leads to immunodeficiency?
Immunodeficiency occurs when the rate of destruction of CD4+ T cells exceeds the body’s ability to produce new, functional CD4+ T cells.
The number of detectable HIV viruses in the blood is called
“Viral Load”
2 main diagnostic tests we use to monitor HIV progression
- CD4+T
- Viral Load
CD4 and Viral Load will be ___ of each other
INVERSE
(OPOSITE)
The HIGHER the VIRAL LOAD the __.
LOWER the CD4- T cells
The number that holds more meaning for diagnosis is the ___.
CD4+T count.
A normal adult CD4+T cell count is
800-1200 cells/µL
What does a HIGH VIRAL LOAD combined with a LOW CD4+ T cell count indicate about a patient’s immune system
A) The immune system is effectively managing the infection with a high level of immune function.
B) The immune system is moderately compromised, but not yet severely affected.
C) The immune system is severely compromised, indicating progression to AIDS.
D) The immune system is in a state of complete recovery, showing an undetectable viral load.
C) The immune system is severely compromised, indicating progression to AIDS.
In the diagnosis of AIDS, what significance does a CD4+ T cell count BELOW 200 have?
A) It indicates that the patient has a mild immune deficiency.
B) It is one of the main criteria for diagnosing AIDS, reflecting severe immune system compromise.
C) It suggests the patient is responding well to antiretroviral therapy.
D) It means the patient has a high viral load but does not meet the criteria for AIDS.
B) It is one of the main criteria for diagnosing AIDS, reflecting severe immune system compromise.
What do viral load numbers indicate?
Viral load numbers provide a measure of disease progression OR control by indicating the amount of HIV in the blood.
What do HIGH viral load numbers typically indicate?
Higher viral load = MORE active disease and further disease progression.
What does it signify when an HIV patient’s viral load is “undetectable”?
An “undetectable” viral load signifies that the number of HIV copies in the blood is BELOW detectable levels, indicating that treatment is effective.
Which of the following statements accurately reflects the significance of an “undetectable” viral load in HIV treatment?
A) An “undetectable” viral load confirms that the HIV virus has been completely eliminated from the body.
B) An “undetectable” viral load indicates that the HIV virus is no longer present in the body and the patient is cured.
C) An “undetectable” viral load means the treatment is working and the virus is at very low levels, but it does not imply a cure.
D) An “undetectable” viral load suggests that the patient’s immune system has fully recovered from HIV.
C) An “undetectable” viral load means the treatment is working and the virus is at very low levels, but it does not imply a cure.
What impact does a HIGH viral load have on the risk of HIV transmission?
It increases the likelihood of HIV transmission to others.
If viral load is undetectable, it does not mean ___.
virus its not there.
- HIV Virus never goes away.
What 9 symptoms are commonly experienced by a patient newly infected with HIV, and when do they typically appear?
- fever
- swollen lymph nodes
- sore throat
- headache
- malaise
- nausea
- muscle and joint pain
- diarrhea
- skin rash
- Flu symptoms - 2 to 4 weeks AFTER transmission (acute infection)
What occurs during the Acute Infection stage of HIV, which typically happens 2-4 weeks after transmission?
The patient’s HIV viral load is high and there is a temporary drop in the CD4+ T cell count.
Why are HIV-infected patients at a greater risk of transmitting the virus during the Acute Infection stage?
due to HIGH viral load in their blood.
The interval between initial HIV infection and time of diagnosis of AIDS
(a period of time)
- Typically about 10 years if HIV is untreated
- Timeframe is highly individualized
What is the “Window Period” in HIV testing, and why does it occur?
The “Window Period” is the delay between initial HIV infection and the point when HIV can be detected by tests, which occurs because it takes time for the virus or antibodies to reach detectable levels.
Can clients infected with HIV transmit the virus to others during the asymptomatic stage, and what factors affect the likelihood of transmission?
Yes, clients infected with HIV can still transmit the virus to others during the asymptomatic stage, although the chance of transmission is generally lower because the viral load is typically lower during this stage.
What 5 symptoms are likely to occur as the CD4+ T cell count DECLINES in HIV patients?
- persistent fever
- frequent night sweats
- chronic diarrhea
- recurrent headaches
- severe fatigue.
CD4+T cell count above ___ usually results in a “healthy” immune system
500
What are 5 common opportunistic infections that are likely to occur when the CD4+ T cell count nears 200 or less?
know
- Oropharyngeal candidiasis (Oral Thrush)
- Shingles
- Kaposi Sarcoma (cancer on lining of blood vessels/lymph nodes)
- Oral Hairy Leukoplakia (side of tongue)
- Persistent Vaginal Candidal Infections
In addition to infections, what conditions are likely to occur when the CD4+ T cell count nears 200 or less?
- Wasting syndrome: Loss of more than 10% of ideal body mass.
- Cognitive changes / HIV Encephalopathy: Ranging from mild to severe, similar to dementia.
AIDS describes a ___ of the HIV illness
stage
What criteria would describe a patient who has progressed to AIDS?
A) The patient has a CD4+ T cell count above 200, without opportunistic infections, cancers, or wasting syndrome.
B) The patient has a CD4+ T cell count below 200, with opportunistic infections, cancers, or wasting syndrome.
C) The patient has frequent non-opportunistic infections and a CD4+ T cell count between 200-400.
D) The patient has a high viral load but does not meet the criteria for CD4+ T cell count or opportunistic infections.
B) The patient has a CD4+ T cell count below 200, with opportunistic infections, cancers, or wasting syndrome.
KNOW
Infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems
Opportunistic infections (OIs)
How do opportunistic infections in HIV-infected individuals differ from those in people with functioning immune systems?
A) They are less severe in HIV-infected individuals due to a stronger immune response.
B) They cause debilitating and life-threatening infections in HIV-infected individuals, whereas they usually do not cause severe illness in people with functioning immune systems.
C) They have no impact on the severity of illness in either group.
D) They are equally severe in both HIV-infected individuals and those with functioning immune systems.
B) They cause debilitating and life-threatening infections in HIV-infected individuals, whereas they usually do not cause severe illness in people with functioning immune systems.
Transmission occurs primarily by one of three modes:
- Sexual Contact
- Direct Blood Contact
- Mother-to-Child Transmission
Which types of bodily fluids can transmit HIV, and why are they significant?
HIV can be transmitted through semen, vaginal secretions, and blood because these fluids contain lymphocytes (WBC) with the virus.
know these three
Is HIV transmitted through blood transfusions?
No- UNLESS screening of blood wasn’t done properly.
Can an HIV test detect the virus immediately after infection?
No. Not immediately.
What is the “WINDOW PERIOD”
- After someone first gets HIV, there’s a gap of a few weeks where tests can’t yet detect it.
- This is because the body hasn’t had enough time to make enough antibodies to show up in a test.
- The interval SEVERAL weeks after infection, but prior to seroconversion, is referred to as “The Window Period”
What is SEROCONVERSION
- This is the stage that happens several WEEKS after infection when the body starts making enough antibodies to be detected by tests.
- Symptoms during this time, if they occur, are similar to the flu and include fever, rash, swollen lymph nodes, and aches.
- Person feels sick bc body is fighting infection- NOT bc viral load is spiking
What does HAART stand for and what does it involve?
- Highly Active Antiretroviral Therapy.
- HAART is a strategy for using ARV drugs in combination to achieve the best possible outcome in managing HIV.
Once initiated, HAART is continued ___.
indefinitely.
What is the primary mechanism by which drug therapy helps manage HIV?
- Drug therapy primarily helps manage HIV by decreasing viral REPLICATION.
know- missed on the test
Proper drug use can reduce viral LOADS by ___%
90-99%
Drugs will NOT block the transmission of HIV, instead ___.
they decrease viral LOAD which will lessen the chances that transmission would occur
What lab test do we check to see if the MEDS ARE WORKING?
VIRAL LOAD
ART stands for
Anti-Retroviral Drug Therapy
Main ART therapy med used
Tenofovir, TDF
5 Signs and symptoms of HIV drug therapy
- Lipodystrophy-uneveness loss of body fat
- Elevated Cholesterol levels
- Mood changes, depression, anxiety
- Elevated Blood Sugar and Diabetes
- Kidney, Liver, Pancreas Damage
-among more
“Wasting Syndrome”
Lipoatrophy
causes abnormal fat loss or distribution in certain areas of your body
Lipodystrophy
- An well-known opportunistic infection in HIV pts- usually pts are diagnosed with HIV bc of this infx.
- serious lung infection (pneumonia) that affects people with weakened immune systems.
Pneumocystis pneumonia (PCP)
(caused by bacteria: pneumocystis jirovecci)
S/S of Pneumocystis pneumonia
- fever
- dyspnea
- non-productive cough
When conducting an HIV assessment, what should be the primary focus for healthcare providers?
A. Identifying individuals at high risk for HIV
B. Treating individuals with advanced HIV symptoms
C. Focusing on individuals with a history of cancer
D. Prioritizing individuals with no risk factors
A. Identifying individuals at HIGH risk for HIV
What is PrEP?
(Pre-Exposure Prophylaxis)
* Its an ART regimen used as a PRE-EXPOSURE preventive treatment for individuals who are at HIGH RISK of contracting HIV.
Who is a “high-risk” individual contracting HIV.
- Gay men
- Transgender women
- Spouse with an HIV infected partner
- Drug users
- Possibly used for pregnant mothers
KNOW
Which of the following medications is typically used in Pre-Exposure Prophylaxis (PrEP) for HIV prevention?
A) Lisinopril and Hydrochlorothiazide
B) Tenofovir and Emtricitabine
C) Metformin and Sitagliptin
D) Atorvastatin and Ezetimibe
B) Tenofovir and Emtricitabine
(brand name: Truvada or Descovy)
know
What does PrEP work in the body?
It’s an non-strong ANTIVIRAL that stops HIV from taking hold and spreading throughout the body.
(doesnt cure)
How long does PrEP take to become effective?
7-20 days
What is PEP?
Post-exposure prophylaxis (PEP)
* a treatment to stop a person becoming infected with HIV AFTER it’s gotten into their body- USED FOR EMERGENCY SITUATIONS, not regular use.
When must Post-Exposure Prophylaxis (PEP) be started after a possible exposure to HIV to be effective?
A) Within 7 days
B) Within 48 hours
C) Within 72 hours
D) Within 5 days
C) Within 72 hours
What is the typical duration of treatment when taking Post-Exposure Prophylaxis (PEP) for HIV prevention?
A) 10 days
B) 21 days
C) 28 days
D) 45 days
C) 28 days
What percentage can proper HIV treatment (ART) reduce the risk of transmission from a mother to her newborn?
A) From 50% to 25%
B) From 25% to less than 2%
C) From 30% to 10%
D) From 25% to less than 5%
B) From 25% to less than 2%
How does a nurse’s self-awareness of personal beliefs and values influence the care provided to individuals living with HIV?
A) It helps the nurse strictly adhere to clinical protocols
B) It ensures the nurse avoids any emotional connection with patients
C) It enables the nurse to deliver unbiased, empathetic care while maintaining ethical boundaries
D) It allows the nurse to adjust care plans based on their own personal opinions
C) It enables the nurse to deliver unbiased, empathetic care while maintaining ethical boundaries
What kind of infection control is used for HIV patients?
STANDARD PRECAUTION
* hand hygiene
* use of mask, gloves, gown and goggles when applicable
What is the Endocardium?
- The endocardium is the innermost layer of the heart.
- It lines the inside of the heart chambers and covers the heart valves.
- Think of it as a smooth, protective coating that helps blood flow easily inside the heart.
- It also plays a role in the heart’s electrical system, which controls your heartbeat.
Infection of the endocardial layer of the heart
INFECTIVE ENDOCARDITIS (IE)
IE is almost always caused bY
bacterial infection
2 most common organisms to cause IE are
- Staphyloccus aureus (skin)
- Streptoccus viridians (mouth, resp, GI, GU tracts)
What are the primary sites where bacteria establish infection in endocarditis?
Bacteria need these 2 things
- Previously damaged areas of the endocardium
- Artificial surfaces (e.g., prosthetic valves)
(these creates a rough surface making it easy for bacteria to latch on)
know
Irregular growths made of bacteria and cell pieces (fibrin, leukocytes, platelets) form ___.
vegetations
Pieces of the vegetations that break off and enter the systemic circulation
Emboli
Systemic emboli are going to move ___ in the circulation.
DISTALLY- with the flow of blood, not backwards!! –
causing blockages in arteries downstream from where they broke loose.
Main 3 symptoms for Infective Endocarditis
- Fever
- murmurs **
- Clubbing of fingers
know
Further assessment for endocarditis should include
listening to heart sounds to assess for NEW or WORSENING MURMURS (wooshing sounds)
What signs might be present if embolization has occurred?
The clinical signs depend on the organ or tissue affected by the embolus.
What patients are at higher risk for INFECTIVE ENDOCARTDITIS?
- Aging ( > 50% of older people have calcified aortic stenosis)
- IVDA (Intravenous Drug Abuse)
- Use of prosthetic valves
- Intravascular (IV) devices (Central lines, Implanted ports, etc.)
- Renal Dialysis
- Previous cardiac disease
know
Know the 6 signs of a STROKE
BE FAST
* Balance difficulties
* Eyesight changes
* Face weakness
* Arm weakness
* Speech difficulties
* Time- Call 911
Another term for Stroke
CEREBRAL VASCULAR ACCIDENT
S/S if vegetation is present ONLY on the LEFT SIDE of heart
- Petechiae
- Splinter Hemorrhages
- Osler’s Nodes
- Janeway’s Lesions
- Roth’s Spots
know
Small areas of bleeding under fingernails or toenails.
What am I?
Splinter Hemorrhage
(Damage to capillaries caused by small emboli)
Flat, painless red spots on palms and
soles
Janeway Lesions
Painful, pea-sized, red or purple
lesions on fingers or toes
Osler’s Nodes
Hemorrhagic retinal lesions
Roth’s Spots
How will we diagnose Infective Endocarditis?
2 main DX
- Blood cultures (most likely positive)
- Echocardiography
know
IE EKG findings would most likely read
afib or heart blocks
Tx for IE will include
- Antibiotics (usually Long-term)
- Fungal infective endocarditis (treat with anti-fungals)
- Associated fever: treated with fluids, rest, and acetaminophen
- replace infected prosthetic valves- surgically
Do we give Anticoags for IE?
No- it practically does nothing.
* will NOT break down vegetation
* bacterial clump is NOT a blood clot
A patient with a history of Infective Endocarditis (IE) is being discharged. What education should the nurse provide to ensure the patient prevents future complications?
List 6
- Avoid contact with individuals who are sick to reduce the risk of infection.
- Importance of communicating hx of IE to future healthcare providers (MD’s, DDS, etc)
- Monitor for s/s of infection such as fever, heart failure, or emboli.
- Teach importance of adherence to treatment regimen
- Schedule follow-up echocardiograms after completing the course of antibiotics.
- Possible bedrest or acitivity limitations
A condition caused by inflammation of the pericardial sac (the pericardium), which may occur in an acute or chronic form.
Pericarditis
What symptom do patients most often present with in Acute Pericarditis
frequent, severe, sharp chest pain
- bc of inflammation, the pericardium layers rub on each other or other surrounding parts causing the pain.
How to alleviate pain for patients with Acute Pericarditis?
Sitting up and leaning forward often relieves pain
How do you differentiate Pericarditis and MI?
Nothing alleviates pain for MI
A patient presents with chest pain, and the nurse suspects pericarditis. What is the hallmark finding that would support this diagnosis?
A. Elevated blood pressure
B. Pericardial friction rub
C. Decreased breath sounds
D. Jugular vein distention
B. Pericardial friction rub
scratching, grating, high-pitched sound
know
A patient is being assessed for chest pain, and the nurse is trying to differentiate between pericardial friction rub and pleural friction rub. Which statement correctly describes a key difference between the two types of friction rubs?
A. A pericardial friction rub will disappear when the patient holds their breath, while a pleural friction rub will persist.
B. A pleural friction rub will disappear when the patient holds their breath, while a pericardial friction rub will persist.
C. Both pericardial and pleural friction rubs will disappear when the patient holds their breath.
D. Neither pericardial nor pleural friction rubs will change when the patient holds their breath.
B. A pleural friction rub will disappear when the patient holds their breath, while a pericardial friction rub will persist.
(pleural = lungs ; pericardial = heart)
EKG finding on Pericarditis
Diffuse (all over) ST Segment ELEVATIONS
- ST Segment should be isoelectric
(troponin levels high)
Abnormal collection of fluid in the pericardial sac
What am I?
Pericardial Effusion
FIRST step to treat Pericardial effusion?
Treat whatever is causing the pericardial effusion FIRST
(Example: if pericarditis is causing p.effusion, treat pericarditis first)
Compression of the heart that results as pericardial fluid volume continues to increase. Restricts the heart from stretching.
What am I?
Cardiac Tamponade
(ALWAYS a medical emergency- can kill pt)
S/S of cardiac tamponade
- Patient may report chest pain
- confused, anxious, and restless
- tachypnea
- tachycardia
- JVD
Beck’s Triad= Distant/muffled heart sounds, JVD, Hypotension
As a nurse, how would you help your pt alleviate Cardiac Tamponade s/s?
Nurse arent able to do anything for Tamponade. We need to get Dr involved so they can perform PERICARDIOCENTESIS.- surgically remove fluid
What 4 meds are available to manage/treat Pericarditis
Management is aimed at treating underlying cause
- NSAIDS – used to control pain and inflammation
- Indomethacin, aspirin, ibuprofen
-
Colchicine – anti-inflammatory drug often used for gout – used for recurrent
pericarditis -
Corticosteroids – used if cause is rheumatologic or autoimmune
** Avoided if possible due to multiple side effects* - its an immunosupressant - Antibiotics- treats bacterial pericarditis
What are the FIRST meds you will use for Pericarditis?
NSAIDs and Colchecine
You are caring for a patient with pericarditis. Which of the following interventions are most appropriate for managing their condition?
Select all that apply:
A. Position the patient in a high Fowler’s or tripod position to facilitate pain relief and optimize respiratory mechanics.
B. Initiate oxygen therapy (if indicated) and closely monitor pulse oximetry and arterial blood gases (ABGs) to assess and manage oxygenation status.
C. Implement strategies for pain and anxiety control, including instructing the patient to sit up and lean forward and applying chest splinting techniques as necessary.
D. Educate the patient on their condition and treatment plan.
E. Advise the patient to lie flat to maximize lung expansion, despite the risk of exacerbating pain and discomfort.
A. Position the patient in a high Fowler’s or tripod position to facilitate pain relief and optimize respiratory mechanics.
B. Initiate oxygen therapy (if indicated) and closely monitor pulse oximetry and arterial blood gases (ABGs) to assess and manage oxygenation status.
C. Implement strategies for pain and anxiety control, including instructing the patient to sit up and lean forward and applying chest splinting techniques as necessary.
D. Educate the patient on their condition and treatment plan.
NOT E.
Location of pericarditis pain
- Precordium or left trapezius ridge
* has a sharp, pleuritic quality that increases with inspiration
- Precordium or left trapezius ridge
Diffuse (entire) inflammation of the myocardium (heart muscle)
What am I?
Myocarditis
Myocarditis is often present concurrently with what two other conditions
pericarditis and endocarditis
(s/s vary for myocarditis)
Myocarditis:
EARLY cardiac signs mimic ___.
Pericarditis
* pleuritic chest pain, fricition rub, effusion
Late cardiac signs mimic ___.
Heart Failure
6 S/S of Heart failure
- S3/S4 heart sound
- crackles
- jugular venous distention
- syncope
- peripheral edema
- angina (chest pain)
Specific MYOCARDITIS diagnostic
Endo-Myocardial Biopsy
* Invasive procedure and therefore accompanied by risks
Is there a NON-INVASIVE diagnostic for Myocarditis?
Nope
What do treatment and interventions for myocarditis primarily focus on?
managing the signs and symptoms of HEART FAILURE.
Drug therapy for Heart Failure (and myocarditis) includes
- ACE-Inhibitors: end in -pril
- Beta-blockers: end in -olol
- Diuretics: loop, thiazide, k+ sparing
- Nitrates: nitroglycerin vasodilator
- Positive Inotropes
How does the stage of a patient’s HEART FAILURE affect their medication regimen?
The stage of a patient’s heart failure dictates which medications they are prescribed, as treatment is tailored to the severity of their condition
An inflammatory process that can develop as a complication of inadequately treated strep throat or scarlet fever.
What am I?
RHEUMATIC FEVER
It is an autoimmune response to the bacteria Streptococcus pyogenes. After a strep throat infection, the immune system can mistakenly attack healthy tissues, particularly in the heart, leading to inflammation.
Strep throat and scarlet fever are caused by an infection with ___ bacteria
streptococcus
Rheumatic fever can cause inflammation and physical changes affecting the heart. Which of the following statements is correct regarding its impact on the heart?
A. Rheumatic fever only affects the outer layer of the heart.
B. Rheumatic fever results in inflammation and physical changes that can impact all layers of the heart.
C. Rheumatic fever exclusively impacts the myocardium without affecting other layers.
D. Rheumatic fever causes changes limited to the pericardium and does not affect the myocardium or endocardium.
B. Rheumatic fever results in inflammation and physical changes that can impact ALL layers of the heart.
What is Pancarditis?
Inflammation that affects all three layers of the heart: the endocardium, myocardium, and pericardium.
How does Rheumatic Heart Disease develop, and what heart layers are involved?
- Rheumatic Heart Disease develops from inflammation caused by ALL 3: endocarditis, myocarditis, and pericarditis **
- It affects ALL layers of the heart (pancarditis) and often leads to chronic valve damage.
What 2 functions are impaired once the heart has fibrous scar tissue
- Contractility: Reduced pumping ability → risk of heart failure.
- Compliance: Impaired relaxation of heart muscle → leads to diastolic dysfunction.
Is Rheumatic heart Disease cureable?
No- damage is already done.
Once a patient has Rheumatic Heart Disease, what meds will they be on?
Antbx - lifetime
and
anti-inflammatory agents
How is valvular heart disease classified?
- Based on affected valve(s): mitral, tricuspid, aortic, pulmonic
-
3 Types of valvular dysfunctions:
Stenosis (narrowing)
Regurgitation (leaking)
Prolapse (improper closure)
Define: Constriction or narrowing of the opening
(valves can’t open)
Stenosis
How does valve stenosis affect pressure in the heart?
- Causes a pressure difference on each side of the stenotic valve.
- Pressure on both sides is usually equal.
- Higher pressure builds up behind the valve where blood is flowing from (ventricles)
Define:
* Incomplete closure of valves- can’t close
* Also ocalled “incompetence” or “insufficiency”
Regurgitation
What are the effects of regurgitation on blood flow in the heart?
- Backward flow of blood through the valve.
- The heart has to re-pump the same blood multiple times.
Define:
* Valves that are often referred to as “floppy”
* valves that have “bulged” backwards
Prolapsed valves
Isn’t an opening or closing problem, but a general change in the overall shape/structure/function of the valve (Think of this as the valve has stretched out and it is now not sitting in the space where it shouldnt be)
How does the degree of prolapse affect management and symptoms?
- Severity of symptoms is influenced by the degree of prolapse.
- Management: managed medically or require surgical intervention
- Same concept applies to all valvular issues
What is Mitral Valve Stenosis
- The valve leaflets (or cusps) become thickened, stiffened, or fused together, reducing the size of the opening through which blood flows.
- This constriction impairs the normal flow of blood from the left atrium to the left ventricle.
What are the effects of MITRAL valve stenosis? (left side valve)
- Decreased blood flow from ATRIUM into the left VENTRICLE.
- Left atrium dilates and may hypertrophy.
- Pulmonary congestion and increased pressures.
- Increased risk for atrial fibrillation (Afib).
What is the primary symptom of Mitral Valve Stenosis?
Dyspnea on exertion
(exertion: shortness of breath occurs during physical activity or exercise.)
Why does dyspnea on exertion occur with mitral valve stenosis?
- Decreased lung compliance: Stiffer lungs reduce the ability to expand and contract, restricting airflow.
- Decreased cardiac output: Reduced blood flow from the heart means less oxygenated blood reaches muscles, causing shortness of breath during activity.
Mitral Valve Stenosis:
It’s Chronic stage may eventually manifest as s/s of ___ sided heart failure.
Right sided heart failure
- as fluid continues to build up from the lungs into RIGHT VENTRICLE.
How can Mitral valve stenosis (left side valve) lead to symptoms of RIGHT-sided heart failure?
Mechanism:
- Fluid buildup: Increased pressure in the lungs (from the left side) causes fluid to back up into the right ventricle.
- Symptoms: This can lead to swelling in the legs, distended neck veins, and fluid accumulation in the abdomen.
Cardiac Output
(review)
- Is a measure of how efficiently the heart is pumping blood throughout the body PER MINUTE
- It’s crucial for ensuring that all tissues and organs receive adequate oxygen and nutrients.
Formula for Cardiac Output (CO)
CO = Stroke Volume (SV) × Heart Rate (HR)
- Stroke Volume (SV): The volume of blood ejected by the left ventricle with each heartbeat.
- Heart Rate (HR): The number of heartbeats per minute.
What happens when the left atrium and left ventricle work harder to preserve cardiac output?
Over time, this increased effort can lead to HEART FAILURE!!!
Mitral Valve PROLAPSE:
What type of chest pain might be present if symptomatic?
Atypical Chest Paint
(refers to chest discomfort that does not fit the classic description of angina (chest pain) or myocardial infarction)
Is it okay to give anti-anginals for Mitral valve prolapse pain?
No- Does NOT respond to anti-anginals
Patient teaching for Mitral Valve PROLAPSE
List 3
- Staying hydrated
- Regular Exercise
- Avoid Caffeine
Causes obstruction of blood from Left ventricle to the Aorta
What am I?
Aortic Valve Stenosis
How does aortic valve stenosis affect the heart’s structure and function?
- Structure: Causes Left Ventricular Hypertrophy (thickening of the heart’s left ventricle).
- Function: Leads to Increased Myocardial Oxygen Demand (the heart requires more oxygen due to the increased workload).
What is the “Classic Triad” of symptoms for AORTIC valve stenosis?
SAD:
* Syncope (fainting)
* Angina (chest pain)
* Dyspnea on exertion (shortness of breath with activity)
Aortic Valve REGURGITATION results in 3 things
- Dilated / Hypertrophied Left Ventricle
- Decreased CO
- CHF
Main S/S of Tricuspid AND Pulmonic valve disease
(RIGHT SIDED OF HEART)
“Right sided Heart Failure”
Problems with Right side of heart mimics ___ heart failure s/s
RIGHT
Problems with LEFT side of heart mimic ____ heart failure s/s
LEFT side heart failure
What is valvular heart disease?
- Involves: Any of the four heart valves (aortic, mitral, tricuspid, pulmonic).
- Impact: Affects the heart’s ability to pump blood efficiently and can have significant clinical consequences.
Main diagnostic study for Valvular Heart Disease
Echocardiogram
(reveals valve structure, function, muscle thickness, and heart chamber size)
Valvular heart disease conservative therapy would include
- Prevention: rheumatic fever, endocaditis
- Medication tx: Rx for heart failure
Valve Replacement:
Prosthetic heart valves may be __ or ___.
Mechanical or biological
How long will a patient have a MECHANICAL prosthetic heart valve?
for entire life
How long will a patient have a BIOLOGICAL prosthetic heart valve?
5-10 - yrs since they tend to stiffen and calcify
Mechanical prosthetics require what type of meds?
anticoagulations- LONG TERM
(no way around them)
know
Why do we use blood thinners for Mechanical prosthethics valves?
- Due to its synthetic material.
- Can not risk anything sticking to that material.
What is the ONLY blood thinner used for Mechanical Prosthetics?
Warfarin- the only one that works
* Normal range for INR = 1
INR levels for a MECHANICAL prosthetic valves should be
3-4
The BIOLOGICAL prosthetics come from
animal or human donors
What blood thinners will pts with a BIOLOGICAL prosthetic valve be on?
NONE- do not require anticoagulant therapy
Another word for CARDIOMYOPATHY?
HEART FAILURE
List the 3 types of Cardiomyopathies (heart failure)
- Dilated cardiomyopathy
- hypertorphic cardiomyopathy
- Restrictive cardiomyopahty
What am I:
- Englarged heart chambers WITHOUT associated thickening of heart muscle walls as seen in heart failure
- Heart muscle fibers are impaired by diffuse (widespread) inflammation
- think of it as SYSTOLIC heart failure
Dilated Cardiomyopathy
know
Review:
What is Systolic Heart Failure
`
- also known as heart failure with reduced ejection fraction or HFrEF
- The heart’s left ventricle cannot contract effectively, leading to a reduced ejection fraction (the percentage of blood pumped out of the left ventricle to the rest of the body with each heartbeat).
What is a unique consideration for clients with Dilated Cardiomyopathy?
know
- Blood Flow: Slows down (stagnates), increasing risk for clots/strokes.
- Management: Clients may need to be on anticoagulants unless contraindicated.
know
Dilated Cardiomyopathy mimics what EKG
AFib
Dilated Cardiomyopathy are at great risk for:
clot formation and emboli
* (due to stasis of blood flow THROUGHOUT the heart- not just atria)
Left ventricular hypertrophy WITHOUT ventricular dilation (enlarged and stretched)
* Heart walls are enlarged but NOT stiff
* Can block aortic valve due to thickening
Deadliest of them all
Hypertrophic Cardiomyopathy
- Systolic function is normal
- Diastolic function is impaired
- Ventricles are resistant to filling- stiff ventricle wall
- Cardiac output fails
RESTRICTIVE CARDIOMYOPATHY
For Hypertrophic and Restrictive Cardiomyopathy – Think of these more like
Diastolic Heart Failure
* also called heart failure with preserved ejection fraction (HFpEF)
Unique consideration for Hypertrophic cardiomyopathy
client/family teaching
regarding Sudden Cardiac Death
Diastolic Heart Failure (review)
- Occurs when the heart’s ventricles become stiff and are unable to relax properly during diastole (the filling phase).
- This limits the amount of blood the ventricles can hold and pump out, even though the heart’s pumping ability (ejection fraction) remains normal.
- leading to reduced overall blood volume being pumped to the body.
- Because the ventricles can’t expand properly, blood backs up into the lungs or veins, causing fluid buildup.
What am I?
Hypertrophic Cardiomyopathy
What am I?
Dilated Cardiomyopathy
What am I?
- Stiff heart muscle (rock hard muscle)
Restrictive Cardiomyopathy
Go back to the CAD PP
Review!!!!!
medical procedure used to diagnose and treat certain heart conditions
Cardiac catheterization
If you are accessing a VEIN, where in the heart will it en up in?
Right side of the heart.
Right Atrium/Right ventricle
If you’re accessing an ARTERY, where in the heart will end up in?
LEFT side of the heart
In the cath lab, are patients awake?
- Not fully awake, but in a consicious sedation.
- Pt will be proteting their airway
What meds are used for these conscious sedations?
Benzos, opioids (Versed)
3 Timeframes for coronary tx (PCI)
- Emergent
- Urgent
- Scheduled
For patients with confirmed MI who are in crisis, what is the FIRST line of tx?
Emergent PCI (percutaneous coronary intervention)
* Straight to CATH LAB
* minimall invasive procedure
* heart treatment to open blocked blood vessels.
* Prof will refer these as CARDIAC CATHS in tests
Goal (time frame) to open blocked artery once pt arrives in facility
90 mins
True clot busters
Thrombolytics
f
- Requires prompt intervention (within 12-72 hours)
but may allow for time to optimize patient condition before going to cath lab (NSTEMI, Unstable Angina)
Urgent PCI
Outpatient or inpatient procedure (Positive
stress test, unexplained chest pain)
Scheduled PCI
Urgent PCI Preparation
- started on Heparin gtt: prevent further clots
- Nitroglycerin gtt: alleviate chest pain- check BP before!!!!!
- IV fluids (Before and/or after procedure)
-Prepare/flush kidneys from contrast - Hold Metformin for DM pts- 48 hrs before & after (oral diabetic med) **
-interacts with IV contrast - NPO after midnight
PCI PRE-Procedure Nurse duties
List 8
- 2 IV lines - pts at risk to deteriorate
- Mark peripheral pulses/establish baseline
-ALL OF THEM - Prep groin/wrist sites
- Continuous Telemetry
- Consents - Drs responsibility
- Foley catheter- ONLY if needed
- Heparin/Nitro/ drips , Aspirin
- TALK TO THE PATIENT AND FAMILY MEMBERS!! **
-Post expectations: laying FLAT for 6hrs, report bleeding , pain
POST-PCI Nursing Care
-
Keep affected limb straight/Flat-several hrs
-prevent damage/bleeding - Maintain bedrest or activity level per physician orders
- HOB needs to be elevated no more than 10 degrees (femoral approach)
- Check peripheral pulses, catheter insertion site, color and sensation of affected extremity per orders (ie. Q15 x4, Q30x2, Q1HR x 4) (Neurovascular checks 6 Ps - KNOW! **
- Frequently observe puncture site for hematoma, bleeding
- Monitor VS and EKG
-
Closely monitor for chest pain- make sure no re-blockage, monitor CLOSELY**
-(normal/”expected” discomfort vs. reperfusion vs. tamponade/STEMI)
6P’s will be checked on what extremitis after a PCI?
ONLY on the extremity where th sheath was inserted!
What if your 6 P’s are not normal from the baseline. What will you do next?
Call the provider, make sure all other assessments are done prior.
Is it normal for patients to feel some DISCOMFORT after cath lab procedure?
Yes, Some discomfort is normal.
true chest pain- is NOT!
What is this called?
Trans-Radial Approach
- used instead of a FEMORAL sheath.
When pulling a sheth out, you hold PRESSURE for how long?
15 mins or more.
What med should ALWAYS be at the bedside when pulling out a sheath and why?
ATROPINE
(anticholinergic-blocks acetylcholine)
* due to pressure on sheath wound, may cause pt to vagal response and lead to SYMPTOMATIC BRADYCARDIA
When removing a sheath patients can have a ___ response.
Vagal response.
- manipulation or pressure near the femoral artery can trigger a reflex involving the vagus nerve INDIRECTLY.
If patient vagus nerve is triggered, what heart symptom can patient start having?
SYMPTOMATIC bradycardia
- with symptoms- know how to treat
How would you treat SYMPTOMATIC bradycardia
- Assess
- O2
- IV access to Atropine- 0.5 mg IV push, Q3-5, max dose of 3 mg.
OR - Dopamine infusion (for hypotension and bradycardia)
- Epinephrine infusion (to increase heart rate and blood pressure)
know
PCI complications:
Most serious complication is
dissection of the newly dilated CORONARY artery
* the mechanical stress exerted by the balloon or other devices used to open the artery can cause a tear in the artery’s inner lining (intima).
* This tear creates a false passage or flap within the artery, called a dissection.
When coronary arteries rupture, what can occur?
- tamponade **
- ischemia- no blood to organs
- infarction
- decreased CO
- possibly death- pts can CODE very quickly!!
PCI complications:
Whats the timeframe where abrupt closure of the vessel can occur post-procedure?
In the first 24 hrs.
What is Restenosis
- the re-narrowing or re-blockage of an artery after it has been treated with procedures like angioplasty or stent placement.
- It usually occurs due to the regrowth of tissue at the site where the artery was previously widened bc body is trying to heal the site.
After PCI surgery, Restenosis risk is greates for the first ___ days
30 days
know
What meds can PREVENT restenosis?
Anti-platelets
(aspirin, P2Y12 Inhibitors (Plavix, Brilinta, Effient))
* these are NOT anticoags (heparing, warfarin)
What organ should we be monitoring for any future PCI patient?
Kidneys
* ALWAYS monitor renal function due to contrast given during procedure.
PCI complications:
3 MOST important complications after PCI’s
- Coronory vessel Dissection- leads to No.2
- Coronary Tamponade- decr. CO= death
- Vessel Restenosis- give anti-platelets
Review:
What is Coronary Tamponade
- the accumulation of fluid or blood in the pericardial sac surrounding the heart, which can compress the heart and impair its ability to pump blood effectively
- heart is STUCK in place
PCI Solutions:
What 3 signs do we assess for Cardiac Tamponade
It consists of three key signs: Becks Triad
“Three Ds”
- Decreased Hypotension: Due to impaired cardiac output caused by the compression of the heart, leading to reduced blood flow.
- Distended Jugular Venous (JVD): Elevated pressure in the jugular veins, observed as distension of the neck veins, is caused by the impaired filling of the heart and increased central venous pressure.
- Distant Muffled Heart Sounds: The sounds of the heart become muffled or distant upon auscultation, typically due to the fluid accumulation in the pericardial space which dampens the heart sounds.
Remember: DDD signs
What 2 types of medications are used for thrombus prophylaxis?
1 . Antiplatelet Medications: Prevent platelet aggregation; used for arterial clots.
- Examples: Aspirin, Clopidogrel (Plavix), Ticagrelor (Brilinta), Prasugrel (Effient)
2 . Anticoagulants: Prevent clot formation by inhibiting clotting factors; used for venous clots.
- Examples: Heparin, Warfarin (Coumadin)
PCI pts will be on a thrombus prophylaxis for how long?
rest of their lives (lifelong)
PCI solutions: Thrombus Prophylaxis
If ASPIRIN is used in conjunction with another anti-platelet medication it is called
dual-antiplatelet therapy
What other meds will be used with Aspirin?
- clopidogrel (Plavix) **
- ticagrelor (Brilinta)
- prasugrel (Effient)
-grel are anti-platellets
know
Other PCI complications
-
Coronary artery spasm prophylaxis-Vasodialators
* Nitrates
* Calcium Channel Blockers -
Assess for hematoma and/or possible retroperitoneal bleeding
-caused by blood leakage from femoral artery. -
Arrhythmias (“reperfusion” vs. lethal)
* Reperfussion: vtach or SVTs but very short- assess & report - Possible MI post-op
What is Retroperitoneal bleeding?
- bleeding in the retroperitoneal space, which is the anatomical area behind the peritoneum (the lining of the abdominal cavity).
- Blood collects in the peritoneal cavity and exerts pressures on tissues within the space
Reversal agents for Benzos
Flumazenil
know
Reversal agent for opioids
Naloxone (Narcan)
know
What 3 main areas of concerns should we be assessing POST PCI
- Hole in the skin (outward bleeding)
- Hole in the blood vessel accessed (hematoma/decreased limb perfusion)
- Coronary arteries (rupture/restenosis/spasm, etc.)
PCI Education will include
-
long-term management is largely aimed at
medication compliance and modifiable risk factors ** - Cardiach Rehab
- Rest/Recover & take it easy **
Type of surgical procedure used to treat severe coronary artery disease (CAD) by improving blood flow to the heart muscle
CABG
(coronary artery bypass grafting)
What is done during a CABG procedure?
- During CABG, a healthy artery or vein from another part of the body is connected or grafted to the blocked coronary artery
- this when we can NOT fix the arteries of heart any longer
- Full chest is opened during surgery!!
Is CABG a cure for coronary artery disease (CAD)?
- CABG improves blood flow to the heart but does NOT cure coronary artery disease.
- Must Be accompanied by treatment of modifiable risk factors such as: smoking, diet, DM, cholesterol,
Education starts
on admissions!
Why do POST-OP CABG patients require incredibly close monitoring?
Their condition can change QUICKLY
How is staffing organized for a patient after CABG surgery?
- The primary RN typically has no other patients
- During the first few hours after surgery, care requires multiple caregivers, including:
-MD (Physician)
-Nurse Practitioner (NP)
-Respiratory Therapist (RT)
-Charge RN - This ensures close monitoring and rapid intervention if the patient’s condition changes.
Multiple parameters will be closely assessed but more emphezised on 2 specific parameters. What are they?
Cardiac Output and Cardiac Index
Why do we care about cardiac output and cardiac index?
Perfussion!!
amount of blood the heart pumps to the body each MINUTE
cardiac output
What other assessments are done IMMEDIATELY after a CABG surgery?
- Strict I & O
- Urinary output q 1 hr- this is how often you report it
- Drain output- from ALL drains (bleeding!)
- Tight glycemic control (Insulin drip)
- all about healing and long term outcomes
know
When will you contact HCP for pt who is post-op CABG surgery?
- Urine < 30ml/hr x 2hr - need perfusion to kidneys
- B/P too high or too low
- Chest tube drainage > 150ml/hr or > 250ml in 2hrs- may include internal bleeding (hemorrhage)
- Lab Abnormalities (low H&H, low K, high WBC, high BUN/Creat)
- Severe agitation/difficulty extubating
- Any S/S of complications
For Cardiac surgery, do we expect large or small amounts of drainage?
SMALL- should resolve within 1st or 2nd day.
If we have chest tubes for a chest trauma, do we expect large or small amounts of drainage?
Large- for trauma large amounts of drainage is an ‘expected’ abnormal.
What are these used for?
Temporary pacing leads
* (temporary electrodes are screwed into the epicardium (not inside the heart) from outside prior to closing the chest). Sometimes heart needs an EXTRA KICK while it recovers from shock of surgery
If a temporary pacing lead is accidentally pulled out, what are the pts at risk for?
Possible Tamponade
(lead goes thru pericardium, then pericardial space, and sits in epicardium space.
Pts will stay in bed for at least ___ AFTER REMOVAL of temporary pacing leads
1 hour.
- after one hr and no complications, then tamponade may not occur
CABG POST-Op priorites/teachings will include
-
Early mobilization
-out of bed by end of surgery - Sternal percautions- heart pillow
-
Pulmonary excercises
-IS, Flutter valves, TCDB - Pain control
Home care instructions POST CABG:
How to care for incision on legs and sternum
- Watch for redness, swelling or drainage.
- Clean with soap & water. Pat dry– no tub soaking
How is the skin bonded after CABG
Dermabond (skin glue)
Home care instructions to patient regarding Dermabond (skin glue)
- will start itching 10-14 days out
- DONT SCRATCH- can get infected!
Other Home Care Instructions for POST CABG surgery
- Limit pushing, pulling, lifting activities until directed by HCP (Sternal Precautions)
- Discuss driving with HCP, may be limited until sternum heals
- Wear TED hose, elevate legs when sitting, avoid crossing legs (vein harvest)
- Lifestyle changes
What is the recommended diet after CABG surgery
- low fat
- low sodium
- smoking cessation
- exercise program
- weight loss (if needed)
Any patient after a surgery (including CABG) may experience
POST-OP cognitive dysfunction (POCD)
-memory problems, difficulty concentrating, or general confusion.
-several factors play role: pts age (older), meds, long procedures, infection- all can affect brain.
What should the nurse do if POST-OP Cognitive Dysfunction occurs?
- This usually improves with time
- Goal is to get clients back into pre-surgery env as quickly as possible
- Help orient pt using clocks, calendars, photos
For heart transplant (or any transplant) patients are on __ for life.
immunosupressants
Pacemakers are usually indicated for clients who
need correction of a SLOW of irregular heart rate/rhythm
Pacemakers shows up on an EKG as a
pacer “spike”
Internal pacemaker placement will only pace the ___ side of the heart
RIGHT side
(RA or RV)
What type of pacing is this
Atrial Pacing (pacemaker= single chamber)
- will show on P wave
What type of pacing is this?
Ventricular Pacing
- These look like PVC but PVC are events not rhythms- not consistent through EKG
- Spike shows before QRS **
know
What type of pacing is on this EKG strip?
Atrial Pacing
What type of pacing is showing here?
AV sequential pacemaker (dual chamber)
What type of pacing is shown here?
Ventricular Pacing
Type of pacemaker malfunction where the pacemaker generates an electrical stimulus, but the heart does not respond so it does not contract.
“Failure to capture”
- Essentially, the pacemaker is “firing” but failing to cause the heart muscle to contract
Type of pacemaker malfunction where pacemaker doesn’t correctly detect the heart’s natural beats. As a result, it may send electrical signals when it’s not needed or fail to send them when they are needed, dysrupting hearts normal rhythm.
“Failure to sense”
Which pacemaker malfunction am I?
Failure to capture
know
Which pacemaker malfunction am I?
Failure to Sense
- you will see pacerspikes all over the place
know
POST-OP Care for PERMANENT pacemaker insertion
- Obtain baseline EkG Recording
- Compare your EKG to patients PULSE
- Assess incision for bleeding/hematoma
- Observe SITE for temp elevation/pain
- Post-insertion Chest X-Ray
POST-OP:
After permanent pacemaker is inserted an arm immobilizer is used for how long
FIRST 12-24 hrs
Why does the patient use an arm immobilizer?
List 3 reasons.
- prevent movement of the arm on the side where the pacemaker leads were placed (usually the left arm)
- prevent lead dislodgment
- Allows heart to heal around pacemaker.
Client/Family Teaching:
What precautions should a patient with a pacemaker take regarding magnets and security detectors?
Avoid close proximity to large generators or magnets
* Ex: MRI machines (most pacemakers are NOT MRI compatible)
What can an MRI do to a pacemaker?
can change the settings of pacemaker and/or interfere with its function
Will Home appliances, cell phones, electronic devices affect pacemakers?
They should not.
WHat is used to program/change the setting on a pacemaker?
Magnets- this is why MRIs are not used for patients with pacemakers.
Review:
A defibrillator is used for what types of dysrhythmias?
- VFIB (always pulseless)
- Pulseless VTACH- this can be pulse or pulseless
“NEVER defibrillate a pulse”
“DEFIB a VFIB”
Pts who HAVE suffered from VFib/Vtach, but also pts who are at HIGH risk for these events use what type of pacemaker?
IMPLANTABLE CARDIOVERTER-
DEFIBRILLATOR (ICD)
What is an ICD’s main job and what’s the voltage amount it should deliver?
detect and correct most life-threatening dysrhythmias
- delivers <25 joules (due to closeness of heart)
What should healthcare workers do if an ICD delivers shocks during an inpatient code?
- Allow the ICD to deliver shocks as needed.
- Continue CPR and other resuscitation efforts without interruption, as the ICD does not replace the need for manual interventions in a code situation.
Defibrillator and CPR are still done!!!– KNOW
What happens if a magnet is placed over an IMPLANTABLE CARDIOVERTER- DEFIBRILLATOR (ICD)? This one is different.
Placing a magnet over an ICD will stop the defibrillation feature.
What happens if a magnet is placed over a “COMBO” device that functions as both an ICD and a pacemaker?
The magnet will not turn off the pacemaker function of the “combo” device.
- It will ONLY turn off the defibrillator function
ICD- Family/Client Teaching should include:
List 4
- Family should learn CPR **
- Driving may not be allowed – depends on state law
- Shock is painful – some describe it like a kick to the
chest - ID Card / Medical Alert Bracelet
ICD Pt/Fam teaching:
If ICD fires ONCE what should pt/family do?
Call HCP immediately
- can mean many things
- Not a true medical emergency
ICD Pt/Fam teaching:
If ICD fires MORE THAN ONCE and pt feels bad or loses consciousness what should they do next?
CALL EMS!!
- this is a medical emergency
A bulge or ballooning (weakening) in the wall of the aorta, the main artery that carries blood from the heart to the rest of the body.
Aortic Aneurysm
* Think of it like a weak spot in a tire that bulges out as pressure builds up.
Are aneurysms and dissection similar?
No.
Can happen together but they are different.
What is this?
Aortic Aneurysms
What is this?
Aortic Dissection
2 Types of Aortic Aneurysms
Abdominal Aneyrysm
Thoracic aneurysm
Which type of Aneurysm is the worst one?
Both are equally dangerous.
2 main surgical procedures used for Aortic Aneurysms
- AAA REpair (OAR)
- Endovascular Stent Graft (EVAR)
AAA Graft stands for
ABDOMINAL aortic Aneurysm Graft
- very invasive procedure where abdomen is cut opened.
Another term used for AAA Graft surgery
Open Aneurysm Repair (OAR)
What major organ implication can occur with AAA Graft/OAR procedure?
Implication for KIDNEY function due to calmping the renal artery during surgery.
Also, where is the aortic vessel in comparisson to your organs?
Aorta sits BEHIND all of your intestines.
What is a POST-OP complication with AAA Graft/OAR procedure in regards to pt’s intestines/organs?
Intestines and organs are manipulated to gain surgical access to aorta- bc of this ILEUS may occur.
Review:
What is ILEUS?
Stops peristalsis in the intestines, preventing food, liquids and gasses to pass through, leading to complete or partial intestinal obstruction
AAA Graft/ OAR MOST important POST-OP Assessment
Maintain adequate BP
Why is maintaining BP important for AAA Graft/ OAR procedure?
- HYPOtension can lead to thrombosis (blood clot) and loss of patency
- Potential for renal injury if kidneys aren’t adequately perfused (perfussion is important)
- Severe HYPERtension can cause leaks or rupture
What would we give to maintain a stable BP for these patients POST-OP AAA Graft/ OAR?
- maintained with fluids
OR - IV vasoactive drugs
2 Vasoactive drugs that INCREASE BP
- norepinephrine
- dopamine
2 Vasoactive drugs that DECREASE BP
- nicardipine-CCB drug
- NTG
Other Post-Op assesstments after OAR/AAA Repair
- Watch for infection- on site, systemic, check WBC
- Frequent abdominal assessment- abdominal girth/ bowel sounds
- STRICT NPO- no ice , nothing!
- Neurovascular checks (6 P’s)
- Renal perfusion- urine output, perfussion **
What body meassurement are we checking during abdominal assessment?
Specific to AAA/OAR
measurement of abdominal girth
If abdominal girth has increased, what may be occuring internally?
internal bleeding or Ileus (ileus is common after this procedure)
* think of it as abdominal tamponade
Another type of Aortic aneurysm procedure but LESS invasive
Endovascular Stent Graft (EVAR)
- minimally invasive procedure where a stent graft is inserted through small incisions in the groin using a catheter.
Benefits of EVAR surgery
- LESS invasive
- shorter recovery time
- Can eat & drink after
- Pts are able to move around more frequently
- No risk of Ileus
POST-OP Care for EVAR repair
- Monitor groin punctures
- Monitor femoral and pedal pulses (6P’s) - same as cardiac cath (PCI)
- Routine follow up scans (CT or MRI)- monitor future implications
Open Repair for Thoracic Aortic aneurysms are similar to
Open heart surgery and require a STERNOTOMY
Thoracic Endovascular Repair is similar to an EVAR except it is called
TEVAR
What may be different in an TEVAR?
sites used for the repair may be different than EVAR.
- May be multiple (ie: upper arm and groin)
- Assess these sites **
Can a TEVAR patient suffer from Ileus?
No! Ileus occurs in the abdomen where the stomach organs are.
- think of this stuff on the test!! **
What is Hemodynamic Monitoring?
refers to the CONTINUOUS assessment of the CARDIOVASCULAR system to evaluate the HEART’S function and BLOOD flow throughout the body
the total amount of blood ejected from the heart per minute
Cardiac Output (CO)
What is the normal range for cardiac output?
4-8 Liters of blood each minute
Why is cardiac output important?
It indicates adequate blood flow and oxygen delivery to tissues, which is crucial for overall health.
- aka ‘perfussion’
amount of blood pumped by the VENTRICLE with each contraction
Stroke volume (SV)
What is the normal range for stroke volume?
A: Each contraction should move between 60 to 100 ml of blood.
Q: Why is stroke volume important?
A: It helps assess heart function and influences overall cardiac output.
What is the cardiac output formula
CO = SV x HR
What are the 2 determinantes of cardiac output
- Stroke volume
- heart rate
- The determinant that can go up and down.
- Most easiest of the equation
Heart Rate
The determinant of the equation that is more trickier bc it is influenced by MULTIPLE variables
Stroke Volume
What 3 variables can influence Stroke Volume (SV)
Preload, Contractility, and Afterload
Determinants of Stroke volume:
- Fill & stretch
- The VOLUME within the ventricles at the end of diastole
is called
Preload
Determinants of Stroke volume:
- “Squeeze”
- How strong the heart squeezes
is called
Contractility
- “Resistance”
- the resistance the LEFT ventricle must overcome to eject blood during contraction.
- The higher the resistance, the harder the heart must work
is called
Afterload
Review:
Helps us to determine the volume status of our patient
Preload
- Preload is measured on the RIGHT side of the heart as ___.
- “RIGHT ATRIAL PRESSURE”
CVP (CENTRAL VENOUS PRESSURE)
Preload can be measured on the LEFT side of the heart as ___.
PCWP/PAWP
(Pulmonary Capillary/Artery Wedge Pressure)
What is Central Venous Pressure (CVP)
- CVP is the pressure in the thoracic vena cava, near the right atrium & ventricle of the heart.
- It reflects the amount of blood returning to the right side of the heart and the heart’s ability to manage that blood volume.
- “RIGHT ATRIAL PRESSURE”
What is the normal levels of Central Venous Pressure (CVP)
2-8 mmHg
HIGH CVP the patient will present with
fluid OVERLOAD- HYPERvolemia
LOW CVP, the patient will present with
DEHYDRATION- HYPOvolemia
Review:
How do you treat Hypervolemia?
Diuretics- classes include
* Loop diuretics: ‘furosemide’
* Thiazides: end in -thiazide
* Potassium-sparing: end in -one (Spironolactone, Amiloride, Triamterene)
know these
How would you treat DEHYDRATION
- IV FLUIDS
- ALBUMIN
- BLOOD TRANSFUSSION
ETC
Most “vasodilators” dilate ___.
ARTERIES (systemic or pulmonary).
Which drug is the one of the drug classes you know that dilate arteries, but also cause the VEINS to dilate as well.
nitrates
This effectively shows you the preload for the left side of the heart.
“Wedge Pressure”
Pulmonary Capillary/Artery Wedge Pressure (PCWP or PAWP)
What is the normal “Wedge Pressure”
Normal 6-12 mmHg
HIGH Wedge Pressure in pt’s means ___.
Fluid OVERLOAD
LOW Wedge Pressure in pt’s means ___.
HYPOvolemia.
Can you determine if a heart issue exists with just one measurement?
No
A simple calculation which measures CO relative to the patient’s size.
Cardiac Index
on test, number will provided for you- no formula needed
medications or substances that increase the strength of heart muscle contractions, enhancing the heart’s ability to pump blood.
Positive Inotropes
Normal Cardiac Index
2.2 - 4.0 L/min/m2
know normal levels- no calculations needed on test
Q: Which drugs are considered positive inotropes that increase CONTRACTILITY?
List 6
- dopamine
- dobutamine
- epinephrine
- norepinephrine
- milrinone
- digoxin.
know
Positive Inotropes also increase ___.
Cardiac workload
increasing the heart’s O2 demands
Medications or substances that decrease the strength of heart muscle contractions, leading to a reduction in CONTRACTILITY.
Negative Inotropes
Q: Which drugs are considered negative inotropes that decrease CONTRACTILITY?
- calcium channel blockers
- beta blockers
They reduce the force of contraction, reducing cardiac workload and O2 demands of heart
Going back to Afterload:
Afterload can be measured using what 2 measurements?
SVR and MAP.
Measures the RESISTANCE of blood flow out of the LEFT ventricle into the AORTA.
Systemic Vascular Resistance (SVR)
- refers to the resistance that the body’s blood vessels provide against the flow of blood from the heart through the systemic circulation.
Systemic Vascular Resistance (SVR) normal value is
800 -1200 dynes/sec/cm-5
Increased SVR indicates
Vasoconstriction
Decreased SVR indicates
Vasodilation
Drugs that cause VASOCONSTRICTION
- Epinepherine
- norepinephrine
- phenylephrine
- vasopressin
think meds that increase BP
KNOW
Drugs that cause VASODILATION
- Calcium channel blockers
- ace-inhibitors
- nitrates
- direct vasodilators (ex: hydralazine)
KNOW
- CRITICAL measure of blood pressure that represents the average pressure in a person’s arteries AFTER blood leaves LEFT side of heart.
- It is an important indicator of perfusion to vital organs.
MAP = Mean Arterial Pressure
Normal MAP is
70 - 105 mmHg
(>60 necessary to sustain vital organs)
What is the MAP formula
MAP = (SBP + DBP x 2) ÷ 3
(diastolic is added 2x)
know
To calculate Preload, what 2 parameters are needed
- CVP
- Wedge pressure
To calculate Contractility, what 2 parameters are needed
- Cardiac Output
- Cardiac Index
3 Non-Invasive methods for hemodynamic monitoring
- Central Lines
- Arterial Lines
- Swan Catheters
Arterial lines give us CONTINUOUS
BP & MAP readings
What should we assess if a patient has an ART- line and how often?
- Assess neurovascular status distal to the arterial insertion site - 6 P’s
- Q 1 hr.
Can you use ARt- lines as an extra lumen for administering medications?
No! The only thing running should be NS
If your’e arterial pressure monitor alarms are going off… what will you assess FIRST!?
ALWAYS ASSESS PT FIRST!!!
What risks follow a Pulmonary Artery Pressure Monitoring (PA catheters) -“SWANS”
List 3
- Blocks blood flow through PULMONARY artery
- Balloon can rupture
- Tear of pulmonary artery
For testing purposes, if the question states ‘The patient is wedged..’, OR ‘Patient has a SWAN/PA catheter and is in distress’ OR ‘Pt turns and accidentaly inserts air into the ballon’ …. what would most likely be the answer you would choose?
DEFLATE THE BALLOON
When a PA Catheter/SWAN is being removed, theres a posibbility that patients can go into __.
VTACH or VFIB
VTACH can be both
with PULSE or PULSELESS
HOW TO TREAT VTACH
- With Pulse: antidysrhythmics or cardioversion (if rx ineffective
- Pulseless: SHOCK, CPR 2 mins, SHOCK, CPR 2 mins, Epi Q3-5 mins, SHOCK, CPR 2 mins, Amiodarone or lidocaine
Q: What is referencing in the context of a PA-Art line?
It means positioning the transducer of the PA catheter so that the zero reference point is at the level of the atria of the heart.
Where is the reference point that ensures correct pressure readings from the PA catheter.
Is the phlebostatic axis,
* located at the 4th intercostal space at the midaxillary line (approximately at the level of the right atrium).
Confirms that when pressure within the system is zero, the monitor reads zero
Zeroing
When should you Zero?
With initial setup, periodically thereafter, or when questioning measurements.
* for this- dont zero when patient moves around
What should you check FIRST before troubleshooting a system?
Assess your patient!!!!
- treat the pt not the monitor
Q: Why should clinicians avoid relying on a single hemodynamic measurement?
A single hemodynamic value is rarely significant; evaluating multiple values provides a clearer picture of the patient’s cardiovascular status.
Increased blood pressures in the pulmonary arteries
What am I?
Pulmonary Hypertension
What happens to the pulmonary arteries in Pulmonary Hypertension?
thicken, narrow, and stiffen
What can Pulmonary Hypertesion cause?
right-sided heart failure (RS HF)
* if untreated RS HF occurs and death within a few years
Pulmonary Vascular Resistance (PVR) will be ___ in Pulmonary Hypertension
elevated
What is the word that means Right Side heart failure that is NOT caused by true heart failure
“Cor pulmonale”
How essential are medications for patients with pulmonary hypertension?
- Medications are considered the lifeline for these patients
- NEVER stop taking them.
3 Levels of Pulmonary HTN
- Mild
- Moderate
- Severe
What meds are used for MILD Pulmonary HTN?
Calcium Channel Blockers
CCB for MILD Pulmonary HTN are used in patients WITHOUT
RIGHT-sided heart failure
In MODERTE Pulmonary HTN, what meds are used?
Phosphodiesterase Enzyme Inhibitors
* prolonged vasodilation, increased blood flow, and enhanced smooth muscle relaxation.
What are the 2 Phosphodiesterase Enzyme Inhibitors meds we need to know?
- sildenafil (Viagra)
- tadalafil (Cialis)
know
Phosphodiesterase Enzyme Inhibitors should NOT be given to patients who are already taking ___.
NTG- may cause refractory hypotension (persistent low blood pressure that does not respond to standard treatments or interventions)
What meds will we give to a pt with SEVERE pulmonary HTN
Vasodilators (inhaled)
Teach pt how to use nebulizer
2 Vasodilators (inhaled) meds we need to know
- iloprost (Ventavis)
- treprostinil (Tyvaso
-prost in the name
How many times a day will INHALED Vasodilators be administerd?
6-9 times /day
Main side effect of Vasodilators
orthostatic hypotension
What are the 3 Vasodilator meds used for SEVERE Pulmonary HTN that we give via PARENTERAL.
- treprostinil (Remodulin)
- epoprostenol (Flolan)
- epoprostenol (Veletri)
end in -tinil/tenol
Pulmonary HTN:
Vasodilator Parenteral meds are given what 2 routes?
- IV - central line
- SubQ
Uncontrolled growth of abnormal cells in the body
Cancer
type of cancer that affects the blood and bone marrow
Leukemia
“Leuk” -white
“Emia” -condition of the blood
2 types of Leukemia Cancer
- Acute
- Chronic
- RAPID replication of immature WBCs that have developed a malignancy
- May develop symptoms within weeks
- Without warning
Acute Leukemia
- involves more mature WBCs
- disease onset is more gradual, may go years without symptoms
Chronic Leukemia
Acute leukemia is primarily classified into 2 main types
- Acute Myeloid Leukemia (AML)
- Chronic Myeloid Leukemia (CML)
Acute Myeloid Leukemia (AML):
The S/S result from insufficient production of
normal BLOOD cells in bone marrow
(includes RBCs, WBCs, Platelets)
S/S of Acute Myeloid Leukemia (AML)
- Fever and infection
- Weakness, fatigue, dyspnea on exertion, pallor
- Petechiae, ecchymoses (bruising), bleeding tendencies
What age category is affected by AML?
adults
3 Diagnostics for Acute Myeloid Leukemia (AML)
- Physicall assessment
- CBC
- Bone Marrow Biopsy **
What cells are found in the Bone Marrow Biopsy that are the HALLMARK to AML?
BLAST cells
(immature leukocytes)
Acute Myeloid Leukemia (AML) Physical Findings
List 4
- Abdominal Pain
- Bone Pain
- Gingival infiltration- leukemic cells in gum
- Leukemia cutis- leukemic cells in skin
How to treat Acute Myeloid Leukemia (AML)
- Induction chemotherapy: initial phase- very agressive
- Consolidation chemotherapy: aims at killing remaining leukemic cells- lower doses
- Medical procedure where damaged or unhealthy blood cells in a patient’s body are replaced with healthy stem cells.
- These stem cells can come from the patient themselves or from a donor.
Hematopoietic stem cell transplantation (HSCT)
Hematopoietic
- process of blood cell formation.
- production and development of various types of blood cells (RBC, WBC, and platelets) primarily in the bone marrow.
What are the 3 sources for stem cells.
- bone marrow
- peripheral blood
- umbilical cord blood
What are the complications for HSCT
- Infection
- Graft-Versus-Host Disease (GVHD) **
know
Graft-Versus-Host Disease (GVHD) attacks 3 main organs.
- Skin
- GI tract
- Liver
After Acute Myeloid Leukemia (AML) treatment what are 2 major complications?
- Disseminated intravascular coagulation (DIC)
- Tumor lysis syndrome
What happens in Disseminated intravascular coagulation (DIC)
- Widespread activation of the clotting process in the blood vessels
- Excessive clotting – massive amounts of tiny clots
- Causes organ failure from ischemia (decr blood flow)
Disseminated intravascular coagulation (DIC):
Once body is no longer able to clott, the patient is at risk for
excessive bleeding
What occurs in TUMOR LYSIS SYNDROME
- Massive leukemic cell destruction from chemotherapy
- Lysed cells release toxins and fluids into blood circulation
What 3 substances increase in Tumor Lysis Syndrome?
- uric acid
- potassium
- phosphate
when K+ increases- calcium decreases
know
- Type of cancer that affects the blood and bone marrow.
- It is characterized by the overproduction/mutation of myeloid cells- (type of WBC involved in the immune response)
Chronic Myeloid Leukemia (CML)
What is the HALLMARK genetic abnormality of Chronic Myeloid Leukemia (CML)?
Philadelphia (Ph+) chromosome
3 Clinical Manifestations for Chronic Myeloid Leukemia (CML)
- Might have no symptoms
- elevated WBC count detected on routine CBC
- May develop into acute phase
Patient with extremely HIGH leukocyte counts will show
- Shortness of breath
- Enlarged, tender spleen
- Occasional enlarged liver
- Anorexia, weight loss
2 Main Medical Managements for CML
- Tyrosinase Kinase Inhibitors (TKIs) -medications **
- Hematopoietic Stem Cell Transplant (HCST)
(Treatments go in this order also- start with TKIs first)
What do * Tyrosinase Kinase Inhibitors (TKIs) do?
- Decreased the need for stem cell transplant
- Targets the BRC-ABL protein that causes the cancer cells to grow
- Attacks cancer cells without harming normal cells **
In Chronic Myeloid Leukemia- Hematopoietic Stem Cell Transplant (HCST) treatment will only be used in patients less than ___ years of age.
65 years of age
How does effective TKI therapy impact life expectancy in Chronic Myeloid Leukemia (CML) patients?
Effective TKI therapy can lead to a normal life expectancy in CML patients.
Another type of Leukemia:
- Leukemia that involves lymphocytes, a type of WBC important for the immune system.
Lymphocytic Leukemia
2 types of Lymphocytic Leukemia
- Acute Lymphocytic/Lymphoblastic Leukemia (ALL)
- Chronic Lymphocytic Leukemia (CLL)
An aggressive form of leukemia that leads to an OVERPRODUCTION of lymphoblasts, which are immature lymphocytes. This interferes with the normal production of blood cells
Acute Lymphocytic/Lymphoblastic Leukemia (ALL)
Acute Lymphocytic/Lymphoblastic Leukemia (ALL) is most common form in what age group?
children
Which condition increases the risk of developing Acute Lymphocytic/Lymphoblastic Leukemia (ALL)?
Down Syndrome
What is the treatment response for children with Acute Lymphocytic/Lymphoblastic Leukemia (ALL)?
A: Children with ALL are very responsive to treatment.
4 Clinical Manifestations for ALL
- WBC may be low or elevated
- Infiltration to other organs very common: abdomoinal pain, bone pain
- CNS involvement common: headache, vomiting
- May spread to testicles and breasts
Medical Management for ALL that makes it different from AML
ALL has 3 phases for medical management.
AML has only 2 phases.
List Medical Managements for ALL
4 total (including the phases)
- Chemotherapy
-Induction Phase: Short, intensive, kill ALL leukemia
-Consolidation Phase:
-Maintenance phase – Less intensive; lasts for about 2 years - intrathecal chemotherapy- due to CNS involvement - unique to (ALL) **
- Type of cancer that affects the blood and bone marrow, specifically targeting mature B lymphocytes
- characterized by the accumulation of abnormal, mature B lymphocytes- Cells dont die
Chronic Lymphocytic Leukemia (CLL)
In Chronic Lymphocytic Leukemia (CLL), cells accumulate in 2 areas.
lymph nodes and spleen
5 Clinical Manifestations for CLL
- Many patient are asymptomatic – CLL found during routine physical exam
- Increased lymphocyte count
- Enlargement of lymph nodes (lymphadenopathy)
- Splenomegaly
- Hepatomegaly
3 Medical Management for CLL
- Wait and watch in early stages
- combined chemo-immunotherapy **
- Intravenous immunoglobulin (IVIG) – if having recurrent infections
Would Stem Cell Transplant be an option for OLDER patients with CLL?
No
Nursing Management for CLL
- Monitor for complications- same as acute
- Monitor lab results: Creatinine, Electrolyte levels, etc
- Report culture results immediately
- Bleeding precautions: soft toothbrush, use electric razor, prevent constipation, avoid sharp objects, prevent falls
- Neutropenic precautions- low levels of neutrophil WBC. Important to prevent infection!!!
A rare blood cancer characterized by the overproduction of red blood cells, which can lead to increased blood viscosity
Polycythemia Vera
(can also result in too many WBC or Platelets)
S/S of Polycythemia Vera
- Reddish (Ruddy) skin complexion
- Increased blood viscosity: Angina, dyspnea, claudication, thrombophlebitis
- Pruritus (itching)
- Bone pain
- Fatigue
- Elevated uric acid levels: waste product
Increased Uric Acid causes
gout, kidney stones, kidney damage
Diagnostic Findings for Polycethemia Vera
- Increased HGB & HCT
- Increased WBC & Platelets
- Genetic testing– mutation in JAK2 gene
- Bone marrow biopsy
Complications for Polycythemia Vera
- blood thickens
- Increased platelets- functionality of platelets can be impaired leading to increased risk of bleeding
- Increased risk for venous or arterial thromboses - heart attack, stroke **
Medical Management for Polycythemia Vera
- Low-dose aspirin
- Phlebotomy: remove 500 mL blood once or twice weekly - Goal maintain HCT < 45%
- Meds
Important Patient teaching for Polycythemia Vera
Avoid Iron supplements and multivitamins
- Type of cancer that originates in the lymphatic system, which is a crucial part of the immune system.
- Tumrs start in the lymph nodes
Lymphoma
2 types of Lymphoma
- Hodgkin Lymphoma
- Non-Hodgkin Lymphoma
Which Lymphoma am I?
* Characterized by the presence of Reed-Sternberg cells **
* Associated with Epstein-Barr Virus
* starts in single lymph nodes and spreads in an orderly fashion
Hodgkin’s Lymphoma
Hallmark of Hodgkins Lymphoma
Reed-Sternberg cells
Clinical Manifestations of Hodgkin Lymphoma
- First: painless, enlarged lymph nodes
- Cluster of symptoms known as “B symptoms”
What are the B symptoms
Systemic symptoms that include:
* Fever without chills
* Drenching sweats, especially at night
* Unintentional weight loss
Most important Diagnostics For Hodgkins Lymphoma
- Lymph node biopsy
- Chest XRAY
- CT Scan: Identify extent of lymphadenopathy
- Positron emission tomography (PET) scan: after therapy to determine effectiveness
Main Medical for Management Hodgkin Lymphoma
- Limited stage - Short course of chemotherapy (2 to 4 months)
- Radiation- first cancer can do this bc its solid tumor.
Nursing Management for Hodgkin Lymphoma
- Monitor for systemic side effects of chemotherapy and radiation
- High risk of infection
- complications based on location of radiation
2nd type of Lymphoma
* Can originate outside of the lymph nodes (e.g. spleen, thymus)
* Spread can be unpredictable
* Most patient have wide spread disease at time of diagnosis
Non-Hodgkin Lymphoma
Medical Management Non-Hodgkin Lymphoma
- Similar to Hodgkin Lymphoma **
- Radiation- if not aggressive
- Combination chemo/monoclonal antbx (MoAb)
- HSCT may be considered for patients younger than 60
- Treatment for low WBC
Non-Hodgkin Lymphoma:
What 2 meds are used for Treatment of low WBC?
- Filgrastim (Neupogen)
- Pegfilgrastim (Neulasta)
WBC growth factor
know
- Type of blood cancer that originates in the PLASMA cells
Multiple Myeloma
- Where do Plasma cells originate
Bone Marrow
Multiple Myeloma:
What do these abnormal plasma cells do to bone?
infiltrate the bone marrow and crowd out the health blood cells and cause bone destruction
Multiple Myeloma:
What do the abnormal plasma cells do to organs?
Rather than produce helpful antibodies, the cancer cells produce abnormal proteins (M-proteins) that cause organ damage
5 S/S of Multiple Myeloma
- Bone pain: pelvis, spine & ribs
- Bone degeneration
- Diffuse (allover) osteoporosis: Myeloma protein destroys bone
- Vertebral destruction
- Bone fractures
Diagnostics for Multiple Myeloma
- Blood tests
- Urine tests
- Bone marrow examination
- Imaging tests – to detect bone problems
Multiple Myeloma:
Blood tests and Urine tests are done to find what exactly?
M Proteins - produced by myeloma cells
Medical Management for Multiple Myeloma
No cure – treatment designed to extend remission or relieve symptoms
What EARLY treatment options are available for Multiple Myeloma
- Corticosteroids (Dexamethasone)- often combined with: Immunomodulatory drug & Proteasonme inhibitor
- Autologous Stem Cell Transplant (HSCT)- own stem cells
Multiple Myeloma Nursing Management
- Pain management – NSAIDS
- Activity restriction – lifting no more than 10 pounds **
-
Biphosphonate therapy **
-Improves bone pain
-Importance of comprehensive oral hygiene to prevent osteonecrosis of the jaw - Renal function: Maintain urine output of 3L/day
Q: What is anemia?
A condition characterized by lower than normal hemoglobin and fewer than normal erythrocytes.
List 3 different ways to be Anemic.
- Hypoproliferative (defective production of RBCs)
- Hemolytic (increased destruction of RBCs)
- Bleeding (blood loss)
Q: What is the result of anemia?
Decreased oxygen-carrying capacity of the blood.
Q: What is considered severe anemia?
(give a number)
hemoglobin < 6 g/dL
Give 6 significant symptoms of Severe Anemia
- Pallor or jaundice
- Difficulty concentrating
- Angina/Heart failure/MI **
- Glossitis or smooth tongue
- Difficulty swallowing, sore mouth
- Bone pain
6 Lab Studies for Anemic Patients
- H&H
- iron studies
- B12 levels
- folate
- erythropoietin levels
- bone marrow aspiration
List 4 HYPOproliferative Anemias
(defective RBC production)
- Iron Deficiency Anemia
- Anemia in Renal Disease
- Aplastic Anemia
- Vitamin B12 or Folate Deficiency (Megaloblastic Anemia)
What happens in Hypoproliferative anemia
Bone marrow does not produce enough RBCs
What are the 3 causes for Hypoproliferative Anemia
- Bone marrow damage from chemicals or medications
- Lack of erythropoietin (EPO)
- Lack of nutrients – (e.g. iron, vitamin B12, folic acid)
What exactly is Erythropoietin (EPO)
hormone produced primarily by the kidneys that stimulates the production of red blood cells in the bone marrow
Most common ANEMIA in the world
Iron deficiency anemia
Iron deficiency anemia results from:
List 4
- Not taking in enough iron in the diet
- Increase in the body’s demand for iron- children/adolescents rapid growth
- Decrease in absorption of iron- need enough stomach acid
- Losing iron (blood loss)
Iron Def. Anemia can lead to:
List 3
- Spoon-shaped nails
- Pica-abnormal cravings
- Restless leg syndrome (RLS) - uncontrollable urge to move the legs
Iron Deficiency Anemia:
Spoon-shaped nails
#1 Common cause of Iron Deficiency Anemia in ADULTS is due to
Bleeding
* menstrual period
* Colon polyps/cancer
* GI bleed from ulcers
Other COMMON cause
- Pregnancy
- Following bariatric surgery /gastrectomy **
- Celiac disease- causes inflammation & kills duodenum cells
- Inflammatory bowel disease
- GERD – taking PPI **
Q: What do decreased hemoglobin (Hgb) and hematocrit (Hct) levels indicate?
A: They indicate the presence of anemia but do NOT provide the cause.
Q: What additional testing is needed to determine the cause of anemia?
- The patient will need blood work, specifically iron studies
- This determines if a lack of iron is the cause of their anemia.
List 4 Iron Studies
- Serum Iron levels -Measures the amount of iron in the blood
- Percent transferrin saturation- Measures how many sites on the transferrin are occupied by iron
-
Total iron binding capacity (transferrin levels)
Measures the amount of transferrin – the body recognizes when iron levels are low and starts producing more transferrin - Ferritin levels- A blood protein that contains iron– low ferritin indicates the body’s iron stores are low
In Iron Deficiency:
What iron studies (blood work) will be HIGH?
Total iron binding capacity (transferrin levels)
In Iron Deficiency:
What iron studies (blood work) will be LOW?
- Serum Iron levels
- Percent transferrin saturation
- Ferritin levels
What is the primary mode of treatment for Iron Deficiency anemia?
oral iron supplements
How long does it typically take for hemoglobin (Hgb) levels to increase when taking Iron supplements (oral)?
a few weeks.
How long does it typically take for anemia to be corrected when taking oral iron supplements?
few months- continue taking 6-12 months
Instructions when taking Oral Iron Supplements.
- Take on empty stomach (1 hr before or 2 hrs after meal) - best absorbed in ACIDIC ENVIRONMENT
- Take with orange juice or other source of vitamin C
- Increase foods rich in vitamin C to enhance absorption
2 main common side effects of Iron supplements
- Stools often appear black, may have constipation, cramping, nausea
- Liquid iron may stain teeth
When might a patient need to take iron supplements with food, and what is the impact on absorption?
- If they experience GI discomfort.
- This can lead to decreased absorption, resulting in a longer time to replenish iron stores.
Q: How can sustained-release iron supplements affect GI side effects?
May help decrease GI side effects compared to standard formulations, providing a gentler option for patients.
Q: What precautions should be taken when using liquid iron supplements to prevent tooth staining?
- drink it with a straw
- rinse the mouth afterward to minimize staining
(liquid iron is undiluted=stronger)
Q: What is the primary approach to managing iron deficiency anemia?
treat the underlying cause
Q: What are the two types of iron replacement therapy?
oral and parenteral (injected).
Q: What are the 2 routes of administration for parenteral iron supplements?
- intramuscular (IM) injection
- intravenously (IV)- risk of an allergic reaction, and the patient should be monitored accordingly.
Q: What precautions should be taken when administering intramuscular (IM) iron solutions?
- may stain the skin
- therefore, separate needles should be used for withdrawing the solution and for injecting the medication.
2nd type of Hypoproliferate anemia:
Occurs due to reduced production of erythropoietin hormone (EPO)
Anemia in Renal disease
Whats the main job of erythropoietin hormone (EPO)
is the hormone that signals the bone marrow to produce RBCs
Renal Disease Anemia is more sever in what type of patients.
patients with BOTH chronic kidney disease (CKD) and diabetes
3 MAIN troubling symptoms of Renal Disease Anemia
- Increased cardiac output
- Reduced oxygen utilization
- Decreased libido
3RD type of Hypoproliferate anemia:
Rare, life-threatening disease – caused by a decrease or damage to bone marrow stem cells = bone marrow failure
Aplastic anemia
“not forming”
How exactly does bone marrow fail in Aplastic anemia
Body’s T-cells attack bone marrow – bone marrow is replaced with FAT
What is pancytopenia
ALL blood cells are decreased
- Aplastic anemia should be called pancytopenia
Q: What complications can arise from aplastic anemia due to bone marrow failure?
All the usual signs of anemia PLUS
* bleeding **
* infection **
* cardiac arrhythmias
* heart failure
7 Treatments for Aplastic Anemia
- Immediate cessation of any medications/chemicals that may have triggered aplastic anemia.
- Stem Cell Transplant
- Immunosuppressive therapy- prevent T-cells (lymphocytes) from destroying stem cells
- Eltrombopag (Promacta) **
- Eryhtropoietin (EPO)
- Transfusion PRBCs
- Treat infections
