TEST 3- Part 1

Question 1

DEFINE:
VIRUS that impairs the functioning of a person’s immune system.

Answer 1

Human Immunodeficiency Virus (HIV)

Question 2

How does HIV impaire our immune system?

Answer 2

The virus impairs/destroys CD4+ T cells

Question 3

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.

Answer 3

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.

Question 4

What actually leads to immunodeficiency?

Answer 4

Immunodeficiency occurs when the rate of destruction of CD4+ T cells exceeds the body’s ability to produce new, functional CD4+ T cells.

Question 5

The number of detectable HIV viruses in the blood is called

Answer 5

“Viral Load”

Question 6

2 main diagnostic tests we use to monitor HIV progression

Answer 6

• CD4+T
• Viral Load

Question 7

CD4 and Viral Load will be ___ of each other

Answer 7

INVERSE
(OPOSITE)

Question 8

The HIGHER the VIRAL LOAD the __.

Answer 8

LOWER the CD4- T cells

Question 9

The number that holds more meaning for diagnosis is the ___.

Answer 9

CD4+T count.

Question 10

A normal adult CD4+T cell count is

Answer 10

800-1200 cells/µL

Question 11

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.

Answer 11

C) The immune system is severely compromised, indicating progression to AIDS.

Question 12

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.

Answer 12

B) It is one of the main criteria for diagnosing AIDS, reflecting severe immune system compromise.

Question 13

What do viral load numbers indicate?

Answer 13

Viral load numbers provide a measure of disease progression OR control by indicating the amount of HIV in the blood.

Question 14

What do HIGH viral load numbers typically indicate?

Answer 14

Higher viral load = MORE active disease and further disease progression.

Question 15

What does it signify when an HIV patient’s viral load is “undetectable”?

Answer 15

An “undetectable” viral load signifies that the number of HIV copies in the blood is BELOW detectable levels, indicating that treatment is effective.

Question 16

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.

Answer 16

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.

Question 17

What impact does a HIGH viral load have on the risk of HIV transmission?

Answer 17

It increases the likelihood of HIV transmission to others.

Question 18

If viral load is undetectable, it does not mean ___.

Answer 18

virus its not there.
- HIV Virus never goes away.

Question 19

What 9 symptoms are commonly experienced by a patient newly infected with HIV, and when do they typically appear?

Answer 19

• 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)

Question 20

What occurs during the Acute Infection stage of HIV, which typically happens 2-4 weeks after transmission?

Answer 20

The patient’s HIV viral load is high and there is a temporary drop in the CD4+ T cell count.

Question 21

Why are HIV-infected patients at a greater risk of transmitting the virus during the Acute Infection stage?

Answer 21

due to HIGH viral load in their blood.

Question 22

The interval between initial HIV infection and time of diagnosis of AIDS
(a period of time)

Answer 22

• Typically about 10 years if HIV is untreated
• Timeframe is highly individualized

Question 23

What is the “Window Period” in HIV testing, and why does it occur?

Answer 23

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.

Question 24

Can clients infected with HIV transmit the virus to others during the asymptomatic stage, and what factors affect the likelihood of transmission?

Answer 24

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.

Question 25

What 5 **symptoms** are likely to occur **as the CD4+ T cell count DECLINES** in HIV patients?

Answer 25

* persistent fever * frequent night sweats * chronic diarrhea * recurrent headaches * severe fatigue.

Question 26

CD4+T cell count **above** ___ usually results in a “healthy” immune system

Answer 26

500

Question 27

What are **5 common opportunistic infections** that are likely to occur when the **CD4+ T cell count nears 200 or less?** **know**

Answer 27

- 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

Question 28

In addition to infections, what **conditions** are likely to occur when the CD4+ T cell count nears 200 or less?

Answer 28

* **Wasting syndrome**: Loss of more than 10% of ideal body mass. * **Cognitive changes / HIV Encephalopathy**: Ranging from mild to severe, similar to dementia.

Question 29

AIDS describes a ___ of the HIV illness

Answer 29

stage

Question 30

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.

Answer 30

B) The patient has a CD4+ T cell count below 200, with opportunistic infections, cancers, or wasting syndrome. **KNOW**

Question 31

Infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems

Answer 31

Opportunistic infections (OIs)

Question 32

**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.

Answer 32

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.

Question 33

Transmission occurs primarily by one of three modes:

Answer 33

* Sexual Contact * Direct Blood Contact * Mother-to-Child Transmission

Question 34

Which **types of bodily fluids** can transmit HIV, and why are they significant?

Answer 34

HIV can be transmitted through **semen, vaginal secretions, and blood** because these **fluids contain lymphocytes (WBC) with the virus.** **know these three**

Question 35

Is HIV transmitted through blood transfusions?

Answer 35

No- UNLESS screening of blood wasn't done properly.

Question 36

Can an HIV test detect the virus immediately after infection?

Answer 36

No. Not immediately.

Question 37

What is the "WINDOW PERIOD"

Answer 37

* 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”

Question 38

What is SEROCONVERSION

Answer 38

* 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**

Question 39

What does HAART stand for and what does it involve?

Answer 39

* Highly Active Antiretroviral Therapy. * HAART is a strategy for using **ARV drugs in combination** to achieve the best possible outcome in managing HIV.

Question 40

Once initiated, HAART is continued ___.

Answer 40

indefinitely.

Question 41

What is the primary mechanism by which drug therapy helps manage HIV?

Answer 41

* Drug therapy primarily helps manage HIV by **decreasing viral REPLICATION.** *know- missed on the test*

Question 42

Proper drug use can reduce **viral LOADS** by ___%

Answer 42

90-99%

Question 43

Drugs will NOT **block** the transmission of HIV, instead ___.

Answer 43

they **decrease viral LOAD** which will lessen the chances that transmission would occur

Question 44

What lab test do we check to see if the MEDS ARE WORKING?

Answer 44

VIRAL LOAD

Question 45

ART stands for

Answer 45

Anti-Retroviral Drug Therapy

Question 46

Main ART therapy med used

Answer 46

Tenofovir, TDF

Question 47

5 Signs and symptoms of HIV drug therapy

Answer 47

* Lipodystrophy-uneveness loss of body fat * Elevated Cholesterol levels * Mood changes, depression, anxiety * Elevated Blood Sugar and Diabetes * Kidney, Liver, Pancreas Damage -among more

Question 48

"Wasting Syndrome"

Answer 48

Lipo**atrophy**

Question 49

causes abnormal fat loss or distribution in certain areas of your body

Answer 49

Lipodystrophy

Question 50

* **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.

Answer 50

Pneumocystis pneumonia (PCP) *(caused by bacteria: pneumocystis jirovecci)*

Question 51

S/S of Pneumocystis pneumonia

Answer 51

* fever * dyspnea * non-productive cough

Question 52

**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

Answer 52

A. Identifying individuals at HIGH risk for HIV

Question 53

What is PrEP?

Answer 53

*(Pre-Exposure Prophylaxis)* * Its an ART regimen used as a PRE-EXPOSURE preventive treatment for individuals who are at HIGH RISK of contracting HIV.

Question 54

Who is a “high-risk” individual contracting HIV.

Answer 54

* Gay men * Transgender women * Spouse with an HIV infected partner * Drug users * Possibly used for pregnant mothers **KNOW**

Question 55

**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

Answer 55

**B) Tenofovir and Emtricitabine** (brand name: Truvada or Descovy) **know**

Question 56

What does PrEP work in the body?

Answer 56

It's an **non-strong ANTIVIRAL** that stops HIV from taking hold and spreading throughout the body. *(doesnt cure)*

Question 57

How long does PrEP take to become effective?

Answer 57

7-20 days

Question 58

What is PEP?

Answer 58

**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.**

Question 59

**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

Answer 59

C) Within 72 hours

Question 60

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

Answer 60

C) 28 days

Question 61

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%

Answer 61

B) From 25% to less than 2%

Question 62

**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

Answer 62

C) It enables the nurse to deliver unbiased, empathetic care while maintaining ethical boundaries

Question 63

What kind of **infection control** is used for HIV patients?

Answer 63

STANDARD PRECAUTION * hand hygiene * use of mask, gloves, gown and goggles when applicable

Question 64

What is the Endocardium?

Answer 64

- 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.

Question 65

**Infection** of the **endocardial layer** of the heart

Answer 65

INFECTIVE ENDOCARDITIS (IE)

Question 66

IE is almost always caused bY

Answer 66

bacterial infection

Question 67

2 most common organisms to cause IE are

Answer 67

* Staphyloccus aureus *(skin)* * Streptoccus viridians *(mouth, resp, GI, GU tracts)*

Question 68

What are the primary sites where bacteria establish infection in **endocarditis**? Bacteria need these 2 things

Answer 68

* **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**

Question 69

Irregular growths made of bacteria and cell pieces (fibrin, leukocytes, platelets) form ___.

Answer 69

vegetations

Question 70

Pieces of the **vegetations that break off** and **enter** the systemic circulation

Answer 70

Emboli

Question 71

Systemic emboli are going to move ___ in the circulation.

Answer 71

DISTALLY- with the flow of blood, not backwards!! -- *causing blockages in arteries downstream from where they broke loose.*

Question 72

Main **3 symptoms** for **Infective Endocarditis**

Answer 72

* Fever * murmurs ** * Clubbing of fingers **know**

Question 73

Further assessment for **endocarditis** should include

Answer 73

listening to heart sounds to **assess for NEW or WORSENING MURMURS** (wooshing sounds)

Question 74

What signs might be present if **embolization has occurred**?

Answer 74

The clinical signs **depend on the organ or tissue affected** by the embolus.

Question 75

What patients are at higher risk for INFECTIVE ENDOCARTDITIS?

Answer 75

* 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**

Question 76

Know the **6 signs of a STROKE**

Answer 76

**BE FAST** * Balance difficulties * Eyesight changes * Face weakness * Arm weakness * Speech difficulties * Time- Call 911

Question 77

Another term for Stroke

Answer 77

CEREBRAL VASCULAR ACCIDENT

Question 78

S/S if **vegetation** is present **ONLY** on the **LEFT SIDE of heart**

Answer 78

* Petechiae * Splinter Hemorrhages * Osler’s Nodes * Janeway’s Lesions * Roth’s Spots **know**

Question 79

Small areas of bleeding under fingernails or toenails. What am I?

Answer 79

Splinter Hemorrhage *(Damage to capillaries caused by small emboli)*

Question 80

**Flat, painless** red **spots** on palms and soles

Answer 80

Janeway Lesions

Question 81

**Painful**, pea-sized, red or purple **lesions** on fingers or toes

Answer 81

Osler's Nodes

Question 82

Hemorrhagic retinal lesions

Answer 82

Roth’s Spots

Question 83

How will we diagnose Infective Endocarditis? 2 main DX

Answer 83

1. Blood cultures (most likely positive) 2. Echocardiography **know**

Question 84

IE EKG findings would most likely read

Answer 84

afib or heart blocks

Question 85

Tx for IE will include

Answer 85

1. Antibiotics *(usually Long-term)* 2. **Fungal** infective endocarditis *(treat with anti-fungals)* 3. Associated fever: *treated with fluids, rest, and acetaminophen* 4. replace infected prosthetic valves- *surgically*

Question 86

Do we give Anticoags for IE?

Answer 86

No- it practically does nothing. * will NOT break down vegetation * bacterial clump is NOT a blood clot

Question 87

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

Answer 87

1. Avoid contact with individuals who are sick to reduce the risk of infection. 2. Importance of communicating hx of IE to future healthcare providers *(MD's, DDS, etc)* 3. Monitor for s/s of infection such as fever, heart failure, or emboli. 4. Teach importance of adherence to treatment regimen 5. Schedule follow-up echocardiograms after completing the course of antibiotics. 6. Possible bedrest or acitivity limitations

Question 88

A condition caused by **inflammation of the pericardial sac (the pericardium)**, which may occur in an acute or chronic form.

Answer 88

Pericarditis

Question 89

What symptom do patients most often present with in **Acute Pericarditis**

Answer 89

frequent, severe, sharp **chest pain** - bc of inflammation, the pericardium layers rub on each other or other surrounding parts causing the pain.

Question 90

How to **alleviate pain** for patients with Acute Pericarditis?

Answer 90

**Sitting up and leaning forward** often relieves pain

Question 91

How do you **differentiate** Pericarditis and MI?

Answer 91

**Nothing** alleviates pain for MI

Question 92

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

Answer 92

B. Pericardial friction rub *scratching, grating, high-pitched sound* **know**

Question 93

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.

Answer 93

B. A pleural friction rub will disappear when the patient holds their breath, while a pericardial friction rub will persist. *(pleural = lungs ; pericardial = heart)*

Question 94

EKG finding on Pericarditis

Answer 94

Diffuse (*all over*) ST Segment **ELEVATIONS** - ST Segment should be isoelectric *(troponin levels high)*

Question 95

Abnormal collection of fluid in the pericardial sac What am I?

Answer 95

Pericardial Effusion

Question 96

FIRST step to treat Pericardial effusion?

Answer 96

Treat whatever is causing the pericardial effusion FIRST *(Example: if pericarditis is causing p.effusion, treat pericarditis first)*

Question 97

**Compression of the heart** that results as pericardial fluid volume continues to increase. Restricts the heart from stretching. What am I?

Answer 97

Cardiac Tamponade *(ALWAYS a medical emergency- can kill pt)*

Question 98

S/S of **cardiac tamponade**

Answer 98

1. Patient may report chest pain 2. confused, anxious, and restless 3. tachypnea 4. tachycardia 5. JVD **Beck's Triad= Distant/muffled heart sounds, JVD, Hypotension**

Question 99

As a nurse, how would you help your pt **alleviate** Cardiac Tamponade s/s?

Answer 99

Nurse arent able to do anything for Tamponade. We need to get Dr involved so they can perform **PERICARDIOCENTESIS**.- surgically remove fluid

Question 100

What 4 **meds** are available to manage/treat Pericarditis

Answer 100

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

Question 101

What are the FIRST meds you will use for Pericarditis?

Answer 101

NSAIDs and Colchecine

Question 102

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.

Answer 102

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.

Question 103

Location of **pericarditis** pain

Answer 103

1. * Precordium or left trapezius ridge * has a sharp, pleuritic quality that **increases** with **inspiration**

Question 104

Diffuse (entire) inflammation of the myocardium (heart muscle) What am I?

Answer 104

Myocarditis

Question 105

Myocarditis is often present concurrently with what two other conditions

Answer 105

pericarditis and endocarditis *(s/s vary for myocarditis)*

Question 106

Myocarditis: EARLY cardiac signs mimic ___.

Answer 106

Pericarditis * *pleuritic chest pain, fricition rub, effusion*

Question 107

Late cardiac signs mimic ___.

Answer 107

Heart Failure

Question 108

6 S/S of Heart failure

Answer 108

* S3/S4 heart sound * crackles * jugular venous distention * syncope * peripheral edema * angina (chest pain)

Question 109

Specific **MYOCARDITIS** diagnostic

Answer 109

Endo-Myocardial Biopsy * *Invasive procedure and therefore accompanied by risks*

Question 110

Is there a NON-INVASIVE diagnostic for Myocarditis?

Answer 110

Nope

Question 111

What do treatment and interventions for **myocarditis** primarily focus on?

Answer 111

**managing the signs and symptoms of HEART FAILURE.**

Question 112

Drug therapy for Heart Failure (and myocarditis) includes

Answer 112

* ACE-Inhibitors: *end in -pril* * Beta-blockers: *end in -olol* * Diuretics: *loop, thiazide, k+ sparing* * Nitrates: *nitroglycerin* vasodilator * Positive Inotropes

Question 113

How does the stage of a patient's HEART FAILURE affect their medication regimen?

Answer 113

The stage of a patient's heart failure dictates which medications they are prescribed, as **treatment is tailored to the severity of their condition**

Question 114

An **inflammatory process** that can develop as a complication of inadequately treated strep throat or scarlet fever. What am I?

Answer 114

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.*

Question 115

Strep throat and scarlet fever are caused by an infection with ___ bacteria

Answer 115

streptococcus

Question 116

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.

Answer 116

B. Rheumatic fever results in inflammation and physical changes that can impact ALL layers of the heart.

Question 117

What is Pancarditis?

Answer 117

**Inflammation** that affects **all three layers of the heart**: the endocardium, myocardium, and pericardium.

Question 118

How does **Rheumatic Heart Disease** develop, and **what heart layers are involved**?

Answer 118

* 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.

Question 119

What 2 functions are impaired once the heart has fibrous scar tissue

Answer 119

1. **Contractility**: Reduced pumping ability → risk of heart failure. 2. **Compliance**: **Impaired relaxation** of heart muscle → leads to **diastolic** dysfunction.

Question 120

Is Rheumatic heart Disease cureable?

Answer 120

No- damage is already done.

Question 121

Once a patient has Rheumatic Heart Disease, what meds will they be on?

Answer 121

Antbx - lifetime and anti-inflammatory agents

Question 122

How is valvular heart disease classified?

Answer 122

* **Based on affected valve(s):** mitral, tricuspid, aortic, pulmonic * **3 Types of valvular dysfunctions:** Stenosis (narrowing) Regurgitation (leaking) Prolapse (improper closure)

Question 123

**Define**: Constriction or narrowing of the **opening** *(valves can't open)*

Answer 123

Stenosis

Question 124

How does **valve stenosis** affect pressure in the heart?

Answer 124

* 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)

Question 125

Define: * Incomplete closure of valves- *can't close* * Also ocalled "incompetence" or "insufficiency"

Answer 125

Regurgitation

Question 126

What are the effects of regurgitation on blood flow in the heart?

Answer 126

* **Backward flow of blood** through the valve. * The heart has to **re-pump the same blood** multiple times.

Question 127

**Define**: * Valves that are often referred to as “floppy” * valves that have “bulged” backwards

Answer 127

**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)*

Question 128

How does the **degree of prolapse affect management and symptoms?**

Answer 128

* Severity of symptoms is influenced by the degree of prolapse. * Management: managed medically or require surgical intervention * **Same concept applies to all valvular issues**

Question 129

What is **Mitral Valve Stenosis**

Answer 129

* 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.**

Question 130

What are the **effects of MITRAL valve stenosis**? (*left side valve*)

Answer 130

* 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).**

Question 131

What is the **primary symptom** of Mitral Valve Stenosis?

Answer 131

**Dyspnea on exertion** *(exertion: shortness of breath occurs during physical activity or exercise.)*

Question 132

Why does **dyspnea on exertion** occur with **mitral valve stenosis**?

Answer 132

* **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.

Question 133

*Mitral Valve Stenosis:* It's Chronic stage may eventually manifest as s/s of ___ sided heart failure.

Answer 133

**Right** sided heart failure - as fluid continues to build up from the lungs into **RIGHT VENTRICLE.**

Question 134

How can **Mitral valve stenosis** (*left side valve*) lead to symptoms of **RIGHT-sided heart failure?**

Answer 134

**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.

Question 135

Cardiac Output *(review)*

Answer 135

* 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.

Question 136

Formula for Cardiac Output (CO)

Answer 136

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.

Question 137

What happens when the left atrium and left ventricle work harder to **preserve cardiac output**?

Answer 137

Over time, this **increased effort can lead to HEART FAILURE**!!!

Question 138

Mitral Valve **PROLAPSE**: What type of chest pain might be present **if symptomatic**?

Answer 138

Atypical Chest Paint *(refers to chest discomfort that does not fit the classic description of angina (chest pain) or myocardial infarction)*

Question 139

Is it okay to give anti-anginals for Mitral valve prolapse pain?

Answer 139

No- Does NOT respond to anti-anginals

Question 140

Patient teaching for Mitral Valve **PROLAPSE** List 3

Answer 140

* Staying hydrated * Regular Exercise * Avoid Caffeine

Question 141

Causes obstruction of blood from **Left ventricle to the Aorta** What am I?

Answer 141

Aortic Valve Stenosis

Question 142

How does **aortic valve stenosis affect the heart's structure and function**?

Answer 142

* **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).

Question 143

What is the “Classic Triad” of symptoms for **AORTIC valve stenosis**?

Answer 143

**SAD:** * Syncope (fainting) * Angina (chest pain) * Dyspnea on exertion (shortness of breath with activity)

Question 144

**Aortic Valve REGURGITATION** results in 3 things

Answer 144

* Dilated / Hypertrophied **Left Ventricle** * Decreased CO * CHF

Question 145

Main S/S of Tricuspid AND Pulmonic valve disease *(RIGHT SIDED OF HEART)*

Answer 145

“Right sided Heart Failure”

Question 146

Problems with Right side of heart mimics ___ heart failure s/s

Answer 146

RIGHT

Question 147

Problems with LEFT side of heart mimic ____ heart failure s/s

Answer 147

LEFT side heart failure

Question 148

What is **valvular heart disease**?

Answer 148

* **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.

Question 149

Main **diagnostic study** for **Valvular Heart Disease**

Answer 149

**Echocardiogram** (reveals valve structure, function, muscle thickness, and heart chamber size)

Question 150

Valvular heart disease **conservative therapy** would include

Answer 150

* **Prevention**: rheumatic fever, endocaditis * **Medication tx**: Rx for heart failure

Question 151

*Valve Replacement:* Prosthetic heart valves may be __ or ___.

Answer 151

Mechanical or biological

Question 152

How long will a patient have a **MECHANICAL** prosthetic heart valve?

Answer 152

for entire life

Question 153

How long will a patient have a **BIOLOGICAL** prosthetic heart valve?

Answer 153

**5-10** - yrs since they tend to stiffen and calcify

Question 154

**Mechanical** prosthetics require what type of meds?

Answer 154

**anticoagulations**- LONG TERM (no way around them) **know**

Question 155

Why do we use blood thinners for **Mechanical** prosthethics valves?

Answer 155

* Due to its synthetic material. * Can not risk anything sticking to that material.

Question 156

What is the ONLY **blood thinner** used for **Mechanical** Prosthetics?

Answer 156

**Warfarin**- the only one that works * *Normal range for INR = 1*

Question 157

**INR** levels for a **MECHANICAL prosthetic valves** should be

Answer 157

3-4

Question 158

The BIOLOGICAL prosthetics come from

Answer 158

animal or human donors

Question 159

What blood thinners will pts with a **BIOLOGICAL** prosthetic valve be on?

Answer 159

NONE- do not require anticoagulant therapy

Question 160

Another word for CARDIOMYOPATHY?

Answer 160

HEART FAILURE

Question 161

List the **3 types of Cardiomyopathies** (heart failure)

Answer 161

1. Dilated cardiomyopathy 2. hypertorphic cardiomyopathy 3. Restrictive cardiomyopahty

Question 162

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

Answer 162

Dilated Cardiomyopathy **know**

Question 163

Review: What is **Systolic** Heart Failure | `

Answer 163

* 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).

Question 164

What is a unique consideration for clients with **Dilated Cardiomyopathy**? **know**

Answer 164

* **Blood Flow**: Slows down (stagnates), increasing *risk for clots/strokes.* * **Management**: Clients may need to be on *anticoagulants* unless contraindicated. **know**

Question 165

**Dilated Cardiomyopath**y mimics what EKG

Answer 165

AFib

Question 166

Dilated Cardiomyopathy are at great risk for:

Answer 166

clot formation and emboli * *(due to stasis of blood flow THROUGHOUT the heart- not just atria)*

Question 167

**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

Answer 167

Hypertrophic Cardiomyopathy

Question 168

* Systolic function is normal * **Diastolic function is impaired** * Ventricles are resistant to filling- *stiff ventricle wall* * Cardiac output fails

Answer 168

RESTRICTIVE CARDIOMYOPATHY

Question 169

For Hypertrophic and Restrictive Cardiomyopathy – Think of these more like

Answer 169

**Diastolic** Heart Failure * also called heart failure with **preserved ejection fraction (HFpEF)**

Question 170

Unique consideration for Hypertrophic cardiomyopathy

Answer 170

client/family teaching regarding **Sudden Cardiac Death**

Question 171

Diastolic Heart Failure (review)

Answer 171

* 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.**

Question 172

What am I?

Answer 172

Hypertrophic Cardiomyopathy

Question 173

What am I?

Answer 173

Dilated Cardiomyopathy

Question 174

What am I? * Stiff heart muscle (rock hard muscle)

Answer 174

Restrictive Cardiomyopathy

Question 175

Go back to the CAD PP

Answer 175

Review!!!!!

Question 176

medical procedure used to diagnose and treat certain heart conditions

Answer 176

Cardiac catheterization

Question 177

If you are accessing a **VEIN**, where in the heart will it en up in?

Answer 177

**Right** side of the heart. Right Atrium/Right ventricle

Question 178

If you're accessing an **ARTERY**, where in the heart will end up in?

Answer 178

LEFT side of the heart

Question 179

In the cath lab, are patients awake?

Answer 179

* Not fully awake, but in a consicious sedation. * Pt will be proteting their airway

Question 180

What meds are used for these conscious sedations?

Answer 180

Benzos, opioids (Versed)

Question 181

3 Timeframes for coronary tx (PCI)

Answer 181

1. Emergent 2. Urgent 3. Scheduled

Question 182

For patients with **confirmed MI who are in crisis**, what is the **FIRST** line of tx?

Answer 182

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

Question 183

Goal (time frame) to open blocked artery once pt arrives in facility

Answer 183

90 mins

Question 184

True clot busters

Answer 184

Thrombolytics

Question 185

# 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)

Answer 185

Urgent PCI

Question 186

Outpatient or inpatient procedure *(Positive stress test, unexplained chest pain)*

Answer 186

Scheduled PCI

Question 187

Urgent PCI Preparation

Answer 187

1. started on **Heparin gtt**: prevent further clots 2. **Nitroglycerin gtt**: alleviate chest pain- check BP before!!!!! 3. IV fluids (Before and/or after procedure) -Prepare/flush kidneys from contrast 4. Hold Metformin for DM pts- 48 hrs before & after (oral diabetic med) ** -interacts with IV contrast 5. NPO after midnight

Question 188

**PCI** PRE-Procedure Nurse duties List 8

Answer 188

* 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**

Question 189

**POST**-PCI Nursing Care

Answer 189

* **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)

Question 190

6P's will be checked on what extremitis after a PCI?

Answer 190

ONLY on the extremity where th sheath was inserted!

Question 191

What if your 6 P's are not normal from the baseline. What will you do next?

Answer 191

Call the provider, make sure all other assessments are done prior.

Question 192

Is it normal for patients to feel some DISCOMFORT after cath lab procedure?

Answer 192

Yes, Some discomfort is normal. true chest pain- is NOT!

Question 193

What is this called?

Answer 193

Trans-Radial Approach - used instead of a FEMORAL sheath.

Question 194

When **pulling a sheth out**, you hold **PRESSURE** for how long?

Answer 194

15 mins or more.

Question 195

What **med** should **ALWAYS be at the bedside** when pulling out a sheath and why?

Answer 195

**ATROPINE** (anticholinergic-blocks acetylcholine) * due to pressure on sheath wound, may cause pt to vagal response and lead to SYMPTOMATIC BRADYCARDIA

Question 196

When **removing a sheath** patients can have a ___ response.

Answer 196

Vagal response. - manipulation or **pressure near the femoral artery** can trigger a reflex involving the vagus nerve **INDIRECTLY**.

Question 197

If patient vagus nerve is triggered, what **heart symptom** can patient start having?

Answer 197

SYMPTOMATIC **bradycardia** - with symptoms- know how to treat

Question 198

How would you treat SYMPTOMATIC bradycardia

Answer 198

* 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**

Question 199

*PCI complications:* **Most serious complication** is

Answer 199

**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.*

Question 200

When **coronary arteries** rupture, what can occur?

Answer 200

* **tamponade** ** * ischemia- no blood to organs * infarction * decreased CO * possibly death- pts can CODE very quickly!!

Question 201

*PCI complications:* Whats the timeframe where **abrupt closure of the vessel** can occur post-procedure?

Answer 201

In the first 24 hrs.

Question 202

What is **Restenosis**

Answer 202

* 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.

Question 203

After PCI surgery, **Restenosis** risk is greates for the first ___ days

Answer 203

30 days **know**

Question 204

What meds can PREVENT restenosis?

Answer 204

**Anti-platelets** (*aspirin, P2Y12 Inhibitors (Plavix, Brilinta, Effient))* * these are NOT anticoags (heparing, warfarin)

Question 205

What **organ** should we be monitoring for any **future** PCI patient?

Answer 205

Kidneys * ALWAYS monitor renal function due to **contrast** given during procedure.

Question 206

*PCI complications:* 3 MOST important complications after PCI's

Answer 206

1. Coronory vessel Dissection- *leads to No.2* 2. Coronary Tamponade- *decr. CO= death* 3. Vessel Restenosis- *give anti-platelets*

Question 207

*Review:* What is **Coronary Tamponade**

Answer 207

* the accumulation of fluid or blood in the pericardial sac surrounding the heart, which can c**ompress the heart and impair its ability to pump blood effectively** * heart is STUCK in place

Question 208

*PCI Solutions:* What **3 signs** do we assess for **Cardiac Tamponade**

Answer 208

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

Question 209

What 2 types of medications are used for **thrombus prophylaxis**?

Answer 209

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)*

Question 210

PCI pts will be on a thrombus prophylaxis for how long?

Answer 210

rest of their lives (lifelong)

Question 211

*PCI solutions: Thrombus Prophylaxis* If **ASPIRIN** is used in **conjunction** with **another anti-platelet medication** it is called

Answer 211

dual-antiplatelet therapy

Question 212

What other meds will be used with Aspirin?

Answer 212

1. clopidogrel (Plavix) ** 2. ticagrelor (Brilinta) 3. prasugrel (Effient) **-grel are anti-platellets** **know**

Question 213

Other PCI complications

Answer 213

1. **Coronary artery spasm prophylaxis**-*Vasodialators* * Nitrates * Calcium Channel Blockers 2. **Assess for hematoma and/or possible retroperitoneal bleeding** -caused by blood leakage from femoral artery. 3. **Arrhythmias** (“reperfusion” vs. lethal) * Reperfussion: vtach or SVTs but very short- assess & report 4. **Possible MI post-op**

Question 214

What is Retroperitoneal bleeding?

Answer 214

* **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

Question 215

Reversal agents for **Benzos**

Answer 215

Flumazenil **know**

Question 216

Reversal agent for **opioids**

Answer 216

Naloxone (Narcan) **know**

Question 217

What **3** main **areas of concerns** should we be assessing **POST PCI**

Answer 217

* **Hole in the skin** (outward bleeding) * **Hole in the blood vessel accessed** (hematoma/decreased limb perfusion) * **Coronary arteries** (rupture/restenosis/spasm, etc.)

Question 218

PCI Education will include

Answer 218

1. **long-term management is largely aimed at medication compliance and modifiable risk factors** ** 2. Cardiach Rehab 3. Rest/Recover & take it easy **

Question 219

Type of **surgical procedure** used to treat severe coronary artery disease (CAD) by improving blood flow to the heart muscle

Answer 219

CABG (coronary artery bypass grafting)

Question 220

What is done during a CABG procedure?

Answer 220

* 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!!

Question 221

Is CABG a cure for coronary artery disease (CAD)?

Answer 221

* 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,

Question 222

Education starts

Answer 222

on admissions!

Question 223

Why do **POST-OP CABG** patients **require incredibly close monitoring**?

Answer 223

Their condition can change QUICKLY

Question 224

How is **staffing** organized for a patient **after CABG surgery**?

Answer 224

* 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.

Question 225

Multiple parameters will be closely assessed but more emphezised on 2 specific parameters. What are they?

Answer 225

Cardiac Output and Cardiac Index

Question 226

Why do we care about cardiac output and cardiac index?

Answer 226

Perfussion!!

Question 227

amount of blood the heart pumps to the body each MINUTE

Answer 227

cardiac output

Question 228

What other assessments are done IMMEDIATELY **after** a CABG surgery?

Answer 228

* **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**

Question 229

When will you contact HCP for pt who is post-op CABG surgery?

Answer 229

* 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

Question 230

For **Cardiac surgery**, do we expect large or small amounts of drainage?

Answer 230

SMALL- should resolve within 1st or 2nd day.

Question 231

If we have chest tubes for a **chest trauma**, do we expect large or small amounts of drainage?

Answer 231

Large- for trauma large amounts of drainage is an 'expected' abnormal.

Question 232

What are these used for?

Answer 232

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*

Question 233

If a temporary pacing lead is accidentally pulled out, what are the pts at risk for?

Answer 233

Possible **Tamponade** (lead goes thru pericardium, then pericardial space, and sits in epicardium space.

Question 234

Pts will stay in bed for at least ___ AFTER REMOVAL of temporary pacing leads

Answer 234

1 hour. - after one hr and no complications, then tamponade may not occur

Question 235

CABG POST-Op priorites/teachings will include

Answer 235

* **Early mobilization** -out of bed by end of surgery * **Sternal percautions- heart pillow** * **Pulmonary excercises** -IS, Flutter valves, TCDB * **Pain control**

Question 236

*Home care instructions POST CABG:* How to care for incision on legs and sternum

Answer 236

* Watch for redness, swelling or drainage. * Clean with soap & water. Pat dry– no tub soaking

Question 237

How is the skin bonded after CABG

Answer 237

Dermabond (skin glue)

Question 238

Home care instructions to patient regarding Dermabond (skin glue)

Answer 238

* will start itching 10-14 days out * DONT SCRATCH- can get infected!

Question 239

Other Home Care Instructions for POST CABG surgery

Answer 239

* 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

Question 240

What is the recommended diet after CABG surgery

Answer 240

* low fat * low sodium * smoking cessation * exercise program * weight loss (if needed)

Question 241

Any patient after a surgery (including CABG) may experience

Answer 241

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.

Question 242

What should the nurse do if POST-OP **Cognitive Dysfunction** occurs?

Answer 242

* 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

Question 243

For heart transplant (or **any** transplant) patients are on __ for life.

Answer 243

immunosupressants

Question 244

Pacemakers are usually indicated for clients who

Answer 244

need correction of a **SLOW** of **irregular** heart rate/rhythm

Question 245

Pacemakers shows up on an EKG as a

Answer 245

pacer “spike”

Question 246

**Internal pacemaker** placement will only pace the ___ side of the heart

Answer 246

RIGHT side (RA or RV)

Question 247

What type of pacing is this

Answer 247

**Atrial** Pacing (pacemaker= single chamber) - *will show on P wave*

Question 248

What type of pacing is this?

Answer 248

Ventricular Pacing - These look like PVC but PVC are events not rhythms- not consistent through EKG - Spike shows **before** QRS ** **know**

Question 249

What type of pacing is on this EKG strip?

Answer 249

Atrial Pacing

Question 250

What type of pacing is showing here?

Answer 250

**AV** sequential pacemaker (dual chamber)

Question 251

What type of pacing is shown here?

Answer 251

Ventricular Pacing

Question 252

Type of **pacemaker malfunction** where the pacemaker generates an electrical stimulus, but the **heart does not respond so it does not contract**.

Answer 252

"Failure to capture" - Essentially, the pacemaker is "firing" but failing to cause the heart muscle to contract

Question 253

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.

Answer 253

"Failure to sense"

Question 254

Which pacemaker malfunction am I?

Answer 254

Failure to capture **know**

Question 255

Which pacemaker malfunction am I?

Answer 255

Failure to Sense *- you will see pacerspikes all over the place* **know**

Question 256

POST-OP Care for **PERMANENT** pacemaker insertion

Answer 256

1. Obtain **baseline** EkG Recording 2. Compare your EKG to patients **PULSE** 3. Assess incision for **bleeding/hematoma** 4. Observe **SITE** for **temp elevation/pain** 5. Post-insertion Chest X-Ray

Question 257

*POST-OP*: After **permanent** pacemaker is inserted an arm immobilizer is used for how long

Answer 257

FIRST 12-24 hrs

Question 258

Why does the patient use an arm immobilizer? List 3 reasons.

Answer 258

* **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.**

Question 259

*Client/Family Teaching:* What precautions should a patient with a pacemaker take regarding magnets and security detectors?

Answer 259

**Avoid close proximity to large generators or magnets** * Ex: MRI machines (most pacemakers are **NOT MRI compatible**)

Question 260

What can an MRI do to a pacemaker?

Answer 260

can change the settings of pacemaker and/or interfere with its function

Question 261

Will Home appliances, cell phones, electronic devices affect pacemakers?

Answer 261

They should not.

Question 262

WHat is used to program/change the setting on a pacemaker?

Answer 262

**Magnets**- this is why MRIs are not used for patients with pacemakers.

Question 263

Review: A **defibrillator** is used for what types of dysrhythmias?

Answer 263

* **VFIB** (always pulseless) * **Pulseless VTACH**- *this can be pulse or pulseless* "NEVER defibrillate a pulse" "DEFIB a VFIB"

Question 264

Pts who **HAVE suffered from VFib/Vtach**, but also pts who are at **HIGH risk for these events** use what type of pacemaker?

Answer 264

IMPLANTABLE CARDIOVERTER- **DEFIBRILLATOR** (ICD)

Question 265

What is an ICD's main job and what’s the voltage amount it should deliver?

Answer 265

detect and correct **most life-threatening** dysrhythmias - delivers <25 joules (due to closeness of heart)

Question 266

What should healthcare workers do if an ICD delivers shocks during an **inpatient code**?

Answer 266

* **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**

Question 267

What happens if a **magnet is placed over** an IMPLANTABLE CARDIOVERTER- DEFIBRILLATOR (ICD)? This one is different.

Answer 267

Placing a magnet over an ICD will **stop** the defibrillation feature.

Question 268

What happens if a **magnet is placed over a "COMBO" device** that functions as both an **ICD and a pacemaker**?

Answer 268

The magnet will **not turn off the pacemaker** function of the "combo" device. - It will ONLY **turn off the defibrillator function**

Question 269

ICD- Family/Client Teaching should include: List 4

Answer 269

* **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

Question 270

*ICD Pt/Fam teaching*: If ICD fires ONCE what should pt/family do?

Answer 270

Call HCP immediately - can mean many things - **Not a true medical emergency**

Question 271

*ICD Pt/Fam teaching*: If ICD fires MORE THAN ONCE and pt feels bad or loses consciousness what should they do next?

Answer 271

CALL EMS!! - **this is a medical emergency**

Question 272

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.

Answer 272

Aortic Aneurysm * *Think of it like a weak spot in a tire that bulges out as pressure builds up*.

Question 273

Are aneurysms and dissection similar?

Answer 273

No. Can happen together but they are different.

Question 274

What is this?

Answer 274

Aortic Aneurysms

Question 275

What is this?

Answer 275

Aortic Dissection

Question 276

2 Types of Aortic Aneurysms

Answer 276

Abdominal Aneyrysm Thoracic aneurysm

Question 277

Which type of Aneurysm is the worst one?

Answer 277

Both are equally dangerous.

Question 278

2 main **surgical procedures** used for **Aortic Aneurysms**

Answer 278

1. AAA REpair (OAR) 2. Endovascular Stent Graft (EVAR)

Question 279

AAA Graft stands for

Answer 279

ABDOMINAL aortic Aneurysm Graft - very **invasive** procedure where abdomen is cut opened.

Question 280

Another term used for AAA Graft surgery

Answer 280

Open Aneurysm Repair (OAR)

Question 281

What major **organ implication** can occur with **AAA Graft/OAR** procedure?

Answer 281

Implication for KIDNEY function due to calmping the renal artery during surgery.

Question 282

Also, where is the aortic vessel in comparisson to your organs?

Answer 282

Aorta sits **BEHIND** all of your intestines.

Question 283

What is a **POST-OP** complication with **AAA Graft/OAR** procedure in regards to pt's **intestines/organs**?

Answer 283

Intestines and organs are manipulated to gain surgical access to aorta- bc of this **ILEUS** may occur.

Question 284

Review: What is ILEUS?

Answer 284

**Stops peristalsis** in the intestines, preventing food, liquids and gasses to pass through, **leading to complete or partial intestinal obstruction**

Question 285

**AAA Graft/ OAR** MOST important **POST-OP Assessment**

Answer 285

Maintain adequate BP

Question 286

Why is maintaining BP important for AAA Graft/ OAR procedure?

Answer 286

* **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

Question 287

What would we give to maintain a stable BP for these patients POST-OP **AAA Graft/ OAR**?

Answer 287

* maintained with fluids OR * IV vasoactive drugs

Question 288

2 Vasoactive drugs that **INCREASE** BP

Answer 288

1. norepinephrine 2. dopamine

Question 289

2 Vasoactive drugs that **DECREASE** BP

Answer 289

* nicardipine-CCB drug * NTG

Question 290

Other Post-Op assesstments after **OAR/AAA Repair**

Answer 290

1. Watch for infection- on site, systemic, check WBC 2. **Frequent abdominal assessment**- abdominal girth/ bowel sounds 3. **STRICT NPO**- no ice , nothing! 4. Neurovascular checks (6 P's) 5. **Renal perfusion**- urine output, perfussion **

Question 291

What body **meassurement** are we checking during **abdominal** assessment? Specific to AAA/OAR

Answer 291

measurement of **abdominal girth**

Question 292

If abdominal girth has **increased**, what may be occuring internally?

Answer 292

internal bleeding or Ileus **(ileus is common after this procedure)** * think of it as abdominal tamponade

Question 293

Another type of Aortic aneurysm procedure but **LESS invasive**

Answer 293

Endovascular Stent Graft (**EVAR**) - minimally invasive procedure where a stent graft is inserted through **small incisions in the groin** using a **catheter**.

Question 294

Benefits of EVAR surgery

Answer 294

1. LESS invasive 2. shorter recovery time 3. Can eat & drink after 4. Pts are able to move around more frequently 5. **No risk of Ileus**

Question 295

POST-OP Care for EVAR repair

Answer 295

1. Monitor groin punctures 2. Monitor femoral and pedal pulses (6P's) - **same as cardiac cath (PCI)** 3. Routine follow up scans (CT or MRI)- monitor future implications

Question 296

Open Repair for Thoracic Aortic aneurysms are similar to

Answer 296

Open heart surgery and require a STERNOTOMY

Question 297

Thoracic **Endovascular** Repair is similar to an EVAR except it is called

Answer 297

TEVAR

Question 298

What may be different in an TEVAR?

Answer 298

sites used for the repair may be different than EVAR. - May be multiple (ie: upper arm and groin) - Assess these sites **

Question 299

Can a TEVAR patient suffer from Ileus?

Answer 299

No! Ileus occurs in the abdomen where the stomach organs are. - think of this stuff on the test!! **

Question 300

What is Hemodynamic Monitoring?

Answer 300

refers to the **CONTINUOUS** assessment of the **CARDIOVASCULAR system** to evaluate the **HEART'S function and BLOOD flow** throughout the body

Question 301

the total amount of blood ejected from the heart per **minute**

Answer 301

Cardiac Output (CO)

Question 302

What is the **normal range for cardiac output**?

Answer 302

**4-8 Liters** of blood each **minute**

Question 303

Why is cardiac output important?

Answer 303

It indicates adequate blood flow and **oxygen delivery to tissues**, which is crucial for overall health. - aka 'perfussion'

Question 304

amount of blood pumped by the VENTRICLE with each **contraction**

Answer 304

Stroke volume (SV)

Question 305

What is the normal range for stroke volume?

Answer 305

A: Each contraction should move between **60 to 100 ml of blood.**

Question 306

Q: Why is stroke volume important?

Answer 306

A: It helps assess heart function and influences overall cardiac output.

Question 307

What is the cardiac output formula

Answer 307

CO = SV x HR

Question 308

What are the 2 determinantes of cardiac output

Answer 308

* Stroke volume * heart rate

Question 309

* The determinant that can go up and down. * Most easiest of the equation

Answer 309

Heart Rate

Question 310

The determinant of the equation that is more trickier bc it is **influenced by MULTIPLE variables**

Answer 310

Stroke Volume

Question 311

What 3 variables can **influence Stroke Volume (SV)**

Answer 311

Preload, Contractility, and Afterload

Question 312

*Determinants of Stroke volume:* * Fill & stretch * The **VOLUME** within the **ventricles** at the **end of diastole** is called

Answer 312

Preload

Question 313

*Determinants of Stroke volume:* * "Squeeze" * How strong the **heart squeezes** is called

Answer 313

Contractility

Question 314

* "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

Answer 314

Afterload

Question 315

*Review*: Helps us to determine the **volume** status of our patient

Answer 315

Preload

Question 316

* Preload is measured on the **RIGHT** side of the heart as ___. * **"RIGHT ATRIAL PRESSURE"**

Answer 316

CVP (CENTRAL VENOUS PRESSURE)

Question 317

Preload can be measured on the **LEFT** side of the heart as ___.

Answer 317

**PCWP/PAWP** (Pulmonary Capillary/Artery Wedge Pressure)

Question 318

What is Central Venous Pressure (CVP)

Answer 318

* 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"

Question 319

What is the **normal levels** of Central Venous Pressure (CVP)

Answer 319

2-8 mmHg

Question 320

HIGH CVP the patient will present with

Answer 320

fluid OVERLOAD- **HYPER**volemia

Question 321

LOW CVP, the patient will present with

Answer 321

DEHYDRATION- **HYPO**volemia

Question 322

Review: How do you treat Hypervolemia?

Answer 322

**Diuretics**- classes include * Loop diuretics: '*furosemide*' * Thiazides: end in *-thiazide* * Potassium-sparing: end in -one (*Spironolactone, Amiloride, Triamterene*) **know these**

Question 323

How would you treat DEHYDRATION

Answer 323

* IV FLUIDS * ALBUMIN * BLOOD TRANSFUSSION ETC

Question 324

Most “vasodilators” dilate ___.

Answer 324

ARTERIES (systemic or pulmonary).

Question 325

Which drug is the one of the drug classes you know that dilate arteries, but also cause the VEINS to dilate as well.

Answer 325

nitrates

Question 326

This effectively shows you the **preload for the left side** of the heart.

Answer 326

“Wedge Pressure” **Pulmonary** Capillary/Artery Wedge Pressure (PCWP or PAWP)

Question 327

What is the normal "Wedge Pressure"

Answer 327

Normal 6-12 mmHg

Question 328

HIGH Wedge Pressure in pt's means ___.

Answer 328

Fluid OVERLOAD

Question 329

LOW Wedge Pressure in pt's means ___.

Answer 329

HYPOvolemia.

Question 330

Can you determine if a heart issue exists with just **one** measurement?

Answer 330

No

Question 331

A **simple** calculation which **measures CO relative to the patient’s size**.

Answer 331

Cardiac Index *on test, number will provided for you- no formula needed*

Question 332

**medications** or substances that **increase the strength of heart muscle contractions**, enhancing the heart's ability to pump blood.

Answer 332

Positive Inotropes

Question 333

Normal Cardiac Index

Answer 333

**2.2 - 4.0 L/min/m2** *know normal levels- no calculations needed on test*

Question 334

Q: Which drugs are considered **positive inotropes** that **increase** CONTRACTILITY? List 6

Answer 334

* dopam**ine** * dobutam**ine** * epinephr**ine** * norepinephr**ine** * milrin**one** * **digoxin**. **know**

Question 335

**Positive** Inotropes also **increase** ___.

Answer 335

Cardiac workload *increasing the heart’s O2 demands*

Question 336

Medications or substances that **decrease the strength of heart muscle contractions**, leading to a **reduction** in CONTRACTILITY.

Answer 336

Negative Inotropes

Question 337

Q: Which drugs are considered **negative inotropes** that **decrease** CONTRACTILITY?

Answer 337

* calcium channel blockers * beta blockers *They reduce the force of contraction, reducing cardiac workload and O2 demands of heart*

Question 338

*Going back to Afterload:* **Afterload** can be measured using what **2** measurements?

Answer 338

SVR and MAP.

Question 339

Measures the **RESISTANCE** of blood flow **out of the LEFT ventricle into the AORTA.**

Answer 339

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.*

Question 340

Systemic Vascular Resistance (SVR) **normal value** is

Answer 340

**800 -1200 dynes/sec/cm-5**

Question 341

**Increased** SVR indicates

Answer 341

Vaso**constriction**

Question 342

**Decreased** SVR indicates

Answer 342

Vaso**dilation**

Question 343

Drugs that cause VASO**CONSTRICTION**

Answer 343

* Epinepherine * norepinephrine * phenylephrine * vasopressin *think meds that increase BP* **KNOW**

Question 344

Drugs that cause VASO**DILATION**

Answer 344

* Calcium channel blockers * ace-inhibitors * nitrates * direct vasodilators (ex: *hydralazine*) **KNOW**

Question 345

* 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.

Answer 345

**MAP** = Mean Arterial Pressure

Question 346

Normal MAP is

Answer 346

**70 - 105 mmHg** *(>60 necessary to sustain vital organs)*

Question 347

What is the **MAP formula**

Answer 347

MAP = **(SBP + DBP x 2) ÷ 3** (*diastolic is added 2x*) **know**

Question 348

To calculate **Preload**, what 2 parameters are needed

Answer 348

* CVP * Wedge pressure

Question 349

To calculate **Contractility**, what 2 parameters are needed

Answer 349

* Cardiac Output * Cardiac Index

Question 350

3 **Non-Invasive** methods for hemodynamic monitoring

Answer 350

1. Central Lines 2. Arterial Lines 3. Swan Catheters

Question 351

Arterial lines give us CONTINUOUS

Answer 351

BP & MAP readings

Question 352

What should we assess if a patient has an ART- line and how often?

Answer 352

* Assess **neurovascular status** distal to the arterial insertion site - **6 P's** * Q 1 hr.

Question 353

Can you use ARt- lines as an extra lumen for **administering medications**?

Answer 353

No! The only thing running should be NS

Question 354

If your'e arterial pressure monitor alarms are going off... what will you assess FIRST!?

Answer 354

ALWAYS ASSESS PT FIRST!!!

Question 355

What risks follow a Pulmonary Artery Pressure Monitoring (PA catheters) -"**SWANS**" **List 3**

Answer 355

* Blocks blood flow through PULMONARY artery * Balloon can rupture * Tear of pulmonary artery

Question 356

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?

Answer 356

DEFLATE THE BALLOON

Question 357

When a **PA Catheter/SWAN** is being **removed**, theres a posibbility that patients can go into __.

Answer 357

VTACH or VFIB

Question 358

VTACH can be both

Answer 358

with PULSE or PULSELESS

Question 359

HOW TO TREAT VTACH

Answer 359

* **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**

Question 360

Q: What is **referencing** in the context of a PA-Art line?

Answer 360

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.**

Question 361

Where is the **reference point** that ensures correct pressure readings from the PA catheter.

Answer 361

Is the **phlebostatic axis**, * located at the 4th intercostal space at the midaxillary line (*approximately at the level of the right atrium*).

Question 362

Confirms that when pressure **within the system is zero**, the **monitor reads zero**

Answer 362

Zeroing

Question 363

When should you Zero?

Answer 363

With initial setup, periodically thereafter, or when questioning measurements. * *for this- dont zero when patient moves around*

Question 364

What should you check FIRST before troubleshooting a system?

Answer 364

Assess your patient!!!! - treat the pt not the monitor

Question 365

Q: Why should clinicians **avoid** relying on a s**ingle hemodynamic measurement**?

Answer 365

A **single** hemodynamic value is **rarely** significant; evaluating multiple values provides a clearer picture of the patient's cardiovascular status.

Question 366

**Increased blood pressures** in the **pulmonary arteries** What am I?

Answer 366

Pulmonary Hypertension

Question 367

What happens to the pulmonary arteries in Pulmonary Hypertension?

Answer 367

thicken, narrow, and stiffen

Question 368

What can Pulmonary Hypertesion cause?

Answer 368

right-sided heart failure (RS HF) * *if untreated RS HF occurs and death within a few years*

Question 369

Pulmonary Vascular Resistance (PVR) will be ___ in Pulmonary Hypertension

Answer 369

elevated

Question 370

What is the word that means Right Side heart failure that is NOT caused by true heart failure

Answer 370

“Cor pulmonale”

Question 371

How essential are medications for patients with pulmonary hypertension?

Answer 371

* Medications are considered the **lifeline** for these patients * NEVER stop taking them.

Question 372

3 Levels of Pulmonary HTN

Answer 372

1. Mild 2. Moderate 3. Severe

Question 373

What meds are used for **MILD** Pulmonary HTN?

Answer 373

Calcium Channel Blockers

Question 374

CCB for MILD Pulmonary HTN are used in patients **WITHOUT**

Answer 374

RIGHT-sided heart failure

Question 375

In MODERTE Pulmonary HTN, what meds are used?

Answer 375

**Phosphodiesterase Enzyme Inhibitors** * *prolonged vasodilation, increased blood flow, and enhanced smooth muscle relaxation.*

Question 376

What are the 2 Phosphodiesterase Enzyme Inhibitors meds we need to know?

Answer 376

1. sildenafil (Viagra) 2. tadalafil (Cialis) **know**

Question 377

**Phosphodiesterase Enzyme Inhibitors** should **NOT** be given to patients who are already taking ___.

Answer 377

**NTG**- may cause **refractory hypotension** (*persistent low blood pressure that does not respond to standard treatments or interventions*)

Question 378

What meds will we give to a pt with **SEVERE** pulmonary HTN

Answer 378

Vasodilators (**inhaled**) *Teach pt how to use nebulizer*

Question 379

2 Vasodilators (**inhaled**) meds we need to know

Answer 379

1. iloprost (Ventavis) 2. treprostinil (Tyvaso **-prost** in the name

Question 380

How many times a day will **INHALED** Vasodilators be administerd?

Answer 380

6-9 times /day

Question 381

Main side effect of Vasodilators

Answer 381

orthostatic hypotension

Question 382

What are the **3 Vasodilator meds** used for **SEVERE** Pulmonary HTN that we give via **PARENTERAL**.

Answer 382

* treprostinil (Remodulin) * epoprostenol (Flolan) * epoprostenol (Veletri) end in **-tinil/tenol**

Question 383

*Pulmonary HTN:* Vasodilator **Parenteral** meds are given what 2 routes?

Answer 383

* IV - central line * SubQ

Question 384

Uncontrolled growth of abnormal cells in the body

Answer 384

Cancer

Question 385

type of **cancer** that affects the **blood and bone marrow**

Answer 385

Leukemia "Leuk" -white "Emia" -condition of the blood

Question 386

**2 types of Leukemia Cancer**

Answer 386

1. Acute 2. Chronic

Question 387

* **RAPID** replication of **immature WBCs** that have developed a malignancy * May develop symptoms within **weeks** * Without warning

Answer 387

Acute Leukemia

Question 388

* involves more **mature** WBCs * disease onset is more **gradual, may go years without symptoms**

Answer 388

Chronic Leukemia

Question 389

**Acute leukemia** is primarily **classified into 2 main types**

Answer 389

1. Acute **Myeloid** Leukemia (**AML**) 2. Chronic **Myeloid** Leukemia (**CML**)

Question 390

*Acute Myeloid Leukemia (AML)*: The S/S result from **insufficient production** of

Answer 390

normal **BLOOD** cells in bone marrow (*includes RBCs, WBCs, Platelets*)

Question 391

S/S of **Acute Myeloid Leukemia (AML)**

Answer 391

* Fever and infection * Weakness, fatigue, dyspnea on exertion, pallor * Petechiae, ecchymoses (bruising), bleeding tendencies

Question 392

What **age** category is affected by **AML**?

Answer 392

adults

Question 393

3 Diagnostics for **Acute** Myeloid Leukemia (**AML**)

Answer 393

1. Physicall assessment 2. CBC 3. **Bone Marrow Biopsy** **

Question 394

What **cells** are found in the **Bone Marrow Biopsy** that are the **HALLMARK to AML**?

Answer 394

BLAST cells (immature leukocytes)

Question 395

**Acute** Myeloid Leukemia (AML) Physical Findings List 4

Answer 395

1. Abdominal Pain 2. Bone Pain 3. Gingival infiltration- *leukemic cells in gum* 4. Leukemia cutis- *leukemic cells in skin*

Question 396

How to treat **Acute Myeloid Leukemia (AML)**

Answer 396

1. **Induction chemotherapy**: initial phase- very agressive 2. **Consolidation chemotherapy**: aims at killing remaining leukemic cells- lower doses

Question 397

* 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.

Answer 397

Hematopoietic stem cell transplantation (**HSCT**)

Question 398

Hematopoietic

Answer 398

* process of blood cell **formation**. * production and development of various types of blood cells (RBC, WBC, and platelets) **primarily in the bone marrow.**

Question 399

What are the **3 sources** for stem cells.

Answer 399

1. bone marrow 2. peripheral blood 3. umbilical cord blood

Question 400

What are the complications for **HSCT**

Answer 400

1. Infection 2. Graft-Versus-Host Disease (GVHD) ** **know**

Question 401

**Graft-Versus-Host Disease (GVHD)** attacks 3 main organs.

Answer 401

1. Skin 2. GI tract 3. Liver

Question 402

After **Acute Myeloid Leukemia (AML)** treatment what are 2 **major** complications?

Answer 402

1. Disseminated intravascular coagulation (DIC) 2. Tumor lysis syndrome

Question 403

What happens in **Disseminated intravascular coagulation (DIC)**

Answer 403

* 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*)

Question 404

*Disseminated intravascular coagulation (DIC):* Once body is no longer able to clott, the patient is at risk for

Answer 404

excessive bleeding

Question 405

What occurs in TUMOR LYSIS SYNDROME

Answer 405

* Massive leukemic cell destruction from chemotherapy * Lysed cells release toxins and fluids into blood circulation

Question 406

What 3 substances **increase** in **Tumor Lysis Syndrome**?

Answer 406

1. uric acid 2. potassium 3. phosphate *when K+ increases- calcium decreases* **know**

Question 407

* 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*)

Answer 407

Chronic Myeloid Leukemia (**CML**)

Question 408

What is the **HALLMARK** genetic abnormality of Chronic Myeloid Leukemia (CML)?

Answer 408

Philadelphia (Ph+) chromosome

Question 409

3 Clinical Manifestations for **Chronic** Myeloid Leukemia (CML)

Answer 409

* Might have **no** symptoms * e**levated WBC count detected** on routine CBC * May develop into **acute** phase

Question 410

Patient with extremely **HIGH leukocyte counts** will show

Answer 410

* Shortness of breath * Enlarged, tender spleen * Occasional enlarged liver * Anorexia, weight loss

Question 411

2 Main **Medical Managements** for **CML**

Answer 411

* **Tyrosinase Kinase Inhibitors (TKIs)** -medications ** * Hematopoietic Stem Cell Transplant (HCST) (*Treatments go in this order also- start with TKIs first*)

Question 412

What do * **Tyrosinase Kinase Inhibitors (TKIs)** do?

Answer 412

* 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** **

Question 413

In **Chronic Myeloid Leukemia**- Hematopoietic Stem Cell Transplant (HCST) treatment will only be used in patients less than ___ years of age.

Answer 413

65 years of age

Question 414

How does effective TKI therapy impact **life expectancy** in Chronic Myeloid Leukemia (CML) patients?

Answer 414

Effective TKI therapy can lead to a **normal life expectancy** in CML patients.

Question 415

*Another type of Leukemia*: * Leukemia that involves **lymphocytes**, a type of WBC important for the immune system.

Answer 415

Lymphocytic Leukemia

Question 416

2 types of Lymphocytic Leukemia

Answer 416

1. **Acute** Lymphocytic/Lymphoblastic Leukemia (ALL) 2. **Chronic** Lymphocytic Leukemia (CLL)

Question 417

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**

Answer 417

**Acute** **Lymphocytic/Lymphoblastic** Leukemia (ALL)

Question 418

Acute Lymphocytic/Lymphoblastic Leukemia (**ALL**) is most common form in what age group?

Answer 418

children

Question 419

Which **condition increases the risk** of developing Acute Lymphocytic/Lymphoblastic Leukemia (ALL)?

Answer 419

Down Syndrome

Question 420

What is the **treatment response** for children with Acute Lymphocytic/Lymphoblastic Leukemia (ALL)?

Answer 420

A: Children with ALL are **very responsive** to treatment.

Question 421

4 Clinical Manifestations for **ALL**

Answer 421

1. WBC may be **low or elevated** 2. **Infiltration to other organs** very common: *abdomoinal pain, bone pain* 3. **CNS involvement** common: *headache, vomiting* 4. May spread to **testicles and breasts**

Question 422

Medical Management for **ALL** that makes it different from **AML**

Answer 422

**ALL has 3 phases** for medical management. **AML has only 2 phases**.

Question 423

List Medical Managements for **ALL** **4 total** (*including the phases*)

Answer 423

1. Chemotherapy -Induction Phase: *Short, intensive, kill ALL leukemia* -Consolidation Phase: -**Maintenance phase** – *Less intensive; lasts for about 2 years* 2. **intrathecal chemotherapy**- *due to CNS involvement* - **unique to (ALL)** **

Question 424

* 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**

Answer 424

Chronic Lymphocytic Leukemia (CLL)

Question 425

In Chronic Lymphocytic Leukemia (CLL), cells accumulate in 2 areas.

Answer 425

lymph nodes and spleen

Question 426

5 Clinical Manifestations for CLL

Answer 426

* Many patient are asymptomatic – *CLL found during routine physical exam* * Increased lymphocyte count * Enlargement of lymph nodes (lymphadenopathy) * Splenomegaly * Hepatomegaly

Question 427

3 Medical Management for CLL

Answer 427

1. Wait and watch in early stages 2. **combined chemo-immunotherapy** ** 3. Intravenous immunoglobulin (IVIG) – *if having recurrent infections*

Question 428

Would Stem Cell Transplant be an option for OLDER patients with CLL?

Answer 428

No

Question 429

Nursing Management for CLL

Answer 429

1. Monitor for complications- *same as acute* 2. Monitor lab results: *Creatinine, Electrolyte levels, etc* 3. Report culture results immediately 4. **Bleeding precautions**: *soft toothbrush, use electric razor, prevent constipation, avoid sharp objects, prevent falls* 5. **Neutropenic precautions**- *low levels of neutrophil WBC. Important to prevent infection!!!*

Question 430

A rare blood cancer characterized by the **overproduction of red blood cells**, which can lead to **increased blood viscosity**

Answer 430

Polycythemia Vera (*can also result in too many WBC or Platelets*)

Question 431

S/S of Polycythemia Vera

Answer 431

* Reddish (Ruddy) skin complexion * **Increased blood viscosity**: *Angina, dyspnea, claudication, thrombophlebitis* * **Pruritus (itching)** * Bone pain * Fatigue * Elevated uric acid levels: *waste product*

Question 432

**Increased** Uric Acid causes

Answer 432

gout, kidney stones, kidney damage

Question 433

Diagnostic Findings for **Polycethemia Vera**

Answer 433

* Increased HGB & HCT * Increased WBC & Platelets * **Genetic testing**– mutation in JAK2 gene * **Bone marrow biopsy**

Question 434

Complications for **Polycythemia Vera**

Answer 434

* 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 **

Question 435

Medical Management for **Polycythemia Vera**

Answer 435

* **Low-dose aspirin** * **Phlebotomy**: *remove 500 mL blood once or twice weekly* - Goal maintain HCT < 45% * Meds

Question 436

Important Patient teaching for Polycythemia Vera

Answer 436

Avoid Iron supplements and multivitamins

Question 437

* Type of cancer that originates in the **lymphatic system**, which is a crucial part of the immune system. * Tumrs start in the **lymph nodes**

Answer 437

Lymphoma

Question 438

2 types of Lymphoma

Answer 438

1. Hodgkin Lymphoma 2. Non-Hodgkin Lymphoma

Question 439

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**

Answer 439

Hodgkin’s Lymphoma

Question 440

Hallmark of Hodgkins Lymphoma

Answer 440

Reed-Sternberg cells

Question 441

Clinical Manifestations of **Hodgkin Lymphoma**

Answer 441

1. First: painless, enlarged lymph nodes 2. **Cluster** of symptoms known as “**B symptoms**”

Question 442

What are the B symptoms

Answer 442

Systemic symptoms that include: * Fever without chills * Drenching sweats, especially at night * Unintentional weight loss

Question 443

Most important Diagnostics For Hodgkins Lymphoma

Answer 443

* **Lymph node biopsy** * Chest XRAY * **CT Scan**: *Identify extent of lymphadenopathy* * **Positron emission tomography (PET) scan**: *after therapy to determine effectiveness*

Question 444

Main Medical for Management Hodgkin Lymphoma

Answer 444

* **Limited stage** - Short course of chemotherapy (*2 to 4 months*) * **Radiation**- *first cancer can do this bc its solid tumor*.

Question 445

Nursing Management for **Hodgkin Lymphoma**

Answer 445

* Monitor for **systemic side effects** of **chemotherapy and radiation** * High risk of infection * complications based on location of radiation

Question 446

*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

Answer 446

Non-Hodgkin Lymphoma

Question 447

Medical Management **Non-Hodgkin Lymphoma**

Answer 447

1. Similar to Hodgkin Lymphoma ** 2. **Radiation**- if not aggressive 2. Combination chemo/monoclonal antbx (**MoAb**) 3. **HSCT** may be considered for patients **younger than 60** 4. Treatment for low WBC

Question 448

*Non-Hodgkin Lymphoma*: What 2 meds are used for Treatment of low WBC?

Answer 448

* **Filgrastim** (Neupogen) * **Pegfilgrastim** (Neulasta) *WBC growth factor* **know**

Question 449

* Type of blood cancer that originates in the **PLASMA cells**

Answer 449

Multiple Myeloma

Question 450

* Where do Plasma cells originate

Answer 450

Bone Marrow

Question 451

*Multiple Myeloma*: What do these abnormal plasma cells do to **bone**?

Answer 451

infiltrate the bone marrow and crowd out the health blood cells and **cause bone destruction**

Question 452

*Multiple Myeloma*: What do the abnormal plasma cells do to **organs**?

Answer 452

Rather than produce helpful antibodies, the cancer cells **produce abnormal proteins (M-proteins)** that **cause organ damage**

Question 453

**5** S/S of **Multiple Myeloma**

Answer 453

1. Bone pain: *pelvis, spine & ribs* 2. Bone degeneration 3. Diffuse (allover) osteoporosis: *Myeloma protein destroys bone* 4. Vertebral destruction 5. Bone fractures

Question 454

Diagnostics for Multiple Myeloma

Answer 454

* Blood tests * Urine tests * Bone marrow examination * Imaging tests – to detect bone problems

Question 455

*Multiple Myeloma*: Blood tests and Urine tests are done to find what exactly?

Answer 455

**M Proteins** - produced by myeloma cells

Question 456

Medical Management for **Multiple Myeloma**

Answer 456

**No cure** – treatment designed to extend remission or relieve symptoms

Question 457

What **EARLY** treatment options are available for **Multiple Myeloma**

Answer 457

1. **Corticosteroids** (Dexamethasone)- often combined with: *Immunomodulatory drug & Proteasonme inhibitor* 2. ***Autologous*** **Stem Cell Transplant (HSCT)**- own stem cells

Question 458

**Multiple Myeloma** Nursing Management

Answer 458

1. Pain management – *NSAIDS* 2. **Activity restriction** – *lifting no more than 10 pounds* ** 3. **Biphosphonate therapy** ** -*Improves bone pain* -*Importance of comprehensive oral hygiene to prevent osteonecrosis of the jaw* 4. **Renal function**: *Maintain urine output of 3L/day*

Question 459

Q: What is anemia?

Answer 459

A condition characterized by **lower than normal hemoglobin** and **fewer than normal erythrocytes**.

Question 460

List **3** different ways to be Anemic.

Answer 460

1. **Hypoproliferative** (***defective** production of RBCs*) 2. **Hemolytic** (*increased **destruction** of RBCs*) 3. **Bleeding** (*blood **loss***)

Question 461

Q: What is the result of anemia?

Answer 461

Decreased **oxygen**-carrying capacity of the blood.

Question 462

Q: What is considered severe anemia? (give a number)

Answer 462

hemoglobin **< 6 g/dL**

Question 463

Give **6** significant symptoms of **Severe Anemia**

Answer 463

1. Pallor or jaundice 2. Difficulty concentrating 3. Angina/Heart failure/MI ** 4. Glossitis or smooth tongue 5. Difficulty swallowing, sore mouth 6. Bone pain

Question 464

**6 Lab Studies** for Anemic Patients

Answer 464

* H&H * iron studies * B12 levels * folate * erythropoietin levels * bone marrow aspiration

Question 465

List **4 HYPOproliferative Anemias** (*defective RBC production*)

Answer 465

1. **Iron Deficiency** Anemia 2. Anemia in **Renal Disease** 3. **Aplastic Anemia** 4. **Vitamin B12 or Folate Deficiency** (*Megaloblastic Anemia*)

Question 466

What happens in **Hypoproliferative anemia**

Answer 466

**Bone marrow** does not produce **enough** RBCs

Question 467

What are the **3 causes** for **Hypoproliferative Anemia**

Answer 467

1. **Bone marrow damage** from chemicals or medications 2. **Lack of erythropoietin** (EPO) 3. **Lack of nutrients** – (e.g. iron, vitamin B12, folic acid)

Question 468

What exactly is **Erythropoietin (EPO)**

Answer 468

**hormone** produced primarily by the **kidneys** that **stimulates the production of red blood cells in the bone marrow**

Question 469

Most common ANEMIA in the world

Answer 469

Iron deficiency anemia

Question 470

**Iron deficiency anemia** results **from**: List 4

Answer 470

* 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)

Question 471

Iron Def. Anemia can lead to: List 3

Answer 471

1. Spoon-shaped nails 2. Pica-*abnormal cravings* 3. Restless leg syndrome (RLS) - *uncontrollable urge to move the legs*

Question 472

*Iron Deficiency Anemia*:

Answer 472

Spoon-shaped nails

Question 473

**#1 Common cause** of Iron Deficiency Anemia in **ADULTS** is due to

Answer 473

Bleeding * menstrual period * Colon polyps/cancer * GI bleed from ulcers

Question 474

Other COMMON cause

Answer 474

1. **Pregnancy** 2. Following **bariatric surgery /gastrectomy** ** 3. **Celiac disease**- *causes inflammation & kills duodenum cells* 4. **Inflammatory bowel disease** 5. **GERD** – *taking PPI* **

Question 475

Q: What do decreased **hemoglobin (Hgb) and hematocrit (Hct) levels** indicate?

Answer 475

A: They indicate the presence of anemia but **do NOT provide the cause**.

Question 476

Q: What additional testing is needed to determine the cause of anemia?

Answer 476

* The patient will need blood work, **specifically iron studies** * **This determines if a lack of iron is the cause of their anemia.**

Question 477

List 4 Iron Studies

Answer 477

1. **Serum Iron levels** -*Measures the amount of iron in the blood* 2. **Percent transferrin saturation**- *Measures how many sites on the transferrin are occupied by iron* 3. **Total iron binding capacity (transferrin levels)** *Measures the amount of transferrin – the body recognizes when iron levels are low and starts producing more transferrin* 4. **Ferritin levels**- *A blood protein that contains iron– low ferritin indicates the body’s iron stores are low*

Question 478

*In Iron Deficiency*: What iron studies (blood work) will be HIGH?

Answer 478

Total iron binding capacity (transferrin levels)

Question 479

*In Iron Deficiency*: What iron studies (blood work) will be LOW?

Answer 479

1. Serum Iron levels 2. Percent transferrin saturation 3. Ferritin levels

Question 480

What is the primary mode of treatment for Iron Deficiency anemia?

Answer 480

oral iron supplements

Question 481

How long does it typically take for **hemoglobin (Hgb)** levels to increase when taking Iron supplements (oral)?

Answer 481

a few weeks.

Question 482

How long does it typically take for **anemia to be corrected** when taking oral iron supplements?

Answer 482

few months- continue taking **6-12 months**

Question 483

**Instructions** when taking **Oral Iron Supplements**.

Answer 483

1. Take on **empty stomach** (1 hr before or 2 hrs after meal) - *best absorbed in ACIDIC ENVIRONMENT* 2. Take with **orange juice or other source of vitamin C** 3. **Increase foods rich in vitamin C** to enhance absorption

Question 484

2 main common side effects of **Iron supplements**

Answer 484

1. **Stools often appear black**, may have constipation, cramping, nausea 2. **Liquid iron** may stain teeth

Question 485

When might a patient need to take iron supplements with food, and what is the impact on absorption?

Answer 485

* If they experience GI discomfort. * This can lead to **decreased absorption**, resulting in a **longer time to replenish iron stores.**

Question 486

Q: How can **sustained-release** iron supplements affect GI side effects?

Answer 486

May **help decrease GI side effects** compared to standard formulations, **providing a gentler option for patients.**

Question 487

Q: What precautions should be taken when using liquid iron supplements to prevent tooth staining?

Answer 487

* drink it with a straw * rinse the mouth afterward to minimize staining (liquid iron is undiluted=stronger)

Question 488

Q: What is the primary approach to managing iron deficiency anemia?

Answer 488

treat the underlying cause

Question 489

Q: What are the two types of iron replacement therapy?

Answer 489

oral and parenteral (injected).

Question 490

Q: What are the 2 routes of administration for parenteral iron supplements?

Answer 490

1. intramuscular (IM) injection 2. intravenously (IV)- *risk of an allergic reaction, and the patient should be monitored accordingly.*

Question 491

Q: What precautions should be taken when administering intramuscular (IM) iron solutions?

Answer 491

* may stain the skin * therefore, separate needles should be used for withdrawing the solution and for injecting the medication.

Question 492

*2nd type of **Hypoproliferate** anemia*: Occurs due to **reduced production of erythropoietin hormone (EPO)**

Answer 492

Anemia in Renal disease

Question 493

Whats the main job of erythropoietin hormone (EPO)

Answer 493

is the hormone that **signals the bone marrow to produce RBCs**

Question 494

**Renal Disease Anemia** is more sever in what type of patients.

Answer 494

patients with BOTH **chronic kidney disease (CKD)** and **diabetes**

Question 495

3 MAIN troubling symptoms of Renal Disease Anemia

Answer 495

* Increased cardiac output * Reduced oxygen utilization * Decreased libido

Question 496

*3RD type of **Hypoproliferate** anemia*: Rare, life-threatening disease – caused by a **decrease or damage to bone marrow stem cells** = bone marrow failure

Answer 496

Aplastic anemia "*not forming*"

Question 497

How exactly does bone marrow fail in Aplastic anemia

Answer 497

Body’s T-cells attack bone marrow – bone marrow is replaced with FAT

Question 498

What is pancytopenia

Answer 498

**ALL** blood cells are **decreased** - Aplastic anemia should be called pancytopenia

Question 499

Q: What complications can arise from **aplastic anemia** due to bone marrow failure?

Answer 499

All the usual signs of anemia **PLUS** * **bleeding** ** * **infection** ** * cardiac arrhythmias * heart failure

Question 500

7 Treatments for Aplastic Anemia

Answer 500

1. Immediate cessation of any medications/chemicals that may have triggered aplastic anemia. 2. **Stem Cell Transplant** 3. **Immunosuppressive therapy**- *prevent T-cells (lymphocytes) from destroying stem cells* 4. Eltrombopag (Promacta) ** 5. **Eryhtropoietin (EPO)** 6. **Transfusion PRBCs** 7. Treat infections