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NUR 131 > TLO 2.2 Cardiovascular Adult > Flashcards

TLO 2.2 Cardiovascular Adult Flashcards

1
Q

Heart sounds: S1 LUB, S2 DUB, begins and ends?

A 
S1 LUB: 
-tricuspid and mitral valves close
-beginning of systole
S2 DUB:
-aortic and pulmonic valves close
-end of systole, beginning diastole
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2
Q

Adult cardiovascular assessment

A

Respiratory infections

  • pneumococcal and influenza vaccines
  • TB tests
  • HIV- pneumocystis carinii or mycoplasma pneumonia

Allergies

  • symptoms of allergies
  • second hand smoke
  • food, drug or insect sting allergies

Health risk

  • family history of lung cancer or cardiovascular disease
  • family presence of infectious disease, TB

Medication

  • list of medications including prescription, OTC, herbal and illicit drugs
  • assess knowledge of medications
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3
Q

What causes pale conjunctivae?

A

Anemia

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4
Q

What causes cyanotic mucous membranes?

A

Hypoxia

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5
Q

What is a cause of neck vein distention?

A

R heart failure

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6
Q

What is a cause of dependent edema?

A

R and/or L heart failure

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7
Q

What is a cause of peripheral cyanosis?

A

Vasoconstriction and diminished blood flow

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8
Q

What is a cause of clubbing of the fingers?

A

Chronic hypoxemia >5 months

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9
Q

Cyanosis assessment abnormalities

A

Bluish discoloration of skin and mucous membranes, often detected in lips and fingers

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10
Q

cyanosis diagnostic

A

Arterial blood gas
Pulse oximetry
**absence of cyanosis does not exclude hypoxemia

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11
Q

what is pallor? causes?

A

Decrease in color due to reduced amounts of oxyhemoglobin

Cause: anemia

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12
Q

Pallor assessment of?

A

Face
Conjunctivae
Nail beds
Palms of hands

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13
Q

Cardiovascular diagnostic blood tests

A

PT- protime: monitors oral anticoagulants such as warfarin/coumadin therapy

INR- international ratio: devised to monitor more correctly anticoagulant therapy for pts receiving warfarin therapy

aPTT- activated partial thromboplastin time: sensitive in detecting clotting factor defects, used to monitor IV heparin therapy and useful in preoperative screening for bleeding tendencies

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14
Q

Cardiovascular diagnosis test, other

A

Venogram

  • assess venous system
  • used to detect DVT and other abnormalities
  • done less frequently than in past
  • dye is injected into foot (ascending) vein or into femoral (descending) vein
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15
Q

Cardiovascular diagnosis test: Venogram: pre and post procedure

A 
Pre:
document presence and quality of pulses
clear liquids for 3-4 hours, maintain hydration
check allergies
informed consent

Post:
pressure dressing on injection site
check site frequently for hematoma, bleeding
complete bed rest for 2 hours if femoral vein
monitor distal pulses for 4-6 hours
continue IV fluids for 8-24 hours

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16
Q

Varicose Veins what is it? Causes?

A

Varicosities:
Dilated, tortuous, subcutaneous veins

Causes:
Permanent distention of veins r/t loss of valvular competence, congenital weakness of veins
Incomplete vein valves allows retrograde blood flow, increased venous pressure and venous distention

**most common sites: greater and lesser saphenous veins and perforator veins in the ankle

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17
Q

Cardiovascular diagnostic test: doppler ultrasonography

A

Assess arterial disease
Evaluate audible arterial signals
Measures limb pressures
No prep

18
Q

Varicose Veins: primary and secondary

A

Primary: Saphenous vein system

Secondary: Esophagus, vulva, spermatic cords (varicocele) and anorectal (hemorrhoids) and arteriovenous connections

19
Q

Varicose veins clinical manifestations

A

Discomfort varies:
heavy, achy, pain after prolonged standing (relieved with walking or limb elevation), pressure, itchy, burning or cramps

Swelling or nocturnal leg cramps

Concerned with cosmetic appearance

20
Q

Varicose vein complications

A

Rare: rupture of the varicose vein leading to bleeding and/or skin ulcers

21
Q

Varicose vein management

A

Prevent venous pooling

  • knee TEDS
  • no prolonged standing, no tight undergarments
  • rest, limb elevation
22
Q

Varicose vein surgical management

A

Sclerotherapy (injection)
Laser therapy
Vein ligation and stripping
Endovenous ablation (catheter emits energy)

23
Q

Thrombophlebitis/DVT what is it?

A

Swelling of a vein caused by a blood clot

Most common disorder of the veins

24
Q

Thrombophlebitis/DVT classifications

A

Superficial vein thrombosis (SVT)

Deep vein thrombosis (DVT
-most common in iliac or femoral veins

25
Q

Thrombophlebitis/DVT etiology: Virchow’s Triad

A

Must have 2 of the following:

  • venous stasis- immobility, surgery
  • hypercoagulability=- altered blood coagulation (cancer)
  • injury to venous wall- surgery
26
Q

Thrombophlebitis/DVT: conditions associated with?

A 
>40 years
General anesthesia longer than 30 minutes
Venous stasis
Pregnancy
Trauma
BC pills
Obesity
Cancer
Orthopedic surgery (hip/femur)
27
Q

Thrombophlebitis/DVT medical management

A

Anticoagulation therapy

  • heparin
  • low molecular weight heparins
  • warfarin
  • dabigatran
  • rivaroxaban
28
Q

thrombophlebitis/DVT manifestations

A 
Redness, warmth, tenderness along vein
Edema
Fullness in thigh or calf
Paresthesias
Systemic temp 100.4
29
Q

Thrombophlebitis/DVT complications

A

Pulmonary embolism
Chronic venous insufficiency
Phlegmasia cerulea dolens (swollen, blue, painful leg)

30
Q

Thrombophlebitis/DVT diagnostic studies

A

Venous duplex ultrasound
CT
MRI
Venogram-phlebogram x-ray with contrast

31
Q

Thrombophlebitis/DVT prevention

A

Early and aggressive mobilization/ambulation
Position change q 2 hr if bed rest
Teach flexion and extension of feet, knee, hips q 2-4 hr
TED hose
Sequential compression devices

32
Q

Thrombophlebitis/DVT nursing care

A

Bed rest
Elevate legs above level of heart with knee bent
IPC’s
Warm packs
Avoid: tight fitting garments, crossing legs, prolonged sitting/standing
Ambulate
Monitor anticoagulation
Monitor for HIT (heparin induced thrombocytopenia) and s/s of bleeding
Monitor for development of pulmonary emboli
-sudden pleuritic pain that worsens with deep breath
-hemoptysis (coughing up blood/mucus)
-cough, diaphoresis, anxiety, dyspnea

33
Q

Anticoagulant therapy medications

A 
Heparin
Enoxaparin
Warfarin
Dabigatran (Pradaxa)
Rivaroxaban (Xarelto)
34
Q

Anticoagulant therapy patient teaching and warfarin antidote?

A

Avoid drugs: NSAIDS, ASA, herbal supplements
Avoid food: high in vit K such as green leafy vegetables

Antidote: Phytonadione (Vitamin K)

35
Q

Anticoagulant therapy medication labs

A

Heparin drip: aPTT
LMWH (low molecular weight heparin) (enoxaparin-lovenox): no monitoring required

Antidote: Protamine Sulfate (partially reverses effect of LMWH as well)

36
Q

Anticoagulants nursing interventions/responsibilities

A

Assessment:
bruising, petechiae, bloody nose, blood in urine or stool, bleeding gums, increase HR, decreased BP, s/s of shock

Injections:
NO IM injections if pt is on heparin drip, if draw labs or give SQ injection need to apply pressure for 5 minutes for bleeding

37
Q

Anticoagulants prevents?

A

Proliferation
Development of new thrombi
Embolization

38
Q

Anticoagulants patient care

A 
Patient care:
Fall precautions
Frequent monitoring of labs INR or PTT
Instruct pt on bleeding precautions
Electric razor
Soft toothbrush
39
Q

HIT (Heparin Induced Thrombocytopenia) complications

A

Immune reaction that causes severe, sudden reduction in the platelet count with paradoxic increase in venous and/or arterial thrombosis

40
Q

HIT diagnosis and treatment

A

Heparin antibodies in blood (PF4 antibody level)
>50% reduction in platelet count
Platelet count <150,000/ul
Developmental of thromboembolic complications

Notify physician for immediate D/C heparin
Non heparin anticoagulant if needed

NUR 131 (38 decks)

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