TLO 2.2 Cardiovascular Adult Flashcards
Heart sounds: S1 LUB, S2 DUB, begins and ends?
S1 LUB: -tricuspid and mitral valves close -beginning of systole S2 DUB: -aortic and pulmonic valves close -end of systole, beginning diastole
Adult cardiovascular assessment
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
What causes pale conjunctivae?
Anemia
What causes cyanotic mucous membranes?
Hypoxia
What is a cause of neck vein distention?
R heart failure
What is a cause of dependent edema?
R and/or L heart failure
What is a cause of peripheral cyanosis?
Vasoconstriction and diminished blood flow
What is a cause of clubbing of the fingers?
Chronic hypoxemia >5 months
Cyanosis assessment abnormalities
Bluish discoloration of skin and mucous membranes, often detected in lips and fingers
cyanosis diagnostic
Arterial blood gas
Pulse oximetry
**absence of cyanosis does not exclude hypoxemia
what is pallor? causes?
Decrease in color due to reduced amounts of oxyhemoglobin
Cause: anemia
Pallor assessment of?
Face
Conjunctivae
Nail beds
Palms of hands
Cardiovascular diagnostic blood tests
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
Cardiovascular diagnosis test, other
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
Cardiovascular diagnosis test: Venogram: pre and post procedure
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
Varicose Veins what is it? Causes?
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
Cardiovascular diagnostic test: doppler ultrasonography
Assess arterial disease
Evaluate audible arterial signals
Measures limb pressures
No prep
Varicose Veins: primary and secondary
Primary: Saphenous vein system
Secondary: Esophagus, vulva, spermatic cords (varicocele) and anorectal (hemorrhoids) and arteriovenous connections
Varicose veins clinical manifestations
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
Varicose vein complications
Rare: rupture of the varicose vein leading to bleeding and/or skin ulcers
Varicose vein management
Prevent venous pooling
- knee TEDS
- no prolonged standing, no tight undergarments
- rest, limb elevation
Varicose vein surgical management
Sclerotherapy (injection)
Laser therapy
Vein ligation and stripping
Endovenous ablation (catheter emits energy)
Thrombophlebitis/DVT what is it?
Swelling of a vein caused by a blood clot
Most common disorder of the veins
Thrombophlebitis/DVT classifications
Superficial vein thrombosis (SVT)
Deep vein thrombosis (DVT
-most common in iliac or femoral veins
Thrombophlebitis/DVT etiology: Virchow’s Triad
Must have 2 of the following:
- venous stasis- immobility, surgery
- hypercoagulability=- altered blood coagulation (cancer)
- injury to venous wall- surgery
Thrombophlebitis/DVT: conditions associated with?
>40 years General anesthesia longer than 30 minutes Venous stasis Pregnancy Trauma BC pills Obesity Cancer Orthopedic surgery (hip/femur)
Thrombophlebitis/DVT medical management
Anticoagulation therapy
- heparin
- low molecular weight heparins
- warfarin
- dabigatran
- rivaroxaban
thrombophlebitis/DVT manifestations
Redness, warmth, tenderness along vein Edema Fullness in thigh or calf Paresthesias Systemic temp 100.4
Thrombophlebitis/DVT complications
Pulmonary embolism
Chronic venous insufficiency
Phlegmasia cerulea dolens (swollen, blue, painful leg)
Thrombophlebitis/DVT diagnostic studies
Venous duplex ultrasound
CT
MRI
Venogram-phlebogram x-ray with contrast
Thrombophlebitis/DVT prevention
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
Thrombophlebitis/DVT nursing care
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
Anticoagulant therapy medications
Heparin Enoxaparin Warfarin Dabigatran (Pradaxa) Rivaroxaban (Xarelto)
Anticoagulant therapy patient teaching and warfarin antidote?
Avoid drugs: NSAIDS, ASA, herbal supplements
Avoid food: high in vit K such as green leafy vegetables
Antidote: Phytonadione (Vitamin K)
Anticoagulant therapy medication labs
Heparin drip: aPTT
LMWH (low molecular weight heparin) (enoxaparin-lovenox): no monitoring required
Antidote: Protamine Sulfate (partially reverses effect of LMWH as well)
Anticoagulants nursing interventions/responsibilities
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
Anticoagulants prevents?
Proliferation
Development of new thrombi
Embolization
Anticoagulants patient care
Patient care: Fall precautions Frequent monitoring of labs INR or PTT Instruct pt on bleeding precautions Electric razor Soft toothbrush
HIT (Heparin Induced Thrombocytopenia) complications
Immune reaction that causes severe, sudden reduction in the platelet count with paradoxic increase in venous and/or arterial thrombosis
HIT diagnosis and treatment
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
