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N362: Practice of Nursing III > Week 13: HF, PVD, Carditis > Flashcards

Week 13: HF, PVD, Carditis Flashcards

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1
Q

Cardiac Infection / Carditis

A

Infectious Processes Involving the Heart

Involves various layers - endocardial, myocardial, and pericardial

Various etiologies

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2
Q

Layers of the Heart in to out

A

Endocardium, Myocardium (Muscle Middle), Epicardium

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3
Q

Pericarditis

A

Inflammation of the pericardial sac

can be primary or secondary - due to surgery or medical causes

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4
Q

s/s of Pericarditis

A

constant subclavicular chest pain - worse with turning or lying flat

pain improved with leaning forward or sitting position

friction rub - grating, creaking sound with each heartbeat

Increased WBC, Temp, ESR, and CRP

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5
Q

What could it mean if a patient is in too much pain to sit back during assessment in semi-fowlers

A

if they cannot sit forward it may indicate pericarditis

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6
Q

Nursing Care for Pericarditis

A

Bed rest if s/s decrease CO until fever is normalized, chest pain and friction rub gone

Morphine, Corticosteroids, NSAIDs, Meds

Observe for s&s of cardiac tamponade - pericardiocentesis

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7
Q

Endocarditis

A

life threatenining inflammation of the inner lining of your heart’s chambers and valves (endocardium)

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8
Q

Where does the infection for endocarditis come from

A

bacteria, fungi, or other microorganisms from another part of the body such as the mouth, limb abscess, or lung infection that spreads through the bloodstream and attaches to damaged areas in the heart (it loves attaching to valves)

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9
Q

If endocarditis is not treated quickly what can happen

A

it can damage or destroy the heart valves

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10
Q

Treatments for Endocarditis

A

IV antibiotics long term (6+ weeks) and sometimes surgery

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11
Q

What are some risk factors for endocarditis

A

poor dental hygiene

cardiac disease (prior)

COVID-19

IV drug user

central line access

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12
Q

Important Nursing Care Considerations for Endocarditis Tx

A

Stabilize the patient depending on the stage

Carry out the provider’s orders to find the source (cultures, monitor labs, radiology exam)

Monitor cardiorespiratory status

Monitor for S&S of sepsis

administer ordered IV antibiotics for some time

Holistic/Wrap around care (social work, substance abuse providers, other specialists)

LISTEN WITHOUT BEING JUDMENTAL

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13
Q

5 Cardiac Valvular Disorders

A

Mitral Valve Prolapse

Mitral Regurgitation

Mitral Stenosis

Aortic Regurgitation

Aortic Stenosis

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14
Q

Diagnostic Testing for Valvular Disorders

A

2D Echocardiogram

Cardiac Catheterization

MRI

CT Scan

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15
Q

Valve Disease: Prolapse

A

Portion of the valve leaflets protrude into the atrium during systole

so, the valve wont stay closed during systole

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16
Q

S/S and Characteristics of Valve Prolapse

A

few symptoms

seen in young women

fatigue
palpitations
SOB
lightheadedness

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17
Q

Valve Disease: Incompetence

A

the valve wont stay closed durign systole

cannot close when blood is pumping

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18
Q

s/s and characteristics of valve incompetence

A

few symptoms

seen in young women

fatigue

SOB

palpitations

lightheadedness

(Similar to prolapse)

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19
Q

Valve Disease: Stenosis

A

Obstruction of blood flow

Valve does not open completely during systole

improper opening

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20
Q

S/S of Valve Stenosis

A

fatigue d/t lowered CO

SOB

cough and hemoptysis

weak, irregular pulse

murmur

CHF

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21
Q

Valve Disease: Regurgitation

A

valve does not close tightly

allows blood to flow backward into the heart

some people may NOT need tx

improper closing

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22
Q

S/S and Characteristics of Valve Regurgitation

A

SOB

fatigue

lightheadedness

rapid fluttering heartbeat

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23
Q

What may more serious valve regurgitation cases need

A

medications like diuretics and blood thinners, or surgery

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24
Q

Types of Replacement Valves

A

Mechanical Valves

Tissue (Biologic) Valves

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25
Q

Mechanical Valves

A

Heart valves that do not deteriorate or become infected easily

Thrombogenic and require life long anticoagulation therapy (Coumadin)

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26
Q

Tissue (Biologic) Valves

A

Xenograft, Homograft, and Autograft

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27
Q

Xenograft

A

Tissue Valve / Heterograft

Pig or Cow Valve Transplant

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28
Q

Homograft

A

Tissue Valve / Allograft

Human Valve Transplant

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29
Q

Autograft

A

Tissue valve

Patient’s own valve transplant

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30
Q

Nursing Management Considerations for Valvular Disorders

A

prophylactic antibiotics (esp. for dental procedures)

anticoagulants - lifelong therapy post-mechanical valve replacement

cardiovascular follow-up

education!!!

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31
Q

Balloon Valvuloplasty

A

A less invasive surgery for valvular stenosis

It opens the valve and vessel up to be more functional with an inflated balloon

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32
Q

Surgical Valvuloplasty

A

For Incompetent Valves - Valve Incompetence

Closing the Valve basically

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33
Q

Self Concept Factors r/t to Cardiac Infections and Valve Disorders

A

Fear

Addiction / Lifestyle Choices

Guilt/Shame (over choices and addictions)

Physical Care of Self

Beliefs about Self

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34
Q

Congestive Heart Failure (CHF)

A

Impaired cardiac pumping, vasoconstriction and fluid retention

an inability of the heart to pump sufficient blood to meet the body’s needs

RIGHT OR LEFT SIDED

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35
Q

Is CHF a disease

A

Not a disease, but is associated with other problems - CAD (60%), HTN, MI, Valvular Dysfunction, cardiomyopathy

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36
Q

What are the majro risk factors for CHF

A

Advancing Age and CAD

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37
Q

Contributing Factors for CHF

A

1 Advancing Age and CAD

HTN

DM

Tobacco

Obesity

High Serum Cholesterol

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38
Q

What may patients exhibit with CHF

A

ventricular dysfunction

reduced exercise tolerance

diminished QOL

self concept issues

shortened life expectancy

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39
Q

Why is CHF increasing in incidence

A

due to improved survival after CV events AND increasing aging population

CHF is a major reason for admission in elderly patients - comorbidities are causing this

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40
Q

How many people ahve CHF

A

5 million

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41
Q

What is the most common reason for admission in adults >65 yo

A

CHF

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42
Q

CHF is associated with …

A

high morbidity, mortality, and economic cost

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43
Q

What are the disparities in CHF for Asian Americans

A

higher risk of ACE inhibitor related cough

lower rates of CHF

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44
Q

What are the disparities in CHF for AA and Hispanic Americans

A

Higher incidence, higher mortality & develops at an earlier age than caucasians

experience more ACE inhibitor related angioedema

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45
Q

How does CHF differ in Men compared to Women

A

Men experience more systolic dysfunction

Better response to ACE Inhibitor therapy (less mortality)

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46
Q

How does CHF differ in Women compared to Men

A

Experience more disatolic dysfunction

Higher risk of ACE cough

More frequently experience a major depression

May be a hormonal thing that explains why ACE response is worse in women

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47
Q

Clinical Picture of Left Sided Heart Failure

A

Nocturnal Dyspnea

Cough

Crackles

Wheezes

Blood Tinged Sputum

Restlessness and Confusion

Orthopnea

Tachycardia

Exertional Dyspnea

Cyanosis

Hypoxia causes much of this

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48
Q

in Left Sided Ventricular Failure what causes the pulmonary congestion

A

the LV not emptying

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49
Q

What would a left sided ventricular failure CXR show

A

CXR would show fluffy infiltrates: fluid in alveoli

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50
Q

What sort of things are auscultated in L Sided Ventricular Failure

A

Lung sounds - crackles

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51
Q

S/S of Pulmonary Decompensation from Left Sided Ventricular Failure

A

Pulsus Alternans

Increased HR

S3 > S4 Heart Sounds

Pleural Effusion

Mental Status Changes - restlessness, confusion

Weakness and fatigue

anxiety and depression

shallow respirations

paroxysmal noctural dyspnea

orthopnea

dry hacking cough

nocturia

mental status changes - hypoxia

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52
Q

Clinical Picture of Right Sided Heart Failure

A

Fatigue

Increased Peripheral Venous Pressure

Ascites

Enlarged Liver and Spleen

Distended Jugular Veins

Anorexia and Complaints of GI Distress

Swelling in Hands and Fingers

Dependent Edema (trunk or torso area)

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53
Q

What does right ventricular failure cause

A

backup of blood into the venous systemic circulation

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54
Q

Right sided heart failure may be caused by …

A

pulmonary heart disease

valve disease

disease of myocardium

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55
Q

S/S of Right Sided Ventricular Failure

A

Edema - legs, scrotum, sacrum

Dependent, bilateral pitting edema

Weight gain

poor tissue perfusion

fatigue

anxiety

Right upper quadrant pain

liver enorgement and failure

anorexia, GI bloating

ascites, anasarca

hepatomegaly

nausea

weakness

56
Q

NYHA Classification

A

Classifications of Heart Failure from I, II, III, and IV

Treatment guidelines are in place for each stage

57
Q

Stage I HF

A

no symptoms with normal physical activity

normal functional status

58
Q

Stage II HF

A

mild symptoms with normal physical activity

comfortable at rest

slight limitation of functional status

59
Q

Stage III HF

A

moderate symptoms with less than normal physical activity

comfortable only at rest

marked limitation of functional status

60
Q

Stage IV HF

A

severe symptoms with features of HF with minimal physical activity even at rest

severe limitation of functional status

61
Q

Commong HF Symptoms

A

fatigue

palpitations

chest pain

dyspnea

syncope

62
Q

BNP

A

B Type Natreutic Hormone - cardiac hormone released by monocytes in ventricles and plays a big role in hemostasis in volume control

Has a significant role in HF diagnosis

63
Q

Elevated BNP of _____ pg/mL is highly sensitive and specific for dx of HF

A

> 100 pg/mL

64
Q

What reflects the severity of heart failure diagnostically

A

the plasma concentration of BNP

65
Q

What are some other labs to look at for HF diagnosis

A

lipid profile

coagulation profile

CBC

CRP

Electrolytes

66
Q

Hemodynamic Monitoring

A

Measures the pressure in the chambers of the heart using invasive equipment and continuous monitoring

Needs specialized nursing educatio

Used in acute HF

67
Q

What sort of catheters may be used for hemodynamic monitoring? What are both capable of?

A

CVC - central venous catheter

Swan Ganz Catheter (PA Catheter)

*Both are capable of measuring pressures in portions of the right heart: CVP (right atrium or superior vena cava) and PA (Pulmonary artery pressure)

68
Q

Nursing Interventions for Chronic Heart Failure related to Activity

A

avoid activities in extreme hot, cold, or humid weather

modify activities to conserve energy

positioning: elevation of the HOB to facilitate breahting and rest, support of arms

monitor VS wiht activity

cardiac rehabilitation

bed rest for acute exacerbations

encourage regular physical activity - 30-45 minutes a day

exercise training

pacing of activities (give more time to complete)

wait 2 hours after eating for physical activity

69
Q

Nursing Interventions for Chronic Herat Failure related to Fluid Volume Excess

A

assessment for symptoms of fluid overload

daily weight

I&O

diuretic therapy; timing of meds

fluid intake/resuscitation

maintenance of sodium restriction

positioning - may elevate legs if no respiratory compromise, otherwise legs down

70
Q

Nursing Interventions: Patient Education Topics for Chronic HF

A

Diet

Stress Management

Prevention of infection

know how and when to conact health care provider

include family in teaching

before the body gets to CHF - prevention teaching

71
Q

What is the diet like with chronic heart failure

A

small frequent meals

bland low residue diet

edema may “cover malnutrition” - know this and make the patient aware

72
Q

Zone Management Tool

A

Education tool for patients with chronic heart failure

It is a tool of green, yellow, red that tells what to do when experiencing certain symptoms

73
Q

Green Zone S/S and What to do (Zone Management)

A

You have: no SOB, weight gain more than 3 pounds a day, swelling of fett, ankles, legs, or stomach, and no chest pain

What to do: Keep up the good work, take your medicine, eat a low salt diet, weight daily

74
Q

Yellow Zone S/S and What to Do (Zone Management)

A

You have: weight gain of 3 poounds in 1 day or 5 pounds in one week, SOB, swelling, feeling more tired, dizziness, new or unusual cough, hard to breath lying down - need to sleep sitting in a chair

what to do: Call the doctor or nurse

75
Q

Red Zone S/S and What to Do (Zone Management)

A

You have: Hard time breathing, struggling to breathe even at rest, chest pain or discomfort, feeling faint

What to do: CALL 911 OR Get help, go to the ER

76
Q

Common medications for CHF

A

ACE inhibitors

ARB receptor blockers

Nitrates

Beta Blockers

Diuretics

Digitalis

Calcium channel blockers

77
Q

Aquapheresis

A

Simple Ultrafiltration of fluids being pulled from a CHF patient that occurs over 2-12 hours

It is controlled with sodium and water intake and output

automated - no clinically significant impact onf lyte balance, BP, or HR

Almost like a CHF Dialysis

see video on blackboard

78
Q

Complications of Heart Failure

A

thromboembolism

pulmonary edema

cardiogenic shock

pericardial effusion and cardiac tamponade

sudden cardiac death / cardiac arrest

resp compromise complications are the most serious due to quick death

79
Q

Ways to Prevent PE Early - Nursing Interventions

A

monitor lung sounds

assess for decreased activity tolerance

assess for increased fluid retention

long term anticoagulation medication

80
Q

Nursing Interventions for PE

A

HIGH FOWLERS POSITIONE AND DANGLE LEGS

O2, VS, assess LOC

indwelling catheter

assess ABGs and lab values

administer ordered meds: vasodilators, analgesics, diuretics, inotropics, bronchodilators

monitor for pink frothy sputum from coughing

81
Q

3 Important Nursing interventions for Cardiogenic Shock

A

correct underlying problem

medications

circulatory assist devices

82
Q

What underlying problems cause cardiogenic shock

A

Rhythm problems the most common reason:

MI

CHF

Tamponade

Dysrhythmias

83
Q

Medications for Cardiogenic Shock

A

Diuretics

Positive inotropic agents and vasopressors

84
Q

What sort of circulatory assist devices are used in cardiogenic shock

A

intra-aortic balloon pump (IABP)

extracorporeal membrane oxygenation (ECMO)

85
Q

IABP

A

intra aortic balloon pump

improves heart flow and improves heart flow to vessels

decreases workload of the heart with an 85-90% occlussive balloon blocking the aorta

86
Q

ECMO

A

veno arterial (VA) extracorporeal membrane oxygenation (ECMO)

Blood is pulled from a vein, sent through the ECMO machine where it is oxygenated and then sent back to the body via an artery

Like dialysis but specific to cardiac system

87
Q

Nursing Interventions for Pericardial Effusion and Cardiac Tamponase

A

monitoring pericardiocentesis and pericardiotomy sites

Monitoring cardiorespiratory and hemodynamic status

monitor chest tube

88
Q

Your client has been diagnosed with CHF. What discharge teaching will you provide?

A

Weigh self daily at the same time and before breakdast

take your pulse before taking digoxin

take your diuretic in the morning

notify MD if you gain 2-3 pounds in a day

notify MD if you gain 5 pounds in a week

89
Q

Your patient notices yellow rings around the lights in her room. You suspect what?

A

Digoxin Toxicity

90
Q

Your patient’s potassium level is 3.2 this morning. She is also on Digoxin and Lasix. You will do what interventions?

A

hold both and get order for K+ (should be 3.6-5.2)

91
Q

Your patient’s digoxin level comes back as 0.4 ng/mL, you know this level is ___?

A

low

92
Q

3 Types of Peripheral Vascular Disease (PVD)

A

Aterial

Venous

HTN

93
Q

Arterial

A

oxygen carrying vessel damage/occlusion

ARTERIES FEED THE TOES

94
Q

Venous

A

portal for transport to the heart

VEINS PULL BACK TO OUR NOSE

95
Q

Hypertension

A

vessel damage

force of blood icnreased causing higher pressure

96
Q

Function fo the Vascular System

A

Blood and nutrients to organs

O2 for aerobic metabolism

Collection fo waste products to ecretory organs

Movement and return of immune system components

97
Q

The perfusion of the vascular system depends on…

A

the heart, the main pump

98
Q

if the heart fails what happens to the vascular system

A

the adequacy to supply of the vascular systme fails

99
Q

What are some local and systemic vessel regulators

A

trauma

histamine

muscle metabolites

heat

cold

nervous system

hormones

100
Q

Risk Factors for Vascular Compromise

A

hypercholesterolemia

hyperlipidemia

HTN

obesity

smoking

diabetes

sedentary life

genetics

101
Q

What happens if the flow rate of the vessels decreases?

A

decreased flow = decreased O2 to tissue = causes ischemia and malnutrition

102
Q

How do the arteries change with metabolic needs?

A

Increased need = arterial dilation

Decreased need = arterial constriction

103
Q

What happens when vessel function is impaired?

A

Cells are malnourished

Arterial - no O2 or nutrients

Venous - system clogged with wastes and excess fluid

Chronic function impairment will lead to arterial and/or venous fysfunction

104
Q

Symptoms fo Venous Insufficiency

A

Varicose Veins

Darkened Hard or Leathery Skin

Swelling

Pain and Heaviness

Leg Cramps or Spasms

Restless Leg Syndrome

Itchy Skin

105
Q

What do veins do

A

return deoxygenated blood to the heart

have thinner less muscular walls

flow is controlled by valves - when the valves are incompetent they cannot push or pull blood back up to the central circulation

106
Q

Manifestations of Venous Compromise (Venous Ulcers)

A

“Gaiter Region” - most common area

Skin Brown, Scaly, Hard

Copious Serous Exudate - common

Wound bed tissue range red granulation to fibrinous tissue to necrosis

Commonly have cellulitis

May lead to lymphedema

Increased venous stasis and edema

107
Q

What do Venous Ulcers Look like?

A

Hemosiderin Staining

Brown Colored Skin

Weeping Tissue

108
Q

Interventions for Venous Insufficiency

A

Walking

Combo Exercise and Rest

Elevate legs too/Elevation

Compression/Pressure Stockings

Infection Control and topical Antiinfectives

Debride large non healing wounds

Skin grafting

Improve mobility

Adequate nutrition

COMPRESSION COMPRESSION COMPRESSION!

109
Q

What is the ideal exercise for venous insuffiencies ?

A

Walking - done in a progressive fashion

110
Q

Particularly in arterial disease what should be a guide to activity?

A

Pain - it signals decreased O2

Exercise UNTIL pain

Increases collateral circulation and muscle activity helps move the fluid around

111
Q

What is important in venous sufficiency that you should not do if there is also arterial insufficiency

A

compression

112
Q

Arterial Ulcers

A

Extremely Painful and often infected limb threatening ischemia ulcers

Treatment is difficult and outcomes are unpredictable - because of poor circulation

113
Q

Where are arterial ulcers typically found

A

on or between the toes

on the upper surface of the foot over the metatarsal heads

114
Q

What results in arterial ulcers

A

decreased blood supply

115
Q

Arterial Ulcer Limbs may be …

A

cool to the touch

116
Q

What do arterial ullcers look like?

A

Punched Out Infected Ulcers

Can be necrotic

Usually a defined circular lesion on the feet

117
Q

What is the major symptom of arterial insuffieincy

A

Intermittent Claudication

118
Q

Intermittent Claudication

A

Pain - sharp, stabbing, decreases with rest, and dependent position often occurs at night

Pain in the lower legs from arterial insufficiency

Can be aching with mild cramping along with the pain

More comfortable at rest and dependent position -arterial insufficiency poorly tolerates activity

119
Q

Diagnostics for Arterial Disease

A

doppler studies

angiography

ankle brachial indexes (doppler)

treadmill testing

120
Q

Interventions for Arterial Insufficiency

A

LOWER feet and raise head - because of deficit of blood in extremities

RAISE feet and lower head - to reverse pooling of deoxygenated blood in extremities

Avoid standing still for extended periods of time

Control pain

121
Q

Surgical Management Modalities for Arterial Insufficiencies

A

Vascular Grafting - bypass grafting

Surgical revascularization is required in advanced cases - esp if problem with ulcer healing (Endarterectomy)

122
Q

Why should some arterial insufficiency patients NOT exercise

A

Increases in metabolic demand - stopping exercise to prevent infection in central circulation

If they have increased metabolic demand there can be / worsening of leg ulcers, cellulitis, gangrene, acute thrombotic occlusion or condition

123
Q

Patient Education for Arterial Ulcers

A

Do NOT cross legs

No constriction/compression

Warmth-avoid cold

STOP Nicotine! (jagged marks in arteries causing occlusion)

Nutrition - esp Vitamin B and C

Avoid injury

Good hygiene

Foot care - shoes, inspection

Adequate Fluids

Emotions! - stimulated SNS

124
Q

Deep Vein Thrombosis (DVT)

A

a blood clot (thrombus) forms in one or more of the deep veins in the body

125
Q

Interventions for Prevention of DVTs

A

Hospitalized pts at risk:

TEDS
SCDS
Heparin SC
Lovenox SC
Maintain Mobility
ROM
Isometrics
NSAIDS

126
Q

Treatment for Existing DVT

A

elevate legs

Do NOT cross legs

heat application

anticoagulants - IV heparin (APTT, PTT, INR) and Coumadin (PT and INR)

Thrombolysis with t-Pa

Embolectomy

Insertion of venous filter (prevent movement to the chest)

127
Q

Medications and Substances that cause Vasoconstriction and can worsen DVT

A

Licorice

Nicotine

Caffiene

Chewing Tobacco

Amphetamines

128
Q

Abdominal Aortic Aneurysm (AAA)

A

an enlargement of the aorta, the main blood vessel that delivers blood to the body, at the level of the abdomen

serious medical problem - classified by shape and location

Can rupture and be fatal

129
Q

Cause of AAA

A

atherosclerotic disease

130
Q

Risk Factors for AAA

A

HTN, Smoking, Genetics

131
Q

S/S of AAA

A

HTN

Back pain with AAA

Bruit or thrill

Abdominal Mass

Throbbing or beating feeling in abdomen

132
Q

Diagnostics for AAA

A

CT Scan

Ultrasound

Cardiac Catheterization

133
Q

Treatment for AAA

A

Surgical Repair and Resection - graft or stent

Monitor

134
Q

Self Concept Aspects for Patients with Vascular Disorders

A

fear of the unknown, limb threatening

motivation - why bother - may be tired of condition

tired of a chronic disease

may be fighting addiction - nicotine

financial affects self concept

physical limitations

does the patient buy into the plan, if not why ?

135
Q

Patient Education topics for Vascular Disorders

A

exercise within limits of pain

when to seek medical attention

how to control precipitating factors: DM, Smoking, Sedentary lifestyle, Diet, Stress

*Think about hwo to get them to buy into change

N362: Practice of Nursing III (15 decks)

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