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H & Illness 4: A & C illness > week 4 - altered perfusion interventions > Flashcards

week 4 - altered perfusion interventions Flashcards

1
Q

perfusion blood pressure , what is the formula for it ? and tell me what it means ?

A

blood pressure = co x svr

heart function is V
and R is blood vessels

this is two main things that play

pump and pipe

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2
Q

vascular disease overview :
recognize cues

A

s& s related to decrease blood flow
perfusion affected ( inadequate perfusion , check cap refill )
vital organs ?

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3
Q

what is our priorities ( vascular disease overview )

A

restore blood flow
avoid tissue/organ injury

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4
Q

what would our interventions be ?

A

meds or surgery to improve blood flow and reduce end organ damage

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5
Q

vascular disease overview ( evaluate/educate )

A

reduce disease progression

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6
Q

true or false. There’s actually no ‘normal reading’ when it comes to blood pressure, it just depends on the baseline of the patient ( you have to make your judgement

A

true facts

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7
Q

what is a hypertension? describe it in a way it was always described

A

silent killer ( more symptoms ) seconday symptoms of hypertension on end organs ( when pipes narrow ) getting lack of perfusion because of decrease of blood flow

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8
Q

when recognizing cues utilizing hypertension: what are the symptoms we could recognize

A

often this is asymptomatic ( silent killer )
symptoms with ++ high bp
secondary symptoms related to the effect of vital organs

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9
Q

what are the vital organs affected by htn

A

myocardium
coronary arteries
kidneys
brain
eyes ( retinas )
arterial vessels of lower extremities

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10
Q

true or false. needs good blood flow or else damaged
increase in progression of atherosclerosis
kidneys causes chronic renal failure
brain - doesn’t get enough perfusion - vision especially in the retinas and stroke

A

true

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11
Q

hypertension ( what is the worst case scenario that could happen )?

A

hypertensive crisis

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12
Q

describe hypertensive crisis

A

severe type of hypertension that comes on quickly and considered a med emergency

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13
Q

what is typically the systolic pressure and diastolic of hypertensive crisis

A

> 200 mmhg, diastolic, <150

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14
Q

what age is hypertensive crisis typically seen

A

30-50 year olds

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15
Q

what are the symptoms of hypertensive crisis ( neurological symptoms )

A

severe headache, blurred vision, dizzy, SOB, epitaxis, anxiety

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16
Q

what is epitaxis again?

A

nose bleed

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17
Q

hypertension : what are our inteventions ?

A

monitor :
- blood pressure
-for organ damage
-response to medication

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18
Q

what are the meds management of htn

A

ABCD

ace inhibitors / arbs
beta adnergic blockers
ca channel blockers
diuretics

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19
Q

true or false. the meds can reduce fluid retention as long as we can vasodilate ( diuretics for htn )

A

yes this this is true

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20
Q

inteventions for hypetensive crisis typically what type of care do we offer?

A

critical care ( frequent vital signs )

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21
Q

inteventions for hypetensive crisis typically meds do we give?

A

iv meds: nitroprusside, labetelol ( gradual reduction of bp over 1-2 days )

we have to give antihypetensive into an iv form

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22
Q

what would the position recommended for someone who is having hypertensive crisis

A

semi fowler’s postiion

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23
Q

true or false. oxygen may be required if the pt needs during htn crisis

A

true

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24
Q

what type of complications are we going to look for when it comes to htn crisis

A

monitor for complications ( cns, cvs, renal )

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25
Q

it is important to check neuro status on someone who is having htn crisis.

A

yes check neurological status ( a and o times 2 or 3 ) see their baseline

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26
Q

why do we put the pt on semi fowler’s position when they are having htn crisis

A

dont want alot of venous return already has too much int his case

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27
Q

are these true or false when it comes to someone who is having htn crisis:
check extremities
peripheral pulses
if they have foley catheter - need to know if producing urine or decrease urine they are producing ( maybe not getting adequate perfusion

A

yes this is true

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28
Q

hypertension
disease management relies on lifestyle modification

A

exercise
healthy diet ( low salt, low lipids )
manage stress
adequate sleep

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29
Q

true or false. it is very important to for lifestyle modification when it comes to htn. So smoking cessation and moderate alcohol intake is something to consider to modify.

A

yes this is true

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30
Q

coronary artery disease ( recognize ) : what are the symptoms

A

chest pain ( that may radiate )
n & v
diaphoresis
dyspnea
anxiety/fatigue

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31
Q

what are the symptoms that often indicates disease progression

A

nausea and vomiting
diaphoresis
dyspnea
anxiety/fatigue

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32
Q

define if these locations is where pain radiates to when it comes to coronary artery disease :
midsternal
left shoulder and down both arms
neck and arms
substernal radiating to neck and jaw
substernal radiating down left arm

A

yes these are true

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33
Q

is epigastric, epigastric radiating to neck jaw and arms along with intrascapular location that pain can radiato to when it comes to coronary artery disease ?

A

yes this is true

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34
Q

what happens when it gets too narrow or sudden obstruction ?

A

clot causes sudden obstruction - pt starts to develop symptoms

we have stable angina and unstable angina

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35
Q

what are the chest pain for coronary artery

A

different for each pt
is this your normal heart pain ?

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36
Q

coronary artery disease
diagnose testing

A

ecg
cardiac enzymes ( troponin )
coronary angiogram

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37
Q

what can an ecg detect ?

A

lack of blood flow - there is change in st, sometimes it’s elevated, sometimes its depression or t wave

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38
Q

what does cardiac enzymes troponin

A

support the idea heart is getting damaged ( lack of blood flow )

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39
Q

true or false. need to monitor something ? a patient getting a dye every time they take a picture ( presses a pedal and light go out and that means fluoroscopy is on ) radiation is coming and lighting up blood vessels and heart

A

true

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40
Q

do you drink or eat anything after the angioram ?

A

no, do no t drink or eat anything in the midnight after the angio

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41
Q

how long is an angiogram ?

A

20-30 mins ( stent is alot longer )

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42
Q

what is the angioplasty

A

angioplasty is a way to open up a blocked or blockage of the heart

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43
Q

are these true when it comes to angiogram : risk for bledding ( monitor afterwards ) through the wrist or through the groin
infection
monitor vital signs
blood loss is not always noticable ( could be internal )

A

yes this is true

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44
Q

coronary artery disease
what can go wrong ?

A

acute coronary syndrome

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45
Q

recall that acute coronary syndrome is what could go wrong with coronary artery disease: define what this is

A

acute coronary syndrome is an obstruction of blood flow to myocardium leading to symptoms of ischemia

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46
Q

continuum from stable angina –> can lead to what

A

ACS

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47
Q

ACS: could lead into what ?

A

unstable angina, nstemi, stemi

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48
Q

it is producing a lot of symptoms
unstable - 15 to 20 minutes the pain stops
stemi - there is an occlusion ( can progress to occlusion, changes in the blood work, rise in the troponin , we do not have blood flow to some part of the heat )

A

these are all true

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49
Q

coronary artery disease
interventions for pt with stable CAD

A

monitor vital signs
administer medication
education on lifestyle changes

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50
Q

they do not have optimal vessels in the heart , one thing you are going to look for :

A

did they have a stent or stent put in

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51
Q

true or false. once nitro is in ( this is going to drop the blood pressure ) if it’s already low ( worst perfusion outcome )

A

true

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52
Q

if the pt is on viagra - what do you not take

A

do not take nitro, vasodilate ( they compound each other ) can cause hypotension

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53
Q

coronary artery disease
interventions for ACS

A

oxygen administration
ecg/cardiac monitoring ( telemetry )
pain assessment & management
frequent vital signs

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54
Q

IV access and meds ( nitro, asa, clopidogrel ) is utilized using coronary artery disease

A

yes this is true

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55
Q

oxygen administration ( < 92 % sats )

A

ensure we have ecg done ( why do you think its important ) it will help triage if its stemi or nstemi

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56
Q

ecg/cardiac monitoring ( telemetry )

A

goes to straight Cath lab ( should be directly there, blocked artery )

if they are tPA ( we have open up blockage ) more we wait we are losing

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57
Q

the heart is demanding more what is needed for supply

A

due to narrowing or complete occlusion

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58
Q

if we needed to supplement oxygen ( we need it to do it immediately, probe on and ensuring their oxygen is above 92%) true or false.

A

true

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59
Q

what helps breakdown platelets, platelets are usually what’s causing the problem

A

ASA

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60
Q

clopdogrel

A

anti platelet drug
with a stemi - usually get a big clavix

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61
Q

if you put a stent there is a what ?

A

big risk of clotting ( so these drugs are good )

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62
Q

insulin, lasix, iv, nitro, have a very big effect quickly ) so this is not the kind of pt u leave for an hour, staying with them is crucial and say in a few mins and how are they feeling

A

medication, fluid ( be careful with a heart not beating well ) –> MI is a cause of going into the HF

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63
Q

open blocked artery :

A

TPA ( far from the hospital )
angioplasty
CABG ( open heart sx )

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64
Q

CABG ( open heart sx )

A

coronary artery by pass grafting

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65
Q

what has to be done before the nitro spray

A

frequent vital signs

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66
Q

coronary disease interventions post angioplasty: what should we monitor for?

A

bleeding from insertion site
acute closure of vessel ( CP, increase ST )
contrast dye reaction
vital signs ( decrease BP, dysrhythmias )

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67
Q

true or false. some people react to the dye
anaphylactic or allergic reaction can occur (allergic to shellfish or dye )

A

true

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68
Q

trans radi band ( cut into the skin and out catheter into the hole )
when we cut arteries under high pressure ( high risk of bleeeding ) and we have to make sure it stops bleeding

** just read *

A
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69
Q

true or false. theres a risk of bleeding ( stent is ocluded )
looks like a symptom they came in with ( chest pain, ekg will show last two segments will go back up

A

true

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70
Q

what happens when heart is irritated ?

A

stretched a bit of the heart, coronary artery is kind of opened up. coronary artery is tissues (starts to die ) oxygen starts circulating

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71
Q

coronary artery disease
What type of care are we typically going to give ?

A

we are going to give ICU initial care

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72
Q

coronary artery disease: re call that we are going to give ICU initial care : initially what are the steps we going to give ?

A

intubated, large chest tubes, pacemaker wires

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73
Q

coronary artery disease
what are we watching out for ?

A

watch for dysrhythmias, fluid and electrolyte imbalance, hypo/hypertension, hypothermia, bleeding, decreased LOC, anginal pain

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74
Q

true or false. brain and kidneys needs to be perfused.

A

this is true

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75
Q

what will chest pain indicate?

A

in a cabagge, this will indicate a complication or clot within the graft scheduled etc

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76
Q

what is a complication of any type of heart surgery ?

A

cardiac tamponade

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77
Q

true or false. coronary artery disease: these pts ned to have bypass surgery

A

true

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78
Q

true or false. not comfortable yet they have sternum thats unstable so thus is important to check when it comes to complication

A

true

79
Q

coronary artery disease: interventions for pts on the cardiac surgery ward

A

db + c
supervised ambulation
monitor for complications
discharge teaching
cardiac rehab referral

80
Q

DB + C why do we this for coronary artery disease

A

want to avoid atelactasis

81
Q

what type of complications are we going to avoid

A

DVTs
we want to use anticoagulants complication related to the surgery ( occlusion of the graft )

82
Q

true or false. infection, decrease cardiac output after surgery, they need blood transfusion

A

true

83
Q

true or false. coronary artery disease could go into a HF kinda thing ( listen for crackles, chest, confirm with p )

A

true, if bp is abnormal hearing crackles might do further investigations

84
Q

what are the potential complications that could occur : coronary artery disease

A

decrease in CO
pain
dysrhythmia
decrease 02 sats
infection
surgical/donor site
neuro status

85
Q

what is the treatment for pain

A

opoids, morphine, fentanyl route IV not tylenol in the moment

86
Q

what is the treatment plan for dysrthmias

A

cardiac monitoring
antiarhythic drugs ( alodarone )
check k levels

87
Q

decresase 02 sats treatment

A

give them oxygen

88
Q

what is the treatment for infection

A

infection site , take from safinus vein atornal mamory

89
Q

what could potentially cause infection?

A

chest tube insertion ( pc wires ) foreign object in the pts body

90
Q

coronary artery disease : what can go wrong with this

A

cardiogenic shock

91
Q

what is cardiogenic shock ?

A

alot of them dont do well, heart fails the other one fails as well

everything is going down ( not able to supply to the body )

92
Q

what is the definition of cardiogenic shock ?

A

sudden severe LV failure causing inadequate oxygen and nutrients supply to tissues ( end organ failure )

93
Q

what most often occurs with MI

A

cardiogenic shock

94
Q

what is our goal for cardiogenic shock ?

A

goal is to restore perfusion

95
Q

coronary artery disease : what is needed ?

A

cardiac catherization ( PCI ) with stent performed ASAP after CP

96
Q

it is important to stbailize pt until angio coronary:

A

yes this is true

97
Q

are there drugs, to make blood vessels tight to get bp up

pump more strongly or put pt on life support ( breathing tube keep them to breathe )

A

true

98
Q

exemplar #3 : peripheral vascular disease : recognize cues : what is peripheral arterial disease

A

a chronic condition in which partial or total arterial occlusion decreases perfusion to extremities

99
Q

what is the four stages of PAD

A

1) asymptomatic
2) claudification
3) rest pain
4) necrosis/gangrene

100
Q

what is caused by a lack of blood flow

A

peripheral arterial disease ( claudification )

101
Q

recognize cues : PAD : what are the symptoms

A

weak peripheral pulses, hairloss ( lower leg– > foot ) , skin thin/shiny/taut, cool, thick toenails, pale with elevation and dependent rubor, muscle atrophy

102
Q

true or false. skin needs continuous perfusion

A

yes this si true

103
Q

hair on toes what does it mean ?

A

perfusion
peripheral arterial disease in hairless at the bottom

104
Q

peripheral arterial disease: ankle brachial index ( ABI )

what is it

A

a PAD screening tool
measured using doppler

105
Q

ankle pressure divided by branchial pressure (.9 or less indicates PAD ) : ankle brachial index

A

this is true

106
Q

peripheral artery disease
what is our priority : arterial ulcers

ulcer location and appearance

A

end/between of the toes
minimal drainage
ulcer bed pale, round edges
little granulation tissue

107
Q

peripheral artery disease: sudden peripheral artery occlusion

A

often from MI or AFib

108
Q

what is the 6 P’s ischemia

A

pain
pallor
pulselessness
paresthesia
paralysis
poikolothermy ( coolness )

109
Q

peripheral artery disease
take action : interventions for stable PAD

A

risk factor modification
drug therapy : antiplatelets ( * no grapefruit when taking plavix )

110
Q

peripheral artery disease: what is the drug

A

pentoxifylliine ( trental ) for claudification ( increase blood flow )

111
Q

peripheral artery disease: exercise therapy and positioning

A

walking to increase collateral circulation

walk until discomfort, rest, resume

position with limbs below heart

112
Q

what happens when u have pain when u have PAD

A

if pain at night dangle from bed

113
Q

how do we promote vasodilation for peripheral artery disease

A

keep feet warm ( socks, insulated shoes )

114
Q

risk for developing clots on we put them into antiplatelets, aspirin, and plavix, is this true

A

yea this is true

115
Q

decreases clauficaition ( proven to be effective )
pts improving blood flow to their legs ( we want them to walk more )

A

yes this is true

116
Q

peripheral artery disease
no surgical interventions to increase blood flow

what are the two ways

A

balloon angioplasty with stent insertion

atherectomy

117
Q

peripheral artery disease

A

catheter inserted via femoral artery
balloon inflated to open artery
stent deployed to keep artery open

118
Q

what is atherectomy

A

catheter inserted into femoral artery
rotational tip attached to end of catheter
breaks up plaque by rotation

119
Q

peripheral artery disease: what should we monitor , what is this related to?

bonus : little layer they ffed to the coronary artery, clears out plaque causing out obstruction

A

( sudden occlusion, sudden chest pain, st elevation, sudden lack of blood flow ) make sure the vessels ( lose pulse )

all related to the ballon angio with stent
refer to rerur ruter

120
Q

peripheral artery disease
surgical intervention to increase blood flow

fem - pop bypass graft around an occluded femoral artery
what is the post op care

A

√ VS, Pain, N&V, DB&C, signs of infection
√ operative extremity for CWCM, pain
√ for bleeding, hematoma, compartment syndrome, thrombosis, embolization (***call MD)

121
Q

are these considered as post op care for pad?

√ Avoid long hours of sitting with legs dependent
√ ambulation as soon as possible

A

true

122
Q

what is compartment syndrome ?

A

swelling- impedes perfusion ( swelling or bleeding

123
Q

what is hematoma ( bleeding under the skin–> press the area ): is this a true statement

A

yes this is true

124
Q

peripheral artery disease
take action : interventions for unstable patient

A

not want them to walk, can move into the lungs or even the heart

125
Q

peripheral artery disease
take action : interventions for unstable patient

A

early treatment essential
- keep client at rest
- call physician immediately

126
Q

peripheral artery disease
take action : interventions for unstable patient

recall that: early treatment essential
- keep client at rest
- call physician immediately

what else ?

A

Anticoagulant therapy
- heparin/warfarin- to prevent thrombus enlargement ( they can deliver like thrombus like therapy )

127
Q

Remove/Dissolve Clot for peripheral artery disease

A

percutaneous thrombolytic therapy
- catheter threaded through the femoral artery

128
Q

TPA ( thrombolytic drug ) infused to site of embolus
urgent surgery to remove clot

is this true in terms to remove/dissolve clot for pad

A

yes this is true

129
Q

peripheral artery disease
evaluate and educate
what do we do ?

A

inspect feet/legs daily
stop smoking, eat healthy, exercise

130
Q

peripheral artery disease
how do we protect from trauma ?

A

protective roomy footwear
clean cotton socks
avoid heat and cold

131
Q

avoid pressure
avoid leg crossing is a way to protect from trauma when we are talking abt pad

A

this is true

132
Q

peripheral venous disease
recognize cues : to function properly veins must be patent with competent valves

3 health problems alter blood flow in veins :

A
  1. thrombus formation ( venous thrombus ) which can lead to PE
  2. defective valves lead to venous insufficiency and varocise veins ( potential for ulcers )
  3. skeletal muscles do not contract to help pump blood to veins ( peripheral edema )
133
Q

true or false. change position frequently, monitor/control infection : keep feet clean, use lotion but not between toes
cover ulcers with sterile drsg

A

true

134
Q

alot of people in bed - peripheral edema they do not have muscle contraction that increases venous return

A

true

135
Q

peripheral venous disease
analyze cues
what is venous duplex used for ?

A

assess blood flow

136
Q

what is the d-dimer blood test used for in peripheral venous disease?

A

marker of coagulation and fibrin breakdown

137
Q

what is the d-dimer blood test used for in peripheral venous disease?

recall that it is the : marker of coagulation and fibrin breakdown

what else ?

A

measures protein fragments that release when a blood clot dissolves

138
Q

peripheral venous disease: identify priorities : deep vein thrombosis

thrombus formation is associated with :

A

stasis of blood flow
endothelial injury
hypercoagulability

139
Q

risk factors of peripheral venous disease

A

prolonged sitting ( airplanes )
bedrest ( hospitalization, surgery )

140
Q

what might you see ? in deep vein thrombosis

A

unilateral leg edema
pain, sense of fullness
hot to touch
systemic temp
postive homen’s

141
Q

true or false. the risk is bigger hypercoaguability any prolong sitting or laying touch it might be warm

A

true

142
Q

peripheral venous disease : venous ulcers
what is the cause?

A

damaged valves in the veins resulting in retrograde blood flow

pooling of blood in the legs and swelling

hydrostatic pressure causes release of fluid into the skin causing irritation

143
Q

associted with swelling ( lack of oxygen flow down to the legs ) adequate circulatoion but not returning the blood to the heart
pooling edema and pain ( there is tissue damage as well as swelling )

hyperpigmenetation - accmulation of molacites

jsut read it: peripheral venous disease

A

yesss

144
Q

peripheral venous disease : what might you assess?

A

dull pain, peripheral edema, skin hyperpigmentation

ulcer : irregular boarders with lots of drainage

145
Q

peripheral venous disease: take action
intervention for stable patient :

anticoagulation therapy

A

unfractionated heparin ( UF ) or low molecular weight heparin ( LMWH )

warfarin

give both drugs for abt 5 days then d/c heparin once coumadin is at a therapeutic level

146
Q

peripheral venous disease: blood coagulation tests why are these taken ?

A

taken frequently to assess therapeutic levels ( aPTT or INR)

147
Q

DOAC ( rivaroxaban, apixaban )
what is the description for peripheral venous disease

A

latest development in anticoagulation
efficacy is similar to warfarin therapeutic index so frequent blood tests not required

148
Q

what is very effective in preventing clots ( becasue it has wide therapeuthic index its better than warfarin )

A

true

149
Q

peripheral venous disease : thrombolytic therapy ( for extensive DVT )

A

using catheter directed approach
TPA directly through a catheter that threads through the femoral vein to the the clot

150
Q

inferior vene cava filtration

A

to prevent complication of pe
if the clot got dislodge and travel up this will stop from reaching the lungs

150
Q

peripheral venous disease : thrombectomy

A

surgery to remove the clot

151
Q

peripheral venous disease: inferior vena cava filtration

A

filtration device inserted into femoral vein or superior vena cava to prevent clots from travelling to lungs

152
Q

peripheral venous disease
take action
what is our goal ?

A

decrease edema and promote venous return

153
Q

peripheral venous disease : decrease edema and promote venous return

A

compression beandages
balanced diet ( vitamins a, c protein, zinc )

154
Q

proper skin care/non scented moisturizers
prevent infection and daily walking program these are all true in terms of peripheral venous disease

A

true

155
Q

avoid standing or sitting for too long, elevate legs to reduce swelling in terms of peripheral venous disease

A

true

156
Q

how is compression bandages helpful ?

A

this is very helpful ( arterial prophelb -

157
Q

muslce squeeze helps venous return to the heart - less edema the more they walk
if they stand or sit ( they have worsenging swelling,

A

true

158
Q

peripheral venous disease
discharge teaching for anticoagulant therapy

A

contact ems for bleeding that doesnt stop ( 10-15 mins )

take med at same time everyday

report tarry stools severe headache or stomach pain, confusion or dizziness or bruising more than usual.

159
Q

avoid contact sports/use soft bristle toothbrush - wear medic alert bracelet ( indicating what you are taking )

is this true amongst discharge teaching for anticoagulant therapy

A

yes this is true

160
Q

inform all HCP providers of anticoagulant therapy ( dentist and do not take nsaids or asa is this true amongst peripheral venous disease ( discharge teaching for anticoagulant theraphy)

A

this is true

161
Q

exemplar #3 is what ?
aortic aneurysm : what is it

A

outpounching or dilation of the arterial wall usually caused by atherosclerosis

162
Q

aortic aneurysm : recognize cues
abdominal aortic aneurysm

what are the charactersitics

A

pulsatile mass in periumbilical area left of the midline

audible bruits

pain to back, epigastric discomfort

163
Q

what is it thoracic aneurysm?

A

diffuse chest pain extending to intrascapular area

often asymptomatic

164
Q

if the aortic is a little more upper what is the pain?

A

neck pain, dysphagia could occur

165
Q

what is aortic ( in aortic aneurysm )

A

largest artery in your body

splits around the kidney area

166
Q

what is the aortic aneurysm common ?

A

most common is the abdominal aortic aneurysm

167
Q

on exam when palpating there is a forsatile mask area peri umbilical just above the belly button, if there is a stethoscope aneurysm ( bruising - swishing sound )

A

true

168
Q

aortic aneurysm : analyze cues

A

diagnostic imaging
ct scan or ultrasound to assess size and location of aneurysm

169
Q

aortic aneurysm prioritization : what is aortic aneurysm

A

potential complication is rupture of aortic aneurysm

170
Q

aortic aneurysm prioritization : what is aortic aneurysm : anterior ?& posterior

A

anterior - bleeds fast into abdominal cavity and has poor prognosis

posterior - bleeds into retroperitoneal space and is tamponaded by surronding organs ( better chance to survive )

171
Q

what is this describing : bleeds into retroperitoneal space and is tamponaded by surronding organs ( better chance to survive )

A

posterior aortic aneurysm

172
Q

what is this describing : bleeds fast into abdominal cavity and has poor prognosis

A

anterior aortic aneurysm

173
Q

what does anterior and posterior aortic aneurysm

A

both require immediate action resuscitation and surgery

174
Q

aortic aneurysm : take actions : interventions

non surgical management ( for small, asymptomatic )

A

monitor growth ( frequent U/S or CT scans )

maintain BP in normal limits

antihypertensive therpahy if necessary

175
Q

aortic aneurysm : control the blood pressure
if there is high ( pressure against the wall ) lower the pressure we can decrease the amount of stress we have on arterial wall
angi hypertensive can be order if its elevate ( if not watch and see what type of approach we needa do )

A

true.

176
Q

aortic aneurysm : take actions : interventions : open surgical repair name the characteristics

A

large abd incision
synthetic graft inserted and native wall closed around graft

177
Q

when must open surgical repair be done during aortic aneurysm ?

A

must be done in 35-40 minutes so clamps can be removed and organs can be perfused before they are damaged

178
Q

true or false. aortic aneurysm take actions : will go to icu post ip for 24-48 hours hrs ( intense monitoring required

A

this is true

179
Q

aortic aneurysm : take actions : interventions

what is endovascular graft procedure EVAR

A

minimally invasive
stents are deployed via femoral artery catheter

180
Q

post procedure care of aortic aneurysm :

A

care of groin site(s) post angiogram

bed rest and keep affected leg straight for 4-6 hrs

monitor peripheral pulses and groin site

monitor for ischemic complications ( emboli )

181
Q

aortic aneurysm : is done through what ?

A

cath ( endovascular procedure )

from the inside we need to protect

182
Q

aortic aneurysm : evaluate and educate

after endovascular repair educate patients on :

A

restricted activity level ( may include )

no stairs
no heavy lifting
no driving

may continue to need frequent ultrasounds

182
Q

true or false. it is important to watch for sign of bleeding
look at pulses and lobe and procedure site
whatever we out in stent for anywhere, clot could develop

A

true

183
Q

aortic dissection : recognize cues
tearing of the inner layer of the arota. blood surges through the tear causing the layers of the vessel to seprate this is considered as what ?

A

life threatening

184
Q

what might u assess in arotic dissection ?

A

sudden severe onset of excruciating chest pain back pain jaw teeth - sharp ripping tearing pain that moves from point of origin
* symptoms of decreased cardiac output.

185
Q

what is the description for : Aortic Arch Dissection

A

decreased LOC, dizziness, weak carotid and temporal pulses
surgical emergency

186
Q

Descending Aorta Dissection

A
  • Pain to back abdomen and legs decreased tissue perfusion to abdominal organs to lower extremities
187
Q

is this true : the tear in inner layer of aorta bleeding actually occurs within the blood vessels
there is different laters - inner wall has rip and it accumulates in the inner wall

A

yes this is true amongst aortic dissection

188
Q

usually excruitating pain, hypotensive and tatchy as blood moves from blood vessels into the blood vessels wall ( not intended for perfusion not reaching the area _)

A

yes this is true

189
Q

Aortic Dissection
Take Action
what is our goal ?

A

goal is to prevent rupture and progression of dissection

190
Q
  • Treatment depends on size and severity of symptoms
  • Proximal dissections usually require surgery (synthetic graft)

Pre-Op Nursing

  • Bedrest, quiet environment*
    BP medication IV* (titrate frequently)
  • Pain medication (opioids)
  • Foley catheter inserted
  • Observe for changes in p.p., ↑pain, restless, anxiety

is this true amongst aortic dissection
yes this is true

A

true

191
Q

bed rest until area has calm down and try to control the blod pressure this is all we can do
to limit pressure inside the dissection
pain 0 anticipate u have to treat it with opoids sudden drop in co we hav tot hink abt urine ( if kidney is geting perfused )
thinkn ab peripherl cirucaltion is beign affected ? all chang in those 3 ps ( there interruption )

A

yes

H & Illness 4: A & C illness (21 decks)

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