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3512 > week 4 Cardiac part 2 > Flashcards

week 4 Cardiac part 2 Flashcards

learn CAD and VI, aneurism, endocarditis and pericarditis, etc

1
Q

is echocardiogram an invasive procedure?

A

no, its like an ultrasound, unless its a transesophageal echo

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2
Q

what test would detect pressure changes in cardiac chambers and quantify the size of valve openings?

A

cardiac catheterization (scope)

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3
Q

what is an angiography?

A

when a catheter is inserted through the femoral artery to look at peripheral arteries

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4
Q

what can a doppler ultrasound assess in cardiac disease?

A

the flow of blood through an area like a peripheral artery

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5
Q

what is an MRA? what is it used for?

A

magnetic imaging angiogram
allows us to see same thing as an angiogram but without catheterization - just imaging

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6
Q

what is a non-invasive cardiac test for measuring peripheral arterial perfusion?

A

segmental blood pressures

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7
Q

who is susceptible to endocarditis?

A

anyone with previously damaged valves and who has bacteria (or virus/fungi) in the bloodstream

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8
Q

what are four ports of entry for infecting organisms that cause endocarditis?

A

oral cavity (via dental procedures)
skin lesions, rashes, or absesses
infections (cutaneous, GI/GU)
surgery or invasive prodecures (IVs, etc)

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9
Q

3 predisposing conditions for infective endocarditis?

A
  • previous endocarditis
  • iv drug use (street drugs or hospital aquired bacteremia)
  • rheumatic heart disease
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10
Q

what symptoms would clue me in that my patient has infective endocarditis?

A

In addition to typical infection things (fever, malaise, chills, anorexia), back pain, headache, weight loss, myalgia and heart murmurs

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11
Q

what compication of infective endo am monitoring for?

A

organ embolization or vascular embolization of vegetations

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12
Q

pt with infective endo has decreased LOC - what am i worried about? what if it was sudden SOB and chest pain?

A

embolism of vegetations in brain, or lung

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13
Q

pt with infective endo has little blisters that have appeared on their hands, and tiny red lines down their fingernails on that hand. what am i suspecting?

A

vascular embolism

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14
Q

what lab tests would be ordered to diagnose/treat infective endocarditis?

A

blood cultures and CBC

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15
Q

which other dx test is used for infective endo?

A

echo

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16
Q

four things to treat/monitor with infective endo

A
  • determine and treat cause
  • monitor and treat fever
  • IV meds (usually via picc)
  • monitor for S&S of decreased perfusions to organs/complications of embolism
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17
Q

4 things to teach pt about inf. endo

A

-prophylactic antibiotics before dentist/surgery
-good oral hygeine
- avoid other w/ infection
- valve replacememt may be necessary

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18
Q

what could be the consequences of local valve damage d/t endocarditis (name 3)

A
  • sepsis
  • heart failure
  • heart block
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19
Q

what is the HALLMARK sign of acute pericarditis?

A

pericardial friction rub

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20
Q

what can cause pericarditis?

A

bacteria, virus, autoimmune disease, radiation, MI or can be idiopathic

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21
Q

pt has sharp chest pain that increases with respiration and is relieved when they sit forward. what could this be?

A

acute pericarditis

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22
Q

what two potential complications are connected with pericarditis?

A
  1. pericardial effusion (increased fluid between visceral and fibrous layers which decreases function of surrounding dissues like laryngeal nerve)
  2. cardiac tamponade
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23
Q

name 5 interventions for acute pericarditis

A
  1. correct underlying problem
  2. high dose anti-inflammatories
  3. bedrest with HOB elevated
  4. manage pain and anxiety
  5. pericardiocentesis if cardiac tamponade
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24
Q

what should i monitor for if pt is on high dose antiinflammatories?

A

gi bleeds

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25
Q

what are some specific symptoms of rheumatic endocarditis?

A

friction rub and murmor, pain in chest, ECG changes, tachycardia, BIG ONE: evidence of strep infection (enlarged lymph noes, sore throat, fever)

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26
Q

patho: what is rheumatic pericarditis characterised by the formation of?

A

aschoff bodies

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27
Q

what should I teach someone who is recovering from rheumatic carditis?

A

that they are at risk for reinfection for the rest of their life, and that they will require prophylactic antibiotics before any invasive or dental procedures

28
Q

are rheumatic carditis symptoms more like endocarditis or pericarditis?

A

it’s like both -similar to endocarditis- it affects the valves
it also causes thickened pericardium and pleural effusion can develop

29
Q

when valve opening is narrowed and blood is restricted from moving forward

A

stenosis

30
Q

when valve fails to close properly - results in blood backflow

A

regurgitation

31
Q

valve disorders occur more frequently on the ______ side of the heart

A

left

32
Q

what will I likely hear on auscultation with a valve disease?

A

murmor

33
Q

explain what happens in mitraAl stenosis in terms of blood flow, compensation, and symptoms
(might help to draw a picture)

A
  • blood backs up in L atrium and lungs.
    -the atrium is not cool with this so it pumps harder, leading to atrial hypertrophy.
    -Failure to compensate results in pulmonary congestion.
    -eventually this congestion can cause blood backup all the way to R ventricle –> right sided heart failure
  • symptoms: SOB, exertional dypnea, hemoptosis
34
Q

what happens in mitral regurg? -talk about blood flow, compensation, results, symptoms

A

-decreased ventricular filling resulting in ventricular hypertrophy
- both ventrical and atrium work harder to preserve CO resulting in dilation
- can cause shock and dyspnea
- bloood can back up to R side of heart therefore symptoms of right sided heart failure can occur

35
Q

what can mitral valve prolapse cause? are there associated symptoms?

A

regurgitation. usually asymptomatic but palpitations, chest pain, etc can occur

36
Q

classic symptoms of aortic stenosis

A

syncope, angina, exertional dyspnea

37
Q

when is surgery indicated for aortic stenosis?

A

when valve is < 1cm

38
Q

why would we be cautious with giving nitro in aortic stenosis

A

because we need to maintain preload to force valve open

39
Q

this condition causes left ventricle hypertrophy and eventual ineffective pump. symptoms are minimal for years but eventually low cardiac output causes hypotension, profound dyspnea and angina

A

aortic regurgitation (incomplete valve closure with blood backup into l ventricle)

40
Q

what would I want to know about my patient with valvular heart disease? (name 3 assessments)

A

1.health hx (family hx, previous rheumatic fever or endocarditis, hx of iv drug use)
2. resp assessment for pulmonary congestion
3. CVS assessment (signs of decreased cardiac output, edema)

41
Q

which four Dx tests are used for valvualr heart disease

A
  1. echo to show structure/mvt of heart
  2. exercise tolerance test
  3. chest x-ray (atrial and ventricular enlargement)
  4. EKG
42
Q

what are the non-surgical management techniques for VHD? (4)

A

-rest,
-treating any a-fib with anticoagulents, antidysrhythmias, cardioversion.
- preventing PE, embolism, and endocarditis
- treat HF with drugs

43
Q

what two ways can valve repair or replacement be done?

A

open surgery or percutaneously (like a transcatheter aortic valve replacement)

44
Q

how long does a mechanical valve last and what consideration does the patient need to know?

A

up to 20 years, requires lifelong anticoagulant and monitoring INR

45
Q

describe the drawbacks of biologic valve replacement

A

less durable than mechanical d/t risk of calcification. failure rate is highest before the 7-10 yr mark

46
Q

Teaching plan for valvular disease:
1. Develop an _________ plan to increase cardiac tolerance.
2. monitor for _______ _______ ______
3. restrict ______, avoid _______
4. administer ______ as ordered
5. _________ ________ before all invasive surgical or Dx procedures or dentist
6. stop _______
7. if mechanical valve, __________ for ______!

A
  1. exercise
  2. increased fluid volume
  3. salt, caffeine
  4. O2
  5. prophylactic antibiotics
  6. smoking
  7. anticoagulants, life
47
Q

what emergency am I monitoring for in valvular heart disease? what are two important assessment findings of this?

A

cardiogenic shock.
1. dusky skin color
2. narrow pulse pressure

48
Q

my patient is in cardiogenic shock. what should I NOT automatically do?

A

replace fluids (like i would in hypovolemic shock)

49
Q

what is claudication in relationship to PAD?

A

muscle pain, cramping when exercising, relieved with rest (like stable angina for the legs)

50
Q

what is the fourth stage of the PAD progression?

A

necrosis./gangrene

51
Q

what should my first action be if I discover a new arterial ulcer on pt’s foot?

A

check pulses

52
Q

what is pentoxifylline, what does it treat?

A

a drug that increases flexibility of RBCs, it treats PAD

53
Q

if my patient just had a aortioliac bypass, what will I expect in terms of wound care?

A

a midline incision in abdominal cavity, as well as an incision in each groin

54
Q

describe the incision(s) for femoropopliteal or femorotibial bypass

A

one long incision down the leg or possibly on both legs if graft was taken from non-diseased leg

55
Q

what will i assess in patient after bypass surgery for PAD?

A

operative extremity for color, cap refill, temp, pulses, sensation, mvt, pain

56
Q

after PAD bypass surgery, encourage ______ as soon as possible

A

ambulation

57
Q

what are 4 things i would teach a post fem- pop bypass pt on discharge about protecting foot from trauma?

A

wear roomy protective footwear
clean cotton socks
avoid leg crossing
avoid extreme temps

58
Q

what is one way a patient with PAD can monitor/control infection?

A

keep feet clean and well lubricated (hydrated)

59
Q

why is it so important to act quickly when i notice signs of acute arterial ischemia?

A

gangrene can occur in a couple of hours (just like an MI)

59
Q

what is the main complication r/t PAD?

A

acute arterial ischemia

59
Q

what are the five Ps when monitoring for acute arterial ischemia?

A

pain, pulse, pallor, paresthesia, paralysis

59
Q

what prophylactic procedure may be done for someone with frequent DVTs?

A

an inferior vena cava filter placement

59
Q

patient says their leg feels “full” and i notice the same leg feels hot to touch proximally, but cool distally. what might it be?

A

DVT

59
Q

what unique treatment is used for DVT using a catheter?

A

catheter directed to site and releases TPA

59
Q

my patient is being discharged after a DVT was treated. what will I make sure to teach them (aside from signs of bleeding)? name 2

A

no NSAIDS, alert all healthcare provider including dentist that you are on anticoagulent therapy

59
Q

is brown, leathery skin a sign of PAD or CVI?

A

CVI

59
Q

true or false: for venous ulcers, it is best to put dry, absorbent dressings on them to absorb all the excess fluid

A

false - though the wounds are weepy, it can be best to put damp dressings to prevent sticking and trauma with removal

3512 (15 decks)

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