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Module 3 > CVPV Exam > Flashcards

CVPV Exam Flashcards

1
Q

what are the risk factors for Hypertension

A 
family history
increasing age
cigarette smoking
obesity
heavy alcohol consumption
Black race
Men (early to mid adulthood)
women (over 50s)
high dietary sodium intake
low dietary intake of K, Ca, Mg
glucose intolerance
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2
Q

what doe the AHA recommend for alcohol

A

2 drinks a day for men

1 drink a day for women

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3
Q

what is considered moderate alcohol consumption a week

A

2-3 drinks per weekw

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4
Q

what is known as the silent killer

A

hypertension

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5
Q

why is hypertension known as the silent killer

A

early stages of disease have no clinical manifestations other than elevated blood pressure readings

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6
Q

what are S/S of hypertension

A 
asymptomatic
HA
visual disturbances
chest pain
flushed face
epistaxis
diziness
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7
Q

what are the two major mechanisms of tissue damage

A

ischemia and edema

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8
Q

how does hypertension cause edema

A

vessels get torn up and fluids start to seep outside the vessel

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9
Q

what begins to get complicated with HTN

A

heart and kidneys

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10
Q

kidneys are _____ structures and the _____ pressure will tear the kidneys apart

A

small; high

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11
Q

a hypertensive heart thickens the walls of the…

A

ventricles

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12
Q

HTN can cause

A

stroke
arteriosclerosis
heart attack
kidney failure

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13
Q

hypertension could be caused by taking meds that cause it or could be because they have

A

kidney disease that cause high BP

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14
Q

an irregular heart beat is not picked up on bp machine so what should you do

A

manually auscultate BP

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15
Q

what is white coat syndrome

A

BP increases when pt goes to the doctors office… take BP at home and log it

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16
Q

what lab test shows us kidney function

A

urine test, BUN and creatinine

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17
Q

what labs predisposes pt to hypertension

A

K, Ca, Mg

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18
Q

what are the treatment goals of hypertension

A

focus on systolic
<140/90 mmHg
preexisting conditons (diabetes, renal disease, heart disease)

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19
Q

how do you find pulse pressure

A

subtracting diastolic from systolic

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20
Q

what are 4 treatment options for hypertension

A

lifestyle modifications
Dash Diet
Exercise
Moderate alcohol consumption

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21
Q

what consists of the dash diet

A

desirable to soncume no more than 1500mg of sodium daily, eliminate soups, ready made dinners, processed meats, no added salt

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22
Q

what is always important in the success of treatment

A

pt compliance

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23
Q

once a pt receives a dx of hypertension they should be evaluated every _____ until their goal is reached, then about every ____ months

A

month; 3-6 months

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24
Q

what are S/S of orthostatic hypotension

A

Dizziness
blurring or loss of vision
syncope and fainting

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25
Q

orthostatic hypertension is very common after a _____ in _____ adults

A

meal; older

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26
Q

how should we monitor orthostatic BP

A

lying/sitting/standing BP (3-4xday)
a decrease of more than 20 systolic and 10 diastolic
tilt table test

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27
Q

what is the treatment of orthostatic hypotension

A

eliminate any known cause
assist pt when sitting/standing
supportive devices
fall precautions

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28
Q

what is the prevention/treatment of atherosclerosis/coronary artery disease

A 
Diet
exercise
medications
tobacco cessation
Managing HTN
controlling DM
managing stress
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29
Q

what is a vasoconstrictor

A

nicotine

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30
Q

what are the 3 evaluations of chest pain

A

physical assessment
EKG
Lab

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31
Q

when assessing chest pain what do we ask ourselves

A

do we hear muffled, strange or extra heart beats
are they having chest pain and where is it locates
head to toe assessment

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32
Q

what are the S/S of angina

A

feeling of indigestion
choking or heavy pressure in sternum
may radiate to neck, jaw shoulders, arms, usually left arm
weakness or numbness in arms, wrists and hands
shortness of breath, pallor, diaphoresis, dizziness, nauseam and vomiting

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33
Q

why will pain sometimes radiate to left arm

A

because heart is slightly shifted to the left in our chest

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34
Q

if pt have any history of cardiac event we will treat it as cardiac until

A

it is ruled out

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35
Q

what will chest pain be described as on an EKG

A

ST depression and ST elevation

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36
Q

represents cardiac ischemia

A

ST depression

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37
Q

what is ischemia

A

lack of oxygen

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38
Q

what is infarction

A

cell death

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39
Q

represents infarction

A

ST elevation

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40
Q

what does STEMI stand for

A

ST elevation, Myocardial Infarction

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41
Q

first hump on EKG

A

P wave

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42
Q

Spike on EKG

A

QRS

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43
Q

p wave=

A

atrial contraction

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44
Q

QRS wave=

A

ventricular contraction

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45
Q

everything from the S on is

A

relaxation of the ventricle and thats when the heart gets filled with blood

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46
Q

what are the serum markers of Acute Coronary Syndrome

A

CK & CKMB
Troponin
Myoglobin

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47
Q

shows up within 4-6 hrs and peaks within 12-24 hours

A

CK & CKMB

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48
Q

what is the only problem with CK & CKMB

A

they also can be elevated with other muscle damage

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49
Q

what is the most specific lab for cardiac event and is rarely high in a non cardiac even

A

troponin

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50
Q

shows up in 3-5 hrs and remains elevated for 1-3 wks

A

troponin

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51
Q

shows up in 1-3hrs and then goes away

A

myoglobin

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52
Q

very good to see if a person is having a cardiac event at that time

A

myoglobin

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53
Q

what are more evaluations of chest pain

A

Echo and Coronary Angiography/Cardiac Cath

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54
Q

when would you never do an exercised stress test

A

in a pt having active chest pain

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55
Q

what is an echo gram good for

A

to look at wall motion and valve function because of that they are going to be a very good assessment of heart failure

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56
Q

what does a lexican do

A

gets heart rate up to mimic exercise and they insert radiopaque dye to show reduced blood flow

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57
Q

what is the primary aim of therapy for myocardial ischemia and angina is to

A

reduce myocardial oxygen consuption

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58
Q

what is the treatment of angina

A

decrease BP
decrease heart rate
assist contractility
decrease left ventricular volume

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59
Q

what medications help the heart take a good strong beat

A

beta blockers and cardiac glycoside (digoxin)

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60
Q

what should you always initiate at the onset of chest pain

A

OXYGEN

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61
Q

what are the 7 nursing interventions of chest pain

A 
get pt to rest
oxygen
quick assessment
vital signs
monitor resp. status
12 leak EKG
nitroglycerin
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62
Q

what does the PQRST stand for in the assessment of angina/chest pain

A 
position
quality
Radiation/relief
Severity
Timing
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63
Q

how can pt manage angina at home

A 
reduce activities 
avoid temp extremes
maintain normal BP
avoid OTC meds that raise BP
stop smoking
take ASA &amp; BBLockers
carry nitro
64
Q

the cold

A

vasocontricts

65
Q

the heat

A

wears a person out

66
Q

what are S/S of MI

A 
SUDDEN onset of chest pain
no response to rest or meds
SOB, dyspnea, tachypnea
N/V
decreased urinary output
cool, clammy pale skin
anxiety, restlessness, fear
67
Q

the s/s of _____ are more sudden and more severe. almost the same s/s of _____ but acts faster

A

MI; angina

68
Q

poor cardiac output does not get to the organs like it should and decreases

A

urinary output, causes N/V, cool clammy skin

69
Q

what is the nursing care for MI

A

bed rest
stool softeners
education

70
Q

why do you want to give stool softeners to MI pt

A

because we do not want them to strain and have a vagal response

71
Q

what is the first phase of cardiac rehab

A

low level activities and education (usually started in the hospital after stabilization)

72
Q

what is the second phase of cardiac rehab

A

4-6wks after discharge and focuses on lifestyle modifications and risk factor reduction

73
Q

what is the third phase of cardiac rehab

A

maintenance of cardiovascular stability (something to do at home and have regular exercise, watch their diet)

74
Q

when can a pt resume sexual activity

A

when they can walk 3-4 mph without SOB or 2-3 flights of stairs before SOB

75
Q

what are surgical interventions for CAD

A

cardiac cath & coronary angiography, percutaneous coronary interventions, coronary artery bypass

76
Q

when there is an obstruction what is the goal

A

to open up the blocked vessel

77
Q

inject dye to visualize the vessels and look for blockage

A

cardiac cath

78
Q

if a blockage is seen then what is done

A

PCI is done- open up the vessel either an angioplasty or stent

79
Q

if the PCI does not work what is done next

A

coronary artery bypass

80
Q

NPO is recommended ______ before a scheduled procedure

A

8-12 hrs

81
Q

what is given to pt to be able to verbalize when chest pain gets worse

A

versed

82
Q

how will the pt feel when dye is injected

A

very warm flushed feeling

83
Q

after a cardiac cath or angioplasty what should we do

A

assess cath site for bleeding
check peripheral pulses, color, temp, pain or numbness, monitor dysrhythmias, bed rest for 2-6hrs, affected extremity straight, HOB no higher than 30 degrees (can’t put pressure on leg), encourage fluid to flush dye out, ensure safety

84
Q

when should we instruct the pt to notify us

A

if they feel anything “pop”, warmness, dampness

85
Q

if there is bleeding at the site what should we do

A

hold pressure and call doc

86
Q

what is an angioplasty

A

balloon, idea is to push or crack that plaque to open up the vessel, there is a vacuum at the end to catch the plaque breaking off

87
Q

what is a stent

A

opens up the vessel with the balloon and place a wire mesh in there and helps hole the vessel open

88
Q

surgery in which a blood vessel form another part of the body is grafted to the occluded coronary artery so that blood can glow beyond the occlusion

A

coronary artery bypass graft

89
Q

what is the most common vein for heart bypass

A

the greater saphenous vein

90
Q

what is the BEST graph to use for the heart bypass

A

left internal mammary artery

91
Q

what are the S/S of valve disorders

A

dyspnea
weakness/fatigue
murmurs
chest pain

92
Q

what are the 2 valve disorders

A

stenosis and regurgitation

93
Q

what is the coronary artery disease big problem

A

blood is not going where it needs to go and so we need to fix it

94
Q

valve disease and heart failures big problem is

A

have too much volume, weak heart, stretched out heart and that makes it an ineffective heart and not a good pump

95
Q

what medications are given for the management of valve disorders

A

diuretics, cardiac glycosides, B blockers, prophylactic antiobiotics

96
Q

since heart is not being an effective pump we are giving ____ so extra fluid is not put in

A

diuretics

97
Q

_____ will help the heart take a strong beat and slows the heart rate down

A

digoxin

98
Q

when admin dioxin what should be done

A

apical pulse for one minute

99
Q

a procedure to improve blood flow through a narrow valve. a catheter is threaded to the valve through a hole temporarily created in the septal wall and inflated

A

valvuloplasty

100
Q

what is done for a stenotic valve

A

commiserautomy

101
Q

a surgical procedure performed to open a stenotic calce. a stenotic valve restricts the flow of blood. a scalpel incision widens the valve

A

commissurotomy

102
Q

what is an annuloplasty ring done on

A

a valve that has regurgitation

103
Q

what are the two types of valve replacements

A

mechanical and tissue valves

104
Q

the pt will need LIFELONG anticoagulation with this valve replacement and why?

A

mechanical; blood platelets, etc like to stick to anything foreign

105
Q

which valve replacement is less likely to generate clots, great for childbearing women, older age and lasts 7-10 years

A

tissue valve

106
Q

what should you watch closely for after valve replacement surgery

A

development of Heart Failure

107
Q

what are the main two S/S of mitral valve prolapse and very common in

A

systolic heart murmur

mid systolic click; younger women

108
Q

mitral valve prolapse could progress to

A

regurgitation

109
Q

mitral valve prolapse pt are not supposed to

A

donate blood

110
Q

volume of blood in ventricles at end of diastole

A

preload

111
Q

resistance left ventricle must overcome to circulate blood

A

afterload

112
Q

left heart failure affects the

A

lungs (pulmonary congestion)

113
Q

left heart failure S/S

A 
dyspnea on exertion
orthopnea
paroxysmal nocturnal dyspnea
oliguria
confusion, anxiety and restlessness
114
Q

pulmonary congestion consists of

A

cough, crackles, wheezes, blood sputum, tachypnea

115
Q

alveoli become filled with fluid

A

pulmonary edema

116
Q

pulmonary edema recognition of early stages

A 
dry, hacking cough
fatigue
weight gain
worsening edema
degree of dyspnea
117
Q

S/S of right hear failure

A 
jugular vein distension
dependent edema-feet, ankles,legs
hepatomegaly-liver
ascites- fluid in peritoneal cavity (has a gut)
weakness, anorexia, weight gain
118
Q

what side heart failure is systemic and has MASSIVE weight gain

A

right sided heart failure

119
Q

what is the most common cause of right sided heart failure

A

left sided heart failure

120
Q

what is class 1 of heart failure

A

client exhibits no more symptoms with activity than a healthy client would

121
Q

what is class 2 of heart failure

A

client has symptoms with ordinary exertion

122
Q

what is class 3 of heart failure

A

symptoms with minimal exertion

123
Q

what is class 4 of heart failure

A

symptoms at rest

124
Q

what are the 3 major nursing management of heart failure

A

I&Os
daily weight assessment
lung assessment

125
Q

if pt gains 2-3 lb within a day they need to

A

notify physician

126
Q

how should HF patient weigh themselves

A

same scale same time everyday

127
Q

how can we reduce preload

A

diuretics, fluid restriction, sodium

128
Q

how can we reduce after load

A

avoid cold or heat, BP meds, quit smoking

129
Q

heart skips a beat is

A

PVCs pre mature ventricular contractions

130
Q

where is a pacemaker placed

A

pocket in left subclavian area

131
Q

why are pt not supposed to get the placemaker site wet for 7 days

A

great place for infection to set in

132
Q

pacemaker pt should be up at least 30 degrees and keep arm still for

A

24-48 hrs

133
Q

what is peripheral arterial disease: intermittent claudication

A

pain in extremities with exercise; relieved by rest

134
Q

pain of int. claud. occurs…

A

one joint space below disease process

135
Q

lower extremity of peripheral arterial disease because

A

increases perfusion and much less painful

136
Q

what are the 5 signs of peripheral arterial disease (PAD)

A 
loss of hair
brittle nails
dry, shiny, scaly skin
ulcerations
bruits
137
Q

turbulent blood flow =

A

bruits

138
Q

what are risk factors of PAD

A

nicotine use, hyperlipidemia, hypertension, diabetes, stress, sedentary lifestyle/obesity

139
Q

what are nursing interventions for arterial insufficiency

A 
lower extremity to increase perfusion
exercise program
avoid extreme cold
no nicotine
avoid stress
proper nutrition
140
Q

what are management of peripheral vascular disease

A

exercise program
weight reduction
smoking cessation

141
Q

surgical interventions for PVD

A

surgical bypass grafts

142
Q

after peripheral artery bypass surgery watch pulses and carefully doc every

A

hour for the first , then 4 hour pulse checks with doppler, keep legs elevated because we don’t want pressure on leg

143
Q

what are signs of venous insufficiency

A

chronic venous stasis (blood stays put)
edema
brownish discoloration
pain

144
Q

what is the management of venous insufficiency

A

elevating extremities, foot pumping, avoid crossing legs, avoid constrictive clothing, compression stockings,

145
Q

what are signs of DVT

A 
limb pain
heaviness
swelling, reddness, warmth
tenderness
diff in leg circumference
venous doppler
146
Q

DVT is

A

clot in vein

147
Q

what is the gold standard for DVT dx

A

venous doppler

148
Q

why is the pulse normal in a DVT

A

because its a venous problem not an arterial problem

149
Q

what is the prevention of DVTs

A 
elastic compressions
active and passive leg exercises
early ambulation
TCDB
enoxaparin
150
Q

what is the treatment of DVT

A

bed rest, elevation, compression stockings, analgesics

151
Q

why is the DVT pt on bedrest

A

don’t want clot moving

152
Q

for arterial problem we _______ legs, for venous problem we ________legs

A

dangle; elevate

153
Q

what meds are used in treatment of DVT

A

anticoagulant and thrombolytic therapy

154
Q

traps blood clot as they travel up the vena cava preventing them from reaching the lungs

A

inferior vena cava filter

155
Q

ppl at risk for dvt usually will get this device

A

inferior vena cava filter

Module 3 (10 decks)

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