Cardiac Flashcards
(194 cards)
1
Q
preload
A
how stretched the LV cardiac muscle is after the end of diastole.
2
Q
afterload
A
amount of resistance the LV is ejecting against the aorta
3
Q
stroke volume
A
amount of blood ejected with each heartbeat
4
Q
cardiac output
A
amount of blood pumped out of LV each min!
5
Q
how to calculate cardiac output
A
to calculate the amount of blood ejected in each MIN
you have to multiple SV(amount of blood ejected each heart beat) and heart rate(heart beats per minute)
6
Q
what are we looking at when we look at a 12-EKG
A
its a ONE TIME THING we want to see the rhythm
that there has to be a P before every QRS
R to R distance is the same
QRS and T should be same direction
HEIGHTS DONT MATTER
hor: time
ver: amplitude
with hor and ver = you can calculate the heart rate.
7
Q
what does it mean if the T wave is downwards and QRS is upwards
A
heart disease
8
Q
what does each part of EKG mean
A
P: atrial depolarization
QRS: v depolarization and unseen atrical repolarization
T: v depolarization
U: you shouldn’t see this wave. if you do this is bad because its disease. its the Purkinje fibers contracting.
9
Q
what does it mean if R to R and if there is P wave mean
A
normal sinus rhythm.
impulse is from SA node or pace maker
10
Q
normal sinus rhythm
A
heart rate 60 to 100 bpm
reg rhythem
P wave before QRS
same R to R distance
11
Q
sinus brady
A
less than 60
regular
p before QRS
same R to R distance
12
Q
sinus tachy
A
more than 100
regular
p before QRS
same R to R distance
13
Q
what is a fib
A
uncoordinated electrical activity. atrial muscle is twitching its NOT contracting to push blood into the ventricle. this is bad
14
Q
how can we see a fib on EKG
A
no P before QRS
R to R distance don’t match
15
Q
how can we treat afib
A
warfarin: for high risk for clots
metoprolol for HR and BP
16
Q
how is a fib different from a flutter
A
its more organized whereas a fib is more chaotic and faster HR.
but there is not P wave. R to R waves are like saw tooth-like baby shark
17
Q
what does ST elevation indicate
A
patient has chest pain so if they have ST elevation: plaque is building up and the patient is not getting oxygen.
there is ischemia: MI
pericarditis
HYPERkalemia
18
Q
ST depression
A
valve disease
HYPOkalemia: digoxin
19
Q
coronary atherosclerosis patho
A
coronary arteries give oxygen to heart muscles.
atherosclerosis is when cholesterol and lipids are building up and turning into a plaque(atheroma) to obstruct circulation.
THROWBACK: fatty streak starts to happen as a kid. but not all of them turn into lesions so it depends on their genetics or smoking or HTN. the lesions will trigger an inflammatory where monocytes(WBC) and platelets gather up. the smooth muscle starts to grow. the smooth muscle has a fibrous cap that covers the inflammation and lipids that is unstable. at some point its going to rupture. when this ruptures, more platelets/clotting factors causing blood to POOL. obstruction will cause an MI!!!
20
Q
atheroma
A
walls of the arteries will start to accumulate lipids and scar tissue to make plaque.
21
Q
signs and symptoms of coronary atherosclerosis
A
ASYMPTOMATIC
chest pain: no oxygen to heart
older patients: SOB, weakness and NO ANGINA because of neuropathy from DM
women: SOB, nausea, weaknes “GI problems”
signs and symptoms depend on where the plaque obstruction is
22
Q
coronary atherosclerosis risk factors
A
Non-Modifiable: Age: men 45 women 55 Gender: men but women after 55 Race: AA Modifiable: HTN DM Diet Exercise.
23
Q
what lab for coronary athero
A
FLP to see
cholesterol
tri
LDL
HDL
24
Q
how often should patients get FLP
A
- over 20? every 5 years
- MI, CABG, Heart catheter? within few months of discharge, every 6 weeks then we check 4 to 6 months for maintenance
25
educate your parent with hyperlipidemia on diet
* MEDI DIET: veggies and fish and only red meat 2 a twice
* watch cholesterol should be less than 200mg PER DAY
* sat fat should be 7 percent of the calories
* fat should be between 25 to 35 percent of total calories(total calories depends on your weight) most fat should come from mono fats (20 percent) whereas poly is 10
* carb is 50 to 60 percent
* protein is 15 percent
* fiber is 20 to 30 percent
26
educate hyperlipidemia parent on exercise
work out 30 mins a day but make sure you are able to talk while you exercise. exercising is good because this will get your blood circulating and lower the triglycerides in your blood.
27
educate your hyperlipidemia patient on smoking
smoking is bad because it can 1. activate your sympathetic NS and this causes an increase in HR and BP vasoconstriction which does not allow blood passage. 2. damages your BV so you increase in platelet aggregation. if the platelets stick together then clots can happen. 3. also hemoglobin will bind to CO2 instead of O2
28
what meds should we give to a patient with hyperlipidemia?
Statins and fibs restrict lipoproteins
Ezetimibe decreases cholesterol absorption
Chole (Bile) removes lipoprotein
29
when should we give statins and with what
food and at night because thats when most of the cholesterol is being made
30
angina patho
when the heart muscle is not getting enough oxygen.
stable angina: relieved by rest and nitro
unstable angina: NOT relieved by rest or angina STEMI BBY
31
patient is experiencing chest pain what should we tell them to do
sit down and rest so the pain can go away then take the nitro. dont just give them morphine give them O2 for oxygen
32
why do patients give chest pain
exercise
stress increases heart workload
cold weather bc vasoconstriction and body is using energy to warm up
heavy meal because all the blood goes to the GI tract for digestion
33
how do patients describe chest pain and ASK WHAT?
choking sensation
elephant on chest
indigestion
chest pain: neck, jaw, shoulder, left arm
SOB
DM patients: numbness in arms but watch out they might not feel anything at all
ASK: WHAT WERE YOU DOING THAT CAUSED THIS CHEST PAIN
34
what assessment do we need for chest pain
12 lead EKG
Troponin: draw 3 times 6 hours apart
Chest X-ray to rule out pulmonary issues
35
chest x-ray preparation
1. No preggo
2. no metals
36
Angina Drugs
* nitro
* beta blocker
* calcium (amlodipine)
* antiplatelet: ASA and Plavis
* Anticoag: Heparin and Enoxaparin
* O2
37
Nitro
What does it do?
Check what?
How many?
S/E?
route
DRUG INTERACTION
decreases preload and afterload
check BP
give nitro 3 times 5 mins apart NO WATER
HA and hypotension
tabs treat patches prevent
VIAGRA
38
nitro patch
patient (3)
nurse (1)
you can swim
take it off at night time
you can put it on chest, left arm, shoulder, or BACK
date time initial
39
beta blockers
assess what
educate patient about what?
contraindiacted in which patients
HR and BP bc blocks sympathetic NS
wean off to prevent rebound HTN and check blood sugars because it can mask hypoglycemia (shaking, sweating, sleepy, dizzy)
patients with asthma. CALL DR if patient has wheezes, crackles, or SOB
40
calcium channel blockers
what does it do
check what
prevent or reduce vasospasm which can be good especially during heart cath because that can cause vasospasms
BP
41
anti-platelet
max ASA
check what
avoid what
325 mg
check **BP and HR(compensatory)** H and H, Vitals, GI BLEEDS and BLEEDING
AVOID IM injections, frequent BP checks, drawing blood, starting IV sites. PUT PRESSURE IF PATIENT IS BLEEDING
42
**anticoag**
indications:
**heparin**
check what?
a/e
**enoxparin**
NURSE DO WHAT?
DVT
aptt(45 to 75) if IV
antidote: protamine sulfate
HIT
give the prefilled syringe with the airbubble to seal the med in the tissue
43
oxygen toxicity
N
V
nasal stuffiness
coughing
substernal pain
44
cardiac stress test
1. what should the patient do before the test?
2. what should the nurse do before the EKG
3. why do we do this test?
4. how do we do this test?
5. what side effects can the vasodilators cause?
6. how long does it take?
7. max HR?
8. what should the patient avoid?
9. does the patient have a NPO status. if so, how many hours?
10. what meds should we hold?
11. when should we stop the test?
12. what is a positive test?
13. what should the nurse start and monitor?
14. what should the patient do and should not do AFTER test?
1. signed consent for CABG in case patient has heart attack and wear comfy shoes and clothes. make sure they do NOT work out three hours before this stress test
2. baseline vitals
3. stressing the heart to see how well the coronary arteries work. we want get 80 to 90 percent of HR
4. arm cramp, treadmill, vasodilators
5. flushing, HA, dizzy(annoying izzy is blushing)
6. 1-3 hours
7. max HR= 220- age
8. alc, tobacco, caf
9. yes, 4 hours NPO
10. beta blockers because it drops the HR
11. patient compains of chest pain, dizziness, fatigue, cramping.
12. Pt complains EKG or vital changes STOP its a **positive test**
13. IV SITE in case patient has a heart attack. Monitor the vital signs via telemetry and cold and clammy
14. no baths after 1-2 hours after stress test because their vessels are dilated from the vasodilator or exercise.
45
Nursing Process for ANGINA
ASSESS
DX
Plan
NI
Eval
* ASSESS
* COLDSPA
* Risk factors
* what were you doing before
* level of understanding
* Physical assessment: Vitals, Aus Heart Lungs, Abdomen, Pulses, Edema
* DX
* Ineffective tissue perfusion
* anxiety
* deficient knowledge
* Planning and Goals
* Perserve heart muscles
* NI
* SIT DOWN
* High-Fowlers
* O2
* Get vitals
* EKG
* Nitro
* ANXIETY MANAGEMENT
* balance activity and rest
* educate their patient
46
REVIEW CASEE STUDY
REVIEW CASE STUDY
47
how good is nitro good for and how should the patient store it
6 months and patient should store it in a dark glass bottle
48
what diet should patients with angina be on if they have a lot of weight gain like 8 pounds in a week(should no more than 5 pounds)
sodium restriction: 2g
fluid restriction: 2L
49
MI is an acute coronary syndrome that includes
STEMI nonSTEMI and unstable angina
50
what is the GOAL of MI
we want to perserve cardiac muscle that isnt dead
51
what are signs and symptoms of MI
chest pain
SOB
N
anxiety
**Indigestion**
**Cold, pale, moist, sweating skin**
52
what is the FIRST med we should give to patient with MI since CP not relieved by nitro
nitro IV drip
morphine IV push
53
how can we diagnose patient with patient with MI
EKG: Read within 10 mins
Troponin: 3 times 6 hours apart
54
What other meds do we give with MI
* Nitro
* **MORPHINE**
* **Ace(DIREUTIC)**
* Beta
* **tPA**
* Anti-platelet
* Anti-coag
* **CARDIAC REHAB**
55
morphine
check what
RR
urine output: myoglobin?
SOB
56
ACE
check what
what does it do
check BP
**diuretic** because inhibits a1 converting and a2 and a2 stimulates aldosterone. now if you block aldosterone you will prevent the reabsorption of water and sodium retention.
**remodels the heart muscles**
57
tpa
given within?
indication
contraindicated?
6 hours
declots PICC lines or central lines
h. stroke, surgery in 3. weeks
58
why can't we give patients with h stroke tpa
because it get rid of those protective clots
59
Nursing Process for MI
* Assess
* Baseline vitals
* Aus Heart, Lung, Abdomen
* COLDSPA
* UO(could have AKI)
* IV site(bc they can have another MI)
* EKG reading
* Assess for post MI
* pulmonary edema
* HF
* Cardiogenic shock
* NI
* High Fowlers
* VS every 4 hrs
* BED REST
* POST MI COMPLICATIONS
60
POST MI COMPLICATIONS
Cardiogenic shock
pulmonary embolism (NOTIFY DR IF THEY HAVE EDEMA OR CRACKLES)
heart failure
61
what should do you do if patient has positive stress test
Cardiac Cath
62
remember after troponin and EKG you do
cardiac stress test.
positive? cardiac cath
63
three types of perc. coronary interventions
- perc trans luminal coronary angioplasty
- coronary artery stent
atherectomy
64
PERCUTANEOUS CORONARY INTERVENTIONS
1. what should patient do before
2. what meds will the patient be on
3. is this treatment GOLD
4. what is this procedure
5. what is stenosis
6. What should the nurse assess before
7. patient might feel:
8. Is the patient NPO, if so how long?
9. What should the nurse do for RIGHT after cath lab?
10. how frequent should we take vital signs?
11. What should the nurse ASSESS for?
12. how should the nurse assess?
13. Patient should be in what position
14. How long should the patient should be in that position?
15. Why is the patient in pain after cath lab?
1. signed consent because patient can have ANOTHER MI so we gotta do CABG
2. plavix and aspirin
3. HELL YEAH GOLD STANDARD
4. **PCI:** this procedure checks how bad the CAD is and stenosis. **CAN USE WITH DYE** so the doc is gonna go into via groin area into the femoral artery ALLL way to the coronary artery with a balloon tipped catheter to where the plaque is. The ballloon will INFLATE to crack that plaque and deflate and remove the balloon. 60 min procedure. CAS: **Coronary artery stent:** same shit but when balloon is up. a MESH STENT will be up there for structural SUPPORT. sometimes the doctor will coat the STENT with ASA. **Atherectomy:** shave that plaque
5. narrowing of CORONARY blood vessels
6. Assess renal function (UO), allergies,
7. warm, flushed feelings
8. yes, 8 hours
9. VITAL SIGNS
10. over 6 hours, every 15 mins in first hour, second hour 30 times 2, every hour times 4
11. ASSESS GROIN FOR HEMATOMA (it should be soft. bad if its hard because hematoma is painful and its basically blood trapped under skin. Patient is going to be sleeping so they won't know. Assess pedal pulses.
12. Use a doppler for pedal pulses and marker it.
13. supine.
14. 6 hours
15. BACK PAIN and HEMATOMA(BAD)
65
now why would we do a CABG
cardiac cath didn't work
66
CABG
1. what should the patient do before?
2. nurse should get what before this procedure
3. what is this procedure?
4. what incisions will the patient have
5. what meds can the doc stop and why?
6. What should we assess for after the procedure when they come back 2 days after ICU
7. what should the patient do after 48 hours? should they rest in bed after a CABG
8. if they should ambulate, how many feet
9. What labs should the nurse monitor
1. signed consent
2. baseline vitals and INCENTIVE SPIROMETRY
3. this procedure is when a vessel from the leg is chosen and grafted to the occulded site to let more blood flow.
4. check the small one on leg and big one chest
5. stop the anti coags and platelets because of BLEEDING
6. VS, UO (kidney damage), LOC, Aus Lungs Heart & Abdodmen, Tele
7. NO REST. SIT in chair get. that blood moving to prevent lung collapse and DVT.
8. yes AMBULATE. 25 to 100 feet
9. infection (WBC, CBC) UO (AKI)
67
hypertension patho
BP=COxPR
cardiac output=amount of blood ejected per min
PR: peripheral resistance
68
why is hypertension is a silent killerr
asymptomatic. but it can damage your heart(MI) brain(stroke) eyes(vision loss), and kidneys(CKD). ⅓ of patients have it and they dont even know.
69
primary HTN
95 percent patients have this and its because of no IDENTIFIED cause
70
secondary HTN
Renal
Preggo
NSAIDs(fluid retention)
Tumor
71
HTN Expected findings
HA
dizziness
vision loss
fainting
but for the most part: no symptoms
72
How do we dx patient with HTN
2 or more readings on bare arms at heart level and patient is sitting.
73
when a patient has HTN was should we monitor
I and Os; UO BUN and Creat because HTN can ruin kidneys
HLD: hyperlipidemia is a risk factor
DM: glucose levels
EKG
74
HTN meds
* **DIURETICS**
* **thiazide**
* **loop**
* **potassium sparing (amiloride)**
* **spironolactone**
* beta
* ACE
* ARBs
* Clonidine
* Calcium channel
75
thiazide assess and do what
give this med with food because GI upset
assess K because K loss
76
loop
monitor BP because hypotension
HR idk why
get K too because K loss
77
why is clonidine given
for uncontrolled HTN
78
what should you do if your patient has hypotension
LAY YO HEAD ON MY PILLOW
lay their head so the blood can go to the brain
elevate legs 15 to 30 degrees
Trendelenburg
FLUID BOLUS
79
HTN nursing process
* assess
* BP
* heart, kidneys, eyes, brain check
* aus lungs why? because fluid retention. secondary HTN can be from NSAIDs, kidney problems.
* SES
* NI
* educate on noncompliance
* older patients and orthostatic hypotension and **involve their family because they can forget**
80
one drink of alc
12 oz of beer
5 oz of wine
1.5 oz of a shot
81
pre HTN
120-139/80-89
82
stage 1
140-159/90-99
83
stage 2
more than 160/100
84
hypertensive emergency
value?
treatment?
organ damage?
goal?
nursing care?
how often should we check the BP?
1. 220/140
2. IV sodium nitroprusside and nicardipine HCl
3. YES
4. bed rest and reduce MAP by 25 percent; next 6 hours 160/100 not too fast because it might mess up perfusion to organs
5. automatic BP machine and check labs: BUN and Creat EKG!
6. every 5 mins then 15-30 mins after stabilization
85
hypertensive urgency
treatment
organ damage?
signs?
nursing care?
1. PO
1. beta
2. ace
3. clonidine
2. NO
3. HA nosebleeds anxiety
4. heart, lungs, peripheral pulses, kidneys
86
AAA main cause
atherosclerosis; the plaque is basically a weakended wall. so remember there are a lot of platelets so the platelets are probably pooling and creating like this bulge.
87
AAA RISK FACTOR
elderly white men in 60s and 90s
88
AAA risk factor
genes
smoking
HTN
89
AAA sign
NO SYMPTOMS besides the pulsation of the abdomen. but you can hear a bruit SOMETIMES
90
AAA patho
damage to media layer
trauma
genetics
91
AAA diagnosis
CT scan
Ultrasound
92
what size is okay for AAA
5.5 cm and smaller
93
what do you do if the AAA is small and whats the goal
1. monitor it for 6 months and check with the CT scan
2. control the BP
3. GOAL 100-120
94
what do you do if the AAA is big bigger than what
1. bigger than 5.5 cm, open surgical repair and endovascular grafting
95
WHAT IS THE SIGN OF IMPENDING RUPTURE FOR AAA
and
WHY
SEVERE BACK PAIN
that AAA IS PRESSING ON THE LUMBAR NERVES
96
how will a ruptured AAA affect vitals and labs
H and H drop
BP and HR rise
because of bleeding
97
what is open surgical repair for
and where is the incision
AAA
surgeons will open up that vessel and place a graft (a man made tube) to replace the weakened vessel wall AFTER IT RUPTURED
incision: midline abdomen
98
what is endovascular grafting
where is that incision
similar to cath lab.
surgeon will thread his way to the weakened vessel and put a stent there to get rid of that built up blood pressure.
GROIN
99
how do you check endovascular grafting post op
SAME AS CARDIAC CATH
SO PLEASE LOOK AT THOSE
100
hypovolemic shock
when your blood cant pump anymore because there is just too much fluid or blood loss
101
what do you do if the AAA ruptures
doctor will want to do surgery but you start the IVs because we got to get that fluid(normal saline) and and blood transfusions running. thats your job as a nurse when vitals are tanking (comp mechanism)
102
AAA post op directions
cath lab directions
pain assignment
vitals
aus heart lungs and abdomen listen for bruit
nutrition for healing
peripheral pulses, skin
I and O: HTN can affect the kidneys
ALSO TEACH THE PATIENT HOW TO DO DRESSINGS!
103
Heart Failure Left sided
* SOB
* Low O2
* S3 heart sound(V gallop so your LV is passively filling)
* crackles
* Cough
* Frothy sputum
* Altered mental status
* fatigue
104
Right Sided HR
* peripheral and GI problems
* JVD
* edema
* Ascites
* Large Liver
* Anoxeria
* Nausea(stasis in the GI)
* Weakness(losing blood)
* WEIGHT GAIN so what DAILY WEIGHTS
105
HF diagnostic procedure
BNP 0-100 pg/ml
echo
106
(neurohormone that regulates fluid volume and blood pressure)
BNP
107
BNP value
100 pg/ml
108
echo ejection fraction
55 to 65 percent
109
what is the echo if the patient askes
lay on the left side while patient is lying still. dr will take pictures of the heart it takes like an hour
110
what is ejection fraction
the percent of blood pumped out of the LV
111
lifestyle recs of HF
* no more than 2g of salt
* fluid restriction no more than 2L
* empty bladder same clothes daily weights
112
what medications can you give HF patients
* ACE
* Diuretics ( Lasix)
* Beta-blockers
* **DIGOXIN**
* ARBs
* **Hydralazine**
* **Isosorbide Dinitrate**
113
what does digoxin
* treats HF and heart rhythm by increasing the myocardial contraction and contractility to RESTORE that rhythm.
* reduces heart rate
* decreases the workload of the heart
114
what is the range for digoxin
0.8 to 2.0
115
what should you do before you give digoxin
1. apical heart rate(listen with stethoscope for ONE minute) and palpate the pulse.
2. make sure both pulses match bilaterrally. we don't want unequal heart rates.
3. assess K levels because digoxin and K will compete for sodium and potassium channels.
116
when giving digoxin what does more calcium mean
more contractility
117
what are signs and symptoms
* anorexia
* N
* V
* Visual disturbances
* halo
* photophobia
* blurred vision
* double vission
* Depression
* brady
* dysrthymia
* fatigue
* weakness
118
how do you know digoxin is getting toxic
GI problems
Visual problems
HR problems (bradycardia)
119
VESSEL
Various positions for arterial and venous disease
1. Various positions that alleviate pain
1. **A**rterial: pain is alleviated **dangling**(elevation makes pain because ischemia and blood flow is impeded). With arterial blood goes down not up
2. **V**enous pain is elevated with an elevation of the legs because it helps decrease swelling and blood flow. Dangling hurts and makes edema worse
120
VESSEL
explain the pain
* Arterial Pain feels:
* sharp WORST at night when RESTING
* patients wake up from sleep from the pain
* **intermittent claudication: activity while** severe pain because of activity uses up oxygen so it goes away when they rest it. (feel like leg day) calves, butt, thighs
* Venous
* heavy, dull, throbbing, and aching
* blood is worse with standing and sitting(dangling)
121
VESSEL
Skin of **lower extremity**
* Arterial: issue with perfusion
* Cool to touch
* thin
* dry/scaly
* hairless
* thick toenails
* Dr. EP
* dangle=red
* elevate =pale
* Venous
* thick, tough skin
* brownish
* swollen from edema
122
Strength of pulse in lower extremity
VESSEL
* Arterial
* Poor/Absent
* GET DOPPLER
* Venous
* Present pulses
123
VESSEL
Edema
* Arterial
* no edema
* Venous
* edema
124
VESSEL
lesions(ulcers)
* Arterial
* end of toes
* top of feet
* lateral ankle region
* little drainage
* no tissue granulation (pink) or (necrotic)
* punched out skin
* Venous
* medical parts of the lower legs
* medial ankle
* swollen with drainage
* granulation deep pink to red
* edges IRREGULAR
* shallow
125
what is PAD lower extremeties
it involves the narrowing and degeneration of the arteries in the neck, abdomen, and extremities.
126
what is the main culprit behind PAD
atherosclerosis
127
what age is mostly affected by PAD
60s and 80s
128
what are risk factors for PAD
* smoking
* DM
* HTN
* hyperlipidmia
129
what arteries are involved in PAD
PPTAF
* Popliteal
* Peroneal
* Tibial
* Aortoiliac
* Femoral
130
why does PAD experience paresthesia
nerves need oxygen too so you can have numbness, tingling, and pain.
injuries go unnoticed
131
what are the complications of PAD
* think of ariel and her tail is green
* MOST SERIOUS
* nonhealing
* gangrene
* amputation and infection
* delayed wound healing
* atrophy of skin and muscles
* infection
* necrosis
132
why does everything die in PAD
NO BLOOD AND O2
133
how to diagnose PAD
Doppler
Ankle-brachial index
Duplex
Angiography
MRA
134
how can we diagnose PAD through doppler
* in a normal person, BP is higher in the leg then upper extremities.
* PAD is its the OPPOSITE
* if the drop is greater than 30 in the doppler then the patient has PAD
135
how can we diagnose PAD with ankle brachial index
also uses a doppler on ANKLE
the number is calculated when the patient is SUPINE. brachial and dorasalis pedis.
normal is 1.0-1.4
less than 0.91
less than 0.5 SEVERE
136
duplex imaging
color doppler and it color codes the artherosclerosis
137
angiography for PAD
visualizes the inside of the BV
138
MRangiography
picture of BV with radiowave energy
139
Drug therapy for PAD
* Aspirin 325 MAX
* Plavix
* ACE inhibitor
* vasodilators so lets blood flow happen. patient can walk more.
* DRUGS for PAD
* Cilo: vasodilates and walk more
* Pento: makes blood less thicker
140
PAD exercise therapy
* 30 to 60 mins 3 to 5 times for 3 to 6 months
* walk until pain rest then walk again
141
PAD nutrition
* BMI less than 25
* waist
* Men \<40 inches
* Women \<35 inches
* Cholesterol \<200 mg
* less than 2g
* low fat, high veggies, and whole grain
142
How to care for limb ischemia
* Infection control
* Revascularization
* Trauma protection
* Angiogenesis: gene therapy
* Hyperbaric oxygen therapy
* Pain management
* Treat risk factors
143
For Severe PAD: why would you do a percutaneous transluminal balloon angioplasty
cath lab
144
what is the peripheral artery bypass
* similar to CABG
* where is synthetic femoral-popliteal artery graft is put is placed in
145
what is last resort for PAD
amputation
146
PAD Assess
* Smoking
* DM
* Hyperlipidemia
* HTN
* Obesity
* Exercise intolerance
* Check the lower extremeties for loss of hair or thick toe nails.
* do they have pulses?
* ABSENT=EMERGENCY=could mean AMPUTATION
147
Nursing Implementation
* Diet
* low sodium
* low sat fat
* high veggies
* Proper foot care
* Avoid injuries because numbness and delayed wound healing
* TELL THEM TO AVOID knee flex position except for exercise
* Turn and position 2x
* AVOID tight clothes
148
Thromboangities
Burgers Disease
Guys like SMOKED Burgers and RUN to get them
* Young men \< 40
* Smokers
* NO OTHER RISK FACTORS
* Intermittent claudication
149
how can we do atherectomy
use a rotating diamond tip, cutting, laser
150
how can you treat burgers disease
sympathectomy: destroy sym. NV nerves for blood flow
151
Raynaud's phenoemnon
what is it
who is affected by it
what are the signs and symptoms
what are triggers
1. young women who are 15 to 45
2. vasospasms induced color change of finger, toe, ear, nose.
3. coldness, numbness, throbbing, aching pain, tinging, swelling
4. exposure to cold, emotions, tobacco, caffiene
152
what colors does raynauds change to
white to blue
black to red
153
Raynauds diseases
* loose warm clothes
* gloves
* avoid extreme temps
* immerse water in warm water
* avoid caf, drugs that vasoconstrict like sudafed
* reduce stress
154
Raynauds
Calcium channel
Symphatehtacmy
155
Virchows triad
1. Venous stasis
2. Endothelial damage
3. hypercoagulability of blood
156
venous stasis
veins valves don't work so blood can back blow
157
virchows triad
the reason behind venous thrombosis
1. venous stasis
2. endothelial damage
3. hypercoag
158
venous stasis
vein valves don't work so blood can back flow
159
endothelial damage
platelet activation
coagulation activation
160
hypercoagulability of blood
smoking
oral BC
hormone replacement
**build up of platelets and RBCs**
161
SVT
caused by a swollen IV port
162
what should the nurse do when we have a SVT(thromplebitis)
1. remove IV
2. elevate arm to reverse edema and pain
3. warm and most heat can help relieve their pain
163
SVT signs and symptoms
* red
* swollen
* warm
* tender
* WBC UP
164
how should you treat SVT
warfarin
Lovenox
NSAIDS
compression stockings
exercise
NSAIDs BUT DONT GIVE WITH WARFARIN\> BLEEDING RISK
165
VTW (DVT)
venous thromboembolism
unilateral edema, pain, paresthesia, erythema, fever
166
what are complications of DVT
PE
CVI
Phlegmasia
167
how do diagnose VTE
aPTT INR
H and H
platelet
D-dimer
Ultrasound
168
D-dimer normal value
less than 250 ng/ml
169
what does the d-dimer tell you
theres a CLOT
170
nonpharm preventions for DVT
mobilization
compression stocking
SCDs
171
when should you wear compression can be worn
ACTIVE CLOT
172
when should you wear the SCDs stocking
NO ACTIVE CLOT AND WEAR IT AT ALL TIMES
173
why cant you wear SCDs when you have a clot
it will dislodge the clot and can cause PE or stroke
174
what is the drug therapy for DVT
* warrfarn
* heparin
* enoxparin
* apixaban
* tpa
* **direct thrombin inhibitor HIRUDIN**
175
Heparin IV
normal 20 to 39 seconds
therapeutic 50 to 100 seconds
176
what should the patient wear if they are on anticoag
bracelet!
177
what meds should patients AVOID with anticoags
Ginkgo and ginseng
Allopurinol
Cimetidine
Phenotyoin
Corticos
Oral hypoglycemic
NSAIDs
Saliculiates
Sulfonamides
178
what is the surgerry. for DVT
open. venous thrombectomy
179
what is the open venous thrombectomy
* you cut the vein and remove the clot using a greenfield stainless steel filter. to prevent PE.
180
inferior vena cava interruption
greenfield stainless steel filter to prevent pulmonary embolism. you have to CATCH the clot before it can turn into a pulmonary embolism
181
ambulatory care for VTE
*WEAR SOCKS FOR 2 YEARS*
182
what should you educate the patient
wear socks for two years
stop smoking
no tight clothes
INR
NO BIRTH CONTROL OR HORMONE THERAPY
don't stand or sit too long
183
pulmonary embolisms
Chest pain
SOB
**BLOOD IN SPUTUM**
184
what cant you do if the patient has a PE
homans sign
SCD
185
varicose veins patho
valves cant close properly so blood is backflowing
186
varciose veins risk factors
* pregnancy
* female
* age
* constipation STANDING
* job
* obesity
* chronic cough
* family history
*
187
varicose veins signs
* tortuous veins
* heavy, aching feeling or pain after standing
* pressure, itching,burning or cramplike sensation (think of how you feel when you do dishes)
* swelling, noctural craamp
188
varicose vein complications
SVT(supervein vein thrombosis)
rupture
skin ulcers
189
varicose veins dx
appearance
duplex ultrasound
190
varicose veins collab
* rest with limb elevation
* graduated compression stockings
* SCLEROTHERAPY
191
sclerotherapy
special agent to shrink the vessel
192
complications of varicose veins sclerotherapy
hyperpigmentation
pain
itching blistering
193
CVI patho
valve problems
194
CVI ucler care
high protein
wound care: moist environmental steril saline with gauze. leave a dressing on for 3 to 5 days
