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NCLEX-RN (5) Adult Health > Cardiac > Flashcards

Flashcards in Cardiac Deck (59)
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1

What is a cardiac catheterization with coronary angiogram (or coronary angiography)?

Cardiac catheterization is the use of a tube inserted into an artery in the neck, groin or arm, and then dye is injected to visualize the heart and vessels.

It is done to diagnose cardiac diseases or as an intervention to treat cardiac disease.

2

What are the pre-procedure interventions for a cardiac catheterization?

Pre-procedure interventions:

  • get informed consent
  • assess for dye allergies
  • NPO beforehand
  • assess pulses and vital signs

3
Teaching:

Cardiac catheterization and dye

Tell client:

  • that they may feel a warm flushing sensation
  • an urge to urinate
  • heart palpitations as the dye is being injected.

4

What are the post-procedure interventions for a cardiac catheterization?

Post-procedure interventions:

  • keep leg straight for 2-6 hours to prevent bleeding
  • assess pulses and vital signs

 

 

5

What is a percutaneous transluminal coronary angioplasty (PCTA)?

A PCTA is when a balloon is used to open up an artery due to plaque build-up.

6

What is laser-assisted angioplasty?

Laser-assisted angioplasty is when a laser is used to vaporize the plaque in the artery.

7

What is a coronary stent?

A coronary stent is placed in the artery to keep it open for adequate blood flow.

8

What is a coronary artery bypass surgery (CABG)?

A CABG is open-heart surgery that uses the client's own veins or arteries to bypass clogged arteries.

 

9
Teaching:

Coronary artery bypass surgery (CABG)

CABG teaching:

  • limit pushing and pulling for 6 weeks
  • don't cross legs
  • wear compression socks and elevate limb that was used for the graft
  • sex is OK if client can walk 1 block or climb 2 flights of stairs without symptoms

10

What is a vena cava filter?

A vena cava filter is a filter placed in the vena cava to trap blood clots.

11

What do the following cardiac procedures all have in common?

  • cardiac catheterization
  • PTCA (percutaneous transluminal coronary angioplasty)
  • laser-assisted angioplasty
  • coronary stents
  • CABG (coronary artery bypass surgery)
  • vena cava filter

All these cardiac procedures are different ways to remove or bypass plaque in the cardiac arteries to re-establish blood flow and oxygen perfusion.

12
Teaching:

Cardiac pre-procedure

Stop taking anticoagulants or antiplatelets about 1 week before the cardiac procedure in order to prevent bleeding.

13

What are the general pre-procedure interventions for most cardiac procedures?

Perform a baseline cardiac assessment:

  • check bleeding time
  • vital signs
  • EKG rhythm
  • peripheral pulses
  • level of consciousness

14

What are the general post-procedure interventions for most cardiac procedures?

Assess for complications such as:

  • bleeding or hematoma formation at the insertion site
  • cardiac dysrhythmias and chest pain
  • embolisms
  • infection

15

What is an embolectomy?

An embolectomy is a blood clot (embolism) removed from an artery.

16

What is a cardiac stress test?

A cardiac stress test checks for coronary artery disease by making the heart work.

It can be performed on a treadmill or with IV meds to increase workload of the heart - cardiac meds are usually held before test.

17
Describe:

Angina

Angina is chest pain caused by inadequate myocardial blood and oxygen supply.

18

Explain the difference between:

1) stable angina

2) unstable angina

3) variant angina

  1. stable angina is chest pain with physical exertion or stress
    • is usually relieved with nitroglycerin
  2. unstable angina is chest pain not related to exercise
    • not usually relieved with nitroglycerin and indicates a worsening situation
  3. variant angina is from coronary artery spasm
    • may see ST segment elevation and client can still be considered stable

19
Describe:

Coronary artery disease

Coronary artery disease is plaque (fatty deposits) in the arteries that puts the client at high risk for myocardial infarction and other heart diseases.

20
Treatment:

Coronary artery disease

  • remove plaque with cardiac procedures
  • medications
    • nitrates
    • antilipidemics

21
Teaching:

Coronary artery disease

Teach about lifestyle changes:

  • stop smoking
  • limit alcohol
  • cardiac diet
  • mild to moderate daily exercise
  • decrease stress

22

Describe the difference between right-sided heart failure and left-sided heart failure.

Heart failure is the back-up of fluids in the body:

  • Right-sided heart failure causes peripheral edema
  • Left-sided heart failure causes back up of fluids in the lungs

23
Signs and symptoms:

Right-sided heart failure

Signs and symptoms of right-sided heart failure:

  • weight gain and edema
  • jugular vein distention
  • increased blood pressure and bounding pulse

24

What is this?

Pitting edema: a symptom a right-sided heart failure.

It can be 1+, 2+, 3+, or 4+.

25

What is this?

Jugular vein distention: a symptom of right-sided heart failure.

26
Signs and symptoms:

Left-sided heart failure

Signs and symptoms of left-sided heart failure:

  • pulmonary edema (fluid back-up in the lungs)
  • dyspnea and tachypnea
  • crackles in the lungs

27
Interventions:

Heart failure

Interventions for heart failure:

  • diuretics
  • fluid and salt-restricted diet
  • assess BNP lab (should decrease as client recovers)
  • obtain weight daily; strict intake and output
  • sleep sitting up

28
Interventions:

Pulmonary edema

Immediate complication

Goal is to get rid of extra fluids and maximize oxygen intake:

  • high-Fowler's position
  • give oxygen
  • diuretics and morphine (morphine eases breathing)
  • foley for strict intake and output

29

What is the last resort treatment for pulmonary edema?

Immediate complication

Intubation and placed on a ventilator

30
Describe:

Cardiogenic shock

Immediate Complication

Cardiogenic shock is low blood pressure caused by damage to the heart that impairs pumping ability. 

It can be from myocardial infarction, tamponade, or heart failure.

31
Describe:

Cardiac tamponade

Immediate complication

Cardiac tamponade is when the space around the heart fills up with fluid.

32

What are the characteristic signs and symptoms of cardiac tamponade?

  • muffled heart sounds
  • narrowing pulse pressure (the difference between systolic and diastolic)
    • less than 40 is very concerning

33
Treatment:

Cardiac tamponade

Immediate complication

pericardiocentesis - removal of fluid around heart with a needle.

34
Describe:

Valvular heart disease

Valvular heart disease is when the heart valves cannot open or close completely. The blood doesn't stay going in one direction, called regurgitation. It causes fatigue in the client.

Client is high risk for blood clots.

35
Treatment:

Valvular heart disease

Treatment for valvular heart disease:

  • possible valve replacement
  • will need prophylactic antibiotics before any surgery or invasive procedure, including dental work

36
Teaching:

Valvular replacement surgery

  • will be on anticoagulants
  • good oral hygiene to prevent endocarditis
    1. no flossing or electric toothbrush due to bleeding and risk of infection
    2. no dental procedures for 6 months
  • prophylactic antibiotics before invasive procedures

37
Describe:

Deep vein thrombosis (DVT)

DVT is a blood clot in an extremity, usually more common in the calf.

Clients who are sedentary are a higher risk, especially post-operative clients.

 

38
Prevention:

Deep vein thrombosis

Prevention of deep vein thrombosis:

  • anti-embolism stockings
  • sequential compression devices
  • adequate fluid intake
  • ambulation
  • ankle pumps and elevate legs
  • no smoking
  • possible subQ heparin or lovenox

39

What are the characteristic signs and symptoms of deep vein thrombosis?

  • pain when leg is dorsiflexed (positive Homan's sign)
    • don't ask client to do this if DVT is suspected due to clot breaking loose
  • warm and tender skin

40
Interventions:

Deep vein thrombosis

Interventions for deep vein thrombosis:

  • bedrest with bathroom privileges
  • elevate extremity above the heart
  • avoid bending the knee
  • no massage
  • warm, moist compresses
  • measure calf

41
Medications:

Deep vein thrombosis

Meds for deep vein thrombosis:

  • thrombolytics
  • heparin IV
  • warfarin

42
Describe:

Varicose veins

Varicose veins are small broken veins on the surface of extremities due to increased pressure in the veins

43
Interventions:

Varicose veins

Interventions for varicose veins:

  • elevate extremities as much as possible
  • possible sclerotherapy (vein stripping)

44
Describe:

Venous insufficiency

Venous insufficiency is when the veins cannot bring blood back to the heart. 

It is usually caused by chronic hypertension stretching the veins and valves. Clients frequently get ulcers on ankles.

45

What are the characteristic signs and symptoms of venous insufficiency?

  • brown skin from ankle and up to calf
  • ulcers around ankles

Blood is unable to travel back up to heart. Nutrients and oxygen are unable to reach lower legs.

 

46
Interventions:

Venous insufficiency

  • "Elevate vEins" - keep the legs elevated to promote blood flow back to the heart
  • wear compression stockings
  • possible wound care for ulcers

47
Describe:

Peripheral arterial disease

Peripheral arterial disease is occlusion of the arteries due to atherosclerosis (plaque buildup). 

 

48

What are the characteristic signs and symptoms of peripheral artery disease?

Intermittent claudication - pain in the muscles due to low blood supply.

49
Interventions:

Peripheral artery disease

  • "dAngle Arteries" - keep the legs below the level of the heart to promote blood flow to lower legs
  • possible surgery to remove plaque
    • PCTA, angioplasty, atherectomy, bypass surgery

 

50
Describe:

Raynaud's phenomenon

Raynaud's phenomenon is poor circulation which causes pain and a red, white and blue color in the extremities.

The cause is unknown but is associated with cold weather, stress and more common in women.

 

51
Describe:

Buerger's disease (Thromboangiitis obliterans)

Buerger's disease is poor circulation which causes pain and a purple color in the extremities.

The cause is unknown but is associated with smoking and more common in men.

52

What are the interventions for both Raynaud's phenomenon and Buerger's disease?

  • stop smoking
  • wear warm clothes
  • vasodilator medications 

53
Describe:

Aortic aneurysm

Immediate complication

An aortic aneurysm is stretching of the arterial wall in the abdomen.

If it ruptures the client will experience pain, difficulty breathing and signs of shock.

54

What is an AAA resection (abdominal aortic aneurysm resection)?

An AAA resection is when a graft is placed where there is an aneurysm.

55
Describe:

Hypertension

Hypertension is blood pressure greater than 120/80.

  • consistently high blood pressure can cause damage to the kidneys, eyes, brain and heart vessels.

This can lead to kidney failure, blindness, stroke, heart damage, and amputations.

56
Risk factors:

Hypertension

Risk factors for hypertension:

  • smoking
  • increased age
  • family history
  • obesity
  • stress

57
Teaching:

Hypertension

Teaching for hypertension:

  • encourage healthy diet, exercise, and no smoking
    • avoid excess sodium and MSG
    • avoid canned foods
  • decrease stress
  • antihypertensives

58

What do the following cardiac conditions all have in common?

  • pericarditis
  • myocarditis
  • endocarditis

The are all inflammatory and infectious diseases of the heart.

59

What are the general interventions for inflammatory heart diseases?

  • monitor for and prevent infections
  • antibiotics
  • assess for heart failure, dysrhythmias, cardiac tamponade and treat if these complications occur