Cardiovascular Flashcards
(114 cards)
1
Q
what is pericarditis
A
inflammation of the pericardium - the sac that encloses the heart
caused by infective organisms:
- bacteria
- virus
- fungi
chest pain the client experiences is causd by inflamed pericaridum rubbing against the myocardium
2
Q
percarditis manifestations
A
sharp substernal chest pain
- often relieved by sitting upright and leaning forward
pain is worse when lying down in a supine position or when they cough
- pericardial rub is present
listen to pericardial rub by using the bell of the stethoscope over the left lateral sternal broder
- you’ll hear one systolic sound and 2 diastolic sounds
- scratchy, grating or squeaky sound
other findingds:
- fever
- sweating
- chills
- dysrthyhmias
cannot lie flat without severe chest pain or shortness of breath
3
Q
percarditis diagnostic studies
A
studies and lab tests will be prescribed to monitor for:
leukocytosis
increased ESR
positive blood cultures that indicate that infection is present
positive antinuclear antibody
12 lead ECG and changes in ST segment elevation
echocardiogram
4
Q
percarditis care pharmacological interventions
A
antiinflammatory:
- NSAIDs
- corticosteroids
antibtiotics - if symptpoms are caused by an infection
analgesics: pain relief
aspirin and anticoagulants should be AVOIDED
surgical intervention may be necessary
- emergency percardiocentesis will be performed if cardiac tamponade develops
5
Q
cardiac tamponade
A
when extra fluid builds up in the space around the heart
6
Q
percarditis management
A
manage pain and anxiety
position in semi-fowlers or high fowlers
administer analgesics
monitor for complications:
- dysrhythmias
- HR
auscultate BP carefully to detect pulsus paradoxus
- a sign of cardiac tamponade
ensure that percardiocentesis tray is ready
initially monitor for: resp status cardiovascular status renal status - every 1-2 hours
7
Q
pulsus paradoxus
A
change in BP with inspiration
to obtain pulsus paradoxus:
- palpate BP and inflate cuff above systolic pressure
- then deflate the cuff gradually and note when sounds are present on expiration
- then note when sounds are audible on inspiration
- then subtract the inspiratory pressure from the expiratory
> 10mmHg is an indication of cardiac tamponade
8
Q
what is infective endocarditis
A
infection of the:
- endocardium
- heart valves
- heart valve prosthesis
9
Q
infective endocarditis risk factors
A
prosthetic heart valves
hospital acquired bacteremia
IV drug use
congenital heart disease
hemodialysis
rheumatic fever
10
Q
infective endocarditis manifestations
A
new or worsesning systolic murmur
fever
chills
night sweats with source of infection
athralgia
- pain in one or more joints
myalgia
- pain in one or more muscles
fatigue
malaise
anorexia
neurologic symptoms if stroke due to embolus
petechiae of teh skin
splinter hemorrhages under nails
Oslers nodes
janeways lesions
Oslers nodes present with tenderness, while JAneway leasions do not
11
Q
infective endocarditis diagnostic studies
A
health hx
evelated WBC
positive blood
elevated CRP and ESR
TEE can show vegetation on valve which indicates endocarditis
12
Q
infective endocarditis care
A
IV antibitiocs
- administered typically for 6 weeks
- or until infection resolves
antipyretics used to control fever
O2 administered to prevent tissue hypoxia
surigcal intention may be necessary to replace the valve that doesn’t respond to antibiotics
13
Q
infective endocarditis management
A
monitor response to antibiotics
arrange for long term venous access for Iv antibiotics like PICC
explain to client and family for long term IV antibiotic therapy
prophylactic antibiotics before dental work and other invasive procedures
report any:
- fever
- tachycardia
- dyspnea
- shortness of breath
14
Q
what is rheumatic endocarditis/rheumatic fever
A
acute inflammation condition that can involve all layers of the heart
when RF becomes chronic
- results in scarring and valvular damage
- referred to as rheumatic heart disease
15
Q
rheumatic endocarditis/rheumatic fever manifestations
A
streptococcal pharyngitis
- sore throat with tonsillar exudate
- swollen lymph nodes
- hedache
- fever
warm and swollen joints
- polyarthritir
- usually in elbows
- wrists
- knees
- ankles
high fever
chills
malaise
shortness of breath or chest pain
chorea
- emotional instablity
- muscle weakness with quick, jerky movements
- usually in the hands, face, feet
erythema margniatum
- ring like or snake-shaped rash on trunk or extremities
elevated temp up to 104 farenheit
16
Q
rheumatic endocarditis/rheumatic fever diagnostic studies
A
increased ASO titer
increased ESR
positive throat culture for streptococci
increased WBC count
17
Q
rheumatic endocarditis/rheumatic fever care pharmacological interventions
A
analgesics ordered for pain and inflammation
antibiotics
O2 to prevent tissue hypoxia
18
Q
rheumatic endocarditis/rheumatic fever management
A
provide or reinforce education about all tests and treatment
instruct client to resume ADLs slowly and schedule rest periods
observe reaction to antibiotics
monitor adherence to meds
avoid exposure to people with upper resp infection
instruct to report symptoms of pharyngitis
- sudden sore throat
prevent falls
monitor for cardiac complications
19
Q
what is mitral stenosis
A
mitral valve thickens and gets narrower
- blocking blood flow from the left atrium to left ventricle
20
Q
mitral stenosis manifestations
A
in early mitral stenosis
- will present with a mild, asymptomatic heart murmur
in moderate to severe stenosis
- experience symptoms of left sided HF,
- due to blood backing up into lungs and decredased cardiac output
other:
- exertion
- cough
- orthopnea
- weakness
- fatigue
- palpitations
- weight gain due to fluid retention
also common on propping up on pillows to sleep or sleeping in a recliner
paroxysmal nocturnal dyspnea
- sudden waking due to shortness of breath
21
Q
mitral stenosis diagnostic studies
A
physical exam
12 lead ECG showing ventricular enlargement
echocardiogram evaluating valve function
CT scan with contrast
cardiomegaly showing cardiac enlargement
22
Q
mitral stenosis pharamcological interventions
A
diuretics
oxygen
ACE inhibitors
beta blockers
low sodium diet
exercise as tolerate
surgery may be necesssary to repair or replace the mitral valve in event of recurrent episodes of heart failure
23
Q
mitral stenosis nanagement
A
similar care to HR
may require antibiotics BEFORE dental care or other invasive procedure
24
Q
what i mitral valve regurgitations
A
when damaged mitral valve allows blood from left ventricle to flow back into the left atrium during ventricular systole
to handle backflow, the atrium and left ventricle will enlarge over time
most cases of MVR care caused by:
- MI
- RF
- IE
25
mitral valve regurgitation manifestation
```
orthopnea
dyspnea
fatigue
weakness
weight loss
```
chest pain
palpitations
high pitched, blowing murmur that may radiate to armpit
jugular vein distention
peripheral edema
hepatomegaly
26
mitral valve prolapse
leaflets of the mitral valve buckle back into the left ventricle during systole
27
mitral valve regurgitations diagnostic studies
med hx and physical exam
chest x ray
CBC
12 lead ECG
echocardiogram or TEE
cardiac catheterization
28
mitral valve regurgitation pharamacological interventions
prophylactic antibiotic therapy
sodium restriction
drug therapy to control HF
drug therapy to control dysrhythmias - beta blockers
drug therapy to prevent embolization - anticoagulants
29
mitral valve regurgitation management
stay hydrated
avoid caffeine and aclohol
exercise regularly
reduce stress
similar to care of HR
30
what is aortic stenosis
aortic vavlve narrows, obstructing blood flow from the left ventricle to the aorta ana drest of body
often leads to:
- left sided HF
- ventricular hypertrophy
- cardiomyopathy
aortic stenosis does increase with age
31
aortic stenosis manifestations
classic triad:
- dyspnea
- syncope
- angina
fatigue
palpitations
left sided HF
orthopnea
paroxysmal nocturnal dyspnea
crackles in lungs
systolic murmur
- loud murmur in early systole
- listen by using diaphragm of the scope with pt in supine
fourth heart sound
- sounds like a gallop, low frequency sound
- listen using bell pressed lightly on the skin of chest in supine position
32
aortic stenosis diagnostic studies
physical and med hx
chest X-ray
CBC
12 lead ECG
echocardiogram or TEE
cardic catheterization
surgery may be needed to repair the valve or to replace it for severe, recurrent episodes of HF
33
aortic stenosis management
very similar care of HR
if client had valve surgery:
- monitor for hypotension and dysrhythmias
- teach long term anticoagulant therapy
34
what is aortic insufficiency/regurgitation
occurs when blood flows back into the left ventricle during diastole
leads to overloading the ventricle and causing it to hypertrophy
blood overloads the left atrium and eventually the pulmonary system
35
aortic insufficiency/regurgitation manifestations
uncomfrtable awareness of heartbeat
palpitations
dyspnea with exertion
orthopnea
paroxysmal noctural dyspnea
cough
fatigue and syncope with exertion or emotion
anginal chest pain unrelieved by sublingual nitroglycerin
nail beds appear to pulsating
Quinckes sign
- when you press down the nail tip, the root of your nail will show that it is pulsating
high pitched diastolic murmur at the third or fourth intercostal space, left sternal border
widened pulse pressure
pulsus bisferience
- double beat pulse
- palpated over the carotid or brachial artery
36
aortic insufficiency/regurgitation management
similar care to HF
if client had valve surgery, monitor for hypotension and dysrhythmias
37
factors affecting myocardial infarction mortality
timeliness of activating emergency response system
initation of CPR including use of an AED
number and location of occluded coronary vessels
previous MI
presence of cardiogenic shock adnvaced age
gender: females have higher mortality
38
myocardial infarction manifestations
persistent, crushing, substernal chest pain
pain may radiate to left arm, jaw, neck nd shoulder blader
feeling of impending doom that will not resolve with rest
39
clues that suggest "ilent" MI
```
HF
change in mental status
unexplained abdominal pain
dyspnea
fatigue
```
40
myocardial infarction diagnostic studies
serum cardiac markers will be elevated
CK-MB rises in 4-6 degreees within 3-6 hours
- peaks in 18-24 hours
LDH appears in 12-24 hours
- peaks in 48-72 hours
- lasts 6-12 days
troponin peaks 4-12 hours
- remaines elevated for up to 3 weeks
41
myocardial infarction pharmacological interventions
MONA
assess vital
12 led ECG
time is muscle so resolve symptoms quickly
enforce bedrest with bathroom priveleges
- activity should be slowly increased as long as client remains hemodynamically stable and free of chest pain
administer:
-antiplatelet/anticoagulants
nitrates
narcotics
beta blockers
- decrease myocardial tissue oxygen
diuretics
- if pulmonary edema occurs
sedatives
antiarrhythmias
stool softeners
- straining can cause vagal stimulation, producing bradycardia and dysrhythmias
"OH BATMAN"
42
myocardial infarction management
vitals
daily weights
intake and output
tPA can be given to dissolve the thrombus in coronary artery and reperfuse the myocardium
induce hypothermia in cardia arrest survivior ASAP after return of spontaneous circulation
- target temp: 32-34 Celsius (89.6 - 93.2 farenheit)
monitor for abnormal heart sounds, esp S3 and gallop
apply antiembolism stockings and tretments
check for cough, tachypnea, crackles
ECH should be continuous
reinforce GRADUAL reconsumption of sexual activity
collarbote with dietitician
43
risk factors for heart failure
heart infection
- endocarditis
- myocarditis
infiltrative disorders
- amyloidosis
tumors
sarcoidosis
collagen-vascular disease
- systemic lupus erythematosus
dysrhythmias that reduce cardiac filling time
disorder that increase cardiac workload
- anemia
- hyperthyroidism
44
right sided heart failure manifestations
weight gain
jugular vein distention
bilateral dependent peripheral edema
liver enlargement
- hepatomegaly with abdominal pain
- anorexia
- nausea
ascites
45
left sided heart failure manifestations
fatigue
cough - often initally dry
mild weight gain
shortness of breath
orthopnea
```
paroxysmal nocturnal dyspnea
tachypnea
crackles
third heart sound
cardiac cachexia
mucle weakness
```
frothy sputum - blood tinged
```
restlessness
irritability
hostility
agitation
anxiety
```
prominent crackles throughout lung fields
diaphoresis
cyanosis
46
heart failure diagnostic studies
med and physical exam
echocardiogram
labs:
- CBC
- electrolytes
- BNP
chest x-ray
ECG changes and/or dysrhythmias
nuclear imaging
- to determine myocardial contractility
hemodynamic monitoring
- BP
- pulmonary artery pressure
- pulmonary artery wedge pressure
- cardiac output
47
heart failure pharamacological interventions
nitrates
diuretics
ACE inhibitors and vasodilators
- to reduce afterload
inotropones
- digoxin
beta blockers
- metoprolol
- carvedilol
antidysrhythmics
anticoagulation therapy
" DOABLE"
if client has prosthetic valve or afib, administer and titrate anticoagulants using PTT for heparin and INR for Warfarin
48
heart failure management
maintain adequate tissue oxygenation
maintain adequate cardiac output
prevent excess fluid volume
manage clients activity intolerance
prevent episodes of acute decompensated HF
ensure clients adherence to med regimen
include clients family in planof care
managing heart failure is complex and emotionally draining
- nurse goal is to support the clients quality of life while lliving with HF
49
heart failure health promotion
```
report:
weight gain
worsening dyspnea
ortopnea
fatigue
```
exercise is important
- start low and go slow
adhere to cardiac medication
low sodium diet
long term anticoagulation therapy
50
what i hyperlipidemia
elevation of liipids in the bloodstream
LDL and cholesterol will be increased
HDL will be decreased
51
hyperlipidemia care
diet that eliminates trans fats and cholesterol
eat whole grains and foods rich in omega 3 fatty acids
-can improve LDL and HDL
meds such as:
-statin
- bile acid sequenstrates
0 niacin may be prescribed
52
hyperlipidemia management
identify client is high risk
```
address modifiable risk factors for CAD
- level of physical activity
- dietary pattern
0 diabetes
- BP
- weight
```
ensure clients adherence to lipid lowering pharmacotherapy
53
what is hypertension
SBP is 140 or higher and DBP is 90 or greater on at least 3 separate occasions
most common complication: target organ diseases including the kidneys
goal of treatment is to maintain a BP of 130/85 and control other CVD risk factors
DASH eating plan
54
risk factors for primary hypertension
fam hx of hypertension
African Americans
Hispanics
Native Americans
stress levels
obesity
diet high in sodium
- should now only limit to 2g/day
use of tobacco
sedentary lifestyle and lack of exercise
older age
55
risk factors for secondary hypertension
renal disease
- renal artery stenosis
- glomerulonephritis
- end stage kidney disease
```
drugs:
- stimulants: cocaine, ephedrine
-immunosuppressants
-contraceptive hormonal
0 excessive alcohol consumption
```
cushings syndrome
- increased levels of stress hormone
pregnancy related hormones
neurologic disorders
- brain tumors
- traumatic brain injury
coarctation of the aorta
often referred to as the silent killer because clients are frequently unaware of having high blood pressure
56
risk factors for coronary artery disease
men over age 40
pot menopausal women
clients whose diabetes is poorly controlled
fam history of CAD
uncontrolled high blood pressure
hyperlipidemia
tobacco smoke
second hand exposure
obesity
physical inactivity
stressful lifestyle
57
coronary artery disease manifestations
early stages: asymptomatic
later:
anginal chest discomfort
cardiac symptoms occur when blockage is greater than 70%
chest discomfort
cardic symptoms appear with exertion and resolve with rest
58
coronary artery disease diagnostic studies
stress test will show ST segment changes with exercise
elevated levels of homocysteine, CRP, LDL, cholesterol and triglyceride
reduced levels of HDL
cardiac catheterization with coronary angiography = GOLD STANDARD for diagnosis
- will show areas of narrowing in coronary arteries
59
coronary artery disease pharamcological interventions
nitrates/ coronary artery vasodilators
- nitroglycerin tablets
- oral isosorbide
beta blockers
- reduce myocardial oxygen demand
antiplatelet
- aspirin
antilipemics
- statin drugs
oxygen therapy
60
coronary artery management
keep client on bed rest during acute events
when cardiac symptoms or chest discomfort occur, quickly assess pain, vitals
administer 12 lead ECG and treat with nitrates, oxygen and aspirin and morphine
(MONA)
encourage client to lose excess weight
low fat, low choleterol diet
resume activity gradually as tolerated and encourage client to participate in cardiac rehab program
```
encourage smoking cessation
avoid factors known to cause angina:
- very cold
- very hot weather
- alcohol
- caffeine
-stimulant
```
keep nitroglycerin tablets with you
61
following post cardiac catheterization and coronary angioplasty
maintain heparinization to reduce risk of thrombosis in stent
monitor for chest pain, hypotension, coronary artery spasm and bleeding from catheter site
keep affected leg striaght and immobile for 6-12 hours
check distal pules
administer IV fluids and drink plenty of fluids
assess potassium level and observe for dysrhythmias: ST segment changes
if needed, give atropine and lay them flat
monitor creatinine levels in dye-related kidney injury
62
what is aneurysm
localized outpouching of the artery due to weakness in arterial wall
63
risk factors of aneurysm
```
age
male
hypertension
CAD
fam hx
tobacco use
hyperlipidemia and obestiy
```
smoking is the most important modifiable risk factors
64
aneurysm manifestations
often asymptomatic until it becomes very large or begins to dissect
rupture of an aneurysm is a life-threatening emergency
vague chest pain that may be sudden onset and severe
dyspnea
distended neck veins
pulsatile mass in periumbilical area
auscultatble bruit
- near the belly button
back pain
epigastric discomfort
Grey turners sign
- bluish discoloration of the flank
aka abdominal aortic aneurysm
65
aneurysm diagnostic studies
chest x ray
ultrasound
CT= gold standard for diagnosing and monitoring an aneurysm
66
aneurysm care
identify high risk clients
change modifiable factors
encourage strict adherence to BP management regimen
67
what is raynauds phenomenon
involves a severe constriction of cutaneous vessles followed by vessel dilation, thena reactive hyperemea
blue, white, red
lead to tissue necrosis
68
raynauds phenomenon manifestations
digit necrosis
excruciating pain
autoamputation of distal digits
- tips fall of spontaneously
vasculitis lesions, often around nails beds
69
cardiac tamponade signs
narrowed pulse pressure
hypotension
muffled heart sounds
distended neck veins
70
raynauds phenomenon pharmacological interventions
GOAL: to promote perfusion to affected digits to prevent gangrene and need for amputation
calcium channel blockers
- Nifedipine
- Diltiazem
alpha adrenergic blocking agents
vasodilators
analgesics for pain relief
encourage tobacco cessation
keep extremities warm at all times
71
raynauds phenomenon management
review stress management and lifestyle changes
avoid temperature extremes
protect themselves from cold
72
what are varicose veins
occurs when there is a dilation of superficial veins of the legs and feet
can occur in anyone, but they are common in adults
will complain of pain after long periods of standing
foot and ankles of the affected leg may swell at the end of the day
- will observe for distended leg veins
venography for diagnostic studies
73
varicose veins care
improve and maintain optimal venous return to the heart
prevent disease progression
manage pain
modify risk factors
three E's:
elastic, compression hose
exercise
elevation
severe varicose veins can be treated with sclerotherapy to vein ligation
74
varicose veins management
post-operative: wearing elastic stockings of banadage and elevating the affected leg
teach NOT to:
- cross their legs
- sit or stand for a long time
should elevate their legs as much as possible
75
what is deep vein thrombosis
clot formation in a deep vein
76
DVT risk factors
Virchows triad:
- hypercoaguability
- hemodynmaic changes
- endothelial injury
immobility during/after surgery, long flights or trips in a vehicle
```
hip or knee replacement surgery
sepsis
malignancies
CHF
obesity
pregnancy
```
77
DVT manifestations
unilateral edema of an extremitiy with warmth, tenderness and rendess at the affected site
venography and doppler ultrasound to diagnose
78
DVT care
prevent complications including: pulmonary embolism
pharmacological interventions:
anticoagulant therapy
thrombolytic therapy
surgical thrombectomy may be performed
placing clients with DVT on bedrest is NO LONGER recommended because it increases their risk for additional thrombses
79
DVT management
monitor for symptoms of PE:
- suddent onset of shortness of breath
- chest pain
- decrease in O2 sat
- hemoptysis
monitor effetiveness of prescribed durg with appropriate blood test
80
what is venous stasis ulcers
tend to develop in clients with hronic venous insufficiency and after often chronic and difficult to heal
81
causes of venous stasis ulcers
chronic venous insufficiency
incompetent valves
pressure of blood pooling causing capillaries to leak
ulcers being as a small, inflamed, tender area
any trauma that causes tisues to break
82
venous stasis ulcers manifestations
open skin leison that tend to have an irregular border
skin around ulcer is borwn and leathery
pain at site
83
venous stasis ulcers health promotion
avoid trauma to the affected limbs
| encourage to increase their intake of protein, vitamin C, E and zinc
84
atrial fibrillation managment
ABCD
anticoagulant
- heparin for short term
- Warfarin for long term
beta blocker
cardioversion
- used if beta blocker or calcium channel blocker are ineffective
digoxin
85
supraventricular dysrhythmias management
if client is asymptomatic
- no nursing intervention is needed
```
if symptomatic, then
administer
- adenosine
-calcium channel blockers
- beta blockers
```
procedures may include cardioversion or na ablation
decrease their use of stimulants, such as caffeine and nicotine
reduce alcohol intake
reduce stress and get adequate sleep
86
ventricular dysrhythmias managment
```
administer meds
administer ongoing treatment
O@
provide restful environment
prepare for cardioversion or implantable cardioverter defbrillator
```
do not rely on ECG strip along
87
what is sickle cell disease
normal adult hemoglobin A is partly o completely replaced by abnormal sickle hemoglobin
50% african americans carry the trait
autosomal, recessive genetic disease
88
sickle cell disease manifestations
```
hypoxia
organ dysfunction
- spleen
- liver
- kidney
```
painful exacerbations called crises:
- vasoocclusive --> painful distal ischemia
- sequestrian crisis --> pooling of blood in liver and spleen
- aplastic crisis --> diminished RBC production
- yperhemolytic crisis --> increased destruction of RBC
newborn screening is usually completed or an electrophoresis
89
sickle cell disease pharmacological interventions
push oral fluids
administer isotonic IV - NS
administer O2
analgesics
- opioids are more effective
antibiotics
- prophylaxis with penicillin is recommended
folic acid
high dose IV steroids
90
sickle cell disease management
drink at least 3-4 liters of liquid every day
avoid alcoholic beverages
avoid smoking or using tobacco
contact HCP at first sing of illness
receive influenza vaccine each year
avoid temperature extremes of hot or cold
wear socks and gloves when going outside on cold days
avoid travel to high altitutdes
avoid strenuous physcial activities
engage in mild, low- impact exercise at least 3 times a week when not in crises
91
what is iron deficiency anemia
develops when there is not enough iron available for formation of RBCs
can be a rsult of insufficienct idetary intake of iron, iron malabsorption disease or pregnancy
92
iron deficiency anemia manifestations
generalized weakness and fatigue
light-headedness
inability to concentrate
palpitations
dyspnea on exertion
pallor
tachycardia
dry, brittle, rigid nails
glossitis
angular stomatitis
93
iron deficiency anemia management
iron supplement
- inexpensive and convenienct
- best absorbed when taking with vitamin C, like orange juice
teach that certain form of iron can stain the teeth and GI side effects are common
iron supplmentary can make stool black in color
- should be able to differentiate balck tool and melena which indiated bleeding
94
what is idiopathic thrombocytopenia purpura
autoimmune disorder where platelets are destroyed faster than the body can make them
95
idiopathic thrombocytopenia purpura amnifestations
```
excessive bleeding
petechiae
symptoms of internal bleeding- hypotension
- tachycardia
- pallor
- orthostatic hypotension
- low urine output
- bloody stools
```
96
idiopathic thrombocytopenia purpura diagnostic studies
platelet count and measurement of bleeding
| bone marrow aspiration
97
idiopathic thrombocytopenia purpura pharmacological interventions
corticosteroids
intravenous immunoglobulins
immunosuppression
apheresis to filter antibodies
splenectomy may be required to treat the chronic form of the disease
98
idiopathic thrombocytopenia purpura management
monitor for bleeding episodes
age-approrpaite diversional acitivities
dont participate in contact sports
avoid using aspirin and to substitute acetaminophen to relieve pain
99
what is hemophilia
missing or defective factor VIII or factor IX are mising
x-linked genetic recessive disorder
100
hemophilia manifestations
miild to severe prolonged bleeding most ofte in muscles and joints
- hemarthrosis
long term loss of range of motion affected
101
hemophilia diagnostic studies
hx of bleeding episodes
PTT
array of lab test for specific factor deficiencies
102
hemophilia pharamcological interventions
replacement of missing clotting factors with factor VIII concentrate
desmopression acetate
- antidiuretic aids inf clotting blood
prophylactic treatment
apply pressure to any bleeding site along with ice and rest, elevate and immobilize the affected area
103
hemophilia management
avoid contact sports, falls and other acitivities
wear medical information bracelet
soft toothbrush to avoid bleeding gums
104
aortic valve auscultation
2nd intercostal space to right sternal border
105
pulmonic valve auscultation
2nd intercostal space to left ternal border
106
erb's point auscultation
3rd intercostal space to left sternal border`t
107
tricuspid valve auscultation
4th intercostal space at left sternal border
represents S1 lub
108
mitral valve auscultation
5th intercostal space at left sternal border at midclavicular line
represent S1 lub
also the point of maximal pulse
- client positioned supine or HOB 45 degrees
109
the base of the heart
includes aortic and pulmonic areas
S2 will be loudest at base
aortic and pulmonic murmurs heard at beast at the base with patient leaning forward and sitting up
110
the apex of the heart
includes the tricuspids and mitral areas
S1 will be loudest at apex
S3 and S4 and mitral stenosis murmurs will be heard best at this position with patient lying on their left side with bell of stethoscope
111
nuclear stress test
do not eat or drink or smoke on day of test
- NPO for at least 4 hours
avoid caffeine products 24 hours before test
avoid decaffeinated products 24 hours before test
do not ttka etheophylline 24-48 hours prior to test
if insulin/pills are prescribed for diabetes, consult with HCP about appropriatedose
do not take the following cardiac medications, unless directed otherwise:
- nitrates (nitroglycerin or isosorbide)
- dipyridamole
- beta blockers
112
what is peripheral artery disease
buildup of plaque within the arteries
commonly affects the lower extremities
can lead to tissue necrosis (gangrene)
113
peripheral artery disease management
home management:
- lower extremities below the heart when sitting and lying down
- engage in moderate exercise
like 30-45 minute, twice daily
- perofrm daily skin care with lotion
- maintain mild warmth
lightweighted blankets, socks
NOT heating pads
- stop smoking
- avoid tight clothing and stress
- take vasodilators and antiplatelets
114
complications of cardiac tamponade
allergic reaction to dye
lactic acidosis
- discontinue metformin 24-48 hours before giving the dye
acute kidney injury due to the contrast dye
- look at BUN, creatinine
