Cardiovascular & Hematology/Lymphatic Study Guide Flashcards
Venous stripping for Varicose vein
S/S, Complications, Patient education, Treatment, Risk factors and Nursing Care
Varicose vein
Signs
- The main sign of varicose veins in the legs is the appearance of dark, tortuous superficial veins that become more prominent when the person stands and appear as dark protrusions.
- These superficial veins can sometimes rupture, causing a varicose ulcer.
Symptoms
- Internal or deep varicose veins cause symptoms such as pain, fatigue, a feeling of heaviness, and muscle cramps.
Complications
- These superficial veins can sometimes rupture, causing a varicose ulcer.
Patient Education
- The client needs teaching about measures that promote venous drainage to avoid the need for possible surgery.
- If surgery is necessary, apply antiembolism stockings to the leg postoperatively, and elevate the foot of the bed to encourage venous return.
- Aspirin is often the drug of choice because of its anticoagulant action.
- Early ambulation is important after surgical treatment.
- Often, the client must ambulate as soon as they recover from anesthesia.
- The client may be alarmed at the idea of walking so soon after the operation, while the legs are stiff and sore, and they will most likely need reassurance and an explanation of the need for moving about.
- The order is often written for the client to walk 5– 10 min each hour during the day and several times at night.
- Assist and encourage the client to follow this regimen.
- Instruct the client how to apply antiembolism stockings correctly and to avoid knee-high stockings and socks with elastic tops.
- If weight reduction is suggested, the clinical dietitian will give instructions.
Treatment
- Treatment includes elevating the legs for a few minutes at 2- to 3-hour intervals throughout the day.
- It also includes avoiding constriction, standing for long periods, or restrictive clothing.
- The client should wear support hose.
- All measures aim at promoting venous return from the legs.
Risk Factors
- Predisposing factors include heredity and weakening of the vein walls resulting from prolonged standing, poor posture, repeated pregnancies, round garters, obesity, tumors, HTN, and chronic diseases of the liver or kidneys.
- Varicose veins may also result from thrombophlebitis.
- Women are more commonly affected with varicosities of the legs than men, especially if they have had several pregnancies.
Nursing Care
- Elevate the legs while sitting.
- Be sure to walk and to avoid standing still in one place for any length of time.
- Avoid sitting for a lengthy time.
- Learn how to apply antiembolism stockings correctly.
- If possible, lose weight.
- Do not use tobacco.
What are the stages of paralysis in hemiplegia?
Generally, hemiplegia progresses through three stages:
-The flaccid stage, in which the affected side exhibits numbness and weakness
-The spastic stage, in which muscles are contracted and tense and movement is difficult
-The recovery stage when therapy and rehabilitation methods are most successful
Nursing Interventions in Coronary Artery Disease; Risk patients for CAD, Preventing instructions against CAD
Nursing Interventions
-Although a familial tendency toward the disease seems to exist, anyone can be affected.
-A familial lifestyle that includes exercise, nutrition, and nonsmoking is known to positively affect the individual’s risk for CAD.
-Therefore, all people should take precautions from an early age.
Risk patients (Patients at risk?)
-CAD typically develops over decades and can be unnoticed until the individual has a myocardial infarction.
-During the early middle years, more men than women are affected.
-However, after menopause, women’s risk is increased
Preventing instructions against CAD
-In addition, health promotion and disease prevention activities have focused on measures to reduce the risk factors for developing CAD, which include the following:
-Smoking tobacco
-Increased levels of cholesterol and lipids in the bloodstream
-Physical inactivity
-Obesity
-Diabetes
What are Nursing Interventions for an Angiogram?
**Ask the client if they have allergy to shellfish or iodine before performing any test using radiopaque dye. The dye can cause a severe anaphylactic reaction.
**Client must sign an informed consent before tests are done because they are considered to be invasive, uncomfortable, and carry some risk.
Nursing Considerations (before procedure):
-Make sure the patient is NPO before the procedure.
-Offer a sedative 30 min - 1 hour before the procedure.
-Ask client void before procedure.
Nursing Considerations (after procedure):
-Watch for signs of allergic reaction: rapid pulse, diaphoresis, shakiness, skin rash, decreased blood pressure.
-Offer ice packs for discomfort.
-Keep client on bed rest until they are fully awake.
-Keep client flat up to 8hr to help with swelling, bruising, and bleeding of site.
-Closely observe the site of insertion for bleeding.
-Check peripheral pulses distal from site.
-Monitor vitals.
-Check for color, warmth, assess motor, and sensory function of extremity.
S/S , and Patient Education for Sickle cell disease
Sicke Cell Disease: a genetic disease in which the person’s RBCs become crescent or sickle shaped.
Signs & Symptoms
- Episodes of acute pain (abdomen, thoracic, muscles and bones)
- Jaundice, dark uring and low grade fever
Patient Education
- Teach the importance of hydration, rest and nutrition
- Appropriate analgesia is important due to episodes of severe pain
Purposes of bleeding time test, PT, PTT
Bleeding Time
- Also known as Aspirin Tolerance Test, Duke Bleeding Time & Ivy Bleeding Time
- a screening test used to detect platelet disorders, evaluate capillary defects and determine the client’s ability to stop bleeding.
- Normal bleeding time is 3-8 min in adults.
Prothrombin Time (PT)
- Amount of time it takes for the blood to clot, generally given in seconds.
- Commonly used to monitor success of oral anticoagulation therapy using Warfarin sodium (Coumadin)
Partial Thromboplastin Time (PTT)
- Test used to monitor the pathway of clot formation
- Used to identify deficiencies of the clotting factors, prothrombin and fibrinogen
- Used to monitor heparin anticoagulation therapy
Description of different states/types of abnormal cardiac rhythm
Cardiac Arrhythmia or dysrhythmia is an irregularity in the heartbeat’s rhythm.
Three most common arrhythmias are as follows:
-Sinus Tachycardia: heartbeat is greater than 100 beats per minute
-Sinus Bradycardia: heartbeat is less than 60 beats per minute
-Premature Ventricular Contraction: irregular ventricular rhythm
Indications/Purposes/Description/Nursing Intervention for: (pages 1436-1438)
Blood lipase
- lipase blood test to find out how your pancreas is doing (from google)
Serum Electrolytes - measures levels of the body's main electrolytes (from google) Electrocardiogram or ECG - Graphic record or tracing that represents the heart’s electrical action. - Tell the client the test is painless and must lie very still Echocardiogram - Uses sound waves to produce a three dimensional view of the heart and its blood flow. - assess the heart size and detect the presence of excess fluid, distention or atrophy of heart chambers Cardiac Catheterization - Performed to obtain information about congenital or acquired heart defects, measure oxygen concentration, determine cardiac output or assess the status of the heart’s structures and chambers. - Ask if client is allergic to iodine, shellfish or contrast media. - Signed consent form and client is NPO at least 6 hours before procedure
Signs of internal bleeding/evidence of abnormal bleeding.
- Restlessness
- Rapid pulse and a drop in blood pressure
- Unusual pallor (unhealthy pale appearance)
- Headache
- Signs of stroke
- Joint pain and swelling
- Hematuria (the presence of blood in a person’s urine)
- Hematemesis (is a very dangerous condition in which a person bleeds internally, and vomits as a result
- Blood in the stool
- Shock
Cardiomyopathy- description, types, s/s, management and occurrence
Cardiomyopathy: Is a chronic, significant condition that occurs when the heart muscle is abnormal and prevents the heart from being an effective pump.
S/S: Arrhythmias, poor cardiac output, and hypertension
Tx: Furosemide (lasix): Cardiac blood flow and reduces pulmonary and dependent edema.
Vasodilators: Relax the arteries, lower blood pressure, and decrease the workload of the left ventricle.
**If disease progresses despite medical treatment, surgically implanted devices may be beneficial, sometimes a heart plant may be necessary.
3 main types:
-Dilated or congestive cardiomyopathy: Most common form of this disorder. Heart activity becomes enlarged or dilated, and usually the condition progresses to heart failure. Dilation of the heart muscles affects the force of the muscle contraction, which results in poor cardiac output and diminished blood flow within the heart and to the pulmonary arteries. Arrhythmias and blood clots may also be problematic because blood flows more slowly through an enlarged heart.
-Hypertrophic cardiomyopathy: Hereditary in more than half of those diagnosed. The left ventricle hypertrophies, which may decrease the flow of blood from the left ventricle into the aorta. It may also cause mitral valve leakage.
S/S: include dyspnea, dizziness, and angina. Some people have arrhythmias. Often, a heart
murmur can be heard.
Tx: beta-blocker or calcium channel blocker, antiarrhythmics, as needed, or surgical treatment if medication treatment fails.
-Restrictive cardiomyopathy: The less common form of the disease. The ventricles of the heart become rigid,making it difficult for blood to flow.
S/S: Fatigue, dyspnea on exertion, peripheral edema, hypertension, . Another disease process usually causes this type of cardiomyopathy.
Tx: Anticoagulants and antiarrhythmics can help. Specific types of treatment relate to the symptoms of cardiomyopathy. Numerous medications are available to treat symptoms
Nursing care for patient with pacemakers and patient education
An electric pacemaker may be used to provide external stimulus to the heart. The electronic pacemaker stimulates heart contractions by means of wires connected to electrodes, which are inserted into the heart. It may be external which is generally temporary, or internal, which is considered necessary for life sustaining cardiac rhythms.
Nursing care:
-Use latex gloves when handling pacemaker terminals or generators to prevent electrical shock.
Critical Observation period is 3 days after the pacemakers insertion:
● Routine post op care
● Check all electrical equipment in the room for grounding.
● Carefully check the client’s pulse, cardiac rhythm, and rate. Heart Rate should correspond to the setting of the pacemaker. Report any deviation at once.
● Observe for neck vein distention or muffled heart sounds, which could indicate heart tamponade. These are serious signs that must be reported at once.
● Use sterile technique and keep the incision site clean to avoid infection.
● Provide active or passive ROM exercises and incentive spirometer treatments to prevent complications.
● Reassure the client, who may find adjusting to dependence on the pacemaker difficult.
Patient education:
-Internal pacemakers require a battery replacement every 5-10 years.
-If a client has s/s of dizziness, lightheadedness instruct to move at least 6ft away from light source of any electrical interference.
-Client should wear medic alert id band
-Teach clients how to count pulse and deviation at once.
Different Abnormal conditions causing CVS Disorders and the terms used
● Arteriosclerosis: Applies to several pathologic conditions in which the walls of the arteries thicken, harden, and lose elasticity.
● Atherosclerosis: The most common type of arteriosclerosis, characterized by fatty deterioration of the arterial smooth muscle walls.
● Hypertension: High blood pressure, the condition of the heart and blood vessels has the greatest effect of blood pressure. Hypertension is a leading cause of MI cardiac damage, kidney damage, heart failure, and stroke.
● Hypotension: Low blood pressure. Causes of hypotension can be classified under one or three mechanisms: a heart rate problem, a heart muscle or pump problem, or a volume problem.
Management, patient care and s/s of Raynaud Phenomenon
A group of vasoplastic arterial diseases in which the arteries have periodic narrowing or spasmodic constriction. It especially affects fingers and toes; often only fingers.
Primary or idiopathic raynaud disease occurs without other illness.
Secondary or raynaud syndrome usually occurs in conjunction without another illness. Affects young women.
S/S: Blanched and cold extremities, numb and prickly eventually turn blue and painful.
Cyanosis, ulcers, tight and shiny skin. Fingernails become deformed and may also develop gangrene.
Tx & Nursing considerations:
-Avoid chilling at all times.
-Wear warm clothes
-Avoid emotional upsets
-Smoking is contraindication
-Sympathectomy may be necessary
-Meds to relieve spasms of arteries and dilate blood vessels provide considerable relief.
Diagnosis of CHF- Tests needed
Congestive heart failure: Occurs when ventricular action and valves of the heart are inadequate and fail to maintain cardiac function that is, the work of pumping blood efficiently throughout the body.
Tests:
● Ekg: Used to assess the severity of symptomatic and asymptomatic cardiac disease.
● X-ray:
-Angiocardiogram: An x-ray study of the heart and major vessels performed after injection of a radiopaque dye into a vessel.
-Arteriogram: An x-ray study of an artery.
● Echocardiography: A graphic record or tracing that represents the hearts electrical action. Provides: rate, rhythm, and presence of certain disorders of the heart.
● Cardiac catheterization: Performed to obtain information about congenital or acquired heart defects, measure oxygen, concentration, determine cardiac output, or assess the status of the heart’s structures and chambers.
Iron deficiency anemia- indications, and nursing interventions
Signs and Symptoms of Anemia:
• Fatigue
• Dizziness and weakness
• Hypotension
• Rapid pulse
• GI complaints
• SOB
• Symptoms of heart failure
• Bone pain and sternal tenderness
• Menstrual problems / male impotence
• Decreased RBCs , hemoglobin, and hematocrit
Iron deficiency anemia- Most Prevalent type in all age groups, but occurs most often in women, young children and older adults.
Causes: inadequate absorption or excessive loss of iron ex: excessive bleeding over period of time, like a gastric bleed or abnormal vaginal bleeding. Primary causes are trauma, excessive menses, bleeding from GI tract, pregnancy, or diet that lacks iron. The diet deficiency is most common in adolescent and elderly populations
Treatment: treating site of blood loss(vaginal bleed or GI bleed), increasing dietary intake, supplemental Iron.
Nursing Interventions when administering Iron:
• Give liquid iron with a straw
• If a droplet type, give droplet with dropper placed at back of the tongue followed by juice or water
• Give oral iron with meals to counteract possible metallic taste
• Mix iron preparation with orange juice, fruit juice, tomato juice as Vitamin C helps with the absorption of iron
• Iron staining on teeth can be removed with Hydrogen peroxide or baking soda
• Iron supplements can cause constipation and black stools. Stool softeners help alleviate this
• Iron can administered IM if orally is not feasible. Always change needle and only inject into outer quadrant of buttock IM , may use Z track method
