Cardiovascular System Flashcards
(309 cards)
1
Q
Blood flow pathway
A
Heart, arteries, arterioles, capillaries, venules, veins, back to heart
2
Q
_________ carry blood away from the heart, while _________ bring blood back to the heart
A
Arteries; veins
3
Q
Membrane that surrounds and protects the heart
A
Pericardium
4
Q
Three layers of the heart wall
A
Epicardium (outer), myocardium (middle), endocardium (inner)
5
Q
Flow of blood through the heart
A
Superior/inferior vena cava, right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic valve, aorta, body
6
Q
Conduction pathway of heart
A
SA node, AV node, bundle of his, L and R bundle branches, purkinje fibers
7
Q
Relaxation of atria and ventricles allowing for filling of blood
A
Diastole
8
Q
Contraction of atria and ventricles ejecting blood
A
Systole
9
Q
The volume of blood in liters ejected from the left ventricle every minute
A
Cardiac output (HR x SV)
10
Q
The number of times the heart contracts in one minute
A
Heart Rate (60-100 bpm)
11
Q
The volume of blood in liters ejected from the ventricle with each heart beat
A
Stroke volume
12
Q
Normal cardiac output
A
4-8 L/min
13
Q
The percentage of blood that leaves the left ventricle each time it contracts
A
Left ventricular ejection fraction (LVEF)
14
Q
Normal LVEF
A
55-70%
15
Q
The volume of blood in the ventricles at the end of diastole that determines the amount of stretch placed on myocardial fibers of heart
A
Preload
16
Q
The peripheral resistance that the left ventricle must overcome in order to push blood into systemic circulation
A
Afterload
17
Q
Amount of pressure exerted on arterial walls during left ventricular contraction
A
Systolic BP
18
Q
Amount of pressure exerted on arterial walls during left ventricular relaxation
A
Diastolic BP
19
Q
Catheter inserted in a small peripheral vein in the arm or hand
A
Peripheral venous catheter
20
Q
Most common type of IV that is 3 inches or less
A
Short peripheral catheter
21
Q
A midline peripheral catheter is between 3 and 8 inches in length and terminates at or below the level of the _________ and distal from the _________
A
Axilla; shoulder
22
Q
Where does the tip of a central venous catheter (CVC) terminate?
A
Superior vena cava right above the right atrium
23
Q
Indications for CVC
A
Long-term antibiotic therapy, TPN, and chemotherapy
24
Q
PICC lines and implantable ports are examples of
A
CVCs
25
Inflammation of the veins
Phlebitis
26
S/S of phlebitis
Erythema, warmth, pain, induration (hardened) vein, red streak
27
Nursing interventions for phlebitis
D/C IV, elevate extremity, apply warm, moist compresses
28
The leakage of IV fluids or medications into surrounding tissues outside the vein
Infiltration
29
S/S of infiltration
Swelling, coolness, dampness, slowed rate of IV infusion, leaking fluid from IV site
30
Nursing interventions for infiltration
D/C IV, elevate extremity, apply warm or cold compresses depending on what was infusing (warm for normal or high pH solutions, cool for low pH solutions)
31
Infiltration with a vesicant agent (medication that causes tissue damage)
Extravasation
32
S/S of Extravasation
Erythema, pain, edema, formation of blisters, necrotic tissues such as slough, ulceration
33
Extravasation nursing care
Stop the infusion, aspirate residual medication, administer antidote, D/C IV, elevate extremity, apply warm or cold compress depending on solution
34
Entrance of air into the venous system from the IV catheter
Air embolus
35
S/S of air embolus
Hypotension, tachycardia, tachypnea, cyanosis
36
Air embolism nursing interventions
Clamp the catheter, place patient in trendelenburg position, administer O2, notify provider
37
Fluid overload nursing interventions
Raise HOB, slow infusion rate, monitor O2 and vitals, administer diuretics as ordered by provider
38
Packed RBCs are infused over ___-___ hours
2-4
39
Fresh frozen plasma is infused between ___-___ min
15-30
40
Fresh frozen plasma should be administered within ___ hours of thawing
2
41
Platelets are infused between ___-___ mins
15-30
42
IV catheter gauge ideal for blood transfusions
18 gauge (20 gauge will also work)
43
Blood transfusion line should ONLY be primed with
0.9% NS
44
T or F: the nurse can administer medications through the blood transfusion line
False
45
If blood is not administered within ___ mins of receiving it, it needs to be sent back to the blood bank
30
46
Blood transfusion nursing care
Take vitals before administration of blood, stay with patient for the first 15 min of administration to make sure they do not have a reaction, take vitals again
47
Transfusion reaction nursing care
Stop the infusion, administer 0.9% NaCl through SEPARATE line
48
Itching, flushing, and urticaria are symptoms of a _________ reaction to blood transfusing
Mild allergic
49
Nursing interventions for mild allergic reaction to blood transfusion
Administration of diphenhydramine (Benadryl)
50
Wheezing, dyspnea, hypertension, and decreased oxygenation are symptoms of an _________ reaction to blood transfusion
Anaphylactic
51
What kind of medications are commonly given for anaphylactic allergic reactions to blood transfusions?
Epinephrine, corticosteroids
52
Fever, chills, hypotension, tachycardia, and tachypnea are symptoms of a _________ blood transfusion reaction
Febrile
53
_________ are anticipated to be ordered for patients with febrile blood transfusion reactions
Antipyretics
54
Fever, chills, and abdominal pain are symptoms of a _________ blood transfusion reaction
Septic
55
Nursing care for septic blood transfusion reaction
Collect cultures and administer antibiotics as ordered
56
What blood transfusion reaction may cause symptoms such as low back pain, fever, chills, tachycardia, tachypnea, and hypotension
Acute hemolytic reaction
57
Acute hemolytic reaction nursing interventions
Collect labs and specimen, give fluids as ordered by provider
58
What kind of blood transfusion reaction may cause symptoms such as dyspnea, tachycardia, tachypnea, crackles, hypertension, and distended neck veins?
Circulatory overload reaction
59
Cardiac enzyme released into bloodstream upon damage to cardiac muscle
CK-MB
60
Normal CK-MB
0%
61
CK-MB will be elevated ___-___ hours after damage to the heart muscle, and it will stay elevated for approximately ___-___ days
3-6; 2-3
62
A protein found in the heart muscle and skeletal muscle
Myoglobin
63
Normal myoglobin should be less than
90
64
Myoglobin will be elevated ___-___ hours after cardiac or skeletal muscle damage and will stay elevated for approximately ___ hours
2-3; 24
65
_________ is the most specific enzyme for identifying ischemia of the heart
Troponin
66
Troponin T should be under _____ and Troponin I should be under _____
0.1; 0.03
67
Troponin T and troponin I will become elevated ___-___ hours after cardiac damage occurs. Troponin ___ will stay elevated for about two weeks. Troponin ___ will stay elevated for 1 week
2-3; T; I
68
Total cholesterol should be less than
200
69
LDL should be less than
130; 100 if high risk for cardiovascular disease
70
HDL should be over ___ for females and ___ for males
55; 45
71
Normal triglycerides for males and females
Males: 40-160
Females: 35-135
72
Normal RBC range for females and males
Females: 4.2-5.4
Males: 4.7-6.1
73
Normal platelet range
150,000-400,000
74
Normal Hgb range for females and males
Females: 12-16
Males: 14-18
75
Normal Hct range for females and males
Females: 37-47%
Males: 42-52%
76
Normal aPTT
30-40 sec
77
Normal aPTT range for clients on heparin
45-80 sec (1.5-2x baseline)
78
Normal PT
11-13 sec
79
Normal PT for clients on warfarin
17-26 sec (1.5-2x baseline)
80
Normal INR
1
81
Normal INR for patients on warfarin
2-3
82
D-Dimer should be less than
0.4
83
A hormone released by the ventricles in the heart in response to fluid overload
hBNP
84
Normal hBNP
<100 (over 100 indicates HF)
85
S/S of fluid volume deficit
Hypotension, tachycardia, tachypnea, weak thready pulses, prolonged capillary refill, low UOP, flattened jugular veins
86
Fluid volume deficit labs
Concentrated blood (increased Hct and osmolarity), concentrated urine (increased BUN)
87
S/S of hypervolemia
Weight gain, edema, hypertension, bounding pulses, JVD, tachycardia, dyspnea and tachypnea, crackles in lungs
88
Fluid volume excess labs
Dilute blood (low Hgb, Hct, osmolarity) and dilute urine (decreased urine specific gravity)
89
Report weight gain of ___-___ lbs in 24 hours or ___ lbs or more in one week
1-2; 3
90
Extracellular electrolyte essential for fluid balance and nerve and muscle function
Sodium
91
Normal sodium range
135-145
92
S/S of hypernatremia
Thirst, agitation, muscle weakness, GI upset
93
Treatment for hypernatremia
Hypotonic solutions such as 0.45% NaCl, diuretics such as furosemide, restrict sodium intake, increase intake of water
94
It is important to SLOWLY correct a patient’s sodium balance in order to prevent
Cerebral edema or seizures
95
S/S of hyponatremia
Confusion, fatigue, N/V, headache
96
Treatment for hyponatremia
Hypertonic solutions such as 2-3% NaCl, increased sodium intake, restrict fluid intake
97
An electrolyte important for bone and teeth formation, nerve and muscle function, and clotting
Calcium
98
Normal calcium range
9-11
99
S/S of Hypercalcemia
Constipation, decreased DTRs, kidney stones, lethargy, weakness
100
Hypercalcemia treatment
0.9% NaCl, calcitonin, dialysis (severe)
101
S/S of hypocalcemia
Positive Chvostek sign, positive trousseau sign, muscle spasms, numbness and tingling in lips and fingers, GI upset
102
Hypocalcemia treatment
Calcium supplements, increased intake in calcium rich foods and vitamin D
103
Electrolyte important in maintaining ICF, and nerve and muscle function
Potassium
104
Normal potassium range
3.5-5
105
S/S of hyperkalemia
Dysrhythmias, muscle weakness, numbness and tingling, N/V
106
Hyperkalemia treatment
Diuretics such as furosemide, Kayexalate, insulin, decreased intake of potassium rich foods (bananas, potatoes, cantaloupe, etc)
107
S/S of hypokalemia
Dysrhythmias, muscle spasms or weakness, constipation, ileus
108
Hypokalemia treatment
Potassium supplements (oral or IV), encourage increased intake of potassium rich foods
109
Electrolyte important for many biochemical reactions in the body and is also needed for muscle and nerve function
Magnesium
110
Magnesium normal range
1.5-2.5
111
S/S of hypermagnesemia
Hypotension, lethargy, muscle weakness, decreased DTRs, respiratory and cardiac arrest
112
Hypermagnesemia treatment
Diuretics such as furosemide, calcium (reverse cardiac effects)
113
S/S of hypomagnesemia
Dysrhythmias (torsades de pointes), tachycardia, hypertension, increased DTRs, tremors, seizures
114
Hypomagnesemia treatment
Magnesium supplements (PO or IV), encourage intake of magnesium rich foods
115
Causes of hypernatremia
Excess sodium intake, Cushing’s syndrome, DI
116
Causes of hyponatremia
Diuretics, kidney failure, diaphoresis, SIADH, hyperglycemia, HF
117
Causes of Hypercalcemia
Hyperparathyroidism, corticosteroids, bone cancer
118
Causes of hypocalcemia
Diarrhea, vitamin D deficiency, hypoparathyroidism, thyroidectomy
119
Causes of hyperkalemia
DKA, metabolic acidosis, salt substitutes, kidney failure
120
Causes of hypokalemia
Diuretics, GI losses (vomiting, NGT suctioning), diaphoresis, Cushing’s syndrome, metabolic alkalosis
121
Causes of hypermagnesemia
Kidney disease, excess intake of antacids or laxatives containing magnesium
122
Causes of hypomagnesemia
GI losses, diuretics, malnutrition, alcohol abuse
123
PH > 7.45
PaCO2 < 35
Respiratory alkalosis
124
Causes of respiratory alkalosis
Hyperventilation (d/t fear, anxiety, etc.), salicylate toxicity, high altitude, shock, pain, trauma
125
S/S of respiratory alkalosis
SOB, dizziness, chest pain, numbness in hands or feet
126
PH < 7.35
PaCO2 > 45
Respiratory acidosis
127
Causes of respiratory acidosis
Hypoventilation — respiratory disorders such as ARDS, asthma, pneumonia, COPD; inadequate chest expansion; respiratory depression with certain meds such as opioids and Benzos
128
S/S of respiratory acidosis
Confusion, lethargy, dyspnea, pale or cyanotic skin
129
PH > 7.45
HCO3 > 28
Metabolic alkalosis
130
Causes of metabolic alkalosis
Antacid overdose, loss of body acid through vomiting or NGT suctioning
131
S/S of metabolic alkalosis
Dysrhythmias, muscle weakness, lethargy
132
PH < 7.35
HCO3 < 21
Metabolic acidosis
133
Causes of metabolic acidosis
DKA, kidney failure, starvation, diarrhea, dehydration
134
S/S of metabolic acidosis
Hypotension, tachycardia, weak pulses, dysrhythmias, kussmaul respirations, fruity breath
135
Metabolic acidosis treatment
Sodium bicarbonate, IV fluids and insulin for DKA, hemodialysis for kidney failure
136
Regular rate and rhythm but with a HR over 100 bpm
Sinus tachycardia
137
Causes of sinus tachycardia
Physical activity, anxiety, fever, pain, anemia, compensation for decrease BP or CO
138
Regular cardiac rhythm but with a HR below 60 bpm
Sinus bradycardia
139
Causes of sinus bradycardia
Excess vagal stimulation, cardiovascular disease, hypoxia, certain medications, athletes (normal and expected finding)
140
Asymptomatic bradycardia does not require treatment, but if the patient is symptomatic they may be administered
Atropine and a pacemaker
141
Rapid and disorganized depolarization of the atria, such that the atria will quiver rather than fully contract
Atrial fibrillation (Afib)
142
Afib increased the risk for
Blood clot formation
143
Afib interventions/treatment
Anticoagulants, cardioversion, antiarrythmics
144
Abnormal electrical circuit that forms in the atria and causes rapid depolarization of the atria (between 250-350 times per min) ; EKG strip reveals sawtooth waves (F waves)
Atrial flutter
145
Atrial flutter treatment
Antiarrythmics, cardioversion
146
Rapid ventricular rhythm (over 100 bpm), no P-waves, wide QRS complexes that occur regularly
Ventricular tachycardia (V-Tach)
147
Causes of V-Tach
Ischemic heart disease
148
Treatment of V-Tach WITH a pulse
Cardioversion, antiarrythmics, correction of electrolyte imbalances
149
Treatment for PULSELESS V-Tach
Defibrillation
150
Rapid, ineffective quivering of the ventricles (will not see P-waves or QRS complexes on EKG strip)
Ventricular fibrillation (Vfib)
151
Vfib treatment
Defibrillation
152
Absence of any ventricular rhythm (flat-line)
Asystole
153
Asystole treatment
CPR
154
Atrioventricular (AV) blocks are typically caused by
Heart disease, MI, certain medication such as BB or digoxin
155
AV block characterized by prolonged impulse conduction time between the atria to the ventricles due to a delay in the AV node; EKG strip will show a long PR interval that is consistent
First-degree AV block
156
AV block characterized by progressive increase in the conduction time between the atria and the ventricles until one impulse fails to conduct at all; EKG strip will show PR intervals that gradually get longer until a QRS complex drops
Second-degree type I AV block (Mobitz I)
157
AV block characterized by sudden failure of impulse conduction between the atria and ventricles without a progressive increase in conduction time; EKG will show a consistent PR interval (consistently long or consistently normal) followed by a dropped QRS complex
Second degree type II AV block (Mobitz II)
158
Treatment for Mobitz II
Pacemaker
159
AV block characterized by complete failure of any conduction between the atria and ventricles; EKG will show no associated between the P waves and QRS complexes
Third degree AV block
160
Third degree AV block treatment
Pacemaker
161
Examples of medications used in chemical cardioversion
Adenosine (NOTE: there may be a brief period of asystole after administration, however, this is normal and expected), procainamide
162
Cardioversion nursing care
Ensure patient has been on anticoagulation for several weeks preceding scheduled cardioversion (d/t risk for dislodging blood clots), ensure all staff is standing clear when shock is delivered, AFTER — maintain patent airway, monitor vitals, monitor EKG, monitor S/S dislodged clot)
163
Pacemaker post-op nursing care/education
Patient’s arm will be in sling, educate patient to avoid lifting their arm above shoulder to avoid displacement of leads, assess insertion site for bleeding and signs of infection, assess for consistent hiccups (indicates pacemaker is pacing diaphragm — notify provider!)
164
Pacemaker patient education
Carry pacemaker ID wherever you go, take pulse daily, avoid contact sports and heavy lifting for several months after surgery, pacemaker will set off airport security devices, but it is okay to use garage door opener and microwaves. MRIs are CONTRAINDICATED
165
S/S of left-sided HF
Dyspnea, crackles, fatigue, pink/frothy sputum
166
S/S of right-sided HF
Peripheral edema, ascites, JVD, hepatomegaly
167
An echocardiogram can be used as a diagnostic for HF by measuring
Ejection fraction
168
HF nursing care
Monitor I&Os, weight patient DAILY, sit patient in high-fowler’s, restrict fluid and sodium intake as order, monitor for complications such as pulmonary edema
169
T or F: HF will cause an increase in central venous pressure (CVC) and pulmonary artery wedge pressure (PAWP)
True
170
A defect or damage to one of the heart valves which can cause stenosis, prolapse (improper closure), and regurgitation
Valvular heart disease
171
Risk factors associated with acquired causes of valvular heart disease
HTN, older age, increased cholesterol, smoking, DM, rheumatic fever, infective endocarditis
172
S/S of valvular heart disease
Murmurs, extra heart sounds, dysrhythmias, dyspnea
173
Procedure/surgery for stenosis related to valvular heart disease
Percutaneous balloon valvuloplasty
174
Prosthetic valve patient education
Required antibiotics prior to any dental work, surgery, or other invasive procedures
175
Bacteria or fungi that adhere to the heart forming vegetative growth which can lead to necrosis of a heart valve or endocardium
Infective endocarditis
176
Infective endocarditis risk factors
Congenital heart disease, valvular heart disease, prosthetic valves, IV drug use
177
S/S of infective endocarditis
Fever, flu-like symptoms, murmurs, petechiae, splinter hemorrhages (red streaks under the nail bed)**
178
Infective endocarditis treatment
Antibiotics, valve repair or replacement
179
Inflammation of the heart following a strep throat infection which can cause long-term damage to the heart and valves
Rheumatic carditis
180
S/S of rheumatic carditis
Tachycardia, cardiomegaly, murmurs, friction rub, chest pain
181
Rheumatic carditis diagnosis
Throat culture, ASO titer
182
Rheumatic carditis treatment
Antibiotics, valve repair or replacement
183
Inflammation of the sac that surrounds the heart
Pericarditis
184
Pericarditis risk factors
Infection from autoimmune disorder, trauma
185
S/S of pericarditis
Chest pain that is worse when supine and better when sitting up leaning forward**, friction rub, fever, dysrhythmias, dyspnea
186
Pericarditis diagnosis
EKG shows ST or T spiking
187
The accumulation of fluid in the pericardia sac that puts pressure on the heart impairing blood flow and decreased cardiac output
Cardiac tamponade
188
S/S of cardiac tamponade
Hypotension, JVD, muffled heart sounds, paradoxical pulse (decrease in SBP of 10 mmHg or more during inspiration)**, electrical alternans (variation in QRS amplitude between heart beats)**, dyspnea, fatigue
189
Treatment for cardiac tamponade
Pericardiocentesis (removal of fluid from pericardial sac)
190
Disease of the heart muscle that can lead to pulmonary edema, dysrhythmias, and heart failure
Cardiomyopathy
191
What are the three types of cardiomyopathy?
Dilated (most common), hypertrophic, restrictive
192
Type of cardiomyopathy in which the ventricles enlarge and weaken and primarily affects systolic function
Dilated cardiomyopathy
193
Type of cardiomyopathy in which the ventricles and septum enlarge and thicken affecting diastolic function and restricting blood outflow
Hypertrophic cardiomyopathy
194
Type of cardiomyopathy in which the ventricles become stiff and rigid restricting filling during diastole
Restrictive cardiomyopathy
195
S/S of cardiomyopathy
SOB, fatigue, dizziness, arrhythmias, murmurs
196
Removal of part of the heart muscle in the septum to thin the septum
Septal myectomy
197
Injection of alcohol into heart septum that kills heart muscle allowing thinning of septum
Septum ablation
198
The build-up of plaque on the arterial walls
Atherosclerosis
199
Atherosclerosis risk factors
Older age, immobility, smoking, increased cholesterol, obesity, DM, stress
200
S/S of atherosclerosis
HTN, bruits (d/t turbulent blood flow)
201
Labs associated with atherosclerosis
Elevated LDLs and triglycerides
202
Family hx, increased sodium intake, obesity, smoking, stress, and hyperlipidemia are risk factors for __________ hypertension
Primary/essential
203
Kidney disease, hyperthyroidism, Cushing’s syndrome, and pheochromocytoma are risk factors for _________ hypertension
Secondary
204
S/S of hypertensive crisis
Headache, chest pain, SOB, dizziness
205
Dietary teaching for hypertension
DASH diet: increased intake of fruits, vegetables, and low-fat dairy; decreased consumption of sodium and fats (saturated and trans)
206
Inadequate blood flow to the extremities
Peripheral arterial disease (PAD)
207
What causes PAD?
Atherosclerosis
208
PAD risk factors
HTN, DM, smoking, obesity, hyperlipidemia
209
S/S of PAD
Intermittent claudication (leg pain worse with exertion, better when dangling legs in dependent position)**, delayed cap refill, decreased pedal pulses, lack of hair on calves, skin cool and shiny, pallor of extremities when elevated, dependent rubor, dry and necrotic wound on feet (particularly toes), delayed wound healing
210
PAD diagnostic that compares ankle BP to arm BP
Ankle Brachial Index (PAD indicated if ankle BP is greatly decreased)
211
PAD patient education
Stop and rest during activity until pain subsides, avoid restrictive clothing and crossing legs, maintain warm environment and wear socks, avoid nicotine and caffeine
212
The rerouting of blood flow around an occluded artery related to PAD
Peripheral bypass graft
213
Peripheral bypass graft post-procedure patient education
Keep leg straight for 24 hours after procedure
214
S/S of peripheral bypass graft occlusion
Pallor, decreased pedal pulses, decreased temperature, sudden increase in pain
215
Increased pressure inside a muscle compartment due to swelling resulting in impaired blood flow
Compartment syndrome
216
S/S of compartment syndrome
Numbness, severe pain even with passive movement, edema, taut skin
217
A balloon-like bulge in the arterial wall caused by congenital disorder, trauma, infection or disease that results in damage and weakening of the arterial wall
Aneurysm
218
Aneurysm risk factors
White males, older age, atherosclerosis, HTN, elevated cholesterol, smoking, Marfan’s syndrome
219
S/S of abdominal aortic aneurysm
Flank or back pain, pulsating abdominal mass, bruit
220
Abdominal aortic aneurysm nursing consideration
DO NOT palpate the area because this can rupture the aneurysm
221
S/S of thoracic aortic aneurysm
Severe back or chest pain, SOB, Dysphagia, cough
222
S/S of ruptured aneurysm
Sudden onset of severe pain, hypotension, diaphoresis, decreased LOC, oliguria, decreased pulses distal to rupture
223
An inflammatory condition that impairs circulation to the extremities (both arms and legs)
Buerger’s disease
224
What is the key risk factor for Buerger’s disease?
Smoking
225
Typical population affected by Buerger’s disease
Males between the ages of 20-50 who smoke
226
S/S of Buerger’s disease
Claudication, numbness and tingling, decreased pedal pulses, decreased temp in extremities, cyanotic extremities
227
Complications of Buerger’s disease
Tissue death, gangrene, amputation
228
A rare vascular disorder that causes vasospasming of the arteries in the finger and/or toes decreasing blood flow to these extremities
Raynaud’s
229
__________ Raynaud’s is Raynaud’s disease with an idiopathic cause
Primary (most common)
230
_________ Raynaud’s is Raynaud’s Phenomenon which is characterized by underlying connective tissue disease such as lupus or scleroderma which damages the arteries
Secondary
231
S/S of Raynaud’s
Upon exposure to cold or stress, fingers will become cyanotic, cold, painful and numb. After spasming, blood flow returns to area causing fingers to turn very red in color
232
Raynaud’s patient education
Avoid cold, caffeine, stress, and smoking
233
Blood clot that starts in a vein
Venous thromboembolism (VTE)
234
What are the two types of VTE?
DVT and PE
235
VTE form in a deep vein due to virchow’s triad which includes
Endothelial injury, impaired blood flow (venous stasis), hypercoagulability
236
VTE risk factors
Hip and knee replacement surgery, HF, immobility, pregnancy, combined oral contraceptives, family hx
237
S/S of DVT
Calf or thigh pain, swelling and redness on affected side
238
S/S of PE
SOB, dyspnea, chest pain with inspiration, tachycardia, hypotension, petechiae
239
VTE diagnosis
Elevated D-Dimer
240
VTE treatment
Anticoagulants (heparin, warfarin), thrombolytics (alteplase), thrombectomy, vena cava filter (prevents embolus from reaching lungs)
241
VTE nursing care
Elevate extremity, do NOT place knee gatch or pillow beneath knee, apply warm/moist compresses, do NOT massage, apply compression stockings as ordered, monitor for S/S of PE
242
PE nursing care
High fowlers position, administer O2 as prescribed
243
Condition by which the veins in the lower extremities do not transport blood back up to the heart effectively
Venous insufficiency
244
Venous insufficiency risk factors
Obesity, immobility, pregnancy, hx of DVT
245
S/S of venous insufficiency
Edema, brown discoloration of skin over lower extremities (stasis dermatitis), heavily draining wounds around ankles
246
Venous insufficiency nursing care
Elevate patients legs to promote blood return, apply compression stockings per orders (best in morning when swelling is reduced), monitor for complications such as cellulitis
247
Venous insufficiency patient education
Avoid sitting or standing for too long, avoid crossing legs or wearing restrictive clothing, apply stockings in morning before getting out of bed
248
Dilated, tortuous veins that occurs in the lower extremities due to pooling of blood in veins causing enlargement and weakening of veins and impaired valve function such that blood flows backwards
Varicose veins
249
Varicose veins risk factors
Females, prolonged standing, pregnancy, obesity, family hx
250
S/S of varicose veins
Distended rope-like veins, feeling of heaviness, itching, aching
251
Varicose veins treatment
Elevation, compression, procedures such as sclerotherapy and laser treatment
252
_________ shock can be caused due to blood loss associated with a trauma or with surgery, GI losses, excess fluid loss
Hypovolemic
253
_________ shock occurs as a result of heart pump failure from an MI, HF, valve or structural problem, and dysthymias
Cardiogenic
254
_________ shock is caused by a blockage of the great vessels or the heart itself (PE, tension pneumothorax, cardiac tamponade)
Obstructive
255
_________ shock is caused by extreme systemic vasodilation causing the patients blood pressure to plummet
Distributive
256
What are the three different types of distributive shock?
Septic, neurogenic, anaphylactic
257
Type of distributive shock in which endotoxins end up in the blood stream from an infection
Septic shock
258
Type of distributive shock in which there is a dysfunction of the sympathetic nervous system based on a trauma such as spinal cord injury
Neurogenic shock
259
Type of distributive shock caused by a reaction to an exposed allergen leading to closure of the airway and systemic vasodilation
Anaphylactic
260
S/S common across all types of shock
Hypotension, tachycardia, tachypnea, weak pulses, decreased urine output
261
Wheezing and angioedema are symptoms associated with _________ shock
Anaphylactic
262
Lab findings associated with shock
Elevated serum lactate, abnormal ABGs
263
Hemoglobin and hematocrit will be _________ with hypovolemic shock
Decreased
264
Treatment for shock
Treat underlying condition, administer IV fluids, blood products, colloids, vasopressors (epinephrine and norepinephrine), antibiotics (septic shock), oxygen
265
In the treatment of shock, which should the nurse perform first, administer vasopressors OR correct hypovolemia?
Correct hypovolemia FIRST, then administer vasopressors
266
Patient positioning for shock
Modified trendelenburg (supine w/ legs elevated)
267
Complications of shock
Multiple organ dysfunction syndrome (MODS) and disseminated intravascular coagulation (DIC)
268
Chest pain due to ischemic heart disease
Angina
269
Chest pain that occurs with exercise and is relieved with nitroglycerin or rest
Stable angina
270
Chest pain that occurs with exercise or with rest and over time the pain will increase in duration, frequency, or severity
Unstable angina
271
_________ angina is caused by spasming of the coronary artery and chest pain will occur at rest
Variant
272
Differentiating angina from MI
Chest pain unrelieved by rest or nitroglycerin and that lasts longer that 30 min is indicative of MI. MI may also have other symptoms such as SOB, N/V, and diaphoresis
273
Sudden blockage of blood flow into the heart
Myocardial infarction (MI)
274
S/S of MI in women
N/V, fatigue, pain in back, shoulders, or jaw
275
MI diagnosis
Elevated cardiac enzymes, abnormal ST elevation or depression
276
Medications used in the treatment of an MI
Aspirin, clopidogrel, thrombolytics, anticoagulants, Antihypertensives (BB, ACE), statins
277
A procedure used to open the coronary arteries indicated for treatment of MI; catheter with balloon threaded through blood vessel (usually femoral artery) up to blocked coronary artery, balloon is inflated, and stent is placed to restore blood flow to heart
Percutaneous Coronary Intervention (PCI)
278
PCI should be performed within ___ hours of the onset of symptoms of an MI
2
279
PCI post-procedure nursing care
Assess site for bleeding, check perfusion to extremity distal from insertion site
280
Procedure that bypasses one or more of the patients coronary arteries due to blockage or persistent ischemia
Coronary artery bypass graft (CABG)
281
CABG typically uses the _________ vein from patients leg
Saphenous
282
Post-CABG nursing care
Closely monitor BP (HTN can cause bleeding from graft site, hypotension can cause collapse of graft site), monitor temperature (post op hypothermia is a complication), monitor for bleeding (chest tube will be in place), assess LOC, fluid and electrolyte balance, cardiac rhythm, pain and neurovascular status of donor site
283
Blood disorder that results in decreased RBCs or decreased Hgb
Anemia
284
What are the three main causes of anemia?
Blood loss, insufficient RBC production, excess destruction of RBCs
285
What population is most at risk for iron deficiency anemia?
Pregnant women and children
286
Blood disorder caused by lack of intrinsic factor which inhibits absorption of B12
Pernicious anemia
287
S/S of anemia
SOB, pallor, fatigue, weakness, tachycardia
288
Autosomal recessive genetic disorder that causes chronic anemia, pain, infection and organ damage
Sickle cell anemia
289
Sickle cell anemia risk factors
Family hx, African Americans and middle eastern descent
290
S/S of sickle cell anemia
Pain, fatigue, SOB, pallor, jaundice
291
Sickle cell vaso-occlusive crisis results in
Severe pain and swelling in hands and feet — treatment involves around the clock administration of opioid analgesics
292
Sickle cell crises caused by blockage of blood flow out of the spleen causing enlargement of spleen and possible hypovolemic shock
Splenic sequestration crisis
293
Sickle cell crisis characterized by severe anemia typically related to a viral infection
Aplastic crisis
294
Sickle cell crisis where blood flow is impaired to the lungs resulting in dyspnea, fever, and cough
Acute chest syndrome
295
Sickle cell crisis characterized by a rapid decrease in Hgb levels
Hyperhemolytic crisis
296
Sickle cell anemia patient education
Encourage adequate fluid intake (avoid dehydration), avoid infection (hand hygiene, avoid crowds)
297
A rare blood disorder that causes an increase in RBCs
Polycythemia
298
S/S of polycythemia
Ruddy (red) complexion, dizziness, headache, fatigue, clubbing, enlarged spleen
299
A patient with polycythemia is at risk for
Clots, ischemia
300
Medications useful in the treatment of polycythemia
Hydroxyurea, aspirin
301
Nursing care for coagulation disorders
Limit venipunctures and IM injections, implement fall precautions, educate patients to use soft toothbrush, electric razor, and to seek immediate medical attention for any kind of head trauma
302
A rare, inherited bleeding disorder that results in a deficiency in clotting factors
Hemophilia
303
Autoimmune disorder that causes a decrease in the lifespan of platelets
Immune thrombocytopenic purpura (ITP)
304
An immune-mediated drug reaction to heparin causing a drop in platelets
Heparin-induced thrombocytopenia (HIT)
305
Labs associated with HIT
Low platelets, normal PT and APTT
306
HIT treatment
Discontinue heparin immediately, administer alternate anticoagulant, platelet transfusion
307
Disorder where clotting factors and platelets are depleted through the formation of micro-clots throughout the body
Disseminated intravascular coagulation (DIC)
308
Labs associated with DIC
Decrease in platelets, increased PT, APTT, and D-Dimer
309
DIC treatment
Administer clotting factors, platelet/plasma transfusion
