IV, CAD, Hypertension

Question 1

What are the common IV sites?

Answer 1

Sites used are hands, arms, leg, foot.

Question 2

How to select a site?

Answer 2

Veins should feel spongy, bouncy, and full. Avoid areas of thrombus/infection/fistulas/grafts/dialysis/mastectomy. Depends on preference and how long it will be in (hands are short term). Start dismally and move our way up.

Question 3

What angle do you insert a needle on?

Answer 3

10-30 degrees

Question 4

What is a bevel?

Answer 4

Looks like a teardrop. You want it facing you when you insert to allow for less pain.

Question 5

Where do you apply tourniquet?

Answer 5

Applied 10-15 cm above the insertion site. Want venous blood to pool so we can see the vein better.

Question 6

How often do we flush with saline?

Answer 6

Once a day or when there’s a problem with patency. You also have to flush before and after giving medication.

Question 7

What can you do to allow for more venous distension?

Answer 7

Apply warm blanket over area, hang limb down below level of heart to allow gravity to help with blood flow.

Question 8

What are the different fluid compartments in the body?

Answer 8

Intracellular (67%) and extra cellular (32%). ECF has 3 divisions. Intravascular (8% blood plasma) interstitial (24%, fluid between cells and outside of vessels) and trans cellular (1%, leftover fluid)

Question 9

What is osmosis?

Answer 9

Movement of water through semi-permeable membrane from low to high concentration solutes to equalize concentrations on either side of membrane.

Question 10

What is osmolality?

Answer 10

Total solute concentrations in aqueous solution.

Question 11

What is isotonic, hypertonic, and hypotonic?

Answer 11

I- same concentration as blood plasma, 0.9 NS, D5W, LR
Hyper- higher concentration of solutes, pulls fluid out of cells to cause shrinkage, D5NS, D5 1/2NS
Hypo- lower concentration of solutes, moves fluid into cells to enlarge them, 0.45 NS

Question 12

What is difference between primary and secondary lines?

Answer 12

P- directly attach to patient, know as maintenance lines
S- additional IV line attached to primary line

Question 13

What is difference between pumps and gravity lines?

Answer 13

P- can program it to administer certain amount of fluid, machine will pump fluid in
G- less precise, uses gravity, how high you hang bag on pole influences rate solution will go in, kinked tubing stops flow, faulty

Question 14

What is infiltration of IV site?

Answer 14

IV fluid enters surrounding space around vein puncture/site and solution goes to surrounding tissues. Causes can be kinked tubing or tape becomes loose. S+S are edema, pain, cool and pale skin. Solution is to stop infusion and remove IV, put on warm blanket, restart IV in another place, extremity should be raised and elevated.

Question 15

What is phlebitis of IV site?

Answer 15

Inflammation of the vein. S+S are pain, edema, erythema, increased skin temperature. Solution is to discontinue IV line and new line inserted in another vein. Put warm/moist heat on site.

Question 16

What is fluid volume excess?

Answer 16

Patient receives too much IV fluid over short time and body can’t handle the excess fluid. S+S are edema, increased urine output, crackles in lungs, SOB, increased BP/HR. Solution is give O2, discontinue and receive doctors order for new amount of fluid.

Question 17

What is the values for micro drip and macro drip?

Answer 17

Micro drip= 60 get/mL
Macro drip= 10 ggt/mL, 15 ggt/mL, 20 ggt/mL

Question 18

What is atherosclerosis?

Answer 18

It’s progressive. Damage to endothelium of blood vessel and plaque develops in area and starts to block vessel. Could eventually cause clot/obstruct the vessel.

Question 19

What are some interventions for atherosclerosis?

Answer 19

Minimize modifiable factors like nutrition therapy to lower LDL cholesterol, physical activity 3-4 times a week for 40 minutes, drug therapy, and complementary and integrative health (low dose B vitamin).

Question 20

How to assess for atherosclerosis?

Answer 20

Cardiovascular assessment (BP, pulses, capillary refill, bruit), health hx (diet, exercise, risk factors), and blood work (LDL cholesterol-bad, HDL cholesterol, triglycerides).

Question 21

What is hypertension?

Answer 21

Persistent elevation of systolic BP (>= 135 mmHg) or diastolic BP (>= 85 mmHg).

Question 22

What influences BP?

Answer 22

For BP to rise= needs to be increase in CO (cardiac output), HR, or peripheral vascular resistance. Arterial baroreceptors also affect HR/BP. Fluid volume influences BP (more Na in bloodstream=more water will join=higher BP).

Question 23

What is primary and secondary hypertension?

Answer 23

P- elevated BP without indemnified cause, usually most cases
S- elevated BP with cause that’s identified/corrected, less common

Question 24

How can we promote health for people with hypertension?

Answer 24

Physical activity for 30-60 minutes a dat, weight/stress reduction, DASH diet (dietary approaches to stop hypertension), smoking cessation, limit/stop alcohol use.

Question 25

How to assess hypertension?

Answer 25

History of heart, physical assessment (S+S), psychological assessment (assess for stressors influencing high BP) dx assessment (assess target organ damage, urinalysis, Na, glucose if they’re diabetic-cause high BP, ECG, chest x ray).

Question 26

Target organ damage for hypertension?

Answer 26

Cardiac disease (CAD is build up plaque in arteries can cause heart attack, stroke), cerebrovascular disease, peripheral arterial disease (decreased blood flow and tissues die), nephrosclerosis (kidney disease), retinal damage (vision impairment because of plaque buildup in eye arteries).

Question 27

Drug therapy in hypertension?

Answer 27

Goal is <135/85 mmHg. Drugs used have actions to reduce PVD and decreased circulating blood volume. Goal in diabetic patients is BP <130/80. Goal in high risk patients is <120.

Question 28

How to treat hypertension?

Answer 28

Lifestyle changes, drug therapy, home management (set alarms, personal BP machine), self management education.

Question 29

What is coronary artery disease CAD?

Answer 29

Includes chronic stable angina and acute coronary syndrome. Affects arteries that supply blood/O2 to myocardium. If blood is partially/completely blocked it results in ischemia or infarction.

Question 30

What is infarction and ischemia?

Answer 30

Ischemia- insufficient oxygen supplied to meet requirement of myocardium
Infarction- occur when ischemia prolonged and decreased perfusion cause irreversible damage to heart

Question 31

What is angina pectoris?

Answer 31

Temporary imbalance between coronary arteries ability to supply oxygen and myocardium’s demand for O2. Chest pain occurs over long periods, same onset/duration/intensity of symptoms, pressure/ache in chest, complaints of indigestion or burning, pain brief (3-5 minutes).

Question 32

What is acute coronary syndrome ACS?

Answer 32

Unstable angina. Chest pain occurs at rest or with exertion which causes activity limits. Increase in number and intensity of angina attacks. Pain/pressure lasts >15 minutes and its poorly relieved by nitroglycerin. Ischemia present but not severe to cause myocardial damage.

Question 33

What is myocardial infarction?

Answer 33

Heart attack. Myocardial tissue deprived of O2, Blood flow reduced by 80-90% ischemia develops which leads to injury and necrosis of myocardial tissue if blood flow not restored.

Question 34

What is NSTEMI and STEMI?

Answer 34

NSTEMI- Ecg changes that is ischemia, troponin level elevated, partial/intermittent occlusion of coronary artery
STEMI- worst, ECG changes least o necrosis, troponin levels elevated, full occlusion of coronary artery

Question 35

What is CAD caused by?

Answer 35

Atherosclerosis

Question 36

Assessment of CAD/symptoms?

Answer 36

History (family, have you had it before), psychosocial (denial, anger, fear, depression), lab assess, physical assessment (chest pain, symptoms- weak/numb in arms, wrists, hands, SOB, pallor/clammy/cool to touch, dizzy, fever, nausea/vomit) assess BP, HR, RR, O2 stats.

Question 37

Diabetes melllitus and women?

Answer 37

DM- might not have pain just some of the other symptoms
W- experience MI differently, could get pain in back or nausea

Question 38

How to manage acute pain for CAD?

Answer 38

Decrease pain to decrease myocardial O2 demand and increase O2 supply. Administer nitroglycerin. Administer O2 at 2-4 L/min to maintain SpO2 >90 %, encourage rest, administer morphine.