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Nursing > Maegan's Test #4 - Circulation > Flashcards

Maegan's Test #4 - Circulation Flashcards

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1
Q

What is the leading cause of morbidity and mortality in the US?

A

Cardiovascular Disease

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2
Q

There are often other diseases that co-exist with cardiovascular disease, What are a few examples?

A

Diabetes

Mellitus

Obesity

Hyperlipidemia

Tobacco and/or alcohol abuse

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3
Q

What is the amount of force exerted on the arterial walls by the blood flowing within the vessels?

A

Blood Pressure

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4
Q

What are the normal ranges for Systolic and Diastolic Blood Pressure?

A

Systolic 100-120 mmHg

Diastolic 60-80 mmHg

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5
Q

What are the components of Blood Pressure?

A

Pump

Fluid Volume

Vascular Bed

(Heart Rate and Force of Contraction)

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6
Q

The ULTIMATE GOAL of Blood Pressure is that it adjusts to maintain _______ Perfusion.

A

Blood Pressure is adjusted to maintain TISSUE Perfusion

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7
Q

What is the amount of blood pumped by the ventricles in 1 minute?

A

Cardiac Output

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8
Q

How do you Calculate Cardiac output?

A

Heart Rate X Stroke Volume (~70mL for healthy adult)

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9
Q

The Venus pressure is ____ _____ to adequately return blood to the heart.

A

The Venus pressure is TOO LOW to adequately return blood to the heart.

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10
Q

What are some of the Assistive mechanisms that help the Venous return?

A

Respiratory Pump

Muscular Pump
(Pushes blood toward heart)

Venous Valves
(Prevents backward flow of blood)

(Draws blood toward heart with deep breath)

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11
Q

What are the three types of Diseases/Disorders of the Cardiovascular system?

A

Congenital (Born with) VS Acquired

Structural VS Functional

Acute VS Chronic

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12
Q

What is the primary problem with a cardiovascular disease?

A

Impaired Tissue Perfusion

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13
Q

What are 3 risk factors for cardiovascular disease?

A

Heredity

Age
(As you get older you are at higher risk)

Gender
(Before menopause men are at higher risk, After Menopause it evens itself out)

(At higher risk if it runs in the family)

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14
Q

What are some of the Modifiable risk factors for cardiovascular disease? (Things that can be changed by client)

A

Elevated Lipid Levels

Hypertension

Cigarette Smoking

Diabetes Mellitus
(High Levels of Glucose damages blood vessels)

Obesity
(Not just the volume of weight but where they carry that weight-Apple shaped at higher risk than Pear)

Waist Circumference

Sedentary Lifestyle

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15
Q

What are some Lab tests you would do to check for cardiovascular problems? (3 tests)

A

Lipid & cholesterol Levels Homocysteine Levels

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16
Q

What are some cardiovascular focused assessments you would do?

A

Level of Consciousness (LOC) Orientation Skin Color, temp, moisture & turgor P,R, BP (Do both arms within 10 mmHg) Apical Pulse (Just know rate/Rhythm) Heart Sounds (Rhythm & if murmur) Peripheral Pulse (Do both at same time and know presence, rate, rhythm, strength and equality) (0-No Pulse 1-Weak 2-Normal 3-Bounding) Edema Tilt test (Test for Orthostatic hypertension)

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17
Q

When performing a tilt test, what would change in blood pressure and pulse to provide a positive tilt test result?

A

Blood Pressure Systolic- decrease 20mm Dystolic- decrease 10mm Pulse Increase by 15-30 bpm

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18
Q

What are some nursing problems/diagnosis for decreased cardiac output?

A

Decreased heart rate or force of contraction Increased heart rate (>150) Decreased fluid volume or hemorrhage Arrhythmias Incompetent valves Myocardial Ischemia (heart not getting enough oxygen)

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19
Q

What is the main Nursing Goal for decreased cardiac output?

A

Maintain & restore cardiac output

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20
Q

What is the main goal for tissue perfusion?

A

Maintain or Improve tissue perfusion

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21
Q

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport ____________ & _____________ to tissues

A

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport OXYGEN & NUTRIENTS to tissues

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22
Q

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport ______ ______ & ______ _______ from tissues for elimination

A

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport WASTE PRODUCTS & CARBON DIOXIDE from tissues for elimination

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23
Q

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport _________ & _____________ to target organs.

A

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport HORMONES & MEDICATIONS to target organs.

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24
Q

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport ______ ________ _______ & ____________ to points of inflammation or infection.

A

The purpose of the purpose of the Cardiovascular system when talking about transportation are to….

Transport WHITE BLOOD CELLS & ANTIBODIES to points of inflammation or infection.

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25
The purpose of the purpose of the Cardiovascular system when talking about transportation are to.... Transport _____________ & __________ \_\_\_\_\_\_\_\_\_\_\_\_\_ to points of injury.
The purpose of the purpose of the Cardiovascular system when talking about transportation are to.... Transport PLATLETS& CLOTTING FACTORS to points of injury
26
The Cardiovascular system is responsible for regulating what items? (There are 3)
Body Temperature pH (Regulates this) Fluid & Electrolyte status (Filtering through Kidney & Producing urine)
27
What is the electrical & mechanical activity that results in one heartbeat?
Cardiac Cycle
28
There are two phases to the cardiac cycle, what are they?
Contraction Relaxation (Diastole - Ventribles refil with blood) | (Systole - Blood ejected from heart)
29
What is it when the atria contract at end of diastole, adding additional volume to the ventricles?
Atrial Kick
30
Cardiac Output is adjusted to meet tissue needs, by adjusting your heart rate & the force of contraction. What are the two effects for those?
Chronotropic Effect Increace Heart Rate Inotropic Effect Increase in how hard it thumps
31
What are some risk factors for Metabollic syndrom? (There are 5)
Central Obesity Elevated Triglycerides Lower HDL Cholesterol Hypertension Increased fasting glucose
32
What are 3 Diagnostic/Lab testsyou could do to check the Cardiovascular system?
12 Lead Electrocardiogram (EKG) Identifies rhythm & diagnose acute events 24 Hour Holter Moniter Catch "Intermittent" events Telemetry/Bedside Monitoring Monitor rhythm continuously
33
What are some nursing implications you could do for Electrophysiological studies (EKG, Telemetry)?
Observe electrical activity No NPO or prep involved Jelly filled electrodes applied to chest or limbs May need to clip hair, dry skin, or abrade skin
34
If there is a change on the monitors what is the 1ST PRIORITY?
ASSESS THE CLIENT Don't assume since it shows no heart rate that the client is dead
35
What are 3 types of Imaging studies you can do to chekc on the cardiovascular system?
Echocardiogram Doppler study (Arterial or Venous blood flow) CT or MRI (Structural Anomalies) | (Structure and motion of the heart)
36
What are some nursing implications for Imaging Studies?
Painless but ultrasound jelly may be unpleasant Client needs to lie still & follow tech's instructions Place client in gown Some echo's & doppler's done at bedside CT or MRI may include contrast Assess for allergies and keep client NPO
37
What are some Bloodwork tests that can be ran to test the Cardiovascular system? There are 5
Lipid & Cholesterol Levels Homocysteine Levels ``` Cardiac Enzymes (Troponin, CPK, LDH) (3 enzymes, 1 test - ordered for specific heart issues) ``` Anemia (Compromises ability to carry oxygen to tissue) Electrolyte Imbalance (Fluid helps contract & relax) | (Common Prractice)
38
What are some nursing implications for bloodwork?
Some tests require NPO status Responsible for notifying PCP of critical values (When at risk for complication) | (Lipid & Cholesterol / Homocysteine Levels)
39
What are some assessment items you would ask when assessing the history on a client with cardiovascular issues?
Medical Hx - Cardio, Respiratory, Diabetes Family Hx Smoking Hx Diet - Especially fat, salt, alcohol & caffeine Exercise - Amount & type Medications - Heart, BP, Circulation, cholesterol; INCLUDE HERBALS Lifestyle - Stressors, support, & coping Method Symptoms - Pain, SOB, fatigue, palpations, cough, fainting
40
What are some physical assesments you would do when focused on cardivascular?
LOC Level of Consciousness Orientation Skin - Turgor, color, temp, moisture P, R, BP (Both arms within 10mmHg) Apical pulse - JUST rate & rhythm Heart Sounds - Know normal & mumur Peripheral Pulses - Presence, rate, rhythm, strength, equality Edema Tilt Test
41
When assessing rhythm of pulse there are 4 stages, what are they?
0 - No pulse 1 - Weak 2 - Normal 3 - Bounding
42
What are some Nursing Problems/Diagnosis for Decreased Cardiac Output? There are 6
Decreased Heart rate or force of Contraction Increased Heart Rate - \>150 (Overall Cardiac output will diminish) Decreased fluid volume or hemorrhage Arrhythmias Incompetent Valves Myocardiao Ischemia (Muscle not getting adequate oxygen)
43
What are some signs & symptoms of decreased cardiac output?
Angina Not getting enough oxygen to blood SOB/Dyspnea(Painful Breathing) Dizziness or lightheadedness Nausea diaphoresis Decreased BP Weak or Irreg pulses Cool skin Pale, ashy, dusky, or cyanotic skin weakness Fatigue
44
What is the MAIN goal for decreased cardiac output?
Maintain or restore Cardiac Output
45
What are 3 MAIN interventions for decreased cardiac output?
Place on Monitor Provide Oxygen SLN (To be able to give fluids and meds)
46
What are two interventions you would do for a decreased heart rate or force of contraction when relating to decreased cardiac output?
Provide inotropic &/or chronotropic med DIGOXIN Pacemaker Internal or External
47
What are 4 interventions you would do if the heart rate was increased to over 150 bpm when relating to decreased cardiac output?
Correct fluid volume deficit FIRST Provide medication to decrease heart rate may require cardioversion Stimulate Vagal Response
48
What are 2 interventions for decreased fluid volume or hemmorhage when relating to decreased cardiac output?
Stop the bleeding Provide IV fluids &/or blood transfusion
49
What are 2 interventions for Arrhythmias when pertaining to decreased cardiac output?
Provide Medications May require cardioversion Unless Chronic
50
What is the MAIN GOAL for impaired tissue perfusion?
Maintain or improve tissue perfusion
51
What is an intervention for incompetent valves when pertaining to decreased cardiac output?
May require surgical replacement
52
What are 4 interventions for Myocardial Ischemia when pertaining to decreased cardiac output?
Provide Notrostat SL to dilate coronary arteries Provide additional meds & support as ordered (Ex- ASA, Beta Blocker, BP support, etc) Remain calm & supportive Order EKG & Lab to Confirm
53
What are the 2 things you evaluate when it comes to Decreased cardiac Output?
Were the interventions effective? Was the goal attained?
54
What are the 2 problems/diagnosis for IMPAIRED TISSUE PERFUSION?
Decreased Cardiac Output Impaired Blood Flow - Thrombus - Clot @ that location - Embolus - Clot or piece of plaque brok look from origin & traveled somewhere else) - Constrictive/Pressure Issue (Ex: Immobility or compartment Syndrome | (5 Etiologies - Doesn't include fluid)
55
What are some assessments you would do for decreased cardiac output when pertaining to impaired tissue perfusion?
All signs and symptoms of decreased cardiac output Organ Specific Assessments: Brain: Confusion, LOC, seizure, weakness, paresthesia, & paralysis Lungs: SOB, dyspnea, tachypnea, cyanosis, anxiety, pain in chest Heart: angina, impending doom, arrhythmias, brady or tachycardia Kidneys: Urine output, fluid volume overload, K level Peripheral: Unequal pulses, isolated color changes, cool skin, edema, hair pattern, positional color changes, non-healing wounds,&/or ulcers, parasthesias, pains/aches
56
What are some interventions for impaired blood flow when talkng about impaired tissue perfusion?
Place client in Tredelenburg Place client on bedrest provide anticoagulant and or antiplatelet aggregator as ordered provide thrombolytic if ordered Relieve Constriction Turn client every 2 hours
57
The best approach to a tissue perfusion problem is to ________ \_\_\_\_\_\_\_\_\_\_
The best approach to a tissue perfusion problem is to PREVENT OCCURENCE
58
What are some ways to prevent tissue perfusion problems?
Leg & Feet Exercises TED Hose (tight to divert blood flow to main veins) SCD's (Sequential Compression Devices) Foot Pumps (Compress veins on bottom of foot) Early Ambulation | (Movement promotes venous return)
59
What are 2 items you evaluate when it comes to impaired tissue perfusion?
Did we restore blood flow to tissue? Were our interventions effective?
60
There are 5 drug classes for cardiovascular problems?
Antihypertensives Anticoagulants (Helps to reduce clotting) Antiplatelet Aggregators (Keep platletts from forming clot) Lipid-Lowering Agents Antiarrhythmics (Helps heart beat @ normal rhythm) | (Lower BP)
61
What medication is an antiarrhythmic, increases the force of the contraction and slows condution through the AV node, Comes in oral & IV form, and has the side effect of Bradycardia & Nausea?
DIGOXIN (LANOXIN)
62
What are some Nursing implications for Digoxin?
Check Apical pulse for 1 minute prior to administering - Hold if \<60 & Notify PCP Monitore Digoxin Level TERAPEUTIC = 0.5-2.0 ng/ml Suspec Toxicity & notify PCP if: Anorexia Nausea, Vomitting, Diarrhea visual disturbances (Halo, Blurred, and diplopia) GINSENG MAY INTENSIFY OR INTERFERE WITH MED!!!
63
Ativan (Lorazepam) is a Benzodiazepine, what are 2 therapeutic uses?
Anxiolytic & Sedative-hypnotic
64
What are some side effects of Ativan (Lorazepam)? **Bold** is most common ALL CAPS is what will kill you
**Bold** is most common Central Nervous System: **Drowsiness, sedation,** dizziness, weakness Cardiovascular: Hyper/Hypotension, Blurred Vision GI: Nausea & Vomitting, abdominal discomfort, anorexia
65
What are some Medication or Food Interactions with Ativan (Lorazepam)?
CENTRAL NERVOUS SYSTEM DEPRESSANTS ANTICONVULSANTS CIMETIDINE ALCOHOL KAVA Phenytoin levels
66
What are some nursing interventions for Ativan (Lorazepam)?
Supervise Ambulation in older patients Lab tests if patient is on long term therapy: CBC (Complete Blood Count) & LFT (Liver Function Test) Supervise for suicide risk
67
What are some teachings for Ativan (Lorazepam)?
Do not drive or engage in hazardous activities for 24-48 hours Do not consume alcohol for at least 24-48 hours Notify PC if datime psychomotor function is impaired Terminate use slowly over several days Discuss termination of trying to get pregnant
68
Valium (Diazepam) is a Benzodiazepine, what are some therapeutic uses?
Anticonvulsant Antianxiety Skeletal muscle relaxant Alcohol Withdrawal
69
What are some side effects for Valium (Diazepam)?
**Dizziness** **Drowsiness** **Tachycardia** **Cardiovascular Collapse** **Laryngospasm** **ECG Changes** RESPIRATORY DEPRESSION Throat/Chest Pain Fatigue Blurred Vision Urinary Retention Ataxia
70
What are some medication or food interactions with Valium (Diazepam)?
Alcohol - Causes increased Central Nervous System Depression Kava(Herbal Supp) - Causes increased sedation Smoking - Decreases sedation & anxiety effect
71
What are some nursing interventions for Valium (Diazepam)?
Monitor I&O Supervise ambulation Suicidal tendencies Monitor for adverse effects
72
What are some teachings you should do for Valium (Diazepam)?
AVOID ALCOHOL & CNS DEPRESSANTS Do not drive Take as prescribed
73
Xanax (Alprazolam) is a Benzodiazepine, what are some therapeutic uses?
Antianxiety Sedative-hypnotic
74
What are some side effects of Xanax (Alprazolam)?
**Drowsiness** **Sedation** Confusion Insomnia Headache Fatigue Tachycardia Hypotension ECG Changes Dyspnea
75
What are some of the medication/food interactions with Xanax (Alprazolam)?
**Alcohol** **Cimetidine** **Disulfiram** **Fluoxetine** KAVA ST JOHNS WART Valerian Antihistamine's
76
What are some nursing interventions for Xanax (Alprazolam)?
Monitor for Signs and Symptoms of drowsiness & Sedation Elderly may need help with ADL's & Ambulation Continued therapy needs periodic lab tests
77
What are some teachings for Xanax (Alprazolam)?
Make position changes slowly No alcohol use or OTC meds for allergies or sleep No driving TAPER OFF!!!
78
Buspar (Buspirone Hydrochloride) is NOT related to other benzodiaepines or barbituates, What is a therapeutic use?
Antianxiety
79
What are some Side effects for Buspar (Buspirone HCI)?
**Dizziness** **Headache** **Drowsiness** **Nausea** Tachycardia Palpitation Blurred Vision Urinary Frequency Hyperventilation/SOB
80
What are some medication or food interactions withBuspar (Buspirone HCI)?
MAOI INHIBITORS TRAZADONE GRAPEFRUIT JUICE ST JOHNS WORT Haloperiod Serum Levels
81
What are some interventions for Buspar (Buspirone HCI)?
Monitor Therapeutic effectiveness in 7-10 days Reinforce importance of continuing treatment plan Monitor Dystonia (Abnormal Muscle spasms) Observe and report adema, decreased urinary output, jaundice, Nausea & Vomitting, and itching
82
What are some teachings for Buspar (Buspirone HCI)?
Report any changes immediately Do not use OTC drugs Do not drive until you know how dose effects you Discuss limits of alcohol intake
83
Benzodiazepines are Anti-anxiety, Sedative-Hypnotics, and Anti-Convulsants, what are some side effects?
Sedating Muscle Relaxing Hypotension CNS Suppressant
84
What are some medication or food interactions with Benzodiazepines?
Alcohol increases it's effects
85
Digoxin (Lanoxin) increases the force of contraction & Slows conduction through AV node which is a negative chronotropic effect, what are some of the therapeutic uses?
Inotropic antidysrhythmic Cardiac glycoside
86
What are some side effects from Digoxin (Lanoxin)?
**\*\*\*Bradycardia** **\*\*\*Nausea** DYSRHYTHMIAS HYPOTENSION AV BLOCK Drowsiness Apathy Confusion Bradycardia
87
What are some medication or food interactions with Digoxin (Lanoxin)?
GINSENG May intensify or interfere with med
88
Proventil (Albuterol) is a Bronchodilator & Beta-Adrenergic Agonist, What are some side effects?
**Tremor** Anxiety Nervousness Weakness Hypertension Muscle Cramps
89
What are some medication/food interactions with Proventil (Albuterol)?
EPINEPHRINE OTHER SYMPATHOMIMETIC BRONCHODILATORS MAOI INHIBITORS TRICLIC ANTIDEPRESSANT BETA ADRENERGIC BLOCKERS
90
What are some nursing interventions for Proventil (Albuterol)?
Monitor for effectiveness Signifigant improvement of pumonary function within 60-90 min Signs & Symptoms of: Tremors, Tachycardia, Hyperactivity, Pulse OX
91
What are some teachings you would do for Proventil (Albuterol)?
Review directions and proper administration Avoid contact with eyes Do not increase dosage Notify if fails to provide relief Causes vertigo & dizziness Do not use OTC drugs(Cold Remedies)
92
Nitro-Dur (Nitroglycerin) is a Nitrate vasodilator & antianginal, what is it given for?
ANGINA \*Repeat every 5 minutes - No more than 3 times
93
What are some therapeutic uses for Nitro-Dur (Nitroglycerin)?
Decreases Peripheral in vascular resistance Decreases blood pressure Decreases Venous Return
94
What are some side effects of Nitro-Dur (Nitroglycerin)?
**Headache** POSTURAL HYPOTENSION CIRCULATORY COLLAPSE
95
What are some medication/food interactions with Nitro-Dur (Nitroglycerin)?
ALCOHOL ANTIHYPERTENSIVE AGENTS Heparin
96
What are some nursing interventions for Nitro-Dur (Nitroglycerin)?
CHECK BP EACH DOSE Hold if BP is less than 100!!
97
What are some teachings for Nitro-Dur (Nitroglycerin)?
Store in original DARK container Sit or lie down when taking, Relax 15-20 min after taking to prevent dizziness Report if no relief is achieved or if an increase in frequency or severity (CALL EMS) Keep records of attacks Replace every 6 months
98
What lung sound is this...
Course Crackles
99
What lung sound is this?
Wheezing
100
What is this lung sound?
Rhonchi
101
What is this lung sound?
Rales
102

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