Midterm Medsurge Flashcards by Carson Unknown

VENOUS DISORDERS

Venous Thrombosis, Deep Vein Thrombosis (DVT),
Thrombophlebitis, and Phlebothrombosis

Chronic Venous Insufficiency

Leg Ulcers

Varicose Veins

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Venous thrombosis

is a blood clot (thrombus) that forms within a vein

can occur in any vein; common lower extremities.

superficial and deep veins of the extremities may be affected

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Is associated with inflammation

Frequently deep vein lower extremities

Thrombophlebitis

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More serious that superficial thrombophlebitis, ↑risk pulmonary embolism

Deep vein thrombophlebitis (DVT)

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Thrombus without inflammation

Result of stasis or hypercoagulability

Phlethrombosis

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Vein inflammation.

Associated with invasive procedures (IV therapy)

Phlebitis

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Stasis of blood

Endothelial injury / vessel wall injury

Hypercoagulability / altered blood coagulation

Virchow’s triad

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are aggregates of platelets attached to the vein wall, along with a tail-like appendage containing fibrin, WBCs , and RBCs

Venous thrombi

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Clinical manifestations DVT

Asymptomatic

Calf or groin tenderness

Unilateral swelling

Phlegmasia cerulea dolens

Functional impairment

↑ temperature

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Positive homan’s sign

Pain in calf on dorsiflexion of the foot

Very poor predictive value, not advised

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Treatment thrombosis superficial veins

Bed rest

Elevation of legs

Analgesics

Anti-inflammatory medication

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Diagnostic test (Thrombosis)

Contrast venography

Duplex ultrasonography

Doppler flow studies

Impedance plethysmography

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Example Anticoagulant therapy (DVT)

Unfractionated Heparin

Low molecular weight heparin

Warfarin

IV unfractionated heparin (low-molecular weight heparin) followed by oral warfarin

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Anticoagulant low molecular weight heparin

Route: Subcutaneous

enoxaparin(Lovenox) dalteparin(Fragmin) ardeparin(Normiflo)

Monitor INR and stools daily for occult blood

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Antidote for warfarin

Vitamin K

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Health teaching warfarin

Do not change eating habits unless indicated

Food with Vitamin K may alter warfarin

Do not eat cranberry products

Do not take aspirin unless indicated

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Contraindication thrombolytic therapy

Postoperatively

During pregnancy

After trauma

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Filter traps large emboli and prevents pulmonary emboli

Inferior vena caval interruption

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Removal of thrombosis

Thrombectomy

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Antidote, reverse effects of heparin

Protamine Sulfate

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At risk of heparin-induced thrombocytopenia

Recieved heparin for >5 days

No readmission after brief interruption of heparin therapy

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Platelet count heparin-induced thrombocytopenia

< 100,000/mL

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is also affected by high-fat and vitamin K-rich foods, such as cabbage, cauliflower, broccoli, asparagus, turnips, spinach, kale, fish, and liver.

The action of warfarin

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Patient education (anticoagulant medication)

Avoid alcohol

Avoid food fad, crash diet, or marked changes in eating habits

Don’t take warfarin unless indicated

When seeking treatment inform provider of taking anticoagulant

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Obstruction of venous valves in legs or a reflux of blood back through valves

Venous insufficiency

chronic venous stasis, resulting in edema, altered pigmentation, pain, and stasis dermatitis Stasis ulceration

Post-thrombotic syndrome

Types of debridement fastest method can be performed by a physician, skilled advanced practice nurse, or certified wound care nurse in collaboration with the physician.

Sharp surgical debridement

Type of debridement Apply isotonic saline dressings of fine-mesh gauze to the ulcer. When the dressing dries, it is removed (dry), along with the debris adhering to the gauze. Need pain management

Nonselective debridement

Wound dressing. promote granulation tissue and reepithelialization. provide a barrier for protection because they adhere to the wound bed and surrounding tissue. Not for deep wounds and infected wounds

Hydrocolloids (eg, Comfeel, DuoDermCGF, Restore, Tegasorb)

Stimulated healing Tissue-engineered human skin equivalent along with therapeutic compression a skin product cultured from human dermal fibroblasts and keratinocytes. Application is not difficult, no suturing is involved, and the procedure is painless

Apligraf

are abnormally dilated, tortuous, superficial veins caused by incompetent venous valves Most commonly occurs in lower extremities, saphenous veins, or lower trunk; can occur elsewhere in body (ex: esophageal varices) occur in up to 60% of adult population in US increased incidence correlated with increased age

Varicose veins (varicosities)

Management varicose veins

Ligation and stripping Endovenous Laser Treatment Radiofrequency Ablation Sclerotherapy

an infection of the deep layer of skin (dermis) and the layer of fat and tissues just under the skin (the subcutaneous tissues). most common infectious cause of limb swelling can occur as a single isolated event or a series of recurrent events. often misdiagnosed, usually as recurrent thrombophlebitis or chronic venous insufficiency

Cellulitis

an acute inflammation of the lymphatic channels. arises most commonly from a focus of infection in an extremity. Cause: hemolytic Streptococcus groin, axilla, or cervical region: Nodes most often involved

Lymphangitis

Most common primary type caused by hypoplasia of the lymphatic system of the lower extremity. usually seen in women and first appears between ages 15 and 25

congenital lymphedema (lymphedema preacox)

most common cause worldwide the direct infestation of lymph nodes by the parasite Wuchereria bancrofti

Filariasis

A (fibrous) ringlike structure, or any body part that is shaped like a ring

Annulus

A site of union of corresponding parts; specifically, the sites of junction between adjacent cusps of the heart valves

Commissure

thread-like bands of fibrous tissue that attach on one end to the edges of the tricuspid and mitral valves of the heart and on the other end to the papillary muscles

Chordae tendineae

small muscle within the heart that anchors the heart valves

Papillary muscles

DISORDERS OF THE MITRAL VALVE

mitral valve prolapse mitral regurgitation mitral stenosis

DISORDERS OF THE AORTIC VALVE

aortic regurgitation aortic stenosis

Surgical management (valve)

Valvuloplasty Closed Mitral commissurotomy or valvotomy Open mitral commissurotomy or valvotomy - to open or rupture the fused commissures of the mitral valve. Percutaneous transluminal valvuloplasty / Balloon valvuloplasty Mitral valve replacement

a high-pitched, blowing sound at the apex. heard best at the apex and radiates to the axilla and usually accompanied by a thrill a heart murmur occurring throughout systole

Holosystolic or pansystolic murmur

CHF Management

Digitalis Diuretic Vasodilators Diet Anticoagulants

Surgical intervention (valve)

Mitral valve replacement Valvuloplasty (annuloplasty)

murmur also reflected to mitral area which may give a false impression of a mitral regurgitation

Gallavardin phenomenon

Palpated over base of heart/ 2nd RICS caused by turbulent blood flow across the narrowed valve orifice

Thrill/Vibration

Clinical manifestations (Regurgitation)

Diastolic murmur Austin flint murmur Corrigan’s pulse Watson's water hammer pulse Widened pulse pressure Hill’s sign

low pitched diastolic rumble similar to mitral stenosis; indicates moderate to severe insufficiency a mid-diastolic or presystolic murmur low-pitched rumbling murmur which is best heard at the cardiac apex. A murmur due to aortic regurgitation, originating at the mitral valve when blood enters simultaneously from both the aorta and the left atrium.

Austin flint murmur

AKA: collapsing pulse, cannonball pulse is the medical sign which describes a pulse that is bounding and forceful, as if it were the hitting of a water hammer that was causing the pulse. PA: radial pulse of a supine patient with arm at side is firmly palpated with slight pressure until the pulse is obscured. The arm is then raised over the patient's head, with the arm perpendicular to the supine patient

Watson's water hammer pulse

anterior chest that overlies the heart and great vessels

precordium

large veins and arteries leading directly to and away from heart

Great vessels

large veins and arteries leading directly to and away from heart

Great vessels

at exit of each ventricle at beginning of great vessels

semilunar valves

Normal Adult CO is

5 to 6 L/min

SV from L ventricle is usually

70 ml

Orthopnea (the inability to breathe while supine) and nocturia may indicate

Heart failure

40% of patients admitted to the hospital with the condition die or are readmitted within 1 year

Heart failure

Atherosclerosis of the coronary arteries is the primary cause (60%)

heart failure

(Heart failure) Signs and symptoms are related to pulmonary congestion and include:

Wheezing (cardiac asthma) Third heart sound Clubbing Hypokalemia (increase level of aldosterone) Polycythemia Reduced urine output Elevated PAP, PCWP, LVEDP

a hormone secreted by the heart at high levels when it's injured or overworked. One of the most specific for heart failure

brain natriuretic peptide (BNP)

Medical management heart failure (4D's)

Digitalis Diuretic VasoDilators Diet

Major treatment in HF Positive inotropic, negative chronotropic & dromotropic effects Monitor HR & K+

Digoxin

Can be used in patients with heart failure and atrial fibrillation to slow conduction through the atrioventricular node, which increases left ventricular function and results in increased diuresis , and to increase the force of myocardial contration

Digoxin

Example of inotropes

Dopamine Dobutamine

To decrease cardiac workload by reducing circulating volume and thereby reduce preload

Diuretic therapy

added to pharmacologic therapy if EF is less than 35% and adequate ACE inhibitor therapy. are approved for NYHA Classes III and IV and must be used cautiously, acknowledging renal function and potassium level. been shown to decrease hospital admissions for heart failure and also increase survival when added to existing therapy.

Aldosterone antagonist

Example Vasodilator

Ace Inhibitors - First line Nitroprusside Hydralazine

To decrease afterload by decreasing resistance to ventricular emptying

Vasodilators

The foundation of heart failure treatment is the ACE inhibitor

Unless contraindicated, EF of less than 40% should receive an ACE inhibitor has been shown to improve ventricular function and patient well-being, reduce hospitalization, and increase survival. If intolerant to ACE inhibitor, an ARB should be initiated

Unless contraindicated or not tolerated, should be started for every HF patient with an EF of less than 40% due to the mortality benefits

Beta-Blockers

may be added as an alternative to an ACE inhibitor or ARB if the patient is intolerant to both drugs or it may be added to existing therapy if symptoms continue to progress

Hydralazine / isosorbide

Fluid Limit (heart Failure)

< 1.2 L/day

Warning sign for I&O, weight (heart failure)

(a 2- to 3-pound [0.9- to 1.4-kg] gain in a day or a 5pound [2.3 kg] gain in a week indicates trouble)

Bland, low calorie, low-residue with vitamin supplement during the acute phase Small frequent feedings

Nursing Management Diet (heart failure)

recommended for NYHA Class III or Class IV with a QRS prolongation of greater than 120 ms who continue to experience symptoms despite adequate pharmacologic therapy

cardiac resynchronization therapy

placed to prevent sudden cardiac death caused by symptomatic and asymptomatic arrhythmias, which are seen frequently in patients with heart failure a primary prevention to reduce mortality for patients with an EF of less than 35% a secondary prevention for patients who survived a ventricular tachycardic event.

Implantable cardioverter defibrillator (ICD)

at discharge when left ventricular EF is less than 40%, indicating systolic dysfunction

an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB)

anticoagulant

if the patient has chronic or recurrent atrial fibrillation

optional beta-blocker therapy

at discharge for stabilized patients with left ventricular systolic dysfunction without contraindications.

Data have shown that 20% to 60% of patients with heart failure

don't adhere to their prescribed treatment plan

Midterm Medsurge Flashcards

(82 cards)