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Concepts ll > Module 2 : Perfusion > Flashcards

Module 2 : Perfusion Flashcards

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1
Q

What is an EKG Review ?

A

EKGs are graphic representations of electrical activity within the heart.

EKGs reflect electrical activity, not mechanical activity. To evaluate mechanical function, assess blood pressure and peripheral pulses.

When electrical impulses stimulate mechanical cells to contract, the heart is expected to contract and pump blood, thus producing a pulse.

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2
Q

what is an isoletric Line ?

A

Flatline that occurs:

-when no electrical activity is occuring

-when pulses are to weak to be detected

  • used a baseline to identify changing electrical movement
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3
Q

EKG Components

A

P-wave – atrial depolarization

PR interval – time between atrial depolarization and beginning of ventricular depolarization

QRS complex – ventricular depolarization

ST-segment – time between end of ventricular depolarization and beginning ventricular repolarization

T-wave – ventricular repolarization (recharge)

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4
Q

EKG components

A

Depolarization is the discharge of energy that transfer electrical charges across the cell membrane.

Repolarization is the return of electrical charges to their original state.

Isoelectric

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5
Q

What are normal electrical Conduction pathways ?

A

Atrium

SA node (generates electrical impulse)

P wave (EKG strip) :Natural Rate 60-100 bpm

Internodal pathway

Junction

Atrial tissue

AV node

PR interval (EKG strip)

Natural Rate 20-40 bpm

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6
Q

What are normal Electrical Conduction Pathway

A

Ventricle

Bundle of his

Right & Left bundle branches

**Purkinje fibers **

QRS complex (EKG strip)

ST segment (EKG strip)

T wave (EKG strip)

QT interval (EKG strip)

Natural Rate 20-40 bpm

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7
Q

What is Perfusion?

A

Perfusion refers to the passage of oxygenated capillary blood through body tissues. Adequate perfusion depends on normal functioning of both the respiratory and cardiac systems. The nurse encounters potential and actual alterations in perfusion in all types of clients and must detect problems and intervene early to prevent life-threatening complications.

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8
Q

Peripheral perfusion

A

leg extremities

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9
Q

Perfusion affects what ?

A

nutrition
oxygenation
pain

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10
Q

what is peripheral Artery Disease ?

A

Peripheral blood vessels that are diseased in the lower extremities

Arterial blood flow is impaired, preventing distal extremities from receiving adequate perfusion

Results in ischemia and necrosis (cell death).

Possible thrombus(clot) that can migrate

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11
Q

Signs of PAD ?

A

Claudication

Rest Pain

Necrosis

Gangrene

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12
Q

How to access the P’s of Artery Disease?

A

Check the P’s
Pain

Pallor

Pulselessness

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13
Q

PAD Diagnostic Test ( Blood Test)

A

cholesterol
triglycerides
LDL
checking build up of fatty

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14
Q

PAD Diagnostics Test

A

Arteriography ( used to look for changes in a blood vessel)

Doppler Ultrasound

Magnetic resonance angiography (MRA) ( x-ray used to check blood vessels)

Ankle-Brachial index

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15
Q

PAD Self-management

A

Patient Education:

Follow Smoking Cessation

Maintaining dietary restrictions

Participating in exercise regimen

Foot Care

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16
Q

What is a Thrombus ?

A

Blood clot
-DVT ( A pool of blood clots)
-VTE ( Venous thrombus embolism) ( a clot that has broken off )

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17
Q

How does a thrombus form?

A

Forms by :

Stasis of blood flow

Endothelial injury

Hyper coagulability

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18
Q

What are common causes of DVT/VTE?

A

Hip surgery

Total knee replacement

Oral contraceptives

Immobility

Prolonged bedrest

Prolonged Sitting

History of DVT

History of Atrial Fibrillation

Peripheral vascular disease

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19
Q

Where are your assessment finding of DVT/ VTE?

A

Calf or groin tenderness/pain

Sudden onset of unilateral swelling in legs

Localized edema

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20
Q

Diagnostic for DVT/ VTE

A

Venography

Doppler ultrasound

D-Dimer ( a protein fragment that your body makes when a blood clot dissolves)

Deep vein MRI

Venous duplex ultrasonography (preferred)

Possible Complication DIC (Disseminated intravascular coagulation) - a rare disorder that causes abnormal blood clotting

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21
Q

Thrombolytic Therapy

A

Tissue plasminogen activator (TPA)

Dissolves thrombus quickly

Prevents further venous insufficiency

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22
Q

What are Nursing Care for DVT/ VTE ( Prevention)

A

Early ambulation

Adequate hydration

Intermittent pneumatic compression {sequential compression devices (SCDs}

Venous plexus foot pump

Anticoagulant therapy

The Patient Receiving Anticoagulant Therapy (Box)

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23
Q

What do the Joint Commision recommend for VTE Core Measure?

A

VTE Prophylaxis

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24
Q

DVT/ VTE ( Nursing Care)

A

Monitor aPTT to adjust Heparin dosage (per protocol)

Ensure antidote for Heparin is available (Protamine Sulfate)

Monitor PT/INR for Warfarin (1.5-2.0)

Ensure antidote for Warfarin is available (Vitamin K)

Monitor for signs and symptoms of bleeding

Bedrest/Elevation

Avoid massaging area

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25
What are DVT/ VTE desired outcomes?
Prevent Pulmonary Embolus (PE) Prevent further thrombus formation Decrease size of existing thrombus Avoid complications of anticoagulant therapy
26
What is Angina ( Chest pain) ?
Perfusion: blockage or spasm of a coronary artery leading to diminished blood supply Oxygenation Lack of oxygen to the myocardial results in tissue hypoxia
27
What is Ischemia ?
Injury necrosis ( Infarction)
28
What is Chronic Stable Angina?
Predictable Oxygen Supply does not meet Myocardial Demand Typically exercise-induced **Pain relieved by rest/sublingual nitroglycerin (vasodilator)** **Pharmacological Management** Sublingual Nitroglycerin (NTG) Aspirin 325mg
29
PT Education for Chronic Stable Angina ( self-management)
Wheezing or difficulty breathing Weight gain of 3 pounds in 1 week or 1 to 2 pounds overnight Severe chest or epigastric discomfort with weakness or nausea Dizziness, faintness, or shortness of breath with activity Place one nitroglycerin tablet or spray under your tongue, allowing the tablet to dissolve.
30
PT Education - Chronic Stable Angina ( Self-management)
Unstable Angina: Increased nitroglycerin use Chest discomfort that does not improve after 5 minutes or 3 sublingual NTG tablet or spray Call 911 for transportation to a health care facility.
31
What are medical Management for chronic stable angina ?
Rest Pain Management Antiplatelet Vasodilators
32
What are the desired outcomes for stable angina?
Relief of Chest Pain Coronary Dilation Increased Tissue Perfusion Decreased Anxiety No Acute Dysrhythmias Maintain Central Perfusion
33
What is Unstable Angina Injury
-Change in previously predicted pattern of angina ( no longer can predict onset) -Part of continuum of ACS -Indicative of plaque instability -Not relieved by Nitroglycerin (vasodilator) -Change requires immediate medical evaluation -ST or T wave changes on EKG
34
What are Physical Presentation of Unstable Angina ( Injury)
Severe chest pain Nausea Vomiting Diaphoresis Dizziness Weakness Palpitations Shortness of breath
35
How to Interpret CAD ( Blood Test)
Lipids Total Cholesterol greater than 200 mg/dL LDL (Bad) Cholesterol) ↑ HDL (Good) Cholesterol) ↓ C- Reactive Protein ↑ B-type natriuretic peptide (BNP) ↑
36
CAD Interpreting ( Central Perfusion)
Cardiac Markers: Troponin ( type of protein found in the heart) Creatine kinase-MB
37
Drug therapy for PAD
HMG-CoA reductase inhibitors (statins) : Simvastatin (Zocor) Atorvastatin (Lipitor) Antiplatelet : Aspirin Clopidogrel (Plavix)
38
Nursing Care for PAD
monitor bp assess tissue perfusion
39
Purpose of Anticoagulation Therapy for ( DVT/ VTE)
Anticoagulant Therapy: Unfractionated Heparin (UFH) Continuous IV drip (based on body weight) Prevents formation of new clots and enlargement of existing clot
39
Purpose of Anticoagulation Therapy for ( DVT/ VTE)
Anticoagulant Therapy: Unfractionated Heparin (UFH) Continuous IV drip (based on body weight) Prevents formation of new clots and enlargement of existing clot
40
DVT / VTE prevention
Heparin 5,000 units subcutaneous (SQ) Low-Molecular Weight Heparin Enoxaparin (Lovenox)
41
Description of chest pain ( Noticing)
Heartburn Indigestion Dull Squeezing Gnawing Aching Tightness Pressure Get a 12-Lead EKG
42
Percutaneous Coronary Interventions ( PCI)
Uses a diagnostic coronary angiography to identify occluded coronary artery Reopens occluded coronary arteries: Stent Restores perfusion Should be performed within 90 minutes of arrival to hospital
43
PCI Nursing interventions
Acute Pain:Pain Management Risk for bleeding: Watch for signs and symptoms of bleeding Back pain (retroperitoneal bleeding) Assess insertion site
44
PCI interventions
Risk for injury : Watch for increased chest pain Monitor EKG for ST elevation Maintain hydration (acute kidney injury) Monitor for acute closure of the vessel Inquire about shellfish allergy
45
PCI Interventions
Risk for ineffective peripheral tissue perfusion Continuous assessment of affected extremity Instruct patient to keep limb straight/minimize movement Head of bed should be less than 30 degrees Monitor distal pulses frequently Assess color, sensation, and temperature in involved extremity
46
Vasodilators - What are they ?
Nitroglycerin Is a vasodilator Helps preload and afterload Myocardial oxygen supply Route is based on patient symptoms Nitroglycerin (nitrostat) Isosorbide dinitrate (isordil) Nitrolingual spray Nitroglycerin patch
47
What are indication for a CABG ?
Severe occluded coronary artery Unstable angina with severe vessel disease Ischemia with heart failure Acute MI with cardiogenic shock Signs of ischemia after PCI
48
What is Heart failure?
The inability of the heart to pump effectively -left-sided heart failure -right-sided heart failure
49
What are the 2 types of Left-sided heart failure?
Systolic heart failure Diastolic Heart failure
50
Causes of left -sided heart failure
Hypertension Coronary artery disease Valvular disease (mitral & aortic) Myocardial Infarction (MI) ( Heart attack) happens when one or more parts of the heart do not receive oxygen
51
Clinical Signs and Symptoms of Heart Failure
Weakness Fatigue Dizziness Confusion Dyspnea Pulmonary Congestion
52
Right Sided Heart Failure Causes
Left ventricular failure, Myocardial Infarction (MI) Pulmonary HTN COPD Cardiomyopathy
53
signs and symptoms of right-sided heart failure
Distended neck veins Increased abdominal girth Hepatomegaly (liver engorgement) Ascites ( accumulation of fluid in the peritoneal cavity Dependent edema Weight—the most reliable indicator of fluid gain or loss Peripheral pitting edema
54
Blood test for HF Diagnostics
B-type Natriuretic peptide ( bnp) -measure the amount of bnp protein in the blood, if the heart work harder more bnp is produced electrolytes Hematocrit and hemoglobin
55
What Imaging are used to diagnose HR ?
Chest X-ray Echocardiography (best diagnostic tool) Decreased Ejection Fraction (EF) EKG Pulmonary artery catheter (Swan-Ganz)
56
Name some Priority Problems for Heart failure
Priority problems: Impaired gas exchange Decreased cardiac output Fatigue/weakness ( heart not contracting ) Activity intolerance Potential for pulmonary edema ( too much fluid in the lung pt can not breathe) Excess Fluid Volume Decrease peripheral tissue perfusion ( Most common in right sided)
57
Patient Outcomes for Heart Failure
The Patient Will: Have improved gas exchange ( increase oxygen to 95%) Have improved cardiac effectiveness (cardiac output) ( Tolerate Activity Have improved respiratory rate/pattern Maintain oxygen saturation greater than 95% Have decreased net volume (output>intake) ( nurse goal: wants pt to have increase output) Increased peripheral tissue perfusion ( check pulses as a goal)
58
Preload - Drug Therapy for Heart failure
Diuretics: Furosemide (lasix) Aldactone (spironolactone) Thiazide (HCTZ) Nitrates : ( helps dilate) Nitroglycerin (nitrostat) Isosorbide dinitrate (isordil)
59
Afterload Drug Therapy for Heart Failure ( drugs that help push blood out the heart)
ACE Inhibitors Enalapril (vasotec) Angiotensin Receptor Blockers (ARB) Nitrates
60
Heart Failure Drug therapy " Contractility"
Cardiac Glycoside: Lanoxin (digoxin) -Increases contractility -Reduces heart rate (HR) -Slows conduction through atrioventricular node
61
Drug therapy for Heart Failure Drug Therapy " Contractility"
Beta Blockers Inotropic drugs (milrinone)
62
What are the therapeutic range and toxic range for Lanoxin ( Digoxin)
Therapeutic level 0.5-2.0 ng/ml Toxicity >2.0 ng/ml
63
What is everything you know about Lanoxin ( Digoxin)
Indications: CHF, atrial fibrillation /flutter Digoxin Toxicity (Signs and Systems): Anorexia, *nausea (toxicity), vertigo, muscle weakness, *confusion (elderly), halos and vision changes Labs associated with Dig toxicity: ↓K, Mg and ↑ Ca Check apical pulse for 1 min hold meds if pulse is less than 60
64
Adjunt Therapy ( another form of trx used with the primary treatment
Beta Blockers: -lol HMG- CoA:- statin Atenolol Atorvastatin Metoprolol Simvastatin Carvedilol check bp, hr ACE Inhibitors: -pril Statins reduce cholesterol in liver Enalapril Contraind: pt w/ liver disease linsinopril Pt Teach: avoid grape juice w/ statin ARBs: -sartan Losartan Valsartan
65
Cardiac Key Drugs
66
Non- Surgical Management for Heart Failure
Non-Surgical Continuous positive airway pressure (CPAP) is a respiratory treatment that improves obstructive sleep apnea Cardiac resynchronization therapy (CRT) - help your heart beat with the right rhythm Surgical: Heart transplantation Ventricular Assist Device (VAD)- helps pump blood from the lower chambers of your heart to the rest of the body
67
What should the nurse do for Heart Failure patients
Monitor vitals signs Monitor electrolytes Monitor for early signs of pulmonary edema (review chart) Implement Medical Regimen
68
What could you teach a patient who has Heart Failure?
MADDL Medications and Compliance Activity Daily weights Diet Limit Fluids Signs of heart failure exacerbations Prevent Readmissions
69
What are signs of Heart Failure Exacerbation ( Increase/ severity of a problem)?
rapid weight gain dyspnea decrease in exercise tolerance cold-like symptoms increase in edema in feet, ankles, hands increase in BNP levels - THE FAILURE TO RESCUE-
70
What is the joint commission Heart FAilure core measure:
provide discharge instruction evaluation of left ventricular systolic function ACE/ ARB for left ventricular systolic dysfunction Adult smoking cessation

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