T2: PAD, PVD, Acute MI, Cardiac Tamponade, Pericardium

Question 1

buildup of fats, cholesterol and other substances in and on the artery walls

Answer 1

arthosclerosis

Question 2

systemic atherosclerosis; partial or total blockage decreasing perfusion to extremities

Answer 2

Peripheral artery disease

Question 3

Peripheral artery disease in legs is called

Answer 3

Lower extremity arterial disease (LEAD)

Question 4

Peripheral artery disease inflow:
Obstruction ____ end of aorta and _____, ______, _____ iliac arteries; pain at __, ___, or _____

Answer 4

-distal end of aorta
-common, internal, and external iliac arteries
-pain at low back, buttocks, or thighs

Question 5

Most inflow PAD patients seek medical attention due to

Answer 5

leg pain
(intermittent claudication)

Question 6

When pulse is not palpable, use:

Answer 6

doppler ultrasound

Question 7

Peripheral artery disease outflow:
Burning or cramping in the ____, _____, _____, and _____; pain at instep or foot discomfort =

Answer 7

-calves, ankles, feet, and toes
-obstruction below the politely artery

Question 8

PAD outflow pain level:
experience pain after walking approx. 5 blocks

Answer 8

mild

Question 9

PAD outflow pain level:
experience pain after walking 2 blocks

Answer 9

moderate

Question 10

PAD outflow pain level:
experience pain after walking 1 block or less or pain at rest

Answer 10

severe

Question 11

PAD outflow S/S (4)

Answer 11

-hair loss on lower calf, ankle, and foot
-dry scaly, dusky, pale, or mottled skin
-thickened toenails
-severe-cold and cyanotic or darkened

Question 12

PAD interventions used to increase arterial flow to the affected leg (s) (6)

Answer 12

-exercise
-positioning
-promoting vasodilation
drug therapy
-invasive nonsurgical procedures
-percutaneous vascular intervention
-bypassing arterial occlusions avocet the superficial femoral arteries (SFAs)

Question 13

Hemorheologic agent that increases the flexibility of red blood cells

Answer 13

Pentoxifylline

Question 14

PAD interventions: medications (2)

Answer 14

-hemorrheologic agents
-anti-platelet agents

Question 15

PAD stage:
-No claudication is present
-Bruit or aneurysm may be present
-Pedal pulse are decreased or absent

Answer 15

Stage I: asymptomatic

Question 16

PAD stage:
-Muscle pain, cramping, or burning occurs with exercise and is relieved with rest
-Symptoms are reproducible with exercise

Answer 16

Stage II: Claudication

Question 17

PAD stage:
-Pain while resting commonly awakens the patient at night
-Pain is described as numbness, burning, toothache-type pain
-Pain usually occurs in the distal part of the extremity (toes, arch, forefoot, or heel), rarely in the calf or ankle
-Pain is relieved by placing the extremity in a dependent position

Answer 17

Stage III: Rest Pain

Question 18

PAD stage:
-Ulcers and blackened tissue occur on the toes, forefoot, and heel
-Distinctive gangrenous odor is present

Answer 18

Stage IV: Necrosis/Gangrene

Question 19

Peripheral Venous disease includes both _____ and _____ complications

Answer 19

thrombus and embolus

Question 20

Peripheral venous disease:
altered immunity

Answer 20

-inflammation occurs around the clot
-vein wall thickens
-possible embolization (PE is most common)

Question 21

Most common type of thrombophlebitis

Answer 21

deep vein thrombosis (DVT)

Question 22

DVT are most often in ___ but can occur in ______ due to central venous devices

Answer 22

-legs
-upper arms

Question 23

interventions to prevent DVT (8)

Answer 23

-Patient education
-Leg exercises
-Early ambulation
-Adequate hydration
-Graduated compression stockings
-Intermittent pneumatic compression, such as sequential compression devices (SCDs)
-Venous plexus foot pump
-Anticoagulant therapy

Question 24

PVD nursing consideration:
notify the health care provider if:

Answer 24

-aPTT value is greater that 70 seconds

Question 25

PVD nursing consideration: assess patient for S/S of bleeding which includes: (6)

Answer 25

-hematuria -frank/occult blood in stool -ecchymosis (bruising) -petechiae -altered level of consciousness -pain

Question 26

PVD nursing consideration: if bleeding occurs:

Answer 26

stop the anticoagulant immediately and call the health care provider or call Rapid Response Team

Question 27

chest pain caused by a temporary imbalance between the coronary arteries' ability to supply oxygen and the cardiac muscle's demand for oxgygen

Answer 27

angina pectoris

Question 28

two types of angina pectoris

Answer 28

-Chronic stable -Unstable

Question 29

Characteristics of Chronic Stable Angina pectoris (3)

Answer 29

-chest discomfort occurring with moderate to prolonged exertion in a familiar pattern to the client -Frequency, duration, and intensity of the symptoms do not change over several months -usually relieved by nitroglycerin

Question 30

unstable angina or ________ = acute coronary syndrome

Answer 30

acute myocardial infarction

Question 31

rupture of atherosclerotic plaque in the coronary artery ruptures

Answer 31

Acute coronary syndrome

Question 32

Characteristics of Acute Coronary Syndrome (3)

Answer 32

-Platelete aggregation "clumping" -Thrombus (clot) formation -Vasoconstriction

Question 33

ACS: the amount of plaque disruption determines:

Answer 33

the degree of the artery blockage and specific disease process

Question 34

ACS: _____% occlusion of artery = impaired blood flow = ______ when the myocardial demand is increased

Answer 34

50% myocardia ischemia

Question 35

chest pain/discomfort that occurs at rest of within exertion causing severe activity limitation

Answer 35

unstable angina

Question 36

unstable angina -may last longer than ______ -______ relieved by nitroglycerin

Answer 36

-15 minutes -poorly

Question 37

Myocardial tissue is abrupt ly and severely deprived of oxygen

Answer 37

Acute Myocardial INfarction

Question 38

Acute MI: _______% reduction in blood flow causing ischemia

Answer 38

80-90%

Question 39

injury and necrosis of myocardial tissue if oxygenation not restored

Answer 39

ischemia

Question 40

Have an ST segment and T-wave changes seen on ECG showing myocardial ischemia

Answer 40

Non-ST-segment elevation myocardial infarction (NSTEMI)

Question 41

NSTEMI characteristics (3)

Answer 41

-ST depression -T-wave inversion -May haver elevated tropic indicating cell death or necrosis

Question 42

NSTEMI causes (3)

Answer 42

-Coronary vasospasm -Spontaneous dissection -Sluggish blood flow (narrowing of the coronary artery)

Question 43

Acute MI typical S/S

Answer 43

-chest discomfort -SOA -Nausea -Sweating

Question 44

Acute MI female/older adult S/S

Answer 44

-Neck, Jaw, Shoulder, upper back, upper abdominal discomfort -SOA, nausea, vomiting -heartburn -Pain in both arms

Question 45

ST-elevation myocardial infarction (STEMI) characteristics (3)

Answer 45

-indicates MI/necrosis -Rupture of the fibrous atherosclerotic plaque -Thrombus formation

Question 46

STEMI: the thrombus causes an abrupt ______% occlusion to the coronary artery; this is a ____________ and requires immediate:

Answer 46

-100% -Medical Emergency -Revisualization of the blocked coronary artery

Question 47

Acute MI treatment was: (4)

Answer 47

MONA -Morphine -Oxygen -Nitroglycerin -Aspirin

Question 48

Acute MI treatment now is: (10)

Answer 48

THRMOBINSS -Thienopyridines -Heparin/enoxaparin -Reninangiotensin System Blockers -Oxygen -Morphine -Beta blockers -Intervention -Nitroglycerin -Statin -Salicylate

Question 49

Acute MI treatment note: Thienopyridines include (3)

Answer 49

-Clopidogrel -Prasugrel (unless hx of stroke or TIA) -Ticagrelor

Question 50

Acute MI treatment note: oxygen

Answer 50

oxygen applied if SpO2 is <90%

Question 51

Acute MI treatment note: Beta-blockers (7)

Answer 51

Contraindications -Older than 70 years old -Systolic BP < 120 -HR >110 or <60 -Pulmonary edema- HF -Active asthma or RAD -PR interval >0.24 sec -2nd or 3rd heart block without a pacemaker

Question 52

Actue MI treatment note: nitroglycerin

Answer 52

make sure client is sitting down prior to administering

Question 53

Tests used to diagnose MI (9)

Answer 53

-Troponin T and I -Chest x-ray -CT -64-clice computed tomography coronary angiography (CTCA) -THallium scans -Contrast-enhanced cardiovascular magnetic resonance (CMR) imaging -Twelve-lead ECG -Cardiac catheterization -Angiography

Question 54

assess for ischemia or necrosis; radioisotopes cannot reach areas with decreased or absent perfusion and they appear as "cold spots:

Answer 54

Thallium scans

Question 55

can result from fluid accumulation in the pericardial sac

Answer 55

Cardiac tamponade

Question 56

Cardiac tamponade S/S (4)

Answer 56

-Hypotension -Jugular venous distention -muffled heart sounds -paradoxical pulse (variance of 10 mmHg or more in systolic blood pressure between expiration and inspiration

Question 57

If cardiac tamponade S/s are observed in patient, nurse should: (4)

Answer 57

-notify provider immediately -administer fluids to combat hypotension as prescribed -expect provider to order chest x-ray or echocardiogram -prepare client for pericardiocentesis if ordered

Question 58

preparing client for pericardiocentesis (3)

Answer 58

- informed consent -gather materials -administer prescribed medications

Question 59

during/after pericardiocentesis (3)

Answer 59

-monitor hemodynamic pressures -monitor heart rhythm -monitor for reoccurrence of s/s after the procedure

Question 60

inflammation of the pericardium; can be caused by an MI

Answer 60

Pericarditis

Question 61

Pericarditis s/s (4)

Answer 61

-chest pressure/pain -friction rub auscultated int eh lungs -shortness of air -pain relived when sitting and leaning forward