w3 Flashcards
1
Q
HF is an issue with
_________ = amount of resistance/pressure LV has to overcome to pump blood out of heart
Increased afterload is harder on heart
_________ = too fast/slow for a long period of time
__________ = amount of blood comes into heart during diastole (filling)
Increases blood volume = increases preload
___________= myocardial cells ability to contract
A
HF is an issue with
- afterload = amount of resistance/pressure LV has to overcome to pump blood out of heart
Increased afterload is harder on heart - heart rate = too fast/slow for a long period of time
- preload = amount of blood comes into heart during diastole (filling)
Increases blood volume = increases preload - myocardial contractility = myocardial cells ability to contract
2
Q
- cause = ventricular repolarization/relaxation
- unexpected = peaked
A
- T wave
3
Q
3 main s/s of PAD
- _________
- ________
- issues r/t _______:
(- Hair loss
- Dry, scaly, dusky, pale or mottled skin
- Thick toenails
- Skin cool to the touch
- Prolonged cap refill
- Decreased/weak pedal pulse
- Dependent rubor - skin of the lower extremities turns a reddish color when the legs are in a dependent position (dangling down).
- Muscle atrophy)
A
intermittent claudication
arterial ulcers
issues r/t lack of arterial perfusion
4
Q
saw tooth =
quiver =
A
A flutter
A fibrillation
5
Q
Spironolactone (potassium sparing diuretic)
class: mineralocorticoid receptor antagonist
- used with chronic HF
- is it being used as a diuretic?
- is it being used for suppression of sodium/water retention to help with offloading the LV?
- watch for hyp__kalemia and worsening__________
A
- Not being used as a diuretic
- Being used for suppression of sodium/water retention to help with offloading the LV
- watch for hyperkalemia and worsening renal failure
6
Q
- cause = SA node triggers atrial depolarization/contraction
A
- P wave
- cause = SA node triggers atrial depolarization/contraction
7
Q
drugs for rhythm control, rate control, or drugs to prevent clots?
metoprolol =
diltiazem, verapamil =
Amiodarone and dofetilide =
Warfarin =
Which is Calcium channel blockers and Beta adrenergic blockers?
A
metoprolol = Beta adrenergic blockers, rate control,
diltiazem, verapamil = Calcium channel blockers, rate control,
Amiodarone and dofetilide = for rhythm control,
Warfarin = drugs to prevent clots
8
Q
A fib/A flutter Treatment
- treatment goals =
- ________ control
- _______ control
- Prevent _______
- drugs for rate control – IV route initially
- ______________
- ______________
- drugs for rhythm control – IV route initially
- ______________
- ______________
- drugs to prevent clots
- ______________
rate or rhythm priority?
A
- Ventricular rate control (lower HR)
- Rhythm control
- Prevent embolic stroke
- drugs for rate control – priority, IV route initially
- Beta adrenergic blockers – metoprolol
- Calcium channel blockers – diltiazem, verapamil
- drugs for rhythm control – IV route initially
- Amiodarone and dofetilide
- drugs to prevent clots
- Warfarin
rate
9
Q
Tachydysrhythmias can cause –
good or bad?
- initially, may __crease CO and BP
- eventually, if sustained or increased, ventricular filling will __crease = __creased CO and BP
- _________ diastole = shortens coronary perfusion time = angina
- workload on heart ___creases = myocardial oxygen demand increases
A
good:
- initially, may increase CO and BP
bad:
- eventually, if sustained or increased, ventricular filling will decrease = decreased CO and BP
bad
- shortened diastole = shortens coronary perfusion time = angina
bad
- workload on heart increases = myocardial oxygen demand increases
10
Q
A fib/A flutter Treatment
- if hemodynamically unstable (VS are not ok) =
A
- Synchronized cardioversion/cardiovert/life pack = synchronized circuit delivers a countershock on the R wave of the QRS complex which gives you back your atrial kick
11
Q
tele vs 12 lead EKG
1- Continuous observation of HR and rhythm (nurse can be at bedside or at nurses station)
2- monitoring only
3- can be diagnostic
4- unidimensional view
5- snapshot in time
6- routine or STAT
7- multidimensional view
8- done by EKG tech at bedside
9- nurse doesn’t interpret
A
1- T
2- T
3- 12 lead EKG
4- T
5- 12 lead EKG
6- 12 lead EKG
7- 12 lead EKG
8- 12 lead EKG
9- 12 lead EKG
12
Q
s/s
- asymptomatic
- may be found during routine physical exam
- pulsatile mass in periumbilical area
- bruit present in abdomen
- back pain
A
Abdominal aortic aneurysm
13
Q
Raynaud’s phenomenon: Nursing care
- primary focus = patient _______
- ________ clothing
- Gloves with _____ items
- Avoid temp _________
- Immersing hands in ______ water may decrease vasospasm
- Avoid _______ – cold, emotional upset, tobacco, caffeine
- drug therapy - _______ blockers
- 1st line
- used to lower BP?
- Used to treat _______ in peripheral vessels
A
Nursing care
- primary focus = patient teaching
- Layered clothing
- Gloves with cold items
- Avoid temp extremes
- Immersing hands in warm water may decrease vasospasm
- Avoid triggers – cold, emotional upset, tobacco, caffeine
- drug therapy - SR calcium channel blockers
- 1st line
- Not used to lower BP
- Used to treat vasospasm in peripheral vessels
14
Q
Some patients may be able to tolerate a HR outside of 60-100 if their ___ remains adequate
How do we know – they will be asymptomatic or symptomatic
Asymptomatic -
- _______ + _______ = asymptomatic = they can tolerate abnormal HR
Symptomatic -
- ________ + ________ = symptomatic = they can’t tolerate abnormal HR
- may lead to
- Myocardial ischemia/infarct
- Dysrhythmias
- Hypotension or HTN?
- HF
A
Asymptomatic -
- Bradycardia/tachycardia + BP remain adequate = asymptomatic = they can tolerate abnormal HR
Symptomatic -
- Bradycardia/tachycardia + BP doesn’t remain adequate = symptomatic = they can’t tolerate abnormal HR
- may lead to
- Myocardial ischemia/infarct
- Dysrhythmias
- Hypotension
- HF
15
Q
cardiovert and defibrillation:
- _________ = synchronized circuit delivers a countershock on the R wave of the QRS complex which gives you back your atrial kick
- ___________ = (synchronized switch is turned on)
- if switch is turned on pt must have _________
- turning the synch switch on means it will fire when?
- If the lifepack is not synched and fires at wrong time = trigger
- For defibrillation
- (synchronized switch is turned _______)
- Pt does or doesn’t have QRS complex/R wave? - when the switch is off = does not synch up with pts QRS and will fire ________
A
- Synchronized cardioversion/cardiovert/life pack
- synchronized cardioversion/cardiovert
- R wave/QRS complex
- This will synch up with pts QRS and fire at the appropriate time
- If the lifepack is not synched and fires at wrong time = trigger life threatening dysrhythmias
- For defibrillation (synchronized switch is turned off) – Pt doesn’t have QRS complex/R wave (ex: Vfib or VTACH)
- This does not synch up with pts QRS and will fire as soon as the button is pressed
16
Q
which dysrhythmia
- originates in ectopic focus anywhere above bifurcation of bundle of His, anywhere in atria
- run of repeated premature beats, that starts and stops abruptly
- usually initiated by a PAC
- rate is > 100 bpm
A
PSVT
Paroxysmal supraventricular tachycardia
- originates in ectopic focus anywhere above bifurcation of bundle of His, anywhere in atria (supraventricular)
- run or repeated premature beats, that starts and stops abruptly (paroxysmal)
17
Q
- start of P wave to start of QRS complex
- expected 0.12 – 0.20 seconds
A
PR interval
18
Q
Afib
Explanation of different rates
- atrial rate > 400 bpm
- ventricular rate up to 100-175 bpm
- ___ node is gate keeper helping to slow >400 bpm down, so only some of the atrial pulses are conducted though the ___ node
- all the little quivers are the _______ firing that didn’t get through to the AV node (called ___ waves)
- the ___________ is the ectopic firing that did get through the AV node
A
Explanation of different rates -
- atrial rate > 400 bpm
- ventricular rate up to 100-175 bpm
- AV node is gate keeper helping to slow >400 bpm down, so only some of the atrial pulses are conducted though the AV node
- all the little quivers are the ectopic sites firing that didn’t get through to the AV node (called f waves)
- the QRS complex is the ectopic firing that did get through the AV node
19
Q
Causes of ______
- can occur with any underlying heart disease
- electrolyte imbalance
- hypoxia
- cardiac surgery
A
A fib
20
Q
You can live with A fib?
You can live with Vfib?
A
yes - You can live with A fib, bc what really matters is ventricular rate
Ex: if patient is A fib with HR 90, he can live with this b/c ventricle rate is under control (not ideal, but possible)
no - can’t live with vfib
21
Q
Venous thromboembolism VTE
Patho:
- 3 things occur
______
______
______
- as a result
________
A
Venous thromboembolism VTE
Patho
- 3 things occur
- Venous stasis
- Endothelial tissue damage
- Blood thickens (hypercoagulability)
- as a result
- Thrombus forms
22
Q
Start of QRS complex to end of T wave
A
- QT interval
23
Q
Causes of ______
- benign (common)
- electrolyte imbalance
- stress
- cardiac stimulants – caffeine
- atrial pathology (any disease or abnormality that affects the atria of the heart, includes: A fib, A flutter)
A
PAC
24
Q
- cause = AV node triggers ventricular depolarization/contraction
- atrial repolarization/relaxation occurs here, can’t see it on EKG
- expected = “skinny or narrow”
A
- QRS complex (R wave)
25
Digoxin –
- 2nd line drug – b/c of ________ risk
- negative chronotrope or positive inotrope? = slows HR
-negative chronotrope or positive inotrope? = increases contractility
- hyp__kalemia can cause:
- digitoxicity
- cardiac dysfunction
- serious dysrhythmias
- levels should be 0.5-2
- s/s of digitoxicity
- bradycardia or tachycardia?
- 3 head things
- 1 GI thing
- 1 eye thing
- take ________ for full minute before giving
- HOLD IF ________
- monitor cardiac _______
- antidote = _______ IV
- pt education – take own ______ at home
Digoxin –
- 2nd line drug – b/c of dysrhythmia risk
- negative chronotrope = slows HR
- positive inotrope = increases contractility
- hypokalemia can cause
- digitoxicity
- cardiac dysfunction
- serious dysrhythmias
- levels should be 0.5-2
- s/s of digitoxicity
- bradycardia
- h/s
- dizzy
- confusion
- nausea
- visual disturbances
- take apical pulse for full minute before giving
- HOLD IF pulse < 60
- monitor cardiac rhythm
- antidote = digibind IV
- pt education – take own pulse at home
26
s/s _______ HF
- fatigue
- increased peripheral venous pressure
- JVD
- hepatomegaly – liver enlarged
- splenomegaly – enlarged spleen
- ascites
- vascular congestion in GI tract – anorexia, nausea
- peripheral edema
- scrotal edema
right
27
life pack/ cardioversion/ defibrillator
T/F
- Make sure people are “clear” before discharging device – not even touching bed
- If pt becomes pulseless (they lost their QRS complex) = Turn off synchronizer switch and perform defibrillation
T - Make sure people are “clear” before discharging device – not even touching bed
T - If pt becomes pulseless (they lost their QRS complex) = Turn off synchronizer switch and perform defibrillation
28
a long PR interval implies there is something wrong with
- if it is longer it implies there is something wrong with the conduction between atria and ventricle
b/c its inbetween the start of P wave to start of QRS complex = atrial contraction and ventricle contraction
29
bradycardia treatment
check for symptomatic or asymptomatic
- asymptomatic = _________
- symptomatic =
1. Atropine
- 1st line
- Route IV
- Vagolytic – ______ vagus nerve, will ___crease HR
- 1 mg q 3-5 mins, 3 mg max
2. Transcutaneous pacing of heart (temp)
- 2nd line – if atropine didn’t work and pt is still brady and symptomatic
3. pacemaker (permanent)
- indicated if it continues
- pacemaker fires when SA nodes aren’t doing their job
1. check for symptomatic or asymptomatic
- asymptomatic = monitor
- symptomatic =
- Atropine
- 1st line
- Route IV
- Vagolytic – blocks vagus nerve, will increase HR
- 1 mg q 3-5 mins, 3 mg max
- Transcutaneous pacing of heart (temp)
- 2nd line – if atropine didn’t work and pt is still brady and symptomatic
- pacemaker (permanent)
- indicated if it continues
- pacemaker fires when SA nodes aren’t doing their job
30
EKG strip
- shows markings for measuring amplitude and duration of waveforms
- smallest box = 0.04 seconds
- bigger box = 0.20 seconds
- strips = __ seconds
6
31
____________
- Normal cardiac rhythm, seen in young healthy people
- d/t changes in intrathoracic pressure w/ breathing
- everything is normal except, R to R interval is not regular
Sinus arrhythmia
32
Peripheral artery disease vs venous disease
9. ulcer tissue
_____– black eschar or pale pink granulation
_____ – yellow slough or dark red/ruddy granulation
10. pain
_____ – intermittent claudication (with walking) or rest pain (constant). Ulcer may/may not be painful
_____– dull ache or heaviness in calf or thigh. Ulcer often painful
11. nails
_____ – thick or normal
_____ – thick and brittle
12. skin color
_____ – bronze/brown pigmentation, varicose veins
_____– dependent rubor (dark purple when legs hang), elevation pallor
9. ulcer tissue
PAD – black eschar or pale pink granulation
Venous disease – yellow slough or dark red/ruddy granulation
10. pain
PAD – intermittent claudication (with walking) or rest pain (constant). Ulcer may/may not be painful
Venous disease – dull ache or heaviness in calf or thigh. Ulcer often painful
11. nails
Venous disease – thick or normal
PAD – thick and brittle
12. skin color
Venous disease – bronze/brown pigmentation, varicose veins
PAD – dependent rubor (dark purple when legs hang), elevation pallor
33
VTACH
CO =
Vfib
CO =
very decreased
NONE
34
Treatment tachycardia
1. treat the cause
- If FVD = __________
- If in pain = __________
- If febrile = ________
- If panic attack/anxiety = ____________
2. give beta adrenergic blockers – _______ HR and ________ myocardial oxygen consumption
Treatment
- treat the cause
- If FVD = fluid volume replacement
- If in pain = give analgesic
- If febrile = give anti-pyretic
- If panic attack/anxiety = give benzo/anxiolytic
- beta adrenergic blockers – reduce HR and myocardial oxygen consumption
35
Chronic venous insufficiency (CVI)
Collaborative care
- ___________ worn daily
- avoid ___________ for long times
- leg position that promotes venous return, reduces swelling?
- daily ________ – venous circulation
- good foot and leg care
- high ______, high ________ diet – r/t skin healing
Collaborative care
- compression (stockings or SCUDS) worn daily
- avoid standing/sitting for long times
- elevate legs above heart – promotes venous return, reduces swelling
- daily walking – venous circulation
- good foot and leg care
- high calorie, high protein diet – r/t skin healing
36
PVC subtypes
-_______ = every other QRS complex is a PVC
- ________ = every third QRS complex is a PVC
- _________ = every forth QRS complex is a PVC
- _________= all PVCs are either above the isoelectric line or below the isoelectric line (all coming from same place)
- _________= PVCs are both above and below the isoelectric line (coming from different places)
PVC subtypes
- bigamy = every other QRS complex is a PVC
- trigeminy = every third QRS complex is a PVC
- quadrigeminy = every forth QRS complex is a PVC
- unifocal = all PVCs are either above the isoelectric line or below the isoelectric line (all coming from same place)
- multifocal = PVCs are both above and below the isoelectric line (coming from different places)
37
s/s
- UNILATERAL leg edema = indicates its r/t ______ not ________
- pain
- tenderness with palpation
- dilated superficial veins
- sense of fullness in thigh or calf
- parasthesia
- warm skin and erythema
- temp > 100.4 = r/t inflammation
most serious complication = ______
VTE s/s
- UNILATERAL leg edema = indicates its r/t blood clot not venous insufficiency
- pain
- tenderness with palpation
- dilated superficial veins
- sense of fullness in thigh or calf
- parasthesia
- warm skin and erythema
- temp > 100.4 = r/t inflammation
most serious complication = PE
38
Collaborative therapy: acute or chronic HF
- treat underlying cause
- O2 therapy NC – helps relieve dyspnea/fatigue
- rest/activity period – conserve energy/minimize O2 demands
- daily weights
- sodium restricted diet – so they don’t retain more water
- drug therapy
- ACE inhibitors and ARBs
- Beta blockers – carvedilol
- - diuretics – loop, potassium sparing, thiazide, osmotic
- Nitrates
- Cardiac glycosides – digoxin
- left ventricular assist device LVAD
- heart transplant
chornic
39
VTE Risk factors: r/t Venous stasis, Endothelial tissue damage, or hypercoagulability?
- caustic or hypertonic IV drugs
- fractured pelvis, hip, leg
- IV drug abuse
- trauma
Risk factors: endothelial damage
40
Peripheral artery disease (PAD)
Risk factors
- atherosclerosis
- tobacco
- DM
- hyperlipidemia
- uncontrolled HTN
- familial
- ___creased CRP – non specific indicator of inflammation
which one is the main one?
- atherosclerosis!!
increased
41
Peripheral artery disease vs venous disease
5. hair
________ – hair could be present or absent
________ – no hair on legs, feet, toes (r/t poor perfusion)
6. ulcer location
________ - medial malleolus (bony bump on the inner ankle)
________ – tips of toes, foot, or lateral malleolus (bony bump on the outer ankle)
7. ulcer margin
________ – rounded, smooth, Punched-out appearance (edges are well-defined, sharp, resembling a hole punched in the skin)
________ – irregular shaped
8. ulcer drainage
________ – minimal amounts
________ – moderate to large amounts
5. hair
Venous disease – hair could be present or absent
PAD – no hair on legs, feet, toes (r/t poor perfusion)
6. ulcer location
Venous disease - medial malleolus (bony bump on the inner ankle)
PAD – tips of toes, foot, or lateral malleolus (bony bump on the outer ankle)
7. ulcer margin
PAD – rounded, smooth, Punched-out appearance (edges are well-defined, sharp, resembling a hole punched in the skin)
Venous disease – irregular shaped
8. ulcer drainage
PAD – minimal amounts
Venous disease – moderate to large amounts
42
________ rhythm
- Normal cardiac rhythm
- Sinus nodes fire 60-100 bpm
- Follows normal conduction pattern
- R to R interval is regular
Normal sinus
43
Causes of bradycardia -
T/F
- excessive vagal stimulation by parasympathomimetic
- Carotid sinus massage
- Vomiting/gagging
- Valsalva maneuvers
- Eyeball pressure
- Administration of parasympathomimetic drugs
- digoxin toxicity
- Hypokalemia – slows depolarization
- MI
- excessive vagal stimulation by parasympathomimetic
- Carotid sinus massage
- Vomiting/gagging
- Valsalva maneuvers
- Eyeball pressure
- Administration of parasympathomimetic drugs
- digoxin toxicity
X - Hyperkalemia – slows depolarization
- MI
44
Ventricular or atrial dysrhythmias are
Life threathening?
Ventricular dysrhythmias
PVC, VTACH, VFIB
45
Peripheral artery disease vs venous disease
1.peripheral pulses
______ – present
_____ – decreases or absent
2. cap refill
_____ – slow >3 secs
_____ – brisk <3 secs
3. ABI Ankle-Brachial Index - compares the BP in your ankle and arm.
_____ – >0.90 (good)
_____ – <0.90 (bad)
4. edema
_____ – none (unless leg is constantly in dependent position (dangling)
_____ – lower leg edema
1.peripheral pulses
Venous disease – present
PAD – decreases or absent
2. cap refill
PAD – slow >3 secs
Venous disease – brisk <3 secs
3. ABI Ankle-Brachial Index - compares the BP in your ankle and arm.
Venous disease – >0.90 (good) no arterial obstruction = ankle pressure is typically normal
PAD – <0.90 (bad) narrowed arteries reduces blood flow to the legs = lower ankle pressures compared to the arm
4. edema
PAD – none (unless leg is constantly in dependent position (dangling)
Venous disease – lower leg edema
46
________ = Amount of blood ejected from LV
___________= amount of blood in the ventricle prior to ejection
SV
---------- =
end diastolic volume
Stroke volume
End diastolic volume/preload
Ejection fraction
47
bradycardia s/s
- symptomatic, asymptomatic, or both?
tachycardia s/s
- symptomatic, asymptomatic, or both?
- may be asymptomatic with HR < 60
- may be symptomatic ***
- may be asymptomatic with HR >100
- may be symptomatic ***
48
waves in order (3)
1st -________
2nd - PR interval
3rd - ________
4th - ST segment
5th - _________
6th - QT interval
7th - isoelectric flat line
P wave
QRS complex/R wave
T wave
49
VTE Risk factors: r/t Venous stasis, Endothelial tissue damage, or hypercoagulability?
- older age
- bed rest or prolonged immobility
- HF
- fractured hip or leg
- long trip w/o adequate exercise
- obesity
- pregnancy
- varicose veins
Risk factors: venous stasis
50
ABI
Ex:
left brachial systolic pressure = 130 mm
left ankle systolic pressure = 110 mm
right brachial systolic pressure = 125 mm
right ankle systolic pressure = 75 mm
right ABI = _____/______ = 0.84
left ABI = ______/______ = 0.58
0.9-1.3 = Normal ABI
< 0.9 = occlusive atrial disease (0.4 – 0.9 is often associated w/ claudication)
< 0.4 = non-healing ulcerations, ischemic rest pain
This person has ___________ in ______ extremity(s), and the _____ leg is probably worse off than the______ leg
left ABI = 110/130 = 0.84
right ABI = 75/130 = 0.58
This person has occlusive arterial disease in both extremities, and the left leg is probably worse off than the right leg
51
Collaborative therapy for acute or chronic HF?
- treat underlying cause
- hourly vitals and UO
- continuous EKG and pulse ox
- monitor ABG results
- position in high fowlers with feet:
horizontal?
elevated?
dangling at bedside?
- O2 by ______ or ______
- daily weights
- hemodynamic monitoring
- drug therapy goal
-__crease intravascular volume
-__creases afterload
-__crease anxiety
-__creases LV function
- drug therapy meds
-diuretics
-vasodilators
-morphine – decrease ____load and ______load
-positive inotropes (increase _________) – digoxin
Collaborative therapy
- treat underlying cause
- hourly vitals and UO
- continuous EKG and pulse ox
- monitor ABG results
- position in high fowlers with feet
horizontal
or
dangling at bedside – decreases venous return/preload
- O2 by mask or bipap
- daily weights
- hemodynamic monitoring
- drug therapy goal
- decrease intravascular volume
- decreases afterload
- decrease anxiety
- increases LV function
- drug therapy meds
- diuretics
- vasodilators
- morphine – decrease preload and afterload
- positive inotropes (increase contractility) – digoxin
52
PAC treatment
- benign =
- if atrial pathology (any disease or abnormality that affects the atria of the heart, includes: A fib, A flutter) is the cause =
treatment
- benign = no treatment
- if atrial pathology is the cause = same treatment as A fib
53
acute or chronic HF?
1.______
- dx in outpatient setting
- marked by periods of acute and/or slowly worsening cardiac function
- may be caused by damage from other cardiac events/disease
2. _______
- dx in inpatient setting
- worsening chronic health failure s/s requiring urgent therapy
- life threatening condition
- s/s – SOA d/t excess fluid caused by cardiac overload
chronic
acute
54
Treatment if a-fib >48 hours
(not an emergency) = planned ___________
- ___________ therapy before cardioversion for 3-4 weeks AND after cardioversion for 3-4 weeks = want to make sure you don’t have _____
- ______ may be performed before cardioversion = way to check and make sure _________
if cardioversion if emergent = low molecular weight heparin or heparin _______
Treatment if a-fib >48 hours
- anticoagulation therapy (warfarin/coumadin) before cardioversion for 3-4 weeks AND after cardioversion for 3-4 weeks = want to make sure you don’t have any clots leading to a stroke
- TEE may be performed before cardioversion = make sure no clots in atrium
- if cardioversion if emergent = low molecular weight heparin or heparin drip
55
- End of QRS complex/R wave to start of T wave
- expected = equal to isoelectric line
4. ST segment
56
HF diagnosis
- hx
- physical exam
- EKG =
- BNP and ProBNP =
- CXR =
- echocardiogram =
- hx
- physical exam
- EKG
- reduced EF will have significant EKG abnormalities
- BNP and ProBNP
- helps distinguish HF from other sources of dyspnea
- pts with dysnea and HF have BNP >400
- CXR
- cardiomegaly
- pleural effusions
- echocardiogram
- EF
57
- episodic
- vasospastic
- autoimmune
- disorder of small cutaneous arteries (often fingers and toes)
- may occur in isolation or with other autoimmune diseases – SLE, RA
Raynaud’s phenomenon
58
_______ nerve = part of parasympathetic nervous system (PNS), causes rest and digest
______________ = substances/conditions that stimulate the vagus nerve, thus the PNS, thus rest and digest
vagal
parasympathomimetic
59
AAA post op care
- ICU after surgery
- monitor for:
- _______ patency
- maintain adequate _____ (too low = poor perfusion, too high = can blow graft)
- CV status – r/t ____ risk
- infection
- GI status – ________ risk
- peripheral perfusion – especially _____ to entrance site
- renal perfusion – hourly ______
- provide discharge teaching
AAA post op care
- ICU after surgery
- monitor for:
- graft patency
- maintain adequate BP (too low = poor perfusion, too high = can blow graft)
- CV status – MI risk
- infection
- GI status – paralytic ileus risk
- peripheral perfusion – especially distal to entrance site
- renal perfusion – hourly u.o.
- provide discharge teaching
60
***Key features of sustained tachy/brady dysrhythmias
HR outside of 60-100 range
- ______ = r/t poor coronary perfusion
- _____, ______, ______ = r/t poor brain perfusion
- ______ and _______ = r/t poor brain perfusion and low BP
- pulse _____ = r/t poor peripheral perfusion
- SOA
- tachypnea or bradypnea?
- ________ = r/t left HF
- _________ (can’t breathe when lying down)
- ________ heart sounds (gallop)
- ____ = r/t right HF
- weakness, fatigue
- pale, cool skin, diaphoresis
- n/v
- ____creases urine output = r/t poor kidney perfusion
- _______ cap refill = r/t poor peripheral perfusion
- hyp__tension = r/t low CO
Only tachydysrhythmias
- palpitations
***Key features of sustained tachy/brady dysrhythmias
HR outside of 60-100 range
- angina = r/t poor coronary perfusion
- restlessness (think hypoxia), anxiety, confusion = r/t poor brain perfusion
- dizziness and syncope = r/t poor brain perfusion and low BP
- pulse deficit (when we check radial and apical pulse at same time, apical is higher than radial) = r/t poor peripheral perfusion
- SOA, tachypnea
- pulmonary crackles = r/t left HF
- orthopnea (can’t breathe when lying down)
- S3 or S4 heart sounds (gallop)
- JVD = r/t right HF
- weakness, fatigue
- pale, cool skin, diaphoresis
- n/v
- decreases urine output = r/t poor kidney perfusion
- delayed cap refill = r/t poor peripheral perfusion
- hypotension = r/t low CO
Only tachy
- palpitations
61
PAD s/s
intermittent claudication
- Location of pain correlates with site of ________
- Pain with ________ r/t peripheral artery occlusion when ________, no pain when _________
arterial ulcers (most ulcers are venous)
- Distal digits (toes)
- Bony prominences
- Deep lesions
- _________ (edges are well-defined, sharp, resembling a hole punched in the skin)
- Little to no ________
- lack of arterial perfusion leads to
- Hair _______
- Dry, scaly, dusky, pale or mottled ______
- Thick _______
- Skin_____ to the touch
- ________ cap refill
- _________ pedal pulse
- ____________- skin of the lower extremities turns a reddish color when the legs are in a dependent position (dangling down).
- Muscle _________
intermittent claudication
- Location of pain correlates with site of occlusion
- Pain with walking r/t peripheral artery occlusion when walking, no pain at rest
arterial ulcers (most ulcers are venous)
- Distal digits (toes)
- Bony prominences
- Deep lesions
- Punched out (edges are well-defined, sharp, resembling a hole punched in the skin)
- Little to no exudate
- lack of arterial perfusion leads to
- Hair loss
- Dry, scaly, dusky, pale or mottled skin
- Thick toenails
- Skin cool to the touch
- Prolonged cap refill
- Decreased/weak pedal pulse
- Dependent rubor - skin of the lower extremities turns a reddish color when the legs are in a dependent position (dangling down).
- Muscle atrophy
62
normal electrical pattern in order
1st - P wave =
2nd - PR interval =
3rd - QRS complex / R wave =
4th - ST segment =
5th - T wave =
6th - QT interval =
7th - isoelectric flat line =
atrial contraction
measure of P wave start to QRS complex start
ventricular contraction (atrial relaxation)
measure of End of QRS complex/R wave to start of T wave
ventricular relaxation
measure of Start of QRS complex to end of T wave
Absence of electrical activity in cardiac cells
63
- ectopic pacemaker (group of cells in the heart, other than the SA node, that spontaneously generates electrical impulses) in atrium fires before SA node fires
- isolated premature atrial beat
- one time early discharge of an ectopic beat outside of the SA node
- we know this by looking at R to R interval, and can see one early beat that is out of the pattern, that is a ____
PAC
Premature atrial contraction
64
Nursing care: Synchronized cardioversion/cardiovert/lifepack
T/F
- airway
- oxygen
- vitals and LOC
- Monitor dysrhythmias
- emotional support
- document results of cardioversion
- airway
- oxygen
- vitals and LOC
- Monitor dysrhythmias
- emotional support
- document results of cardioversion
65
Treatment PSVT
Paroxysmal supraventricular tachycardia
1. _____ maneuvers – trigger _______ response/_NS, brings pt out of PSVT
Ex: ________ maneuver – most effective, hold breath 10-15 secs, should see JVD, then resume breathing
Ex: Coughing
Ex: Carotid sinus massage – HCP only
2. diving reflex/_____ water submersion
3. If that doesn’t work
med = atropine or adenosine?
- IV push followed with rapid ________ (may use stop cock)
- Warn pt may see _______ on rhythm strip
- Onset is 10-40 _____
- Duration – 1-2 _____
- very _____ half life
4. if that doesn’t work and pt becomes hemodynamically unstable
- cardioversion or defibrillation?
- synchronized switch on or off?
- vagal maneuvers – trigger vagal response/PNS, brings pt out of PSVT
- Valsalva maneuver – most effective, hold breath 10-15 secs, should see JVD, then resume breathing
- Coughing
- Carotid sinus massage – HCP only
- diving reflex/cold water submersion
If that doesn’t work
- adenosine
- IV push followed with rapid NS flush (may use stop cock)
- Warn pt may see pause on rhythm strip – flat line
- Onset is 10-40 secs
- Duration – 1-2 mins
- very short half life
if that doesn’t work and pt becomes hemodynamically unstable
- cardioversion, synchronized switch on
66
EF = ____-____% normal
<___% = HF
EF = 55-70% normal
<40% = HF
67
2 leads/electrodes are next to each other anatomically =
ST elevation in 2 contiguous leads =
Contiguous leads
pt is having/had a STEMI
68
Treatment for VTACH
1. depends on if the pt has ________ or _______
- ACLS
- anti-___________ drug – beta blocker, calcium channel blockers, amiodarone
- electrolyte replacement
s/s
- will be __________ very quickly unless converts back to other rhythm
- depends on pulse (perfusion) or pulseless (no perfusion)
- ACLS
- anti-dysrhytmic drug – beta blocker, calcium channel blockers, amiodarone
- electrolyte replacement
s/s
- will be symptomatic very quickly unless converts back to other rhythm
69
s/s PSVT Paroxysmal supraventricular tachycardia
- depends on
- __________
- How _______ the ventricular rate is
(if it’s too high ____ is reduced)
***
- depends on
- How long it lasts
- How fast the ventricular rate is (tachycardia), if it’s too high CO is reduced
70
VTACH
Ventricular tachycardia
- 3 or more______ together
- ectopic focus within the ventricles takes controls and fires ________
- no _______ contractions occurring
- ______ ______ cardiac output
- rate _____-____ bpm,
- regular or irregular?
- p wave?
- PR interval?
VTACH
Ventricular tachycardia
- 3 or more PVCs together
- ectopic focus within the ventricles takes controls and fires repeatedly
- no atrial contractions occurring
- very decreased cardiac output
- rate 150-200 bpm,
regular
- no p wave,
PR interval not measurable
71
s/s _______ HF
- pulmonary congestion/edema
- cough
- crackles, rhonchi, wheeze
- blood tinged sputum
- tachypnea
- restlessness, confusion
- Orthopnea – SOA when lying flat
- tripod position
- tachycardia
- exertional dyspnea
- fatigue
- cyanosis
- late sign = paroxysmal nocturnal dyspnea - sudden SOA that awakens a person from sleep
left
72
- SA node fires < 60 bpm
- may be a normal rhythm in athletes and during sleep
- SA node fires >100 bpm
Sinus bradycardia
Sinus tachycardia
73
PAD treatment
Post op nursing care
- frequent _________ assessment
- when to notify HCP
- Dramatic increase in ______
- Loss of pulses_______ to site (doppler)
- Extremity _______ or _______ (color)
- Change in any other _______ status
- avoid ___________ position – impedes arterial flow
- early __________
- foot care
Post op nursing care
- frequent peripheral vascular system assessment (PVS)
- when to notify HCP
- Dramatic increase in pain
- Loss of pulses distal to site (doppler)
- Extremity pallor or cyanosis
- Change in any other PVS status
- avoid knee flexed position – impedes arterial flow
- early ambulation
- foot care
74
Causes of _____
- if it’s isolated – may be benign
- stimulants
- electrolyte imbalance
- Hypoxia
- fever
- exercise
- emotional stress
- CVD
PVC
75
HR < 60
HR > 100
Bradydysrhythmias
Tachydysrhythmias
76
Atrial flutter
- Atrial ______dysrhythmia
- identified by
recurring or single?
irregular or regular?
"________" shaped flutter waves
- originates from a _______ ectopic focus, reentry impulse is repetitive and cyclic
- R to R interval can be regular or irregular
- atrial rate may be >_____ bpm
- ventricular rate slower
- atria is not _______, atria is ________
Atrial flutter
- Atrial tachydysrhythmia identified by
recurring,
regular,
saw tooth shaped flutter waves
- originates from a single ectopic focus, reentry impulse is repetitive and cyclic
- R to R interval can be regular or irregular
- atrial rate may be >250 bpm
- ventricular rate slower
- atria is not contracting/kicks (p wave), atria is fluttering (f wave)
77
Bradydysrhythmias could cause -
which is good/bad?
- ________ myocardial oxygenation demand
- ________ diastole (extended period of relaxation and filling of the heart's chambers, particularly the ventricles)
- if HR is too slow = ___crease in coronary perfusion
good
- reduced myocardial oxygenation demand
good
- prolonged diastole (extended period of relaxation and filling of the heart's chambers, particularly the ventricles) = improve myocardial perfusion
The bad:
- if HR is too slow = decrease in coronary perfusion = angina
78
Causes of ________
- can occur with any underlying heart condition
- electrolyte imbalance
A flutter
79
A fib/A flutter Treatment: if hemodynamically stable (VS are ok), but symptomatic***
- ___________ and ______ with either IV calcium channel blockers, beta blockers, digitalis, amiodarone
- “Bolus and start a drip” may be ordered = bolus med to get to therapeutic level and then put the med on a drip to keep it at that level
- Slow ventricular rate and control rhythm
80
Cardioversion vs defibrillation
1- elective procedure
2- emergency
3- call a code
-4 pt awake and often sedated
5- synchronized with QRS (switch turned on)
-6 pulselessness – vfib, VTACH
7- no cardiac output
8- 200-360 joules
9- 50-200 joules
10- consent form
11- pt unconscious
12- EKG monitor
13- not synchronized with QRS (switch turned off)
1 c
2 d
3 d
4 c
5 c
6 d
7 d
8 d
9 c
10 c
11d
12 both
13 d
81
with PACs
When to contact HCP
___
___
why?
When to contact HCP
- new PACs
- increasing PACs
why? could indicate pt is about to convert to A fib
82
Chronic venous insufficiency (CVI)
s/s
- _______ skin
- ________color
- edema
- eczema with itching
- ulcer location medial malleolus – ______ ankle
- _________ positon makes pain worse
- w/out treatment ulcer gets deeper and wider and increases risk of _______
s/s
- leathery skin
- brownish/brawny color
- edema
- eczema with itching
- ulcer location medial malleolus – inside ankle
- dependent positon (leg dangle) makes pain worse
- w/out treatment ulcer gets deeper and wider and increases risk of infection
83
Peripheral artery disease vs venous disease
13. Skin texture
____– thick, hard/indurated
____ – thin, shiny, taut
14. skin temp
____ – cool temperature gradient down the leg (toes are cool)
____ – warm, no temperature gradient
15. dermatitis
____ – rare
____ – frequent
16. pruritus
____ – frequent
____ – rare
13. Skin texture
Venous disease – thick, hard/indurated
PAD – thin, shiny, taut
14. skin temp
PAD – cool temperature gradient down the leg (toes are cool)
Venous disease – warm, no temperature gradient
15. dermatitis
PAD – rare
Venous disease – frequent
16. pruritus
Venous disease – frequent
PAD – rare
84
left ventricular assist device LVAD
T/F
- treatment for acute or chronic HF?
- used as a bridge to transplant or if no surgery is planned (destination therapy)
- must take BP manually with doppler
- LVAD machines are in continuous flow so BP can’t be read
- heart tones S1/S2 can still be heard
- if pt is unresponsive – make sure pump is turned on or off? then start CPR
- education
- chronic
T - used as a bridge to transplant or if no surgery is planned (destination therapy)
T- must take BP manually with doppler
T - LVAD machines are in continuous flow so BP can’t be read
F - heart tones S1/S2 cant be heard – just a humming sound of LVAD
- if pt is unresponsive – make sure pump is turned off, then start CPR
- education
85
PVC Treatment
1. treat the cause
2. drugs
- beta blockers
- lidocaine
- amiodarone or atropine?
PVC Treatment
1. treat the cause
2. drugs
- beta blockers
- lidocaine
- amiodarone
86
- irregular waveforms of varying shapes and sizes
- ventricles are quivering
- no effective contractions = NO cardiac output
Ventricular fibrillation
87
If A fib/A flutter treatment doesn’t work
- long term ________ required
- drug of choice - ________
- Have to monitor ____ regularly
- Antidote – ________
- alternatives – dabigatran, apixaban, rivaroxaban, eboxaban
- Don’t require ________
- More _________
- dosing?
- Contraindicated with __________
- antidote -
If A fib/A flutter treatment doesn’t work
- long term anti coagulation required
- drug of choice - warfarin/coumadin
- Have to monitor INR regularly
- Antidote – vitamin K
- alternatives – dabigatran, apixaban, rivaroxaban, eboxaban
- Don’t require routine lab testing
- More expensive
- May have to takes >once per day
- Contraindicated with renal dysfunction
- No antidote
88
- Elevated ST seg. + elevated troponin =
- Not elevated ST seg. + elevated troponin =
- Not elevated ST seg. + not elevated troponin + chest pain =
STEMI
NSTEMI
stable or unstable angina
89
does this cause bradycardia or tachycardia?
1. excessive vagal stimulation by parasympathomimetic
2. vagal inhibition (restraining)
3. physical activity
4. low BP
5. anxiety
6. Hyperkalemia – slows depolarization
7. pain
8. digoxin toxicity
9. stress
10. Carotid sinus massage
11. Vomiting/gagging
12. anemia
13. hypoxia
14. Valsalva maneuvers
15. Eyeball pressure
16. Administration of parasympathomimetic drugs
17. dehydrated/ hypovolemia/ low SV
18. MI
19. HF
20. fever
1. excessive vagal stimulation by parasympathomimetic = B
2. vagal inhibition (restraining) = T
3. physical activity =T
4. low BP = T
5. anxiety =T
6. Hyperkalemia – slows depolarization = B
7. pain =T
8. digoxin toxicity =B
9. stress=T
10. Carotid sinus massage =B (vagal stimulation)
11. Vomiting/gagging = B (vagal stimulation)
12. anemia = T r/t lack of RBC to oxygenate
13. hypoxia =T
14. Valsalva maneuvers =B (vagal stimulation)
15. Eyeball pressure =B (vagal stimulation)
16. Administration of parasympathomimetic drugs =B (vagal stimulation)
17. dehydrate/hypovolemia/low SV = low BP = T
18. MI = low BP = T or B
19. HF = low BP = T
20. fever=T
90
Causes of _______
- overexertion
- emotional stress
- stimulants
- digitalis toxicity
- various forms of heart disease
PSVT Paroxysmal supraventricular tachycardia
91
non waves (segments, intervals, measures) in order
1st - P wave
2nd ________
3rd - QRS complex / R wave
4th - ________
5th - T wave
6th - _______
7th - isoelectric flat line
- PR interval
ST segment
QT interval
92
Raynaud’s phenomenon
s/s
- _______ changes in fingers and toes d/t ____________
- lasts _____-______
- cold or hot?
- numbness
- when perfusion returns – (4)
- event is triggered by - (4)
Diagnosis
- based on symptoms for __ years
s/s
- color changes (red, white, blue) in fingers and toes d/t vasospasms
- lasts mins – hours
- cold
- numbness
- when perfusion returns – throbbing, aching, tingling, swelling
- event is triggered by cold, emotional upset, tobacco, caffeine
Diagnosis
- based on symptoms for 2 years
93
Stroke/emboli risk and A fib
A flutter
fibrillating/quivering atria (not a properly ______ atria) =
________ of blood =
_____ formation =
risk for _______ =
risk for _______
fibrillating/quivering atria (not a properly contracting atria) = pooling of blood = clot formation = risk for embolus = risk for stroke
94
- graphic tracing of electrical impulses produced by heart
- waveforms represent activity of charged ions across membranes of myocardial cell
EKG
95
Ankle brachial index ABI
- Right ABI formula = ________ pressure in ________ /
_________ pressure in ________
- Left ABI formula = ________ pressure in ________ /
_________ pressure in ________
- 0.9-1.3 = _______
- < 0.9 = _________
- < 0.4 = _________
non-healing ulcerations
ischemic rest pain
occlusive atrial disease
Normal ABI
often associated w/ claudication
- Right ABI formula = highest pressure in right foot /
Highest pressure out of BOTH arms
- Left ABI formula = highest pressure in left foot /
Highest pressure out of both arms
- 0.9-1.3 = Normal ABI
- < 0.9 = occlusive atrial disease (0.4 – 0.9 is often associated w/ claudication)
- < 0.4 = non-healing ulcerations, ischemic rest pain
96
PAD diagnostic tests
- ______________
- can determine degree of blood flow
- ______________
- screening tool
- uses hand held doppler on all 4 extremities, gel, BP cuff
PAD diagnostic tests
- doppler ultrasound
- can determine degree of blood flow
- Ankle brachial index ABI
- screening tool
- uses hand held doppler on all 4 extremities, gel, BP cuff
97
- 3 or more PVCs together
- ectopic focus within the ventricles takes controls and fires repeatedly
- no atrial contractions occurring
- very decreased cardiac output
- rate 150-200 bpm, regular
- no p wave, PR interval not measurable
VTACH
Ventricular tachycardia
98
When to contact HCP
- isolated?
- if new PVC?
- increasing frequency PVCs?
why?
- if new PVC or
increasing frequency PVCs
could be turning into VTACH
99
drugs for rhythm control (anti-dysrhythmic), Slows ventricular rate
(Vagolytic) blocks vagus nerve, will increase HR
antiarrhythmic drug used to convert paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm.
| all the a drugs - atropine, Amiodarone, adenosine
drugs for rhythm control (anti-dysrhythmic), - Slow ventricular rate - Amiodarone and dofetilide
atropine - - Vagolytic – blocks vagus nerve, will increase HR
adenosine - antiarrhythmic drug used to convert paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm.
100
_______ sided HF
- blood backs up in _____ atrium and pulmonary veins
______ sided HF
- blood backs up into the ____ atrium and venous circulation
left sided HF
- blood backs up in left atrium and pulmonary veins
- think LHF think lungs
right sided HF
- blood backs up into the right atrium and venous circulation
- think RHF think body
101
VTE nursing care
- early/aggressive _______ or _____ q 2 hours
- _______ and _______ of feet, hips, knees q 2-4 hours while awake = mimics __________
- anti__________ therapy
- pt teaching to minimize risk factors
- inferior vena cava interruption _______ – “greenfield _______”
- Uses stainless steel filter to prevent ______
- as blood travels up the vena cava, clots are trapped in the filter, preventing them from reaching lungs
nursing care
- early/aggressive mobilization or turn q 2 hours
- flexion and extension of feet, hips, knees q 2-4 hours while awake – mimics skeletal muscle pump
- anticoagulation therapy
- pt teaching to minimize risks
- inferior vena cava interruption filters – “greenfield filter”
- Usus stainless steel filter to prevent PE
- as blood travels up the vena cava, clots are trapped in the filter, preventing them from reaching lungs
102
CVI
Compression therapy – Promotes venous return back to heart
- recommended if pt currently has VTE?
static vs dynamic
_________ = compression hosiery
- Graded compression from distal to proximal
- Prescriptions by HCP specializing in vascular disease
- Measure in morning
- TED hose – can impede flow if put on incorrectly
________ = intermittent pneumatic compression pumps/sleeves
- SCUDs
Compression therapy – Promotes venous return back to heart
- not recommended to pt currently has VTE
static vs dynamic
- static = compression hosiery
- Graded compression from distal to proximal
- Prescriptions by HCP specializing in vascular disease
- Measure in morning
- TED hose – can impede flow if put on incorrectly
- dynamic = intermittent pneumatic compression pumps/sleeves
- SCUDs
103
Permanent localized out-pouching of vessel wall in abdominal aorta
- aorta undergoes very high pressure so it is a susceptible place to get ________
Abdominal aortic aneurysm
104
A fib/A flutter Treatment: non-pharm therapy/surgical
1. Catheter _________ – radiofrequency or cryothermal therapy
- Invasive or noninvasive?
- Destroys irritable _____ causing the dysrhythmias
- Must undergo ____ studies and mapping procedure to locate the focus
2. ______ procedure
- Surgical or catheter procedure?
- Creates numerous atrial incisions to disrupt dysrhythmias, only one path from SA node to AV node
- Catheter abliation – radiofrequency or cryothermal therapy
- Invasive
- Destroys irritable focus causing the dysrhythmias
- Must undergo EP studies and mapping procedure to locate the focus
- Maze procedure
- Surgical procedure
- Creates numerous atrial incisions to disrupt dysrhythmias, only one path from SA node to AV node
105
Abdominal aortic aneurysm
Complications
- _______
Collaborative care
- early _________ – know familial tendency
- goal = prevent _________
1. if AAA is small (<4 cm)
- surgery or Watchful waiting?
- Reduce ________
- Reduce ______
- Monitor ______ annually
2. surgical therapy – elective vs emergency
- Prefer ________
- If ________ – mortality very high
- Open aneurysm repair (OAR)
- Open surgical repair = pt comes back w/ large abdominal incision or dressing over artery entrance site?
- Surgery procedure involves – artery clamped and sew synthetic graft
- endovascular aneurysm repair (EVAR)
- open surgery or performed inside the vessel?
- pt comes back with abdominal incision or dressing over artery entrance site?
- Less or more invasive?
- Similar post op care to cardiac cath – lay flat, don’t bend effected extremity, etc.
which procedure has better morbidity/mortality rates?
Complications
- rupture
Collaborative care
- early detection – know familial tendency
- goal = prevent rupture
- if AAA is small (<4 cm)
- Watchful waiting
- Reduce risk factors (CV risk factors)
- Reduce BP
- Monitor size annually
- surgical therapy – elective vs emergency
- Prefer elective
- If rupture – mortality very high
- Open aneurysm repair (OAR)
- Open surgical repair = pt comes back w/ large abdominal incision
- Surgery procedure involves – artery clamped and sew synthetic graft
- endovascular aneurysm repair (EVAR)
- Not open surgery, performed inside the vessel =
- pt doesn’t come back with abdominal incision, pt comes back with dressing over artery entrance site
- Less invasive
- Similar post op care to cardiac cath – lay flat, don’t bend effected extremity, etc.
- Both procedures have similar morbidity/mortality rates
106
PAD:Collaborative care
1.modify _______
2.drug therapy
- Statins
- Anti____________
- Anti__________
- Cilostazol – inhibits _________ and increases vaso__________ (1st line drug for __________ if modifying risk factors alone isn’t effective)
- 3.________ exercises
- Walk until pain starts, stop/rest until pain goes away, repeat
- Purpose – increase ________ circulation
- 4.proper foot care
- 5.angioplasty/stenting – minimally invasive
- 6.intervention radiology ________-based procedures
- Alternative to _________
- In cath lab
- Similar to angiography/specialized catheter inserted via femoral artery:
- PTA - Percutaneous transluminal angioplasty (balloon)
- Stents (balloon)
- Atherectomy – plaque removal
- Cryoplasty – PTA + cold therapy
- 7.________ surgery
- 8.amputation
1.modify risk factors
- atherosclerosis
- tobacco
- DM ?
- hyperlipidemia
- uncontrolled HTN
X- familial
- ___creased CRP – non specific indicator of inflammation
- 2.drug therapy
- Statins
- Antihypertensives
- Antiplatelets – ASA
- Cilostazol – inhibits platelet aggregation and increases vasodilation (1st line drug for intermittent claudication if modifying risk factors alone isn’t effective)
- 3.walking exercises
- Walk until pain starts, stop/rest until pain goes away, repeat
- Purpose – increase collateral circulation
- 4.proper foot care
- 5.angioplasty/stenting – minimally invasive
- 6.intervention radiology catheter-based procedures
- Alternative to open surgery
- In cath lab
- Similar to angiography/specialized catheter inserted via femoral artery:
- PTA - Percutaneous transluminal angioplasty (balloon)
- Stents (balloon)
- Atherectomy – plaque removal
- Cryoplasty – PTA + cold therapy
- 7.bypass surgery
- 8.amputation
107
A fib and A flutter s/s
- depends on
- _________ rate
- how long _______ has been present
- _____ status
- typically, s/s of tachydysrhythmia ***
s/s
- depends on
- ventricular rate
- how long rhythm has been present
- CV status
- typically, s/s of tachydysrhythmia ***
108
PAD treatment
Types of bypass surgery
- name is based on _______ and _________
- Ex: femoral popliteal bypass “fem-pop bypass”
- Femoral occlusion
- Graft in femoral artery and popliteal artery, bypassing the occlusion
Types of bypass surgery
- name is based on where blockage is and what they are bypassing
- Ex: femoral popliteal bypass “fem-pop bypass”
- Femoral occlusion
- Graft in femoral artery and popliteal artery, bypassing the occlusion
109
Cor pulmonale
- type of _____HF
- caused by _________
- enlargement of ______ side of heart
Cor pulmonale
- type of RHF
- caused by pulmonary HTN
- enlargement of right side of heart
110
VTE Risk factors: r/t Venous stasis, Endothelial tissue damage, or hypercoagulability?
- dehydration
- malnutrition
- high altitudes
- oral contraceptives
- pregnancy
- cancer
- tobacco
Risk factors: hypercoagulability of blood
111
Vfib
Treatment
- CPR
- ACLS
- defibrillation
synch switch turned on or off?
Treatment
- CPR
- ACLS
- defibrillation (synch switch turned off, no QRS)
112
Atrial fibrillation
- described as “________”
- most common dysrhythmia
- total disorganization of atrial electrical activity d/t ________ ectopic foci firing all at the same time
- this causes loss of effective __________
- atrial isn’t _______, atrial is ___________
- SA is being taken over and is no longer the ________of the heart
- atrial rate > ____ bpm
- ventricular rate up to ____-____ bpm
- R to R intervals are "________ _________"
- prevalence ___creases with age
Atrial fibrillation
“quiver”
- most common dysrhythmia
- total disorganization of atrial electrical activity d/t multiple ectopic foci firing all at the same time = loss of effective atrial contraction/kick (p wave)
- atrial isn’t contracting, atrial is quivering
- SA is being taken over and is no longer the pacemaker of the heart
- atrial rate > 400 bpm
- ventricular rate up to 100-175 bpm
- R to R intervals are irregularly irregular (irregular and erratic)
- prevalence increases with age
113
Causes of _______
- MI
- CAD
- electrolyte imbalance
- HF
- drug toxicities
VTACH
