Week 07 Flashcards
Cardiac Dysfunction/ CVAD (217 cards)
1
Q
what is a central venous access device (CVAD) used for and where is it inserted
A
- administration of medications, IV fluids, and blood products
- inserted into large veins
2
Q
where does the tip of the CVAD sit
A
in the superior or inferior vena cava
3
Q
what veins are used for CVAD
A
- internal jugular vein (IJ)
- subclavian vein
- femoral vein
- bronchial vein
- planted under the skin
4
Q
after insertion of the CVAD it is very imperative that the location of the tip of the catheter be verified/ confirmed by what
what is the only exception to this rule
A
- chest x-ray
- if the CVAD was placed under fluoroscopy or using 3CG technology with PICC lines
5
Q
depending on the type, how long may central line catheters remain in place for
A
several weeks to months
6
Q
avoid flushing or giving medications with a syringe smaller than
A
10 mL
7
Q
why should a 10 mL syringe be used
A
smaller syringes may result in too much pressure and rupture the catheter
8
Q
who are some candidates for a CVAD
A
infection, dialysis, TPN
9
Q
who are not candidates for a CVAD
A
IV drug users
10
Q
how do you make sure line is not to short or to long
A
x-ray
11
Q
what are indications for a CVAD
A
- TPN
- chemotherapy
- vesicant/ irritating solutions
- blood products
- antibiotics
- limited peripheral access
- central venous pressure (CVP) monitoring
- hemodialysis
12
Q
what are single lumen CVADS used for
A
TPN
13
Q
why can single lumen CVAD not be used to transfuse blood
A
blood cells tend to adhere to tubing, impeding the flow of the TPN
14
Q
multi lumen CVAD can have up to how many lumens
A
5
15
Q
each lumen has a what associated with it
A
port
16
Q
what are the types of CVAD catheters
A
- short peripheral
- midline
- peripherally inserted central (PICC)
- non-tunneled
- tunneled
- percutaneous
- central venous (CVC)
- hemodialysis
- implanted port
17
Q
where are short peripheral catheters placed
A
- superficial veins
- forearm veins
- jugular if situation is emergent
18
Q
when should short peripheral catheters be assessed
what about vulnerable patients
A
- every 2 hours
- every 1-2 hours
19
Q
what size IV needles is best practice
A
16 G and 18 G
20
Q
where are midline catheters inserted and what are they used for
A
- through the vein in the upper arm
- hydration and drug therapy
21
Q
what is the duration of a midline catheter
A
longer than 6 days up to 14 day
22
Q
should you use a midline catheter to draw blood
A
no
23
Q
*where should peripherally inserted central catheters (PICC) be inserted
which is preferred
A
basilic vein (preferred) or cephalic vein through the arm
24
Q
where does the end of the PICC catheter rest
A
in the superior vena cava just above the right atrium (cavo atrial junction)
25
- how is PICC placement verified
- whats the golden standard and what rhythm does the patients heart have to be in
- CXR
- golden standard is 3CG technology if the patient is in normal sinus rhythm (NSR)
26
what are considerations for a PICC line
- patients requiring IV treatments at home
- no BP, blood draws, or injections in extremity with PICC
- greatest risk to patient is DVT
- indicated for IV fluids, medications, blood products, blood sampling
27
what can happen with drawing blood from a PICC line
DVT and infection
28
what can happen to PICC line if blood pressure is taken in that arm
dislodge or break line
29
where are non tunneling central venous catheters inserted
through the subclavian vein in the upper chest or jugular veins in the neck, can insert in femoral vein as well
30
with femoral vein inserted non tunneling central venous catheters what is the greatest risk
infection
31
where does the tip of a non tunneling central venous catheter reside
superior vena cava
32
what is the duration of use for a non tunneling central venous catheter
short term use
33
where does a portion of a tunneled central venous catheter lie
in subcutaneous tunnel
34
describe a tunneled central venous catheter tube
soft, hallow, tube made of silicone
35
what does a tunneled central venous catheter have to help reduce infection
cuff of antibiotic containing material
36
what are other names for tunneled central venous catheters depending on location
Broviac, Hickman, Groshongs
37
what is special about a Groshongs catheter
it can be tunneled or non tunneled
38
what environment are tunneled central venous catheters inserted
OR
39
what is a implanted port (port-a-cath)
placed under the skin without any part exiting the skin, may be single or double injection port
40
with a implanted port what does the catheter connect to
the port
41
with a implanted port what does the reservoir connect to
which one
- a central vein
- superior vena cava typically
42
what are implanted ports used for
administering medications, IV fluids, chemotherapy, draw blood
43
what do you use to ALWAYS assess a implanted port
non-coring, non-barred Huber needle
44
how long may a implanted port be accessed with the same needle,
what about when not accessed
- 7 days
- monthly flushing is sufficient
45
what should you do after accessing and prior to each use for a implanted port
- aspirate for blood return
- flush with 10 mL NS
46
what should you do prior to de-accessing or removing the huber needle
lock with a heparin solution per hospital protocol or flush with normal saline
47
why do hemodialysis catheters have such large lines
they are pushing and pulling large volumes
48
are hemodialysis catheters tunneling or non tunneling
they can be either
49
what is the most common complications of a hemodialysis catheter
CLABSI and vein thrombosis
50
when should sterile dressing changes be done for hemodialysis catheters
- every 48 hours
- with dialysis treatments
- when soiled
51
what are the common causes for a CLABSI (microorganism wise)
- staphylococcus aureus
- yeast
- fungi
52
what should you monitor for with a CLABSI
fever, redness, swelling, drainage at site, pain, chills
53
how to prevent a CLABSI
proper technique, hand hygiene, dressing changes, assess necessity daily, notice early signs of infection
54
what is a pneumothorax r/t CVADs
ling collapsed due to needle puncturing the lung during insertion
55
CVAD pneumothorax interventions
- immediate CXR
- oxygen therapy
- monitor condition
- surgical intervention
56
what is thrombosis r/t CVADs
blood clots form around the catheter, potentially blocking blood flow
57
CVAD thrombosis interventions
- anticoagulation therapy
- catheter removal
- thrombolytic therapy
- mechanical thrombectomy
-monitoring and follow up
58
what is catheter malposition
the catheter may be incorrectly positioned which can affect function
59
catheter malposition interventions
- remove and reposition
60
what is mechanical complications r/t CVADs
catheter malfunction, central vein stenosis, thrombosis
61
mechanical complication interventions
- reposition
- replace
- flush
- thrombolytic
- repair
- securement devices
62
what is central vein stenosis
a narrowing of the large veins that carry blood from the arms, head, and chest back to the heart
63
*signs and symptoms of a central catheter infection
redness, swelling, pain, drainage, fever
64
*nursing interventions to prevent CLABSI
- preform hand hygiene
- proper sterile draping, sterile gloves, gown, and mask
- prepare the insertion site with greater than 0.5% chlorhexidine and alcohol
- scrub the access port with an appropriate antiseptic before each use
- assess daily for the need for the CVAD
- change huber administration set at least every 7 days, but no more than every 4 days
- follow facility policy for the frequency of site care
65
*what should you prepare the insertion site with
greater than 0.5% chlorhexidine and alcohol
66
*when should you change the huber administration set
at least every 7 days but no more than every 4 days
67
*what should you assess daily for with CVADs
the need for them
68
what is best practice for central line insertion
- patient assessment
- hand hygiene
- maximal barrier protection
- site selection
- skin antisepsis
- ultrasund guidance
- insertion technique
- securement and dressing
- daily review
- documentation
69
*what are the 8 sterile dressing change steps in order
1. prepare your work area
2. hand hygiene
3. wear protective gear
4. remove the old dressing
5. inspect the site
6. clean the site
7. apply a new dressing
8. document the procedure
70
*what should you do/ gather for a sterile dressing change
- clean and prepare your work area
- gather all necessary supplies
71
*why should you measure the length of the catheter
to ensure it hasn't moved
72
*what supplies are needed for a sterile dressing change
- sterile gloves
- clean gloves
- mask
- chlorohexidine or antiseptic solution
- sterile gauze
- transparent dressing
- tape or securement device
- sterile field drape
- hand sanatizer
73
*steps for central line discontinuation
- prepare the patient and environment
- hand hygiene and protective gear
- stop infusion
- remove dressing and sutures
- catheter removal
- apply pressure to the dressing
- monitor and document
74
* what position should the patient be in for central line discontinuation and why
- supine for easy access
- prevent air embolism
75
*what is the Valsalva Maneuver and why is it important
- hold breath and bear down
- to prevent air from entering the blood stream
76
other than the Valsalva Maneuver what can the patient do
hum continuously
77
what should you do to achieve hemostasis when removing a central line catheter
immediately apply pressure to the site
78
what should be documented after removing a central line catheter
the condition of the site and any patient reactions
79
what are air embolism managements
- close the tubing
- *turn the patient on left side trendelenburg, with head down
- check tubing for leaks
- administer oxygen 100%
- notify medical direction
80
* what are signs and symptoms of a air embolism
- A: anxiety- the patient may feel anxouis and restless
- I: increased heart rate- tachycardia is common
- R: respiratory distress- SOA or difficulty breathing
- S: sudden chest pain- sharp, sudden chest pain
81
*what are complications of IV infusion
which 3 are the most common
- infection, hematoma, air embolism
- phlebitis, infiltration, extravasation
82
*infection symptoms of IV infusion
- local: pain, warmth, edema, induration, malodorous drainage
- systemic: fever, chills, malaise, elevated WBC
83
*IV complication: what is phlebitis
occurs when the cannula is too large for the vein or if it improperly secured
84
*IV complications of phlebitis
erythema, edema, warmth, pain, vein may be indurated, red streak that follows superficial vein
85
*IV complication: what is infiltration
when IV fluids or medications leak out of the vein and into the surrounding tissue
86
*IV complications of infiltration
swelling, damp site, cold to the touch, pain, slowed rate of IV infusion, fluid may leak from the IV site
87
*IV complication: what is extravastion
another type of infiltration, occur when a vesicant agent in the IV leaks into surrounding tissues and causes serious damage
88
*IV complications of extravastion
pain, edema, burning, erythema, formation of blisters, necrotic tissue, slough, eschar
89
*IV complication: what is hematoma
occurs when the IV angiocatheter passes through more than one wall of a vein or if pressure is not applied to the site where the catheter is not removed
90
*IV complications of hematoma
swelling, pain, ecchymosis
91
*IV complication: what is air embolism
occurs when air enters the venous system from the IV catheter and circulates
92
*IV complications of air embolism
hypotension, tachycardia, difficulty breathing, cyanosis
93
what is erythema
redness of the skin
94
what is slough
soft, yellow or white, moist, stringy material composed of dead cells and debris that accumulates on the surface of a wound
95
what is eschar
crusty, brown or black layer of dead tissue that forms over a wound or burn
96
what is ecchymosis
a bruise
97
*what are interventions for infiltration and extravastion
- stop infusion
- discontinue IV
- thoroughly assess
- warm, moist or cool compress
- restart IV in opposite arm
- follow unit protocol
- notify doctor
- fill out drug report form
- monitor closely
98
what are ways to prevent IV complications
- hand hygiene
- monitor site every 2 hours minimum
- careful vein selection
- assess site for color, swelling, drainage, blood return
- clean all injection ports prior to use
- apply CHG caps to ports
- make sure IV is current according to facility policy
- when in doubt, change IV out
99
what is a arrhythmia
irregular heartbeats caused by issues with the hearts electrical conduction system
100
examples of arrhythmias
- arterial fibrillation
- ventricular tachycardia
- ventricular bradycardia
101
what is a heart block
occurs when the electrical signals are partially or completely blocked between the atria and ventricles, leading to a slower heart rate and reduced cardiac output
102
what is long QT syndrome
a condition that affects the hearts electrical activity, leading to prolonged repolarization and increasing the risk of sudden cardiac arrest
103
what is heart failure
a condition that occurs when the heart muscle is unable to pump blood effectively, leading the inadequate perfusion of tissues
104
what is valvular heart disease
dysfunction of the heart valves that can impair blood flow through the heart, leading to reduced cardiac output and perfusion
105
what are examples of valvular heart disease
- stenosis
- regurgitation
106
what is cardiomyopathy
disease of the heart muscle that affects it ability to contract and pump blood, leading to heart failure and poor perfusion
107
what is the function of the right atrium
receives deoxygenated blood
108
what is the function of the right ventricle
pumps deoxygenated blood to the lungs via the pulmonary arteries
109
what is the function of the left atrium
receives oxygenated blood from the lungs via the pulmonary veins
110
what is the function of the left ventricle
pumps oxygenated blood through the aorta
111
what are the three layers the heart is composed of
endocardium, myocardium, epicardium
112
what layer is the endocardium
inner layer
113
what layer is the myocardium and its function
middle layer, muscular and responsible for contractions
114
what layer is the epicardium and its function
outer layer, protective
115
*where is the tricuspid valve located and its function
- between the right atrium
- prevents back flow of blood into the right atrium
116
*where is the mitral valve located and its function
- between the left atrium and left ventricle
- prevents back flow into the left atrium
117
*where is the pulmonary valve located and its function
- between the right ventricle and pulmonary artery
- prevents back flow into the right ventricle
118
*where is the aortic valve located and its function
- between the left ventricle and aorta
- prevents back flow of blood into the left ventricle
119
what does arteries do
carry oxygenated blood away from the heart to body's tissues
120
what does veins do
returns deoxygenated blood back to the heart
121
what does capillaries do
tiny blood vessels where oxygen, nutrients, and waste are exchanged
122
*what is the function of the SA node
hearts natural pace maker, generates electrical impulse that initiates the heartbeat
123
*where is the SA node located
located in the upper wall of the right atrium
124
* what is the function of the AV node
receives electrical impulses from the SA node
125
*where is the AV node located
in the lower part of the right atrium near the septum
126
*what is the bundle of HIS function
transmits electrical impulses from the AV node to the ventricles, splits into right and left bundle branches
127
*where is the bundle of HIS located
throughout the ventricles
128
*what does systole indicate and its action
- contraction of the heart muscle
- ejection of blood from the ventricles
129
*what does diastole indicate and its action
-relaxation of the hearts muscle
- filling of the ventricles occurs
130
*what is stroke volume
the amount of blood ejected by a ventricle in one contraction
131
*what is cardiac output
the amount of blood pumped by each ventricle in one minute
132
*what does a high systole number indicate
the heart is working harder
133
*what happens when the heart fills with more blood during diastole
it contracts harder and pumps out more blood during systole
134
*what system controls heartrate
the autonomic nervous system
135
*what does increased work load of the heart lead to
increased oxygen demand
136
*what is preload
- stretching of the ventricles at the end of diastole
- volume of blood in ventricles at end of diastole
- the end of diastolic pressure
137
*what is afterload
- peripheral resistance against which the left ventricle must pump
- resistance left ventricles must overcome to circulate blood
138
*what can increase preload
- hypervolemia
- regurgitation of cardiac valves
- heart failure
139
*what can increase afterload
- hypertension
- vasoconstriction
140
what does increased after afterload do to cardiac workload
increased cardiac workload
141
*where is the left coronary artery (LCA) located and its function
- runs down the front of the heart
- supplies blood front to bottom of the left ventricle and front of the septum
142
*where is the left circumflex (LCX) located and its function
- circles the left side of the heart
- supplies blood to the left atrium and the side/back of the left ventricle
143
*where is the right coronary artery (RCA) function
- supplies blood to the right atrium and right ventricle, bottom of both ventricles, back of the septum, and SV/AV nodes
144
* where is the posterior descending artery (PDA) located and its function
- runs down the back of the heart
- supplies the bottom of the left ventricle and back of the septum
145
what is the location and function of the great cardiac vein
runs alongside the LAD artery and drains the front of the heart
146
what is the location and function of the middle cardiac vein
runs alongside the PDA and drains the back of the heart
147
what is the function of the small cardiac vein
drains the right atrium and right ventricle
148
what is the location and function of the coronary sinus
a large vein on the hearts posterior surface that collects blood from the coronary veins and empties into the right atrium
149
*what is blood pressure
the force of blood against the walls of the arteries
150
*what does blood pressure indicate
the health of the cardiovascular system
151
true or false: high cholesterol means you have a bad heart
FALSE
152
*what does a wide pulse pressure indicate
increased cardiovascular risk
153
*what does a narrow pulse pressure indicate
poor cardiac output
154
*what is systemic vascular resistance (SVR) and what is it a crucial factor in determining
- the force opposing blood flow in the arteries and arterioles
- blood pressure and cardiac output
155
*what is mean arterial pressure (MAP)
the average pressure in the arteries
156
*what number does MAP have to be greater than and why
- 60, unless the kidneys are already bad, if not this will hurt them if it drops under
- for organ perfusion
157
short term mechanisms in blood pressure regulation
- sympathetic nervous system (SNS)
- parasympathetic nervous system (PNS)
- baroreceptors
- vascular endothelium
158
what happens if short term mechanisms for blood pressure begin to fail
long term kicks in
159
what are long term mechanisms in blood pressure regulation
- the renal system
- sodium retention
- renin angiotensin
- aldosterone system and endocrine system
- epinephrine
- beta 2 adrenergic receptors
160
what does long term hypertension lead to
heart failure
161
what are the four types of BP
- primary
- secondary
- orthostatic
- malignant
162
*primary BP diagnosis
no specific cause for 90%-95% of all cases
163
*primary BP risk factors
- obesity
- smoking
- stress
- family history
- increased age
- excessive sodium intake
164
*primary BP management
- regular exercise
- smoking cessation
- avoid drugs and alcohol
- good sleep habits
- heart healthy, low sodium diet
165
*what is secondary BP
an underlying medical condition
166
*secondary BP diagnosis
cause that can be identified and corrected
167
*secondary BP risk factors
- renal disease
- primary aldosteronism
- pheochromocytoma
- cushing's syndrome
- medications
168
*secondary BP management
- thiazide diuretics
- ACE inhibitors
- beta blockers
- angiotensin II
- calcium channel blockers
- renin inhibitors
169
*what is orthostatic hypertension
significant elevation in BP with position changes
170
*orthostatic BP diagnosis
increase in HR by 20 mmHg and decrease in SBP by 20 mmHg
171
*orthostatic BP risk factors
- advanced age
- antihypertensives
- cardiac failure
- kidney disease
172
*orthostatic hypertension management
- increased sodium intake
- compression stockings
- getting up slowly
- plenty of fluids
- exercise
173
*what is malignant BP
severe sudden elevation of BP that causes organ damage
174
*malignant BP diagnosis
severe hypertension that rapidly progresses BP greater than 180/120
175
*malignant BP risk factors
- uncontrolled hypertension
- pre-eclampsia
- kidney/renal failure
- RAS
- glomerulonephritis
176
*malignant BP management
- IV nipride
- target organ damage
- requires hospitalization
- head bleed
- heart attack
- renal failure
- dissecting aneurysm
177
*primary hypertension key aspects, think GENETICS
- G: genetics
- E: excessive salt intake
- N: no identifiable cause
- E: exercise lack
- T: tobacco use
- I: increased age
- C: chronic stress
- S: sodium sensitivity
178
*orthostatic hypertension key aspects, think STANDUP
- S: slow position changes to avoid sudden drop in BP
- T: thirst (increased fluid intake
- A: avoid prolonged bedrest
- N: neurological disorders (parkinsons disease)
- D: dehydration (common cause)
- U: use compression stockings
- P: pharmacological management
179
*secondary hypertension key aspects, think KIDNEY
-K: kidney disease
- I: intake of certain medications (birth control, decongestants)
- D: disorders of the adrenal galnds (cushing's syndrome, pheochromocytoma)
- N: neurological disorders (sleep apnea)
- E: endocrine disorders (thyroid isses, hyperparathyroidism)
- Y: young age (secondary hypertension is more common in younger individuals compared to primary)
180
*malignant hypertension key aspects, think SEVERE
- S: systolic BP greater than 180 mmHg
- E: emergency (requires immediate medical attention
- V: very high diastolic BP greater than 120 mmHg
- E: end organ damage (kidneys, heart, brain)
- R: rapid onset
- E: IV antihypertensives
181
what are some diagnostic tools for establishing a treatment plan for hypertension
- *BP managements (correct cuff, level of heart)
- no caffeine, smoking, or exercise 30 minutes before checking BP
- history and physical
- fasting blood glucose
- routine urinalysis
- CBC
- BMP
- lipid panel
- uric acid, magnesium, calcium
- 12 lead ECG
182
what are managements of hypertension
- home monitoring
- HCP every 3-6 months once hypertension is stabilized
- *restrict sodium, cholesterol, and saturated fats
- maintain adequate K+ and Ca+ intake
- weight management
- *regular physical activity
- tobacco cessation
- moderate alcohol consumption
- stress management
- antihypertensive medications
- patient and caregiver teaching
183
what are sympatholytic medications
antihypertensives to treat anxiety by reducing sympathetic nerve
184
what are diuretic medicaitons
known as water pills, helps the kidneys remove the salts and water from the body via urination
185
what are vasodilator medications
work in the muscles of the arteries and veins, preventing the muscles from tightening
186
what are angiotensin inhibitor medication
relaxes the blood vessels to ease the heart to pump blood properly
187
what are the first line drug therapies for hypertension
- ACE inhibitors
- ARBs
- calcium channel blockers
- diuretic thiazides
- loop diuretics
188
examples of ACE inhibitors
lisinopril, captopril, enalapril
189
examples of diuretic thiazides
HCTZ, chlorothiazide, metazolone
190
examples of ARBs
candesartan, valsartan, losartan
191
examples of loop diuretics
bumetanide, furosemide, torsemide
192
examples of calcium channel blockers
diltiazem, verapamil, amlodipine, nicardipine
193
what are the second line drug therapies for hypertension
- beta blockers
- potassium sparing diuretics
- direct vasodilators
- adrenergic inhibiting agents
194
examples of cardiac selective beta blockers
metoprolol, bisoprolol, esmolol IV
195
examples of non cardiac selective beta blockers
propranolol
196
examples of mixed cardiac selective beat blockers
carvedilol, labetalol
197
examples of potassium sparing diuretics
spironolactone, eplerenone, triamterene
198
examples of direct vasodilators
hydralazine, nitroglycerin, sodium nitroprusside
199
examples of adrenergic inhibiting agents
clonidine (last resort)
200
main classes of hypertensive medications, think ABCD
A: ace inhibitors
B: beta blockers
C: calcium channel blockers
D: diuretics
201
how does ace inhibitors work
ends in
- helps relax blood vessels by blocking the formation of a natural chemical that narrows the blood vessels
- pril
202
how does beta blockers work
ends in
- reduce your heart rate and the force of your heartbeats, which lowers blood pressure
- olol
203
how does calcium channel blockers work
ends in
- prevent calcium from entering the cells of the heart and blood vessel walls, resulting in lower BP
- pine
204
how does diuretics work
- help your body get rid of excess sodium and water, reducing blood volume
205
what are the five C's of hypertension complications
- coronary artery disease
- chronic renal failure
- congestive heart failure
- cardiac arrest
- cerebrovascular accident
206
what does coronary artery disease do
narrow the blood vessels, increasing the risk of heart attack
207
what does chronic renal failure do
damage the kidneys, impairing their function
208
what does congestive heart failure do
the heart becomes to weak to pump blood effectively (enlarged left heart)
209
what is cardiac arrest
sudden loss of heart function
210
what is cerebrovascular accident
stroke
211
what raises the risk of heart attack and heart failure
a thickened and enlarged left ventricle
212
nursing interventions of hypertension
- blood pressure monitoring
- medication administration
- lifestyle modifications
- patient education
- stress management
- dietary counseling (dash diet)
- physical activity promotion
- monitor for complications
- support and follow up
213
normal BP range
<120/<80
214
elevated BP range
120-129/<80
215
stage 1 BP range
130-139/80-89
216
stage 2 BP range
140-159/90-99
217
stage 3 BP range
>160/>100
