week 4 Cardiac part 2

Question 1

is echocardiogram an invasive procedure?

Answer 1

no, its like an ultrasound, unless its a transesophageal echo

Question 2

what test would detect pressure changes in cardiac chambers and quantify the size of valve openings?

Answer 2

cardiac catheterization (scope)

Question 3

what is an angiography?

Answer 3

when a catheter is inserted through the femoral artery to look at peripheral arteries

Question 4

what can a doppler ultrasound assess in cardiac disease?

Answer 4

the flow of blood through an area like a peripheral artery

Question 5

what is an MRA? what is it used for?

Answer 5

magnetic imaging angiogram
allows us to see same thing as an angiogram but without catheterization - just imaging

Question 6

what is a non-invasive cardiac test for measuring peripheral arterial perfusion?

Answer 6

segmental blood pressures

Question 7

who is susceptible to endocarditis?

Answer 7

anyone with previously damaged valves and who has bacteria (or virus/fungi) in the bloodstream

Question 8

what are four ports of entry for infecting organisms that cause endocarditis?

Answer 8

oral cavity (via dental procedures)
skin lesions, rashes, or absesses
infections (cutaneous, GI/GU)
surgery or invasive prodecures (IVs, etc)

Question 9

3 predisposing conditions for infective endocarditis?

Answer 9

• previous endocarditis
• iv drug use (street drugs or hospital aquired bacteremia)
• rheumatic heart disease

Question 10

what symptoms would clue me in that my patient has infective endocarditis?

Answer 10

In addition to typical infection things (fever, malaise, chills, anorexia), back pain, headache, weight loss, myalgia and heart murmurs

Question 11

what compication of infective endo am monitoring for?

Answer 11

organ embolization or vascular embolization of vegetations

Question 12

pt with infective endo has decreased LOC - what am i worried about? what if it was sudden SOB and chest pain?

Answer 12

embolism of vegetations in brain, or lung

Question 13

pt with infective endo has little blisters that have appeared on their hands, and tiny red lines down their fingernails on that hand. what am i suspecting?

Answer 13

vascular embolism

Question 14

what lab tests would be ordered to diagnose/treat infective endocarditis?

Answer 14

blood cultures and CBC

Question 15

which other dx test is used for infective endo?

Answer 15

echo

Question 16

four things to treat/monitor with infective endo

Answer 16

• determine and treat cause
• monitor and treat fever
• IV meds (usually via picc)
• monitor for S&S of decreased perfusions to organs/complications of embolism

Question 17

4 things to teach pt about inf. endo

Answer 17

-prophylactic antibiotics before dentist/surgery
-good oral hygeine
- avoid other w/ infection
- valve replacememt may be necessary

Question 18

what could be the consequences of local valve damage d/t endocarditis (name 3)

Answer 18

• sepsis
• heart failure
• heart block

Question 19

what is the HALLMARK sign of acute pericarditis?

Answer 19

pericardial friction rub

Question 20

what can cause pericarditis?

Answer 20

bacteria, virus, autoimmune disease, radiation, MI or can be idiopathic

Question 21

pt has sharp chest pain that increases with respiration and is relieved when they sit forward. what could this be?

Answer 21

acute pericarditis

Question 22

what two potential complications are connected with pericarditis?

Answer 22

1. pericardial effusion (increased fluid between visceral and fibrous layers which decreases function of surrounding dissues like laryngeal nerve)
2. cardiac tamponade

Question 23

name 5 interventions for acute pericarditis

Answer 23

1. correct underlying problem
2. high dose anti-inflammatories
3. bedrest with HOB elevated
4. manage pain and anxiety
5. pericardiocentesis if cardiac tamponade

Question 24

what should i monitor for if pt is on high dose antiinflammatories?

Answer 24

gi bleeds

Question 25

what are some specific symptoms of rheumatic endocarditis?

Answer 25

friction rub and murmor, pain in chest, ECG changes, tachycardia, BIG ONE: evidence of strep infection (enlarged lymph noes, sore throat, fever)

Question 26

patho: what is rheumatic pericarditis characterised by the formation of?

Answer 26

aschoff bodies

Question 27

what should I teach someone who is recovering from rheumatic carditis?

Answer 27

that they are at risk for reinfection for the rest of their life, and that they will require prophylactic antibiotics before any invasive or dental procedures

Question 28

are rheumatic carditis symptoms more like endocarditis or pericarditis?

Answer 28

it's like both -similar to endocarditis- it affects the valves it also causes thickened pericardium and pleural effusion can develop

Question 29

when valve opening is narrowed and blood is restricted from moving forward

Answer 29

stenosis

Question 30

when valve fails to close properly - results in blood backflow

Answer 30

regurgitation

Question 31

valve disorders occur more frequently on the ______ side of the heart

Answer 31

left

Question 32

what will I likely hear on auscultation with a valve disease?

Answer 32

murmor

Question 33

explain what happens in mitraAl stenosis in terms of blood flow, compensation, and symptoms (might help to draw a picture)

Answer 33

- blood backs up in L atrium and lungs. -the atrium is not cool with this so it pumps harder, leading to atrial hypertrophy. -Failure to compensate results in pulmonary congestion. -eventually this congestion can cause blood backup all the way to R ventricle --> right sided heart failure - symptoms: SOB, exertional dypnea, hemoptosis

Question 34

what happens in mitral regurg? -talk about blood flow, compensation, results, symptoms

Answer 34

-decreased ventricular filling resulting in ventricular hypertrophy - both ventrical and atrium work harder to preserve CO resulting in dilation - can cause shock and dyspnea - bloood can back up to R side of heart therefore symptoms of right sided heart failure can occur

Question 35

what can mitral valve prolapse cause? are there associated symptoms?

Answer 35

regurgitation. usually asymptomatic but palpitations, chest pain, etc can occur

Question 36

classic symptoms of aortic stenosis

Answer 36

syncope, angina, exertional dyspnea

Question 37

when is surgery indicated for aortic stenosis?

Answer 37

when valve is < 1cm

Question 38

why would we be cautious with giving nitro in aortic stenosis

Answer 38

because we need to maintain preload to force valve open

Question 39

this condition causes left ventricle hypertrophy and eventual ineffective pump. symptoms are minimal for years but eventually low cardiac output causes hypotension, profound dyspnea and angina

Answer 39

aortic regurgitation (incomplete valve closure with blood backup into l ventricle)

Question 40

what would I want to know about my patient with valvular heart disease? (name 3 assessments)

Answer 40

1.health hx (family hx, previous rheumatic fever or endocarditis, hx of iv drug use) 2. resp assessment for pulmonary congestion 3. CVS assessment (signs of decreased cardiac output, edema)

Question 41

which four Dx tests are used for valvualr heart disease

Answer 41

1. echo to show structure/mvt of heart 2. exercise tolerance test 3. chest x-ray (atrial and ventricular enlargement) 4. EKG

Question 42

what are the non-surgical management techniques for VHD? (4)

Answer 42

-rest, -treating any a-fib with anticoagulents, antidysrhythmias, cardioversion. - preventing PE, embolism, and endocarditis - treat HF with drugs

Question 43

what two ways can valve repair or replacement be done?

Answer 43

open surgery or percutaneously (like a transcatheter aortic valve replacement)

Question 44

how long does a mechanical valve last and what consideration does the patient need to know?

Answer 44

up to 20 years, requires lifelong anticoagulant and monitoring INR

Question 45

describe the drawbacks of biologic valve replacement

Answer 45

less durable than mechanical d/t risk of calcification. failure rate is highest before the 7-10 yr mark

Question 46

Teaching plan for valvular disease: 1. Develop an _________ plan to increase cardiac tolerance. 2. monitor for _______ _______ ______ 3. restrict ______, avoid _______ 4. administer ______ as ordered 5. _________ ________ before all invasive surgical or Dx procedures or dentist 6. stop _______ 7. if mechanical valve, __________ for ______!

Answer 46

1. exercise 2. increased fluid volume 3. salt, caffeine 4. O2 5. prophylactic antibiotics 6. smoking 7. anticoagulants, life

Question 47

what emergency am I monitoring for in valvular heart disease? what are two important assessment findings of this?

Answer 47

cardiogenic shock. 1. dusky skin color 2. narrow pulse pressure

Question 48

my patient is in cardiogenic shock. what should I NOT automatically do?

Answer 48

replace fluids (like i would in hypovolemic shock)

Question 49

what is claudication in relationship to PAD?

Answer 49

muscle pain, cramping when exercising, relieved with rest (like stable angina for the legs)

Question 50

what is the fourth stage of the PAD progression?

Answer 50

necrosis./gangrene

Question 51

what should my first action be if I discover a new arterial ulcer on pt's foot?

Answer 51

check pulses

Question 52

what is pentoxifylline, what does it treat?

Answer 52

a drug that increases flexibility of RBCs, it treats PAD

Question 53

if my patient just had a aortioliac bypass, what will I expect in terms of wound care?

Answer 53

a midline incision in abdominal cavity, as well as an incision in each groin

Question 54

describe the incision(s) for femoropopliteal or femorotibial bypass

Answer 54

one long incision down the leg or possibly on both legs if graft was taken from non-diseased leg

Question 55

what will i assess in patient after bypass surgery for PAD?

Answer 55

operative extremity for color, cap refill, temp, pulses, sensation, mvt, pain

Question 56

after PAD bypass surgery, encourage ______ as soon as possible

Answer 56

ambulation

Question 57

what are 4 things i would teach a post fem- pop bypass pt on discharge about protecting foot from trauma?

Answer 57

wear roomy protective footwear clean cotton socks avoid leg crossing avoid extreme temps

Question 58

what is one way a patient with PAD can monitor/control infection?

Answer 58

keep feet clean and well lubricated (hydrated)

Question 59

why is it so important to act quickly when i notice signs of acute arterial ischemia?

Answer 59

gangrene can occur in a couple of hours (just like an MI)

Question 59

what is the main complication r/t PAD?

Answer 59

acute arterial ischemia

Question 59

what are the five Ps when monitoring for acute arterial ischemia?

Answer 59

pain, pulse, pallor, paresthesia, paralysis

Question 59

what prophylactic procedure may be done for someone with frequent DVTs?

Answer 59

an inferior vena cava filter placement

Question 59

patient says their leg feels "full" and i notice the same leg feels hot to touch proximally, but cool distally. what might it be?

Answer 59

DVT

Question 59

what unique treatment is used for DVT using a catheter?

Answer 59

catheter directed to site and releases TPA

Question 59

my patient is being discharged after a DVT was treated. what will I make sure to teach them (aside from signs of bleeding)? name 2

Answer 59

no NSAIDS, alert all healthcare provider including dentist that you are on anticoagulent therapy

Question 59

is brown, leathery skin a sign of PAD or CVI?

Answer 59

CVI

Question 59

true or false: for venous ulcers, it is best to put dry, absorbent dressings on them to absorb all the excess fluid

Answer 59

false - though the wounds are weepy, it can be best to put damp dressings to prevent sticking and trauma with removal