WEEK 4 : Vascular disorders Flashcards by mary doe

true or false. the concept of perfusion is cells receiving adequate oxygen and nutrients

true

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what is this describing : ability to pump and how well that blood can mov into blood vessels

perfusion : blood pressure

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which area does altered perfusion affect ?

low blood flow to a specific area or generally

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sensation changes is one of the signs and symptoms : what undergoes this

numbness or pins and needles

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ishcemic pain does not have to be in peripherally or centrally it can be chest pain as well with altered perfusion?

yes this is true

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these are the diagnostics tests for altered perfusion: vascular problem

EKG
Blood work (enzyme rise)
Angiography
Ultrasound (doppler)
CT scan

explain

ischemia to the heart

lack of oxygen release enzymes
tropinin is released from a cardiac muscle – patency blocked areas

can be deployed to open up

extremities to palpate a pulse
blood flow to the area to the body - angiogram is much better

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when it comes to arterial occlusion:
limb is affected
what does pulse indicate?
if we cannot palpate ( act quickly )
pain because of ischemia

pulse indicate blood flow

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abrupt occlusion is something we can deal quickly
quick symptoms
notify dr as soon as possible
are those true ?

what can obstruction be ?

can be blood clot, or fibrin, or narrowin

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Medication to promote increased blood flow
* vasodilators, antihypertensives, diuretics

why are diuretics used ?

to remove excess fluid because of venous dysfunction

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what is this describing : the disease is undetected for years -impedded the blood flow
and accelerating the plaque in the artery walls

hypertension

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what could be a caused of hypertensive crisis?

diagnosed in hypertension but stopped taking medications

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what does patients develop when they have htn crisis ?

cerebral edema

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hypertensive crisis: severe headache, blurred vision, dizzy, SOB, epistaxis, anxiety , recall these are the symptoms

why are they experiencing sob
and epitaxis?

pressure gets very high in the lungs
tiny blod vessles get burst and then nose bleeds- epitaxis
often feel anxious when these symptoms are occuring

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affected in lowering blood pressure
should not be dropped too quickly when it comes to hypertensive crisis

with hypertensive crisis - cerebral edema , why is this happening , and what would out intervention be ?

because of leakage
to reduce this - position in semi fowlers , less blood is flowing through their brain

ensure oxy sat is 92 is above

assess head to toe ( neuro done frequently )

ensure is producing adequate amount of urine

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what is causing the cad

coronary artery disease

the diseae is caused by atheroclesoris causing it to narrow
can have a clot formed on top of the plaque and continuum in coronary artery
stable angina to mi

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where does the symptoms typically occurs with pts who have cad /

majority happen in centralize chest pain
( chest pain that may radiate )

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recall that these : * nausea & vomiting
* diaphoresis
* dyspnea
* anxiety/fatigue

often indicates disease progression

start with stable angina and cannot control indicate progressing partial or full occlusion

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Coronary Artery Disease
Analyze Cues- ACS
Diagnostic Testing

ECG
Cardiac enzymes (Troponin)
Coronary angiogram*

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define the description for the diagnostic testing for cad
* ECG
* Cardiac enzymes (Troponin)
* Coronary angiogram*

changes in st segment
st elevation is infraction

depression is associate with ischemia and st elevation is associated with infraction
not receiving oxygenated blood

cardiac enzymes - whenever its damage. releases troponin - this support the diagnoses of mi
coronary angio - catheter for femoral artery in the groin or the wrist , threaded dye in injected radiologist and look at the big screen can see blood flow through the heart

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Coronary Artery Disease
Plan and Prioritize-ACS

what is the worst thing that can happen?

complete occlusion of a cornary artrey

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Any patient who presents with chest pain: with complete occlusion of a coronary artery
what type of diagnostic test are we doing ?

ECG
Cardiac enzymes

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big priority :
competed occluded part of the heart muscle not receiving oxygenated blood

chest pain understand the severity - do ekg and cardiac enzymes 0 recognize quickly

just read

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exemplar : #2 coronary artery disease
take acion - acs
intervention for acs

give a brief description on cad

myocardium not receiving adequate oxygenated blood

oxygen
ecg/cardiac monioring
pain assesmetn and management
frequent s
iv access
meds ( nitro, asa, clop)

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why is cardiac monitoring important ?

is when myocardial developing dysrthmias

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pain assesment what are we utilizing ?

opqrstuv and pain scale ( nitroglycerin ) if not controlling might change in iv route in continous hepful in doesnt help in original morphine could also be used, this causes vasodiliation

why should frequent vital signs be utilized ?

establish a baseline not lowering bp, too much nitro and morphine - cause low bp

asa and clop decreases what ?

decrease amount of platelets aggression, could be causing blockage in coronary arteries

open blocked artery: what are the interventions

angioplasty cabg ( open heart sx ) TPA ( far from hospital )

what is angioplasty?

gold standard injecting dye with balloon stent

cabg ( open heart sx )

may open up corporate vessel

tpa causes bleeding in the ____, therefore frequent assessments of what is needed ?

brain , frequent neuro checks

cabg could open what type of vessel?

corporate vessel

interventions for post angioplasty monitor for :

bleeding from insertion site acute closure of vessel ( CP, increase st ) contrast dye reaction vital signs ( low bp , dysrhythmias )

band is over the incision wrist that band is inflated with air ( we take a syringe to inject air ) little punch to apply a bit of pressure in over time to deflate and remove of air and no signs take off the band bandage insertion site - job is look for any signs of bleeding, blood pouring out or it might be a lot of swelling under the ski ( internal bleeding ) put pressure to stop bleeding reocclude- back to where they started , chest pain, st elevation and go right back to intervention ( ekg, vs, adequate oxy, nitro, notfiy dr) reaction to the dye - pt may have develop rash and give antihistamine anaphylaxis- immediate intervention vital signs - regular intervention, look for blood pressure ( closely ) increase chance of dyes. because heart is manipulated ( causing dizzy=- not adequate co ) notify dr just reead ( interventions for post angio )

exemplar #2 coronary artery disease take action - acs in manitoba, all cardiac surgery is done at st boniface hospital icu initial care : initially

intubated, large chest tubes, pacemaker wires

icu initial care : watch out for

anginal pain bleeding decreased loc/dysrhythmias electrolyte + fluid imbalance hypothermia/hypertension/hypotension

is this true or false. this is initially come out in the cardiac ICU lot of tubes and intubated and chest tube against their lungs and tubes draining from sites.

true

true or false. pacemaker wires from heart muscles is seen. What is this in risk for ?

dysrhythmias

OR is very cold and what can this caused ?

this can caused hypothermic, and blood loss in the surgery ( nurses will use warming blanket )

interventions for patients on the cardiac surgery ward : cabg recall is deep breathing and coughing discharge teaching cardaic rehab refferal monitor for complications supervised ambulation explain

db and coughing to avoid atelectasis in the lungs supervisd ambulation to avoid dvt discharge teaching such as not driving, or how much weight and activities ( take a while to heal ) cardiab rehab referall - after a cabg , refit or wellness ( physio or nurses to get exercise or walk around, monitor health )

just read : supplmeent oxyegn for awhile to improve that situation if there is alot of pain the sternum ( breast bone ) avoid taking deep breaths ( the patient ) not getting good exchange and decrease oxygen sat incision site and graft sites ( chest or leg ) any tubes coming out of he body ( infection ) neuro status is something we will monitor ( anaesthetic ) or clot has dislodged ( rate complication ) but monitor

what is this describing in terms of the complications of cad: loss of cardaic output as nurses say crashing bp is low, unrespoinsive not getting to the brain, and shutting down organs this is emerg

cardiogenic shock

true or false. cardiogenic shock is a large mi

true

what is pad ?

partial or total occlusion, usually in the legs

what is claudification?

intermittent ( ishcemic muscle ache, resolve with rest, triggered with exercise )

what is this describing : did not get enough blood supply, extreme part of the body ( end of the toes and the feet )

necrosis/gangrene

what is an ankle brachial index?

ankle pressure is compared to arm- if its lower than 1 - low blood flow to the foot

what are the two major complications ? what is our priorities

ulcer location and appearance sudden peripheral artery occlusion

furthest from the heart - hardest to supply blood flow is what location?

end/between on the toes

pale and round edges is due to what

due to lack of bloodflow

true or false. clot that makes it way down the artery and blocks off bloodflow can occur

yes this is true, often from mi or AFIB ( sudden peripheral artery occlusion )

true or false. sometimes clot from coronary artery - goes peripheral

this is true

PAD take action promote blood vessel health : risk factor modification and exercise what is it

walking to increase collateral circulation walk until discomfort, rest, resume

what is the goal for promoting blood vessel health

increase the amount of the pt can walk before experiencing clotication

what should the position be for pad

keep limbs below heart ( anything above the heart - harder to perfuse ) if pain at night dangle from bef

what is the drug theraphy for pad

antiplatelets, antihypertensive, pentoxifylline

what does pentoxifylline do ?

increase blood flow, by reducing viscosity, and enhancing ( rbc flexibility )

what is the intervention to promote vasodillation?for apd

keep feet warm ( socks ( not too tight ) insulated shoes

what are the two non surgical interventions to increase blood flow

balloon angioplasty with stent insertion atherectomy

true or false. thrombus can form immediately after and stop bloodflow - look for changes to the feet (the p’s)

true

true or false. pad has the same complications as coronary angioplasty?

true

atherectomy : what happens ?

dislodges plaque and gets rid of it - often on blood thinners for a while to avoid clot formation

what is surgical intervention to increase blood flow for pad

femoral popliteal bypass graft around an occluded femoral artery

what should we look for when it comes to cwcm after post op care

look for htn - bad for graft and cause it to fail hypotension- can indicate blood loss and bleeding atlectasis or pneumonia

comapartment syndrome think of 6 p's this is alot of swelling in a fixed area - affects circulation

ambulation as soon as possble when it comes to femoral politeal bypass graft

yes but supervised first

WEEK 4 : Vascular disorders Flashcards

(67 cards)