321 - Cardiovascular System P. 1-5

Front 1

CAD – Risk Factors

tell me about age and gender..who is at highest risk

Back 1

-men have a higher risk than women do until the women goes through menopause
-with age causes thickening or hardening of the arterial wall

Front 2

CAD – Risk Factors

what is the primary risk factor in the development of CAD?

Back 2

atherosclerosis (is build up of fatty deposits on the inner wall causing a narrowing of the blood vessel diameter)

Front 3

CAD – Risk Factors

what is the most important risk factor for developing CAD in women?

Back 3

age

Front 4

CAD – Risk Factors

-tell me other risk factors

Back 4

-family history
-physical inactivity (what is considered adequate physical activity: 5-6 days a week, HR above the normal level for a sustained level of time for 20-30 minutes)
-obesity – increases lipid levels

Front 5

CAD – Risk Factors

-tell me about race..who has the highest risk?

Back 5

African American and Hispanic women have higher CAD risk factors than white women

Front 6

CAD – Risk Factors

-what is the #1 greatest risk factor for developing CAD? why?

Back 6

-Smoking (always the answer on an exam)- greatest risk factor – doubles your risk factor for CAD b/c it causes endothelial dysfunction and increased vessel wall thickness. this increases the risk for clot formation and vessel occlusion

Front 7

CAD – Risk Factors

-why is cholesterol (lipids) a risk factor?

Back 7

-Elevated cholesterol (lipids) damages the inner layer of the artery

Front 8

CAD – Risk Factors

-high cholesterol is common among what racial groups?

Back 8

high cholesterol is common in African American and Hispanic populations

Front 9

CAD – Risk Factors

LDL=
what is the ideal range?
where is it deposited?

Back 9

•LDL (<100 mg/dL ideal) – deposited in artery walls

Front 10

CAD – Risk Factors

HDL = what is the ideal range?
what does it do?

Back 10

•HDL (>40 mg/dL --> CAD)
– removes cholesterol --> liver

Front 11

CAD – Risk Factors

Hypertension is a risk factor. why?
-what racial group is it most prevalent in?

Back 11

–increases workload of the heart.
- High in African Americans (weakens the vessel wall)

Front 12

CAD – Risk Factors

Tell me about diabetes

Back 12

-Diabetes mellitus (even with good control they will develop heart disease and injury the inner layer of the artery)

Front 13

CAD – Risk Factors

-Tell me about stress?

Back 13

–increases the workload of the heart

Front 14

CAD – Risk Factors

Hormones?

Back 14

-Sex hormones (estrogen protects us) this is why women have a greater risk after menopause

Front 15

CAD – Risk Factors

Birth control and alcohol?

Back 15

-BCP – if smoke or HTN increases the risk, even with low dose
-ETOH

Front 16

CAD – Risk Factors

homocysteine levels?
-what is it?
-what is it necessary for?

Back 16

Increased homocysteine levels – homocysteine is an amino acid that is produced when proteins break down. a certain amount is present in blood
-necessary for tissue growth and nail and tissue disorders

Front 17

CAD – Risk Factors

increased homocysteine levels is a risk factor, why?
(3)

Back 17

-it increases platelet adhesiveness (plaque formation that clot),
-enhances LDL deposition in arterial wall,
-activated coagulation cascade

Front 18

CAD – Risk Factors

elevated homocysteine levels _____is considered high which contributes to CAD. simple fix:

Back 18

10-13

folic acid 1mg a day.
(vitamin B supplements can decrease homocysteine levels -- textbook)

Front 19

CAD – Management

•what drugs are usually prescribed?

Back 19

Antilipidemics

Front 20

CAD – Management

-tell me about exercise..how much should they exercise?

Back 20

Exercise 5-6 days a week, HR above the normal level for a sustained level of time for 20-30 minutes)

Front 21

CAD – Management

Diet (what 3 things should they adjust to?)

Back 21

•Sodium 2gm/day
•Fluids 2L/day
•Increase fiber

Front 22

CAD – Management

when should the pt be instructed to call the doctor?

Back 22

sudden increase in weight gain over a few days.
1.4-1.8 (3-4lb) over 1-2 days

Front 23

CAD – Management

other drugs that are used

Back 23

beta blockers
ACE inhibitors ,
ARBs,
diuretics,
iontropics (used short term in severe cases),
vasodilators

Front 24

Coronary Artery Bypass Graft Surgery (CABG)

-explain that the pt will have what post-opertively?
(incisions? tubes?)

Back 24

•a sternal incision,
•possibly a leg incision,
•1-3 chest tubes,
•indwelling urinary catheter,
•pacemaker wires,
•ET tube will be connected to a ventilator for several hours post-op. The pt will not be able to talk while the ET tube is in place.
•May have NG tube to prevent ilius.

Front 25

Coronary Artery Bypass Graft Surgery (CABG)

Preop anxiety is common
--what is a nursing intervention?

Back 25

identify the level of anxiety and the coping methods pts have used in the past.

Front 26

Coronary Artery Bypass Graft Surgery (CABG)

-prevent hypothermia, why?

Back 26

shivering causes the heart to work hardern.. provide warm blankets

Front 27

Cardiac rehab
-when does it start?
-what is the goal?

Back 27

-starts on admission
-goal is to monitor and improve the patients CV status (improve quality of life)

Front 28

Cardiac rehab (4 phases)

admission to cardiac care unit

Back 28

Phase I:

Front 29

Cardiac rehab (4 phases)

starts to understand disease process, procedures, goals, and meds

Back 29

Phase I:

Front 30

Cardiac rehab (4 phases)

-scared, made deals to live (how often they will go to McDonalds),

Back 30

Phase I:

Front 31

Cardiac rehab (4 phases)

-pt is admitted to the ED and you tell them they have had a heart attack. You tell them you are going to do everything you can to help them resume to their normal life.

Back 31

Phase I:

Front 32

Cardiac rehab (4 phases)

transfer from cardiac care unit to discharge

Back 32

Phase 2:

Front 33

Cardiac rehab (4 phases)

activity increasing, assuming life style changes ( evaluate lifestyle, family diet changes)

Back 33

Phase 2:

Front 34

Cardiac rehab (4 phases)

-you tell them that they need to stop smoking, involve family members.

Back 34

Phase 2:

Front 35

Cardiac rehab (4 phases)

-talking about the diet they should be on and lifestyle modifications

Back 35

Phase 2:

Front 36

Cardiac rehab (4 phases)

-walking is monitored and paced (always checking the heart rate)

Back 36

Phase 2

Front 37

Cardiac rehab (4 phases)

time of convalescence at home and start cardiac rehab

Back 37

Phase 3:

Front 38

Cardiac rehab (4 phases)

-follow up stress rest in about 8 weeks

Back 38

Phase 3:

Front 39

Cardiac rehab (4 phases)

-exercise program

Back 39

Phase 3:

Front 40

Cardiac rehab (4 phases)

-needs encouragement and support

Back 40

Phase 3:

Front 41

Cardiac rehab (4 phases)

-increase the amount of exercise and endurance (always checking HR)

Back 41

Phase 3:

Front 42

Cardiac rehab (4 phases)

-diet and lifestyle modifications continue. They are going to classes

Back 42

Phase 3:

Front 43

Cardiac rehab (4 phases)

time of recovery to maintenance

Back 43

Phase 4

Front 44

Cardiac rehab (4 phases)

-this is where people fall off

Back 44

Phase 4

Front 45

Cardiac rehab (4 phases)

-pt uses no salt when cooking, small bowel of ice cream – watching carbs

Back 45

Phase 4

Front 46

Heart Healthy Diet

-how many calories should one get from saturated fats?
-how about from trans fats?

Back 46

-calories <7% from saturated fats
-0% from trans fats

Front 47

Heart Healthy Diet

tell me about:
-cholesterol
-sodium
-carbs

Back 47

-cholesterol <200 mg/day
-limit sodium intake to 2gm per day
-educate what foods contain sodium (canned, preserved foods)
-decrease carbs

Front 48

Heart Healthy Diet

-tell me about alcohol, why is it bad for the heart?
-what 3 things do you tell them to decrease?

Back 48

-no alcohol (cardiac depressant)
-decrease fat, carbs, sodium

Front 49

Basic Care and Comfort of an MI

-what should you do first?
-HOB?

Back 49

-1st action* have them stop what they are doing and sit down
-HOB ↑ (semi fowlers position enhances comfort and tissue oxygenation)

Front 50

Basic Care and Comfort of an MI

-tell me about oxygen

Back 50

-O2 (2-4 L/min)

-POX (keep above 95%)

Front 51

Basic Care and Comfort of an MI

Tell me about their IV and the fluid

Back 51

-IVF at TKO/KVO TKO= To keep open / keep vein open to prevent fluid overload. we don’t want to add more fluid and make the heart work harder (run it at 25-50 mL/hr)

Front 52

Basic Care and Comfort of an MI

-Keep warm , why?

Back 52

(shivering increases metabolism and makes the heart work harder)

Front 53

Basic Care and Comfort of an MI

what is an invasive test for heart disease to confirm CAD or MI?

Back 53

-Cardiac catheterization with PTCA (percutaneous transluminal coronary angioplasty)

Front 54

PTCA (percutaneous transluminal coronary angioplasty)

-what is it looking at?

Back 54

-includes studies of the right or left side of the heart and some coronary arteries

Front 55

PTCA (percutaneous transluminal coronary angioplasty)

-what is it improving?
-what is happening during this procedure?

Back 55

-improves arterial blood flow.
-one or more arteries are dilated with a balloon catheter advanced through a cannula, which is inserted into or above an occluded artery. when this is successful, it opens the vessel and improvers arterial blood flow.
-stents may be used to keep the vessel open

Front 56

PTCA (percutaneous transluminal coronary angioplasty)

-this has been associated with excellent return of blood flow through the coronary artery when it can be performed when?

Back 56

within 2-3 hrs of the onset of symptoms

Front 57

Basic care and comfort for an MI

-daily physical activity and weight management help reduce lipid levels
-what other supplements can you recomment to help reduce lipid levels?

Back 57

-omega 3 fatty acids, fish oil, flaxseed, walnuts, canola oil

Front 58

Basic Care and Comfort for a
CABG

-when are they able to ambulate?

Back 58

-Pt out of bed night of surgery. early ambulation is important to decrease the risk of DVT and possible PE

Front 59

Basic Care and Comfort for a
CABG

-NG?
-Voley cathetrer?

Back 59

-may have NG tube to prevent ilieus
-monitor urine output / they will have a catheter placed

Front 60

Basic Care and Comfort for a
CABG

-Diet?

Back 60

(heart healthy, decrease carbs)

Front 61

Basic Care and Comfort for a
CABG

-what should you tell them to do avoid doing with their legs?

Back 61

-avoid crossing legs and wear elastic stockings until edema subsides

-elevate the surgical limb when sitting in a chair

Front 62

Basic Care and Comfort for a
CABG
-teach the pt and family that during the first 2-5 weeks after discharge, what 3 things may be bothersome for older adults

Back 62

fatigue,
chest discomfort,
lack of appetite

Front 63

Basic Care and Comfort for a
CABG

-monitor skin integrity
-what should they do with their incision when coughing or any strenous movement?

Back 63

-splint incision

Front 64

Basic Care and Comfort for a
CABG

Activity
-what should you tell them to do for the first week home after discharge?
-what are they allowed to do?

Back 64

-instruct the pt to remain near home and continue a walking program.
-pts may engage in light housework or any activity one while sitting and that does not precipitate angina.

Front 65

Basic Care and Comfort for a
CABG

Activity-
what are they allowed to do during the 2nd week?

Back 65

they are encouraged to increase social activity and possible return back to work part time

Front 66

Basic Care and Comfort for a
CABG

activity
-3rd week, what can they begin to do?

Back 66

-they may begin to lift objects as heavy as 15 lbs (2 gallons of milk)

Front 67

CABG - Discharge Teaching



S&S of complications such as:

Back 67

chest pain, dizziness, palpitations, irregular or fast heart beat, weight gain, edema, SOB

Front 68

CABG - Discharge Teaching

-what should you teach them about lifting objects?

Back 68

Avoid lifting > 10 – 15 lbs for 3 months (ex: bag of groceries)

Front 69

CABG - Discharge Teaching

•Wound care and S&S of infection, specifically monitoring where the artery came from.. why?

Back 69

monitor where the artery came from because blood flow is different. it will be harder for the incision in the leg to heal where they took the artery from rather than the sternum incision
•diabetes causes healing to be delayed

Front 70

CABG - Discharge Teaching

Diet:

Back 70

Diet –low fat, low sugar, low calories – cardiac diet

Front 71

CABG - Discharge Teaching

-what should you teach them about arm movement?

Back 71

Avoid strenuous arm movement – use arms only for balance (you want that incision to heal)

Front 72

CABG - Discharge Teaching

-when can they drive?

Back 72

No driving for 6 weeks until the physician gives permission

Front 73

CABG - Discharge Teaching

-when can they resume sexual activity?

Back 73

when they can climb 2 flights of steps without stopping

Front 74

CABG - Discharge Teaching

Use alternative positions , why?

Back 74

to avoid pressure on sternum

Front 75

CABG - Discharge Teaching

• if the person has had a heart attack, it takes a couple weeks for the scar tissue to form and they can have ___________developing after discharge.

Back 75

dysrhythmias

Front 76

door to balloon time is how long?

Back 76

90

Front 77

Cardiac Catheterization

-what are 2 big things the nurse should monitor for?

Back 77

-monitor for bleeding or hematoma

Front 78

Cardiac Catheterization

--monitor VS and distal pulses , why?

-CSM?

Back 78

(can cause spasms in arteries)

assess color, cap refill, sensation (CSM)

Front 79

CABG - Discharge Teaching

•Wound care and S&S of infection, specifically monitoring where the artery came from.. why?

Back 79

monitor where the artery came from because blood flow is different. it will be harder for the incision in the leg to heal where they took the artery from rather than the sternum incision
•diabetes causes healing to be delayed

Front 80

CABG - Discharge Teaching

Diet:

Back 80

Diet –low fat, low sugar, low calories – cardiac diet

Front 81

CABG - Discharge Teaching

-what should you teach them about arm movement?

Back 81

Avoid strenuous arm movement – use arms only for balance (you want that incision to heal)

Front 82

CABG - Discharge Teaching

-when can they drive?

Back 82

No driving for 6 weeks until the physician gives permission

Front 83

CABG - Discharge Teaching

-when can they resume sexual activity?

Back 83

when they can climb 2 flights of steps without stopping

Front 84

CABG - Discharge Teaching

Use alternative positions , why?

Back 84

to avoid pressure on sternum

Front 85

CABG - Discharge Teaching

• if the person has had a heart attack, it takes a couple weeks for the scar tissue to form and they can have ___________developing after discharge.

Back 85

dysrhythmias

Front 86

door to balloon time is how long?

Back 86

90

Front 87

Cardiac Catheterization

-what are 2 big things the nurse should monitor for?

Back 87

-monitor for bleeding or hematoma

Front 88

Cardiac Catheterization

--monitor VS and distal pulses , why?

-CSM?

Back 88

(can cause spasms in arteries)

assess color, cap refill, sensation (CSM)

Front 89

Cardiac Catheterization

-what care do you do with the puncture site?

Back 89

apply a pressure dressing to the puncture site & apply direct pressure for 20-30 minutes

Front 90

Cardiac Catheterization

-monitor for what 2 cardiac complications?

Back 90

MI and ventricular tachycardia

Front 91

Cardiac Catheterization

-what do you remind them to do with their leg after the procedure?

Back 91

-keep leg flat and straight for 6 hrs

Front 92

Cardiac Catheterization

- tell me about the HOB

Back 92

can be elevated 30 degrees (max), we want them flat

Front 93

Cardiac Catheterization

they are placed on bed rest for 6 hrs
-why?

Back 93

-need them to stay still because moving around can dislodge a clot

Front 94

Cardiac Catheterization

-after the procedure, what will happen if the pt has to use the bathroom and they are on bedrest?

Back 94

-use urinal or bedpan
-they may have to have a catheter in if they can’t use a bedpan (we don’t want the bladder distended because it can push on arteries and dislodge a clot)

Front 95

Cardiac Catheterization

-what if the pt can not lie still?

Back 95

-if they can’t lie still, we will have to restrain them

Front 96

Femoral bypass
-what is this?

Back 96

go above occlusion, reattach artery below occlusion. if the bypass doesn’t work, then you need an amputation

Front 97

Femoral bypass

-what do you assess every 15 minutes / hr (4)

Back 97

-assess skin color,
CSM,
pulses,
capillary refill time

Front 98

Femoral bypass

-what position do you tell them to avoid with their knee?

Back 98

-avoid flexed knee - don’t kink off bypass graft. do not sit up in a chair. you need to recline, feet up, don’t cross legs or ankles
-don’t want edema/occluded graft

Front 99

Femoral bypass

-tell them to avoid 90 degree angles for how long while the area is healing

Back 99

-avoid 90 degree angles for 2 weeks while healing

Front 100

Femoral bypass

-what position should they avoid? broad term

Back 100

-avoid dependent positions