321 - Cardiovascular System P. 19-28

Front 1

PTCA (percutaneous transluminal coronary angioplasty) is also called

Back 1

angioplasty

Front 2

PTCA (percutaneous transluminal coronary angioplasty) / Angioplasty

-Monitor for complications
such as: (3)

Back 2

–Recurrent MI – you might also hear people say “wrap around MI”
–Cardiogenic shock
–Ventricular septal wall rupture (so much damage that the muscle is mush)

Front 3

Cardiac Cath – Preprocedure

-Diet?

Back 3

-NPO 6 hours after midnight

Front 4

Cardiac Cath – Preprocedure

what meds are held before the procedure? 2

Back 4

-diuretics
-stop Warfarin

Front 5

Cardiac Cath – Preprocedure

-what meds are held before the procedure if the pt is diabetic?

Back 5

-if you have a diabetic pt, have them stop metformin the night before
surgery, and then 3 days after the procedure they will have creatitine done and see if they can start it again

if they can't stop their metformin, give it with BICARB

Front 6

Cardiac Cath – Preprocedure

-what labs should be done? when?

Back 6

electrolytes, BUN, creatinine, coagulation profile, and CBC is essential before and after

Front 7

Cardiac Cath – Preprocedure

-informed consent by:
-make sure they have IV access, what do you do about the dye?

Back 7

-radiologist or cardiologist
-Allergies b/c they are injecting the dye. tell them with the dye they will have a warm flushed feeling

Front 8

Cardiac Cath – Preprocedure

-the nurse can give valium for mild sedation preop and what can she give to help prevent the allergic reaction to the dye?

Back 8

atarax to prevent allergic reaction to dye.

Front 9

Cardiac Cath – Preprocedure

-what type of sedation is the procedure done under?

Back 9

-the procedure itself is done under conscious sedation

Front 10

Cardiac Cath – Preprocedure

-Teach them that when the dye is injected, they may feel what

Back 10

temporary hot flash or flushing, may feel palpitations from the catheter being passed up into the left ventricle, or desire to cough

Front 11

Cardiac Cath – Preprocedure

-pt is admitted to the hospital on the day of the procedure because fluid and acetylcysteine (Mucomyst) may be given 12-24 hrs before the procedure, why?

Back 11

for renal protection (the contrast used can have a toxic effect on renal tubes)

Front 12

Cardiac Cath - Preprocedure

-tell them that after the procedure, the guide wire or sheath may be left in because they can’t always remove it if the pt receives anticoagulants during the procedure. moving around can dislodge the wire and bleed
-what if they didn't have the wire in?

Back 12

they shouldn’t move because u don’t want them to dislodge the clot
-afterwards they may have to lie still for 6 hrs

Front 13

Cardiac Cath - Intraprocedure

-Continual assessment (tell them to report what?)

Back 13

any chest pain or pressure

Front 14

Cardiac Cath - Intraprocedure

be prepared for what complication?

Back 14

-Be prepared for cardiac arrest

Front 15

Cardiac Cath - Intraprocedure

-stents are coded to prevent sticking of clots
-what happens a stent is put in. 3 steps

Back 15

1) the stent is positioned between the plaque
2) the balloon is inflated, expanding the stent
3) the balloon is then deflated and removed and the implanted stent is left in place

pts put on anticoags

Front 16

Cardiac Cath – Sheath Removal

-you enter the artery, the sheath is in, you enter the catheter and inject the dye
-what medication do they give the pt that prevents you from removing the sheath?
-why?

Back 16

-they give IV aspirin (angiomax)
-can't remove sheath for several hours because the pt has no ability to clot and you would have to use pressure with all your weight for 2 hrs

Front 17

Cardiac Cath – Sheath Removal

-when it is time to remove it, usually it is stitched in place, they snip it and remove the sheath, and apply pressure. during the pressure holding, you need a 2nd person to do what?

Back 17

to check their pulses (because they can lose that pressure in that extremity)

Front 18

Cardiac Cath – Sheath Removal

-when removing the sheath, how long do you have to apply direct pressure for?

Back 18

for 20 – 30 minutes or use commercial devices or patches
-commercial devices that are put in the insertion site and you do not have to hold pressure

Front 19

Cardiac Cath – Sheath Removal

-it is important to assess the distal extremity for what? (4)

Back 19

pulse, color, cap refill, sensation

Front 20

Cardiac Cath – Sheath Removal

Teach patient to lie flat for 4 – 6 hours (most important time to be still is when?

Back 20

after the sheath
is removed.
-have them sit at the side of the bed first. you check VS before and after they move to make sure the clot has not removed

Front 21

Cardiac Cath – Sheath Removal

Check site dressing every 4 – 6 hours for what?

Back 21

bleeding and integrity

Front 22

Cardiac Cath – Postprocedure

keep extremity straight. what can the nurse do to help with this?

Back 22

– teach no bending
-(can apply a soft knee brace)

Front 23

Cardiac Cath – Postprocedure

-Maintain IVF, po fluids, and oxygen, why?

Back 23

-the contrast acts as an osmotic diuretic, monitor urine output and ensure that the pt receives sufficient oral and IV fluids for adequate excretion of the contrast

Front 24

Cardiac Cath – Postprocedure

what labs should you check before sheath removal?

Back 24

-Check coagulation labs

Front 25

Cardiac Cath –
Postprocedure

-if the pt experiences symptoms of cardiac ischemia (chest pain, dysrhythmias, bleeding, or change in peripheral pulses in the affected extremity) what should the RN do?

Back 25

contact rapid response.

Front 26

Cardiac Cath – Postprocedure

-if the pt complains of back pain, what are you thinking/assessing?
-what intervention can you do for the back pain if they have to lie flat for 6 hrs.

Back 26

-assess puncture site for bleeding. there can be retrograde bleeding (bleeding into the back of the abd cavity which can cause back pain)
-you can put a pillow under their knee that doesn’t have to be straight, elevate the HOB to 20-30 degrees

Front 27

Cardiac Cath – Postprocedure

-when assessing the puncture site, touch the site looking for what?

Back 27

hardness indicating bleeding in the tissue

Front 28

Discharge Teaching for postprocedure of a cardiac cath:

what about activity?

Back 28

-limit activity for several days (avoid lifting and exercise you don’t want to dislodge clot)

Front 29

Discharge Teaching for postprocedure of a cardiac cath:

what about the dressing from the puncture site?

Back 29

-leave the dressing in place for at least the first day at home

Front 30

Discharge Teaching for postprocedure of a cardiac cath:

-teach them to observe the insertion site for what?

Back 30

-for swelling, redness, warmth, and pain.
-bruising is expected

Front 31

Discharge Teaching for postprocedure of a cardiac cath:

-fluids?

Back 31

-encourage fluids to flush dye out so it doesn’t cause acute renal failure

Front 32

DVT

-how many days does it take for a clot to form?
-what is the biggest key to avoid DVT formation?

Back 32

-7 days for a clot to form

-(prevention is the biggest key)-walking is better than SCDs, push fluids, foot pumps, SCDs, don’t cross ankles

Front 33

Discharge Teaching for postprocedure of a cardiac cath:

-what use to be old practice to test if DVT is suspected in a patient that we are NOT told to perform anymore?

Back 33

-do not perform Homans sign if DVT is suspected (dislodges the clot)
-Homan’s sign is pain in the calf on dorsiflexion of the foot

Front 34

-A thrombus is a blood clot that requires 2/3 categories in Virchow’s triad to be a DVT:

Back 34

-endothelial injury,
-venous stasis of blood flow,
-hypercoagulability

Front 35

DVT clinical manifestations?

Back 35

-edema
-pain
-warm skin
-erythemia (inflamm process)

Front 36

DVT diagnosis

Back 36

CT
ultrasound
D-dimer: a marker of coagulation activation and measures fibrin degradation products produced from clot breakdown-Doppler

Front 37

Management of DVT:
-Interventions

Back 37

-bedrest and elevation of extremity
-wear knee high or thigh high compression or elastic stockings for an extended period of time
-warm moist socks to the affected area
-filters: used so the clot doesn’t travel. any piece that would travel would be caught

Front 38

Management of DVT:
-what medications are prescribed?

Back 38

anticoagulants (herparin, coumadin, or lovenox)

Front 39

Management of DVT:

-do not massage the affected extremity , why?

Back 39

may dislodge and becoming an embolus – traveling clot

Front 40

Management of DVT:
-avoid what supplements?
-avoid what vitamin?

Back 40

-avoid vitamin K supplements
-avoid vitamin E
-ETOH

Front 41

Pulmonary Embolism results from what?

Back 41

collection of matter (solids, liquids, or air) that enters venous circulation and lodges in the pulmonary vessels

Front 42

-fat, oil, air, tumor cells, foreign objects (broken IV catheters), injected particles, and infected clots or pus can enter a vein and cause a PE (true or false)

Back 42

true
a PE is life threatening
-most patients die within 1 hr of the onset of symptoms

Front 43

Pulmonary Embolism

-large emboli do what?

Back 43

obstruct pulmonary blood flow, leading to reduced oxygenation of the whole body

Front 44

-in PE, a blood clot from a DVT breaks lose from one of the veins in the legs or pelvis. The clot breaks off, travels through the vena cava into the right side of the heart and then lodges into the pulmonary artery. platelets collect on the embolus, triggering the release of substances that cause what?

Back 44

blood vessel constriction. widespread pulmonary constriction and pulmonary hypertension impair gas exchange. deoxygenated blood is moved into arterial circulation, causing hypoxemia (low arterial blood oxygen level)

Front 45

Pulmonary Embolism CM

-what kind of pain?

Back 45

-pleuritic chest pain (sharp, shooting pain on inspiration)

Front 46

Pulmonary Embolism CM in the respiratory system?

Back 46

-shortness of breath
-tachypnea
-breath sounds = crackles
-a dry cough is present
-hemoptysis (bloody sputum) = late sign

Front 47

Pulmonary Embolism CM in the cardiac system?

Back 47

tachycardia
abnormal heart sounds
hypotension

Front 48

Pulmonary Embolism CM

3 other CM:
(nuero - 2?
(skin - 1?

Back 48

-low grade fever
-change in LOC
-petechiae on the skin over the chest and axillae

Front 49

Manaegment of PE in the hospital?

Back 49

-O2, IV heparin, rest, analgesics, thrombolytic agent, filter

Front 50

Manaegment of PE:

-teach pts who are traveling for long periods to do what:

Back 50

drink plenty of water, change positions often, avoid crossing the legs, and get up from the sitting position at least 5 minutes out of every hour

Front 51

Management of PE:

-avoid what kind of clothing?

Back 51

-avoid the use of tight garters, girdles, and constrictive clothing

Front 52

Management of PE:

-should you elevate the extremities?

Back 52

-elevate extremities above the level of the heart to improve venous return

Front 53

Labs for PE:

-the hyperventilation triggered by hypoxia and pain first leads to respiratory ___________

Back 53

alkalosis.
-as blood is shunted without picking up oxygen from the lungs, the PaCO2 levels start to rise, resulting in respiratory acidosis

Front 54

Pulmonary embolism

-what acid base imbalance results at the end of a PE?

Back 54

-later, metabolic acidosis results from the build up of lactic acid due to tissue hypoxia

Front 55

Is heart failure a symptom or a disease?

Back 55

-symptom not disease, it comes from something

Front 56

Backward effects of left heart failure

CM (3)

Back 56

-if the blood can’t be pumped out of the LV it will back up into the LA and into the lungs

-crackles in the lungs
-people feel like they are drowning
-pulmonary edema: pink secretions because the capillary beds have been destroyed)

Front 57

Forward effects of left heart failure

-what will you see as a compensatory mechanism of the body?

Back 57

-increase blood volume and BP because the body is trying to compensate

Front 58

Backward effects of right heart failure

CM (3)

Back 58

-blood can’t get into the heart
-it backs up in the body

- increased pressure in great veins: neck vein distension
-peripheral edema
-congestion of organs – liver, spleen (hepatomegly, splenomegly)

Front 59

Forward effects of right heart failure

-tell me about the amount of blood

Back 59

-decrease in the amount of blood that is pumped from the right side of the heart into the lungs

Front 60

CM of heart failure: Respiratory system

Back 60

-fatigue
-Dyspnea at rest or with exertion (in left sided heart failure, fluid is backing up in the lungs, alveoli are becoming congested, causing dyspnea)
--Adventitious breath sounds (crackles or wheezes)

Front 61

CM of heart failure: Cardiac system (4)

Back 61

-Tachycardia
-Chest pain
-third heart sound - S3
-Jugular vein distension/neck vein distension

Front 62

CM of heart failure:

PND (paroxysmal nocturnal dyspnea)
-what is it caused by:

Back 62

– reabsorption of fluids from dependent areas --> ↑pulmonary pressure and fluid in lungs

Front 63

CM of heart failure:

-PND (paroxysmal nocturnal dyspnea)
-what is it?

-what helps this?

Back 63

–sudden awakening with a feeling of breathlessness 2-5 hrs after falling asleep.. sudden onset.

- sitting upright, dangling the feet, or walking helps

Front 64

CM of heart failure:


orthopnea is what?

Back 64

difficulty breathing when lying flat

Front 65

CM of heart failure:

Skin:

Back 65

-Skin changes: cool, dusky, shiny, ↓hair growth

Front 66

CM of heart failure:

Edema results from what? (3)

Back 66

-abdominal hepatojugular reflex (edema of the organs)
-leg swelling (blood pooling in the periphery)

Front 67

CM of heart failure:

-abdominal cavity?

Back 67

ascites (really really bad – fluid in abdominal cavity. means liver is so congested and it leaks out of the abdominal cavity)

Front 68

CM of heart failure:

-urinary system?

Back 68

nocturia

Front 69

CM of heart failure:

-Behavioral changes?

Back 69

-Mental status changes (lack of O2 since it is not reoxygenationg in the lungs)

Front 70

Heart Failure – Diagnostics

Labs- BUN and creatinine?

Back 70

-impairment of renal function resulting from inadequate perfusion causes elevated BUN and creatinine

Front 71

Heart Failure – Diagnostics

- elevated B-type natriuretic peptide (BNP) – bodys response to what?

Back 71

decreased CO

Front 72

Heart Failure – Diagnostics

-breath sounds?

Back 72

crackles

Front 73

Heart Failure – Diagnostics

Chest x-ray shows:

Back 73

cardiomegaly (shows enlargement of the heart)

Front 74

Heart Failure – Diagnostics
-12 lead EKG and other tests can be used:

Back 74

-Echocardiogram (may show ventricular hypertrophy, dysrhythmias, and any degree of myocardial ischemia, injury, or infarction. it is NOT helpful in determining the presence or extent of CHF)
-Cardiac cath

Front 75

Heart Failure - Management

•Daily weights (I kg of weight gain or loss equals what?

Back 75

1 L of retained or loss fluid)

Front 76

Heart Failure – Teaching

•Sodium restriction , why?

Back 76

decrease fluid retention

Front 77

Heart Failure – Teaching

-salt substitutes, are they good?

Back 77

-not all salt substitutes are good (can still contain Na and K)

Front 78

Heart Failure – Teaching

-Limit sodium to 2g/day but they can be more restricted. teach them what foods are high in sodium:

Back 78

processed foods, canned foods, lunch meat, ham, anything preserved… making your own food is better than buying food.. teach them to taste the food before you salt it
--teach them to use other spices (lemon, herbs)

Front 79

Heart Failure – Teaching

-avoid alcohol, why?

Back 79

ETOH is a cardiac depressant

Front 80

Heart Failure – Teaching

-what type of exercise should they do?

Back 80

walking, no weight lifting –pressure on the heart (walk around the block, walk in the mall, park in the furthest spot away from the door)

Front 81

Heart Failure – Teaching

When should you instruct a patient to call their MD?

Back 81

weight gain greater than 2 lb in 1day or 5 lb in a week

Front 82

1L (1.06 quarts) of water weighs ____kg?

Back 82

1 kg (2.2 lbs)

Front 83

Heart Failure – Teaching

When should you instruct a patient to call their MD.
-what are other CM?

Back 83

–↑ SOB, orthopnea, sleeping with more pillows
–CP (chest pain)
–faint, weak dizzy when stand

Front 84

Heart Failure – Teaching

-what about fluid intake?

Back 84

– limit daily fluid intake to 2L

Front 85

Heart Failure – Drugs

Morphine
-what does it do to preload?
-what does it do to afterload?

Back 85

given to reduce anxiety,
-decrease preload and afterload,
-slow respirations, and reduce pain associate with the MI

Front 86

Heat Failure Drugs

-ACE inhibitors (pril)
what do they do to afterload?

Back 86

decrease afterload and limit remodeling (help prevent stretching)

Front 87

ACE inhibitors (pril)–

2 big SE:

Back 87

nagging, dry cough, hypotension

Front 88

ACE inhibitors (pril)
ACE inhibitors prevent conversion of angiotension I to angiotension II, resulting in what 3 things?

Back 88

arterial resistance,
arterial dilation,
increased stroke volume

Front 89

Diuretics – loop, thiazides, spironolactone

-what do they do to preload?

Back 89

decrease preload
-enhance renal excretion of sodium and water by reducing circulating blood volume

Front 90

-spironolactone (Aldactone) is used for pts at risk for what?

Back 90

dysrhythmias.
-it helps retain potassium and thus decreases the risk of ventricular dysrhythmias

Front 91

Heart failure

Βeta blockers
-what drug should you avoid using with b blockers?

-what does this do to blood sugar?

Back 91

digoxin and beta blockers should not be used together.
-check HR. they can also mask the signs of hypoglycemia.

Front 92

Heart failure

Βeta blockers

if someone has DM, tell them to check their BS,why?

Back 92

because they might not have their typical s/s of hypoglycemia.

Front 93

Calcium Channel Blockers
- limit use if can’t control BP
-not drug of choice

-what does it cause to happen in the arteries?
-what is the big SE:

Back 93

-cause smooth muscle relaxation in the arteries

(big SE is constipation)

Front 94

Nitrates
-what do they do to preload?

Back 94

venous dilators- decrease preload