321 - Cardiovascular System P. 39-

Front 1

-what is an aneurysm

Back 1

a permanent localized dilation of an artery which enlargers the artery to at least 2x its normal diameter

Front 2

-how does an aneurysm form?

Back 2

when the middle layer of the artery is weakened, producing a stretching effect in the inner layer and outer layer of the arteries. as the artery widens, tension in the wall increases and further widening occurs, thus enlarging the aneurysm

Front 3

what is the most common type of aneurysm?

-what is the most common cause of aneurysms?

Back 3

-AAA (abdominal aortic aneurysms)

-atherosclerosis is the most common cause of aneurysms

Front 4

S/S of aneurysms:
-most often asymptomatic but becomes symptomatic when pressing on something else, resulting in pain located where?

Back 4

abdominal, back, or flank pain

Front 5

S/S of aneurysms:
--auscultate for what?

Back 5

-auscultate for a bruit, do not touch the mass because it may be tender and rupture

Front 6

aneurysms are treated conservatively

-surgery is done when?

Back 6

if the aneurysm is greater than 5-6cm or grows 0.5cm in 6 mo

Front 7

Aneurysms can be either true or false:

what is a false aneurysm:

Back 7

-saccular is an example
-it is a bulge and weakness of 1 side of the artery
where the outer layer of the artery is breaking away from the inner layer.
-it will occur where there is an organ

Front 8

Aneurysms can be either true or false:

-what is a true aneurysm?

Back 8

-true: weakening in all the layers of the artery, causing a bulge on both sides (fusiform)

Front 9

Aneurysms complication:
-rupture is the most frequent complication and is life threatening, why?

Back 9

b/c abrupt massive hemorrhagic (hypovolemic) shock results

Front 10

Aneurysms S/S

-how would you know if the aneuryism is leaking?

Back 10

-flank ecchymosis – grey turners sign (bruising in the flank because the aneuryism is leaking)

Front 11

-Interventions & Management of aneurysms

-how will they monitor the aneurysm?

-start on what medication, why?

Back 11

-CT every 6 months, looking at the growth
-surgery if greater than 5-6 cm


-Maintain BP: they will go on antihypertensives to keep their BP low (Take pressure off the artery)
-life style changes: lose weight, stop smoking

Front 12

Diagnosis of aneurysms

Back 12

-found by accident
-CT
-MRI
-AAA is found by an x-ray and looks like an eggshell

Front 13

venous insufficiency occurs secondary to incompetent valves in the deeper veins of the lower extremities, which allows what?

The veins inability to carry fluid and wastes from the lower extremities precipitates the development of (3)

Back 13

pooling of blood and dilation of the veins.

swelling/edema, venous stasis ulcers, and cellulitis.

Front 14

chronic venous insufficiency

CM:

Back 14

-pitting edema
-brown pigment
-difficult to find pulses (because of edema)
-ulcers around ankle

Front 15

chronic venous insufficiency

what happens to the extremity when it is dependent?

Back 15

-cyanosis when extremity is dependent

Front 16

chronic venous insufficiency management

Back 16

•Compression stockings and elevation
•Diuretics
•Foot care with moisture lotion to skin
•Avoid dependent positions, avoid constrictive clothing
•Moist environment dressing
•Antibiotic therapy if ulcers are infected
•Diet- well balanced and high protein
•Radiant heat bandage
•Split thickness skin graft to get them to heal

Front 17

Hypertension is defined as what?

Back 17

systolic BP is 140 OR diastolic BP is at 90 in people who do not have DM

Front 18

Hypertension
-sustained increase in mean arterial pressure (MAP). several readings over a period of time
--sustained hypertension does what?

Back 18

produces thickening of the arteries and perfusion decreases causing damage to vital organs

Front 19

3 mechanisms regulate BP
-ANS: excites or inhibits system activity in response to chemoreceptors and baroreceptors
-what do baroreceptors do?
-where are they located?
-when are they stimulated?

Back 19

-baroreceptors decrease BP/HR are located in the aorta and carotid arteries
-stimulated when the arterial walls are stretched by an increase in BP

Front 20

3 mechanisms regulate BP
-ANS: excites or inhibits system activity in response to chemoreceptors and baroreceptors
-chemoreceptors do what to BP/HR?
-where are they located?
-what are they sensitive to?
-what happens when this is stimulated?

Back 20

increase it
-are found in the carotid arteries and aortic arch

-sensitive to hypoxemia. when stimulated, these chemoreceptors send impulses along the vagus nerve to activate a vasoconstrictor and raise BP

Front 21

How do they kidneys regulate BP?

Back 21

they sense a change in blood flow and activate the rennin-angiotensin aldosterone mechanisms

(angiotension II vasoconstricts and controls aldosterone release, which causes the kidneys to reabsorb sodium and inhibit fluid loss)

Front 22

Kidneys and BP
-when renal blood flow or pressure decreases, the kidneys do what?

Back 22

kidneys retain sodium and water. BP tends to rise because of fluid retention
-aldosterone results in vasoconstriction and sodium retention, and thus fluid retention.

Front 23

CM of hypertension

-enlarged heart (compensation – how?)

Back 23

increases to increase the force of contraction

Front 24

CM of hypertension

-what does it do to the kidney?

Back 24

-arterioles in the kidney harden and restrict oxygenation of the glomeruli, causing scarring and kidney failure

Front 25

CM of hypertension

what does it do to the eye?

Back 25

-retinopathy of the eye (effects blood vessels within the eye)

Front 26

CM of hypertension
-increases the work load of the heart --> decreasing oxygen supply leading to what?

Back 26

= HF, MI, angina, stroke

Front 27

Pacemaker
-what is a temporary pacer?

Back 27

-whenever the pacemaker is outside the body, it is temporary pacemaker and they will insert a central line to the SA node where they want to place the pacemaker

Front 28

Pacemaker
- temporary pacer
how is energy supplied?
how is energy delivered?

Back 28

-the energy source is provided by an external battery pack
-energy is delivered to the heart by 2 electrode patches placed on the skin

Front 29

-internal (permanent) pacemaker: when the generator is implanted.
-how is this implanted?

Back 29

- they make an incision and create a whole in the fat, put the pacemaker in there, put the wire into the heart (SA or AV node) and they close it out

Front 30

how can you tell when someone has a pacemaker

Back 30

there is a pacing spike on the tele strip.

Front 31

Teaching with pacemakers

-what do you tell them to check daily?

Back 31

they have to check their pulse every day. it will be a set at a HR. so the pulse should be at that rate.

Front 32

Teaching with pacemakers

-avoid lifting their arm after surgery to avoid dislodging the pacer for how long?

Back 32

about a week and gradually increase activity

-rest the arm in a pillow or sling (don’t want them to dislodge the wire)

Front 33

Teaching with pacemakers

-what about microwaves?
-electrical plugs?

Back 33

-they can stand next to microwaves (unless the microwaves are30 y/o)
-shouldn’t do anything on a computer that doesn’t have a 3 whole plug

Front 34

Teaching with pacemakers

-carry their pacemaker identification card at all times
-how long do the batters last?

Back 34

-the pacemaker battery has to be changed every 7 years (they lost longer than that but you don’t want it to fail)

Front 35

Teaching with pacemakers

-if they are having an MRI done, make sure the MRI techs know they have a pacemaker in. as well as pts who have stents in.

Back 35

-you can travel on airplanes, it shouldn’t set off the alarms (if they are worried..they can show their cards)

Front 36

Teaching with pacemakers

-diet

Back 36

-push fluids, fruits, veggies.. don’t want constipation (straining can disrupt the pacer)

Front 37

-ACD- this is a defibrillator
-it is an automatic internal cardiac defibrillator
-wraps around the ventricles so if u go into vfib, it will defibrillate you
-how can you stop this defibrillation if needed?

Back 37

-you can deactivate it with a doughnut magnet if this keeps firing and malfunctions

Front 38

-for pts with pacer defibrillators, inform the pt and family that anyone touching the client when the device delivers a shock will feel an electrical impulse but that impulse will not harm the person

(true or false)

Back 38

true

Front 39

what is a dysrhythmia?

-what do they result from?

Back 39

heart beat disturbances

-disturbance in relationship between electrical conductivity, impulses, delays and blocks

Front 40

Sinus bradycardia occurs as the normal response to:

Back 40

a reduced demand for blood flow

Front 41

Sinus bradycardia
--Looking at the ECG you'll see that:
--rate and rhythm?

Back 41

Rhythm - Regular
-Rate - less than 60 beats per minute

Front 42

Sinus bradycardia
-ECG shows:
-QRS Duration - Normal
-P Wave - Visible before each QRS complex
-P-R Interval - Normal

Back 42

-Usually benign and often caused by patients on beta blockers

Front 43

1st Degree AV Block
-this block is atrial ventricular so the amount of time from the P wave is what?

Back 43

The P wave is going through the SA node, to get to the AV node, and it is delayed

Front 44

1st Degree AV Block
if the PR interval is greater than 0.2 (5 blocks) it is a first degree AV block.
-what do we do for this block?

Back 44

we don’t do anything for it. just monitor. it tells you that the conduction form the SA to AV node is delayed.

Front 45

Valves

Stenosis: means what?

Back 45

-narrowed opening that impedes blood moving forward

Front 46

Valves

-insufficiency/regurgitation means what?

Back 46

improper closure – some blood flows backward

Front 47

Mitral valve stenosis:
--hardening of the mitral valve caused by fibrosis or calcification. This hardening results in narrowing of the valve opening, which obstructs blood flow from

Back 47

the LA to the LV = LA volume and pressure increases and the chamber dilates

Front 48

Mitral valve stenosis:

-most commonly results from

Back 48

rheumatic fever and is associated with congenital anomalies

Front 49

Mitral valve stenosis:
-when would you hear a murmur?

Back 49

- blood flow is narrowed,

diastole

Front 50

S1 =

S2 =

Back 50

S1 = systole (hear best at the apex or bottom of the heart)
-Mital and tricuspid valves snap shut


S2 = diastole (hear best at the base or top of the heart)
-aortic and pulmonic valves snap shut

Front 51

-Systole
what valves are closed?
what are open?

Back 51

(mitral and tricuspid valve should be closed)

aortic and pulmonic should be open

Front 52

-Diastole
what valves are closed?
-what are open?

Back 52

pulmonic and aortic should be closed

(mitral and tricuspid valve should be open)

Front 53

-aortic valve stenosis

-the pulmonic valve and aortic valve are open. blood is being pumped OUT of the heart. so if you have an aortic stenosis, you will hear a murmur on _________.

Back 53

systole

the valves should be open but it is not because it is stenosed (S1)

Front 54

-if it is a mitral valve or tricuspid valve stenosis, you will hear a murmur on ___________

Back 54

diastole (S2)

because that is when the chambers of the heart are filling and the mitral and tricuspid valve would be open.

Front 55

-if you hear an aortic valve regurgitation (backflow of blood) you will hear a murmur on _________

Back 55

diastole or (S2)

because the pulmonic and aortic valve are closed..

Front 56

-if you hear a mitral or tricuspid valve regurgitation, you will hear that on ____________

Back 56

systole (S1)

Front 57

Valvular Heart Disease

2 CM

Back 57

murmurs and CHF (impaired blood flow)

Front 58

Valvular Heart Disease Management with drugs

Back 58

–Treat symptoms (if they are in HF, treat the HF)
–Prophylactic antibiotic therapy
-diuretics are used

Front 59

Valvular Heart Disease Management with surgery

valvuloplasty or valve replacement
-what is valvuloplasty?

Back 59

can open aortic or mitral valves affected by stenosis. a surgeon inserts a small balloon catheter through the skin at the femoral vein and advances it until it reaches the affected valve. The balloon is then inflated, forcing the valve opening to widen

Front 60

Valve Replacement (rather than a nice lub dub, you will hear a click with a valve replacement)
-what can you teach them about any future invasive procedures?
-what other kind of medication therapy will they need for life?
-safety with coumadin?

Back 60

Prophylactic antibiotics for life with any invasive procedure
•Coumadin or some type of anticoagulant therapy
-Safety: no NSAIDS, same time every day

Front 61

Valve Replacement
-what about their diet?

Back 61

–Diet ( do not restrict vit k foods, green leafy foods, just be minimal ) it should be consistent
–INR

Front 62

Peripheral Arterial Disease (PAD) is a result of:

Back 62

systemic atherosclerosis

Front 63

Peripheral Arterial Disease (PAD) is a chronic condition in which.............

Back 63

-it is a chronic condition in which partial or total arterial blockage deprives the lower extremities of oxygen and nutrients

Front 64

Peripheral Arterial Disease (PAD)

what is the big CM:

Back 64

pain with activity
-claudication (when the person walks, the person needs more oxygen because the artery is occluded and they have pain)

Front 65

Peripheral Arterial Disease (PAD)

-usually they can only walk a certain distance before cramping, burning muscle discomfort, or pain forces them to stop. the pain stops when?

Back 65

-the pain stops after rests but then can come back when they start walking again

Front 66

Peripheral Arterial Disease (PAD)

-Rest pain (numbness or burning sensation)
-pts can get some pain relief how:

Back 66

by keeping the limb in a dependent position (below the heart)

(hang foot over the edge of the bed to relieve pain)

Front 67

PAD – Lower Extremities Clinical manifestations

-what did they skin look and feel like?

Back 67

–thin, shiny, cold, and taut skin with hair loss

Front 68

PAD – Lower Extremities Clinical manifestations

what about their pulses?

Back 68

–Diminished or absent pulses (check both pulses on the feet)

Front 69

PAD – Lower Extremities Clinical manifestations

what happens to the color when they elevate their leg?

Back 69

Pallor or blanching with leg elevation (when someone has PAD, do not put their leg up on the pillow, because it causes pain (you are decreasing the blood flow) they will sit in a chair or hang their leg over the side of the bed to enhance blood flow)

Front 70

PAD – Lower Extremities Clinical manifestations

what happens to the color of their leg when they have their leg hanging over the side of the bed or in a dependent position?

Back 70

–Reactive hyperemia (redness) when in dependent position (dependent rubor)

Front 71

PAD – Lower Extremities Clinical manifestations

-tell me about the ulcer forming from PAD
-shallow or deep?
-other characteristics?
-where will it occur on the lower leg?

Back 71

-an ulcer from PAD will be deep, painful, smelly because of lack of o2. usually it will occur on an extremity (toes, foot) – more distal

Front 72

CVI– Lower Extremities Clinical manifestations

a venous ulcer will occur where?

Back 72

-a venous ulcer will occur on the calf or shin of the leg.

Front 73

Interventions for PAD:

-exercise to develop collateral circulation

Back 73

(exercise gradually and slowly and walk until the point of pain, stop and rest, and then walk a little further)

Front 74

Interventions for PAD:

-avoid crossing legs and wearing tight clothing
-goal is to promote vasodilation or vasoconstriction?

Back 74

vasodilation - how do we do that?

-maintain a warm envt by wearing socks and shoes to promote vasodilation
-quiet smoking – want to avoid vasoconstriction

Front 75

Coronary Artery Disease (CAD) results from?

Back 75

-atherosclerosis ---> injury to inner layer artery

-deposits of fatty substance, cholesterol, cellular waste, calcium, fibrin, plaque = partially or completely blocked artery

Front 76

Coronary Artery Disease (CAD)

plaque can become necrotic --> calcification , hemorrhage, thrombus = decreased or
absent blood flow. when do you show S/S of CAD?

Back 76

-shows s/s when there is 75% occlusion

Front 77

Heart Failure in PEDS
CM

Back 77

–Scalp sweating
–Tachy
–Decreased UO – weigh diapers
–Tired, sleepy, no energy
–Restless
–Cool pale extremities
–SOB: gaspy, retractions, flaring, grunting
–Edema, weight gain, ascites

Front 78

Is the BP a reliable indicator of shock in a child?

Back 78

-no because a child can compensate for a 25% blood loss by increasing HR and PVR
-BP is not the best indicator for shock in a child because they have more fluid volume than we do. we dry out as we get older so therefore a child can maintain their BP longer than an adult can.

Front 79

Sign of shock in an 8 week old infant would include?

Back 79

-sunken fontanels and sunken eyes
-they will not have tears because their tear ducts haven’t opened yet (no tears in less than 3 months old)

Front 80

-no tears is a sign of dehydration in a child (true or false)

Back 80

true

Front 81

Cardiac surgery- child
Pain meds?

Back 81

-give scheduled IV opioids till taking foods/fluids (because they may not ask for pain meds or they may be too young to ask)

Front 82

General Pediatric Rules – Meds/Digoxin

what should you make sure to do?
-don't (2)

Back 82

*Lock cabinets
*Don’t give with meals or in full bottle
*Don’t give missed doses

Front 83

General Pediatric Rules – Meds/Digoxin

*Hold if HR < ___till age 7
*Hold if HR < ___school age
*Hold if HR < ___teens

Back 83

*Hold if HR < 100 till age 7
*Hold if HR < 70 school age
*Hold if HR < 60 teens

Front 84

General Pediatric Rules – Meds/Digoxin

*Weight based
*Always double check
-give potassium with what?
-dig toxicity S/S?

Back 84

*Give potassium with juice

*Dig toxicity :
decreased HR
N/V
anorexia

Front 85

Kawasaki Disease - Mucotaneous Lymph Node Syndrome

-Acute, febrile systemic inflammatory illness, affecting what?

Back 85

Affects primarily skin and mucous membranes of respiratory tract, lymph nodes, heart

Front 86

Kawasaki Disease - Mucotaneous Lymph Node Syndrome

-autoimmune
-tell me about their recovery?

Back 86

-Spontaneous recovery in 3-4 weeks

Front 87

Kawasaki Disease - Mucotaneous Lymph Node Syndrome

Assessment
-fever?

Back 87

-Sudden onset high fever 102 – 106
-Fever lasts 5 days no relief with antipyretics

Front 88

Kawasaki Disease - Mucotaneous Lymph Node Syndrome

-when looking in their mouth, what will you see?

-when look at their palms of hands and feet, what will you see?

Back 88

-Oropharyngeal reddening and “strawberry tounge”
-Desquamation of palms of hands and feet (skin pealing)

Front 89

Kawasaki Disease - Mucotaneous Lymph Node Syndrome

Management
-give what med?

Other interventions:

Back 89

•ASA


•Cool fluids
•Cool, loose fitting clothes and blankets
•Vaseline to lips
•Bland foods - avoid hot spicy foods
•Prevent infection
•Prevent dehydration
•Monitor for cardiac complications

Front 90

Endocarditis -inflammation

Back 90

of the inner chambers and valves of the heart.

Front 91

Endocarditis
-vegetations form as a result of bacteria, debri, and organisms. they stick to the valves, causing damage and the vegetations can also cause clots to form which can break off and this is where you get the additional CM:

Back 91

petechiae, organ damage, damage to the nails

Front 92

Endocarditis
Etiology:

Back 92

–Aging
–IV drug use (people that share needles)
–Increased survival rate of children with heart disease
–Prosthetic valves
-Invasive dental procedures

Front 93

Endocarditis -Clinical Manifestations

tell me about their fever? is it low or high?

Back 93

•High fever, chills, weakness, malaise, fatigue, anorexia = come from infectious process

Front 94

Pathology of what?
-inflammatory process (organism enters the heart) and the organisms multiply in the heart and the inflammatory process starts and WBCs stick and form vegetations. vegetations can form on the valves and they can break off and travel anywhere through the body.

Back 94

Endocarditis

Front 95

Endocarditis -Clinical Manifestations

•Aortic or mitral valve murmur as a result of the valve damage from the vegetations
-blood vessels breaking causes:

Back 95

•can see petechiae

Front 96

Endocarditis -Clinical Manifestations

Vascular CM:
-Emboli, organmegaly, gangrene, brain, PE
-what can you see in their nails?

Back 96

-Splinter hemorrhages –sometimes in the nail..a dark line in the nails

Front 97

Endocarditis / Interventions:

-Blood cultures to find out what the organism is and treat it appropriately (_________is the drug of choice)

Back 97

penicillin

-on antibiotics for awhile (6 weeks)
•Rest till fever gone (NSAIDS)

Front 98

Endocarditis -teaching

-future invasive procedures?

Back 98

may be on prophylactic antibiotics if they go to the dentist or have any invasive procedure done. tell any doctor that could be doing anything invasively that they had endocarditis. for small procedures they may not be on prophylactic antibiotics but for large procedures, knee replacement, they will
-may need to have a valve replaced