Adult 1 Exam 3 - Cardiac

Front 1

Thrombophlebitis -
causes and S/Sx

Back 1

-aka venous thrombosis; vein side
-caused by trauma, immobility, surgery
-s/sx incl. leg pain, warm temp, edema, inspect bilaterally with tape measure, risk factors

Front 2

Thrombophlebitis -
prevention

Back 2

-elastic stockings
-IPC (intermittent pneumatic compression device)
-positioning
-exercise
-Heparin

Front 3

ANTICOAGULANT
THERAPY for thromboembolism

(administration)

Back 3

-continuous IV infusion of Heparin
-intermittent injection of heparin SQ
-oral anticoagulants (coumadin)
-intermittent injection of Lovenox SQ (low molecular wt heparin)

Front 4

ANTICOAGULANT
THERAPY for thromboembolism

(precautions)

Back 4

-spontaneous bleeding
-heparin induced thrombocytopenia
-drug interactions

Front 5

Manifestations of Thrombophlebitis-
Deep Vein Thrombosis

Back 5

-usually asymptomatic
-dull, aching pain, especially when walking.
-tenderness, warmth, erythema along affected vein.
-cyanosis
-edema

Front 6

Manifestations of Thrombophlebitis-
Superficial Vein Thrombosis

Back 6

-localized pain and tenderness
-redness and warmth
-palpable cordlike structure
-swelling and redness of surrrounding tissue

Front 7

Heparin Therapy

Back 7

Heparin interferes withte clotting cascade by inhibiting the effects of thrombin and preventing the conversion fibrinogen to fibrin. The prevents the formation of a stable fibrin clot. At therapeutic levels, heparin prolongs the thrombin. time, clotting time and activated partial thromboplastin time.
-IV is immediate
-SQ onset 1 hr.

Front 8

PT INR

Back 8

Inceased to 2.0-3.0 in Warfarin (coumadin) therapy.
Prothrombin time measurements. Normal is 0.9-1.2.

Front 9

aPTT

Back 9

the activated partial thromboplastin time (or PTT).
-LMW heparin dosage is calculated to maintain the aPTT at approx twice the normal level.
-frequent monitoring is an important responsibility

Front 10

Antedote for Heparin

Back 10

Protamine sulfate to treat excessive bleeding

Front 11

Antedote for Coumadin (Warfarin)

Back 11

Vitamin K

Front 12

Coumadin

Back 12

Inhibits extension of existing thrombi and the formation of new clots. Its action is cumulative and more prolonged that that of heparin.

Front 13

Nursing Diagnoses for prevention of venous thrombosis

Back 13

-pain-from inflammation
-Ineffective tissue perfusion:peripheral-deprived tissues leading to ulceration/infection
-Ineffective Protection-bleeding
-Impaired physical mobility
-Risk for ineffective tissue perfusion:cardiopulmonary-low O2 sats therefore initiate O2 therapy and elevate HOB.

Front 14

DVT

Back 14

usually asymptomatic; first indicator is a pulmonary embolism in some patients.

Front 15

Hypertension

Back 15

systolic pressure 140mmHg or highter, diastolic pressure 90mmHg or higher, based on the average of three of more readings taken on separate ocassions.

Front 16

Primary Hypertension

Back 16

-a persistently elevated systemic blood pressure.
-1:3 people in US and 90% of those have primary HTN
-aka essential HTN
-140-159/90-99

Front 17

Risk factors of primary HTN

Back 17

Modifiable
-high Na intake
-low K, Ca and Mg intake
-Obesity
-Excess alcohol consumption
-insulin resistance, tobacco, stress

Nonmodifiable
-genetic factors, family Hx, Age, race
(blacks significantly higher)

Front 18

Secondary Hypertension (Stage 2)

Back 18

elevated blood pressure resulting from an identifiable underlying process.
-kidney disease number one cause

Front 19

Risk factors of secondary hypertension

Back 19

-coarctation of the aorta (narrowing)
-renal disease
-endocrine-cushing's hyperaldosteronism
-sleep apnea
-pregnancy
-cocaine, BC pill, NSAIDS

Front 20

Diagnostic tests for HTN

Back 20

Serial blood pressure readings
Urinalysis
IV pyleography
BUN and creatinine levels
ECG
CXR

Front 21

H Y P E R T E N S I O N
Nursing Diagnosis

Back 21

-Altered health maintenance R/T lack of knowledge of
Pathology, complications & management of hypertension
-Anxiety R/T diagnosis, regimen, complications & lifestyle
changes
-Sexuality dysfunction R/T HTN & Rx
-Ineffective management of regimen R/T
-Knowledge deficit
-Medication side-effects, Cost of meds, schedule for meds
-Body image disturbance

Front 22

Nursing Implementation for HTN

Back 22

Administer medications
-Thiazide, loop, and potassium-
sparing diuretics
-ACE (angiotensin-converting
enzyme) Inhibitors
-Adrenergic Inhibitors (alpha, beta,
central)
-Vasodilators
-Angiotensin Inhibitors
-Calcium Channel Blocker
Monitor blood pressure
Patient and Family teaching

Front 23

H Y P E R T E N S I O N
CLIENT EDUCATION

Back 23

medications
diet
weight control
lifestyle changes
follow-up

Front 24

D I U R E T I C S

Back 24

-Decrease volume; inhibit Aldosterone; Negative Sodium Balance
-controls HTN by preventing tubular reabsorption of Na, thus promoting Na and water excretion and reducing blood volume.
Types include:
-Thiazide Diuretics, Loop Diuretics and K-sparing Diuretics

Front 25

Beta Blockers

Back 25

-reduce blood pressure by preventing beta-receptor stimulation in the heart thereby decreasing heart rate and cardiac output.
-assess BP and AP before giving dosage
-containdicated with asthma, lung disease, bradycardia and heart block
-lopressor®

Front 26

ACE Inhibitors

Back 26

-lowers blood pressure by preventing conversion of Angiotensin I to Angio II. This prevents vasoconstriction and Na/H2O retention. Most end with -ril like Monopril®
-Adverse rx-persistent cough, first dose hypetension and hyperkalemia

Front 27

ARBs (Angiotensin II Receptor Blockers)

Back 27

ARBS have the same effect as ACE inhibitors but they act by blocking the effect of angiotensin II on receptors.
-Adverse rx-persistent cough, first dose hypetension and hyperkalemia

Front 28

ND r/t Primary HTN
(same for Secondary HTN)

Back 28

All patients with primary HTN and families need significant teaching to manage.
-Health Maintenance is a high priority problem. r/t patho, complications, and mgmt of HTN.
-Risk for noncompliance
-Imbalanced nutrition: more than body reqmts
-Excess Fluid volume
-for secondary HTN, underlying process is treated.

Front 29

More NDs r/t HTN

Back 29

-Anxiety r/t diagnosis, regimen complications and lifestyle changes
-sexuality dysfunction r/t HTN and Rx
-Ineffective mgmt of regimen r/t
knowledge deficit
Rx S/E, cost, and schedule
Body image disturbance

Front 30

H Y P E R T E N S I O N
Monitor/Manage Potential
Complications

Back 30

Assess
-vascular sys, eyes, heart, nervous sys, and kidneys
Expected outcomes
-maintains adequate tissue perfusion; compliance; free of complications

Front 31

Hypertensive Crisis

Back 31

-BP greater than 180/120.
-immediate Tx (within 1 hour) is needed.
-usually occur when patients suddenly stop taking meds or poorly controlled
-younger pts, AA men, pregnant women with pre-eclampsia, renal disease

Front 32

HTN Crisis Manifestations

Back 32

headache
confusion
swelling of optic nerve (papilledema)
blurred vision
restlessness
motor and sensory deficits

Front 33

Nursing care for those with HTN crisis

Back 33

-focus is on continuous monitoring of BP and titrating drugs as ordered to achieve the desired BP.
-provide psycho and emotional support.
-teach measures to effectively manage HTN

Front 34

Pre HTN teaching

Back 34

-maintain normal body wt, lose wt.
-dietary mods
-limit ETOH
-Aerobic exercise
-stop smoking
-stress mgmt

Front 35

Venous stasis

Back 35

low-blood flow in lower extremeties
Tx: Low molecular weight heparin
IPCDs intermittentpneumatic compression devices

Front 36

Buergerʼs disease

Back 36

Occlusive vascular disease ; small and midsize peripheral arteries become
inflamed and spastic, causing clots to form
It progresses to collateral vessels
Occurs in men under 40 that smoke
Arterial bypass surgery
ND:focus is on smoking cessation

Front 37

Rienauds disease

Back 37

Occlusive vascular disease; intense vasospasm in small arteries and arterioles
of fingers and toes;
Usually secondarily to another disease (ie: rheumatoid arthritis)
primarily young women 20 - 40

Front 38

Cardiac Catheterization aka Percutanueous transluminal coronary angioplasty (PCTA)

Back 38

treatment for angina
-pre- assess for allergies to seafood, iodine or contrast dyes.
-intra-supine, hold still, cough and deep breathe frequently
-post- heck pulses, warmth, muscle tone, BP, vitals, temp.
encourage patient to drink lots of fluids to flush out dye; maintain HOB at 30degrees or less; distal pulses; I & O

Front 39

Coronary Artery Disease

Back 39

-Atherosclerosis
fatty streak
raised fibrous plaque
complicated lesion
-Collateral Circulation
-Risk Factors
Unmodifiable: age, sex, race,
family history
Modifiable: serum lipids, HTN,
smoking, obesity, physical
inactivity, diabetes, stress

Front 40

collateral circulation

Back 40

-This is a process in which small (normally closed) arteries open up and connect two larger arteries or different parts of the same artery. They can serve as alternate routes of blood supply.
-provides alternate routes of blood flow to the heart in cases when the heart isn't getting the blood supply it needs (myocardial ischemia)

Front 41

Diabetes and CHD (CAD)

Back 41

increases the risk of CHD by accelerating the atherosclerotic process.

Front 42

Diabetes and HTN

Back 42

share common risk factors.

Front 43

Peripheral Vascular Diseases -
Atherosclerosis

Back 43

Acute: Trauma, Thrombosis or Embolism
Chronic: Atherosclerosis, inflammation, thrombosis, embolism, trauma,
autoimmune

Administer meds, Vasodilators, anticoagulants, antilipemic, thrombolytics
Regular daily exercise is a primary intervention for all types of peripheral arterial disease.

Front 44

smoking

Back 44

Contributes to CAD in 3 ways
CO picked up by hemoglobin more
readily than 02 then low O2
delivered to tissues
Nicotine causes vasoconstriction
Smoking increases platelet
adhesion →formation of a
thrombus

Front 45

Angina Pectoris
-Stable Angina

Back 45

Intermittent chest pain
Over long period of time
Same or similar circumstances
Not usually at rest
Meds usually control

Front 46

Unstable Angina - aka. Acute Coronary Syndrome

Back 46

Unpredictable
(may previously had Stable Angina)
May occur w/minimal or no exercise
Increased chance of thromb→MI

Front 47

Prinzmetal’s Angina

Back 47

-response to spasm of coronary artery
-hx of migraines or Raynauds
-may be at rest
-with or w/o CAD
-maybe precipitated by Histamine or Epinephrine

Front 48

Causes of Angina

Back 48

-physical exertion increases myocardial demand of O2
-cold exposure-vasoconstriction and elevated BP
-eating large meal; blood going to GI instead of myocardium

Front 49

S/Sx of Angina

Back 49

-chest pain, pressure
-apprehension
-neck, jaw, shoulders or extremity pain
-choking sensation
-Indigestion
-diaphoresis

Front 50

Chest pain

Back 50

Myocardial hypoxia at the cellular level.

Front 51

Angina Tx

Back 51

-PCTA
-stent replacement
-CABG
-Laser angioplasty

Front 52

Drug Therapy for Angina

Back 52

ASA - 50% reduction
-prophylaxis; at time of pain
Nitrites (vasodilators)
-dilate peripheral vessels
-decreases cardiac work by reducing venous return to heart
-increases myocardial blood flow via vasodilation of coronary vessels

Front 53

Nursing Diagnosis R/T Angina

Back 53

High priority ND include:
ineffective cardiac tissue perfusion and mgmt of the prescribed therapeutic regimen.

Front 54

more ND related to Angina

Back 54

-decreased cardiac output
impaired gas exchange
activity intolerance
pain
risk for infection
sleep disturbance
knowledge deficit
altered family process

Front 55

Acute Arterial Occlusion S/Sx

Back 55

6 P's
pain; pallor; polar; pulselessness; paresthesia; paralysis
ND: focuses on protecting affected extremity, managing anxiety and reducing complications r/t anticoagulation therapy

Front 56

Peripheral arterial vascular disease
NDs

Back 56

Impaired tissue prefusion:peripheral
Acute and Chronic Pain- ischemia, build up of lactic acid
Impaired skin integrity as a result of O2 and nutrient deprivation
Activity Intolerance

Front 57

intermittent claudication

Back 57

is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise and is relieved by a short period of rest.