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178 Cards in this Set
- Front
- Back
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What is angina |
Chest pain usually a symptoms of underlying problem Happens when heart doesnt get enough O2 |
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Angina is usually a symptom |
coronary microvascular disease MVD |
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What puts people at risk for angina? |
Unhealthy Cholesterol High BP Smoking Diabetes Overweight/obesity Metabolic syndrome Inactivity Unhealthy diet Older age family hx |
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Tests that we do to R/O angina and to make sure nothing else is wrong |
EKG Stress test Blood tests Chest xray Cardiac cath CT Angiography |
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What treatment do we do for angina? |
Lifestyle change Meds Cardiac procedures |
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What are the 4 types of angina? |
Stable angina Unstable angina Variant angina Microvascular angina |
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Describe the quality and severity of pain associated with angina. |
Squeezing Viselike pain |
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Location and radiation of pain associated with angina? |
Substernal May spread across the chest and the back Down the arms |
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What are the duration and relieving factors for angina? |
Usually left side of the chest without radiation. Usually lats less than 15 min Relieved with rest Nitrate med oxygen therapy |
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Myocardial infarction: |
Sudden without precipitating factors Often early in the morning |
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Quality and severity of pain associated with myocardial infarction? |
Intense stabbing Viselike pain Pressure Severe |
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Location and radiation of pain associated with myocardial infarction. |
Substernal May spread throughout the anterior chest to the arms jaw back neck *Jaw is the difference between the myocardial and angina* |
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Duration and relieving factors for myocardial infarction. |
Either continuous or no chest discomfort. M: Morphine vaso dilatorO: Oxygen helps with decreased O2 N: Nitrate Vaso dilator A: Aspirin: anti platelet, keeps platelets from sticking together. Chew the aspirin. |
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Using gordons functional health patterns assessment for cardio, what questions can you ask regarding health perception/health management. |
What advice has your health care provider offered you about exercise, diet or smoking? Can you follow that advice? What meds are you supposed to be taking? (both OTC and prescribed) Are you taking them as suggested or prescribed? What problems have you had with the meds? |
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Using gordons functional health patterns assessment for cardio, what questions can you ask regarding nutrition and metabolic pattern? |
What is your usual daily diet? (analyze diet for sat fat, cholesterol, total calorie, and NA+ content) How much fluid do you drink daily? Are you thirsty? What do you weigh? When did you last weigh yourself? How often do you weigh yourself? What is your height? Do you know your cholesterol level? What is it? How often do you feel nauseated or not interested in eating? Do your feet/ankles swell during the day? At night, too? |
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Using gordons functional health patterns assessment for cardio, what questions can you ask regarding elimination pattern? |
How often do you urinate in the daytime? How often do you wake up at night to urinate? |
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Using gordons functional health patterns assessment for cardio, what questions can you ask regarding activity/exercise pattern? |
What is the most strenuous exercise you did last week? How active are you compared with 6 months ago? 1 year ago? How often do you feel fatigued or tired? Can you climb a flight of stairs and walk a block without feeling short of breath or experiencing chest pain? Do you experience leg cramps when you walk or climb stairs? |
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Using gordons functional health patterns assessment for cardio, what questions can you ask regarding sleep/rest pattern? |
Where do you sleep? (in bed? in a lounge chair?) How many pillows do you sleep on? Do you ever wake up at night SOB? Do you every wake up at night with pain or cramps in your legs? How do you relieve that sensation? |
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Using gordons functional health patterns assessment for cardio, what questions can you ask regarding cognitive/ perceptual pattern? |
How is your memory? What does your family say about your memory? How often do you feel dizzy, disoriented, or faint? Do you ever have chest discomfort? How often? What precipitates it? What is it like? How do you relieve it? What is its level on a scale 0-10? Do you ever have leg or buttock pain? What are its characteristics? |
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Using gordons functional health patterns assessment for cardio, what questions can you ask regarding Role/Relationship pattern? |
What is your job? What does a days work entail? What are your family responsibilities? With whom do you live? Who is available to help you? |
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Using gordons functional health patterns assessment for cardio, what questions can you ask regarding sexuality/Reproductive pattern? |
Has your ability to engage in sexual activity changed in the past year? IF so how? Do you take any medications that affect your sexual response? If so what? |
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Using gordons functional health patterns assessment for cardio, what questions can you ask regarding coping/stress tolerance pattern? |
What do you think has been happening to you? How do you respond to being caught in a traffic jam or meeting a deadline? What do you do to relax? What do you do when you feel stressed? |
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What happens to the cardiac valves as we age? |
calcification and mucoid degeneration occur, especially in mitral and aortic valves. |
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What is the result of the cardiac valves as we age? |
Murmurs may be detected before other symptoms Valvular abnormalities may result in rythm changes. |
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What happens to the conduction system as we age? |
Pacemaker cells decrease in number. Fibrous tissue and fat in the sinoatrial node increase. Few muscle fibers remain in the atrial myocardium and bundle of His. Conduction time increases. |
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What is the result of the conduction system with age? |
The SA node may lose its inherent ryhtm. Atrial dysrhythmias occur in many older adults; 80% of older adults experience premature ventricular contractions. |
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What happens to the L ventricle as we age? |
Size of the L ventricle increases L Ventricle becomes stiff and less distensible. Fibrotic changes in the L ventricle decrease the speed of early diastolic filling by about 50% |
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What are the results of the L ventricle aging? |
Results in decreased stroke volume, ejection fraction, and cardiac output during exercise; the heart is less able to meet increased oxygen demands. Maximum heart rate with exercise is decreased. The heart is less able to meet increased oxygen demands. |
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What happens to the aorta and other larger arteries as we age? |
The aorta and other large arteries thicken and become stiffer and less distensible. Systolic BP increases to compensate for the stiff arteries. Systemic vascular resistance increases as a result of less distensible arteries; therefore the left ventricle pumps against greater resistance, contributing to L ventricular hypertrophy. |
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What is the result from aging aorta and other larger arteries? |
Hypertension may occur and must be treated to avoid target organ damage |
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What happens to the baroreceptors as we age? |
Baroreceptors become less sensitive |
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What is the result of aged baroreceptor? |
Orthostatic postural and postprandial changes occur because of ineffective baroreceptors. Changes may include BP decreases of 10 mm HG more, dizziness and fainting. |
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What are some non modifiable things that put people at risk for cardiovascular disease? |
Age Gender Ethnic Origin Family hx |
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What are some modifiable things that put people at risk for cardiovascular disease? |
Lifestyle habits Physical activity Obesity Psychological: stress, anger management, depression |
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What information do we want to collect in the assessment? |
Patient history Nutritional history Family history Current health problems Functional hx |
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What do we want to look for during the physical assessment? |
General appearance Skin extremities Vitals pulses |
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Acute myocardial infarction can be confirmed by abnormally high levels of certain proteins or isoenzymes. There serum studies are commonly referred to as cardiac markers which include: |
Troponin Creatine kinase MB Myoglobin |
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______ is a myocardial muscle protein released into the bloodstream with injury to the myocardial muscle. |
Troponin Not found in healthy pts, so any rise in values indicates cardiac necrosis or acute MI. |
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______ ______ is an enzyme specific to cells of the brain, myocardial, and skeletal muscle. |
Creatine kinase They remain elevated for up to 12 hours after MI and appear to be very sensitive and specific early diagnostic markers of MI |
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Another early marker of an _______. _______ a low molecular weight heme protein found in cardiac and skeletal muscle, is the earliest marker detected as early as 2 hours after an MI with rapid decline after 7 hrs. |
Myoglobin |
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Creatine Kinase levels for Female and Males |
Female: 30-135 Male: 55-170 |
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Total lipids value? |
400-1000 |
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Cholesterol levels? |
122-200 Older adult: 144-280 |
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Triglyceride levels? |
Female: 35-135 Male: 40-160 |
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HDL level? |
Female >55 Male: >45 |
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LDL level? |
60-180 |
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HDL:LDL ratio |
3:1 |
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CRP level? |
<1.0 |
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Cardiac troponin T level?
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<0.20 |
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Cardiac troponin I level? |
<0.03 |
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Myoglobin level? |
<90 mcg/L |
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Diagnostic tests that we can do for the heart? |
Cardiac catheter ECG EP study Stress test Echo TEE MRI |
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The _______ provides graphic representation, or picture, of cardiac electrical activity. |
ECG |
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What can be said of the standard 12 lead ECG?
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12 views of the heart Six of the leads are called limb leads because the electrodes are placed on the four extremtities in the frontal planes. The remaining 6 leads are called chest leads because the eletrodes are placed on the chest on the horizontal plane. |
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For continuous ECG monitoring, the electrodes are not placed on the limbs because movement of the extremities causes noise, or motion artifact, on the ECG signal. Where do you want to place the electrodes? |
On the trunk, a more sable area, to minimize such artifacts and to obtain a clearer signal. |
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What does the P wave represent? |
Represents atrial depolarization? |
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What does the PR segment represent? |
Represents the time required for the impulse to travel through the AV node, where it is delayed, and through the bundle of His, bundle branches, and pukinje fiber network, just before ventricular depolarization. |
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Represents the time required for atrial depolarization as well as impulse travel through the conduction system and pukinjie fiber network, inclusive of the P wave and PR segment. It is measure from the beginning of the P wave to the end of the PR segment. |
PR interval |
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Represents ventricular depolarization and is measured from the beginning of the Q or R wave to the end of the S wave. |
QRS complex |
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Represents the junction where the QRS complex ends and the ST segment begins. |
J point |
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Represents early ventricular repolarization |
ST segment |
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Represents ventricular repolarization |
T wave |
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Represents late ventricular repolarization. |
U wave |
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Represents the total time required for ventricular depolarization and repolarization and is measured from the beginning of the QRS complex to the end of the T wave. |
QT interval |
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How can you determine the HR on a ECG strip? |
300 divided by the number of Big boxes between QRS complexes |
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Rhythm Analysis What are the first 3 things we analyze? |
1. Determine Heart Rate 2. Determine Heart Rhythm (regular or irregular) 3. Analyze the P waves Are they present? Are they occurring regularly? Is there 1 Pwave for each QRS complex? Are the Pwaves smooht, rounded, upright or inverted? Do they all look similar? |
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Rhythm analysis What are the last 3 things we analyze? |
4. Measure the PR interval
5. Measure the QRS duration 6. Interpret the rhythm |
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What are the different types of rhythms? |
Normal sinus rhythm Dysrhythmias Tachycardia Bradycardia Atrial Fibrillation Ventricular Tachycardia Ventricular Fibrillation |
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Assessment for dysrhythmias. |
May be asymptomatic always assess the pt Obtain pts past and current hx Vitals ECG monitor Psychological impact (anxious and fearful) |
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For pts at risk for vasovagal attacks causing bradydysrhytmias, what can you do? |
Avoid doing things that stimulate the vagus nerve, such as raising your arms above your head, applying pressure over your carotid artery, applying pressure on your eyes, bearing down or straining during a bowel movement, and stimulating a gag reflex when brushing your teeth or putting objects in your mouth. |
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For pts with premature beats and ectopic rhythms what do we want to do for that pt? |
Have them take the meds that have been prescribed for you, and report any adverse effects to your physician. Stop smoking, avoid caffeinated beverages as much as possible, and drink alcohol only in moderation. Learn ways to manage stress and avoid getting too tired. |
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For pts with ischemic heart disease what do we want to do for that pt? |
If they have an angina attack, treat it promptly with rest and nitroglycerin administration as prescribed by your physician. This decreases your chances of developing a dysrhythmias. If chest pain is not relieved after raking the amount of nitroglycerin that has been prescribed for your, seek medical attention promptly. Also seek prompt medical attention if the pain becomes more severe or you experience other symptoms, such as sweating, N, weakness, and palpitations. |
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For pts at risk for K+ imbalance, how to prevent or decrease dysrhythmias? |
Know the symptoms of decreased K+ levels, such as muscle weakness and cardiac irregularity. Eat foods high in K+ such as tomatoes, beans, prunes, avocados, bananas, strawberries, and lettuce. Take the K+ supplements that have been prescribed for you. |
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Special nursing considerations for the older pt with dysrhythmias are: |
Evaluate the pt with dysrhytmias immediately for the presence of a life threatening dysrhythmia or hemodynamic deterioration. Assess the patient with a dysrhythmia for angina, hypotention, heart failure, and decreased cerebral and renal perfusion. Consider these causes of dysrhythmias when taking the patients hx: hypoxia, drug toxicity, electrolyte imbalances, heart failure, and myocardial ischemia or infarction. |
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Special nursing considerations for the older pt with dysrhythmias are: (continued) |
Assess the pts level of education, hearing, learning style, and ability to understand and recall instructions to determine the best approaches for teaching. Assess the pts ability to read written instructions. |
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Special nursing considerations for the older pt with dysrhythmias are: (continued) teaching |
Teach the pt the generic and trade names of prescribed antidysrhythmic drugs, as well as their purposes, dosage, side effects, and specail instructions for their use. Provide clear written instructions in basic language and easy to read print. Provide a written drug dosage schedule for the pt, considering all the drugs the pt is taking and possible drug interactions. |
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Special nursing considerations for the older pt with dysrhythmias are: (continued) |
Assess the pt for possible side effects or adverse reaction to drug considering age and health status. Teach the pt to take his or her pulse and to report significant changes in heart rate or rhythm to the health care provider. Inform the pt of available resources for blood pressure and pulse checks, such as BP clinics, home health agencies, and cardiac rehab programs. |
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Special nursing considerations for the older pt with dysrhythmias are: (continued) |
Instruct the pt on the importance of keeping follow up appointments with the health care provider and reporting symptoms promptly Include the pts family members or significant other in all teaching whenever possible. Teach the pt to avoid drinking caffeinated beverages, to stop smoking, to drink alcohol only in moderation, and to follow his or her prescribed diet. |
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Interventions for irregular rhythms? |
Drugs: K+ is needed Vagal maneuvers: cuts off blood supply pacing: pacemaker cardioversion: shocks your heart defibrillation radiofrequency catheter ablation: burns or freezes one conduction point. |
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What are the types of heart failure? |
Left sided Right sided High output failure |
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What is usually affected 1st during heart failure? |
Usually L ventricle is first to be affected then both ventricles fail. |
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What is ejection fraction? |
As you get older or as the cardiac disease progresses the ventricles change physiologically, they get larger and the blood flow decreases, ejection decreases, blood supply to the body decreases. |
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What organ is usually the first affected by heart failure? |
Kidneys |
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Left sided heart failure is caused by? |
Hypertension CAD Valve disease Mitral or aorta |
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What happens with Right sided heart failure? |
The right ventricle cannot completely empty. |
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What are symptoms of R sided heart failure? |
Peripheral edemaBacks up in the body |
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What are symptoms of L sided heart failure? |
Blood backs into the lungsPulmonary edema |
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What is cardiac output |
Cardiac output is the heart rate and stroke volume |
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What is stroke volume? |
The kick that actually gets the blood out to the rest of the body. |
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What happens to the cardiac output and stroke volume with heart failure? |
Cardiac output and stroke volume decrease. Remember, you can have a fast HR but the heart is not squeezing all the blood out. |
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What happens to the heart muscle with heart failure? |
Muscle gets tired Muscle gets bigger The ventricle will become dilated Heart gets tired and cant keep up and eventually gives out. Because the heart gets bigger the inside of the heart gets smaller and is not able to hold enough blood to supply the body |
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What do you want to assess with Left sided heart failure? |
Decreased cardiac output Fatigue Weakness Restlessness Dizziness Weak peripheral pulses Pallor and cool extremities Pulmonary congestion Hacking cough Dyspnea/breathless Crackles/wheeze frothy pink tinged sputum tachypnea |
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What do you want to assess with R sided heart failure |
JVD Anorexia N Edema: legs and scrotum Distended abdomen Polyuria at night Weight gain Increased BP |
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What psychosocial issue happens with heart failure.. |
Anxiety Frustration Depression |
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What do we want to assess the family for? |
Depression Anxiety |
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What labs are done for heart failure? |
Electrolyte imbalances: Side effects of drug therapy. BNP: Acute dyspnea, differentiates between heart and lungs dysfunction. Urinalysis: Early indication of heart failure ABGs PT PTT INR ATP |
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What images do we do for heart failure? |
Chest xray: enlarged heart, hypertrophy, dilation. Radionuclide Studies: L ventricle ejection fraction ECG |
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What Nursing Dx or goals do we want to do for heart failure? |
Improves gas exchange Improve Cardiac output Decrease fatigue and weakness Preventing or managing pulmonary edema |
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What interventions do we do for heart failure? |
Drug therapy O2 administration Vitals Cardiac Resynchronization therapy Ventricular assisted devices Heart reduction surgery |
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Signs and symptoms of pulmonary Edema
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crackles
dyspnea at rest Disorientation or acute confusion Tachycardia Hypertension or hypotension Reduced urinary output Cough with frothy, pink sputum Premature ventricular contractions and other dysrhythmias Anxiety Restlessness lethargy |
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What is MAWDS? |
Heart failure self management health teaching stands for Medications Activity Weight Diet Symptoms |
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The M in MAWDS stands for medication.
What do we want to teach our heart failure pt about their meds? |
Medications: Take medications as prescribed and do not run out. Know the purpose and side effects of each drug Avoid NSAIDS to prevent sodium and fluid retention. |
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The A in MAWDS stands for activity. What do we want to teach out heart failure pt about activity? |
Stay as active as possible, but dont overdo it. Know your limits Be able to carry on a conversation while exercising. |
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The W in MAWDS stands for Weight. What do we want to teach our Heart failure pt about weight? |
Weigh each day at the same time on the same scale to monitor fluid retention. |
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The D in MAWDS stands for Diet. What do we want to teach our Heart Failure pt about Diet? |
Limit sodium intake to 2-3 grams as prescribed. Limit daily fluid intake to 2 liters. |
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The S in MAWDS stands for Symptoms. What do we want to teach out heart failure pt about symptoms? |
Note any new or worsening symptoms, and notify the health care provider immediately. |
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A home care assessment for heart failure includes assessing signs of heart failure which include: |
Changes in VS HR >100bpm New AFib BP <90 or >150 Indications of poor tissue perfusion Fatigue Angina Activity intolerance Changes in mental state Pallor or cyanosis Indications of congestion Presence of cough or dyspnea Weight gain JVD & Peripheral |
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A home care assessment for heart failurincludes assessing function ability including: |
Performance of ADLs Mobility and ambulation (review, frequency and duration of walking, development of symptoms and pulse rate) Cognitive ability |
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A home care assessment for heart failure includes assessing the nutritional status, including: |
Food and fluid intake Intake of Na+ rich foods Alcohol Consumption Skin turgor |
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A home care assessment for heart failure includes assessing the home environment, including: |
Safety hazards, especially r/t O2 therapy Structural barriers affecting functional ability Social support |
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A home care assessment for heart failure includes assessing the pts adherence and understanding of illness and its treatment, including: |
Signs and symptoms to report to health care provider. Dosages, effects, and side of toxic effects of medications. When to report for lab and health care provider visits Ability to accurately weigh self on scale Presence of advance directive Use of home O2, if appropriate Assess pt and caregiver coping skills |
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What are the primary causes of hypertension? |
Family hx African American Hyperlipidemia Smoking Age Na+ and Caffeine Weight Stress Men vs Women: women are more prone and men are more prone as they get older |
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What are prehypertension BP levels? |
120-139 / 80-89 |
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What level is stage one hypertension? |
140-159/ 90-99 |
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What level is stage 2 hypertension? |
_>160/_>100 |
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What information do you want to collect in your hx assessment for hypertension? |
Age Ethnic origin or race Family hx of hypertension avg dietary intake of calories Na+ and K+ containing foods Alcohol intake Exercise habits Smoking |
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What are the physical manifestations of primary hypertension? |
HA Facial Flushing Dizziness Fainting Anxiety Sometimes eye changes |
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Signs and symptoms of secondary hypertension? |
Abd bruits Tachycardia sweating pallor Coarctation of aorta |
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What do you want to look for in your psychosocial assessment of a pt with hypertension? |
Evaluate job related, economic and other life stressors Assess past coping strategies |
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What is orthostatic hypotension? |
Is a decrease in BP (20mm HG systolic and or 10 mm HG diastolic) when the pt changes position from lying to sitting. |
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What lifestyle changes do we want to teach our pt with hypertension? |
Restrict Na+ Reduce weight Control ETOH (alcohol) Exercise Relaxation Techniques No smoking or caffeine |
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What drugs do we want to teach our pt about with hypertension? |
Hypertensive Drugs Diuretics: (makes you pee, K+ sparing? If not at risk for Hyperkalemia, if so at risk for hypokalemia) |
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Patients who require medications to control essential Hypertension usually need to take them |
for the rest of their lives
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Pts who do not adhere to antihypertensive tx are at risk for: |
target organ damage and hypertensive urgency or crisis. |
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When a pt is experiencing hypertensive crisis, what do we want to assess? |
Severe HA Extremely high BP Dizziness Blurred vision SOB Epistaxis (nose bleed) Severe anxiety |
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What interventions do we want to do for the pt experiencing hypertensive crisis? |
Place pt in semi fowlers position. Administer O2 Start IV of NS solution slowly to prevent fluid overload. Administer IV antihypertensive drugs then oral. Monitor BP q5-15mins until the diastolic pressure is below 90 and not less than 75. Then monitor BP q30mins to ensure that BP is not lowered too quickly. |
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When a pt is experiencing hypertensive crisis we want to observe for neurologic or cardiovascular complications, such as: |
Seizures numbness Weakness Tingling of extremities Dysrhythmias Chest pain |
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______ _________ __________ includes disorders that change the natural flow of blood through the arteries and veins of the peripheral circulation. |
Peripheral arterial disease |
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What is the primary cause of PAD? What other common risk factors contribute? |
Primary cause: atherosclerosis Common risk factors: Hypertension hyperlipidemia DM Cigarette smoking Obesity Family predisposition |
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Patients who have PAD have an increased risk for developing |
Chronic angina MI Stroke |
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There are 4 stages of chronic PAD. In this stage: Muscle pain, cramping, or burning occurs with exercise and is relieved with rest. Symptoms are reproducible with exercise. |
Stage 2: Claudication |
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There are 4 stages of chronic PAD. In this stage: Ulcers and blackened tissue occur on the toes, the forefoot, and the hell. Distinctive gangrenous odor is present. |
Stage 4: Necrosis/ Gangrene |
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There are 4 stages of chronic PAD. In this stage: No claudication is present. Bruit or aneurysm may be present. Pedal pulses are decreased or absent |
Stage 1: asymptomatic |
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There are 4 stages of chronic PAD. In this stage: Pain while resting commonly awakens the pt at night. Pain is described as numbness, burning, toothache type pain. Pain usually occurs in the distal portion of the extremity (toes, arch, forefooot, heel), rarely in calk or the ankle Pain is relieved by placing the extremity in a dependent position. |
Stage 3: Rest Pain |
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What do we want to assess the pt for with PAD?
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Resting pain Numbness and burning in Toes Feet Heels Calves and ankles: more rare |
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A pt who is having Inflow disease PAD experiences pain in |
low back butt thighs This causes the pt to stop walking |
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A pt who is having outflow disease PAD experiences BURNING and cramping of the |
Calves Ankles Feet Toes May be relieved by rest |
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What are the symptoms of PAD? |
Hair loss on lower calf, ankle and feet Dry, scaly, dusky, pale, or mottled skin Thickened nails |
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What are the symptoms of SEVERE PAD? |
Extremities are Cold, cyanotic and darkened Muscle atrophy |
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What imaging do we want to use for PAD? |
Arteriograph *Usually done if stenting of the narrowed vessel is planned or to determine the exact amount of narrowing or occlusion before peripheral bypass surgery* CAUTION: at risk for hemorrhage, thrombosis, embolus, and death. |
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What Noninvasive testing is done for PAD? |
Doppler probe, segmental Systolic BP measurements. Ankle brachial index Doppler derived maximal systolic Exercise tolerance test Plethysmograpy |
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Interventions for PAD |
Palpate pulses in both legs Assess for ulcers especially in the toes. Teach the pt about intermittent claudication. |
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Non surgical interventions |
Exercise Elevate Feet (not above heart) Sit in chair instead of laying in bed |
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With PAD this is arterial. How do we get the blood to travel further down the leg? |
Provide warmth, BUT NOT DIRECTLY Reduce exposure to cold (wear socks, shoes) No smoking or caffeine |
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What type of drugs are usually prescribed to the pt with PAD? |
Hemorheologic (increases flexibility of RBCs) Antiplatelet agents (aspirin) |
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What invasive procedures are done for the pt with PAD? |
Arterial Revascularization: increases blood flow Bypass Thrombectomy |
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What is arterial revascularization? |
Used to increase arterial blood flow by using grafts, and bypassing affected arteries. |
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What is a thombectomy? |
Emergency removal of the clot, can be performed at bedside. Most common tx for acute graft occlusion. |
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When doing a home care assessment for the pt with PAD we want to assess tissue perfusion to affected extremity(ies) by checking: |
Distal circulation, sensation, and motion Presence of pain, pallor, paresthesias, pulselessness, paralysis, poikilothermy (coolness) Ankle brachial index |
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When doing a home care assessment for the pt with PAD we want to assess adherence to therapeutic regimen, including: |
Following foot care instructions Quitting smoking Maintaining dietary restrictions Participating in exercise regimen Avoiding exposure to cold and constrictive clothing |
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When doing a home care assessment for the pt with PAD we want to assess ability to manage wound care and prevent further injury bt assessing: |
Use of compression stocking or compression pumps as directed. Use of various dressing materials. Signs and symptoms to report to nurse. |
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When doing a home care assessment for the pt with PAD we want to assess the family for? |
Coping ability of the pt and family members |
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When doing a home care assessment for the pt with PAD we want to assess home environment including: |
Safety hazards Especially r/t falls |
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What do we want to teach the pt with PAD about foot care? |
Keep feet clean by washing them with a mild soap in ROOM temp water. Keep your feet dry, especially the ankles and between the toes. Avoid injury to your feet and ankles. Wear comfortable, well-fitting shoes, never go without shoes. Keep toenails clean and filed, have someone cut them if you cannot see them clearly and cut straight across. To prevent dry, cracked skin, apply a lubricating lotion to your feet. Prevent exposure to extreme heat or cold. Never use a heating pad on your feet. Avoid constricting garments. IF a problem develops, see a podiatrist of physician. Avoid extended pressure on your feet or ankles, such as occurs when you lean against something. |
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What is an arterial occlusion? |
Embolus, blood clot that travels |
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What are the symptoms of arterial occlusion? (6 P's) |
Pain Pallor Paralysis Paresthesia Poikilothermic (coolness) Pulseless |
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What interventions are done for the pt experiencing arterial occlusions? |
Anticoagulant therapy Thrombectomy/Embolicectomy Pain meds Assess pulses |
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What is PVD? |
Veins that are not operating properly. Deoxygenated blood is not returning to the heart. |
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What are the causes of PVD?
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THrombus VTE or DVT Varicose veins Defective valves Defective skeletal muscles |
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What are the causes of DVT? |
hip therapy Total knee replacement Prostate surgery Ulcerative Colitis Heart Failure Cancer Oral contraceptives Immobility |
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What can the pt do to prevent DVT's? |
Avoid oral contraceptives Drink plenty of fluids Exercise daily, especially the legs Early ambulation Compression stockings SCDS |
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What do we want to assess the pt experiencing a DVT for? |
Calf or groin pain Swelling Positive human's sign- but not proven Compare the legs Warmth edema Redness |
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How do we dx a DVT? |
Assessment Ultrasound Doppler MRI D-Dimer |
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Interventions for the pt experiencing a DVT |
Rest Elevate the legs Do not massage Apply warmth Warm soaks |
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The pt with DVT will more than likely receive anticoagulant therapy. What should you do before administering the anticoagulant? |
Carefully check the dosage, even if the pharmacy prepared the drug. |
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When a pt is on anticoagulant therapy we want to monitor the pt for signs and symptoms of bleeding including: |
Hematuria frank or occult blood in the stool Ecchymosis Petechiae Altered mental status Pain (esp in abd) |
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When a pt is on anticoagulant therapy we want to monitor the pts vital signs for: |
for decreased BP and increased pulse indicating possible internal bleeding) |
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When a pt is on anticoagulant therapy we want to have _______ as needed. |
Antidotes EX Heparin: protamine sulfate Warfarin: vit k |
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What labs do we want to monitor for the pt on anticoagulant therapy? |
aPTT- for pt on unfractionated heparin PT& INR: for pt receiving warfarin/coumadin |
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Apply _____ ______ over venipuncture sites and injection sites for the pt on anticoagulant therapy |
prolonged pressure |
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When administering Subcutaneous heparin, apply pressure over the site and do not: |
massage
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Teach the pt going home while taking anticaogulant to : |
Use only electric razor avoid injury report signs and symptoms of bleeding Take the prescribed dosage of drug at the precise time that it was prescribed to be given. Do not stop taking drug abruptly |
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What surgical interventions are done for the pt with a DVT? |
Thrombectomy |
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When teaching a pt with venous insufficiency, you want to teach them about graduated compression stockings which includes: |
Wear stockings as prescribed Put stockings on first thing after waking before getting out of bed. Do not bunch up stocking when putting on. Make sure rough side is on the outside Do not put stockings down for comfort, because they may function like a tourniquet and further impair venous return. Put on clean pair of stockings each day. Wash by hand If stockings seem to be stretched out, replace with a new pair. |
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What are the Dos for the pt with venous insufficiency? |
Elevate your legs for at least 20 mins four or five times a day. When in bed elevate your legs above the level of your heart Avoid prolonged sitting or standing |
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What are the Don'ts for the pt with venous insufficiency? |
Do not cross your legs. Crossing at the ankles is acceptable for short periods. Do not wear tight, restrictive pans Avoid girdles and garters |
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15 lead ECG is used to view what? |
Right ventricular infarction. ST elevation |
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18 lead ECG is used to view what? |
Posterior wall infarction |
