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134 Cards in this Set
- Front
- Back
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Essential HTN
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An elevated systemic arterial pressure
Unknown cause |
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Normotension
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a client with normal blood pressure
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Secondary HTN
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is an elevated blood pressure associated with several primary deseases
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How does the release of renin affects hyportension?
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Renin is released to conserve water, thus increasing systemic blood pressure
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Malignant HTN
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is a medical emergency that can occurs after the admin of anesthetics.
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potassium theraputic level
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3.5 - 5.1
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What is the first response for a nurse that has a pt who's heart rhythm changes to ventricular tachycardia?
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Quickly assess the client's lvel of conciouness, bp, and p. If conscious may admin lidocain or give precordial thump. If not use defibrillator
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Pseudoephedrine should not be taken by pts with what condition?
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Hypertensive pts that take antihypertensive medications
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Alteplase (Activase) is what type of medication?
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Thrombolytic, used to dissolve existing blood clots
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aminocaproic acid (Amicar) is what type of medication?
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Hemostatic, used to control excessive bleeding. Can be applied topically to stop a local hemorrhage or be admin parenterally to stop systemic hemorrhage
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sotalol (Betapace)
What type of med and S/E? |
Beta-adrenergic blocking agent
S/E: bradycardia, difficulty breathing, wheezing, bronchospasm, GI Disturb, anxiety, nervousness, weakness, mood changes, dpression and loss of libido |
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Signs of shock from loss of blood
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tachycardia, cool, clammy skin, and chenges in mental status
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Signs of Right-Sided CHF
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Right-sided heart failure leads to backward venous congestion, resulting in JVD, portal hypertension (i.e. palpable liver edges), and ascites from abd venous congestion
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What is a potentially dangerous electrolyte imbalance related to the use of peniclillins?
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Hypokalemia
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The bell of the stethoscope is used to hear what sounds?
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Low-pitched sounds
Murmurs and bruits bell is placed lightly on the skin |
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Define Angina Pectoris
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Is pain related to insufficient oxygen supply to meet the workload demands of the hear if the workload demand is decreased (as in rest) the pain goes away
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EKG of an Atrial Fibrillation would have what characteristics?
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Irregular
No discernable P waves Often has fast ventricular response (inc HR) |
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When giving calcium via IV to a pt that takes digoxin the nurse should be aware of which potential side effect?
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Severe bradycardia
Can have severe hypotension, but is an after affect |
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What is the highest priority nursing care for a pt with Raynaud's disease?
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Keeping the pt's hands and feet warm and injury free
Cold temp is a trigger stimulus Is a vascular disorder that affects blood flow to the extremities when exposed to cold temp or in response to stress |
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Signs of a pneumothorax
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SOB, labored resp, dry cough, sucking sound from chest wound and dec breath sounds on side of injury
occurs when air or gas is present the pleural cavity |
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indipamide (Lozol) is what type of drug?
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A thiazide diuretic. can cause hypokalemia (s/s leg cramps, muscle weakness)
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What are the triggers for Raynaud's disease
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Cold, caffeine, smoking and stress
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spironolactone (Aldactone) is what type of diuretic?
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Potassium-sparing diuretic
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Signs of hyperkalemia
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irregular heart rate
diarrhea stomach cramping |
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Amiodarone (Cordarone)
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antiarrhythmic agent - for Afib, Vfib and superVfib. Many side effects -Lungs, Thyroid, eyes,sun.
Can take a long time for the S/E to show up |
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Buergers's disease
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is a recurring inflammation and thrombosis (clotting) of small and medium arteries and veins of the hands and feet. It is strongly associated with use of tobacco products
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Buerger' Disease is als known as
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also known as
thromboangiitis obliterans & tunying streptococcus |
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Heparin therapy is assessed by looking at which lab value?
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PTT
Partial Thromboplastin Time (H is later than C= 2 Ts) |
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Coumadin therapy is assessed by looking at which lab value?
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PT
Prothrombin Tme (C is sooner than than H=1 T) |
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What infusion will reduce third spacing?
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Infusion of Albumin will pul fluid intothe intravscular space
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Hydroxyethyl starch (Hespan) is used for what purpose?
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It increases the blood volume, allowing red blood cells to continue to deliver oxygen to the body.
A frequently used blood plasma substitutes is used to prevent shock following severe blood loss caused by trauma, surgery, or some other problem. |
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Which Lactic Dehydrogenase (LDH) is expected to be elevated with acute MI?
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LDH 1 or 2
LDH 3 is for pulmonary LDH 4 an % fo hepatic dyfunctin |
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signs of hyperkalemia
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Muscle weakness, flaccidity of muscles, diarrhea, abd cramping, and cerebral irritability/restlessness
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Common Side Effects of Nitrates
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Dizziness
Headaches Flushing of your face and neck Upset stomach or throwing up Low blood pressure (hypotension) Irregular heart rhythms (arrhythmia) |
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Less Common Side Effects of Nitrates
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Fainting
Restlessness Rare S/E Dry mouth Skin rash and peeling Blurry vision |
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Each unit of PRBCs inceases hemoglobin by how many grams and Hct by how many %?
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Should raise the hemoglobin by 1 gram and Hct by 3%
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Clinical signs of mitral stenosis
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Dilation and hypertrophy of the left atrium
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How far is the sternum depressed for cardiac compressions?
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1.5-2 inches
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When giving CPR, how is the airway opened? With a potential neck injury and without?
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Neck injury-Jaw thrust method
Normal - Head-tilt-chin-lift method |
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How many breaths should an nurse give to initiate resp during CPR
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2 breaths to initiate ventilation
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Pulseless Electrical Activity (PEA) refers to what?
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refers to any heart rhythm observed on the electrocardiogram that should be producing a pulse, but is not. The condition may or may not be caused by electromechanical dissociation. The most common cause is hypovolemia.
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What are the causes of PEA?
(6 H's and 5 T's) |
Hypovolemia
Hypoxia Hydrogen ions (Acidosis) Hypothermia Hyperkalemia or Hypokalemia Hypoglycemia Tablets or Toxins (Drug OD) Cardiac Tamponade Tension pneumothorax Thrombosis (Via MI) Thrombosis (Via PE) Trauma (Hypovolemia from blood loss) |
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Should a defibulator be used to resolve a PEA?
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Defibrillators are not used for this rhythm, as the problem lies in the response of the myocardial tissue to electrical impulses.
so NO |
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What is the typical treatment of a PEA?
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pulseless electrical activity should receive treatment methods as if the patient were in asystole. Treatment is intravenous delivery Epinephrine 1 mg every 3-5 minutes, and, if the underlying rhythm is bradycardia, Atropine 1 mg IV up to .04 mg/kg
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How high is a theapeutic PT level?
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A therapeutic PT level is 1.5 to 2.0 times higher than the normal level.
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What is a normal PT time for a male and female?
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The normal prothrombin time (PT) is
9.6 to 11.8 sec (male adult) or 9.5 to 11.3 sec (female adult). |
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The normal therapeutic range for digoxin
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is 0.5 to 2.0 ng/mL
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The normal activated partial thromboplastin time (aPTT)
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between 20 and 36 seconds
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The therapeutic dose of heparin for treatment of deep vein thrombosis is
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between 1.5 and 2.5 times normal
Normal range 20-36 sec so = 30 - 90 |
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Transcutaneous pacing
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is a temporary means of pacing a patient's heart during a medical emergency. It is accomplished by delivering pulses of electric current through the patient's chest, which stimulates the heart to contract
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During CPR, how many chest compressions are delivered with every two rescue breaths?
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30 compressions for every 2 breaths
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Signs of Cardiogenic shock
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occurs with severe damage (more than 40%) to the left ventricle. Classic signs include hypotension, a rapid pulse that becomes weaker, decreased urine output, and cool, clammy skin. Respiratory rate increases as the body develops metabolic acidosis from shock.
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A nurse is preparing for a client with pt with heart failure to enter the ER. Which drug should she prepare?
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Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a variety of mechanisms. Digoxin is the medication of choice to treat heart failure.
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A pt with Pulmonary Edema will have which type of lung sounds on ausculation?
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Auscultation of the lungs reveals crackles.
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Signs of Pulmonary Edema
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extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink tinged sputum. Auscultation reveals crackles
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When looking at an EKG what are the signs of a normal sinus rhythm?
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Normal sinus rhythm is a regular rhythm, with an overall rate of 60 to 100 beats/min.
PR Interval = 0.12 to 0.20 secs QRS complex = 0.04 to 0.10 sec |
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What are the characteristcs of a sinus tachycardia?
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Has the characteristics of normal sinus rhythm
A regular PP interval and normal width PR and QRS intervals the rate is the differentiating factor. Atrial and ventricular rates are higher than 100 beats/min. |
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Ventricular tachycardia is characterized by
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Absence of P waves
Wide QRS complexes (longer than 0.12 second), and typically a rate between 140 and 180 impulses/min. The rhythm is regular. |
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Why is Ventricular Tachycardia a major concern?
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The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Clients frequently experience a feeling of impending doom. Ventricular tachycardia is treated with antidysrhythmic medications, cardioversion (client awake), or defibrillation (loss of consciousness). Ventricular tachycardia can deteriorate into ventricular fibrillation at any time.
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First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is
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Use of antidysrhythmics such as amiodarone (Cordarone), lidocaine (Xylocaine), and procainamide (Pronestyl). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia). Defibrillation is used with pulseless ventricular tachycardia. Epinephrine would stimulate an already excitable ventricle and is contraindicated.
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What are signs of atrial fibrillation?
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The client with uncontrolled atrial fibrillation with a ventricular rate more than 100 beats/min is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.
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What are the EKG characteristics of Afib?
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Atrial fibrillation is characterized by a loss of P waves and fibrillatory waves before each QRS complex. The atria quiver, which can lead to thrombi formation.
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What are the EKG characteristics of VFib?
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Irregular chaotic undulations of varying amplitudes. Ventricular fibrillation has no measurable rate and no visible P waves or QRS complexes and results from electrical chaos in the ventricles.
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What is the level of J that a defibrillator should be set and how often?
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A client may be defibrillated up to three times in succession. The energy levels used are 200, 300, and 360 J for the first, second, and third attempts, respectively.
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A nurse suspects a Pulmonary embolism when which signs occur?
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Chest pain is the most common symptom, which is sudden in onset, and may be aggravated by breathing. Other signs include dyspnea, cough, diaphoresis, and apprehension.
On exam: Tachycardia and tachypnea, crackles and cardiac gallp (S3 and possibly S4), low grade fever Note difficult to determine PE from MI or pneumonia signs |
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What is the treatment for a Pulmonary Embolism?
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Supportive treatment: O2 is started and analgesics maybe ordered to relieve chest pain and axiety. Anticoagulants dmin. Pulmonary artery and Wedge pressures are monitored with Swan-Ganz catheter. EKG
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What is Sclerotherapy?
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Used to tx varicose veins. It is the injection of a sclerosing agent into a varicosity. The agent damages the vessel and causes aseptic thrombosis, which results in vein closure. With no blood flow through the vessel, there is no distention
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What is Vein Ligation?
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The surgical procedure for varicose veins is vein ligation and stripping. This procedure involves tying off the varicose vein and large tributaries and then removing the vein with hook and wires via multiple small incisions in the leg.
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Myocardial ischemia is indicated by what change in the EKG?
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ST segment elevation or depression. .
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Hyperkalemia is indicated by what EKG change?
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Tall, peaked T waves may indicate hyperkalemia
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First-degree heart block is indicated by what EKG change?
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A prolonged PR interval indicates first-degree heart block
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A bundle branch block is indicated by what EKG change
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A widened QRS complex indicates delay in intraventricular conduction, such as a bundle branch block.
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Dipyridamole (Persantine)
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A vasodilator, used to for stress tests, inhibits thrombus formation
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thallium-201 is used for what purpose?
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Used for heart stress test for pt. with CAD
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What are the expected outcomes of surgery to an extremity?
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An expected outcome of surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow
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pericardiocentesis is what?
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pericardiocentesis is a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart).
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What are the signs that pericardiocentesis is succeful?
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A rise in blood pressure and a fall in central venous pressure are expected.
Pt.expresses immediate relief. Heart sounds are no longer muffled or distant. |
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Cardiac tamponade
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Also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium (the sac in which the heart is enclosed). If the fluid significantly elevates the pressure on the heart it will prevent the heart's ventricles from filling properly.
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Pt with abdominal aortic aneurysm could have what signs?
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Not all clients exhibit symptoms. TMay have:
A feeling of the “heart beating” in the abdomen when supine Able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass. |
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Venous ulcers (or varicose ulcers)
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are wounds that are thought to occur due to improper functioning of valves in the veins usually of the legs. They are the major cause of chronic wounds, occurring in 70% to 90% of chronic wound cases.[1] Occur anywhere between the knee and the ankle.
The skin has a brown pigmentation from accumulation of metabolic waste products resulting from venous stasis. The client also exhibits peripheral edema. |
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The first signs and symptoms of digoxin toxicity in adults
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include abdominal pain, nausea, vomiting, visual disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, and other dysrhythmias
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What is Prinzmetal’s angina?
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Variant angina, or Prinzmetal’s angina, is prolonged and severe and occurs at the same time each day, most often at rest.
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What is Stable angina?
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is induced by exercise and relieved by rest or nitroglycerin tablets.
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What is Unstable angina?
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occurs at lower and lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction.
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The antidote to heparin is?
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protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur.
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What is the antidote for warfarin?
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Vitamin K is an antidote for warfarin sodium.
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What is the antidote for Thrombolytic Therapy?
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Aminocaproic acid is the antidote for thrombolytic therapy.
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Why would a pt. be started on both heparin and warfarin sodium?
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Warfarin sodium works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited.
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Streptokinase
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intravenously as soon as possible after the onset of a heart attack (acute phase - myocardial infarction) to dissolve clots in the arteries of the heart wall. This reduces the amount of damage to the heart muscle. Streptokinase is a bacterial product so the body will build up an immunity to it. Can cause allergic reaction. Also used for pulmonary embolism.
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Overdose of streptokinase or tPA is treated with?
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aminocaproic acid
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What is the antidote for Warfarin?
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Vitamin K
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What fruits and vegetables should be avoided in a Low Fat diet?
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Fruits and vegetables, except avocado, olives, and coconut, contain minimal amounts of fat.
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What are signs of Toxic Shock Syndrome?
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TSS resulting from infection with the bacteria Staphylococcus aureus typically manifests in otherwise healthy individuals with high fever, accompanied by low blood pressure, malaise and confusion, which can rapidly progress to stupor, coma, and multi-organ failure. The characteristic rash, often seen early in the course of illness, resembles a sunburn, and can involve any region of the body, including the lips, mouth, eyes, palms and soles.
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What is the typical cause of Toxic Shock Syndrome?
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TSS is caused by infection (Staphylococcus aureus) and is often associated with tampon use. Disseminated intravascular coagulation is a complication of TSS
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Assessment findings associated with cardiac tamponade include
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tachycardia, distant or muffled heart sounds, jugular vein distention, and a falling blood pressure accompanied by pulsus paradoxus (a drop in inspiratory BP greater than 10 mm Hg
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A pt. being Rx ACE inhibitor for the first time should be given what educational instructions?
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Clients are advised to avoid standing in one position for long periods of time, to change positions slowly, and to avoid extreme warmth such as with baths, showers, or heat from the sun in warm weather. The client should be instructed to monitor for signs of orthostatic hypotension such as dizziness, lightheadedness, weakness, and syncope.
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What types of products should a pt avoid if on a low-sodium diet?
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oothpaste and mouthwash; over-the-counter medications such as analgesics, antacids, laxatives, and sedatives; and softened water, as well as some mineral water (bottled water is ok)
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What are the characteristics of a Arterial Ulcers?
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Arterial ulcers have a pale, deep base and are surrounded by tissue that is cool with trophic changes such as dry, skin and loss of hair.
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What causes Arterial Ulcers?
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Arterial ulcers are caused by tissue ischemia from inadequate arterial supply of oxygen and nutrients.
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Describe a Venous Stasis Ulcer
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A venous stasis ulcer is one that has a dark red base and is surrounded by brown skin with local edema. This type of ulcer is caused by the accumulation of waste products of metabolism that are not cleared, as a result of venous congestion.
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Describe a Stage 1 Ulcer
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A stage 1 ulcer indicates a reddened area with an intact skin surface
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What is the standard treatment of DVTs?
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Standard management for the client with DVT includes bed rest for 5 to 7 days, limb elevation, relief of discomfort with WARM MOIST HEAT, and analgesics as needed. Ambulation is contraindicated
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What is a normal fibrinogen level for a male?
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The normal fibrinogen level is 180 to 340 mg/dL for males
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What is a normal fibrinogen level for a female?
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The normal fibrinogen level is 190 to 420 mg/dL for females.
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What is a critical value of Fibrinogen when considering DIC?
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A critical value is one that is less than 100 mg/dL. With DIC, the fibrinogen level drops because fibrinogen is used up in the clotting process.
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An Intra-Aortic Balloon Pump is typically used for what heart condition?
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IABP therapy most often is used in the treatment of cardiogenic shock and is most effective if instituted early in the course of treatment.
It is not used for CHF, PE, aortic insufficiency and thoracic and abdominal aneurysms. |
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A normal INR range for a pt on anticoagulant therapy is
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2.0 - 3.0
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A normal INR range for a pt on anticoagulat thereapy, who is a survivor of Acute MI is
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2.5 - 3.5
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The cardinal EKG sign for Hyperkalemia is
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tall and peaked T waves
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S-T segment depression is found with which electrolyte imbalance?
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Hypokalemia
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Prolonged PR interval, widening of the QRS complex, shortening of the QT interval, and disappearance of the P wave are related to what imbalance?
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Hyperkalemia
But the cardinal sign is tall and peaked T waves |
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In the client with hypokalemia, the nurse would note EKG findings?
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ST-segment depression on a cardiac monitor and may also exhibit a flat T wave.
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Education information given to a pt who is having an exercise stress test
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The client should wear loose, comfortable clothing for the procedure. Electrocardiogram (ECG) lead placement is enhanced if the client wears a shirt that buttons in the front. The client should wear rubber-soled, supportive shoes, such as athletic training shoes. The client should receive nothing by mouth after bedtime, or for a minimum of 2 hours before the test. The client should avoid smoking, alcohol, and caffeine on the day of the test.
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Sinus arrhythmia has all of the characteristics of normal sinus rhythm except
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Presence of an irregular PP interval. This irregular rhythm occurs because of phasic changes in the rate of firing of the sinoatrial node, which may occur with vagal tone and with respiration. Cardiac output is not affected
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Ventricular fibrillation is characterized by
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the absence of P waves and QRS complexes. The rhythm is instantly recognizable by the presence of coarse or fine fibrillatory waves on the cardiac monitoring screen.
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If a pt. is having PVC's (premature ventricular contractions) what should the nurse antipate being Rx if they are allergic to lidocaine?
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Procainamide is an antiarrhythmic that may be used to treat ventricular arrhythmias in clients who are allergic to lidocaine
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PVCs are considered dangerous when they are
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frequent (more than 6/min), occur in pairs or couplets, are multifocal (multiform), or fall on the T wave. In each of these instances, the client’s cardiac rhythm is likely to degenerate into ventricular tachycardia or ventricular fibrillation, both of which are potentially deadly arrhythmias.
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quinidine sulfate is a heart medication used for what purpose?
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To suppress arrhythmia
(do not chew tabs) |
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Long-term management/Education of peripheral arterial disease consists of measures that increase peripheral circulation
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(exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). Application of a heating pad directly to the extremity is contraindicated. The affected extremity may have decreased sensitivity and is at risk for burns. Also, the affected tissue does not obtain adequate circulation at rest. Direct application of heat raises oxygen and nutritional requirements of the tissue even further.
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What is the priority teaching concern for a home health nurse who is advising a pt recovering from cardiogenic shock, secondary to MI?
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The client recovering from cardiogenic shock secondary to a myocardial infarction will require a progressive rehabilitation related to physical activity. The heart requires several months to heal from an uncomplicated myocardial infarction. The complication of cardiogenic shock will increase recovery period for healing. Paced activities with planned rest periods will decrease the chance of experiencing angina or delayed healing.
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What are values of and logic behind Cardiac Output and Wedge Pressure
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The normal cardiac output is 4 to 7 L/min. With cardiogenic shock, the CO falls below normal because of failure of the heart as a pump. The PCWP (<12 mmHg), however, rises because it is a reflection of the left ventricular end-diastolic pressure, which rises with pump failure.
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Signs of Right-Sided Heart Failure
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Dependent edema (legs & Secrum
JVD Abd Distention Swelling of fingers & hands Weight Gain Hepatomegaly & Splenomegaly Anorexia & Nausea Inc BP (via Fluid Volume Excess) or Dec BP from pump failur Nocturnal diuresis |
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Signs of Left-Sided Heart Failure
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Left = Lungs
-Pulonary congestion signs-Dyspnea, Tachypnea, Cracles, Dry Hacking cough, Paroxysal Nocturnal dyspnea |
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Define Afterload
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The force against which the heart has to pump (peripheral resisteance) to Eject blood from the left ventricle.
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Define Arterial Pressure
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The pressure of the blood against the arterial walls. Pressure can be measured indirectly by sphygmomanometer or directly by Arterial catheter.
Mean Arterial Pressure (MAP) = 70-100 mmHg |
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Define Capillary Pressure or Hydrostatic Pressure
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The pressure exerted by th blood against the capillary wall. Normal capillary pressure is 25-30 mm Hg at atrial ends and 10-15 mm Hg at venous ends
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Define Cardiac Output
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The total volume of blood pumped through the heart in 1 minute. Norm = 4-7 L/min.
CO = Stroke Voume X HR Can be calculated via thermodilution with a Swan-Ganz Catheter |
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Define Conductivity
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The ability of the heart muscle fibers to propagate electrical impulses along and across cell membranes
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Define Mean Arterial Pressure (MAP)
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An approx of the average pressure in the systemic circulation throughout the cardiac cycle.
MAP must be at least 60 mm Hg for adequate organ perfusion |
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Define Paradoxical Blood Pressure
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An exaggerated decrease in systolic pressur by more that 10 to mm Hg during th einspiratory phase of the respiratory cycle.
Norm is 3-10 mm Hg |
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Define Preload
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The volume of blood stretching the left ventricle at the end of diastole. Preload is determined by total circulation blood volume and is inc by an inc in venous return to the heart
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Define Pulmonary Capillary Wedge Pressure (PCWP)
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The measurement obtained during momentary balloon inflation of the pulmonary artery catheter; it is shows the left ventriclar end-diastolic pressure.
Norm = 6-12 mm Hg Dec indicates hypovolemia, Inc indicates hypervolemia, left ventricular failure or mitral regurgitation |
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Define Pulse Pressure
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The difference between the systolic & diastolic pressure.
Norm = 30-40 mm Hg |
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Define Stroke Volume
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The amount of blood ejected from the left bentricle with each contraction.
Norm = 70-130 mm Hg |
