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99 Cards in this Set

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What is an acute pulmonary edema considered?
Medical emergency
What causes pulmonary edema?
Anything that decrease the ability of the left ventricle to pump: MI, HTN, valvular disease, rapid arrhythmias
How should pulmonary edema be reasoned in terms of its effects on the heart>
This of it backwards: LV not pumping well, get stasis of blood from LV. Blood coming in from LA cannot get in. Back up in LA comes from the lungs. The pressure in the vessels of the lungs goes up. As pressure goes up the fluid builds up in capp and leaks into alveoli
What are the nursing assessments for Pulmonary edema?
1. Restless
2. Sudden SOB, PND, orthopnea
3. crackles
4. cyanosis
5. gurgling respirations
6. PINK FROTHY SPUTUM
What is the trademark SxS of pulmonary edema?
Pink frothy sputum
What is PND?
Paraxcismal Nocturnal dyspnea: when lying down the pts legs are level of the heart. Increase of the preload on the heart which makes is hard to breathe!
What are the nursing goals for Pulmonary edema?
1. Improve the pumping of the left ventricle
2. Improve respiratory exchange
What are some nursing interventions with pulmonary edema?
1. O2
2. Positive Inotropics
3. Morphine
4. Diuretics
5. Other meds
6. Swan Ganz Catheter
7. Assess for shock
What are the nursing interventions for Pulmonary Edema relating to O2?
1. Peep
2. Pulse oximeter monitoring
3. ABGs
What are example of positive inotropics?
1. Digoxin
2. Dopamine
3. Primacore, Inocor
What must be assessed prior to administering morphine and why?
RR (get a baseline)

-It is a peripheral venous dilator
What are the common diuretics used in pulmonary edema?
1. Thiazide: HCTZ
2. Loop: Lasix
3. K sparing: Aldactone
How should a pt with pulmonary edema be positioned?
Have them sit up and put legs dependent
Why is PEEP good to use in pulmonary edema?
It keeps (+) pressure in alveoli and drops the amount of fluid to leak into alveoli
What is congestive heart failure?
The heart cannot pump adequate amount of blood to meet metabolic demands
What are the classifications of CHF?
I: No limitations
II: Slight limitations
III: Limitations to ADL
IV: symptoms even at rest
What is the most frequent cause of hospitalization over the age of 65 in the US?
CHF

Is the second highest reason for seeing the HCP
What can cause CHF (pathophysiology of CHF)?
1. CAD
2. Systemic or pulmonary HTN
3. Valvular heart disease
4. Increased workload of the heart

-anything that knocks out the L vent
Describe the viscous cycle of CHF?
Decrease in amount of blood ejected from the left vent --> Drop in CO --> increase in SNS -->Release of renin --> Angiotensin II and aldosterone --> Vasoconstriction and Fluid retention --> more drop in amount of blood ejected from the heart

(kidneys hold on to fluid to increase preload which should be a compensatory mech but it becomes a specific cycle
List the nursing assessments that may be seen with a pt with Left sided CHF. (15)
1. DOE
2. Orthopnea
3. PND
4. Cough
5. Crackles
6. Restlessness and anxious
7. Tachy
8. Pale
9. Nocturia
10. Decrease Urine
11. Increase BUN and Na
12. Fatigue
13. ABGs
14. Weight gain
15. Swan Ganz
Where does the majority of the manifestations of left sided heart failure take place?
In the lungs
What is the primary cause of R sided heart failure?
Left sided heart failure
What is the pathophysiology behind R sided heart failure?
1. Right vent cannot empty fully
2. blood in right atrium becomes backed up
3. venous blood return to the heart becomes backed up --> congestion of large vessels and body organs.
What are the Nursing assessments for RIGHT sided heart failure?
1. Edema
2. Weight gain
3. JVD
4. CVP, swan ganz
5. anorexia
6. nocturia
7. Fatigue
8. Hepatomegaly, splenomegaly
9. ascites
Why is anorexia seen in pts with R sided heart failure?
The blood gets backed up into the portal system (venous engorgement) and then the person loses their appetite
What are the possible nursing diagnoses for CHF?
1. FVE
2. Ineffective breathing pattern
3. Alteration in cardiac output: decreased
4. noncompliance with medications
5. knowledge deficit
LIst the nursing goals associated with CHF?
1. decrease workload of the heart
2. increase myocardial contractility
3. eliminate excess fluid
For a patient with CHF, what will the nurse due during her interventions to treat the pt?
1. Bedrest
2. O2
3. V/S
4. Breath sounds
5. Is & Os
6. Daily weights
7. skin care
8. diet
9. patient education
What are the common classes of meds used to treat CHF?
1. Ace Inhibitors
2, ARBs
3. Diuretics
4. Beta Blockers
5. Digitalis
6. Dobutamine/ Primacor
7. anticoags
8. antihypertensives
9. antianginal
What is the function of ACE Is? what is their base name?
Used in the Tx of CHF. Decrease the afteroad

-Dont have vasoconstricting actibvity. They decrease the work on the heart.

-Also decrease aldosterone which decreases the preload

-The prils
What is a common adverse effect of ACEIs?
Dry cough due to bradykinin production
What does ARB stand for?
Angiotensin II Renin blockers
What is the function of ARBs?
to block renin which will decrease preload and afterload
What are the common drugs associated with ACEI's and ARBs?
1. ACE: Capoten and Vasotec "prils"
2. ARB: Losartan
What is the most common diuretic used to treat CHF?
Furosemide: Lasix
What must a nurse monitor for a pt on furosemide?
K levels. Can also be dropped with Na and cause arrhythmias
Which class of drugs end in lol?
Beta blockers
What is the function of beta blockers
(-) chronotropic. Slow down heart rate. If it goes too slow then it will set off the SNS to increase the HR (BAD reaction)
What are the two Beta Blockers that are approved for CHF Tx?
Metoprolol and Carvedilol
What is the function and caution of digitalis?
Function: decreases the symptoms of heart failure to help pts icnrease their ADLs

- (+) inotroph= more efficient cardiac pumping

Caution: dig toxicity. Very small therapeutic level. causes blue green halos and bradycardia
What must a nurse assess prior to giving Dig?
The apical pulse! If < 60 hold the meds
What is the function of primacor in treating CHF?
Can decrease SxS of CHF to increase ADLs

Can also be used on an outpatient basis
what is a pulmonary embolism?
An embolism that becomes lodged in the pulmonary artery, obstructing the blood supply to the lungs
The symptoms of a PE often depend on the ____ and _____of the PE?
size and location
When a pulmonary embolism occurs there IS ______, but NO _____ to that area.
Ventilation; perfusion
Where does a PE often come from?
DVT
What disease are known to increase the risk for PE?
1.CHF
2. pelvic and leg trauma
3. post op (bed rest)
4. post partum
What are some predisposing factors for PE?
1. increase age
2. obesity
3. pregnancy4
4. BCPs
5. sedentary
6.smoking
What is known as Verchow's Triad and what condition is it related to?
Risk factors for PE

1. Venous Stasis
2. Hypercoaguability
3. Venous endothelial damage
What are some examples of hypercoaguability?
1. increase platelet count
2. tumor
3. massive injury
What are possible ways to get venous endothelial damage?
IV catheters and Thrombophlebitis
What are the nursing assessments for a person with PE?
1. Cyanosis
2. SOB
3. Tachypnea
4. Hemoptysis
5. Drop in O2 stat, Drop in PaO2
6. Chest pain
What are the nursing diagnoses for PE?
1. INEFFECTIVE GAS EXCHANGE
2. Ineffective breathing pattern
3. Drop in CO
4. Alteration in comfort: pain
5. Fear
What is the pattern of Pain for a PE?
It increases with each breath
What is the worst case scenario for PE?>
Syncope, sudden shock, death
What is the most important nursing intervention for PE?
Prevention!
What are the prevention methods for PE?
1. Passive/active ROM
2. OOB and ambulating ASAP
3. Adequate fluid intake: NO DEHYDRATE
4. Compression socks: TEDs
5. Do not cross legs
6. Assess Homan's Sign
7. If pt is at risk give: ASA, Plavix, Heparin, Lovenox
what are the nursing interventions to TREAT PE?
1. O2
2. Morphine
3. Anticoags, Thrombolytics: for big clots
4. ABGs
5. ECG
6. Surgical intervention: embolectomy
7. Greenfield filter
What is pericardial effusion? What is it aka?
Fluid in the pericardial sac

-aka: Cardiac Tamponade
What are some causes of pericardial effusion?
-infection: pericarditits
-CHF
-cardiac surgery
-trauma
What is PVD?
Peripheral vascular disease

Disease of the blood vessels that supply the extremities. Usually in the legs
What is the pathophysiology of ARTERIAL PVD?
1. Arteriosclerosis /athero
2. Obstruction by thrombus or emboli
3. Sever vasoconstriction as in RAYNAUD's
4. Arterial inflammation usually associated with clots, as in Buergers
What are the diagnostic mechanisms for artreial PVD?
1. Doppler
2. Duplex Ultrasound
3. MRA
4. Arteriography or angiography
When would a doppler be used to Dx arterial PVD?
When pedal pulses are undetected
What is the gold standard for Dx methods for arterial PVD? How does it work?
Duplex Ultrasound.

Non-invasive, small machine, no prep can be done at the bedside

Uses sound waves
What is MRA in diagnosing PVD?
Magnetic resonance angiography.

-uses contrast dye injected into arterial flow. SImilar to an MRI but uses different software
What is the ankle/brachial index? When is it used?
Test to check for PVD

-Check the systolic BP brachially, then check it on the leg and compare the ratio. should be close to1

the more it goes down, the worse the disease
What are the 6 Ps that help assess a pt with arterial PVD?
1. Pain: intermittent claudication with exercise
2. Pulselessness
3. Polkilothermic: leg is cool
4. Pallor
5. Paresthesias
6. Paralysis
If a pt with arterial PVD complains of pain in their knee, where is the obstruction most likely located?
In the thigh. Usually pain is felt one joint level below the obstruction
Describe arterial ulcers of arterial PVD.
Due to pulselessness and decrease flow

-Tend to be small, deep on the tip of the toes or even in between the toes.
-the medial side of the helix (grape toe)
-can develop into gangrene, may need amputation!
What does the phrase Red, White and Blue correspond to?
A pt with arterial PVD. when their leg is dependent it is red; when it is level with the body it is white, and when it is lifted up to the ceiling it turns blue
What is poikilothermic?
The extremity is cool due to arterial PVD
What are nursing Dx for pt with arterial PVD?
1. Risk for infection: may not realize they are injured
2. Risk for injury: Not aware because of lack of pain
3. Alterations in comfort: pain
4. Potential for impairment of skin integrity of lower extremities
5. Ineffective individual coping: amputation
6. Fear: amputation
What disease has the same risk factors as arterial PVD?
CAD
What are the nursing interventions for a pt with arterial PVD?
1. Control the underlying disease and/or risk factors
2. Improve blood supply
3. Avoid vasoconstrictors
4. Prevent tissue damage
What are ways to improve blood supply for pts with arterial PVD?
1. Position
2. Warmth
3. Exercise
What position is NOT recommended for a pt with arterial PVD?
Feet up in the air
What are the methods for preventing tissue damage for pts with arterial PVD?
1. Assess pulses
2. Good nutrition
3. obtain ideal body weight
4. inspect feet regularly
5. have podiatrist cut thick toenails
6. No tight shoes or socks
What is the medical management for Arterial PVD (procedures, surgery and meds)?
1. PTA
2. Meds: ASA, Ticlid, Heparin, Coumadin
3. Surgery: Endarterectomy, Vascular grafting, Amputation, Embolectomy
What is PTA in regards to PVD?
Percutaneous transluminal angioplasty: usually with a stent
qWhat is an endarterectomy?
Used in PVD:

separate the plaque from the artery wall to prevent its breakage and subsequent travel to smaller arteries
Describe vascular grafting in PVD?
Femoral popliteal bypass graft. Diverts flow by bypassing the blocked artery
List the many terms that describe venous peripheral vascular disease?
1. Phlebitis: inflammation of the vein
2. Venous Thrombosis: Clot
3. Thromboembolism: piece broken off and traveled
4. Deep vein thrombosis
5. Thrombophlebitis: clot and inflammation in the vein
What is the pathophysiology of venous PVD?
Blood stasis --> initial damage --> hypercoaguability --> clot
Who is at risk for venous PVD?
1. Family Hx
2. Patients with own Hx
3. > 40yr
4. surgery of >30 mins duration
5. varicose veins
6. estrogen treatment: BCP or as a cancer treatment
What will the nurse notice in a pt with venous PVD?
1. Calf pain and tenderness
2. Edema
3. increase warmth to leg
4. Homan's sign
What actions should the nurse take for a pt with venous PVD?
1. TED stocking or sequential compression
2. Early ambulation
3. RAISE the foot of the bed (not for arterial)
4. Passive and active ROM
5. Monitor IV sites and discontinue ASAP
What 3 actions can be taken if thrombophlebitis is present?
1. Rest
2. Moist heat
3. anticoagulants
What are the important aspects of Pt teaching for PVD?
1. Instruct pt on elastic hose
2. walking
3. instruct for anticoag meds
4. SxS of bleeding
5. follow up blood tests
6. No smoking
7. Maintain normal weight
8. DC BCPs
9. ScS of phlebitis: call DR
10. No leg crossing, tight socks or garters
What are some nursing interventions for Chronic VENOUS stasis?
1. Elevate the legs
2. Pressure stockings
3. Encourage walking
4. Protect from trauma
5. Inspect daily & keep clean dry
Describe venous ulcers.
Typically large, superficial and highly exudative.

Often occur on the medial or lateral malleous.
What Assessment findings are common for Carotid Artery Disease?
1. Transient Weakness
2. weakness, tingling
3. Speech may slur
What are some Tx for Carotid artery disease?
Carotid sten or carotid endarterectomy
What are the Post-Op nursing care for a Carotid Endarterectomy?
-Labile B/P (because of baroreceptors of carotid)
-Airway (internal bleeding can press on trachea)
-Make sure trachea is midline
-Neuro checks qh for the 1st 24 hours
Define an aortic aneurysm?
A localized sac or dilation of the aorta wall
What are the 2 most common locations for an aortic aneurysm?
1. Thoracic
2. Abdominal aortic aneurysm "triple A"
What is the most common procedure for an aortic aneurysm?
Dacron graft that acts as the walls of the aorta
How may an aortic aneurysm feel if it is large enough?
The pulse may actually be distinctly palpable over the abdomen.
What diseases are common in pts with aortic aneurysms?
HTN, arteriosclerosis and atherosclerosis