Health Differences: Across The Lifespan 1 Cardiac (Excelsior College/studygroup101)

Front 1

primary HTN

Back 1

occurs in 90%–95% of cases & tends to develop gradually over many yrs
risk factors: obesity, stress, sedentary lifestyle & smoking

Front 2

secondary HTN

Back 2

appears suddenly & causes higher blood pressure than primary


has specific identified causes: renal disease, adrenal gland tumors, congenital coarctation, & obstructive sleep apnea


meds that can cause: hormonal contraceptives, cold remedies, certain pain relievers & illegal drugs (cocaine & amphetamines)

Front 3

malignant HTN

Back 3

a severe & sudden form of HTN

Front 4

HTN (prognosis)

Back 4

good if detected early & tx begins before complications develop

Front 5

hypertensive crisis

Back 5

severely elevated bp. may be fatal. are associated w/ evidence of target organ damage

Front 6

HTN (s/s)

Back 6

possibly none
blurry vision
bruits over abdominal aorta or carotid, renal & femoral arteries
confusion
dizziness or lightheadedness
edema
elevated bp from baseline
fatigue
nocturia
nose bleeds

Front 7

chest tube drainage system (requires nursing action)

Back 7

continuous bubbling in the water–seal chamber indicates a possibility of an air leak & should be investigated promptly, intermittent bubbling in water–seal chamber means it's functioning properly


occasional bubbling in the suction chamber indicates something could be wrong (bubbling should be continuous)


presence of small clots in tubing indicates nurse needs to "milk" tubing in direction of drainage chamber (important but not urgent)


during transport, drainage system should remain as is and stay below pt's chest level to maintain tubing patency & prevent fluid from flowing back

Front 8

chest tube drainage system

Back 8

tidaling (fluid fluctuation) in water–seal chamber indicates system is working effectively. drainage system should be placed below pts chest level
blocking (clamping) of the chest tubing can lead to a tension pneumothorax


water–seal drainage: used to maintain neg intrathoracic pressure

Front 9

cardiac surgery (monitor for)

Back 9

cessation of chest tube drainage may signal clotting which can lead to fluid build–up in the pericardium & cardiac tamponade


hypokalemia can cause dysrhythmias & even cardiac arrest. renal failure is a possible complication that is indicated by urinary output that drops below 25mL/hr but is not first priority


temp of pt after cardiac surgery is usually low due to the bypass machinery & procedures used

Front 10

aminoglycoside [gentamicin sulfate] (AE)

Back 10

nephrotoxic (especially in older)

Front 11

cor pulmonale

Back 11

R–sided heart failure w/ chronic respiratory failure. irritability & agitation are signs of air hunger
s/s: sob, cough, edema, & h/a (cor pulmonale w/ R ventricular failure)


clinical manifestations: increasing edema of feet, distended neck vein, enlarged palpable liver, pleural effusion, ascites & heart murmurs, h/a, confusion & somnolence.


pt will show wt gain especially when associated w/ COPD

Front 12

normal VS

Back 12

bp: 120/80P: 60–100

R: 12–20
O2: 95%–100%

Front 13

thrombolytic therapy (contra)

Back 13

contra: active, uncontrolled bleeding (pt is at risk for bleeding during therapy)

Front 14

myocardial infarction (nursing action)

Back 14

assess cardiac enzymes

Front 15

pt w/ lung ca who develops superior vena cava syndrome

Back 15

monitor neurological status which can be compromised by increased intracranial pressure & lack of o2 as a result of superior vena cava syndrome

Front 16

super vena cava syndrome (nursing care)

Back 16

monitor for dysphagia which is a clinical manifestation of edema associated. position pt based on facilitating breathing to improve comfort & decrease anxiety

Front 17

sickle cell crisis (priority)

Back 17

oral hydration is of highest importance during painful sickle cell crisis (dehydration is a common complication)

Front 18

chronic anemia (s/s)

Back 18

fatigue, weakness, dyspnea, & anorexia

Front 19

delegation

Back 19

pt education should not be delgated

Front 20

pacemaker

Back 20

telephone–based pacemaker monitoring is now available from home or at pacemaker clinic site


"loss of capture" place pt on L side before changing battery or generator or adjusting sensitivity
"failure to sense" pacemaker is unable to detect an electrical conducted signal produced by the heart such as a P wave or QRS complex & ST segment
"failure to capture" no response of the ventricle to the electrical conducting system


VVI: ventricular paced, ventricular sensed, inhibited


avoid high–output electrical generators b/c they can reprogram pacemakers. affected arm should NOT be raised above shoulder for 1 wk following placement

Front 21

angina

Back 21

anginal cisode is often precipitated by insufficient coronary blood flow. coronary insufficiency results in a decreased o2 supply to meet an increased myocardial demand for o2 in response to a physical condition or emotional stress


exposure to extreme temps, especially cold, leads to increased o2 demand, as does exercise. pt should be encouraged to exercise but avoid adding stress of extreme temps. pt should balance rest w/ activity. sexual activity may trigger angina but proper planning can make it possible to continue

Front 22

congestive heart failure (infant)

Back 22

tachycardia (rapid sleeping heart rate, greater than 160 in infants) is often first sign. tachypnea is also early sign (breaths greater than 60/min in infants)

Front 23

digoxin (lanoxin)

Back 23

.8 – 2.0 ng/mL
must be admin over min of 5 mins


cardiac glycoside that slows the heart rate (monitor pulse!). useful for pts w/ HF who remain symptomatic w/ ACE inhibitors & beta blockers
strengthens myocardial contraction, thus increasing cardiac output. useful to control ventricular response to a–fib

ab pain in pt whose dose has been increased may indicate early toxicity

early s/s of toxicity: fatigue, nausea, anorexia & depression. bradycardia & dysrhythmia may indicate toxicity
vision changes**
w/hold if HR is less than 60 or irregular. brush teeth after admin to avoid tooth decay
quinidine, verapamil & amiodarone tend to increase serum digoxin concentration. metoclopramide tends to decrease serum dig lvls

Front 24

nifedipine (procardia)

Back 24

calcium channel blocker that decreases contractility and o2 demand. prescribed for angina

Front 25

nitroglycerin (nitrostat)

Back 25

smooth muscle relaxation in blood vessels around the heart. reduces o2 demand and decreases L ventricular preload & afterload. causes vasodilation, decreases venous return, decreases cardiac output (reduces stroke volume).


prescribed for angina. pt should rest 15–20 after taking since fainting still may persist. tab sublingual q 5 mins up to 3, if pain persists go to hospital. replenish q 6 months & protect from light.

Front 26

propranolol hydrochloride (inderal)

Back 26

beta blocker that reduces o2 demand, heart rate & bp. can produce insomnia in conjunction w/ mental depression.


commonly used to prevent migraines

Front 27

first action at onset of acute anginal pain

Back 27

pt should sit or lie down to promote comfort & reduce chance of injury from a fall

Front 28

coronary artery disease

Back 28

cigarette smoking increases risk of clot formation by promoting platelet aggregation

Front 29

infant w/ iron deficiency

Back 29

infant can receive supplemental iron from iron–fortified cereals & formula

Front 30

warfarin sodium (coumadin) therapy

Back 30

take at the same time everyday. blood tests need to be scheduled regularly to ensure proper levels of anticoagulant. vegetables contain vitamin K which counteract the affects of warfarin


therapeutic level: prothrombin time (pt) is 11/2 to 2 times the control. higher values indicated increased risk of hemorrhage, lower values indicate increased risk of blood clot formation

Front 31

antihypertensive meds (se)

Back 31

some have sexual SEs, nurse should indicate willingness to help help pt if they occur. meds can possibly be changed to avoid this
can cause postural hypotension or light–headedness w/ movement

Front 32

coupled PVCs

Back 32

means that 2 premature ventricular contractions (beats) are occurring together. this increases the potential that the ventricles will not be fully repolarized, leading to a more dangerous arrhythmia

Front 33

unifocal PVCs

Back 33

occur in isolation & are not especially associated w/ serious arrythmias

Front 34

premature ventricular contractions (PVCs) [ecg]

Back 34

have no associated p waves. most dangerous PVCs are r/t the t wave

Front 35

pernicious anemia

Back 35

linked w/ vitamin b12 deficiency & in most cases is addressed w/ monthly injections

smooth, beefy red tongue


children w/ persistent anemia: otitis media & URIs

Front 36

disseminated intravascular coagulation (DIC)

Back 36

coagulation disorder characterized by formation of tiny clots in the microcirculation. normal hemostatic mechanisms are altered
clinical manifestation profuse hemorrhaging


increased fibrin split products (norm hemostatic mechanisms are altered & many tiny clots form in microcirculation which cause increased fibrin split products in lab results)


aka consumption coagulopathy & defibrination syndrome
s/s: abnormal bleeding w/o hx of serious hemorrhagic disorder, bleeding in skin, excessive bleeding for IV site, n&v, chest pain, hemoptysis, epistaxis, seizures, oliguria, severe muscle back & abd pain, acrocyanosis, dyspnea, diminished peripheral pulses, decreased bp & mental status change


dx: d–dimer (measure fibrin breakdown), considered more specific than fibrin degradation products in DXing DIC

Front 37

furosemide (lasix)

Back 37

K wasting diuretic. muscle weakness is a sign of hypokalemia


bolus should take effect within 5 mins

Front 38

L–sided heart failure (s/s)

Back 38

restlessness is one of the key features caused by decreased cardiac output
**exertional dyspnea
frothy sputum sometimes develops & indicates pulmonary edema
crackles indicate failure of L ventricle
cough d/t congestion is one of the earliest signs

Front 39

anticoagulant therapy

Back 39

long–term therapy: pt must consult physician before taking any meds or supplements


avoiding injury & bleeding is key

Front 40

atherosclerosis

Back 40

a type of arteriosclerosis. primary cause of heart failure
embolization of plaque (fats, cholesterol & other substances)
at increased risk when homocysteine is elevated

Front 41

myocardial infarction (MI)

Back 41

**thrombic occlusion is the pathophysiological factor


irreversible cell damage (necrosis) of muscle tissue due to prolonged ischemia (20 mins) of the coronary artery


ventricular dysrhythmias following thrombolytic therapy is generally considered a sign of reperfusion of coronary artery

Front 42

acute coronary syndrome

Back 42

spasm of the peripheral arteries occur

Front 43

ventricular tachycardia

Back 43

wide & bizarre QRS complexes at regular intervals, pt may not have a pulse


suspected cause should be atrial fibrillation for v–tach w/ irregular rhythm


after initial d–fib, 5 cycles of CPR alternating w/ rhythm check & d–fib are TX to convert v–fib to electrical rhythm that produces a plus

Front 44

premature ventricular contractions (cardia monitor)

Back 44

wide & bizarre QRS complexes at regular intervals but pt may feel nothing or report a sense of that the heart has skipped a beat

Front 45

ventricular fibrillation (cardiac monitor)

Back 45

displays irregular waves w/ no recognizable QRS complexes & disorganized, quivering ventricular rhythm. pt will have no palpable pulse

Front 46

sinus tachycardia (cardiac monitor)

Back 46

usually displays normal QRS shape. pt will have a pulse

Front 47

cardiac failure (nrsng intervention)

Back 47

**support low arm of pt w/ pillows when head of bed is elevated 30 degrees. this decreases workload of the heart


**if pulse is less than 60 w/ atrial fibrillation, digitalis should be w/held, this may indicate that an AV conduction block is developing


place pt in fowler's & give supplemental o2 to help breathe easily. organize activity for max rest periods. weigh pt daily, mntr for peripheral edema, mntr i&o, blood urea nitrogen & serum creatinine, K, NA, Cl & Ma levels. help prevent dvt from vascular congestion w/ ROM exercises

Front 48

decreased cardiac output r/t loss of mechanical pumping ability secondary to MI: cardiogenic shock as an affect of inadequate output of the heart following a myocardial infarction (s/s)

Back 48

cyanotic nail beds, decreased urinary output & cool skin

Front 49

transfusion reaction

Back 49

stop transfusion & admin NS to maintain venous patency & then notify physician & follow protocols

Front 50

pericarditis

Back 50

inflammation of pericardium (fibroserous sac that envelops, supports & protects the heart)



*classic sign: friction rub


to relieve pain place pt in fowler's position, if pt is able to sit upright and lean forward, chair rest may be appropriate. pain will be worse with lying down

Front 51

R–sided ventricular failure

Back 51

dependent edema is key indicator

Front 52

pt suddenly develops chest pain

Back 52

applying o2 is first priority to minimize myocardial damage

Front 53

plasma transfusion

Back 53

platelet count is usually ordered 1 hr after & data on coagulation is reviewed to determine effectiveness of transfusion

Front 54

anxiety

Back 54

increases body's o2 demand

Front 55

acute PAD

Back 55

peripheral artery disease
requires emergent, aggressive tx to revascularize the extremity & prevent limb loss

Front 56

chronic PAD

Back 56

peripheral artery disease
may vary in severity from mild to sever ischemia (w/ tissue necrosis)
risk factors: smoking, aging, htn, hyperlipidemia, diabetes mellitus, & family hx of vascular disorder

Front 57

PAD (s/s)

Back 57

peripheral artery disease
intermittent pain w/ exercise relieved w/ rest (chronic PAD), pain at rest, tingling, numbness, pallor, dependent rubor, cyanosis, coolness of affected extremity w/ delayed capillary refill, hardness of extremity from fibrotic changes, diminished or absent pulses, hair loss, thick nails, necrotic ulcers (severe ischemic disease), paralysis (severe ischemic disease)

Front 58

PAD (tx)

Back 58

peripheral artery disease
bypass sx to revascularize limbs w/ acute occlusion or severe chronic disease, fibrinolytics to dissolve clot, balloon angioplasty, atherectomy or stenting, meds to lower cholesterol, antiplatelet meds, anticoagulants, control risk factors & regular exercise program

Front 59

PAD (nursing mngmnt)

Back 59

peripheral artery disease
mntr affected limb frequently for changes, admin analgesics & anticoagulants if indicated, post–sx mntr limb for circulation & wound healing. encourage increasing activity as ordered & tolerated. emotional support & other appropriate support if amputation

Front 60

angina pectoris

Back 60

a symptom of ischemic heart disease characterized by paroxysmal & usually recurring substernal or precordial chest pain or discomfort


caused by vary combo of increased myocardial demand & decreased myocardial perfusion

Front 61

angina (classifications)

Back 61

chronic exertional angina, variant angina (prinzmetal's), unstable or crescendo angina, or silent ischemia

Front 62

chronic exertional angina

Back 62

(stable, typical)
usually caused by obstructive coronary artery disease


chronic stable: characterized by exertional, rest relieved discomfort, located anywhere btwn umbilicus & ears that may be associated w/ numbness of arms or hands, generally caused by fixed obstructive atheromatous lesions, TXed w/ rest & nitrates during attacks & beta–adrenergic blockers for prevention

Front 63

prinzmental's (variant) angina

Back 63

may occur in people w/ normal coronary arteries who have cyclically recurring angina at rest


characterized by resting discomfort. caused by coronary artery vasospasm, causes reversible ST–segment elevation during event


TXed w/ CA channel blockers & nitrates, possibly beta–adrenergic blockers or coronary stenting if hard to deal w/

Front 64

unstable angina

Back 64

DXed in pts who report changing character, durtion & intensity of their painsi

Front 65

silent ischemia

Back 65

not all ischemic events are perceived by pts even though such events may have adverse implications for the pt

Front 66

microvascular (cardiac syndrome X) angina

Back 66

characterized by stable angina–like chest pain, caused by impairment of vasodilator reserve, poses no risk of cardiac ischemia b/c capillaries are too small to block oxygenation of cardiac cells, TXed w/ nitrates, beta–adrenergic blockers or calcium channel blockers

Front 67

beta blockers

Back 67

antianginal: reduce myocardial o2 demands by slowing heart rate & ^ force of myocardial contractions. rx long–term prevention of angina


anti–htn: clock catecholamine–induced ^ bp

Front 68

thrombolytics

Back 68

complication: systemic bleeding

Front 69

angiotension–converting enzyme (ACE) inhibitors

Back 69

cough: most common se, usually resolves in 1–4 days after therapy begins


antihypertensive: decrease vasoconstriction & re–uptake of fluid


ae: hyperkalemia (w/hold next dose & notify physician)


enalapril: decreases ventricular remodeling which results in less than optimal ventricular function


work by blocking conversion of angiotensin I to angiotensin II

Front 70

Angina (risk factors)

Back 70

increases w/ age & predispositions to atherosclerosis (smoking, htn, diabetes mellitus, hyperlipoproteinemia)at younger age men are at greater risk for MI but for women prevalence of angina is higher w/ AM 40–74

Front 71

angina (nursing assessment)

Back 71

ask pt to describe past chest discomfort quality (aching, sharp, tingling, knifelike, choking, squeezing), location, radiation, precipitating factors, duration, alleviating factors & associated s/s during attack


often described as ache than actual pain, chest heaviness, pressure or tightness, squeezing, indigestion. typically located in substernal region or across anterior upper chest. often the pain is the size of a clenched fist & pt may place first over area of discomfort (levine's sign). sensation may radiate to neck, jaw, tongue; to elbow, write or hand; or to upper abd. discomfort is typically of short duration (3–5 mins) but can last up to 30 mins or longer. upon auscultation pt may have atrial or ventricular gallops

Front 72

angina (nursing dx)

Back 72

altered tissue perfusion r/t narrowing of coronary artery & associated w/ atherosclerosis, spasms & thrombosis

Front 73

angina (nursing planning & implementation)

Back 73

pain mngmnt is priority not only for comfort but to also decrease myocardial o2 consumption. physician orders therapies that either decrease myocardial o2 demand or increase coronary blood & o2 supply

Front 74

angina (diet)

Back 74

low cholesterol, fat, calories & Na. drinks usually decaf & not too cold or hot

Front 75

antianginals (beta–adrenergic blockers)

Back 75

beta–adrenergic blockers: reduce myocardial o2 demands by slowing heart rate & increasing force of myocardial contractions

Front 76

CA channel blockers (–olol)

Back 76

antianginal. slow ventricular rate
dilate coronary & peripheral arteries & prevent coronary vasospasm, used when other drugs fail to prevent angina


anti–htn: dilate arteries to lower bp & decrease cardiac contractility
verapamil: used to control rapid ventricular response to either a–fib or atrial flutter
metoprolol: avoid for those w/ asthma, can cause bronchospasms

Front 77

nitrates

Back 77

antianginal
produce vasodilation, decrease preload & afterload, & reduce myocardial o2 consumption,


ex: nitroglycerin (nitro–bid, nitrostat, nitrolingual), isosorbide dinitrate (isordil)

Front 78

abd aortic aneurysm

Back 78

localized outpouching or abnormal dilation of a weakened arterial wall of aorta. when developing, lateral pressure increases, causing vessel lumen to widen & blood flow to slow. may result in hemodynamic forces that can create pulsatile stresses on weakened wall & press on small vessels that supply nutrients to arterial wall causing aorta to b/c bowed & torturous. aneurysm may rupture or tear suddenly, possibly causing death (medical emergency)


pt can feel heartbeat in and when lying down, and mass or throbbing
signs of impending rupture: restlessness, lower back pain & hypotension or shock symptoms


aortic dissection occurs when innermost lining of arterial wall separates from the other 2 to allow blood flow between layers rather than through the lumen of the artery, as is norm. this can completely obstruct true lumen of vessel. most classic sign of aortic dissection is "ripping" or "tearing" w/ abrupt onset

Front 79

abd aortic aneurysm [abd] (s/s)

Back 79

lumbar pain radiating to flank & groin, systolic bruit over aorta, tenderness on deep palpation & palpation of abd throbbing

Front 80

abd aortic aneurysm [ascending] (s/s)

Back 80

bradycardia, different bp in R & L arm (more than 20 mmHg), jugular vein distention, murmur of aortic insufficiency, pain, pericardial friction rub & unequal carotid & radial pulses

Front 81

abd aortic aneurysm [descending] (s/s)

Back 81

dry cough, dysphagia, dyspnea & stridor, hoarseness & pain (sudden, between shoulder blades & chest)

Front 82

abd aortic aneurysm (tx)

Back 82

small, asymptomatic aneurysms: mntr q 6 mnths w/ ultrasonography, x–ray or ct


large or symptomatic aneurysms: resection or repair to prevent rupture


mntr of bp & tx w/ antihypertensives as needed

Front 83

abd aortic aneurysm (nursing considerations)

Back 83

allow pt to express fears & concerns. help pt identify effective coping strategies as they deal w/ dx


before elective sx, weigh pt, insert indwelling catheter & IV. assist w/ insertion of arterial line & pulmonary artery cath to mntr hemodynamic balance

Front 84

abd aortic aneurysm (tx in acute situation)

Back 84

insert multiple large–bore IV to facilitate blood replacement, prep pt for impending sx, as ordered, obtain blood samples for kidney function tests, cbc w/ differential, blood typing & cross matching, & ABG levels, admin ordered meds. mntr pts cardiac rhythm & VS. assist w/ insertion of pulmonary artery line.
be alert for signs of rupture which may be fatal. watch closely for signs of acute blood loss (decreasing bp, increasing pulse & respiratory rates, restlessness, decreased sensorium & cool clammy skin)

Front 85

gangrene

Back 85

death of tissue caused by lack of blood supply. poor circulation of lower extremities contribute to poor wound healing & development of gangrene which occur after prolonged, severe ischemia & represent tissue necrosis


Dry & Wet gangrene

Front 86

dry gangrene

Back 86

occurs when portion of bodily tissue dies b/c blood supply has been decreased or completely cut off. it will NOT spread to other healthy tissue & infection is not present. usually slow process w/ affected area gradually b/c cold, discolored & eventually totally black. shrinkage & withering away of affected tissue occurs as tissue dies

Front 87

wet gangrene

Back 87

when dry gangrene b/c infected, often due to injury. infection cause tissue to die

Front 88

dry gangrene (common causes)

Back 88

arterial obstruction or occlusion of an artery caused by arteriosclerosis, diabetes mellitus, aids or blood clot; severe blunt trauma causing obstruction of artery; frostbite; diseases that affect blood vessels especially arteries (buerger's or raynaud's disease); traumatic occurrences (crushing injuries, fractures, burns & even injections into skin or muscles)

Front 89

wet gangrene (common causes)

Back 89

streptococcus (serious but rare form of infection w/ group A strephtococcus. necrotizing fasciitis or infectin of skin & tissues directly beneath skin) & staphylococcus

Front 90

gas gangrene

Back 90

most serious form of wet gangrene, often caused by clostridium bacteria (normally inhabitants of gi, repiratory & female genital tracts). initially characterized by red line on skin that marks border of affected tissues. onset of dry gangrene normally characterized by dull aching pain at site


dramatically sudden, rapid onset. frequently first noticed as marked swelling & either pallid or brownish–red colored area surrounding wound site. borders of infected area can expand w/in mins

Front 91

gas gangrene (s/s)

Back 91

edema at injury site that expands quickly, pain in area surrounding injury, crepitus (bubbly) crackling sound hear upon palpation, pallor at injury site then increasingly dusky discoloration, low–grade – mod temp elevation

Front 92

coronary artery disease [CAD]

Back 92

occurs when arteries that supply blood to the heart muscle harden & narrow. result is loss of o2 & nutrients to myocardial tissue b/c of diminished coronary blood flow. reduction in blood flow can lead to coronary syndrome (angina or mi)

Front 93

CAD (s/s)

Back 93

possibly none, abnormal stress test or echocardiogram findings, angina, typically w exertion of stress, uncontrolled htn & diabetes mellitus, & major complications (acute coronary syndrome, heart failure, arrhythmias or sudden death)

Front 94

CAD (tx)

Back 94

drug therapy: angiotensin–converting enzyme inhibitors, thrombolytics, diuretics, glycoprotein IIb/IIIa inhibitors, nitrates, beta–adrenergic or CA channel blockers, antiplatelet, antilipemic, antihypertensive drugs
coronary artery bypass grafting (cabg)
angioplasty
arthrectomy
stent placement to maintain patency of reopened artery
lifestyle modifications to limit progression of CAD: smoking cessation, exercising, maintain ideal body wt & eating low–fat, low–sodium diet

Front 95

CAD (nursing considerations)

Back 95

during anginal episode: mntr bp & hr. 12–lead elecrtocardiogram before admin nitro or other nitrates. record duration of pain & amount of meds to relieve & accompanying symptoms.after cardiac cath: mntr catheter site & check for distal pulses
after percutaneous transluminal coronary angioplasty (ptca) & intravascular stenting: maintain heperinization, observe for bleeding at site, keep affected leg immobile & chek for distal pulses. precordial blood must be taken q 8 hrs for 24 hrs for cardiac enzyme levels. complete bld count & electrolyte levels are monitored
after rotational albation: mntr pt for chest pain, hypotension, coronary artery spasm & bleeding from cath site. provide heparin & antibiotic therapy for 24–48 hrs as ordered
after bypass sx: mntr bp, i&o, breath sounds, chest tube drainage & cardiac rhythm. watch for signs of ischemia & arrhythmias. mntr cap glucoase, electrolyte levels & ABGs. follow weaning parameters while pt is on mechanical ventilator. pt may need temporary epicardial pacing, especially if sx included replacement of aortic valve

Front 96

myocarditis

Back 96

inflammation of myocardium (heart muscle) & is often asymptomatic w/ spontaneous recovery. may occasionally result in cardiomyopathy & heart failure

causes: infection, immune reactions (rheumatic fever), radiation therapy, toxins & alcoholism

Front 97

myocarditis (s/s)

Back 97

fatigue, dyspnea, fever, mild chest soreness, tachycardia, palpitations, mitral murmur, pericardial friction rub (scratchy sound over intercostal space on L chest) & heart failure

Front 98

myocarditis (dx test)

Back 98

elevated CK–MB, WBC, eosinophil sedimentation rate (esr), positive blood culture, ecg, chest x–ray, echocardiogram & endomyocardial biopsy

Front 99

myocarditis (nursing interventions)

Back 99

admin antibiotics, diuretics, anitpyretics & possibly antidysrhythmics & anticoagulants, admin corticosteroids & immunosuppressants, admin o2 & provide rest

Front 100

myocarditis (sx mngment)

Back 100

often not necessary but may include temporary pacemaker, cardiac assist devices or transplantation

Front 101

acute pericarditis

Back 101

can be fibrinous or effusive w/ purulent, serous or hemorrhagic exudate. fluid buildup can cause pericadial effusion. if effusion builds up too rapidly, cardiac tamponade can occur


prognosis depends on underlying cause but is generally good w/ acute pericarditis unless constriction occurs

Front 102

chronic constrictive pericarditis

Back 102

characterized by dense fibrous pericardial thickening which causes constriction of normal heart size & movement. this can lead to permanently reduced stroke volume & cardiac output.

Front 103

acute pericarditis (s/s)

Back 103

pericardial friction rub at L third intercostal space, sharp sudden pain usually starting over the sternum & radiating to the neck, shoulders, back & arms

Front 104

chronic pericarditis (s/s)

Back 104

ascites, peripheral edema, chest pain w/ exertion, dyspnea, fatigue & inspiratory jvd (kussmaul's sign)

Front 105

pericarditis (tx)

Back 105

bed rest as long as fever & pain persist, tx of underlying cause, nsaids, coricosteroids, antibacterials, antifungals, antivirals, partial or total pericardectomy, diuretics & pericardiocentesis

Front 106

pericarditis (nursing considerations)

Back 106

stress the importance of bed rest, assist pt w/ bathing if needed, place pt n upright position to relieve dyspnea & chest pain, provide analgesic meds to relieve pain & o2 to prevent tissue hypoxia, cardiac tomponade requires immediate tx so keep pericardiocentesis tray handy if suspect pericardial effusion, assess cardiovascular status frequently, reduce anxiety & allow pt to express concerns, reassure that restrictions are temporary, observe venipuncture site for signs of infiltration or inflammation, rotate venous access sites to reduce risk

Front 107

endocarditis

Back 107

infection of endocardium, heart valves or cardiac prosthesis resulting from bacterial or fungal invasion
infection causes fibrin & platelets to aggregate on the valve tissue & engulf circulating bacteria or fungi that flourish & form friable, wartlike vegetative growths on the heart valves, the endocardial lining of a heart chamber or the epithelium of a blood vessel
growth may cover the valve surfaces causing ulceration & necrosis. they may also extend to the chordae tendineae, leading to rupture & subsequent valvular insufficiency, ultimately they may embolize to the spleen, kidneys, cns & lungs

Front 108

endocarditis (s/s)

Back 108

weakness & fatigue, anorexia, arthralgia, intermittent fever that may recur for weeks (in 90% of pts), wt loss, loud, regurgitant murmur (petechiae), osler nodes & asymmetrical arthritis

Front 109

endocarditis (tx)

Back 109

long–term antibiotic therapy, adequate rest periods, aspirin or acetaminophen for fever & aches, sufficient fluid intake, corrective urgery if refractory herat failure develops or heart structures are damaged, replacement of infected prosthetic valve, prophylactic tx for high–risk individuals

Front 110

endocarditis (nursing considerations)

Back 110

stress importance of adequate rest, provide bedside commode, reduce anxiety & allow to express concerns, assess cardiovascular status frequently & watch for s/s of L–sided heart failure (dyspnea, hypotension, tachycardia, tachypnea, crackles & wt gain). watch for changes in cardiac rhythm or conduction, adimin o2 & evaluate ABGs to ensure adequate oxygenation, mntr pts renal status to check for signs of renal emboli & drug toxicity

Front 111

rheumatic fever, heart/valve disease

Back 111

inflammatory autoimmune disease that affects connective tissues of the heart, joints subcutaneous tissues & blood vessels of the cns


presents 2–6 wks following unTXed or partially TXed group A beta–hemolytic streptococcal infection of upper respiratory tract

Front 112

rheumatic fever, heart/valve disease (most serious complication)

Back 112

rheumatic heart disease (affects cardiac valves, particularly the mitral valve)


pt is at high risk for new infection & worsening of problems r/t to heart & joint damage

Front 113

rheumatic fever, heart/valve disease (dx)

Back 113

jones criteria

Front 114

rheumatic fever, heart/valve disease (assessment)

Back 114

low–grade fever that spikes in the late afternoon, elevated antistreptolysin 0 titer, elevated sedimentation rate, elevated c–reactive protein level, aschoff bodies (lesions) found in herat, blood vessels, brain & serous surfaces of the joints & pleura

Front 115

rheumatic fever, heart/valve disease (nursing intervention)

Back 115

control joint pain & inflammation w/ massage & alternating hot/cold applications as rx, provide bed rest during acute febrile phase, limit physical exercise in the child w/ carditis, admin antibiotics, salicylates, anti–imflamatory (meds should not be admin before dx b/c the mask polyarthritis), seizure precaution if child is experiencing chorea

Front 116

kawasaki disease

Back 116

mucocutaneous lymph node syndrome, acute systemic inflammatory illness, cardiac involvment is most serious complication, aneurysms can develop

Front 117

kawasaki disease (assess)

Back 117

acute stage: fever, conjuctival hyperemia, red throat, swollen hands, rash & enlargement of cervical lymph nodes


subacute stage: cracking lips, fissures, desquamation of skin on tips of fingers & toes, cardiac manifestations & thombocystosis


convalescent stage: child appears norm but signs of inflammation may be present

Front 118

kawasaki disease (intervention)

Back 118

mntr temp frequently, asses heart, extremities for edema, redness & desquamation, eyes for conjunctivitis, mucous membranes for inflammation, strict i&o, admin soft foods & liquids (neither too hot or cold), weigh daily, provide passive ROM exercises, admin meds & parent education

Front 119

cardiac failure

Back 119

syndrome characterized by myocardial dysfunction that leads to diminished cardiac output or frank heart failure & abnormal circulatory congestion


R–sided, L–sided, systolic or diastolic and acute or chronic

Front 120

cardiac failure

Back 120

congestion of systemic or venous circulation may result in peripheral edema or hepatomegaly, congestion of pulmonary circulation may cause pulmonary edema. pump failure usually occurs in damaged L ventricle but may occur in R ventricle either as primary disorder or secondary to L sided heart failure. sometimes L & R heart failure develop simultaneously

Front 121

L–sided heart failure

Back 121

result of ineffective L ventricular contraction causing fluid to possibily accumulate & backing into L atrium & then into the lungs. may lead to pulmonary congestion or pulmonary edema & decreased cardiac output

Front 122

L–sided heart failure (common causes)

Back 122

L ventricular MI, htn & aortic or mitral valve stenosis or insufficiencey

Front 123

L–sided heart failure (s/s)

Back 123

dyspnea (initially on exertion), confusion, bibasilar crackles, cough, cyanosis or pallor, fatigue, muscle weakness and tachycardia

Front 124

R–sided heart failure

Back 124

result of ineffective R ventricular contraction
pedal edema (gen in heart failure but more suggestive of R–sided)

Front 125

R–sided heart failure (possible cause)

Back 125

R ventricular infarction or pulmonary embolism. most common cause is profound backward blood flow due to L–sided heart failure

Front 126

R–sided heart failure (s/s)

Back 126

edema (initially dependent), generalized wt gain, hepatomegaly, jvd & ascites. n&v (from venous stasis & venous engorgment w/in the abd organs


hepatojugular reflex: hob @ 45 degrees, put pressure on R upper abd, liver, for 30–40 seconds

Front 127

systolic herat failure

Back 127

L ventricle can't pump enough blood out to systemic circulation during systole & ejection fracture fails causing blood to back up into pulmonary circulation, pressure rises in pulmonary venous system & cardiac output fails

Front 128

diastolic heart failure

Back 128

L ventricle can't relax & fill properly during diastole & stroke volume fails. large ventricular volumes are needed to maintain cardiac output

Front 129

acute heart failure

Back 129

refers to timing of onset of s/s. & whether compensatory mechanisms kick in. fluid status is typically normal or low & sodium & water retention doesn't occur

Front 130

chronic heart failure

Back 130

s/s have been present for some time, compensatory mechanisms have taken effect & fluid volume overload persists. drugs, diet change & activity restrictions usually control symptoms

Front 131

cardiac failure (tx)

Back 131

tx underlying disorders may improve heart failure. lifestyle changes, meds

Front 132

MI (defined by location of damage)

Back 132

R coronary artery (rca) occlusion results in inferior MI or R ventricular infarction


L circumflex artery (cx) occlusion results in lateral wall infarction


L anterior descending artery (lad) results in anterior wall infarction

Front 133

MI (defined by extent of damage)

Back 133

q–wave (transmural) damage occurs when all layers of myocardium are affected
non–q–wave (subendocardial) damage occurs only n the inner or middle layers of myocardium

Front 134

MI (result of damage)

Back 134

infarcted myocardial cells release cardiac enzymes into the bloodstream (ck–mb, troponin). *troponin T & I levels are elevated 3–4 hrs following MI, peak at 4–24 hrs & remain elevated 1–3 wks


w/in 24 hrs, infarcted area b/c edematous & cyanotic


w/in several days, leukocytes arrive & remove dead cells


by wk 3, scar formation may inhibit contractility


compensatory mechanisms may be enabled by body in attempt to increase cardiac output


ventricular dilation may occur due to heart's remodeling process after MI

Front 135

schilling test

Back 135

tests for vit b12 deficiency
requires urine produced over 24 hr period to be collected along w/ admin of radioactive & nonradioactive preparations of vitamin b12

Front 136

deep vein thrombophlebitis (dvt)

Back 136

primary sign is pain in affected area & unilateral edema

Front 137

atropine

Back 137

drug of choice for 3rd degree atrioventricular block (bradydysrhythmias, sinoatrial arrest & av block)


drug of choice for symptomatic sinus bradycardia (admin 0.5mg IV rapidly bolus q 3–5 mins to a max total of 3mg

Front 138

epinephrine

Back 138

initial tx for ventricular asystole. increases cardiac output

Front 139

lidocaine

Back 139

**initial drug of choice for premature ventricular contractions (PVCs)

Front 140

chronic arterial occlusive disease (teaching)

Back 140

pt is very susceptible to tissue injury, daily walking program provides appropriate level of activity, elevating legs impedes arterial flow, keep legs dependent as much as possible

Front 141

abdominal aortic aneurysm

Back 141

abdominal throbbing is common complaint


severe back pain indicates impending rupture & need for emergency measures

Front 142

nicotine

Back 142

increases risk for clots by increasing platelet aggregation & are a key factor in peripheral arterial disease

Front 143

iron deficiency anemia

Back 143

serum ferritin lvls will be low reflecting depletion of iron stores, serum hemoglobin will be low reflecting effect of depletion


long–term: smooth, sore tongue is characteristic, brittle nils & corner of mouth ulcers


imferon (IM iron) given IM Z track method

Front 144

chronic arterial occlusive disease (manifestation)

Back 144

diminished hair growth on extremities is indicative of arterial insufficiencycool skin, diminished or absent pulses is also typical

Front 145

venous insufficiency (manifestations)

Back 145

swelling of extremities

Front 146

congestive heart failure CHF (normal values for adult)

Back 146

pulmonary artery wedge pressure (PAWP): 4–12 mmHg
cardiac output (CO): 4–7L/min
systemic vascular resistance (svr): 800–1500 dynes/sec
central venous pressure (cvp): 0–8mmHg

Front 147

combo of nitro IV & dopamine

Back 147

admin for cardiogenic schock

Front 148

NSAIDs

Back 148

admin to tx dressler's syndrome (pericarditis after myocardial infarction). if bacterial, admin antibiotics

Front 149

morphine sulfate to tx acute myocardial infarction

Back 149

drug of choice for MI to reduce preload & in turn decrease cardiac workload overall

Front 150

idiopathic thrombocytopenic purpura (ITP)

Back 150

**occurs after certain childhood illnesses. clinical manifestations: bruises especially over boney prominences


platelets are mistaken as a threat & gets attacked by immune system

Front 151

MI (rehab)

Back 151

phase 1 rehab begins as soon as pt is hemodynamically stable (when medical tx has stabilized cardiac supply & demand)
period immediately following discharge from coronary care unit is later part of phase 1 rehab
early period of convalescence home is part of phase II rehab
phase III: pt may return to norm activity w/in 6–8 wks after MI

Front 152

cardiac system (physiological changes in adults)

Back 152

may have enlarged L atrium & increased atrial irritability, slower SA node rate of impulse discharge, decreased conduction speed across AV node & increased interval for the heart rate to return to baseline after any elevation

Front 153

digitalis (se)

Back 153

nausea is fairly common. if combined w/ several other symptoms, it can be an early indicator of digitalis toxicity

Front 154

pacemaker

Back 154

designed to provide electric stimulus to heart by generating a pulse. tx dysrhythmias not demand problems

Front 155

defibrilator

Back 155

automatically delivers a countershock upon sensing ventricular fibrillation

Front 156

balloon angioplasty

Back 156

pacemaker is inserted into coronary artery where it is inflated & opens artery

Front 157

nitroglycerin (use)

Back 157

place 1 tab under tongue when pain begins

potency decreases over time, supply should be replaced w/in 6 mnths or less


for long–term nitro therapy pt should take a tab if an angina–causing activity is planned


pt may take 3 tabs in 5 min intervals. if pain is not relieved call for emergency medical services

Front 158

stage IV adenocarcinoma

Back 158

indicates tumor has metastasized, gas exchange b/c impaired as cancerous tissues increase

Front 159

tumor lysis syndrome

Back 159

arises when contents of cells destroyed by chemo or radiation are released into the body causing electrolyte imbalances.


increasing fluids assists kidneys in flushing the material

Front 160

cachexia

Back 160

weakness & wasting away for body due to chronic illness

pt needs best nutritional content possible. small, frequent meals often work best to maintain wt

Front 161

lost chord club

Back 161

support group of those who have had laryngectomies (removal of larynx including vocal chords)

Front 162

abdominal–perineal resection for rectal CA

Back 162

sidelying position in bed is resting position that is least likely to be uncomfortable or irritating while surgical wound is healing

Front 163

wilm's tumor

Back 163

palpation of abd may cause CA cells to migrate into nearby or even distant sites

Front 164

radical prostatectomy

Back 164

impotence is expected
a penile prosthesis can enable pt to achieve erection

Front 165

multiple myeloma

Back 165

dx test: serum electrophoresis reveals excessive bence jones proteins


hypercalcemia is a common complication b/c breakdown of bone releases calcium into bloodstream. maintaining hydration is important to help prevent hypercalcemia

Front 166

nitrites & nitrates (cause risk of...)

Back 166

associated w/ increased risk of CA

Front 167

ileal conduit

Back 167

appliance most typically last 3–7 days w/ leakage, should be changed before it leaks. to modify opening in skin barrier, open to a max of 1.6mm or 1/8inch larger than stoma


skin barrier between pts skin & appliance protects against infection & excoriation around stoma. tape is used around skin barrier but never directly on pouch

Front 168

colostomy sx

Back 168

return of norm fecal output may take several days following sx. in 3–6 days colostomy will begin to function
dark red or black coloring of stoma may indicate infection
edema at stoma site & small amount of drainage from stoma is norm postSX finding

Front 169

claudication

Back 169

leg pain resulting from obstruction of blood vessels


intermittent claudication: pain in legs, edema & hair loss


ABI <1.0 indicates possible claudication of peripheral arteries. used to assess degree of stenosis of peripheral arteries

Front 170

causes person to be more susceptible to CA

Back 170

pts w/ genetic abnormalities are several times more susceptible

Front 171

radiation therapy (diet)

Back 171

high protein, high carb & low residue


it affects gi tract, diet should be highly nutritious but not irritating

Front 172

distant metastasis of a neuroblastoma

Back 172

indicated by periorbital edema & exophthalmus

Front 173

neutropenia

Back 173

low absolute neutrophil count


greatest risk is infection

Front 174

colostomy

Back 174

wash area w/ mild soap & PAT dry to prevent skin breakdown

pouch opening should be trimmed 0.3cm (1/8 inch) larger than stoma

drainage bag should be emptied when 1/3 – 1/4 full. drainage pouch may not be needed if pt is able to learn an irrigation routine for emptying colon

Front 175

unilateral modified radical mastectomy

Back 175

elevation of arm on affected side relieves pain after mastectomy

Front 176

risk for infection (entry sites)

Back 176

oral cavity, IV sites & perineum

Front 177

combo chemo

Back 177

uses drugs that target diff phases of cell cycle or have diff chemical action to increase the # of cells destroyed

Front 178

internal radiation therapy (visitors)

Back 178

no pregnant women! visitors must remain 6 feet from source of radiation

Front 179

myocardial infarction (s/s)

Back 179

crushing stubsternal chest pain that may radiate to L arm, jaw, neck or shoulder blades, n&v, cool extremities, diaphoresis, anxiety, elevated bp & pulse in early stage & jvd


many older adults don't have common signs of chest pain, instead dyspnea, fatigue & syncope. women & those w/ diabetes mellitus may experience dyspnea, back pain or be asymptomatic

Front 180

myocardial infarction (dx tests)

Back 180

serial 12 lead ECG, serial cardiac enzymes (CK–MB, troponin), echocardiogram, nuclear imaging & cardiac cathm

Front 181

myocardial infarction (nursing intervention)

Back 181

w/in 10 mins of onset "MONA greets every client" (IV morphine, o2 2–3L/min, nitro if BP >90 systolic & aspirin)


continuous cardiac mntr, ECG, IV fibrinolytic therapy w/in 6 hrs, IV or SQ heparin, admin appropriate drugs


in recovery stage, pt may need cardiac rehab & education (meds, diet, daily wt)


immediate cardiac cath may be needed, CABG may be needed for multiple lesions or L main coronary artery disease

Front 182

aortic insufficiency

Back 182

incomplete closure of aortic semilunar valve. usually caused by scarring or retraction of valve leaflet


s/s: blowing diastolic murmur or s3, cough, exertional dyspnea or chest pain, L–sided heart failure, pulsus bisferiens (rapidly rising & collapsing pulse), fatigue, weakness & palpitations


tx: valve replacement, low NA diet, digoxin, diuretics, vasodilators, & ace inhibitors

Front 183

aortic insufficiency (nursing considerations)

Back 183

stress adequate rest, provide bed–side commode, alternate periods of activity w/ periods of rest, place pt in upright position to relieve dyspnea & admin o2 to prevent tissue hypoxia

Front 184

aortic stenosis

Back 184

increased L ventricle pressure tries to overcome resistance of narrowed valvular opening. added workload increased demand for o2 & diminished cardiac output causing poor coronary artery perfusion, ischemia of L ventricle & L–sided heart failure

Front 185

aortic stenosis (s/s & tx)

Back 185

s/s: angina, palpitations, cardiac arrhythmias, exertional dyspnea, paroxysmal nocturnal dyspnea, L–sided heart failure, syncope & systolic murmur at base of carotids


tx: commissurotomy (child & no calcification), valve replacement in symptomatic or those at risk of L–sided heart failure, percutaneous balloon aortic valvuloplasty, antibiotic prophylaxis, digoxin

Front 186

aortic stenosis (nursing considerations)

Back 186

stress adequate rest, provide bed–side commode, alternate periods of activity w/ periods of rest, keep pt's legs elevated while seated in chair to improve venous return to heart, place pt in upright position to relieve dyspnea & admin o2 to prevent tissue hypoxia, low NA diet


notify physician of change in peripheral pulses distal to the insertion site, in cardiac rhythm & vs & chest pain.

Front 187

mitral insufficiency

Back 187

abnormality of mitral leaflets, mitral annulus, chordae tendineae, papillary muscles, L atrium or L ventricle can lead to mitral insufficiency


can start suddenly w/ characteristic sign of dyspnea.


chronic mitral insufficiency is slow process accompanied w/ fatigue & insomnia


s/s: angina, palpitations, fatigue, now–onset atrial fibrillation, orthopnea, dyspnea, systolic murmur, light–headedness, cough (especially when supine) & pitting leg edema

Front 188

mitral insufficiency (tx & nursing considerations)

Back 188

tx: drugs to relieve symptoms, valvuloplasty, valve replacement


nursing considerations: provide periods of rest between activity, reduce anxiety, low–NA diet, mntr for L–sided heart failure, pulmonary edema, provide O2 to prevent tissue hypoxia
mntr: vs, ABGs, i&o, daily wt, bld chemistry, chest xray & pulmonary artery cath readings

Front 189

mitral valve prolapse

Back 189

click–murmur syndrome (d/t ascultatory sound)
one or both valve leaflets protrude into L atrium. occurs more commonly in women. typically bengin


s/s: possibly none, chest pain, dizziness, heart murmur, palpitations, syncope, fatigue, dyspnea


tx: beta blockers, aspirin, anticoagulants, valve repair or replacement

Front 190

mitral valve prolapse (nursing considerations)

Back 190

provide rest between activities, reduce anxiety, low–NA diet, mntr vs, ABGs, i&o, daily wt, bld chemistry, chest xray & pulmonary artery cath readings

Front 191

mitral valve stenosis

Back 191

narrowing of valve by valvular abnormalities, fibrosis or calcification that obstruct blood flow from L atrium to L ventricle causing L atrial vol & pressure rise & camber dilates. greater resistance to blood flow causes pulmonary htn, R ventricular hypertrophy & R–sided heart failure. inadequate filling of L ventricle produces low cardiac output

Front 192

mitral valve stenosis (s/s & tx)

Back 192

s/s: holosystolic murmur at apex, angina, crackles, dyspnea, fatigue, hepatomegaly (R–sided heart failure), jvd, orthopnea, palpitations, peripheral edema, pulmonary edema & tachycardia


tx: anticoagulants, drugs for heart, synchronized cardioversion for atrial fibrillation & valvuloplasty or valve replacement

Front 193

mitral valve stenosis (nursing considerations)

Back 193

stress adequate rest, reduce anxiety, upright position to relieve dyspnea, o2 to prevent tissue hypoxia, low–NA diet

Front 194

cardiomyopathy

Back 194

disease of heart where muscle tissue can't work properly or efficiently


primary: changes in heart muscles w/o specific cause
secondary: involves other organs as well as the heart


4 types: dilated, restrictive, hypertrophic & arrhythmogenic R ventricular dysplasia

Front 195

dilated cardiomyopathy

Back 195

result from extensively damaged myocardial muscle fibers. interferes w/ myocardial metabolism & grossly dilates all four chambers giving heart globular appearance & shape. poor prognosis


s/s: sob, orthopnea, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, dry cough at night from L–sided heart failure, tachycardia w/ irregular pulse (if atrial fibrillation exists), pansystolic murmur associated w/ mitral & tricuspid insufficiency, peripheral cyanosis, peripheral edema, hepatomegaly, jvd, wt gain from R–sided heart failure, s3 gallop


tx: o2 therapy, ace inhibitors as 1st line, diuretics, digoxin if not responding to ace inhibitors & diuretic therapy, vasodilators, beta–adrenergic blockers (for mild or mod heart failure), antiarrhythmics, cardioversion, automatic implanted cardioverter defibrillator insertion, anticoagulants (w/ atrial fibrillation), revascularization, valvular repair or replacement, lifestyle mods, L ventricular assists device

Front 196

dilated cardiomyopathy (nursing considerations)

Back 196

alternate rest & ADLs, provide active or passive rom exercises to prevent muscle atrophy, low–NA diet, mntr for progressive failure, mntr for compromised renal perfusion, admin o2 prn, wt daily, prevent constipation & stress ulcers

Front 197

restrictive cardiomyopathy

Back 197

restricted ventricular filling (from L ventricular hypertrophy) & endocardial fibrosis & thickening. severe & irreversible.


s/s: fatigue, chest pain, dyspnea, edema, high systemic & pulmonary venous pressure, liver engorgement, orthopnea, abd distention & palpitations


tx: mngmnt of underlying cause, digoxin, diuretics, restricted–NA diet, oral vasodilators, pacemaker, cardiac transplantation if intractable disease

Front 198

cardiogenic shock

Back 198

clinical syndrome of reduced perfusion to organs & tissues, hypovolemic shock, cardiogenic shock, anaphylactic shock, septic shock, neurogenic shock


s/s: tachycardia, restlessness, tachypnea, diminishing urine output, hypotension, cold clammy skin, loss of consciousness, shallow cheyne–stokes respirations & anuria (in late stages)


dx tx: bld, urine or sputum cultures, SBC & ESR rates, hematocrit & coagulation studies, ABGs, chest xray, echocardiogram & ECG

Front 199

cardiogenic shock (nursing considerations)

Back 199

tx underlying cause, maintain airway, IV fluids to help maintain bp, continuous hemodynamic mntring, & appropriate drugs for each type of shock

Front 200

venous thrombosis

Back 200

acute condition characterized by inflammation & formation of thrombus w/in a vein. damage to epithelial lining of vein wall causes platelets to aggregate & release clotting factors that cause fibrin in the blood to form a clot. superficial thrombophlebitis, dvt & pe


s/s: superficial: palpable induration fo affected vein, heat & redness along vein & pain & tenderness along vein | dvt: fever, chills, malaise, severe pain in affected extremity, sudden nonpitting edema of affected extremity, prominent superficial veins, erythema of affected extremity, cool, pale, edematous extremity


tx: anticoagulants, thrombolytics, venal caval filter to prevent PE, bed rest & elevation of extremity, warm moise soaks to the area, analgesics prn, thrombectomy

Front 201

venous thrombosis (nursing considerations)

Back 201

perform risk assessment for DVT on admissions. high risk pts admin prphylactic meds, admin anticoagulants & o2 therapy, measure girth of affected area, encourage ambulation when appropriate or limb exercise, elevate affected limb, mntr coagulation studies

Front 202

cardiac tamponade

Back 202

rapid, unchecked increase in pressure in pericardial sac. results from blood or fluid that accumulates in sac & compresses the heart which obstructs blood flow to ventricles & reduces amount of blood pumped


pulmonary artery wedge pressure (pawp) is typically increased. fever is not typical. s/s: falling bp, restlessness, & sob, narrowing pulse pressure



s/s: 3 classic signs (beck's triad)
1. elevated central venous pressure w/ jvd
2. muffled heart sounds due to fluid accumulation
3. pulsus paradoxus (drop in systemic bp > 15mmHg) due to arterial compression during inhalation


tx: o2, continuous ecg & hemodynamic mntrng, pericardiocentesis, pericardial window, pericardectomy, trial val lading w/ crystalloids, inotropic drugs, for post–traumatic injury (bld transfusion, thoracotomy, repair bldng), for heparin–induced tamponade (protamine sulfate), emergency resuscitation & for warfarin–induced tamponade (vit K)

Front 203

cardiac tamponade (nursing considerations)

Back 203

after pericardiocentesis: reduce anxiety, mntr bp & cvp during & after. IV solutions as ordered to maintain bp. decrease in cvp & concomitant increase in bp indicating relieve of cardiac compression, admin o2 as needed


after thoracotomy: antibiotic, protamine sulfate or vit k as ordered. post–op mntr vs, ABGs, heart & breath sounds.maintain chest drainage system

Front 204

iron deficiency anemia

Back 204

common world–wide. inadequate supply of iron for optimal formation of RBCs which produce small cells w/ less color on staining. insufficient iron stores lead to depletion of RBC mass & in turn decrease hemoglobin lvl & o2 carrying capacity of bld
causes: inadequate diet, iron malabsorption, bld loss, pregnancy, intravascular hemolysis & mechanical erythrocyte trama


s/s: fatigue, inability to concentrate, h/a, sob, increased infections, pica, numbness of extremities, dysphagia, hx of menorrhagia, vasomotor disturbances, neuralgic pain, red swollen smooth shiny & tender tongue, mouth may be eroded, tender & swollen, brittle nails, tachycardia, increased cardiac output & o2 sat < 90%


tx: iron replacement, parenteral iron, total–dose IV infusion of supplemental iron

Front 205

iron deficiency anemia (nursing considerations)

Back 205

provide o2 therapy prn, assess family dietary habits, nonirritating foods due to sore mouth & tongue, analgesics, pt's drug hx (pancreatic enzymes & vit E interfere w/ iron metabolism & absorption), provide fx rest periods, admin total dose IV infusions of iron dextran in NS over 8 hrs, z–track injection for iron IM to prevent skin discoloration scarring & irritation from iron

Front 206

megaloblastic anemia

Back 206

cause by incomplete formation of RBCs result in gin large # of immature & incompletely developed cells. results from a deficiency of vit B12 & folic acid & can be result of a lack of intrinsic factor


s/s:fatigue, muscle weakness, loss of appetite, wt loss, diarrhea, nausea, tachycardia, smooth or tender tongue, tingling in hands & feet


schilling test helps w/ dx (evals vit B12 absorption)

Front 207

pernicious anemia

Back 207

chronic, progressive, microcytic anemia caused by deficient intrinsic factor which prevents absorption of vit B12. RBCs are defective as they mature w/o intrinsic factor


s/s: tingling & paresthesia of hands & feet, wt loss, anorexia, dyspepsia


dx: bone marrow aspiration show increased megaloblasts, peripheral bld smear

Front 208

sickle cell anemia

Back 208

congenital hemolytic disease from defective hemoglobin molecule that cause RBCs to become sickle shaped


s/s: Developing after 6 mnths old, chronic fatigue, unexplained dyspnea, joint welling, ching bones, chest pain, ischemic leg ulcers, ^ susceptibility to infection, hx of pulmonary infarctions & cardiomegaly, jaundice or pallor, small for age appearance in children, growth & puberty delays, spiderlike body build (narrow shoulders & hips, long extremities, curved spine & barrel chest), tachycardia, hepatomegaly, systolic & diastolic murmurs & avascular necrosis

Front 209

sickle cell crisis

Back 209

hx of conditions or situations tat provoke hypoxia, sleepiness w/ difficulty waking up, severe pain, hematuria, pale lips tongue palms & nail beds, lethargy, istlessness & irritability, body temp > 104 or temp of 100 that persists for 2 days or longer


tx: polyvalent pneumococcal & haemophilus influenzae B vaccine, anti–infective, chelating agent, analgesics, iron supplements, hydroxyurea to increase hemoglobin level, prophylactic penicillin, transfusion of packed RBCs, hematopoietic cell transplantation using sibling donors (curative potential)

Front 210

acute sequestration crisis

Back 210

sedation & admin of analgesic, bld transfusion, o2 therapy, large amounts of oral or IV fluids

Front 211

sickle cell anemia (nursing considerations)

Back 211

HHOP: Heat, Hydration, Oxygen & Pain relief



in sudden development of painful priapism, reassure that episodes lasting 1–2 hrs are common w/o harmful effects, ensure pt receives adequate folic acid–rich foods & encourage adequate fluid intake to hydrate pt, warm compress on painful areas, bed rest w/ hob elevated to decrease tissue o2 demand, admin bld transfusions as ordered, w/ general anesthesia for sx, ensure pt received adequate ventilation to prevent hypoxic crisis, provide preop transfusion of packed RBCs prnpo

Front 212

polycythemia vera

Back 212

aka primary poplycythemia, erythema, polycythemia rubra vera splenomegalic polycythemia & vaquez–osler disease. chronic myeloproliferative disorder characterized by RBC mass, leukocytosis, thrombocytosis & increased hemoglobin level w/ norm or decreased plasma vol

increase in rbc concentration in blood (due to body attempting to improve o2 carrying capacity) thicker than normal blood. onset is gradual & runs chronic but slowly progressive course. mortality is high if unTXed


s/s: in early stages possibly no s/s, fullness in head, rushing in ears, tinnitus, h/a, dizziness, vertigo, epistaxis, night sweats, epigastric & join pain, scotomas, double & blurred vision, decreased urine output, pruritus, sense of abd fullness, pleuritic chest pain or L–upper quad pain


tx: phlebotomy therapy (350–500mL of bld can be removed till pt's hematocrit is reduced to low–norm values, myelosuppressive therapy, radioactive phosphorus or chemo, pheresis technology that allows removal of RBCs, WBCs & platelets individually or collectively, admin cyproheptadine & allopurinol to reduce serum uric acid lvl

Front 213

polycythemia (nursing considerations)

Back 213

keep pt active & ambulatory to prevent thrombosis, regularly examine for bleeding, give pt additional fluids to compensate for increased uric acid producion, small rx meals followed by rest period for those w/ symptomatic splenomegaly to prevent n&v, report acute abd pain immediately (may signal splenic infarction, renal calculus formation or abd thrombosis), check vs prior to phlebotomy & immediately following, have pt sit up for about 5 mins before walking to prevent vasovagal attack & orthostatic hypotension

Front 214

hemophilia/hemophilia A

Back 214

factor VIII deficiency, inhearied coagulation disorder. genetic disorder carried by females but mostly affects males

Front 215

christmas disease/hemophilia B

Back 215

factor IX deficiency, less common w/ similar s/s to hemophilia A

Front 216

disseminated intravascular coagulation disorder

Back 216

consumption coagulopathy. accelerates clotting which can cause hemorrhaging

Front 217

thrombocytopenia

Back 217

**most common coagulation disorder. lack of circulating platelets in bld. includes idiopathic thrombocytopenia


low bld platelet count, usually improves when underlying cause is TXed


causes of thrombocytopenia: enlarged spleen, condition that involves bone marrow, pregnancy, idiopathic thrombocytopenic purpura (itp), autoimmune diseases, bacteria in blood, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome, meds


s/s: easy or excessive bruising, superficial bleeding, prolonged bleeding, spontaneous bleeding from gums or nose, blood in urine or stools, unusually heavy menstrual flow, profuse bleeding during sx or after dental work

Front 218

von willebrand's disease

Back 218

hereditary disorder w/ prolonged bleeding time d/t clotting factor deficiency & impaired platelet function. most common hereditary coagulation disorder

Front 219

hypoprothrombinemia

Back 219

congenital deficiency of clotting factors that can lead to hemorrhage

Front 220

hemophilia C

Back 220

factor XI deficiency. afflicts 1 in 100,000 people & 2nd most common bleeding disorder among women

Front 221

factor VII deficiency

Back 221

serum prothrombin conversion accelerator (SPCA) deficiency. 1 in 500,000 people may be afflicted, often dx in newborns b/c bleeding into brain as result of traumatic delivery

Front 222

myoglobin test

Back 222

when elevated, first marker of cardiac injury following acute MI

Front 223

high–sensitivity C–reactive protein (hs–CRP)

Back 223

excess lvls may indicate increased risk of CAD

Front 224

HDL

Back 224

primarily protein


the higher the lvl the lower the risk of CAD

Front 225

LDL | VLDL

Back 225

primarily cholesterol | primarily triglycerides


the higher the LDL | VLDL lvl the higher the incidence of CAD

Front 226

triglycerides

Back 226

excess lvls identify hyperlipidemia in pts at risk for CADt

Front 227

total cholestrerol

Back 227

excess lvls may indicate hereditary lipid disorders, CAD

Front 228

A–type natriuretic peptide (ANP) & B–type natriuretic peptide (BNP)

Back 228

neurohormones produced from cardiac cells. help ensure cardiac equilibrium. disruption can trigger release of these hormones which act as natural diuretics & antihypertensives


***BNP help accurately dx & grade severity of heart failure***

Front 229

electrolytes

Back 229

K: 3.5–5 mEq/L (imbalance is life threatening)
NA: 135–145 mEq/L (low lvls indicate severe HF)
CA: 8.2–10.3 mg/dl (high lvls cause cardiac toxicity & arrhythmias)
Cl: 100–108 mEq/L (partners w/ NA, low lvls indicate HF & metabolic acidosis)
MG: 1.3–2.1 mg/dl (high lvls cause ECG changes, ventricular tachy & v fib. low lvls cause ECG changes, bradycardia & hypotension)
CO2: 23–30 mEq/L (bicarb, regulate kidneys, reduce thiazide diuretics)

Front 230

partial thromboplastin time, prothrombin time (pt) & activated clotting time

Back 230

measures response to tx as well as screens for clotting disorder

Front 231

international normalized ratio (INR)

Back 231

generally viewed as best standardized measurement of PT. used to mntr warfarin tx.


increased INR may indicate DIC, cirrhosis, hepatitis, vit K deficiency, salicylate intoxication or uncontrolled oral anticoagulation

Front 232

12–lead ECG

Back 232

can identify myocardial ischemia, MI, rhythm, conduction disturbances, chamber enlargement, electrolyte imbalances & drug toxicity

Front 233

exercise ECG

Back 233

assess heart's response to increased workload

Front 234

holter monitor

Back 234

ambulatory ECG. used to identify intermittent arrhythmias. usually 24 hrs (about 100,00 cardiac cycles)

Front 235

cardiac cath

Back 235

*assess coronary artery patency.


involves passing of cath through veins & arteries to measure heart chambers, lungs, blood flow btwn chambers, valve competence, cardiac wall contractility, artery pressures, intracardiac status, visualize coronary artery

Front 236

echocardiography

Back 236

uses ultra–high fx sound waves to help examine size, shape & motion of heart's structures. special transducer is place over pts chest


TEE (transesophageal echocardiography) combo w/ endoscopy. used to dx thoracic aortic disorders, endocarditis, congenital heart disease, intracardiac thrombi & tumors. *NPO 6 hrs pre–op, continuous mntring, not heavily sedated

Front 237

anticoagulants

Back 237

reduce blood's ability to clot. rx for mitral insufficiency & a fib or prevent clots in artery or vein


avoid vit K which can interfere w/ anticoagulation

Front 238

angiotensin II receptor blockers (ARBs)

Back 238

antihypertensive: inhibit vasoconstriction, protect against renal failure in pts w/ type 2 diabetes
routine blood work is required

Front 239

diuretics

Back 239

anti–htn: help kidneys excrete h2o & electrolytes which lower bp

Front 240

antilipemics

Back 240

lower cholesterol, triglyceride & phospholipid lvls. used in combo w/ lifestyle changes to decrease rick of CAD

Front 241

inotropics

Back 241

increase force of the heart's contractions

cardiac glycosides (slow heart rate & electrical impulse conduction through sinoatrial & AV nodes) & phosphodiesterase (PDE) inhibitors (short–term mngmnt of heart failure or long–term mngmnt for pts awaiting heart transplant sx)

Front 242

fibrinolytics

Back 242

can dissolve clot or thrombus that caused acute MI, ischemic stroke or peripheral artery occlusion or pe. they can dissolve thrombi & reestab bld flow in arteriovenous cannulas, grafts & IV cath

Front 243

ginseng (risk)

Back 243

can increase risk of digoxin toxicity & can decrease clotting time

Front 244

temporary transvenous pacemaker

Back 244

provides more reliable pacing beat. this type of pacing is more comfortable for the pt b/c the pacing wire is insereted in the heart via a major artery

Front 245

permanent pacing

Back 245

self–contained device surgically implanted under pt's skin. allow's pt's heart to beat on it's own but keep heartbeat from falling below a preset rate. pacemakers tx persistent bradyarrhythmias, complete heart block, congenital or generative heart disease, stokes–adams syndrome, wolff, parkinson–white syndrome & sick sinus syndrome


pacing electrodes can be placed in atria, ventricles or both

Front 246

implantable cardioverter–defibrillators (ICD)

Back 246

used for arrhythmia pacing, cardioversion & defibrillation. detects & terminates life–threatening episodes of v–tach & v–fib. some have the ability to pace atrium & ventricle & some perform biventricular pacing. leads are placed transvenously in endocardium of chambers and connects to generator box implanted in R or L upper chest near clavicle. if lethal rhythm is detected a shock is delivered to convert rhythm

Front 247

coronary artery bypass graft (CABG)

Back 247

surgery relieves symptoms of CAD & decreases rick of future heart attack or HF. performed either on pump or off pump (beating heart method or OPCAB). termed according to how many vessels are bypassed


monitor for complications of severe hypotension, decreased cardiac output & cardiogenic shock

Front 248

minimally invasive direct coronary artery bypass (midcab)

Back 248

performed on a beating heart through a small thoracotomy incision, pt receives only R lung ventilation & drugs to slow heart rate & reduce heart movement during sx. procedure is minimally invasive so fewer complications & shorter hospital stay


pts eligible: proximal L anterior descending lesions & some lesions of R coronary & circumflex arteries

Front 249

heart transplantation

Back 249

tx end–stage cardiac disease in pts who have poor quality of life & aren't expacted to survive for more than 6–12 months

pts must be TXed for rejection w/ monoconal antibodies & potent immunosuppressants that can increase the risk of life–threatening infection

Front 250

intra–aortic balloon pump conterpulsation (iabp)

Back 250

temporarily reduces L ventricular workload & improves coronary perfusion. tx cardiogenic shock caused by acute MI, septic shock, intractable angina before surgery, intractable ventricular arrythmias, ventricular septal or papillary muscle ruptures & pump failure

Front 251

enhance external counterpulsation (eecp)

Back 251

provides pain relief for pts who suffer from recurrent stable angina when standard tx fail. noninvasive, increases o2–rich blood flow to heart & reduces heart's workload. can reduced angina pain, improve exercise tolerance & stimulate collateral circulation

Front 252

percutaneous transluminal coronary angioplasty (ptca)

Back 252

angioplasty, nonsurgical alternative to CABG. performed in cardiac cath lab under local anesthesia involves balloon–tipped cath to dilate blocked coronary artery


pts usually recuperate quickly, walking same day, return to work in 2 wks

Front 253

valve tx

Back 253

prevent HF w/ valvular stenosis or insufficiency accompanied by severe, unmanageable symptoms


valvuloplasty (valvular repair), commissurotomy (separation of adherent, thickened leaflets of mitral valve), valve replacement (w/ mechanical or prosthetic valve)


can cause serious complications: hemorrhage, stroke, bacterial endocarditis, valve dysfunction or failure.

Front 254

percutaneous balloon valvuloplasty

Back 254

used when valve surgery isn't an option. used to enlarge orifice of stenotic heart valve

Front 255

aortic endovascular stent graft

Back 255

used to repair abd aortic aneurysm & other aneurysmal arteries by reinforcing vessel walls. fluoroscopic guidance is used to insert a delivery cath w/ an attached compressed graft through a small incision into the iliac or femoral artery. cath is advanced into aorta & positioned across aneurysm below the renal arteries.
helps present aneurysm from enlarging & possibly rupturing

Front 256

arterial bypass graft

Back 256

serves to bypass arterial obstruction resulting from arteriosclerosise

Front 257

embolectomy

Back 257

remove an embolism from artery by balloon–tipped indwelling cath in artery & passing it through embolus, inflates balloon & w/draws cath to remove occlusion

Front 258

vena caval filter

Back 258

umbrella traps emboli originating from pelvis or LE in vena cava preventing them from reaching pulmonary vessels but allowing venous blood flow

Front 259

ventricular assist device (VAD)

Back 259

implantable device that consists of a bld pump, cannulas & pneumatic or electrical drive console. pump is synchronized to pt's electrocardiogram & functions as heart's ventricle. decreases heart's workload while increasing cardiac output

Front 260

subjective hx

Back 260

chest pain, persistent fatigue, dyspnea, palpatations, syncope

Front 261

objective hx

Back 261

diet, meds, past illness, personal habits, health hx

Front 262

priorities

Back 262

set based on assessment of pt needs

Front 263

expected outcomes

Back 263

care r/t to health promotion, health maintenance & health restoration

Front 264

nursing interventions

Back 264

on basis of estab standards to help pt move toward expected outcomes

Front 265

implementation for cardiac nursing measures to...

Back 265

improve circulation, cardiac output, increase o2 supply & decrease o2 demand, maintain bld vol, prevent complications,

Front 266

systole

Back 266

action of heart chambers becoming smaller & ejecting blood


time between s1 & s2

Front 267

normal conduction route of heart

Back 267

SA node AV node to bundle of HIS to purknje fibers

Front 268

apical (PMI)

Back 268

left midclavicular line of chest wall @ 5th intercostal space. usually palpable. heart at first heart sound, lasting for only half of systole

Front 269

myocardium

Back 269

responsible for pumping action of heart

Front 270

afterload

Back 270

influences stroke volume

arterial vasoconstriction increases systemic vascular resistance which increases afterload

Front 271

following MI (fear of resuming sexual activity)

Back 271

physiologic demands of sexual activity are equivalent to walking up 2 flights of stairs

Front 272

peripheral & central cyanosis

Back 272

peripheral: nails, lilps, earlobes & extremities
central: tongue & buccal mucosa

Front 273

pulse pressure

Back 273

difference between systolic & diastolic pressure

Front 274

diastole

Back 274

time between s2 & s1

Front 275

exercise stress test

Back 275

up to 4 hr fast required, avoid stimulants prior


positive result: ST segment depression (ECG changes)

Front 276

hypo/hypervolemia | central venous pressure monitoring

Back 276

hypovolemia may cause decreased CVP
hypervolemia may cause increased CVP

Front 277

pulmonary artery pressure monitoring (PAPM)

Back 277

assess L ventricular function, dx etiology of shock & evaluating pt's response to medical interventions like fluid fluid admin & vasoactive meds

Front 278

systemic arterial pressure monitoring (SAPM)

Back 278

continually monitors BP

Front 279

heart sounds

Back 279

s1 & s2 are norm & s3 could indicate L ventricular failure which is life threatening

s3: heart w/ heart failure from increased filling pressure

s3 gallop: best heard w/ bell & when pt is lying on L side
s4: caused by resistance to ventricular filling
murmur: turbulent blood flow across valves

Front 280

cardiac health

Back 280

exercise 3–4 times a week

Front 281

friction rub

Back 281

classic sign of pericarditis


auscultate: use diaphragm of stethoscope & have pt sit up & lean forward

Front 282

blood specimen for lipid profile

Back 282

should be obtained after 12 hr fast. routinely done in morning

Front 283

prolonged uncontrolled htn

Back 283

can result in renal failure, MI, stroke, impaired vision, L ventricular hypertrophy, & cardiac failure

Front 284

chlorothiazide

Back 284

alcohol can potentiate SE of postural hypotension

Front 285

smoking

Back 285

doesn't not cause HTN but increase risk of heart disease

Front 286

spironolactone (aldactone)

Back 286

K–sparing diuretic, puts should avoid salt substitutes b/c they are high in K

Front 287

NY heart association classification of heart failure

Back 287

class I: ordinary physical activity doesn't cause undue fatigue, dyspnea, palpitations or chest pain
class II: slight limitations w/ ADLs but symptoms present w/ increased physical activity
class III: marked limitations on ADLs
class IV: cardiac insufficiency at rest

Front 288

sleeping w/ heart failure

Back 288

cardiac workload is decreased & renal perfusion is increased & GFR is increased which may lead to nocturia

Front 289

how to reduce venous return to heart

Back 289

upright w/ LEs dependent

Front 290

sodium bicarb

Back 290

initial dose is 1mEq/kg IV

Front 291

pulsus paradoxus

Back 291

systolic bp markedly lower during inhalation (exceeding 10 mmHg)

Front 292

v–fib or v–tach

Back 292

immediate defibrillation

Front 293

confirm placement of endotracheal tube

Back 293

primary: visualization of ET through vocal chords, auscultation of BS in 5 areas of chest or bilateral chest expansion (over R & L chest w/ airflow heard & over stomach w/ no airflow heard)


secondary: CO2 detector

Front 294

t–wave

Back 294

ventricular muscle depolarization, resting state

Front 295

QRS complex

Back 295

represents depolarization of ventricle (electrical activity of ventricle)

Front 296

calculate heart rate on ECG

Back 296

1500 divided by # of small boxes between R waves

Front 297

3rd degree AV block

Back 297

fewer QRS complexes than p waves

Front 298

atrial fibrillation

Back 298

s/s: palpitations, light–headedness, weakness & pulse deficit

loss of P waves w/ wavy baseline. QRS can be normal but heart rate ranges from 100–160bpm


loss of atrial kick which means approx 30% less cardiac output

Front 299

amiodarone

Back 299

promotes conversion to sinus rhythm


antidysrhythmic drug of choice for stable v–tach

Front 300

BP & Pulse Rate (indicate...)

Back 300

hemodynamic effect of dysrhythmias

Front 301

defibrillation

Back 301

maintain good contact between paddles & pt's skin to prevent arcing, apply appropriate conducting agent between skin & paddles, d–fib must be in non–sync mode, "all clear" must be called 3 times


NEVER attempted on pt w/ pulse



epinephrine is admin after 3 consecutive d–fibs to make it easier to convert dysrhythmia to normal sinus rhythm

Front 302

cryoablation therapy

Back 302

uses cooled probe to create small scar on endocardium to eliminate source of dysrhythmias.

Front 303

endocardium resection

Back 303

involves peeling away a specified area of endocardium

Front 304

electrical ablation

Back 304

uses shocks to eliminate area causing dysrhythmias

Front 305

radio frequency ablation

Back 305

uses high–fx sound waves to destroy area causing dysrhythmias

Front 306

cardiac conduction sx

Back 306

considered in pots who don't respond to TXs for atrial & ventricular tachycardia

Front 307

atrial flutter (stable, ARS narrow & R–R interval is regular

Back 307

6mg of adenosine may be rapidly admin followed by 20mL saline flush & elevate arm. if rhythm doesn't convert to sinus rhythm w/in 1–2 mins admin 12mg bolus & repeat if needed w/in 1–2 mins

if adenosine fails to convert rhythm or if R–R interval is irregular then admin magnesium, diltiazem or beta–blockers

Front 308

atrioventricular nodal reentry tachycardia [avnrt] (no response to vagal maneuvers & meds)

Back 308

cardioversion

Front 309

ventricular asystole

Back 309

TXed the same as pulseless electrical activity (PEA). focus on high quality CPR w/ minimal interruptions


CPR>intubation>epinepherine

Front 310

sinus bradycardia

Back 310

most common arrhythmia that occurs during endotracheal suctioning. vagal stimulation (vomiting, suctioning, severe pain & extreme emotions may cause sinus bradycardia)

when experiencing syncope, weakness & low bp, prepare to have pacemaker inserted

sinus & atrial rate of < 60


if pt suddenly develops bradycardia emergency pacing can be started w/ transcutaneous pacemaker which most defibrillators can now perform. if pt is alert, sedation & analgesia should be used

Front 311

ST segment

Back 311

represents early ventricular repolarization. analyzed to id whether it is above or below isoelectric line which may be a sign of cardiac ischemia

Front 312

catheter ablation therapy

Back 312

uses radio frequency energy to ablate or burn accessory pathways or ectopic sites in atria, AV node or ventricles that cause tachyarrhythmias

Front 313

decreased cardiac output r/t cardiac arrhythmias

Back 313

sudden drop in bp & symptoms of hypoxemia (decreased mentation, chest pain & dyspnea)

Front 314

ECG (pt prep)

Back 314

slightly abrade skin w/ a clean, dry gauze pad & place electrodes on body at specific areas. abrading enhances signal transmission

Front 315

raynaud's disease

Back 315

intermittent arteriolar vasoconstriction causing coldness, pain & pallor of fingertips or toes. best when one has control of environmental temp & avoid exposure to extreme weather

Front 316

arterial ulcers

Back 316

small, circular, deep ulcers usually on tips of toes or in web spaces between toes. pain w/ rest may be present. gangrene & pale wound bed`

Front 317

hydrocolloid dressing

Back 317

maintains a moist environment & promotes granulation but should NOT be used if ulcer is infected

Front 318

antiembolism stockings

Back 318

prevent DVT by forcing blood into the deep venous system instead of allowing it to pool

Front 319

venous ulcer

Back 319

mod – heavy exudate, irregular wound margins, superficial wound bed & ruddy granular tissue

Front 320

buerger's disease

Back 320

spasms of arteries & veins occur primarily in LE. nonatherosclerotic inflammatory vascular disorder, typically occurs in young men who are cigarette smokers


tobacco is highly detrimental to this disease b/c it is a powerful vasoconstrictor


s/s: toe & finger ischemia, advanced condition frequently have ulcerations on fingers & toes. complications include progressive ischemia leading to gangrene & amputatino

Front 321

virchow's triad

Back 321

characteristics that put pt at significant risk for DVT
1. venous stasis
2. vessel wall injury
3. altered blood coagulation

Front 322

cellulitis

Back 322

s/s: acute onset of swelling, localized redness, & pain. frequency associated w/ signs of fever, chills & sweating

Front 323

lymphangitis

Back 323

actue inflammation of lymphatic channels.characteristic red streaks that extend up arms or legs from infected wounds outlining the course of lymphatic vessels as they drain

Front 324

unstable angina vs acute MI

Back 324

acute MI involves myocardial cell death

Front 325

tissue perfusion (complications in elders)

Back 325

peripheral vascular resistance increases w/ age

Front 326

acute MI

Back 326

dysrhythmia is major cause of death
elevated ST segments in early phase indicate injury
ST depression indicate ischemia
Q waves reveal necrosis
ventricular dysrhythmia can indicate hypoxemia, hypokalemia or reperfusion following thrombolytic therapy

Front 327

major precipitating factor of endocarditis in the US

Back 327

IV drug use

Front 328

pt w/ heart disease experiences dyspnea

Back 328

this finding is not normal & indicates diminished cardiac reserve

Front 329

JVD

Back 329

jvd w/ HOB elevated indicates significant fluid overload

Front 330

patent ductus arteriosus (pda)

Back 330

significant murmur, signs of heart failure & bounding pulses

Front 331

ventricular septal defect

Back 331

will have symptoms of heart failure, abnormal ABGs, dusky skin color d/t pulmonary congestion

Front 332

negative chronotropic effect

Back 332

expected to decrease heart rate

Front 333

pain not relieved by nitro

Back 333

often associated w/ MI

Front 334

ventricular dysrhythmias

Back 334

most commonly caused by hypokalemia & hypoxemia

Front 335

niacin therapy

Back 335

helps to reduce LDL & raise HDL. can cause extreme flushing of the face, neck & ears. take 325mg of aspirin 30 mins prior to reduce flushing


ae: hyperglycemia

Front 336

heparin (antidote)

Back 336

antidote: protamine sulfate

Front 337

aspirin

Back 337

for post–MI pts to help prevent reinfarction by decreasing platelet aggregation

Front 338

BP cuff too large

Back 338

bp would be falsely low

Front 339

parasympathetic

Back 339

influences decrease heart rate & slow conduction through AV node

Front 340

transient ischemic attach (TIA)

Back 340

effects are temporary.TIA is a warning that there is a problem w/ perfusion to part of the brain. TIA should initiate investigation into cause of disruption in perfusion


nursing dx: ineffective peripheral tissue perfusion

Front 341

carotid disease

Back 341

meds: aspirin (anti–platelet), balloon angioplasty w/ carotid stenting,

Front 342

carotid endarterectomy

Back 342

plaque is surgically removed from carotid artery to reduce chance of stroke


priority assessment: ABCs, cranial nerve function assessment by checking for speech difficulty, facial symmetry, ability to show one's teeth, determine smells, shrug shoulders, swallow, etc

Front 343

subclavian steal syndrome

Back 343

occur if subclavian artery is obstructed, particularly if internal mammary is then used for bypass grafting in coronary artery bypass pt.may not be apparent till after bypass


s/s: dizziness, syncope & vertigo, bp difference of >20 mmHg between arms

Front 344

SA node

Back 344

located at junction of R atrium & superior vena cava. considered to be main pacer of heart rate

Front 345

av node (atrioventricular

Back 345

located in interventricular septum & receives impulse & transmits to bundle of his

Front 346

heart block

Back 346

conduction system of heart fails to conduct impulses normally. can occur from structural changes or toxic effects of drugs

assessed through ECG

Front 347

first–degree av block

Back 347

when sa node continues to function normally but transmission of impulse fails causing heart to beat irregularly


pts are usually asymptomatic & all impulses eventually reach ventricles

Front 348

second–degree heart block

Back 348

impulses reach ventricles but others don't

Front 349

third–degree heart block

Back 349

complete heart block


none of sinus impulses reach ventricle causing erratic heart rates where sinus node & av nodes are beating independently


results: hypotension, seizures, cerebral ischemia or cardiac arrest

Front 350

normal ECG

Back 350

//fce-study.netdna-ssl.com/2/images/upload-flashcards/54/87/87/11548787_m.jpeg

Front 351

v tach

Back 351

absence of p wave. usually exceeds 140–180bpm. lethal arrhythmia that leads to v fib.

tx: o2, amiodarone, procainamide, or mag sulfate to slow rate & stabilize rhythm

Front 352

v fib

Back 352

primary mechanism associated w/ sudden cardiac arrest
hypotension or lack of BP & heat sounds
tx: d fib. o2 & antidysrhythmic meds

Front 353

v fib

Back 353

primary mechanism associated w/ sudden cardiac arrest

hypotension or lack of BP & heart sounds

tx: d fib. o2 & antidysrhythmic meds

Front 354

normal sinus rhythm

Back 354

Front 355

pulmonary embolism

Back 355

positive d-dimer & ventilation/perfusion (v/q) indicate pulmonary embolus

Front 356

valvular heart disease (most common cause)

Back 356

rheumatic heart disease

Front 357

marfan's syndrome r/t cardio problems

Back 357

pts w/ marfan's syndrome have life threatening cardio problems (mitral valve prolapse, progressive dilation of aortic valve ring & weakened arterial walls. don't usually live past 40