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222 Cards in this Set
- Front
- Back
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Explain the Heart
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Four-chambered, hollow, muscular organ, not much bigger than a fist
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The heart lies...
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in the mediastinum
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Heart wall: three layers
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Epicardium: serous membrane on the outside of the heart
Myocardium: constructed of cardiac muscle Endocardium: lines the inner surface of the chambers of the heart |
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The heart carries how many gallons of blood each day?
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1,000 gallons of blood each day
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How many times per day does the heart beat?
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about 100,000
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Describe the heart chambers
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Right atrium—receives deoxygenated blood
Left atrium—receives oxygenated blood Right ventricle—pumps deoxygenated blood Left ventricle—pumps oxygenated blood |
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Describe the Heart valves
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Atrioventricular valves
Tricuspid and bicuspid valves Semilunar valves Pulmonary and aortic semilunar valves |
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What role is played by the valves?
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The valves open and close to let the blood flow in only one direction
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Electrical conduction system involves...
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Automaticity,Irritability, Impulse pattern
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Automaticity is
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An inherent ability of the heart muscle tissue to contract in a rhythmic pattern
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Irritability is...
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The ability to respond to a stimulus
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Impulse pattern
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Sinoatrial node to AV node to bundle of His to right and left bundle branches to Purkinje fibers
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What factors may influence the ability of the heart to demonstrate synchronicity between the contracting structures?
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anything that happens mechanically is preceded by electrical activity, therefore any factors that impair electrical implulse will effect mechanical activity.The SA node starts electrical activation by sending stimulation so the L and R atria have electrical depolorization (p-wave) then mechanical activity (such as the atria contracting) and the valves open up (mechanical activity) and the process will continue to electrically stimulate the rest of the heart
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What is the natural pace maker?
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The SA node (Sinoatrial node)
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Explain a complete heartbeat
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Atria contract while ventricles relax
Ventricles contract while atria relax |
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What is systole?
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Phase of contraction
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What is Diastole?
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Phase of relaxation
Period between contraction of the atria or ventricles during which the blood enters the relaxed chambers |
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When the heart is functioning as designed...
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there is coordination between contraction of the atria and ventricles. With each heartbeat cycle, there are the characteristic “lubb and dubb” sounds.
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What explanations could explain a heartbeat cycle without these tones or with modifications in these lub/dubb tones?
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an abnormal rhythm might result from heart disease or a malfunctioning in the heart's electrical system, little hisses, whooshes and other odd noises are usually the result of faulty valves in the heart
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What actions are responsible for lub/dubb tones?
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the opening and closing of the heart valves
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Blood vessels of the heart include...
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Capillaries
arteries veins |
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Capillaries
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Tiny blood vessels joining arterioles and venules
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arteries
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Large vessels carrying blood away from the heart
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veins
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Vessels that convey blood from the capillaries to the heart
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Coronary blood supply involves...
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The Right and left coronary arteries and Coronary veins
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Explain the Right and left coronary arteries in regards to blood supply
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Branch off of the aorta
Encircle the heart like a crown Supply the myocardium with blood |
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Explain the coronary veins in regards to blood supply
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Return the unoxygenated blood to the coronary sinus, then to the right atrium
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Systemic circulation
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Circulates blood from the left ventricle to all parts of the body and back to the right atrium
Carries oxygen and nutritive materials to all body tissues and removes products of metabolism |
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Pulmonary circulation
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Circulates blood from the right ventricle to the lungs and back to the left atrium of the heart
Carries deoxygenated blood to the lungs to be reoxygenated and removes the metabolic waste product, carbon dioxide |
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Diagnostic studies of a cardiovascular disorder can be divided into categories:
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visualization, assessment of conduction, and serum values.
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Describe the use of imaging in providing diagnostic information about the heart.
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radiographic examination of the chest provides a film rcord of the heart size, shape, and position, and outline of shadows.
-lung congestion is shown, indicating heart faliure -pleural effusion may be noted |
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Which of the tests (Diagnostic imaging, Cardiac catheterization and angiography, Electrocardiography,Thallium scanning ) will require a signed consent from the patient?
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cardiac cath
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Diagnostic imaging involves...
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Fluoroscopy-see movement of going on
Angiogram-visualization of the vessels Aortogram-visualization of the aorta |
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Cardiac monitors
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allows you to look at the heart from various places in the body
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Thallium scanning
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use of a thallium scan to look at the vessels
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Laboratory tests involve...
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CBC, blood cultures, coagulation studies, ESR electrolytes, lipids, arterial blood gases, cardiac markers
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Electrocardiogram (ECG)
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No prep
Studies the conduction system Electrodes placed on the skin pick up the electric impulses Placement of pads determines the area of the hearts electrical activity The cardiac cycle is represented by a wave ( P,Q,R,S |
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Prep for Cardiac Cath
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May be done as and outpatient
Chest x-ray, EKG, CBC, coagulation studies NPO or light breakfast Shave, & cleanse Check for allergies Total assessment Teach client Mild sedative may be given |
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Post care for cardiac cath...
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lie flat, bedrest, may use a closure device, vital signs, CMS, cath site
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An electrocardiogram involves the use of...
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electrodes to assess cardiac impulses with the heart’s conduction
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Nonmodifiable Risk factors for cardiovascular disease...
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Non-modifiable factors
Family history Age Sex (gender) Race |
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Modifiable risk factors for cardiovascular disease...
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Smoking
Hyperlipidemia Hypertension Diabetes mellitus Obesity Sedentary lifestyle Stress Oral contraceptives Psychosocial factors |
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What are Cardiac dysrhythmias
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Any cardiac rhythm that deviates from normal sinus rhythm
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Examples of Cardiac dysrhythmias
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Sinus tachycardia
*Sinus bradycardia* Supraventricular tachycardia Atrial fibrillation Atrioventricular block Premature ventricular contractions *Ventricular tachycardia* *Ventricular fibrillation* |
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What is cardiac arrest?
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The sudden cessation of cardiac output and circulatory process
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What are the causes of cardiac arrest?
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ventricular tachycardia, ventricular fibrillation, and ventricular asystole
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What are signs and symptoms of cardiac arrest?
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abrupt loss of consciousness with no response to stimuli; gasping respirations followed by apnea; absence of pulse and blood pressure; pupil dilation; pallor and cyanosis
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What are treatments for cardiac arrest?
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cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS)
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How much time can elapse between cardiac arrest and resuscitation before damage to vital organs and the accompanying loss of function result?
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Failure to restore a normal heart rhythm within 4 to 6 minutes can result in irreversible brain damage. After 10 minutes the survival rate may be only 2 percent-or less
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Outline the parameters of ACLS.
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ACLS includes
1. basic life support 2. the use of adjunctive equipment and special techniques for establishing and maintaining effective ventilation and circulation 3. ECG monitoring and dysrhythmia recognition 4. establishment therapies for emergency treatment of patient with cardiac or respiratory arrest; and 5. treatment of patient with suspected acute MI |
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A patient would revieve what if they are experiencing more than six PVC a minute
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lidocaine
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Coronary artery disease (CAD)
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A variety of conditions that obstruct blood flow in the coronary arteries
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Atherosclerosis
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A common arterial disorder characterized by yellowish plaques of cholesterol, lipids, and cellular debris in the inner layers of the walls of the arteries; the primary cause of atherosclerotic heart disease (ASHD)
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What influence does race and ethnicity have on the development of coronary artery disease?
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white, middle-aged men have the highest incidence of coronary artery disease
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What is angina pectoris?
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Cardiac muscle is deprived of oxygen
Increased workload on the heart |
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Angina Pectoris:
Clinical manifestations |
Pain (usually relieved by rest)
Dyspnea Anxiety; apprehension Diaphoresis Nausea |
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Angina Pectoris:
Nursing Interventions |
Correct cardiovascular risk factors
Avoid precipitating factors Medications |
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What are medications for angina pectoris?
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Dilate coronary arteries and decrease workload of heart
Nitroglycerin Beta-adrenergic blocking agents Calcium channel blockers |
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When a patient presents with an episode of suspected angina, what data should be collected by the nurse? What subjective data might the patient report?
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*the nurse should note the patients behavior such as rubbing the left arm or pressing a fist against the sternum, should monitor vital signs, increase resp. rate, pulse, and BP may be noted.<BR>subjective-statements abt location, intesity, duration, and radiation of pain. Precipitating factors, relief measures used, and if there has been any changes in severity and frequency.
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What diagnostic tests will be ordered to determine the cause of the patient’s complaints in regards to angina?
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* (made on the basis of the pts. history)
-electrocardiogram -holter monitoring -thallium 201 scanning and PET -coronary angiography |
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What are surgical interventions for a patient with angina pectoris?
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Coronary artery bypass graft (CABG)
Percutaneous transluminal coronary angioplasty (PTCA) Stent placement |
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At times, surgical intervention for angina pectoris can be indicated in conjunction with or in lieu of pharmacological therapies. What patients are candidates for the procedures?
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*
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Discuss the education that is needed for the patient undergoing CABG or PTCA.
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*-the PTCA patient will be required to sign a surgical consent for a CABG as well
-the PTCA pocedure will take one to two hours -PTCA pt will usually be awake and mildly sedated -PTCA pt. is monitored in the cardiac care unit usually for one day before dismissal to the med surg unit -total hospitalization stay is 1-3 days for PTCA; 4-6 for CABG -rapid return to work, usually 5-7 day;s 2-8 wks for CABG |
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What is myocardial infarction?
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Occlusion of a major coronary artery or one of its branches with subsequent necrosis of myocardium
Most common cause is atherosclerosis Ability of the cardiac muscle to contract and pump blood is impaired |
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Myocardial Infarction:
Clinical manifestations |
Asymptomatic (silent MI)
Pain (not relieved by rest, position, or nitroglycerin) Nausea SOB; dizziness; weakness Diaphoresis Pallor—ashen color Sense of impending doom |
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Myocardial Infarction:
Nursing Interventions |
Oxygen
Fibrinolytic agents Percutaneous transluminal coronary angioplasty (PTCA) Coronary artery bypass graft surgery Medications: vasopressors, analgesics, nitrates, beta-adrenergic blockers, calcium channel blockers, antidysrhythmics, diuretics, inotropic agents, diuretics, stool softeners |
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A myocardial infarction can result from...
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atherosclerosis, an embolus, or thrombus
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What factors will determine the degree of damage or loss of function experienced by the patient suffering from an MI?
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*Ischemia lasting more than 35-45 minutes producing cellular damage and necrosis
-the location of the occlusion and the extent of the tissure damage affect the patients response to injury |
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What manifestations can be anticipated in the patient’s vital signs when suffering from an MI?
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*typical vital signs reveal hyptotension, pulse abnormalities such as tachycardia, a barley perceptible pulse, and early temp elevation
-labored respiration -cardiac dysrhythmias |
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Describe nursing interventions and assessments that will be performed on a patient after they have suffered an MI
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*-oxygen is prescribed to facilitate cardiac tissue perfusion
-attention is given to respiratory difficulties, fluid overload, and cardiac dysrhythmias diagnostic tests are used to confirm the diagnosis; such as. serum tests, serum cardiac markers (tropin 1) -antiplatelets such as aspirin should be administered as well as stool softeners -bed rest for 24-48hrs -assist with ADL's -Increase activity gradually -diet withheld until pt. is stabilized -antiembolic stocking used -once pt can climb two flights of stairs they can have sexual intercourse |
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What is heart failure?
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Abnormal condition characterized by circulatory congestion resulting from the heart’s inability to act as an effective pump
Left ventricular failure Most common Right ventricular failure Usually caused by left ventricular failure |
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Heart failure was once known as congestive heart failure. This term is now considered somewhat antiquated. Why has this term been replaced in the medical community?
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*because it excludes patients who don't experience congestion
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Heart failure can result from chronic neurohormonal conditions or result from other medical conditions. What are examples of medical conditions associated with the development of heart failure?
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-may develop after an MI, in response to prolonged hypertension or diabetes mellitus, -or in relation to valvular heart disease -inflammatory heart disease -other factors include infection, stress, hyperthyroidsim, anemia, and fluid replacement therapy |
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Heart failure:
Clinical manifestations |
Decreased cardiac output
Fatigue Angina Anxiety; restlessness Oliguria Decreased GI motility Pale, cool skin Weight gain |
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In addition to the objective clinical manifestations of Heart Failure, the nurse is also responsible for assessing subjective patient reports. What questions can the nurse ask to facilitate the exchange of information?
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*if they have to sit or stand in order to breathe deeply (sign of orthopnea)
-if they are experiencing any sudden awakening from sleep because of shortness of breath (paroxysmal nocturnal dyspnea) -if they have had any weight gain |
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What are clinical manifestations for Left Ventricular Failure?
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Pulmonary congestion
Dyspnea Paroxysmal nocturnal dyspnea Cough; frothy, blood-tinged sputum Orthopnea Pulmonary crackles Pleural effusion (x-ray) |
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What are the implications of untreated left-sided heart failure?
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*patient may require specialized treatment strategies including mechanical circulatory support, continuous inotropic infusions, heart transplant, or hospice care. These patients are continuously hospitalized.
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What are clinical manifestations for Right Ventricular Failure?
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Distended jugular veins
Anorexia, nausea, and abdominal distention Liver enlargement Ascites Edema in feet, ankles, sacrum; may progress up the legs into thighs, external genitalia, and lower trunk |
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Right ventricular failure most commonly results from...
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effects of the failing left ventricle
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Heart Failure:
Nursing Interventions |
Increase cardiac efficiency
Bedrest, HOB elevated Oxygen Treat edema and pulmonary congestion Monitor fluid retention (weigh daily; strict I&O) |
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Increase cardiac efficiency involves..
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Digitalis
Vasodilators ACE inhibitors (decrease blood pressure) |
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Diagnosis of heart failure uses the presenting clinical manifestations and confirming tests such as...
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Chest radiographs, electrocardiograms, and echocardiography
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What findings on Chest radiographs, electrocardiograms, and echocardiography will support a heart failure diagnosis?
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*a chest tadiograph reveals pulmonary casvular congestion, pleural effusion, and cardiomegaly
-an ecg reveals cardiac dysrhythmias -an echocardiogram is used to determine ejection fraction |
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What is pulmonary edema?
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Accumulation of fluid in lung tissues and alveoli
Complication of congestive heart failure (CHF) |
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Clinical Manifestations:
Pulmonary Edema |
Restlessness
Agitation Disorientation Diaphoresis Dyspnea and tachypnea Tachycardia Pallor or cyanosis Cough—large amounts of blood-tinged, frothy sputum Wheezing, crackles Cold extremities |
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Nursing Interventions:
Pulmonary Edema |
*administer oxygen, place patient in an upright position with legs in dependent postion to decrease venous return to the heart. monitor blood gases and administer drugs as ordered.
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Pulmonary edema is caused by...
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Left-sided heart failure
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When pulmonary edema is suspected, what diagnostic tests can be used to confirm diagnosis?
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High Fowler’s or orthopnic position
Morphine sulfate Oxygen Nitroglycerin Diuretics Inotropic agents Vasodilators |
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The goal for management of Pulmonary Edema is...
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seek to increase oxygenation, improve cardiac output and reduce congestion
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What nursing diagnoses would be appropriate for the care of the patient diagnosed with pulmonary edema?
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-excess fluid volume r/t fluind accumulation in pulmonary vessels -impaired gas exchange r/t fluid in the lungs anxiety r/t fear of suffocating |
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What is Valvular heart disease?
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Heart valves are compromised and do not open and close properly
Stenosis Insufficiency |
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Causes of Valvular heart disease can be either...
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Congenital
Rheumatic fever |
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Clinical manifestations:
Valvular heart disease... |
Fatigue
Angina Oliguria Pale, cool skin Weight gain Restlessness Abnormal breath sounds Edema |
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What can cause stenosis of the valves?
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*Congenital heart defect
rheumatic fever calcium build up on the valves valvular heart disease |
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Discuss populations at risk for the development of valvular heart disease.
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*valvular disorders occur largely in children and adolescents primarilry from congenital conditions
also -individuals with a history of rheumatic fever, 10-40 yrs after having rheumatic fever |
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Nursing Interventions for Valvular heart disease
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Restrict activities
Sodium-restricted diet Diuretics Digoxin Antidysrhythmics Surgery Open mitral commissurotomy Valve replacement |
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Diagnostic tests used to confirm the presence of valvular heart disease:
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include radiographs, ECG, echocardiogram, and cardiac catherization.
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Initial management options for Valvular heart disease focus on:
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noninvasive interventions such as medications, diet, and activity restrictions. When these treatment modalities are no longer helpful, surgical intervention might be indicated.
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What is Rheumatic heart disease?
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Rheumatic fever
Inflammatory disease which is a delayed childhood reaction to inadequately treated childhood upper respiratory tract infection of beta-hemolytic streptococci Causes scar tissue in the heart |
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Explain Rheumatic heart disease's connection with Rheumatic fever....
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Rheumatic heart disease occurs after an individual has had rheumatic fever. The time span between the two disorders can be many years.
Since the 1980s, rheumatic fever has become increasingly uncommon in the United States. |
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Clinical manifestations:
Rheumatic heart disease |
Elevated temperature
Elevated heart rate Epistaxis Anemia Joint pain and stiffness Nodules on the joints Specific to valve affected Heart murmur |
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Explain the changes in the heart’s valves in response to the disease process of Rheumatic heart disease
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*the heart valves are typically the most affected by Aschoff's nodules and become fibrous and incompetent. With healing, the valves beocme thickeded and deformed which result in valvular stenosis and insufficiency
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What are the diagnostic tests for Rheumatic heart disease?
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There is no specific diagnostic test. Diagnosis is made by combining the clinical manifestations with supportive data from the test results. Tests include scanning studies and laboratory tests. An echocardiogram and ECG can be ordered.
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What laboratory tests can be ordered for Rhuematic heart disease?
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*no specific diagnostic tests exists for rheumatic fever
-an echocardiogram is done to determine the extent of damage to the valves and myocardium -an ecg shows cardiac dysrhythmia -sedimentation rate and leukocyte count will be elevated |
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Nursing Interventions:
Rheumatic Heart Disease |
Prevention
Treat infections rapidly and completely Bedrest NSAIDs Application of heat Well-balanced diet (supplement with vitamins B and C) Encourage fluids Commissurotomy or valve replacement |
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What is the role of the nurse in providing care to the patient diagnosed with rheumatic heart disease?
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*the focus of teaching is to facilitate an understanding of the disease process as well as the signs and symptoms
-if polyarthritis is present, the nurse helps minimize joint pain by proper positioning of the patient |
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What is the prognosis for the patient diagnosed with rheumatic heart disease?
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*prognosis depends upon involvement of the heart, carditis can result in a serious heart disease and valvular heart disease may also result
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What is Pericarditis?
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Inflammation of the membranous sac surrounding the heart
May be acute or chronic Bacterial, viral, or fungal Noninfectious conditions |
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What are noninfectious conditions R/T Pericarditis?
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Azotemia, MI, neoplasms, scleroderma, trauma, systemic lupus erythematosus (SLE), radiation, drugs
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Inflammation of the pericardium of the heart results in...
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thickening and constriction of the structure
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What alterations in functioning of the heart result whenthickening and constriction of the structure occur?
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*reduced cardiac output
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Clinical Manifestions:
Pericarditis? |
Debilitating pain
Dyspnea Fever Chills Diaphoresis Leukocytosis Pericardial friction rub Pericardial effusion |
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What questions concerning the characteristics and precipitating the pain’s onset are indicated in a patient with pericarditis?
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*Is the pain aggravated by lying supine, deep breathing, coughing, swallowing, and moving the trunk?
Is the pain relieved by sitting up and leaning forward? |
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Nursing Interventions:
Pericarditis |
Analgesia
Oxygen IV fluids Salicylates Antibiotics Antiinflammatory agents Corticosteroids Surgery: pericardial window, pericardial tap |
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What diagnostic tests are used to support the diagnosis of pericarditis?
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* ECG changes (dysrhythmias) will be noted
-echocardiography will show the presence of pericardial effusion or cardiac tamponade -lab studies will show leukocytosis and sedimentation rate will be elevated -chest radiographic studies are generally normal |
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What is a pericardial window?
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*A procedure in which an opening is made in the pericardium to drain fluid that has accumulated around the heart. A pericardial window can be made via a small incision below the end of the breastbone (sternum) or via a small incision between the ribs on the left side of the chest.
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What is a pericardial tap?
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*Pericardiocentesis, also called a pericardial tap, is an invasive procedure that involves using a needle and catheter to remove fluid (called a pericardial effusion) from the sac around the heart (the pericardium).
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What is endocarditis?
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Infection or inflammation of the inner membranous lining of the heart
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Clinical Manifestaions:
endocarditis |
Influenza-like symptoms
Petechiae on the conjunctiva, mouth, and legs Anemia Splinter hemorrhages under nails Weight loss Heart murmur |
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What events might precede the onset of endocarditis?
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*
-it may result from injury to the lining -an invasion of an organism -may develop after cardiac surgery -preceded by intrusive procedures such as dental procedures, monor surgery, gynecological exams, insertion of indwelling cath -those who "mainline" street drugs |
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What populations are at an increased risk for the development of endocarditis?
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*
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Nursing Interventions:
Endocarditis |
Bedrest
Antibiotics IV for 1-2 months Prophylactic antibiotics for “high-risk” patients Surgical repair of diseased valves or valve replacement |
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What are Diagnostic tests used for endocarditis?
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are ECG, chest radiography, complete blood count, erythrocyte sedimentation rate, and blood cultures
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What prognosis is associated with endocarditis?
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*prompt treatment with intensive antibiotic therapy will now cure about 90% of patients with this condition
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What is myocarditis?
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Inflammation of the myocardium
Rheumatic heart disease Viral, bacterial, or fungal infection Endocarditis Pericarditis |
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Why do dysrhythmias result with myocarditis?
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*Because there is an enlargement of the myocardium
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What prognosis is associated with endocarditis?
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*
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Clinical manifestations:
Myocarditis |
symptomatic
Vary according to site of infection Cardiac enlargement Murmur; gallop; tachycardia |
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What is myocarditis?
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Inflammation of the myocardium
Rheumatic heart disease Viral, bacterial, or fungal infection Endocarditis Pericarditis |
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Why do dysrhythmias result with myocarditis?
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*beccuase there is an enlargement of the myocardium
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Nursing Interventions:
Myocarditis |
Bedrest
Oxygen Antibiotics; antiinflammatory agents Assessment and correction of dysrhythmias |
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Clinical manifestations:
Myocarditis |
symptomatic
Vary according to site of infection Cardiac enlargement Murmur; gallop; tachycardia |
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What is Cardiomyopathy?
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A group of heart muscle diseases that primarily affects the structural or functional ability of the myocardium
Not associated with CAD, hypertension, vascular disease, or pulmonary disease Primary Secondary |
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Primary Cardiomyopathy is caused by?
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Unknown
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Nursing Interventions:
Myocarditis |
Bedrest
Oxygen Antibiotics; antiinflammatory agents Assessment and correction of dysrhythmias |
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What is Cardiomyopathy?
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A group of heart muscle diseases that primarily affects the structural or functional ability of the myocardium
Not associated with CAD, hypertension, vascular disease, or pulmonary disease Primary Secondary |
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Secondary Cardiomyopathy is caused by?
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Secondary—Infective, metabolic, nutritional, alcohol, peripartum, drugs, radiation, SLE, rheumatoid arthritis
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Primary Cardiomyopathy is subdivided by...
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type of damage
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Primary Cardiomyopathy is caused by?
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Unknown
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Subdivisions of Primary Cardiomyopathy include...
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dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy
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Secondary Cardiomyopathy is caused by?
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Secondary—Infective, metabolic, nutritional, alcohol, peripartum, drugs, radiation, SLE, rheumatoid arthritis
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Primary Cardiomyopathy is subdivided by...
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type of damage
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Subdivisions of Primary Cardiomyopathy include...
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dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy
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Primary Cardiomyopathy: Dilated cardiomyopathy...
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*characterized by ventricular dilation, the most common type of primary cardiomyopathy
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Primary Cardiomyopathy:
Hypertrophic Cardiomyopathy |
*results in increased size and mass of the heart becuase of increased muscle thickens and decreased ventricular size
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Primary Cardiomyopathy:
Restrictive Cardiomyopathy |
*the ventricular walls are rigid, thus limiting the ventricles ability to expand and resulting in impaired diastolic filling
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Clinical Manifestations:
Cardiomyopathy |
Angina
Syncope Fatigue Dyspnea on exertion Severe exercise intolerance Signs and symptoms of left- and right-sided CHF |
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Signs and Symptoms of Cardiomyopathy are similar to those seen in...
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heart failure
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The most common symptom of cardiomyopathy is...
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severe exercise intolerance
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Nursing Interventions:
Cardiomyopathy |
Treat underlying cause
Diuretics ACE inhibitors Beta-adrenergic blocking agents Internal defibrillator Cardiac transplant |
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What diagnostic tests can be anticipated for cardiomyopathy?
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*diagnostic studies include ECG, chest radiograph, echocardiogram, CT scan, nuclear imaging studies, multiple-gated radionuclide angiocardiography, cardiac cath, and endomyocardial biopsy
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What results will support a cardiomyopathy diagnosis?
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*the patient may have signs of both left-sided and right sided heart failure including dyspnea, peripheral edema, ascites, and hepatic dysfunction
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Explain Artierial Assessment: PATHCES
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P = Pulses
A = Appearance T = Temperature C = Capillary refill H = Hardness E = Edema S = Sensation |
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Arterial blood circulation refers to...
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to the blood being transported from the heart to the body
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Explain Venous assessment
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First symptom is usually edema
Dark pigmentation Dryness and scaling Ulcerations Pain, aching, and cramping Usually relieved by rest or elevation (pain is not as profound as in arterial) |
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Venous circulation involves
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the transportation of blood from the body’s tissues en route to the lungs
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Another common symptom of a disorder of the perepheral vascular symptom involves changes in skin appearance. What pathophysiology is responsible for this?
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*stasis of the blood from venous insufficiency causes darker pigmentation
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What differences exist between arterial and peripheral disorders?
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*
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Which disorder do you elevate your legs, venous disorders or Perepheral disorders?
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Venous
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In regards to Diagnostic tests for peripheral vascular disease, what are noninvasive procedures?
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Treadmill test
Plethysmography Digital subtraction angiography (DSA) Doppler ultrasound |
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In regards to Diagnostic tests for peripheral vascular disease, what are invasive procedures?
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Phlebography or venography
125 i-fibrinogen uptake test Angiography |
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The treadmill test is used to..
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evaluate blood flow in the extremities after exercise
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What education will need to be provided to the patient prior to the completion of the treadmill test?
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*
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A Doppler ultrasound can be used to...
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evaluate the blood flow in blood vessels
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What types of disorders can be detected by using the doppler test?
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*helpful in assessing intermittent claudication, obstruction of deep veins, and other disorders of peripheral veins and arteries
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What is Arteriosclerosis?
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Thickening, loss of elasticity, and calcification of arterial walls, resulting in decreased blood supply
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What is Atherosclerosis?
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Narrowing of the artery due to yellowish plaques of cholesterol, lipids, and cellular debris in the inner layers of the walls of large- and medium-sized arteries
A type of arteriosclerosis |
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What is hypertension?
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A sustained elevated systolic blood pressure greater than 140 mm Hg and/or a sustained elevated diastolic blood pressure greater than 90 mm Hg.
Vasoconstriction (increases blood pressure ) |
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Percentage of Essential (primary) hypertension?
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90-95% of all diagnosed cases
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What is Secondary hypertension?
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Attributed to an identifiable medical diagnosis
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A diagnosis of hypertension requires
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elevations in readings that meet the set criteria and are taken at different times
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Prehypertension is defined as
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a systolic blood pressure reading of 120-139 mm Hg or 80-89 mm Hg diastolic
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Clinical manifestations:
Hypertension |
Headache; blurred vision
Epistaxis Angina |
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Nursing Interventions:
Hypertension |
Antihypertensive medications; diuretics
Diet: weight control, reduction of saturated fats, and low sodium No smoking |
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What is Arteriosclerosis obliterans
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Narrowing or occlusion of the blood vessel with plaque formation—little or no blood flow to the affected extremity
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Clinical manifestations:
Arteriosclerosis obliterans |
Pain—intermittent claudication
Pulselessness Pallor Paresthesia Paralysis |
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When performing an assessment of the patient suspected of having arteriosclerosis what questions should the nurse ask to collect data?
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*does the pain occur with activity, and is it relieved by rest? Is the pain occuring at rest?
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Nursing Interventions:
Arteriosclerosis obliterans |
Anticoagulants
Fibrinolytics Surgery |
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Arteriosclerosis obliterans:
Surgery |
Embolectomy
Endarterectomy Arterial bypass Percutaneous transluminal angioplasty Amputation |
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Pharmacological agents used for Arteriosclerosis obliterans include
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anticoagulants, fibrinolytics, and vasodilators
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What is the mode of action that aids in the management of arteriosclerosis obliterans?
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*
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What are nursing interventions for an Arterial embolism?
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Anticoagulants
Fibrinolytics Endarterectomy Embolectomy |
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What is an Arterial aneurysm
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Enlarged, dilated portion of an artery
Causes: arteriosclerosis; trauma; congenital |
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Clinical manifestations:
Arterial aneurysm |
Asymptomatic
Large pulsating mass Pain, if large enough to press on other structures |
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What sites are more commonly associated with the development of an aneurysm?
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*aneurysms of the lower extremities acommobly affect the popliteal artery. Other areas are the thoracic and abdominal aorta as well as the coronary and cerebral arteries. the aorta is especially prone to aneurysms.
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What is an Arterial embolism
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Blood clots in the arterial bloodstream
May originate in the heart Foreign substances |
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Clinical manifestations:
Arterial embolism |
Pain
Absent distal pulses Pale, cool, and numb extremity Necrosis |
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When the emboli lodge in the vessels, what is a the chief symptom
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Pain
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Nursing Interventions:
Arterial embolism |
Assess for signs and symptoms of rupture, thrombi, ischemia
Control hypertension Surgery Ligation Grafts |
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Although aneurysms are largely asymptomatic, diagnostic tests are available to aid in the diagnostic process. What diagnostic tests will be anticipated if an aneurysm is suspected?
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*fluoroscopy, chest radiographic studies, CT scan, ultrasound, and arteriography are utilized to diagnose the presence of an aneurysm.
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What is Thromboangitis obliterans (Buerger’s disease)
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Occlusive vascular condition in which the small- and medium-sized arteries become inflamed and thrombotic
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Clinical manifestations:
Thromboangitis obliterans (Buerger’s disease) |
Pain; sensitivity to cold
Skin cold and pale Ulcerations on feet or hands; gangrene Superficial thrombophlebitis |
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Nursing Interventions:
Thromboangitis obliterans (Buerger’s disease) |
No smoking
Exercise to develop collateral circulation Surgery Amputation of gangrenous fingers and toes Sympathectomy |
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What population is most likely to be affected by Thromboangitis obliterans (Buerger’s disease)?
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*men btwn the ages of 25 and 40 yrs who smoke are usually those affected
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Discuss the prognosis of the patient diagnosed with thromboangiitis obliterans.
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*amputation may be necessary if the condition progresses to gangrene with chronic infection and extensive tissue destruction
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What is Raynaud’s disease?
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Intermittent arterial spasms
Primarily affects fingers, toes, ears, and nose Exposure to cold or emotional stress |
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Clinical manifestations:
Raynaud’s disease |
Chronically cold hands and feet
Pallor, coldness, numbness, cyanosis, and pain during spasms; erythema following a spasm Ulcerations on the fingers and toes |
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Nursing interventions:
Raynaud’s disease |
*educate the pt. on the effects of smoking, techiniques for stress reduction, and ways of avoiding exposure to cold
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The intermittent episodes of Raynaud’s disease result from...
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attacks of ischemia
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Raynauds may be primary or associated with other diseases including...
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scleroderma, rheumatoid arthritis, systemic lupus erythematosus, drug intoxication, and occupational trauma
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What populations are more likely to develop Raynauds?
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*it commonly affects women btwn 20-40 and is more prevalent during the winter months
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Nursing Interventions:
Raynauds |
No smoking
Avoid exposure to cold Medications Vasodilators Calcium antagonists Muscle relaxants Surgery: sympathectomy Amputation for gangrene |
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Diagnosis of Raynaud’s disease includes...
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a cold stimulation test
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What is involved in a cold stimulation test?
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*
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Pharmacological interventions for Raynaud’s disease often include...
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calcium channel blockers
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What education will assist the Raynauds patient to avoid episodes?
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*
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What is Thrombophlebitis?
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Inflammation of a vein in conjunction with the formation of a thrombus
Risk factors: venous stasis, hypercoagulability, trauma of a blood vessel, immobilization after surgery |
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Clinical manifestations:
Thrombophlebitis |
Pain
Edema Positive Homans’ sign Erythema, warmth, and tenderness along the vein |
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Nursing Interventions:
Superficial Thrombophlebitis |
Superficial
Bedrest Moist heat Elevate extremity NSAIDs Motrin Aspirin |
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Nursing Interventions:
Deep Thrombophlebitis |
Bedrest
Anticoagulants Fibrinolytics Elevate extremity Antiembolism stockings Surgery: thrombectomy; vena cava umbrella (Greenfield filter |
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What diagnostic tests will be used to confirm the presence of thrombophlebitis?
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*
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What are Varicose veins?
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Tortuous, dilated vein with incompetent valves
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Clinical manifestations:
Varicose veins |
Dark, raised, tortuous veins
Fatigue; dull aches Cramping of the muscles Heaviness or pressure of extremity Edema, pain, changes in skin color, and ulcerations with venous stasis |
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Nursing Interventions:
Varicose veins |
Elastic stockings
Rest Elevate legs Sclerotherapy Surgery Vein ligation and stripping |
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Varicose veins may be primary or secondary. Compare and contrast these types.
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*Primary-gradual onset and affect superficial veins
Secondary-affect deep veins and result from chronic venous insufficiency or venous thrombosis |
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What are Venous stasis ulcers?
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Ulcerations of the legs from chronic deep vein insufficiency and stasis of blood in the venous system of the legs
Open necrotic lesion due to an inadequate supply of oxygen-rich blood to the tissue |
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What are causes of Venous stasis ulcers?
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Varicose veins, burns, trauma, sickle cell anemia, diabetes mellitus, neurogenic disorders, and hereditary factors
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What are clinical manifestations of Venous stasis Ulcers?
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Pain
Ulceration with dark pigmentation Edema |
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Nursing Interventions:
Venous stasis Ulcers |
Diet: increased protein; vitamins A and C and zinc
Debridement of necrotic tissue Antibiotics Unna boot |
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Why are Venous stasis ulcers present a challenge to manage?
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The reduced blood flow to the area makes healing prolonged. Further, the populations most likely affected frequently have co-morbid conditions adding to this dilemma
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Discuss the types of debridement with Venous stasis ulcers
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* debridement may be mechanical, such as applying wet-to-dry dressings
chemical-use of enzyme ointment such as fibronolysin deoxyribonuclease surgical debridement using a scalpel is done when other measures are not successful |
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How is edema documented?
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*
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