Nu 236 Exam 2 (Cardiac)-Diagnostic Test /thromboembolic D/o's

Front 1

DOPPLER FLOW STUDIES WITH DUPLEX IMAGING

Back 1

NONINVASIVE TEST
USES ULTRASOUND TO LISTEN FOR BLD VELOCITY IN THE VEINS
ASSESSES BLD FLOW DISTURBANCES

Front 2

IMPEDANCE PLYTHYSMOGRAPHY

Back 2

NONINVASIVE
DETECTS DVT
MEASURES ELECTRICAL RESISITANCE OF BLD TO DETECT CHANGES IN VENOUS VOLUME

Front 3

DOPPLER FLOW STUDIES WITH DUPLEX IMAGING

Back 3

NONINVASIVE TEST
USES ULTRASOUND TO LISTEN FOR BLD VELOCITY IN THE VEINS
ASSESSES BLD FLOW DISTURBANCES

Front 4

CONTRAST VENOGRAPHY
ALSO CALLED: (PHLEBOGRAPHY-VENOGRAM-PHLEBOGRAM)

Back 4

INVASIVE TEST
*GOLD STANDARD OF DETECTING DVT*
INJECTION OF RADIO-CONTRAST DYE INTO THE VENOUS SYS THROUGH A VEIN IN THE FOOT
-EXAMINES VEINS FOR EVIDENCE OF BLOCKAGE

Front 5

WHICH TESTS DETECT DVT?

Back 5

1.DOPPLER FLOW STUDIES W/DUPLEX IMAGING
2.IMPEDANCE PLETHYSMOGRAPHY
3.CONTRAST VENOGRAPHY

Front 6

WHICH TESTS DETECT PULMONARY EMBOLI?

Back 6

VENTILATION-PERFUSION SCAN
PULMONARY ANGIOGRAPHY

Front 7

WHICH TESTS DETECT ARTERIAL THROMBOSIS?

Back 7

ANGIOGRAPHY
CXR
ABG
ECG

Front 8

VENTILATION-PERFUSION SCAN

Back 8

LUNG SCAN
2 PART TEST USED TO DETECT VENTILATION ABNORMALITIES (EMPHYSEMA,TUMORS) AND PERFUSION (VASCULAR ABNORMALITIES)EXP:PULMONARY EMBOLUS)

Front 9

VENTILATION SCAN (PART 1 OF VENTILATION -PERFUSION SCAN)

Back 9

CLT BREATHES INHALATION OF AIR MIXED W/ RADIOACTIVE GAS
DELINEATES AREAS OF GAS DISTRIBUTION

Front 10

PERFUSION SCAN

Back 10

RADIOACTIVE DYE INJECTED INTRAVENOUSLY
X-RAY PICTURES TAKEN AT INTERVALS TO SEE HOW WELL THE DYE PERFUSED THE PULMONARY VASCULATURE;PERFUSION OF THE LUNGS

Front 11

VENTILATION-PERFUSION MISMATCH

Back 11

THE LUNG SCAN IS POSITIVE FOR PULMONARY EMBOLI...WHEN THE VENTILATION SCAN IS NORMAL IN AN AREA WHERE THERE IS DIMINISHED OR ABSENT BLD FLOW DEMONSTRATED ON THE PERFUSION SCAN

Front 12

PULMONARY ANGIOGRAPHY

Back 12

**GOLD STANDARD TEST FOR PULMONARY EMBOLI**
INVASIVE TEST
CONTRAST AGENT INJECTED INTO PULMONARY ARTERIAL SYS ALLOW VISUALZATION OF OBSTRUCTION TO BLD FLOW
USED WHEN LUNG SCAN IS NOT DIAGNOSTIC

Front 13

ANGIOGRAPHY

Back 13

DYE IS INJECTED INTO VESSELS TO DIAGNOSE ARTERIAL EMBOLI

Front 14

WHICH TEST IS USED TO MEASURE IMPAIRED GAS EXCHANGE?

Back 14

ABG
TESTS HYPOXEMIA WITH PULMONARY EMBOLUS

Front 15

PARTIAL THROMBOPLASTIN TIME (PTT)& ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)

Back 15

STAGE 1 CLOTTING TEST
USED TO MONITOR HEPARIN DRUG THERAPY
(APTT) IS MORE SPECIFIC

Front 16

NORMAL PTT:
NORMAL APTT:

Back 16

PTT IS 30-40 SEC
APTT IS 16-25 SEC

Front 17

NORMAL PTT:
NORMAL APTT:

Back 17

PTT IS 30-40 SEC
APTT IS 16-25 SEC

Front 18

PROTHROMBIN TIME (PROTIME,PT)

Back 18

MEASURES DEFECTS IN STAGE 2 OF CLOTTING MECHANISM
MONITORS COUMADIN (WARFARIN) DRUG THERAPY

Front 19

NORMAL PROTHOMBIN TIME (PROTIME,PT)

Back 19

11-16 SEC

Front 20

INTERNATIONAL NORMALIZED RATIO (INR)

Back 20

MEASURE USED TO MONITOR COUMADIN
IF ON COUMADIN TO ANTICOAGULATION DESIRE,THE INR TO BE BETWEEN 2.0 & 3.0

Front 21

THOMBIN TIME (TT)

Back 21

MEASURES DEFECTS OF DEFECTS IN STAGE 3 OF THE CLOTTING MECHANISM
**BEST FOR MONITORING THROMBOLYTIC DRUG THERAPY**

Front 22

NORMAL THROMBIN TIME (TT)

Back 22

7-12 SEC

Front 23

WHAT IS THE GOAL OF ANTICOAGULANTS?

Back 23

TO DELAY CLOTTING TIME
**ANTICOAGULANTS DO NOT DISSOLVE THE CLOT!!!***
AIM IN TXT IS TO REMOVE THROMBUS/EMBOLI

Front 24

HEPARIN

Back 24

CLASSIFICATION:ANTICOAGULANT
MECH OF ACTION:INHIBITS PROTHOMBIN TO THROMBIN IN STAGE 1 OF CLOTTING
USE:PREVENTION & TXT OF THROMBOEMBOLIC D/O
SAFE DOSE RANGE:MAINTAIN APTT 2-3 X'S THE PTS BASELINE APTT
ROUTE:PARENTAL,FIRST BOLUS 5,000 UNITS,
THEN CONTINUOUS DRIP TO MAINTAIN BLD LEVELS**GIVEN SUB Q**
(1000 UNITS/HR IV THEN TITRATED TO APTT
ADVSERSE EFFECTS:BLEEDING(ALL PARTS)
ANTAGONIST-PROTAMINE SULFATE IV**

Front 25

NURSING RESPONSIBILITES FOR HEPARIN

Back 25

1.OBTAIN APTT AS ORDERED-1ST DRAW IT EVERY 2-4 HRS,LATER EVERY 6 HRS
AND TITRATED IV INFUSION AS ORDERED
IV CONTINUED 5-7 DAYS
2.ASSESS FOR BLEEDING FROM ANY SITE ON BODY**HAVE PROTAMINE SULFATE READY**

Front 26

COUMADIN (WARFARIN)

Back 26

ANTICOAGULANT
MECH OF ACTION:ACTS ON LIVER TO INHIBIT SYNTHESIS OF VIT K
USE:LONG TERM TXT OF THROMBOEMBOLIC D/O
SAFE DOSE:MAINTAIN PT 1.5-2 X PTS BASELINE PT....INR 2.0-3.0
ROUTE:ORAL,GIVEN ONCE A DAY
ADV EFFECT:BLEEDING
ANTAGONIST: VIT K

Front 27

NURSING RESPONSIBILITIES FOR COUMADIN:

Back 27

1.OBTAIN PT AS ORDERED
EXPECT CLT TO BE ON BOTH HEPARIN & COUMADIN FOR 2-3 DAYS BEFORE STOPPING HEPARIN
2.ASSESS FOR BLEEDING
3.REMIND PT TO GET WEEKLY OR BIWEEKLY PT'S-PT MAY BE ON COUMADIN FOR REST OF LIFE

Front 28

PT EDUCATION FOR ANTICOAGULANTS:

Back 28

1.AVOID INJURY
2.USE ELECTRIC RAZOR
3.SOFT TOOTH BRUSH
4.WEAR MEDIC ALERT BRACELET
5.AVOID DRUGS THAT CAUSE BLEEDING(ASPIRIN)**

Front 29

THROMBOLYTIC THERAPY

Back 29

DRUGS THAN CAN LYSE AND DISSOLVE CLOT
MUST BE GIVEN W/IN CERTAIN TIME OF THE OCCLUSION
1.DOSAGE BASED OIN THROMBIN TIME
2.SIDE EFFECTS:BLEEDING
3.EXP:STREPTOKINASE,UROKINASE,rtPA
4.ANTAGONIST:AMINOCAPRIC ACID (AMICAR)

Front 30

RISK FACTORS FOR EMBOLI

Back 30

1.ARTERIAL:CARIAC DISEASE-ATRIAL FIBRILLATION
VASCULAR
ALTERED BLD COAGULABILITY
2.VENOUS:PULMONARY EMBOLI "VIRCHOWS TRIAD"
STASIS OF BLD "IMMOBILITY"
INJURY TO VESSEL WALL "IV INSERTION"

Front 31

WHO ARE THE PPL AT RISK FOR AN EMBOLI?

Back 31

SMOKERS,OBESE
OVER AGE OF 40
MALIGNANCY
PREGNANT,BIRTH CONTROL,PREV HISTORY OF EMBOLI
MAJOR SURGERY

Front 32

ASSESSMENT FOR ARTERIAL:
S/S

Back 32

1ST- CHECK PULSE AND COLOR
S/S:ACUTE SEVER PAIN-LACK OF O2,NUMBNESS
LOSS OF DISTAL PULSES
PALE,MOTTLED
LINE OF DEMARCATION

Front 33

S/S OF SUPERFICIAL THROMBOPHLEBITIS

Back 33

RED,WARM,TENDER

Front 34

S/S OF DVT:

Back 34

1/3 ASYMPTOMATIC
**UNEXPLAINED FEVER**
**CHANGE IN CIRCUMFERENCE OF CALF***
EDEMA,SWELLING,WARMTH,TACHYCARDIA
AS NURSE:SQEEZE CALF TO TEST
LOOK FOR TENDERNESS ON PALPATION

Front 35

PULMONARY S/S IF MAJOR:

Back 35

SHARP, STABBING CHEST PAIN
BREATHLESS
CARDIO-RESP ARREST

Front 36

S/S OF PULMONARY EMBOLUS IF SMALL:

Back 36

MILD DYSPNEA
MILD PAIN
HEMOPTYSIS
FEVER
TACHYCARDIA

Front 37

IF PT HAVING CHEST PAIN FROM PULMONARY EMBOLISM...WHAT IS TO BE DONE AS NURSE:

Back 37

1ST CHECK VS
YOU WILL NOTICE DECREASE IN BP & WHEEZES AND CRACKLES (RALES) IN ASSOCIATED AREA

Front 38

NURSING DIAGNOSIS FOR PULMONARY EMBOLSIM

Back 38

1.ALTERED TISSUE PERFUSION:
(PERIPHERAL/CARDIOPULMONARY)
2.INEFFECTIVE BREATHING PATTERN
3.IMPAIRED GAS EXCHANGE (ONLY IF ABG'S CHECKED 1ST !)*

Front 39

DIAGNOSTIC TEST FOR PULMONARY EMBOLISM

Back 39

DOPPLER FLOW STUDIES WITH DUPLEX IMAGING

Front 40

INTERVENTIONS FOR ALL EMBOLI:

Back 40

1.ANTICOAGULANT THERAPY
2.THROMBOLYTICS
2.BED REST (ARTERIAL-KEEP LEGS DOWN)
EMBOLECTOMY OR BYPASS SURG
(VENOUS-ELEVATE LEGS)

Front 41

INTERVENTIONS FOR THROMBOPHLEBITIS

Back 41

1.GIVE WARM PACKS
2.MILD ANALGESICS-TYLENOL
3.ELEVATE LEGS
4.MEASURE CALFS
GIVE:LOVENOX

Front 42

INTERVENTIONS FOR PE

Back 42

1.CARDIO RESP SUPPORT
2.VENA CAVA UMBRELLA (MECHANICAL FILTER)
3.GREENFIELD FILTER

Front 43

PREVENTION OF EMBOLI

Back 43

1.INCREASE FLUIDS-3,000 CC/DAY
2.LEG EXERCISES
3.ELASTIC STOCKINGS-PUT ON BEFORE GETTING OUT OF BED

Front 44

PROPHYLACTIC HEPARIN

Back 44

ADM SQ TO PTS AT RISK
5,000 UNITS SQ EVERY 2 HRS PRE OP
5,000 UNITS SQ EVERY 12 HRS
GIVEN IN ABDOMEN OR THIGH
DO NOT MASSAGE**

Front 45

WHAT ARE OTHER MEDS GIVEN FOR EMBOLI

Back 45

1.LOVENOX (ENOXAPRIN)-LOW MOLECULAR WT HEPARIN
SUPPRESSES PLATELET AGGREGATION
2.ASA-1 EVERY DAY
DECREAES PLATELET AGGREGATION
3.DIPYRIDAMOLE-PERSANTINE
4.COUGH & DEEP BREATH 10X Q HR