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115 Cards in this Set
- Front
- Back
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Myocardial Infarction
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The obstruction of a coronary artery or one of its branches
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What does the obstruction of a coronary artery or one of the hearts branches result in?
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Death of the myocardial tissue supplied by that vessel.
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Why does the myocardial tissue die during an MI?
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Because of oxygen deprivation (infarction or necrosis)
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What depends on the hearts ability to regain or maintain its function after an MI?
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The location and size of the are of infarction.
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A myocardial infarction can occur when?
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Whenever a coronary artery or branch of the artery becomes occluded by a thrombus, emboli, or the atherosclerotic process.
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Signs and symptoms of a myocardial infarction:
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1. "Crushing" chest pain lasting longer than 15 minutes and unrelieved by rest or drugs.
2. SOB 3. N & V 4. Diaphoresis and pallor 5. Temp. rise after 48hr. 6. Tachycardia 7. Elevation of the cardiac enzymes. 8. Arrhythmias 9. Anxiety |
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Define Heart Failure
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The inability of the heart to function as a pump to meet the needs of the body.
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Heart Failure May Result From:
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Any condition that:
(1) impairs effective contration of the heart muscle. (2) Chronically increases the workload of the heart, or (3) acutley increases the workload of the heart. |
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What are the leading causes of heart failure?
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Hypertension and coronary heart disease with myocardial exchemia and myocardial infarction.
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The incidence of heart failure increases significantly with:
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Age; 10% or more of people age 75 or older are affected.
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Impaired function causes of heart failure:
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*Coronary heart disease
* Cardiomyopathies *Rheumatic Fever * Inefective endocarditis |
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Increase Workload causes of heart failure:
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* Hypertension
*Valve Disorders *Anemias *Congenital Heart Defects |
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Noncardiac Conditions of heart failure:
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* Volume Overload
*Hyperthyroidism * Fever/Infection * Pulmonary Embolus |
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Heart failure is often classified by:
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The primary pumping chamber affected.
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In heart failure which ventricle is more often affected and why?
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The left ventricle because of its high workload and oxygen demand.
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What does left sided heart failure result from?
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Ventricular muscle damage or overloading.
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What is the result of left ventricle deterioration?
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Cardiac output falls (forward effect)
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What is the result of impaired emptying of the left ventricle?
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Leads to increased pressures on the left side of the heart and in the pulmonary vascular system (backward effects)
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What is the result of increased pressure in the left ventricle
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Increased pressure pushes fluid from the blood vessels into interstitial tissues and the alveoli.
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The manifestations of left-sided heart failure result from?
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Pulmonary congestion and decreased cardiac output.
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What are early manifestations of left sided heart failure?
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* Fatigue
* Activity Intolerance * DOE * Inspiratory crackles * Wheezes * Orthpnea (breathing difficulty while lying down) |
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Define Acute Pulmonary Edema
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Accumulation of fluid in the interstitial spaces and alveoli of the lungs, that may occur with severe left ventricular failure.
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Signs and Symptoms of Acute Pulmonary Edema:
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* Acute and severe dyspnea
* SOB * Anxiety * Cool, clammy, cyanotic skin. * Productive cough with pink frothy sputum. * Crackles throught out lung fields. * As the condition worsens, breathing becomes more labored and lung sounds harsher. |
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What is the most common cause of Right Sided Heart Failure?
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Left Ventricular Failure
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Pathophysiology of Right Sided Heart Failure:
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Increased pressures in the pulmonary system or damage to the right ventricle impairs blood flow into the pulmonary circulation. the right ventricle and atrium become distended, and blood accumulates in the systemic venous system. Increased venous pressure leads to abdominal organ congestion and peripheral tissue edema.
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What is Viventricular Failure?
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When both ventricles fail to function adequately, the client has manifestations of both right and left sided or biventricular heart failure.
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Define Paroxysmal nocturnal dyspnea (PND)
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A frightening condition in which the client awakens at night acutely SOB.
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Paroxysmal Nocturnal Dyspnea (PND) occurs when:
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Edema fluid that has accumulated during the day is reabsorberd into the circulation at night, causing fluid overload and pulmonary congestion
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Acute Heart Failure Occurs As:
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A result of acute damage to the heart muscle, for example, resulting from a large acute myocardial infarction.
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Chronic Heart Failure Occurs As:
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developing gradually as the result of a long standing or progressive condtion such as hypertension or valve disease.
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Left-sided Heart failure leads to:
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Pulmonary congestion
Dyspnea Orthopnea Nonproductive cough that worsens at night Anxiety and restlessness Fatigue |
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Right sided failure may follow lfet side failure and result in:
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Systemic venous congestion
Weight gain caused by fluid accumulation in the tissues. Dependent edema in the from of anikle edema or sacral edema. Ascites caused by the collection of fluid in the abdominal cavity; (may hinder respirations) Fatigue GI symptoms Decreased urine output Distended neck veins (jugular) |
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Diagnostic Tests and Methods for heart failure:
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Pt. Hx and physical exam, including the findings of edema, abnormal heart sounds and the presence of crackles with dyspnea.
Chest x-ray exam. ABG's Live Function Tests Renal Function Studies. |
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Treatment of Chronic Heart Failure Includes:
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Drug therapy (digitalization, diuretics, and sedatives) Daily weight, I&O, O2 therapy, Hemodynamic monitoring, Restricting Fluids, Sodium restriction, Bed rest with progressive activity, elevating head of bed, monitoring vitals.
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Nursing Interventions for heart failure:
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Provide ongoing assessment, Monitor O2, record I&O, Dialy weight, Administer meds, determine activity that the pt can tolerate, Monitor for dependent edema, raise head of bed, Apply ted hose, have pt cough and deep breath, provide emotional support, educate pt. Fluid restrictions.
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Valvular stenosis results from:
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Cardiac Infections
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What is valvular stenosis?
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The valve leaflets become fibrotic and thicken and may even fuse together, thus hindering blood flow.
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When does valvular insufficiency occur?
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After repeated infections.
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What is Valvular insufficiency?
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When the valve leaflets become inflamed and scarred and can no longer close completely; the incomplete closure allows blood to leak from the left ventricle into the left atrium during systole.
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What is the result of valvular conditions?
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Blood flow through the heart is altered, resulting in decreased cardiac output, systemic and pulmonary congestion, and dilation of the heart chambers.
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Causes of Valvular Conditions?
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Rheumatic heart disease is the primary cause of valvular dysfunction. Other causes include syphilis, bacterial endocarditis, and congenital malformations.
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Signs and Symptoms of Mitral Stenosis:
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* DOE
* Orthopnea * Pink-tinged sputum * fatigue * Palpitations * Heart murmur |
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Signs and Symptoms of Mitral Insufficiency:
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* Fatigue
* DOE * Heart murmur * Orthopnea * Pulmonary Congestion |
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Signs and Symptoms of Aortic Stenosis:
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* Fatigue
* Angina * Syncope (Sudden brief loss of consciousness due to inadequate blood supply to the brain) * Heart murmur * Heart Failure |
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Signs and Symptoms of Aortic Insufficiency:
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* Palpitations
* Dyspnea * Fatigue * Orthopnea * Anginal pain occuring even at rest. |
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Diagnostic tests and methods for valvular conditions:
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* Physical exam, a murmur is a common finding.
* ECG *Chest x-ray to determine heart size. *Cardiac cath for pressure changes. * Echocardiogram for structure and function of valves. * Lab studies. |
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Treatment for Mitral Stenosis:
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1. Antibiotics administered prophylaxis (dental procedures)
2. Drug therapy: diuretics, cardiotonics, and antiarrhythmics. 3. Restricted Sodium Diet 4. Planned activity 5. Surgical correction |
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Treatments for Mitral insufficiency:
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1. Planned exercise
2. Sodium Restrictions 3. Drug therapy 2. Surgical Correction. |
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Treatment for Aortic Stenosis
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1. Prevention of infective endocarditis.
2. Treatment of Sx 3. Drug Therapy 4. Sodium restriction. 5. Valve replacement. |
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Nursing Interventions for Valvular conditions:
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Administer prescribed meds (watch for Side Effects), provide calm quit environment, Monitor vitals, Weigh daily, Provide prescribed diet, Monitor I&O, Educatione pt.
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What adverse effects of an ACE inhibitor should a nurse teach about?
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Dizziness, headache and hypotension are all common advers effects of ACE inhibitors.
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QRS complex of an ECG strip represents?
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Ventricular depolarization
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A client is recovering from an acute myocardial infarction. During the clients first week of recover the nurse should stay alert for which abnormal heart sound?
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Pericardial Friction Rub: Resulting from inflammation of the pericardial sac.
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The nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease should be to?
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Enhance myocardial oxygenation: enhancing myocardial oxygenaion is always the first priority when a client exhibits signs or symptoms of cardiac compromise.
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How long after oral administration should a nurse expect to see digoxins peak effect?
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2 to 6 hours.
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A client is admitted to the emergency department after complaining of acute chest pain radiating down his left arm. Which lab tests would be indicated?
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Creatinine phosphokinase (CPK)
Troponin T and troponin I Myoglobin: CPK, and Tropoinin T and I elevate because of cellular damage. Myoglobin elevation is an early indicaotr of myocardial damage. |
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In a client with chronic bronchitis what sign would leat the nurse to suspect right-sided heart failure.
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Leg edema: Right sided heart failure is characterized by signs of ciruclatory congestion, such as leg edema, jugular vein distention, and hepatomegaly.
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What mechanical device increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in the client with cardiogenic shock?
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Intra-aortic balloon pump:
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Which condition may arise with a person who has mitral stenosis?
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Pulmonary Hypertension: Mitral stenosis impdes blood flow through the stenotic valve, increasing pressure in the left atrium and pulmonary circulation.
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A client with left sided heart falilure complains of increasing SOB and is agitated and coughing up pink sputum. The nurse should recognize these findings as signs and symptoms of?
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Acute Pulmonary Edema:
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A nurse in the emergency department is caring for a client with acute heart failure. Which lab values is most important for the nurse to check before administering medications to treat heart failure?
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Potassium: Diuretics such as lasix are commonly used to treat acute heart falure. most diuretics increase the real excretion of potassium.
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Which sign or symptom suggest that a client's abdominal aortic aneruysm is extending?
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Increased abdominal and back pain: signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. BP would decrease.
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The most common site for aneurysm formation is in the.
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Abdominal aorta, just below the renal arteries.
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Definition of an aneurysm?
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the enlargement or ballooning of an artery, usually caused by trauma, congenital weakness, arteriosclerosis, or infection; aorta is the most frequently affected artery.
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What are the causes of aneurysms?
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Causes are varied, but the prime culprit is arteriosclerosis; plaque formation causes degenerative changes, leading to loss of vessel elasticity, weakness, and dilation. Syphilis, infections, congenital disorder, trauma.
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Risk factors for an aneurysm?
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Obesity, smoking, hypertension, stress, high blood cholesterol levels.
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Signs and Symptoms of an abdominal aneurysm?
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*Increased blood pressure
*Visible or palpable pulsating mass. *Pain or tenderness in the abdominal area |
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Signs and symptoms of a thoracic aneurysm?
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*Dyspnea
*Dysphagia *Hoarseness or cough *Severe chest pain |
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Signs and symptoms of a ruptured aneurysm?
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*Anxiety
*Restlessness *Pain *Diminished pulses *Hypotension and shock |
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Diagnostic tests and methods for an aneurysm?
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Patient history and physical exam, chest x-ray exam, ultrasonography, angiography, arteriography, routine ECG, lab studies.
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Conservative treatment measures for an aneurysm?
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Drug therapy: antihypertensives, pain relievers, and negative inotropic drugs.
Correction of hydration and electrolyte imbalances. Decreased activity. |
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Surgical repair aneurysm treatment:
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Resection and replacement with a prosthesis of teflo or dacron. Resection and replacement with a graft.
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Nursing interventions for an aneurysm?
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Provide immediate post op care which includes assess vital singsn and peripheral pulses, record I&O, compare extremities for warmth and color, administer IV fluids at prescribed rate, relieve pain with prescribed analgesic, monitor oxygen therapy, give prescribed prophylactic antibiotics as ordered, assess loc, auscultate lung sounds and bowel sounds at least every 4 hours, monitor for arrhythmias, have patiend turn C&DB.
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Other post op considerations for a person who had an aneurysm:
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Provide antiembolism stockings, provide emotional support, and allay anxiety, encourage early ambulation as prescribed, instruct patient to observe for changes in the extremities, such as color and warmth, instruct patient on assessments of peripheral pulses.
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Definition of myocardial infarction?
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The obstruction of a coronary artery or one of its branches.
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Diagnostic methods and tests for someone who has had a MI?
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Patient history and physical examination, ECG, Cardiac enzyme studies (troponin, SGOT, LDH, CPK-MB), chest x-rat exam.
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What is the treatment of someone who has had a MI?
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Analgesic drugs to relieve pain, oxygen to relieve resp distress, vasopressor drugs to prevent circulatory collapse (cardiogenic shock), cardiac monitoring to detect arrhythmias, hemodynamic monitoring: internal monitoring of the BP, and pulmonary artery pressure, bed rest with progressive activity to allow the damaged myocardium to heal, Iv fluids to provide for EV drug administration, cardio pulmonary resuscitation in the even to cardiac stand still, pacemaker insertion, anticoagulant therapy, thrombolytic therapy to dissolve blood clot and restore blood flow, nitrates.
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Nursing Interventions for someone with a MI?
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Administer oxygen and monitor, pain relief, vital signs, I&O during acute period, bed rest with progressive activity, antiembolism stockings, monitor pulse, stool softeners, caution pt, against straining to have a BM. Low sodium, low cholesterol, caffeine may be restricted, give prescribed antiarrhytmics and monitor for side effects.
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Complications to monitor for with a person that has had a myocardial infarction:
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Cardiogenic shock: circulatory collapse caused by decreased cardiac output; the vital organs are not being perfused.
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Nursing interventions to perform to monitor for complications: Cardiogenic Shock
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Monitor vital signs q 15 min., Record intake and output hourly, report changes in rate, rhythm, and conductivity, observe and report signs and symptoms of restlessness, diaphoresis, pallor, low blood pressure, and tachycardia, administer and monitor prescribed vasopressors and antiarrhythmics, administer o2, provide cardiac hemodynamic monitoring (hemodyynamic monitoring refers to the internal monitoring of BP and pulmonary artery pressure)
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Nursing interventions to perform when monitoring for pulmonary edema?
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Pulmonary edema: left ventricle failure caused by strain on diseased heart; cardiac output is reduced resultin in lung congestion. Observe and report symptoms of anxiety; dyspnea; orthopnea; frothy pink tinged sputum; crackle in the lungs; decreased urine output; and dependent edema. Record vital signs every 15 minutes, record I&O hourly, place bed in high Fowlers position, administer cardiotonics and diuretics as prescribed, adminster O2, provide emotional support.
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Definition of Rheumatoid Arthritis:
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A chronic, systemic disease in which inflammatory changes occur thoughout the body's connective tissue, destroying joints internally; joints most involved are hands, wrists, elbows, knees, and ankles.
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Pathology of Rheumatoid Arthritis:
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Cause is unknown; related thriories include autoimmune, microoranisms, viruses, and genetic predisposition.
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Subjective signs and symptoms of rheumatoid arthritis:
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Sore, swollen joint or joints, fatigue, weakness, malaise, loss of appetite, morning stiffness lasting less then 1 hour, joint pain.
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Objective Signs of Rheumatoid arthritis:
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Low grade fever, weakened grip, anemia, weight loss, subcutaneous nodes, enlarged lymph nodes, joint deformity, muscle atrophy, limited ROM, edema and tenderness of joint, extraarticular symptoms: lung, heart, blood vessels, muscle, eye and skin.
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Diagnostic tests and methods for rheumatoid arthritis:
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Elevated ESR (shows inflammation), slightly elevated WBC count, presenc of serum rheumatoid factors, syovial fluid aspirations, xray film to reveal joint deformity, low hemoglobin and hematocrit.
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Treatment for Rheumatoid arthritis:
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Antiinflammator agents, analgesics, corticosteroids, gold salts, antineoplastics (methotrexate), immunosuppressive drugs, heat applications, surgical interventions (remove damaged joints), physical therapy to maintain optimal function.
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Nursing interventions for rheumatoid arthritis:
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Provide undisturbe periods of rest- should receive 8 to 10 hours of sleep per night with frequent naps during the day, use firm mattress, foot boards, splints to maintain proper alignment, encourage self performance activites, assist with ROM.
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Definition of Osteoarthritis:
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A local joint disorder affecting weight bearing joints (hips, knees); results in disintegration of the cartilage covering the ends of bones.
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Pathology of osteoarthritis?
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Cause is unknown; predisposing factors include aging, joint trauma, and obesity.
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Signs and symptoms of osteoarthritis?
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Pain after exercise; relieved by rest, morning stiffness lasting less than an hour, muscle spasms, reduced strength, limite ROM, Crepitant joint, Prominent bony enlargement, Heberden's nodes are present at the distal joint of the fingers.
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Diagnostic test for osteoarthritis?
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Xray stucies reveal joint abnormalities.
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Treatment for osteoarthritis:
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Weight reduction to relieve pain, heat and massage for aching and stiffness, physical therapy to maintain optimum level of functioning.
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Drugs to relieve symptoms of osteoarthritis:
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Analgesics, antinflammatory agents, steroids.
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Nursing interventions for person with osteoarthritis:
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Provide moist heat, massage, and prescribed exercise, if ordered, to relax muscle and relieve stiffness or discomfort.
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Definition of Lupus:
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A chronic multisystem inflammatory disorder involving he connective tissues, such as the muscles, kidneys, heart and serous membranes; may affect the skin, lungs, and nervous system.
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Pathology of Lupus:
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Cause is unknown; believed to be an autoimmune disorder.
Inflammation produces fibroid deposits and structural changes in connectiv etissue of organs and blood vessels. Results in problems with mobility, oxygenation and elimination. |
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Signs and Symptoms of Lupus:
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abdominal, joint and muscle pain. Weakness, fatigue, depression, low grade fever, weight loss, butterfly skin rash over bidge of nose and cheeks which increases with exposure to sunlight, anemia, alopecia.
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Diagnostic tests for Lupus
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Positive LE test, elevated ESR, increased gamma globulin levels, positive antinuclear antibody titer, high anti dna test
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Treatment for person with Lupus:
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Corticosteroids, analgesics, and medications for anemia, the drug hydroxychlorouine is indicated in some individuals, avoidance of exposure to sunlight
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Nursing interventions for a person with Lupus:
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Provide emotional support, planned rest periods, avoid persons with infections, undue exposure to sunlight, emotional stress, which can cause exacerbations, encourage intake of food high in iron content: liver, shelfish, leafy vegetables, and enriched breads and cereals
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Osteoporosis definition:
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Metabolic bone disorder in which bone mass is decreased. Bones become weak and brittle. Prevention is crucial; adequate calcium intake must be maintained throughout life.
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Pathology of osteoporosis:
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Common in postmenopausal women, especially caucasian and asian individuals, may resulft of deficit of estrogen and androgens, prolonged immobilization, insufficent calcium intake or absorption, or endocrine disorders. Sites usually affected are vertebrae, pelvis, hip, writst, and femur.
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Signs and Symptoms of Osteoporosis:
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Bachache that worsens with sitting, standing, coughing, and sneezing, kyphosis, loss of height, pathological fractures.
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Diagnostic test for osteoporosis:
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Xray film reveals bone demineralization and compression of vertebrae.
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Treatment for osteoporosis
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Physical activity and exercise to prevent atrophy, estrogen replaacement to provide calcium balance, diet high in proteing and calcium, vitamin D supplements, support of spine with brace or corset, the medications Fosamax and Actonel are bone resorption inhibitor and are used to alleviate bone loss.
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Nursing interventions for osteoporosis:
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Encourage fluid intake to avoid formation of renal calculi, give instruction on food high in protein and calcium, emphasize need to follow prescribed daily activity and exercise, teach safety measures to protect from fractures.
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Cushing Syndrome Definition:
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Hyperactivity of the adrenal cortex.
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Pathology of cushing syndrome:
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Excessive cortisol is secreted, disorder results from abnormal growth of cortices or tumor on one of the glands, may occur because of pituitary gland dysfunction, causing excessive production of ACTH
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Signs and symptoms of cushing syndrome:
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weakness, bruises easily, amenorrhea, decreased libido, change in secondary sex characteristics, fat deposits to face, back of neck and abdomen, decreased muscle mass on limbs, unusual growth of body hair, purple striate over obese areas, impaired wound healing, hypertension, mood lability.
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Diagnostic tests for cushing syndrome:
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Increased plasma cortisol levels, ACTH stimulating test, cortisone suppression test.
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Treatment for Cushing Syndrome:
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Drugs to inhibit cortisol production, bilateral adrenalectomy, resection of pituitary gland, potassium supplements, diet with sodium restriction.
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Nursing interventions for Cushing Syndrome:
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Assist patient in adjusing to altered body image, place in noninfectious environment, maitain diet low in claories, carbs and sodium and high in potassium, weigh daily, monitor glucose and acetone levels, follow post op nursing action if patient undergoes adrenalectomy, instruc on self administration of replacement hormones and drugs.
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Defintion of Addisons Disease:
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hypofunction of adrenal cortex.
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Pathology of Addisons:
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As a result of dysfunction, adrenal cortex shrinks and atrophies.
Disorder usually originates within itself or may result from destruction of the adrenal cortex. Results in disturbances of sodium and potassium. |
