Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
151 Cards in this Set
- Front
- Back
|
Acute coronary syndrome
|
(ACS) signs and symptoms that indicate unstable angina or acute myocardial infarction
|
|
|
angina pectoris
|
chest pain brought by myocardial ischemia
|
|
|
atheroma
|
fibrous cap of smooth muscle cells that forms over lipid deposits within arterial vessels and protrudes into the lumen of the vessel, narrowing the lumen and obstructing blood flow; also called plaque
|
|
|
atherosclerosis
|
abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and the lumen
|
|
|
contractility
|
ability of the cardiac muscle to shorten in responpse to an electrical impulse
|
|
|
coronary artery bypass graft
|
a surgical procedure in which a blood vessel from another part of the body is grafted onto the occluded coronary artery below the occlusion in such a way that blood flow bypasses the blockage
|
|
|
creatine kinase (CK)
|
an enzyme found in human tissue; one of the three types of CK is specific to heart muscle and may be used as an indicator of heart muscle injury
|
|
|
ischemia
|
insufficient tissue oxygenation
|
|
|
metabolic syndrome
|
a cluster of metabolic abnormalities including insulin resistance, obesity, dyslipidemia, and hypertension that increase the risk of cardiovascular disease
|
|
|
myocardial infarction
|
death of heart tissue caused by lack of oxygen
|
|
|
percutaneous coronary intervention (PCI)
|
an invasive procedure in which a catheter is placed in a coronary artery and one of several methods is employed to remove or reduce a blockage within the artery
|
|
|
percutaneous transluminal coronary angioplasty (PTCA)
|
a type of percutaneous coronary intervention in which a balloon is inflated within a coronary artery to break an atheroma and open the vessel lumen, improving coronary artery blood flow
|
|
|
stent
|
a woven mesh that provides structural support to a coronary artery blood flow
|
|
|
sudden cardiac death
|
abrupt cessation of the effective heart activity
|
|
|
thrombolytic
|
an agent or process that breaks down blood clots
|
|
|
troponin
|
myocardial protein; measurement is used to access heart muscle injury
|
|
|
pathophysiology of the cardiovascular disease called coronary atherosclerosis
|
an abnormal accumulation of lipid, or fatty substances in coronary arterial blood vessels from repeated inflammation leading to injury of vascular endothelium may be increased by smoking, hypertension and insulin resistance. This results in increase in platelets congregation. This develops into atheromas or plaque
|
|
|
thrombus
|
plaque in inflammed vascular endothelium may break of forming a thrombus which leads to acute coronary syndrome, may lead to myocardial infarction
|
|
|
other etiologies of heart disease?
|
vasospasm of a coronary artery, myocardial trauma from internal or external forces, structural disease, congenital anomalies, decreased oxygen supply (e.g. acute blood loss, anemia, or low blood pressure) and increased oxygen demand (e.g. from rapid heartrate, thyrotoxicosis, or use of cocaine)
|
|
|
Coronary Artery Disease manifestations (signs and symptoms)
|
Chest pain, shortness of breath, weakness and nausea, tachycardia and dizziness
By location and degree of narrowing of arterial lumen, thrombus formation, and obstruction of blood flow to the myocardium (ischemia) Angina pectoris is pain from myocardial ischemia |
|
|
Lessening of blood flow from heart causes
|
heart failure (where not enough blood supplied to body to support need)
heart stops pumping (sudden cardiac death) |
|
|
Atypical symptoms of Coronary Artery Disease
|
dyspnea, nausea and weakness
|
|
|
What risk factor besides metabolic syndrome increase chances for a heart attack?
|
Hypertension and smoking
|
|
|
Prevention of Coronary Artery Disease
|
Decrease saturated fats, LDL's, tryglicerides, carbohydrates, read meats, and increase fruits, vegetables, fibers, weight loss, excercise
Cessation of tobacco products (carbon monoxide, increased heart rate and blood pressure, and can injury vascular endothelium |
|
|
Hypertension management
|
risk of cardiovascular disease with blood pressure above 120/80 by increasing stiffness of vessel walls resulting in hypertrophy of cell walls and workload of left ventricle resulting in hypertrophy
|
|
|
Diabetes Mellitus management
|
Development of heart disease from diabetes is the most likely cause of death because hyperglycemia fosters dyslipidemia, increases platelet aggregation and altered red blood cell function
|
|
|
Angina pectoris phathophysiology
|
Develops from atherosclerotic disease that has large obstruction of a coronary artery
|
|
|
variant angina
|
pain at rest in middle of night
|
|
|
infractable or refractory angina
|
sever incapacitating chest pain
|
|
|
what causes angina
|
physical exertion, coldness, heavy meal, stress
|
|
|
What are the clinical manifestations of angina pectoris?
|
shortness of breath, pallor, diaphoresis, dizziness or lightheadness and nausea and vomiting
|
|
|
What is the treatment for angina pectoris?
|
Morphine to dull pain, Oxygen, Nitroglycerine if heart rate systolic above 90 mm HG, Asprin, Plavix, Heparin, Beta adrenergic and Calcium Channel Blockers to lower heart rate and blood pressure,
|
|
|
What is the nursing process for treating angina?
|
1. Stop all activity.
2. Assess PQRST 3. ECG 4. Nitroglycerin, Oxygen 5. Repeat 6. Address anxiety 7. Prevent Pain |
|
|
What teach patient with angina?
|
teach to take come to hospital if pain persists over fifteen minutes while taking nitroglycerin.
have a home nurse visit to ensure medicaiton therapy is being followed and monitor blood pressure and daily activities to prevent angina and reduce anxiety |
|
|
Pathophysiology of Acute Coronary Syndrome/MI
|
ACS emergent situation where unstable angina(preinfarction angina) where blockage to coronary artery is severe and leads to MI
Vasospasm, oxygen supply loss (blood loss, anemia, or low blood pressure) and increased oxygen demand( rapid heart rate, cocaine) |
|
|
Clinical manifestations of Myocardial Infarction
|
Chest pain, shortness of breath, indigestion, nausea, and anxiety
cool pale moist skin heart rate and respiratory rate faster than normal |
|
|
Nursing care plan
|
Assess patients history for angina pectoris, heart failure, Coronary artery disease
Apply 12 Lead ECG within 10 minutes of arrival to hospital CK MB, Troponin, Myoglobin |
|
|
What is a treatment for Acute Coronary Syndrome/MI
|
aspirin, IV bolus morphine(decrease pre and afterload of the heart decreasing workload and relaxes bronchioles to enhance oxygenation)(vascular response monitored for blood pressure and respiratory rate depression) , IV beta-blocker, ace inhibitor (diuresis which decreases oxygen demand on heart by reducing blood volume, thrombolytic therapy
|
|
|
How does thrombolytic therapy help an MI?
|
Dissolves (lyse) the thrombus in a coronary artery allowing reperfusion(blood flow again through artery)
Used when PCI's are not available Cause increase risk of bleeding so contraindicated for patients with bleeding problems, ischemic stroke, major surgery Minimize number of punctures to patient. |
|
|
Rehabilitation of cardiac patient after an MI?
|
CAD rehabilitation focuses on risk reduction by teaching patient to alter lifestyle, physical activity, diet, extending life and improving quality of life.
If excercising need to to stop when feel palpitations, dyspnea, weakness and fatigue from increasing heart rate too high (overdoing it) |
|
|
MI rehabilitation has a target heart rate of no more than?
|
20 mm Hg. During hospital stay an increase of 10%
|
|
|
Patients admitted to hospital for Acute Coronary Syndrome have what done first?
|
assessed for history of pain related to cardiovascular disease and given 2 iv lines for emergency bolus of medication.
|
|
|
What is the major goal for relieving an Myocardial Infarction?
|
1. Relief of pain or ishemic signs (eg. ST-segment changes) and
2. prevention of mycoardial damage 3. absence of respiratory dysfunction 4. Reduce anxiety |
|
|
What are complication of acute coronary syndrome?
|
pulmonary edema
heart failure cardiogenic shock dysrythmias and cardia arrest pericardial effusin and cardiac tamponade |
|
|
What is a percutaneous coronary interventions?
|
Percutaneous Transluminal Coronary Angioplasty which has a balloon inflate a stent in a coronary artery after a angiography is made from injected radioplaque contrast agent (dye) shows plaque formation in the coronary arteries.
|
|
|
What is the complications that can occur during a percutaneous transluminal coronary Angioplasty?
|
dissection, perforation, abrupt closure, or vasospasm of the coronary artery, acute MI, acute dysrhythmia (e.g. ventricular tachycardia) and cardiac arrest
|
|
|
Medications for post Cutaneous Transluminal Cardiac Angioplasty?
|
IV heparin or a thrombolic inhibitor (bivaliruding (angiomax) and closely monitored for bleeding
|
|
|
What intervention is necessary when sheath complication from a PCTA?
|
Patient must remain flat in bed and leg straight until the sheath is removed. Remove when clotting time is normal (heparin no longer active).
Atropine administered if heart rate and blood pressure decrease upon sheath removal by bolus atropine. |
|
|
When is CABG used over PCI?
|
when left ventricular dysfunction from coronary artery left 60 percent blockage), other coronary artery 70 % blockage, dysrhythmias, or heart failure
|
|
|
How does a CABG surgical operation work?
|
Saphenous greater or lesser is connected between the upper aorta and the coronary artery.
|
|
|
What monitor in patient after cardiac surgery?
|
Cardiac output by continuous monitoring of hear rate and rhythm, peripheral pulses (pedal, tibial, radial), systolic volume, ECG pattern.
Cardiac marker results Urine output every out (no less than 30 ml/h indicates renal perfusion |
|
|
What also monitor in post cardiac surgery patients?
|
buccal mucosa, nail beds, lips, earlobes, skin color, cyanosis, cool moist skin (vasoconstriction)
fluid and electrolyte imbalance impaired gas exchange impaired cerebral cirulation |
|
|
What is preload?
|
Amount of blood presented to left ventricular
|
|
|
What is afterload?
|
amount of resistance to ventricular ejection of blood
|
|
|
What is contractility?
|
the force of ventricular contraction which increase force when influenced by the hormone catecholamines from sympathetic nervous system
|
|
|
Beta blockers
|
carvedilol (Coreg) and metropolol (Lopressor, Toprol) reduce constant sympathetic stimulation of the heart by the CNS so reduces contractility in additon to ACE inhibitors (stop retaining sodium and water(aldosterone)),
Side effects are dizzyness, hypotension, and bradycardia. Dose slowly increased to correct therapeutic level (titrated) Teach patients may worsen during first few weeks of taking and improve after several weeks. Can cause bronchiole constriction |
|
|
Loop diuretics
|
furosemide (Lasix) inhibit sodium and chloride reabsoroption in ascending loop of Henle. Patients receive loop diuretics first. excrete potassium
|
|
|
Thiazide diuretics
|
metolazone (Zaroxylin) inhibit sodium and chloride reabsorption in distal tubule. excrete potassium
|
|
|
Spironalaction (Aldactone)
|
potassium sparing diuretic
|
|
|
What are blood vessels tissue?
|
intima, media, adventitia
|
|
|
What is a microcirculation?
|
arterioles and venules attached to capillaries
|
|
|
Veins ability to contract?
|
Greater than arteries because of thin cell walls
|
|
|
Veins all blood flow in one direction because of what?
|
capacitance vessels which has sympathetic nerve stimulated cells which can cause vein walls to contract to move blood and contraction of skeletal muscles. Some veins like arteries have one-way bicuspid valves that prevent blood backflow seeping backward at it is propelled toward the heart
|
|
|
What causes blood to flow from left side of heart to aorta and system?
|
difference in arterial pressure (100 mm Hg) greater then venous pressure (40 mm Hg)
|
|
|
What happens when inadequate peripheral blood flow occurs ?
|
left-sided heart failure causes accumulation of blood in the lungs and reduction of forward blood flow or cardiac output.
|
|
|
What happens when right sided heart failure occurs?
|
Venous congestion and forward flow reduction.
|
|
|
What can cause poor peripheral blood flow beside heart failure?
|
Poor patency from atherosclerotic plaque, thromboemobli, chemical or mechanical trauma, infections, or inflammatory process, vasospasitc disorders and congenitla malformaitons
|
|
|
What causes poor venous blood flow?
|
thromboemolus obstructing the vein, incompetent venous valves, or by a reduction of the surrounding muscles
|
|
|
What are the manifestations of circulatory insufficiency?
|
pain (intermitten claudation to sharp unrelenting constent), skin color changes (rubor, cyanosis), diminished pulse, and edemaq
|
|
|
What need assess in patient with insufficient blood flow?
|
History of pains and precipitating factors?
|
|
|
What is intermittent claudation?
|
inadequate blood flow in face of increased demand for oxygen (metabolic lactic acid produces causing pain)
|
|
|
What is an aneurysm?
|
an abnormal dilation of a blood vessel
|
|
|
What are the manifestations of an aneurysm?
|
dyspea, nausea and vomiting, sweating, tachycardia and numbness of extremities
|
|
|
What is the medical intervention for intermittent claudation?
|
increase walking distance till pain and then rest and then start again.
|
|
|
How can arterial blood flow be increased?
|
Arterial blood supply to a region can be improved by placing area blood the level of the heart.
Dilation Walking |
|
|
What must be avoided in patients with arterial insufficiency?
|
smoking
Cold air Constrictive clothing crossing Legs for more then 15 Minutes unadvised!!!! |
|
|
What is Buerger's Disease?
|
Inflammation of the intermediate and small arteries and veins of the upper and lower extremeties with thrombus formation and segmental occlusions of the vessels.
|
|
|
What is the clinical manifestations of Buerger's Disease?
|
microscopic appearance
pain bilateral and symetrical with focal lesions foot cramps cold sensitivity |
|
|
Assessment of Brueger's disease
|
assess for segmental limb blood pressures
severe difficulty walking |
|
|
Raynauld's phenomen is not Brueger's because why?
|
intermittent vasoconstriction primary or secondary
coldness pain pallor fingertips or toes |
|
|
Pathology of Deep Vein Thrombosis (DVT)
|
stasis of blood, injury to cell wall and altered blood coagulation
|
|
|
The stasis of blood occurs because why
|
congestive heart failure, veins dilated from medications or when skeletal muscle contraction is reduced as in immobility, paralysis or anesthesia
|
|
|
How do venous thrombus form?
|
platelet aggregation on vascular wall create a tail that grow
|
|
|
Nursing intervention of hypertension?
|
Regularly monitoring blood pressure frequently
for effectiveness of medications Complete history to assess and damage to target organs |
|
|
What are the clinical manifestations of hypertension?
|
anginal pain; shortness of breath; alterations in speech, vision, or balance; nosebleeds; headaches; dizziness; or nocturia
Rate, rhythm, and character of the apical and peripheral pulses Adherence to medication therapy (financial, social, personal interference) |
|
|
Complications of Hypertension
|
left ventricular hypertrophy
myocardial infarction heart failure TIAs Cardiovascular Accident (CVA, stroke, or brain attack) Renal insufficiency |
|
|
What is the goal for hypertension management?
|
lowering and controlling the blood pressure without adverse effects.
|
|
|
Patient teaching of hypertensive patients?
|
rebound hypertension of patients with sudden stopping of hypertensive medicaitons.
|
|
|
What is hematopoiesis?
|
Formation of new blood cells in the bone marrow to replace loss red blood cells or create new neutrophils to fight infection.
|
|
|
What creates new cells in marrow?
|
stem cells which can replicate by differentiation into myeloid (erythrocyte, lymphocyte or platelets) or lymphoid (T or B Lymphocytes)
|
|
|
What are red blood cells composed mostly of?
|
95 percent of hemoglobin for carrying oxygen
|
|
|
When have low red blood cells (anemia) erythropoietin hormone produce by kindneys signal more production of red blood cells which requires what ingredients?
|
B12, Iron, Folic Acid
|
|
|
What is homeostasis?
|
The process of preventing blood loss from intact vessels and of stopping bleeding from a severed bessel, which requries adequate numbers of functional platelts.
|
|
|
There are two steps in hemostatis?
|
step one is platelet aggregation
step two is the process of fibrin from coagulation outside the platelets to hold them in place |
|
|
Bone marrow aspiration?
|
from bone marrow in iliac crest and the sternum
skin is cleansed using aseptic technique |
|
|
anemia is a condition of which the hemoglobin concentration is lower than normal
|
hematocrit is percentage of blood volume consisting of erythrocytes
|
|
|
What causeses anemia from destruction of red blood cells?
|
Hemolysis of red blood cells or hemolytic anemia
|
|
|
What is a clinical manifestation of anemia?
|
Increase release of hemoglobin which results in increase bilirubin in blood shown up in tests.
|
|
|
what are the causes for hemolytic anemia?
|
Damage to bone marrow from medications, or chemicals or from lack of B12, folic acid, erythropoietin
|
|
|
Steps in assessment of anemia include?
|
Health history and physical examination about the type of anemia involved , the extent and type of symptoms it produces and the impact of those symptoms on the patient.
Weakness, fatigue, general malaise and pallor of hte skin and mucous membranes. tachycardia from low hemoglobin can lead to heartfailure, nutrional status, family history of anemias, alcoholic intake, athletic endeavors to avoid killing erythrocytes |
|
|
What is a symptom in megaloblastic anemia or hemolytic anemia?
|
jaundice
iron deficiency has smooth and red tongue or beefy red and sore in megaloblastic anemia |
|
|
A significant complication in megaloblastic anemia?
|
nueorological which clinical manifestation is numbness in lower feet and legs which gradually progresses. poor balance and position sense
|
|
|
Megaloblastic anemia has what clinical manifestations?
What test shows abnormal? |
abnormal large shaped erythrocytes (megaloblastic)
MCV shows high because RBC are large |
|
|
What causes folic acid deficiency?
|
low consumption of uncooked vegetables
|
|
|
What causes low B12?
|
diet low in meats and milk
|
|
|
What should nurse assess for in megaloblastic anemia?
|
gait, tongue redness, mild jaundice, and seen best in sclera, premature graying of the hair,
|
|
|
What is the pathophysiology of leukemia?
|
diminished level of either neutropenia(2000/mm3) - high risk for infection
shown on routing CBC with differential lymphocyte below 1500/mm3 from ionizing raditon, coriticsteroidsq |
|
|
What need assess in patient with neutropenia?
|
every system for infection (skin, oral, respiratory, GI, Urinary, Neurological and temperature
|
|
|
What is counter medication to anticoagulants?
|
Protamine Sulfate
|
|
|
What are the signs of reaction in transfussion?
|
fever, chills, backpain, respiratory distress, nausea and pain at IV site
|
|
|
The goal of nursing process in transfusions?
|
educate client on possibility of complications, prevent complicaitons, recognize complications, and stop treatment if complications occur
|
|
|
What do if patient has allergic reaction?
|
continue and give benadryl
|
|
|
What happens if have circulatory overload?
|
tachycardia, dyspnea, orthopnea, crackles in base of lung, jugular vein distenstion
must slow infusion and give diuretics if severe overload sit upright with feet in a dependent position and discontinue and notify physician. |
|
|
What is agnosia?
|
failure to recognize familiar objects
|
|
|
What is apraxia?
|
inability to perform previously learned purposeful motor acts on a voluntary basis
|
|
|
What is aphasia?
|
inability to express oneself or to understand language
|
|
|
dysarthria
|
defects of articulation due ot neurologic causes
|
|
|
expressive aphasia
|
inability to express onself; often associated with damage to the left frontal lobe area
|
|
|
hemianopsia
|
blindness of half ot he field of vision or both eyes
|
|
|
hemiplegia/hemiparasis
|
weakness/paralas of one side of the body, or part of it, due to an injurty of the motor area of the brain
|
|
|
penumbra region
|
area of low cerebral blood flow
|
|
|
receptive aphasia
|
inability to understand what someone else is saying; temporal lobe damage
|
|
|
ischemic stroke
|
vascular occlusion and sygnificant hypoperfusion occur
|
|
|
hemorrhagic stroke
|
extravasation of blood into the brain or subarachnoid space
|
|
|
brain attack or ischemic stroke, CVA l
|
loss of functioning result of disruption of blood supply to part of the brain
|
|
|
treatment of brain attack
|
3 hour window thrombolytic therapy
|
|
|
infarction
|
deprivation of blood supply to target tissue
|
|
|
lacunar stroke
|
small penetrating thrombotic strokes leave a cavity of dead tissue
|
|
|
cardiogenic embolic strokes
|
due to embolism from cardiovascular dysrhythmias
|
|
|
cardiogenic embolic strokes prevention
|
anticoagulants on patients with atrial fibrillation
|
|
|
brain attack
|
ischemic cascade after ischemia causing loss energy, acidosis of blood from no oxygen, calcium influx and cells cease to function (prenumbra region) around ischemic blood vessels needed to be saved
|
|
|
An ischemic stroke can cause
|
a number of neurological deficits depending on whre occurs in the brain
|
|
|
ischemic stroke clinical manifestations
|
hemiplegia
confusion dysarthria(muscles for speaking shot) aphasia(loss of speech) apraxia(inability performing learned tasks) visual disturbances (hemianopsia-half vision field) coordination headache agnosia(unable to recognize objects) |
|
|
What happens when damage frontal lobe?
|
learning, capacity, memory or other higher cortical intellectual functions (limited attention span, difficulty comprehending, forgetfulness and lack of motivation)
|
|
|
Nursing Process
|
1. Airway clearance (gagging)
2. Respiratory pattern normal 3. Cardiovascular status (blood pressure, cardiac rate and rhythm, carotid bruit) and gross neurological deficits. |
|
|
TIA
|
less than an hour
warning of an impending stroke loss of motor, sensory and visual function |
|
|
ER steps on a stroke or TIA admittance
|
1. Determine with a non contrast CT scan if ischemic or hemorrhagic stroke.
2. Look for source of thrombi or embolis if ischemic by 12 Lead ECG and carotid ultrasound or MRI of brain and neck |
|
|
Prevention of stroke best approach?
|
Healthy diet, normal weight, no smoking,
controlled diabetes, and hypertension |
|
|
What are modifiable risk factors for stroke?
|
smoking, weight, diabetes, hyperlipidemia, atrial fibrillation, and hypertension
|
|
|
atrial fibrillation and stroke
|
prevention of stroke by warfarin an anticoagulant
|
|
|
prevention of stroke by what medication
|
statins, ace inhibitors (prils) and thiazide diuretics
|
|
|
thrombolytic therapy
|
3 hours onset
ischemic not hemorrhagic stroke t-PA bind fibrin and convert plasminogen to plasmin stimulating fibrinolysis of the atherosclerotic lesion |
|
|
Nursing interventions of thrombolytic therapy
|
Vital signs every fifteen minutes for first two hours, every thirty minutes next six hours until 24 hours after treatment
Blood pressure goal below 190 systolic and 105 diastolic |
|
|
primary complication of carotid endartecomy
|
stroke, cranial nerve injuries infection or hematoma at the incision, and carotid artery disruption
postop maintain blood pressure (avoid hypotension- cerebral ischemia and thrombosis, hypertension cerebral hemorrhage, edema, hemorrhage at incision site cardiac monitoring because have high number of cardiovascular disease patients |
|
|
Assess post op carotid endarectomy
|
thrombis in brain causing neurological deficits to occur (weakness on one side of body) hard to swallow, hoarsness, facial vagus, spinal and hypoglass
edeam in neck |
|
|
Symptoms of a stroke
|
neck stiff eyes different sizes, face rainbow colors, hot extremities, pule and rate qualities, ability to speak, fluid ingested and urine volume 24 hours, bleeding, blood pressure within desired parameters
|
|
|
bladder control in ischemic patient
|
intermittent catheterization until muscles develop
bed pan or urinal offered for men standing on a schedule |
|
|
hemorrhagic stroke
|
intracranial or subarachnoid bleeding
primarily intracranial from hypertension sub arachnoid is from intracranial aneurysm |
|
|
symptoms of cerebral aneurysm
|
severe headache
loss of consciousness nuchal rigidity and spine pain visual loss, diplopia, ptosis tinnitus, dizziness and hemiparesis |
|
|
prevention of hemorrhagic anemia?
|
hypertension and alcohol
|
|
|
hyperproliferative anemia
|
In hypoproliferative anemias, there is an inability to produce an adequate number of erythrocytes in response to the appropriate stimulus.4
• In hyperproliferative anemias, the bone marrow is consistently producing RBCs, but they are destroyed in the periphery at a rate that is beyond the capacity of the bone marrow to replace.5 • Loss of blood causes a consequent reduction in the oxygen carrying ability of the blood. |
