Nclex Review Cardio

Front 1

What is always a major consideration in the elderly and those on medications?

Back 1

vital signs especially orthostatic hypotension

Front 2

Where will I find the heart sound of the Aortic valve?

Back 2

2nd intercostal space (ICS), right sternal border

Front 3

Where will I find the heart sound of the Pulmonic valve?

Back 3

2nd ICS left sternal boarder (LSB)

Front 4

Where will I find the heart sound of the Tricuspid valve?

Back 4

4th ICS, LSB

Front 5

Where will I find the heart sound of the Mitral valve?

Back 5

5th ICS, midclavicular line

Front 6

Pnemonic to remember heart sounds in order?

Back 6

All (Aortic) Physicians (Pulmonic) Take (Tricuspid) Money (Mitral)

Front 7

What is S1?

Back 7

the closure of the MITRAL and TRICUSPID valves and heard loudest in those areas

Front 8

What is S2?

Back 8

the closure of the AORTIC and PULMONIC valves and heard loudest in those areas

Front 9

How many seconds is each small block on a rhythm strip?

Back 9

0.04 seconds, this may be used to determine intervals such as the PR interval or the duration of the QRS complex. If the complex is really small, adjust the gain or amplitude on the monitor

Front 10

What is a U wave?

Back 10

an extra bump seen after the T wave, when seen, it could mean hypokalemia or stroke

Front 11

What wave is the first part of the beat, which signifies the atria have contracted?

Back 11

P wave

Front 12

What does it mean if there is no P wave?

Back 12

there is a problem is with the SA node.

Front 13

If a question is about heart blocks where is the problem?

Back 13

AV node

Front 14

What is the PR interval?

Back 14

from the beginning of the P wave to the beginning of the QRS complex

Front 15

Normal time for the PR interval is?

Back 15

0.14 -0.20

Front 16

If the PR interval is greater then 0.20 the client has a?

Back 16

first degree block

Front 17

What is the tallest part of a rhythm strip and signifies the ventricles have contracted?

Back 17

The QRS complex

Front 18

Wide QRS complexes are associated with what?

Back 18

Hyperkalemia along with Tall Tented T waves

Front 19

Normal QRS rhythm is ?

Back 19

0.08-0.12

Front 20

The ST segment is the point where the end of the ______ and the _____ wave join.

Back 20

QRS and the T wave join.

Front 21

What does ST segment elevation signify?

Back 21

ischemia over the area of the infarction

Front 22

What is the bump seen after the QRS complex and signifies return to resting for the heart?

Back 22

The T wave

Front 23

Tall and peaked T waves can mean?

Back 23

hyperkalemia

Front 24

If you defibrillate on the T wave what would result?

Back 24

ventricular fibrillation can result

Front 25

QT interval is from the beginning of the ____ comples until the ____ of the _____

Back 25

QRS comples until the end of the T wave.

Front 26

If the QT interval is prolonged what is happening

Back 26

bradycardia and is seen with some medications and conditions

Front 27

Describe Asystole

Back 27

lack of rhythm with no QRS compleses, it may also be called cardiac standstill (flat line)

Front 28

What do you give to a client in Asystole

Back 28

Epinephrin and Atrophine to treat the rhythm, may also give sodium bicarbonate if prolonged.

Front 29

How soon with the client die in Asystole if not corrected

Back 29

8 minutes

Front 30

Describe Atrial Flutter

Back 30

Saw tooth pattern of the P wave ^^^^^^^^^^

Front 31

What is Atrial Flutter associated with

Back 31

stokes due to turbulent blood flow through the chambers and valves

Front 32

Describe Atrial Fibrillation

Back 32

Chaotic P waves are seen,

Front 33

What is Atrial Fibrillation associated with

Back 33

turbulent blood flow through the chambers and valves.

Front 34

What do you see with Ventricular Fibrillation

Back 34

Chaotic QRS complexes

Front 35

Is V Fib a lethal rhythm

Back 35

YES, die within 8 minutes if not correctd

Front 36

How do I treat V Fib

Back 36

Defibrillate

Front 37

What is the most common cause of death immediately after an acute MI

Back 37

V Fib, or V tachcardia

Front 38

What do you see with Ventricular Tachycardia

Back 38

Wide, bizarre QRSs

Front 39

Tx for Ventricular Tachycardia

Back 39

check the pulse if none treat like V Fib and Defibrillate, tx with xylocaine (Lidocaine) diluted with D5W

Front 40

Describe Premature Ventricular Contractions (PVCs)

Back 40

Periodice wide, bizarre QRS, premature beats followed by a compensatory pause

Front 41

When do I become concerned with PVCs

Back 41

more then 6 per minute, occure in pairs, are multifocal, fall on the T wave, or more then 6 in a row.

Front 42

What do PVCs signify

Back 42

ventricular irritablity, monitor the client, no treatement needed unless risk factors such as heart disease or more then 6 per minute, occure in pairs, are multifocal, fall on the T wave, or more then 6 in a row.

Front 43

Will PVCs cause palpitations in the client

Back 43

yes, feel for a pulse deficit when the beats occur

Front 44

Describe Supraventricular Tachycardia

Back 44

A rapid rhythm coming from above the ventricles

Front 45

Treatment for Supraventricular Tachycardia

Back 45

Give adenosine (Adenocard) and beta blockers to treat

Front 46

What is Hemodynamic monitoring

Back 46

invasive procedure which tells left heart function, a Swan Ganz catheter is inserted with the tip of the catheter positioned in the pulmonary artery

Front 47

What is PCWP

Back 47

Pulmonary artery wedge pressure and it is very significant

Front 48

Where is PCWP most accurate of

Back 48

most accurate assessment of the left ventricle

Front 49

Normal PCWP

Back 49

4-12 mmHg

Front 50

What could it be if client has a higher then 12 mmHg PCWP

Back 50

fluid overload, left ventricular failure, ischemia, mitral stenosis, cardiac tamponade

Front 51

What could it be if client has a lower the 4 mmHg PCWP

Back 51

dehydration

Front 52

What is CVP

Back 52

Central Venious Pressure, tells right heart funciton, increases and decreases simular to PCWP

Front 53

What is normal CVP

Back 53

2-8 mmHg

Front 54

Inotropic agents action

Back 54

increases the force of contract and perfusion to the organs. An increase in urine output would indicate an increased perfusion to the kidneys. Advisse the client to rest during the day to decrease the demands on the heart and prevent fatigue.

Front 55

Do inotropic agents control angina

Back 55

NO

Front 56

Side effect os Inotropic agents

Back 56

slow heart rate, do not give if HR is below 60 or above 120, call Dr. 1st

Front 57

Signs of toxicity with Inotropic agents

Back 57

N&V, diarrhea, bradycardia, heart block, halos in the visual field

Front 58

What potentiates the effects of digoxin (Inotropic agent)

Back 58

Hypokalemia, the clients level could be high normal in the presence of hypokalemia and toxic rhythms and symptoms may develop

Front 59

How is Digoxin excreted

Back 59

by the kidneys dosage must be DECREASED in renal dysfunciton

Front 60

What is the antidote for digoxin toxicity

Back 60

digoxin immune fab (Digibind)

Front 61

Action of Antidysrhythmics

Back 61

treat abnormal heart rhythms which can begin in the atria or the ventricles

Front 62

Side Effects of Antidysrhythmics

Back 62

Hypotension, Dizziness, Other dysrhythmias, Confusion especially in the elderly

Front 63

Side Effect with Quinidine gluconate (Quinaglute)

Back 63

Diarrhea, N&V, Loss of appetite, Dizziness

Front 64

Xylocaine (Lidocaine) which is an Antidysrhythmic can cause

Back 64

toxicity signs of it are SAMS S= Slurred or difficult speech, Paresthesi and numbness of the tongue and lips, A= Altered CNS with drowsiness, dizziness, restlessness, confusion, Arrhythmias, M= Muscle Twitching, tremors, S= Seizures and convusions, repiratory depression, cardiac arrest remember SAMS in trouble with Lidocaine

Front 65

Additional Antidysrhythmics

Back 65

Disopyramide (Norpace), Flecainide (Tambocar), Mexiletine HCL (Mexitil), Moricizine (Ethmozine), Procainamide (Pronestyl, Procan), Propafenone HCI (Rythmol), Tocainide (Tonocard), Acebutolol (Sectral, Monitan), Esmolol (Brevibloc), Metoprolol (Lopressor), Propranolol (Inderal), Sotalol (Betapace), Amiodarone (Cordarone), Dofetilide (Tikosyn), Diltiazem (Cardizem), Verapamil (Calan, Isoptin, Verelan)

Front 66

Action of Nitrates and Vasodilators

Back 66

Relax smooth muscles in the coronary arteries to increase blood supply to the heart muscle for better perfusion and to relieve chest pain. These drugs can also relax the blood vessels in the peripheral circulation to lower blood pressure and decreased preload and afterload to impove heart function. In otherwords it DECREASES Preload and Afterload.

Front 67

Side effects of Nitrates and Vasodilators

Back 67

Headache, Hypotension, Dizziness, Lightheadedness

Front 68

What do you know about Diazoxide (Hyperstat) a Nitrate/Vasodilator

Back 68

Fast acting with in one to five minutes of administration, duration of effect form 2-12 hours

Front 69

What do you know about Nitroprusside (Nipride) a Nitrate

Back 69

Must be protected from light, becomes unstable when exposed

Front 70

Nitrates

Back 70

Isosorbide dinitrate (Isordil, Sorbitrate), Isosorbide monoitrate (Imdur), Nitroglycernine, Pentaerythritol tetranitrate (Peritrate)

Front 71

Vasodilators

Back 71

Hydralazine (Apresoline), Minoxidil (Loniten, Rogaine), Sildenafil (Viagra)

Front 72

What is the action of Beta Blockers

Back 72

Block the effects of the sympathetic nervous system and can be used to treat abnormal rhythms, chest pain and can protect the heart after an acute MI, they DECREASE HR, BP, Cardiac Output, Myocardial Oxygen Consumption.

Front 73

Side Effects of Beta Blockers

Back 73

Hypotension, Bradycardia, SOB, Impotence, Decreased Libido, also can exacerbate Heart Failure, Asthma and Depression

Front 74

Beta Blockers

Back 74

Acebutolol (Sectral), Atenolol (Tenormin), Bisprolol (Zebeta), Metoprolol (Lopressor, Toprol), Carvedilol (Coreg), Nadolol (Corgard), Pindolol (Visken), Propranolol (Inderal)

Front 75

Calcium Channel Blockers Action

Back 75

Relax the blood vessels reducing blood pressure and improving blood flow. They also slow down the electrical conduction in the heart and can be used to control rapid dysrhythmias.

Front 76

Side Effects of Calcium Channel Blockers inclued the 5 H’s

Back 76

Hypotension, HA, Hot Flashes, Heart Block, Hard Bowel Movements

Front 77

When should I give Calcium Channel Blockers

Back 77

before meals and at bedtime

Front 78

Common Calcium Channel Blockers

Back 78

VERY = Verapamil (Calan, Isoptin, Verelan), NICE= Nifedipine (Adalat, Procardia), DRUGS= Diltiazem (Cardizem, Dilacore, Tiazac) others are Amlodipine (Norvasc), Bepridil (Vascor), Nicardipine (Cardene) (tend to end ind ipine)

Front 79

Angiotensin-converting enzyme (ACE) inhibitors use

Back 79

to control high blood pressure and help the heart funciton better in those with heart failure and after a heart attack

Front 80

Lab effects of ACE inhibitors

Back 80

Increase K+ and decrease WBC

Front 81

Side Effects of ACE Inhibitors

Back 81

Frequent cough, Angioedema (large tongue), HA, Fatigue, Hyperkalemia

Front 82

Common ACE Inhibitors

Back 82

(End in Pril) Benazepril (Lotensin), Captopril (Capoten), Enalapril (Vasotec), Enalapril plus thiazide (Vaseretic, Prinzide, Zestoretic), Fosinopril (Monopril), Linsinopril (Prinivil, Zestril), Moexipril (Univasc), Perindopril (Acenon), Quinapril (Accupril), Ramipril (Altace)

Front 83

Angiotensin II receptro blockers (ARBs) action

Back 83

work like the ACE inhibitors except they allow for an additional step in the drugs conversion which decreases the incidence of the side effects of a dry annoying cough.

Front 84

Common ARBs

Back 84

(End in artan) Candesartan (Atacand), Eposartan (Teveten), Irbesartan (Avapro), Losartan (Cozaar), Telmisartan (Micardis), Valsartan (Diovan)

Front 85

Alpha-blockers use

Back 85

to treat hypertension and benigh prostatic hypertrophy in men

Front 86

How do I give the 1st dose of an Alpha Blocker

Back 86

give at night due to can get first dose effect and get hypotension.

Front 87

Methyldopa (Aldomet) (Alpha-Blocker) what do you know about it

Back 87

can cause hepatotoxicity within 2-4 weeks of beginning the drub. Hemolytic anemia occurs in 4% of the clients.

Front 88

Common Alpha-Blockers

Back 88

Clonidine (Catapress), Doxazosin (Cardura), Mecamylamine HCL (Inversine), Prazosin (Minipress), Terazonsin (Hytrin), Guanabenz acetate (Wytensin), Guanfacine HCL (Tenex)

Front 89

Coagulation Modifiers action

Back 89

Antiplatelet and anticoagulants interfere with the formation of blood clots to prevent heart attacks, strokes, and DVT. Thrombolytics dissolve blood clots

Front 90

Side effect of Coagulation Modifiers

Back 90

bleeding

Front 91

What is a mainstay of the treatment for DVT

Back 91

Heparin

Front 92

How long should aspirin, coumadin and plavix be held prior to surgery

Back 92

minimum of 48 hours but 5 days is best

Front 93

What drug helps to protect the clients artivical heart valves after surgery

Back 93

Dipyridamile (Persantine)

Front 94

Common Antiplatelets

Back 94

Abciximab (ReoPro), Anagrelide (Agrylin), Cilostazol (Pletal), Clopidogrel bisulfate (Plavix), Dipyridamole and aspirin (Aggrenox), Eptifibatide (Ticlid), Tirofiban (Aggrastate), Treprostinil (Remodulin), Deltaparin (Fragmin), Danaparoid (Orgaran), Enoxaparin (Lovenox), Tinzaparin (Innohep), Anisindione (Miradon)

Front 95

Common Thrombolytics

Back 95

Alteplase (Activase, t-PA), Reteplase (Retavase), Streptokinase (Streptase, Kabikinase), Tenecteplase (TNKase)

Front 96

Antilipemic agents action

Back 96

Decrease the amount of LDL cholesterol in the blood stream and reduce the amount of plague deposits. Some agents can increase the amount of HDL cholesterol

Front 97

SE of Antilipemic agents

Back 97

Constipation, Heartburn, Bloating, Belching, Nausea, Lowers ADEK vitamins, Muscle Pain with Statin drugs, Headache, Vertigo, UTIs, Impotence, Formation of gallstones with Fibric acid derivatives Can increase liver enzymes

Front 98

Common HMG CoA reductase inhibitor (Statin Drugs)

Back 98

Atrovastatin (Lipitor), Fluvastatin (Lescol), Lovastatin (Mevacor), Pravastatin (Pravachol), Rosuvastatin (Crestor), Simvastatin (Zocor)

Front 99

Common Fibrin acid derivatives

Back 99

Clofibrate (Atromid-S), Fenofibrate (Tricor), Gemfibrozil (Lopid), Niacin

Front 100

Bile acid Sequestrants use

Back 100

they are a powder that I mix in water, may bind to other medications so give alone, Take 1 hours before or 4-6 hours after other meds

Front 101

Common Bile acid Sequestrants

Back 101

Cholestryramine (Questran), Colestipol (Colestid), Colesevelam (Welchol)

Front 102

Common Colony Stimulating Factors

Back 102

Erythropoietin (Epogen, Procrit) makes Erythrocytes (RBCs), Filgrastin (Neupogen) and pegfilgrastim (Neulasta) makes Neutrophils (WBC)

Front 103

What form can Colony Stimulating Factors be given

Back 103

SQ and IV

Front 104

SE of Colony Stimulating Factors

Back 104

hypertension and tachycardia

Front 105

What is Coronary artery disease

Back 105

Plague buildup resulting in a reduction of blood flow to the myocardium. Affected by blood cholesterol levels

Front 106

Target levels of Triglycerides

Back 106

less than 150

Front 107

Target levels of Cholesterol

Back 107

less than 200

Front 108

Target Levels of LDL

Back 108

less than 100 LDL for those with risk factors, less than 160 LDL for all others

Front 109

Target levels of VLDL

Back 109

less than 100 LDL for those with risk factors, less than 160 LDL for all others

Front 110

Target levels of HDL

Back 110

Greater than 40 for men, greater then 50 for women, greater than 60 for cardioprotection

Front 111

What is LDL

Back 111

cholesterol and protein

Front 112

What is VLDL

Back 112

triglyceride and protein

Front 113

What is HDL

Back 113

phospholipids and protein

Front 114

What is Angina

Back 114

Lack of blood supply to the myocardium causing pain in chest

Front 115

Stable Angina

Back 115

pain with a stable pattern

Front 116

What do unstable angina clients have

Back 116

cardiac insufficiency

Front 117

What type of angina occurs at night or at rest and is due to vasospasm of the coronary arteries

Back 117

Variant Angina

Front 118

What do you call damage to the myocardium resulting from an interruption of blood flow

Back 118

Acute myocardial infarction (AMI)

Front 119

Clinical manifestation of an MI

Back 119

Chest pain, pallor, cool, clammy, increased BP, dyspnea, Heart Failure, Fatigue, Weakness, N & V, Decreased LOC, Temp elevation

Front 120

What EKG changes will I see with an area of infaction

Back 120

irreversible damage, causes a Q wave to dip down on the EKG

Front 121

What EKG changes will I see with an area of injury

Back 121

Next to the infacted tissue, increase O2 to save the tissue, ST segment elevation or depression on the EKG

Front 122

What EKG changes will I see with an area of ischemia

Back 122

ST segment depression and T wave inversion on the EKG, will be next to injury tissue, increase O2 to save tissue, circulation is able to compensate

Front 123

Treatment of an MI

Back 123

O2, Nitro, Aspirin, Morphine in order for NCLEX and give thrombolytics within 1-4 hours from and AMI, BSC for BM inituall after an AMI

Front 124

What is a major factor in clients not to seek treatment for an MI

Back 124

denial

Front 125

What is a defense mechanism after an MI

Back 125

Noncompliance

Front 126

When can sexual relations begin after an AMI

Back 126

when the client can climb a flight of stairs without fatique or discomfort

Front 127

Complications of an AMI

Back 127

Dysrhythmias, Cardiogenic shock, Heart Failure, Recurrent MI

Front 128

Where is a Coronary Artery Bypass Graft taken from

Back 128

Saphenous vein in the leg

Front 129

What does a slow heart rate after heart surgey indicate

Back 129

heart block

Front 130

Expected chest tube drainage after 1st 2 hours of placement

Back 130

100 ml

Front 131

Expected chest tube drainage in 24 hours of placement

Back 131

500 ml

Front 132

What is Angioplast (PTCA)

Back 132

Ballon therapy to open up the arteries, angioplasty may be preceded by an angiogram when contrast dye is injected.

Front 133

What will a coronary artery angiogram and angioplasty due

Back 133

improve blood flow to the mycardium

Front 134

What will a femoral angiogram and angioplasty do

Back 134

improve blood flow to the leg

Front 135

What will an illiac artery angiogram and angioplasty do

Back 135

improve blood flow to the plevis and leg, if bleeding occurs after the proceudre, it causes blood to accumulate in the retroperitoneal area.

Front 136

What is a disorder of the mycardium that impaired venous return occures

Back 136

cardiomyopathy

Front 137

What is it called when a client has damage to their valves resulting in a murmur or necessitating a valve replacement

Back 137

Valvular heart disease

Front 138

What is it when the right atrial pressure is increase and enlarged and a systolic murmur is heard

Back 138

Tricuspid Regurgitation

Front 139

What is it when the left atrial pressure is increased and enlarged and diastolic murmur is heard

Back 139

Mitral Stenosis

Front 140

What is is called when the left atrial pressure is increased and enlarged and systolic murmur

Back 140

Mitral Regurgitation

Front 141

What is ic called when the left ventricular pressure is increased and enlarged and Systolic murmur

Back 141

Aortic Stenosis

Front 142

What type of valve needs Coumadin for life

Back 142

Mechanic Valve

Front 143

What is an inflammatory disorder which may develop after a Group A beta hemolytic streptococcal infection and can involve the heart, joints, skin and brain

Back 143

Rheumatic Fever

Front 144

Clinical manifestations of Rheumatic Fever

Back 144

Fever and histry of sore throat, Erythema Marginatium (red raised skin lesions starting on the trung and spreading outward, Chorea (involuntary movements of extremities and face), Carditis, Polyarthritis, Subcutaneious Nodules, Abdominal pain in some, will have a + ASO titer and increased ESR.

Front 145

Inflammation of all parts of the hear, especially the mitral valve

Back 145

carditis

Front 146

Complication of Rheumatic Fever

Back 146

Endocarditis

Front 147

Tx for Acute Phase of Rhumatic Fever

Back 147

Treat with antibiotics and bedrest Penacilin is 1st option if allergy then Erythromicin

Front 148

Inflammation of the inner lining of the heart incluing the vlaves

Back 148

Endocarditis two types

Front 149

Acute Endocarditis

Back 149

most often affects healthy people

Front 150

Subacute Endocarditis

Back 150

Usually have a pre-existing condition such as rheumatic heart disease, mitral valve prolapse, or immunosuppression

Front 151

Tx for endocarditis

Back 151

Hospitalization for 7-10 days

Front 152

Lesions on the heart valves increase the risk of

Back 152

microthrombi, erosion, or perforation of the valve, or absecessess in the mycardial tissue, ATB therapy is needed

Front 153

Failure of the heart to act as a pump

Back 153

heart failure, the heart cant pump in relation to the bodys needs, avoid sodium to decrease the work load of the heart

Front 154

Left sided heart failure proceeds _____

Back 154

right sided except in the case of pulmonary hypertension

Front 155

Left sided HF clinical manifestation

Back 155

Paroxysmal nocturnal dyspnea, Orthopnew, Dyspnea on exertion, Cough, Blood tinged sputum, Crackles, Wheezes, Restlessness, Confusion, Cyanosis, Increased HR, BP and PCWP.

Front 156

Right sided HF clinical manifestations

Back 156

Fatigue, Distended Jugular veins, swelling in hands and fingers, dependent edema, enlarged liver and spleen from increased pulmonary pressure due to long term repiratory acidioses, ascites, anorexia and complaints of GI distress

Front 157

Treatment of HF

Back 157

“UNLOAD FAST in heart failure” U= Upright postion, N= Nitrates, L = Lasix, O = Oxygen, A = Aminophylline, D = Digoxin F= Fluids reduced, A = Afterload reduction, S= Sodium restiction, T= tests include DIG level, ABGs, K+ level

Front 158

Fluid accumulation in the alveoli

Back 158

Pulmonary edema

Front 159

Clinical manifestations of Pulmonary Edema

Back 159

Extreme dyspnea, Suffocation feeling, Wheezing, Anxiety, Restlessness, Frothy Sputum, Diaphoresis, Pallor, Chest pain, Tachycardia, Palpitations, - put HOB 90 degrees

Front 160

Treatement for Pulmonary Edema

Back 160

“MAD DOG” M=Morphine, A=Aminophylline, D=Digitalis (Lanoxin), D=Diuretics (Lasix), O=Oxygen, G=ABGs (this is not in orde follow ABC rule for order)

Front 161

Inflammation of the pericardium

Back 161

Pericarditis

Front 162

Clinical Manifestations of Pericarditis

Back 162

Chest pain, Dyspnea when supine, low grade fever, ST segment elevation and T wave inversion, Weakness and fatigue, Dry cough, Dependent edeam

Front 163

Complcation of Pericarditis

Back 163

Pericardial Tamponade (a whole bunch fo fluid around the heart)

Front 164

Signs of Pericardial Tamponade

Back 164

Tachycardia, Hyptension, Paradoxial Pulse, Distant or muffled heart tones, Jugular vein distention

Front 165

Treatment of Pericardial Tamponade

Back 165

Pericardiocentesis, which drains the pericardial cavity

Front 166

An electronic device used to generate electrical activity for the heart

Back 166

Permanent pacemake, stimulates a normal heart beat

Front 167

What type of pacemaker Fires as needed when the heart rate slows down

Back 167

Synchronous (demand)

Front 168

What type of pacemaker Firsts at a constant rate and not in relation to demand by the heart, may be used briefly to evaluate pacemaker function

Back 168

Asyncrhonous pacemaker

Front 169

Device used to pace or defibrillate a client our of a dangerous dysrhythmia

Back 169

Implantable cardioverter defibrillator

Front 170

Nursing teaching relating to Implantable cardioverter defribrillator

Back 170

device may discharge for a dysrhythmia, avoid magnetic fields (warning signla will beep if near a magnet field), there will be activity restrictions after the device is place, avoid strenous activity, Driving may be restricted due to possible rhythm abnormalities and discharges

Front 171

Distended vains due to incompetent valves. Usually complain of heaviness in the legs

Back 171

Vericose Veins

Front 172

Tx for Varicose Veins

Back 172

Stripping and ligation procedure removes the dilated, superfical veins, bedrest for 24 hours with ambulation for 5-10 minutes every 2 hours after the procedure. Elastic compression of the leg for one week after surgery (not TED hose, but Ace bandages or jub hose)

Front 173

Formation of a blood clot in the deep vein

Back 173

Deep Vein Thrombosis

Front 174

Most commong sign is unilateral swelling of an extremity

Back 174

DVT, ambulation best prevention for lower leg DVT

Front 175

Teachings with DVT

Back 175

Activity limitaitons, never a pillow under the knee, heat to increase blood flow to promote dissolution of the clot, Heparin, Enoxaparin (Lovenox) and Warfarin (Coumadin) for drug therapy to prevent further clot formation. Remember will not dissolve the current clot but will prevent others from forming.

Front 176

Inability of the body to return blood from the distal cirucation due to incompetent valves or obstruction

Back 176

Venous insufficiency, varicose veins common in these clients

Front 177

What will I see with venous insuffienciency

Back 177

Thick, pigmented skin, elevation relieves pain, possible cyanosis when foot dependent, venous stasis ulcers are common, ankle swelling during the day, FOB should be elevated at night to promote venous return.

Front 178

Inability of the body to supply adequate blood flow due to vessel damage

Back 178

Arterial insufficiency know they can get arterial ulcers, intermittent claudication is the pain and cramping experience with activity which is relieved by rest

Front 179

Pale, shiny skin with decreased pulses, pale when elevated, red when dependent. Need to tell client to check pulses periodically

Back 179

signs of arterial insufficiency

Front 180

What will relieve pain in arterial insufficiency

Back 180

putting legs down

Front 181

What procedure is done to supply blood flow to a compromised extremity

Back 181

femoral popliteay bypass gravt

Front 182

When do I ambulate a femoral popliteal bypass graft

Back 182

the day after surgery

Front 183

What could compromise the intra-abdominal graft after a femoral poplieteal bypass graft surgery

Back 183

Hypertension

Front 184

Ass the color of extremities and feel for pulses how often after a femoral popliteal bypass graft

Back 184

every day

Front 185

Blood pressure consistently greater than 140/90 Systolic and diastolic BP

Back 185

Hypertension

Front 186

Systolic and diastolic BP does what in the elderly population

Back 186

increase

Front 187

Risk factors for Hypertension

Back 187

Heredity, Race, Age, Obesity, Alcohol Abuse, Increased sodium intake, Oral Contraceptives

Front 188

Which side of the heart fails with Hypertension

Back 188

Left ventricular failure

Front 189

Complications of Hypertension

Back 189

CAD Coronary Artery Disease, CRF Chronic Renal Failure, CHF Congestive Heart Failure, CVA Cerebrovascular Accident “ the 4 C’s of hypertension

Front 190

A widening, Stretching, or ballooning of the aorta usually due to hypertension

Back 190

Abdominal Aortic Aneurysm AAA

Front 191

What will I see with a AAA

Back 191

Palpable pulsating mass may be felt, Dissection of the aneurysm may occur, Those at highets risk are African American Men and those with severe hypertension

Front 192

What can happen during surgical repair of a AAA

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Kidney damage, due to large arteries are clamped for a time period so monitor BUN, creatinine, and ratios

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Deficeincy of red blood cells

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Anemia (Labs will be low RBC, Hgb, Hct

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What type of Anemia has Malfuncitoning bone marrow

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Aplastic

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What type of Anemia has a genetic defect of hemoglobin S. Life span of RBC is less than 40 days

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sickle cell or speroidal anemia

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What can I give to a sickle cell pt to help

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folic acid and HOP H=Hydration, O=Oxygenation (no matter what the pulse ox states always give O2 to sickle cell), P= Pain relieve only Morphine or Hydromorphone (Dilaudid) NEVER DEMORAL WILL CAUSE SEIZURES

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What culture is prone to sickle cell

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African, Meditrainin, Will not see until 6 months old

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Labs for Sickle Cell Trait

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HbgAS

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Labs for Sickle Cell Disease

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HbSS

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Labs for Sickle Cell Disease and Trait

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NGBS

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What is Hypochromic

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Iron or vitamin deficiency

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Who gets Hypochromic

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anyone who is growing

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Red cell destruction by antibodies

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Erythroblastosis this is a type of hemolytic disease, will see low Hgb and Hct and high bilirubin due to the breakdown of the blood cells

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Secondary anemia can develop with

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persistent bleeding, leukemia, cancer, or chronic kidney disease

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What type of anemia has a lack of intrinsic factor (form of megaloblastic anemia)

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Pernicious

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What can cause Pernicious anemia

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gastritis or gastic surgery or problem with ileum where B12 is absorbed

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Signs of Pernicious anemia

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signs of malnutrition, weakness, mild diarrhea, and a SMOOTH, SORE RED TONGUE

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Treatment of Pernicious anemia

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B12 injections once a month for life

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What test is done to dx Pernicious anemia

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Schilling test, Cobalamin is injected, if it cannot be absorbed as in pernicious anemia, very little is excreted in the urine. Collect a 24 and 48 hour urine specimens

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Tx for iron deficiency anemia

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iron tablets

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How do I give iron tablets

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not with milk or antacid, take without food if possible, OJ increased absorption, Nausea and heartburn initially with use but keep taking will go away, causes constipation

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Excess red blood cells as a result of an abnormality of the bone marrow

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Polycythemia vera

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Clinical manifestation of Polycythemia vera

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Ruddy complexion, hypertension, chest pain, SOB, HA, fatigue, dizzyness, signs of heart failure, blood is think so will have increased BP due to heart has to work harder

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Lab effects of Polycythenia vera

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increased Hgb, Hct, if COPD on increased Hct

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Peticia in a Christmas tree pattern with what type of blood dyscrasias

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Thrombocytopenia and immune thrombocytopenic purpura (ITP), bone marrow shows increased number of megakaryocytes which is the precursor to platelets

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Neutrophils less than 1000

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Leukopenia

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What type of shock occurs with bleeding of any kind

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Hypovolemic

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What is treatment of hypovolemic shock

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Give fluid isotonic such as 0.9% NaCl and blood

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What type of schock occurs with damage to the spinal cord

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Neurogenic

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What is treatment of Neurogenic shock

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Give fluids and vasopressors early

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What type of shock occurs with damage to the heart muscle

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Cardiogenic shock, pulmonary edema may result

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What is treatment of Cardiogenic shock

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Give fluids, vasopressors (such as Levophed or Dopamine), vasodilators, and insert an intra-aortic balloon pump. Monitor for the development of pulmonary edema.

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What position due I put a Pulmonary Edema patient in

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High Fowlers with legs down to decrease venous returen

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What shock occurs due to histamine release

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Anaphylactic shock, will see broncial constriciton and decreased periperal resistance, leads to hyptension and flushed appearance

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What is the treatement for Anaphylactic shock

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Give fluid, antihistamines, bronchodilators, and steroids, Epinephrine 1:1000, 0.2-0.5 ml SQ for mild reaction 1:10,000, 0.5 ml for severe reaction “ remember give the $10,000 drug for a severe reaction”

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What type of shock occurs due to an infectious process

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Septic

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What is the treatment of Septic shock

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Give fluids, vasopressors, and anti-infectives. May need digitalis (Lanoxin) to increase contractility of the heart

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What type of shock is caused by vasodilation

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Distrubutive shock and ther are three, Neurogenic, Anaphylactic and Septic

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Clinical manifiestation of early shock

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increased anxiety, agitation and restlessness, normal BP, increase HR, color normal , cool and mosit, increased deep respirations, decreased urine output

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Clinical manifestations of late shock

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BP less than 90 systolic (hypotension), Weak increased heart rate, pale, cold and clammy, coma, incrased shallow respirations, NO urine output

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What stage of shock will I see Tachycardia, Cap refil more then 2 seconds, Irritable due to increasing hypoxia

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Compensated

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What stage of shock will I see Metabolic acidosis, widespread cellular injury, third spacing, multisystem organ dysfunction

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Decompensated or progressive

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What stage of shock will I see client dying

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irreversible

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A client is bleeding from everywhere what do they have

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DIC, give blood, paletlets, FFP and heparin to prevent further depletion of clotting factors

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Lab effects of DIC

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Decreased RBC, platelets, fibrinogen and increased FDP

Front 236

What is a disorder of blood vessels resulting in vasoconstriciton and decreased blood flow

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Raynauds disease and phenomena

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What is Raynauds phenomenon

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unilateral involvement

Front 238

Raynauds disease is bilateral

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extremity involvment

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What can trigger a vasospasm in Raynauds

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stress

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What is Thromboangiitis obliteran (Buergers disease)

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Similar to Raynauds, treat the same it is just the lower extremeties and more common in smokers and men.

Front 241

What blood level elevation is the earliest indicator of AMI

Back 241

Troponin and CPK-MB

Front 242

What is most predicative of CAD

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Elevated LDL and cholesterol levels

Front 243

What is the study called when wires are put into the right side (veneous) heart to stimulate abnormal rhythms

Back 243

Electrophysiology EP study

Front 244

A non invasive EP study is a

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holter monitor diary should be kept with the following info, medication times and does, chest pain episodes, and description, valsalva, sexual activity, exercise

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Do MUGA and Thallium scans involve radioisotopes injections

Back 245

YES they look at blood flow and musle function

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What does an ECG or EKG provide

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multiple vies of the electrical activity of the heart

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What is done on ALL AMI clients

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Echocardiogram

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Cardiac Catherterization Nursing Teachings

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Invasive procedure performed in the cath lab, activity restricted afterwards, Must be supine position for minimum of 4 hours and keep leg straight for 6 hours , Dye injection to visualize the vessels. Vitals will be monitored frequently to detect any bleeding

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CPR needs renewed every

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2 years

Front 250

CPR ratio

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30:2 of compressions to respirations

Front 251

How often do I reevaluate pulse and breathing during CPR

Back 251

after 5 cycles

Front 252

CPR Cycles

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15 with 100/min compressions then switch with another person for a break, when changing people begin with compressions

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Contributing factors to cardiac arrest

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Hypovolemia, Hypoxia, Hydrogen ion acidosis, Hyp/Hyperkalemia, Hypoglycemia, Hypothermia, Toxinx (overdose), Tamponade (cardiac), Tension Pneumothorax, Thrombosis (cardiac or pulmonary), Trauma

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Cardia Monitoring Nursing teachings

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May need to clip the hair on the chest, change electrodes every 24 hours due to irritation unless hypoallergenic once are used, if diaphoretic, tincture of benzoin or alcohol used to clean the skin and increased adhesiveness

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Universal donor

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O –

Front 256

Universal recipient is

Back 256

AB +

Front 257

Priority with blood administration is

Back 257

proper typing and cross matching

Front 258

What do Gas bubbles in a unit of blood indicate

Back 258

possible bacterial growth do not use

Front 259

How long do I have to give 1 unit of blood

Back 259

no longer then 4 hours

Front 260

When preparing to give a unit do in what order

Back 260

vital signs to make sure blood can be transfused and the IV is still patent, got to lab to check the integrity of the unit and compatibility, Check the blood at the bedside with 2 RNs, Prepare the solution and tubing, start the infusion, remain with the client, Use only normal saline to flush the tubing for blood. Never add medications to a blood bag.

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Febrile reaction

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Chills, fever, HA, N & V, Anxiety

Front 262

Allergic reaction

Back 262

Hives, facial fluhsing, and bronchospasm

Front 263

Hemolytic reaction

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immediate onset, low back pain, hypotension, fever, chest pain, dyspnea and HA

Front 264

Treatment for ANY transfusion reaction

Back 264

STOP the blood and turn on the saline to keep the vein open, get a new bag of saline with NEW tubing so the person does not get more of the blood, send a urine specimen to the lab to check for free hemoglobin in the urine. Red blood cells break during the transfusion reaction, hemoglobin is released into the circulation and found in the urine.

Front 265

Albumin tranfusion are given for very low albumin level, when are they contrainindicated

Back 265

sever anemia, heart failure and renal insufficiencly level

Front 266

What level do you transfuse Albumin at

Back 266

less than 2

Front 267

Steps to cardioversion and defibrillation

Back 267

call “all clear” before discharge of energy in defribrillation, lubrication on chest for discharge, TURN OFF O2 if possible before defibrillation due to combustion, need to remove nitroglycerine patch if present due to it has metal in it.

Front 268

Cardioversion is it an elective procedure

Back 268

YES, client is awake but sedated, need consent form, EKG monitor, Sychronized with heart rhythm

Front 269

What do I begin joules at for Cardioversion

Back 269

50-100 joules

Front 270

What do I begin joules at for Defibrillation

Back 270

200 joules up to 360, clinet is uncouscious, EKG monitor, no cardiac output, Must be in Ventricular Fibrillation or Tachycardia, it is an emergent procedure to safe a life.