ATI Learning Systems RN Medical-Surgical: Cardiovascular and Hematology – Flashcards

prepare for replacement of missing clotting factors -hemophilia is a hereditary bleeding disorder in which blood clots slowly and abnormal bleeding occurs -caused by a deficiency in most common clotting factor, factor VIII (hemophilia A) -aggressive factor replacement is initiated to prevent hemarthrosis that can result in long-term loss of range of motion in repeatedly affected joints -coagulation tests that measure platelet function, such as bleeding time, are used to Dx, not treat, hemophilia -aspirin and other NSAID's, and some herbal supplements should be avoided b/c they interfere w/ clotting function -affected joint should be elevated to allow blood to drain away from pt

omega 3 fatty acids -helps lower risk of cardiovascular dz and stroke by decreasing triglyceride levels -antioxidants: substances naturally occurring in fruits and veggies, as well as in nuts, grains, and some meat, poultry, and fish -beta-carotene, vitamin A, C, E, and selenium are some of most commonly known antioxidants -can slow/prevent development of cancer -beta-carotene: precursor to vitamin A, functions as fat-soluble antioxidant which protects body from deleterious free-radical rxns

prothrombin time (PT_ -FFP is plasma rich in clotting factors and is administered to treat acute clotting disorders -desired effect: decrease in PT -review WBC's if there's possible infection -review platelet count following admin of platelets -review HCT following admin of packed RBC's

dependent edema -blood return from venous system to R atrium is impaired by weakened R heart -consecutive systemic venous backup leads to development of dependent edema -Left-sided HF: pts w/ this disorder have decreased cardiac output which causes decreased capillary refill; blood returns from lungs via pulmonary vein is slowed, causing fluid buildup in lungs that results in SOB; dizziness can occur d/t decreased cardiac output

stop infusion -Priority: b/c pt has manifestations of allergic rxn -nurse should maintain IV access by initiating infusion of 0.9% sodium chloride solution using a new IV administration set -nurse should send blood container and tubing to blood bank for a repeat typing and culture -nurse should obtain urine sample from pt to determine if hemoglobin is in urine

ventricular dysrhythmias -after MI, electrical conduction system of heart can be irritable and prone to dysrhythmias -ischemic tissue caused by infarction can interfere w/ normal conduction patterns of heart's electrical system -infective carditis: occurs when bacteria invades endothelial surface of heart; usually seen in pts who have prosthetic heart valves or pacemakers -pericarditis: can occur 10 days to 2 months following MI; is an inflammation of pericardial sac that surrounds heart and usually results from infection, connective tissue disorders, or trauma

remove the unit of plasma immediately and start an IV infusion of NS -FFP that's not compatible can cause hemolytic transfusion rxn -stop transfusion and infuse 0.9% sodium chloride w/ new tubing -ABO compatibility is required for transfusion of FFP; blood type B can only receive type B or AB plasma -nurse shouldn't continue infusing plasma that's not compatible w/ pt; no indication that a repeat type and crossmatch is necessary -should admin. diphenhydramine IV only if pt manifests allergic txn

admin. antihypertensive med for BP -b/c HTN can cause sudden rupture of aneurysm d/t pp on arterial wall -monitor that pt has adequate kidney profusion determined by urinary output of at least 30 mL/hr; oliguria can indicate rupture of aneurysm -administer pain med b/c pain occurs d/t pp from aneurysm on lumbar nerves; pain can cause HTN -take pt VS at least every 15 min in order to monitor fr sudden drop in BP, can indicate ruptured aneurysm

lower back discomfort -involves a widening, stretching, ballooning or aorta -back and abdominal pain indicate aneurysm is extending downward and pressing on lumbar spinal nerve roots, causing pain -nurse should auscultate for bruit heard over location of mass -pitting edema is manifestation of HF; not an assessment finding for abdominal aortic aneurysm

jugular vein distention, moist crackles, increased HR -JVD: results from increase in venous pp d/t excessive circulating blood volume -moist crackles: indicator of pulmonary edema that can quickly lead to death -increased HR: FDE, or hypovolemia, an expansion of fluid volume in extracellular fluid compartment, results in increased HR and bounding pulses; also causes HTN -postural hypotension occurs in pts experiencing dehydration

auscultate BP for pulsus paradoxus -pt w/ cardiac tamponade will have this when systolic BP is at least 10 mm Hg higher on expiration than on inspiration; this occurs b/c of sudden decrease in cardiac output from fluid compressing atria and ventricles -manifestations: d/t sudden decrease in cardiac output from fluid compressing atria and ventricles, hypotension pulsus paradoxus, and muffled heart sounds occur -check for cardiac tampondae by checking apical and radial pulses simultaneously to determine if rate is same; if different, indicates cardiac dysrhythmias

HTN is common adverse effect of this medication -b/c of rise in production of erythrocytes and other blood cells -epoetin alfa: synthetic version of human erythropoietin and it's used to treat anemia associated w/ kidney dz or med thearpy; increase and maintains RBC levels -teach pt about self-administration at home -teach maximum effect will occur w/in 2-3 months -its administered to decrease need for periodic blood transfusions

dry, pale skin w/ minimal body hair -caused by narrowing of arteries in legs and feet that causes a decrease in blood flow to distal extremities and leads to tissue damage -manifestations: dry, pale skin w/ minimal body hair, mottled skin, intermittent claudication (leg pain w/ exercise). cold/numb feet at rest, weakened pulses -venous insufficiency: can display pitting edema, reddish-brown skin pigmentation b/c valves of veins are damaged from venous HTN from sitting or standing in place for too long; can also be manifestation of CHF d/t CAD -desquamation: a loss of bits of outer skin by peeling/shedding, is associated w/ sunburn, Kawasaki dz, and various other skin lesions

telemetry monitoring shows QRS complexes occurring at a rate of 74/min with no pacing spikes -shouldn't expect pacers spikes when pts pulse is > set rate of 72/min b/c pts intrinsic rate overrides set rate of pacemaker -report: displaying frequent ventricular complexes and when pt experiences hiccups b/c this is complication that can indicate lead wire is displaced in ventricle -report: when pace spikes w/out QRS complexes b/c this complication can indicate noncapture of pacemaker

weight gain 1 kg (2.2 lb) in 1 day -pt is retaining fluid and is at risk of fluid volume overload which indicates HF is worsening -pitting edema of +3 is indication that pt has developed fluid volume overload and HR is worsening -a cough that is irritating and occurring at night may be reported in early stages of HF -B-type natriuretic peptide (BNP) increases as result of ventricular hypertrophy that occurs in HF; a level above 100 pg/mL indicates HF and levels continue to increase w/ severity of HF

dyspnea w/ hiccups -manifestations: dyspnea w/ hiccups, nonporductive cough, tachycardia, chest pain, chest discomfort -can indicate HF from pericardial compression d/ obstructive pericarditis or cardiac tamponade -is usually seen on ECG as ST-T spiking, which represent ischemic changes caused by inflammation around heart -can have tachycardia d/t decreased cardiac output and O2 perfusion -chest pain will increase w/ deep inspiration d/t increased pp on pericardial sac -chest discomfort will decrease when pt sits upright or leans forward, as this relieves pp in pericardial sac

course crackles -recent MI = at risk for L-sided HF -crackles are breath sounds caused by movement of airways through partially or intermittently occluded w/ fluid and are associated w/ HF and frothy sputum; heard at end of inspiration and are not cleared through coughing -wheezes: will manifest high-pitched musical squeak on inspiration or expiration through narrow or obstructed airway -rhonchi: will manifest couars, loud, low-pitched sounds during inspiration or expiration; coughing often clears airway and stops sound -friction rub: manifests loud, dry, rubbing/grating sounds over lower lateral anterior chest surface during inspiration or expiration

iron toxicity -pt whose received several transfusions is at risk for developing hemosiderosis, an excessive storage of Fe in body, which can come from overuse of supplements or having too frequent transfusions, as in sickle cell anemia -also at risk for hyperkalemia b/c stored blood releases increased amounts of K d/t RBC hemolysis -also at risk for hypocalcemia b/c citrate in transfused blood bonds w/ Ca, causing it to be excreted -not at risk for lead poisoning

"before taking my medication, i will count my radial pulse rate" -beta blocker will induce bradycardia -should consume foods low in sat. fats to decrease further atherosclerotic plaque development in arteries -exercise at least 3-5X per wk for minimum of 30 min -do not d/c med b/c adherence to medical regimen will help prevent complications following MI

increased pulmonary congestion -d/t R-sided HF -b/c of defect in mitral valve, left atrial pp rises, L atrium dilates, and there's an increase in pulmonary artery pp, and hypertrophy of R ventricle occurs -dyspnea is indication of pulmonary congestion and R-sided HF -mitral valve opening narrows, blood flow from atria to ventricle falls causing a back-up, and increased pp, in L atria -pulmonary artery pp increases as a result of back-up from narrowing/stenosis of mitral valve that affects flow of blood from L atrium to L ventricle

chest pain last longer than 15 min -can have this as well as chest pain even while resting, minimal, if any relief from nitroglycerin, and chest pain/ discomfort w/ exertion d/t reduced blood flow in coronary artery d/t atherosclerotic plaque and thrombus formation causing partial arterial obstruction or from artery spasm

position pt supine w/ legs elevated when in bed -elevate above heart to promote venous return by gravity -during d/c reinforce importance of periodic positioning of legs above heart -encourage ambulation for 5-10 min every hr while awake to prevent venous stasis -discourage pt from sitting/ standing for any duration to prevent venous stasis -pt should wear graduated compression stockings for up to 1 wk post-surgery to promote venous return

K 2.8 mEq/L -flattened T wave or development of U waves indicates low K (.8 ng/mL) -low hemoglobin manifests tachycardia on ECG rhythm b/c of compensatory mechanism that provides O2 to vital organs -prolonged S-T interval and prolonged Q-T interval indicated hypocalcemia (<9)

monitor for bleeding -complication of PTCA b/c of administration of heparin during procedure and removal of femoral (or brachial) sheath -manual pp of closure device is used to obtain hemostasis to site -pt should remain on bed rest until hemostasis is assured -provide teaching about cardiac rehabilitation prior to d/c -administer aspirin to maintain patency of pts coronary arteries by preventing platelet aggregation and thrombus formation around newly placed stent -monitor for peak lab markers of myocardial damage following MI and reperfusion of thrombolytic therapy

petechiae and ecchymosis -are manifestations of aplastic anemia -all 3 major components of blood are reduced or absent (RBC's, WBC's, platelets), known as pancytopenia; manifestations usually develop gradually -polycythemia vera: pt will have plethoric (dark, flushed) manifestation of facial skin and mucous membranes -pernicous anemia: pt will have manifestation of glossitis (smooth, beefy-red tongue) and weight loss -sickle cells anemia: pt will have manifestations of jaundice w/ enlarged liver and spleen

atrial rate of 300/min w/ QRS complex of 80/min -findings indicates lack of conduction b/w atria and ventricles -normal sinus rhythm = P waves occurring at 0.16 sec before each QRS complex -ventricular ectopy, such as ventricular contractions = ventricular rate of 82/min w/ atrial rate of 80/min -ventricular tachycardia = irregular ventricular rate of 125/min w/ wide QRS complex

initiate weekly injections of vitamin B12 -and then decrease to monthly -this disorder is caused by lack of intrinsic factor needed to absorb B12 from GI tract -admin ferrous sulfate to pt who has Fe deficiency anemia, which is a decrease in RBC's by inadequate intake of dietary Fe -megaloblastic anemia: pt should increase intake of foods containing folic acid b/c it causes a decrease in RBC's caused by folate deficiency -aplastic anemia: initiate blood transfusion when bleeding is life-threatening from low platelet count or it pt has blood loss from trauma/ surgery -

0.9% sodium chloride - a crystalloid, physiologic isotonic solution that replaces lost volume in blood stream and is only solution to use when infusion blood products -0.45% sdium chloride: hypotonic solution not to be used for fluid replacement b/c it can cause lysis of RBC's b/c it has fewer solutes than the cell, and osmotic pp pulls the fluid into the few cells remaining -dextrose 5% in 0.9% sodium chloride & dextrose 10% in water: hypertonic solution not to be used for fluid replacement; will diffuse into cells of tissue, having no effect on circulating volume; when fluid surrounding cells is hypertonic or has more solutes than the cells, osmotic pp pulls fluid from cells

10 gtt/min 10 gtt / 1 mL x 250 mL / 4 hrs x 1 hr / 60 min = 2,500 gtt / 240 min = 10.4166667 --> 10 gtt/min

witness informed consent -least invasive priority-setting framework -nurse should hand IV infusion of 0.9% sodium chloride w/ blood to dilute blood and maintain IV infusion line -nurse should check ID band of pt w/ # on blood to ensure pt receives correct unit of blood; should check provider Px, identify product, pt, and compatibility of blood and pt all w/ another nurse present -nurse should obtain pts pretransfusion VS