Cardiac-Vascular Nursing General Notes – Flashcards
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Benifecence means?
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Doing good
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Nonmalifecence means?
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preventing harm
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Systolic Murmors
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may be normal Mitral Regurgitation Aortic stenosis
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Regurgitation
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valves not closing
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Stenosis
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valves not opening
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Diastolic Murmors
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Indicate disease Mitral Stenosis Aortic Regurgitation
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With stenosis what's a common symptom?
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angina
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With mitral stenosis what is a risk?
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Increased risk of Pulmonary Embolism
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Systolic Murmors are S3 or S4 sounds?
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S3
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Diastolic Murmors are S3 or S4 sounds?
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S4
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What is the Nursing Process?
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Assessment Diagnosis Outcome Identification Plan Implement Evaluate
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Illness is subjective or objective?
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subjective - personal
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Disease is subjective or objective?
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objective - discrete symptoms
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Erik Erikson Infant stage
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trust -vs- mistrust
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Erik Erikson Toddler stage
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autonomy -vs- shame/doubt
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Erik Erikson Preschooler stage
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initiative -vs- guilt
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Erik Erikson School stage
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industry -vs- inferiority
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Erik Erikson Adolescent stage
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identity -vs- role
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Erik Erikson young adult stage
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intimacy -vs- isolation
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Erik Erikson Middle Age stage
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generativity -vs- absorption
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Erik Erikson Older Adult stage
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integrity -vs- despair
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Qualitative Research
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Inductive, covering broad topics, uses words
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Quantitative Research
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Deductive, uses numbers
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Flu epidemic of 1918
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Spanish flu epidemic killed 50 million people
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Independent variable
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manipulated to create an effect on the dependent variable
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Dependent variable
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response, behavior or outcome that the researcher wants to predict or explain
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Prevalence
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total # of cases of the disease in the population at a given time
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Incidence
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# of new cases of the disease in the population during a given period of time
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Nominal
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number functions as a label. Example 1 = male, 2 = female
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Ordinal scale
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number is significant in terms of relative position i.e. 1st or 10th
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Interval scale
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equal numerical distance between intervals
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Ratio scale
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absolute zero is contained within scale
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Increased CVP is indicative of?
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JVD caused by R atrial dysfunction
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MI has increased risk of what in 1st 24 hrs?
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Increased risk of V. fib
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What is a low sodium diet?
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1500 mg per day
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Xanthelesma
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yellow plaque in eye indicating high levels of cholesterol
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What is the treatment for Acute Pulmonary Edema?
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1. Oxygen - decreases dyspnea 2. Nitroglycerin - decreases preload 3. Loop diuretics - Increases diuresis and venodilation 4. Morphine - reduces anxiety
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What medication can cause Acute Pulmonary Edema?
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Calcium Channel Blockers
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What is the treatment for Stage I HTN?
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thiazide diuretics
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What is the treatment for Stage II HTN?
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2 drug combo such as thiazide diuretic with ACE inhibitor, ARB, Beta-Blocker, or Ca-Channel Blocker
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Patient goals are developed from?
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a problem list
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ACE inhibitors are contraindicated for?
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Renal Failure
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Aortic Stenosis may present itself as?
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syncope with exercise
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What is a common problem after Cardiac Surgery?
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A-fib, Flutter and Tachycardia
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Therapeutic communication involves
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1. Empathy 2. Acceptance 3. Recognizing worth
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The Domains of Learning
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1. Cognitive - facts/info 2. Affective - attitudes/beliefs 3. Psychomotor - skills
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Conditions of Learning
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1. motivation 2. ability 3. environment
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Internal locus of control
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success/failure is attributed to self
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External locus of control
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Success/failure is attributed to others/fate/luck
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When you quit smoking, risk for cardiac and vascular mortality drops
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significantly during the 1st year and then more gradually through ensuing years
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How does Health promotion differ from Health maintenance
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Health promotion decreases risk for the population at a MACRO level
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What are the different types of nursing homes?
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1. SNIF - licensed healthcare professionals 2. Nursing - for the patients who cannot perform ADLs 3. Residential - for independent patients
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What is the treatment for V. Tach when the patient is unconcious?
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Defibrillation
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Ischemia is characterized in the EKG by?
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Inverted T waves
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S4 is?
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extra beat called the "atrial gallop" occuring between S2 and S1 associated with L ventricular Hypertrophy, HTN and Aortic Stenosis
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S3 is?
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extra beat called "Kentucky" occuring between S1 and S2 and associated with L ventricular compliance, L ventricular failure and Mitral regurgition
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S1 is?
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systoly: closure of tricuspid and mitral valves (pulmonic and aortic valves open)
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S2 is?
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diastoly: closure of pulmonic and aortic valves (tricuspid and mitral valves open)
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How long are you going to continue a patient on anticoagulation after a cardioversion?
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Patient is kept on anticoagulation for 6 months
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After a cath, a manual compression device is applied and inflated to?
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20 mmHg above the patients systolic pressure
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What effect can cocaine use have on the heart?
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It causes vasoconstriction resulting in HTN, increased HR and chest pain/AMI
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What are characteristics of venous ulcers?
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they are superficial, irregular and edematous
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What are characteristics of arterial ulcers?
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they are painful, deep, circular, necrotic with shiny, pale cool skin
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ACE inhibitors can prevent?
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diabetic neuropathy
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People that suffer from Raynaud's syndrome must avoid what product?
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nicotine
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BP cuff should be what % of width and lenght of limb circumference?
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40% width and 80% lenght of limb circumference
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What is Marfan syndrome?
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Connective tissue abnormality that results in mitral valve problems. Solution is Repairing the valves. Valves can not be replaced because of connective tissue abnormality.
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What smoking cessation medication is dangerous?
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Varenicline (Chantix) is a smoking cessation medication that can have dangerous side effects: psych, suicidal thoughts
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What is the DASH diet and its recommendations
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Dietary Approaches to Stop HTN Total fat = 27% Saturated fat = 6% Protein = 18% Carbs = 55% Cholesterol 150 mg/day Na 1500-2300 mg/day
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Absolute hypovolemia
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Internal shifting of fluid or external loss of fluid: massive hemorrhage, burns, vomit/diarrhea, ruptured spleen
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Relative hypovolemia
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vasodilation, increased capillary membrane permeability from: sepsis, injury, cirrhosis
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Hypovolemic shock
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inadequate intravascular fluid
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Blood Pressures
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Normal <120/80 Pre HTN 120-130/80-90 Stage I HTN 140-159/90-99 Stage II HTN 160/100
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HgA1C
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Normal <6% High 7% or greater Normal fasting BS 70-99 mg/dL
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Whats the expected HR during a stress test?
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HR increases to 80%-90% normal coronary arteries dilate 4X the resting diameter
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What chemical is used for a chemical stress test?
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Adenosine or dypyridamole (persantine)
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What's the immunologic response to ENDOCARDITIS?
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Janeway lessions, splinter hemorrhages, Roth's spots, petichiae on oral mucosa and glumerulonephritis
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What's the immunologic response to PERICARDITIS?
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Pain, mild fever, Increased ESR, WBC count, and friction rub
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What's the immunologic response to MYOCARDITIS?
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asymptomatic with palpitations. High risk for sudden cardiac death
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Hypokalemia can cause?
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u wave, AV Block, Flat/Inverted T Wave
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Hyperkalemia can cause?
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Tall T wave, Wide QRS, Wide QT
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Hypomagnesimia can cause?
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dysrrhytmias, prolonged PR/QT and flat T
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Hypermagnesemia can cause?
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cardiac arrest
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Hypercalcemia can cause?
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dysrrhytmias
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What's considered abdominal obesity?
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> 35 in. in women/>40 in. in men
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What's considered high triglyceride levels?
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>150
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What's considered low HDL
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<40 in men/<50 in women
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Whats a high fasting blood sugar level?
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>110
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Cor Pulmonale is seen in?
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Right ventricular hypertrophy and R sided HF
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What is the effect of the activation of the renin-angiotensin-aldosterone system?
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It increases BP by causing vasoconstriction and the retention of sodium
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How does the AICD control tachycardia and Afib?
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It provides on demand synchronous small electrical impulses
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What can cause digitalis toxicity?
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lasix and/or antibiotics (tetracycline) given in conjunction with digoxin can lead to toxicity. Normal dig levels are 0.5-2.0 The antidote = Digoxin Immune FAB (digibind)
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What are the 5-Ps of obtaining sexual history?
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Partners - gender and # Prevention of Pregnancy - contraception Protection from STDs Practices - oral, anal, vaginal and condom use Past history (STDs) - drug use (injection) and sex for money
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What are therapeutic INRs for A-fib, DVT and PE/Mechanical Heart Valve?
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A-fib: 2-3 DVT: 1.5-2 PE/Mech: 3-4
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Why are hiccups a big concern after a pacemaker insertion?
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Hiccups are an indication that a pacemaker lead has become dislodged and is causing phrenic nerve or muscle stimulation
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Whats a common symptom of cocaine abuse?
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Coronary artery spasm
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What is variant Printzmetal angina?
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cyclical and predictable, occuring at rest and at the same time each day associated with substance abuse
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What are the contraindications to thrombolytic therapy (tPA)
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Age > 75 Pregnancy Aortic Aneurysm Hemorrhagic stroke in past 2 months Recent surgery Bleeding Pericarditis/Endocarditis Severe HTN (>210/130) that is uncontrolled by meds
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What is the timeframe for tPA therapy for stroke?
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Ideally within 90 minutes but some may be given in 6-12 hours
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What is the CAGE assessment
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a drinking assessment Cutting down - do you think about cutting down Annoyed by criticism - are people criticizing your drinking? Guilty feeling - do you feel guilty? Hide your drinking? Eye opener - need a drink earlier in the day?
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What medications are critical before a cardioversion?
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Hold digoxin for 48 hours Give coumadin for 3 wks May give antiarrhytmics before procedure
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What are the HF classess?
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Class I: asymptomatic Class II: symptoms with excertion Class III: limitation with ADLs Class IV: symptoms at rest
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What's the best way to test for heart transplant rejection?
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Biopsy is used to diagnose rejection of a heart transplant
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Why is sexual dysfunction common after heart transplants?
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It results from anti-HTN medications
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What may increase the effect of coumadin?
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Caffeinated beverages
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What do different TEE waveforms indicate?
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1. Short waveform with rounded apex - L ventricular failure 2. Pointed wave with narrow base - Decreased preload (hypovolemia) 3. Wide base of wave - Increased preload 4. Pointed/short/narrow wave - Increased systemic vascular resistance
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What is post pump delirium?
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psychosis that occurs 48 hours or less post CABG and may last 2-5 days
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What are normal cholesterol levels?
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Total Cholesterol 120-200 Tryglyceride 0-150 HDL 40-70 LDL 50-129
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What are elevated cholesterol levels?
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Total cholesterol 200-239 Tryglyceride 150-199 LDL 130-159
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What are some post PCI complications?
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1. Bruit - psydoaneurysm and AV fistula caused by vessel trauma 2. Bleeding/Hematoma - hard lump and discoloration caused by coughing, vomiting, HTN or bladder distention 3. Arterial thrombus/embolus - cool cyatonotic extremity and a loss of pulse distal to the sheath insertion site 4. Retroperitoneal bleed - bleeding in flank area leading to pain, HypoTN, Tachycardia, Log Hgb and low Hct
