question

Hypertension related to age

answer

Hypertension actually occurs more commonly in males below 55 years of age and also higher Women get older 55 - and more at risk for developing strokes from their hypertension

question

Normal creatine kinase

answer

36-160 Units/L (F) 50-204 units/L (M)

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Normal Ck-MB

answer

Less than 4-6% of total CK

question

Normal troponin

answer

< 0.35 ng/ml (I) < 0.2 mcg/L (T)

question

Rise, Peak, Fall, of Ck-MB

answer

Rise 4-6 hrs Peak 18-24 hrs Return to baseline 24-36 hrs

question

Rise, Peak, Fall, of troponin

answer

Rise 2 - 6 hrs Peak 15-24 hrs Return to baseline 7-10 days

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Total cholesterol range

answer

< 200 mg/dL

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Total LDL range

answer

Without CAD <130mg/dL With CAD ≤100mg/dL(< 70)

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Total HDL range

answer

> 40 mg/dL (men) > 60 mg/dl (women)

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Total triglyceride range

answer

< 150 L

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Normal BNP

answer

Less than 100

question

BNP Ranges

answer

100-199 mild heart failure 200-400 moderate heart failure More than 400 - moderate to severe heart failure

question

Normal homocysteine level

answer

4.6-11.2 mcg/L

question

What happens if homocysteine level increases

answer

Damage inside lining of artery Encourage clot formation Stroke Heart disease

question

What is homocysteine

answer

amino acid your body uses to make protein and to build and maintain tissue.

question

Prep for transesophageal echocardiogram

answer

NPO for 6 hours prior to test Consent IV access Remove dentures

question

Nursing care after transesophageal echocardiogram

answer

Vital signs including pulse oximetry No eating or drinking 2 hours after procedure, or until gag reflex returns Monitor for shortness of breath, chest pain, bleeding, or fever

question

Standing orders for stress test

answer

Consent NPO No caffeine for 12-24 hours Hold medication that slows heart rate - Beta blockers (Metoprolol, Carvedilol) Digoxin (Lanoxin) Calcium channel blockers (Diltiazem, Verapamil only)

question

Angiography nursing care

answer

Invasive procedure using local anesthesia and conscious sedation Consent required NPO Check for allergy to iodine, shellfish, xray dye

question

What is cardiac catheterization used to diagnose?

answer

Coronary artery disease Disease of heart valves Etiology of Congestive heart failure Structural defects

question

Standing orders for cardiac catheterization

answer

Explain procedure Consent NPO Intravenous access Shave and prep right/left groin Hold anticoagulants Check allergy Iodine, shellfish, contrast dye If allergic, give Benadryl and Solucortef Hold basal insulin and oral hypoglycemic agents

question

Preparation for cardiac catheterization

answer

Several routine tests will be done: -ECG -Complete Blood Count (CBC) - WBC Hgb, Hct, Platelets -Electrolyte panel - Sodium, Potassium, BUN, creatinine -PT/INR (if on Coumadin)

question

Post Cardiac Catheter Nursing Care

answer

Bed rest for 3 to 4 hours Head of bed elevated 20 to 30 degrees Keep the affected extremity straight Frequent vital signs Monitor groin site for bleeding Check pedal pulses After 3 to 4 hours & stable, check blood pressure and heart rate lying, sitting, and standing

question

Complications that can occur from cardiac catheterization

answer

Dissection of aorta or coronary artery MI (Heart Attack) Thrombus/embolus Stroke Hematoma Retroperitoneal bleed Pseudoaneursym or A-V fistula Allergic reaction to xray dye

question

Electrophysiology Study Standing Orders

answer

NPO Consent Shave & prep groin Catheter inserted right femoral vein Bed rest 3-4 hours Monitor vital signs and puncture site Assess pedal pulses

question

Normal blood pressure

answer

Less than 120 / less than 80

question

Prehypertension range

answer

120-139 / 80 - 89

question

Stage 1 Hypertension range

answer

140 - 159 / 90 - 99

question

What xray view is better to see fluid in the lungs?

answer

Lateral

question

What do you make sure to check before doing an x-ray?

answer

If the patient is pregnant

question

Hypokinesia

answer

low muscle movement in that particular wall

question

Akinesia

answer

Dead tissue (Myocardial infarction)

question

Ejection Fraction

answer

Calculation of how much blood a ventricle can eject with one contraction

question

Pseudohypertension

answer

False hypertension; occurs when walls of arteries are thickened; can't really compress the artery until you get a really high reading. This tends to happen in elderly as their vessels have become more scarred, sclerotic, and hardened. Hard to compress it.

question

Secondary hypertension

answer

Caused by another disease (such as kidney failure)

question

What lifestyle changes can be done to lower bp?

answer

DASH, Sodium restriction, losing excess weight, exercise, smoking cessation, limiting alcohol, stress management

question

ALLHAT STUDY (Antihypertensive & Lipid Lowering Treatment to prevent Heart Attack Trial)

answer

1st choice - diuretics

question

How do you assess tissue perfussion?

answer

MAP

question

Risk factors for atherosclerosis

answer

Tobacco Use Dyslipidemia Hypertension Diabetes mellitus Physical Inactivity Obesity

question

Treatments for Atherosclerosis

answer

Restrict Lipoprotein Production with statins, Niacin, Fibric acid derivatives, Increase lipoprotein removal with bile acid sequestrants, and decrease cholesterol absorption with zetia and vytorin

question

PAD s/s

answer

Intermittent claudication Calf pain Buttock and thigh pain Erectile dysfunction Paresthesia Changes to skin Diminished or absent pulses

question

What are some complications of PAD?

answer

Atrophy of the skin and muscles Delayed healing Wound infections Tissue necrosis Arterial ulcers Gangrene Amputation

question

Normal Ankle-Brachial Index

answer

0.91-1.30

question

What does an ABI of less than 0.4 mean?

answer

Severe PAD

question

Treatment for PAD

answer

***Dangle or reverse trendelenburg for improved perfusion Wear soft, roomy, protective shoes Arterial ulcers - keep clean & dry, cover w/ drsg Thrombosis or embolism - EMERGENCY! Lubrication (avoid soaking ft) Exercise

question

Cilostazol (Pletal)

answer

inhibits platelet aggregation & vasodilates, significantly increases walking distance & QOL

question

Pentoxyfylline (Trental)

answer

increase RBC flexibility

question

Nursing care for PAD

answer

Assess peripheral pulses, skin color & temp, capillary refill, sensation, & movement Aggressive pain management Monitor for complications: bleeding, hematoma, thrombosis, embolization, & compartment syndrome Avoid knee- flexed positions except w/ exercise Prioritization: Notify dr. of significant change - increased level of pain, loss of palpable pulse distal to operative site, ext. pallor/cyanosis, cold ext, numbness or tingling.

question

Patient teaching for PAD

answer

Risk factor management - NO TOBACCO! Meticulous foot care How to check pulses, temp & capillary refill Gradual increase in physical activity post-op Regular physical activity

question

Acute arterial ischemia

answer

Causes: Thombosis, Embolism, Trauma EMERGENCY!!! Six P's: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia (usually cool) Treatment: Anticoagulation, Thrombolysis, Embolectomy, Surgical Revascularization, Amputation

question

Buerger's disease

answer

Rare, nonathersclerotic, inflammatory disorder Common in young men Affects: small and medium size arteries, veins, and nerves upper and lower extremities Strong correlation with smoking

question

Pathophysiology of Buerger's disease

answer

Inflammatory process damages arterial wall Lymphocytes and giant cells infiltrate the vessel Fibroblast proliferation Thrombosis and fibrosis occur Tissue ischemia develops

question

s/s Buerger's

answer

Often confused with PAD or autoimmune disorders Intermittent claudication of feet, hands, or arms Color and temperature changes in affected limbs Paresthesia Superficial thrombophlebitis Cold sensitivity Rest pain Ischemic ulcerations

question

Treatment Buerger's

answer

Smoking cessation Avoid trauma to the extremity Medication therapy Surgical therapy - Sympathectomy, bypass Amputation

question

s/s raynaud's

answer

Vasospasm induced color changes of fingers, toes, nose, and ears Pallor--decreased perfusion Coldness and numbness Cyanosis--decreased perfusion Throbbing, aching pain Rubor--hyperemia Tingling and swelling Precipitated by cold weather, emotional upsets, smoking, or caffeine use Usually lasts for minutes

question

Treatment raynaud's

answer

Prevention of recurring episodes Avoid temperature extremes Smoking cessation Avoid vasoconstrictors (caffeine, meds) Coping strategies Drug therapies: Ca-channel blockers Surgical options: Sympathectomy

question

Diagnostic test for abdominal aneurysm

answer

*Chest xray, ECG, Echo, Abdominal Ultrasound, CT SCAN MOST ACCURATE, MRI, Angiography

question

S/S Thoracic Anneurysm

answer

Often asymptomatic Deep, diffuse chest pain Angina Hoarseness Dysphagia Distended neck veins Facial & upper extremity edema

question

S/S abdominal anneurysm

answer

Often asymptomatic Found on routine exam Coincidence Pulsatile mass Bruit Abdominal or back pain Problems with bowel elimination Distal embolization

question

Open Surgical Repair Care of Patient Pre-Op

answer

Bowel prep, NPO, shower with antimicrobial soap, IV antibiotics

question

Open Surgical Repair Care of Patient Post-Op

answer

ICU Graft patency: Maintain adequate BP, IV fluids, blood transfusion as needed CV status: Telemetry monitoring, oxygen, electrolytes, ABGs, pain control Infection: antibiotics, monitor for fever & leukocytosis, Strict aseptic technique - Foley, IVs, incisions

question

Discharge Teaching for Open Surgical Repair

answer

Gradual increase in activity Expect fatigue, poor appetite, & irreg. bowel habits at first Avoid heavy lifting X 4-6 wks Report any fever; redness, swelling, pain, or drainage from incision Prophylactic antibiotics before future procedures Possible sexual dysfunction

question

Most common loc of aortic dissection

answer

thoracic Aorta LIFE THREATENING!

question

Causes of aortic dissection

answer

HTN, Marfan's, Blunt Trauma

question

Complications of aortic dissection

answer

Cardiac tamponade, exsanguination, death

question

Diagnostic tests for aortic dissection

answer

CXR, Transesophageal echocardiogram, CT scan

question

Collaborative care of aortic dissection

answer

Lower BP & myo. contractility, conservative rx if asx; emergency surgery

question

major causes of venous disorders

answer

Weak and damaged vein walls Stretched or injured one-way valves Blood clot

question

Varicose vein treatment

answer

Conservative Treatment Weight loss Exercise Elevate leg Compression stocking Avoid activities that promote venous stasis

question

Pt edu after endovenous laser and ambulatory phlebectomy

answer

Compression bandage to minimize bruising Walking is encouraged immediately following the procedure Compression stocking Anti-inflammatory medication Heavy exercise avoided for 2 weeks Avoid hot tubs and swimming for 2 weeks

question

Pt Edu After Vein Litigation/Stripping

answer

Monitor for bleeding Assess extremities for color, movement, sensation, temperature, presence of edema Check dorsalis pedis & posterior tibial Compression stocking Elevate leg Anti-inflammatory pain medication Resume normal activities in two weeks or less. Exercise

question

Thrombophlebitis

answer

Catheter greater than 3 days, not flushing line, highly irritating meds S/s - redness, tenderness, pain Treatment - immediate removal of catheter

question

Treatment for thrombophlebitis

answer

Heat or cold application Elevation of affected extremity Pain management Tylenol Non-steroidal anti-inflammatory drugs (NSAIDS) Antibiotic Therapy if severe Anticoagulants typically not needed

question

Causes of DVT

answer

Major surgery Leg trauma--a broken hip or leg Prolonged travel Family history of a blood-clotting disorder Cancer Oral contraceptives/HRT Smoking Varicose Veins Central venous lines (pacemaker & ICD leads) Repetitive motion

question

Symptoms of DVT

answer

Majority have no symptoms Dull, aching pain in the affected extremity Leg pain that may worsen when you walk or stand Swelling Redness Warm to touch Homan's sign

question

Diagnostics for DVT

answer

D-dimer A blood test measuring fragments of fibrin as result of fibrin degradation & clot lysis. Elevated result suggests deep vein thrombosis - Normal: <230ng/ml - Abnormal: ≥ 230ng/mL

question

Surgical Treatment of DVT

answer

Inserted in the inferior vena cava via femoral vein Pre: Consent, check dye allergy, NPO, Shave Post: same as angiography May go home after 1-2 days

question

Anticoagulant Therapy

answer

Subcutaneous Baseline CBC, PTT, PT, INR, Platelet Count No continuous PTT monitoring Dose determined by weight of patient 1mg/kg every 12 hours The average administration 7 days or until therapeutic goal of INR is achieved

question

Causes of chronic venous insuffiency

answer

Smoking Sitting/standing for prolonged periods of time Varicose Veins Superficial thrombophlebitis DVT Trauma

question

Symptoms of CVI

answer

Leg pain Leg/ankle swelling Discoloration of the skin - hemosiderin Thickened skin Varicose veins Leg ulcers

question

Venous Ulcer S/S

answer

Dark red or purple over the affected area Thick, dry itchy skin Shallow wound Moderate to heavy drainage Slow to heal

question

Prevention & treatment

answer

Lifelong Compression stockings -Customized Jobst stockings Prevention of venous ulcers Elevation Avoid sitting or standing for long periods of time Lifestyle changes Weight loss Exercise

question

Lymphedma S/S

answer

Puffiness and a feeling of heaviness in the affected limb Tightness of the skin Limited range of motion Graded 1 - 4+

question

Drug treatment for lymphedma

answer

Antibiotics Coumadin Lasix Pain management NSAIDs Hydromorphone ( Dilaudid)

Nursing care for patients with Cardiovascular Alterations – Flashcards

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