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Terms in this set (132)
What is Rheumatic Fever?
Inflammatory disease that can develop as a complication of inadequately treated strept throat or scarlet fever.
What is Rheumatic heart disease?
damage to the heart by one or more episodes of rheumatic fever (can also effect the joints, skin and brain) caused by group A strept
What is Rheumatic endocarditis?
damage to the heart, particularly the valves resulting in valve leakage and/or stenosis; heart chambers compensate by enlarging.
Rheumatic heart disease is fairly rare in developed countries, T/F?
T. It is more common in developing countries with malnutrition and crowded living. Usually in ages 5-15.
What is the most common finding in those with Rheumatic heart disease? What are other findings?
history of streptococcal pharyngitis
-sudden sore throat, swollen lymph nodes, headache and fever to 104
-polyarthritis, warm and swollen joints
-shortness of breath and chest pain
-chorea- emotional instability, muscle weakness, uncoordinated jerky movement
-rash- erythema marginatum
How is Rheumatic heart disease managed?
-antibiotics- IV for up to 6 weeks or until infection resolves
-surgery- valve replacement if valvular damage causes HF
When teaching this patient, what intervention is important to teach about dental work?
patient should take antibiotics before dental work or invasive procedure
mitral valve thickens and gets narrower, blocking blood flow from the atrium to the left ventricle
Most cases of mitral valve stenosis is caused by?
What findings are associated with Mitral Valve Stenosis?
mild- asymptomatic heart murmur
moderate to severe stenosis- symptoms of LEFT sided HF due to blood backing up into the lungs and poor cardiac output
-heart murmur, dyspnea, paroxysmal nocturnal dyspnea, crackles in lungs, mild weight gain
Think "DO-ABLE" when managing Mitral Valve symptoms.
D: diuretics- to relieve pulmonary congestion, fluid overload and return to baseline weight
O: oxygen- to correct hypoxia
A: Ace inhibitors: to reduce preload and after load
B: Beta blockers- to prevent arrhythmias and reduce workload of the heart
L: low sodium diet
If a patient has valve surgery, what 2 things should the nurse monitor for?
hypotension and arrythmias
When administering and titrating anticoagulants, what would you use for heparin? warfarin?
What signs would you teach a patient to report due to HF?
We should teach patients with cardiac problems to adhere to a low sodium diet, this means only ________ mg per day.
2000 or 2 grams
If a patient is on longterm anticoagulant therapy, we should teach them what?
periodic lab testing of INR for warfarin, maintain steady dietary vitamin K levels and report signs of bleeding.
What is Mitral Valve insufficiency (regurgitation)?
damage to the mitral valve allows the blood from the left ventricle to flow back into the left atrium during ventricular systole. To handle the back flow, the atrium enlarges; the left ventricle also enlarges.
What is the cause of mitral valve insufficiency?
older adults- mitral valve becomes calcified
can be due rheumatic fever
What findings are associated with mitral valve insufficiency?
patient may be asymptomatic
orthopnea, dyspnea, fatigue, weakness, weight loss
chest pain and palpations
systolic murmur at the apex
jugular vein distention
hepatomegaly- abnormal enlargement of the liver
What diagnostic studies would be done for mitral valve insufficiency?
What is Tricuspid stenosis?
narrowing of the tricuspid valve between right atrium and right ventricle
What is the etiology of tricuspid valve stenosis?
uncommon, usually associated with lesions of the other valves, can be caused by rheumatic fever.
Finding associated with tricuspid valve stenosis?
dyspnea, fatigue, weakness, syncope, peripheral edema
*Jaundice with severe peripheral edema and ascites can mean that the tricuspid stenosis has led to right ventricular failure
distended jugular vein
What is tricuspid valve insufficiency (regurgitation)?
tricuspid valve doesn't close properly during ventricular systole, allowing blood to leak from the right ventricle back into the right atrium
What is the etiology of tricuspid valve insufficiency?
most common in late stages of heart failure from rheumatic fever or congenital heart disease, IV drug abuse
What are the findings associated with tricuspid valve insufficiency?
right heart failure and poor cardiac output when severe.
dyspnea, fatigue, weakness and syncope
distended jugular vein
peripheral edema, ascites
What is pulmonary stenosis?
narrowing of the pulmonic valve between the right ventricle and pulmonary artery obstructs right ventricular outflow leading to right ventricular hypertrophy and right heart failure
What is the etiology associated with pulmonary stenosis?
usually congenital, often occurring with other birth defects such as Tetralogy of Fallot
rare among elderly
may result from rheumatic fever
Findings associated with Pulmonary stenosis?
cyanosis, dyspnea, fatigue, syncope, findings of right sided heart failure
in babies- cyanosis and failure to thrive
What is pulmonary valve insufficiency?
pulmonary valve fails to close, so that blood flows back into the right ventricle
What is the etiology associated with pulmonary valve insufficiency?
result of pulmonary hypertension
Findings associated with pulmonary valve insufficiency?
dyspnea, fatigue, chest pain and syncope
advanced- jaundice with ascites and peripheral edema
What is the mnemonic to remember to treat Pulmonary Edema?
G: blood gases
What is aortic stenosis?
aortic valve becomes narrowed causing poor cardiac output and increasing left heart pressure
What is the etiology associated with aortic stenosis?
most significant valvular lesion seen among elderly people.
it usually leads to left sided heart failure, left ventricular hypertrophy and cardiomyopathy.
80% affected are males
Findings associated with aortic stenosis include:
classic trade: dyspnea, syncope, and angina
left sided heart failure may occur with orthopnea, paroxysmal nocturnal dyspnea, and crackles in lungs
4th heart sound
What is aortic insufficiency (regurgitation)?
blood flows into the left ventricle during diastole overloading the ventricle and causing it to hypertrophy.
extra blood also overloads the left atrium and eventually the pulmonary system.
Aortic insufficiency may be accompanied by what genetic disorder?
What does the systolic BP have to be to be considered HTN? What about diastolic?
on at least 3 separate occasions
What is the BP for pre HTN?
What is the BP for stage 1 HTN?
What is the BP for stage 2 HTN?
To be considered chronic HTN of pregnancy what is the rule?
high BP already present before week 20 of gestation
What is secondary HTN?
High BP from identifiable cause including:
Cushing's syndrome- increase level of cortisol
renal disease- renal artery stenosis, glomerulonephritis, end stage renal disease
pregnancy related hormones
drugs- stimulants (decongestants, cocaine), contraceptives, alcohol
neurological disorder- brain tumor, traumatic brain injury
coarctation of the aorta- congenital narrowing
What is the initial treatment for pre HTN and uncomplicated stage 1 HTN?
lifestyle modification: weight reduction, regular physical activity, DASH diet, limit sodium, alcohol in moderation, smoking cessation, stress reduction
What medications do we use to treat HTN?
initial therapy: start with beta blocker or diuretic
What medication is used to treat LEFT sided heart failure?
What medication is preferred to treat HTN in patients with diabetes?
ACE inhibitors to protect the kidneys
In a HTN crisis what is the medication choice?
What is the goal of HTN treatment?
to get BP down to 130/85 and control of other cardiovascular risk factors
What medications should we teach our HTN patients to avoid?
What benefits does Omega 3 fatty acid give our cardiac patients?
Why should we teach our cardiac patients to avoid Licorice?
Cause an increase in BP which is bad for our HTN patients
What is Coronary Artery Disease?
fatty deposits in coronary arteries narrow the artery reducing the blood and oxygen to the heart
What is the most common cause of CAD?
What are the risk factors associated with CAD?
white males over the age of 40
women after natural or surgical menopause
diabetes, poorly controlled
uncontrolled high BP
hyperlipidemia- high LDL and triglycerides and low HDL
What findings are associated with CAD?
anginal chest discomfort occur with exertion and resolve with rest
Who present with atypical symptoms of CAD?
women, elderly and diabetics
dyspnea, lightheadedness, GI complaints
What labs would be elevated in CAD?
What is the gold star for diagnosing CAD?
cardiac catheterization with coronary angiography because it shows areas of narrowing in coronary arteries
What medications are used to treat CAD?
nitrates- coronary artery vasodilators
beta blockers- reduce myocardial oxygen demand by decreasing heart rate
antiplatelet agents (Aspirin) 81 mg daily- reduce platelet aggregation
antilipemics- treat hyperlipidemia "stain drugs"
What diet should patients with CAD adhere to?
low fat and low cholesterol
What nursing interventions should take place when cardiac discomfort occurs?
quickly assess pain, vital signs, 12 lead ECG, treat with MONA
Post cardiac catheterization and angioplasty/stent, what medication will the patient be on to reduce risk of thrombosis?
How long should the affected leg be kept straight after cath?
If you observe findings of hypotension, bradycardia, diaphoresis, dizziness, what drug would you administer?
What should we teach our CAD patients?
avoid activities that cause angina
avoid physical activity for 2 hours after a meal
avoid very cold and very hot weather
avoid alcohol and caffeine
avoid stimulants such as diet pills, nasal contestants
What is the protocol for nitro?
1 tablet every 5 minutes up to 3, if no relief call 911
What is hyperlipidemia?
an elevation of lipids (fats) in the bloodstream (cholesterol, triglycerides, ect.)
What is the cause for hyperlipidemia?
hereditary and dietary
What does the elevation of lipids and cholesterol cause?
It leads to atherosclerosis which leads to Coronary Heart Disease
What diet modifications can be done to manage Hyperlipidemia?
choose healthier fats and eliminate trans fat
eat foods rich in omega 3 fatty acid
What medications are used to treat hyperlipidemia?
bile acid sequestrates
What is an aneurysm?
rupture of an artery due to a weakness in the arterial wall
What type of aneurysm requires emergent care?
dissecting- accumulation of blood separating the layers of the arterial wall
What are the 2 common locations for aneurysms?
abdominal aorta and thoracic aorta
What findings are associated with abdominal aorta aneurysm?
vague abdominal or back pain
if severe, this may be a sign of active dissection, requiring emergency care!!
diminished pulses in lower extremities
How is an aneurysm diagnosed?
How is an abdominal aneurysm managed?
tight control of BP and surgical repair emergent for dissecting
We should remind patients to avoid _______ and _____ if they have an abdominal aneurysm.
heavy lifting and sitting for long periods
What is Occlusive arterial disease?
insufficient blood supply in the arteries, usually in legs; may be acute or chronic. Basically it's a build up of fatty substances in the wall of the artery.
What is the etiology associated with acute occlusive arterial disease?
embolism, thrombosis and trauma. the femoral artery is most often affected.
Findings associated with acute occlusive arterial disease are:
pain in affected limb, especially with walking and activity.
cyanosis in affected limb.
paresthesia in affected limb
if left untreated, gangrene
What pharmacology measures are used to manage acute occlusive arterial disease?
IV heparin titrated based on PTT
What are the 6 P's of acute arterial occlusion?
pain, paralysis, paresthesias, pallor, poiklithermia (cold), pulselessness
What is the etiology associated with chronic occlusive arterial disease?
slow, progressive arteriosclerosis gives a chance for collateral circulation to form. This does't give tissue enough oxygen resulting in hypo perfusion leading to ischemia.
aneurysms, hypercoagulability states, tobacco use
Findings associated with chronic occlusive arterial disease?
intermittent claudication (predictable pain with walking, relieved with rest- indicates mild to moderate obstruction). pain at rest indicates severe arterial obstruction.
How will an affected limb of chronic occlusive arterial disease present?
affected limb will show:
skin: waxy, hairless, cool, pale, cyanotic
weak or absent pulses
What pharmacology treatment will we use to manage chronic occlusive arterial disease?
anticoagulants- to prevent blood clots
anti platelet drugs
pentoxifylline- promotes blood flow by making blood cells more slippery
What is Raynaud's phenomenon?
episodic vasospasm of the small cutaneous arteries that result in intermittent pallor or cyanosis of the skin- usually affects the fingers bilaterally, but occasionally affects the toes, nose or tongue that result in intermittent pallor or cyanosis of the skin
What can trigger Raynaud's phenomenon?
stress, cold, products that cause vasoconstriction such as tobacco, caffeine, and chocolate.
The treatment goal of Raynaud's phenomenon is __________. What medications can we use to do this?
promote perfusion to affected digits and prevent gangrene.
calcium channel blockers
alpha adrenergic blocking agents
analgesics for pain relief
What is Thromboangiitis obliterates (Buerger's diseases)?
rare, inflammatory disease of the arteries and veins affecting the arms and legs. The blood vessels become inflamed, swell and can become blocked with blood clots. Eventually damaging or destroying tissue and may lead to infection and gangrene.
This disease usually affects who?
Men, aging from 20-40 years old with heavy tobacco use.
The only way to stop the disease is what?
stop using all forms of tobacco
What findings are associated with Buerger's diseases?
pain, including intermittent clarification
numbness and tingling of toes
weak or absent peripheral pulses
ischemic ulceration may occur
can lead to gangrene and amputation
What are the 2 biggest risk factors for varicose veins?
standing for long periods and pregnancy
What findings are associated with varicose veins?
pain after period of standing
foot and ankle swelling at the end of the day
distended leg veins
Post op care after vein ligation for varicose veins, we should elevate the leg, T/F?
What is Thrombophlebitis?
a thrombus (clot) accompanied by the inflammation of the wall of a superficial blood vessel.
What is the etiology associated with thrombophlebitis?
trauma, IV catheter, prolonged immobility, IV drug use
What finding are associated with thrombophlebitis?
redness, swelling, tenderness, warmth, complication- thromboembolism (dislodgement and migration of a thrombus)
How is thrombophlebitis managed?
bed rest, with elastic stockings
elevation of affected extremity
anticoagulants- reduce clot formation
What is DVT?
clot formation in a deep vein
What findings are associated with DVT?
unilateral edema of an eternity, with warmth, tenderness and redness at site
What is the goal for managing DVT's?
eliminate the clot and prevent complications of pulmonary embolism
How will we manage a patient with a DVT? medications?
bed rest, compression stockings, monitor for PE
How will we teach patients to reduce their risk of bleeding?
use electric razor and soft bristled toothbrush
What is Sickle cell disease? How is it caused?
When normal adult Hgb A (HbA) is partly or completely replaced by abnormal sickle Hgb (HbS). RBC's shape becomes sickled and clump. This causes generalized microvascular occlusion.
autosomal recessive disease. 1/12 African American carries the trait.
What findings are associated with Sickle cell disease?
obstruction caused by sickled RBC's
organ dysfunction (spleen, liver, kidney) due to ischemia and infarction
What are Sickle cell crises?
vasoocclusion- painful distal ischemia usually hands and feet
destruction of RBC's
pooling of blood in liver and spleen
What therapeutic management is associated with sickle cell disease?
prevent sickling phenomenon
analgesics (narcotics during sickle crisis)
antibiotics (prophylaxis with penicillin)
high dose IV steroids
What is B-Thalassemia? How is it caused? Who is more likely to get this disease?
inherited blood disorder characterized by deficiencies in rate of production of specific global chains in Hgb. It's an abnormal, chronic production and destruction of RBC's resulting in insufficient amounts of normal circulating Hgb.
Autosomal recessive disorder
What are the findings associated with B-Thalassemia?
severe anemia, pallor
What is Idiopathic thrombocytopenia purport (ITP)?
An acquired hemorrhagic disease.
The cause is unknown but often occurs one to two weeks after a febrile viral illness. It is an autoimmune disorder. Platelets are killed and fewer are made. It may be acute or self limiting.
What findings are associated with Idiopathic thrombocytopenia purport (ITP)?
bruising, petechiae, internal bleeding
How is Idiopathic thrombocytopenia purport (ITP) managed?
splenectomy for chronic disease
What is the most important nursing intervention for Idiopathic thrombocytopenia purport (ITP) patients?
monitor for bleeding
What are important teaching points for Idiopathic thrombocytopenia purport (ITP) patients?
no contact sports
don't use aspirin, use acetaminophen
What is Von Willebrand's disease?
The clotting protein (called von Willebrand factor) is deficient or defective, affecting both males and females.
Von Willebrand's disease is the most common ________.
congenital bleeding disorder (autosomal dominant).
What findings are associated with Von Willebrand's disease?
easy bruising, nosebleeds, heavy menstrual cycle, prolonged bleeding times, epistaxis (nosebleeds), blood in stool or urine.
How is Von Willebrand's disease managed?
usually doesn't require treatment if findings are mild
avoid certain meds: blood thinners- aspirin and NSAIDs, warfarin, heparin, some antidepressants- citalopram, fluoxetine or sertraline
replace missing clot factor
What is aplastic anemia? How is it caused?
rare condition that occurs when the body STOPS producing enough new blood cells. The bone marrow stops making erythrocytes, leukocytes and platelets. This results in pancytopenia.
can be congenital (Faconi's anemia)
acquired due to exposure to overwhelming infection (hepatitis, HPV)
exposure to toxic chemicals, ect
What findings are associated with Aplastic anemia?
petechia, brusing, pallor, fatigue, headache, myelosuppression
How can Aplastic anemia be managed?
coticosteriods, antibiotics, blood transfusion
What is Hemophilia?
group of bleeding disorders in which there is a deficiency of one of the factors necessary for coagulation of blood. This is an x-linked recessive disorder. A factor (VII or XI) blood component necessary for blood coagulation is missing.
What findings are associated with Hemophilia?
mild-severe prolonged bleeding, most often in muscles and joints. long term loss of range of motion of affected joints.
How can Hemophilia be managed?
replacement of missing clotting factor
desmopressin acetate- antidiuretic that aids blood clotting
The nurse should teach the patient what important interventions?
no contact sports
activities that may cause trauma
brush teeth with soft tooth brush
Medic alert bracelet
What is Disseminated intravascular coagulation (DIC)?
disorder of coagulation characterized by clotting followed by bleeding. It begins with excessive clotting, stimulated by a substance that enters the blood as part of a disease (infection, cancer, complicated childbirth, ect.). As the clotting factor and platelets are depleted excessive bleeding occurs.
What findings are associated with DIC?
bleeding, brusing, petechiae
altered serum levels of clotting related factors; decreased platelets
clotting, hypoxia, intracranial hemorrhage, progressive organ failure
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