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ACS, CAD, HF & VD (Ch. 34 & 35 & 38)
Terms in this set (87)
What is Coronary Artery Disease
An obstruction of the coronary arteries due to atherosclerosis
The nurse assesses the right femoral artery puncture site as soon as the patient arrives after having a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What should the nurse do next to ensure the femoral artery is intact?
Inspect the patient's right side and back for retroperitoneal bleeding
Patients with CAD may be asymptomatic OR develop....
Chronic Stable Angina (chest pain)
Unstable angina and MI are more serious and are classified as...
Acute Coronary Syndrome
What is atherosclerosis (hardening of the arteries)
Accumulation of plaques in the inside of the arteries that contain lipids & cholesterol
Inflammation and endothelial injury play a central role in the development of atherosclerosis. What can cause damage to the endothelium?
1. Tobacco use
4. Toxins (infections that cause local inflammatory response)
What rises when there is systemic inflammation
Levels of C-Reactive Protein
Stages of development of atherosclerosis
1. Fatty streak (lipids accumulate)
2. Fibrous plaque (lumen narrowed, blood flow reduced)
3. Complicated lesion (plaque rupture, thrombi form, more narrowing)
What is collateral circulation?
-When more than one artery can supply a muscle with O2
The development of collateral circulation takes time and develops when chronic ischemia occurs to meet metabolic demands. Therefore, who is more at risk for having a lethal response from an obstruction?
-A younger individual
-Rapid onsets of CAD (familial hypercholesterolemia) or coronary spasms
1. Coronary arteries supply blood to the
2 Blockage or narrowing creates what?
3. Right Main Coronary Artery supplies the...
4. Left Main Coronary Artery splits into the...
4. Left anterior descending supplies the...
5. Circumflex artery supplies the...
3. RA/RV, Inferior LV, Posterior septum, SA&AV node
4. L.anterior descending & circumflex
4. Anterior L.V/Septum, Apex of LV
5. LA, Lateral&Posterior LV
1. When does myocardial ischemia occur?
2. What is the symptom for reversible myocardial ischemia?
3. Chronic stable angina
4. When ischemia is prolonged and not reversible immediately, what occurs?
1. When the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen.
2. Angina (chest pain)
3. Same onset, duration and intensity of symptoms
4. Unstable angina, STEMI-MI, NSTEMI-MI
-Age, Gender, Ethnicity
-Family & Genetics
-↑ Serum Lipids, BP, Homocysteine
-Smoking, Obesity, No exercise
-how many years earlier
-what is the first manifestation?
-s/s big what?
-more what and ↑ mortality with?
-10-15 yrs earlier
-Acute MI is first manifestation vs Angina
-Classic symptoms, Big ventricle
-Better Collateral circulation
-More deaths & ↑ mortality with CABG
-Fatigue, ↑LDL after menopause, Palpitations
-Often not treated quickly & S/S not classic (silent MI)
-When blood flow is reduced & ischemia occurs, what will you see in the monitor?
-With infarction, cell injury results in what?
2. 12-lead ECG detects what?
3. Chest x-ray reveals what?
4. Serum lipid levels indicate
5. Exercise/Stress tests & Ambulatory test
6. Nuclear Imaging used to determine...
7. PET scan is used to...
9. Echo w/exercise used to:
-ST-depression, T-wave inversion
-ST-elevation, T-wave inversion, Abnormal Q-wave
-Cardiac enlargement, Cardiac calcifications, Pulmonary Congestion
4. Risk factor
5. ST & T-wave changes that indicate ischemia with exercise, 24-48 hr monitor helps identify silent ischemia
6. Perfusion, Contractility, EF
7. idenitify ischemia and infarction
8. visualize coronary arteries and help plan treatment&prognosis
9. Diagnose coronary artery stenosis
1. #1 Goal
2. Life style changes (DIET)
3. FITT formula designed
1. Identify risk factors to slow disease progression
2. ↓fats,↑fiber,NO tobacco, ↑exercise
3. Frequency, Intensity, Type, Time
Lipid Lowering Drugs "OR" LipitOR, ZocOR, CrestOR
1. Block synthesis of cholesterol & HMG-CoA enzyme.
2. Inhibits VLDL & ↓ triglycerides
3. ↓ VLDL&triglycerides, ↑HDL levels
4. Bind with bile salts
8. A patient who has recently started taking pravastatin (Pravachol) and niacin (Nicobid) reports the following symptoms to the nurse. Which is most important to communicate to the health care provider?
1. Statin drugs (lipitor, zetia), monitor liver, CK
2. Niacin, take aspirin/nsaids
3. Fibric Acid Derivatives
4. Bile acid sequestrants, interfere with medications
8. Muscle aches and pains may indicate myopathy and rhabdomyolysis
1. This is recommended for most people at risk for CAD, unless contraindicated due to GI bleed
2. Plavix considered for who? (stent placement)
1. Low dose Aspirin
2. High risk women with Aspirin intolerance, people who cannot have aspirin
-A.E: TTP: causes blood clots in small arteries and can lead to neuro/kidney disease ↓ platelets
-stop 5-7 days before surgeries
1. Be sure to inform clients about what in regards to diet changes?
2. Question patients about family hx of CAD in?
1. They are not temporary, MUST be maintained always
2. Parents or siblings
1. To compress the plaque against the walls of the artery and dilate the vessel
2. To vaporize the the plaque
3. To remove plaque from artery
4. To prevent artery from closing and prevent stenosis
5. To improve blood flow to myocardial tissue that is at risk for ischemia or infarction because of the occluded artery
2. Laser Angioplasty
4. Vascular stent
5. Coronary artery bypass grafting
Chronic Stable Angina (Exertional angina)
1. what is wrong with the arteries?
2. This is a type of chest pain that occurs how?
3. No change in position or breathing, but pain does subside with...
4. Within the first 10 seconds of coronary occlusion, what happens to the myocardium?
5. referred pain to
6. In ischemic conditions, how long are cardiac cells viable for?
1. They cannot meet the heart's O2 demand
2. Intermittently, over long period,same pattern of onset, duration, intensity
4. Becomes hypoxic
5. shoulders, neck, lower jack, arms)
6. 20 mins, when O2 is restored, aerobic metabolism resumes & cellular repair begins
7. Episode lasting, 5-15 mins, provoked on exertion, relieved by stress
PQRST assessment for Angina:
-Precipitating event (what led to it?)
-Quality of pain (pressure, dull?)
-Radiation (where is pain? does it move elsewhere?)
-Severity (0-10 scale)
-Time (when did it start?)
Precipitating factor for ANGINA
2. Extreme temperatures
3. Strong emotions
4. Eating heavy meals
6. Sexual activity
7. Drugs (cocaine,↑HR&O2demand)
8. Circadian rhythm patterns
-how will their chest feel?
-weak? numb where?
ECG= ST ↓, T-wave inversion
Pain(5-15mins) gone with rest, unusual if pain at rest
1. Choking, Pressure, Squeezing, Heavy chest
2. Weak/Numb upper extremities
1. ECG during rest
2. Troponin levels
3. Chest X-ray may show...
4. Calcium score screening heart scan locates
5. Cardiac Catherization & Coronary angiography provide images of ...?
6. If coronary blockage is open to an intervention what is done?
7. Explain process of PCI
8. Intracoronary stents are often inserted in conjunction with balloon angioplasty, what are stents used for?
9. Describe a stent
10. Stents are thrombogenic, therefore, what is started to keep the vessel open?
11. After PCI, patient is treated with what medication?
12.Many stents are coated with a drug that prevents overgrowth of new intima, this is the primary cause of what?
13. MOST serious complications of stent placement
14. Other less common complications
15. Is possibility of dysrhythmias during and after procedure always present?
16.People who are not good candidates for a PCI
1. normal, ST ↓, T-wave inversion during episode of pain
2. Normal levels in angina
3. Heart enlargement, aortic calcifications, pulmonary congestion
4. Ca+ deposits in atherosclerotic plaques in coronary arteries
5. coronary circulation&identify location/severity of blockage
6. percutaneous coronary intervention (PCI) is done
Catheter with balloon tip inserted into coronary artery-> catheter passed through blockage -> plaque is compressed&vessel dilates (Balloon angioplasty)
8. Treat abrupt or threatened abrupt closure and restenosis after balloon angioplasty
9. Expandable, meshlike, designed to keep vessels opened by compressing arterial walls
10. Unfractioned heparin, or low molecular weight heparin
11. dual antiplatelet agents (aspiring and ticagrelor) until intimal lining can grow over the stent and provide a smooth vascular surface
12. Stent re-stenosis
13. Closure and Vascular Injury
14. Acute MI, Stent embolization, coronary spasm, & emergent CABG surgery
16. Patient with 3-vessel CAD, L main coronary artery disease (CABG surgery may be recommended)
1. Obtain informed consent and assess for allergies of:
2. What should you withhold for 4-6 hours to prevent vomiting and aspiration?
3 Why will client feel fatigued? Why obtain weight and height?
4. What will patient feel?
5. After procedure, how often should you monitor vitals for dysrhythmias
6. If dysrhythmias, chest pain, numbness and tingling,extremities become cool,pale or cyanotic, loss of peripheral pulses occur what will you do?
7. Monitor pressure dressing for
8. How should patient keep their extremities?
9. strict bed rest for how long?
10. Major nursing responsibilities
1. Iodine, seafood, Radiopaque dyes (if allergic medicate with antihistamines)
2. Solid food & Liquids
3. Pt.will lie still and quiet on hard table for 2 hrs, to see how much dye will be needed
4. fluterry feeling as catheter passes, flushed, warm feeling when dye injected and desire to cough&palpitation by heart irritability
5. every 30 mins for 2 hours
6. call health care provider
8. extended for 4-6 hours to prevvent arterial occlusion
9. 6-12 hrs but encourage fluid intake to flush out the dye
10. Monitor for signs or angina, vitals, HR, bleeding, neurovascular assessment of extremities, BED rest
1. First line of therapy for treatment of angina:
2. What is their effect?
3. Sublingual nitrate relieves pain when and has a duration of what?
4. If s/s not changed after 5 mins, what should patient do?
5. How should tablets be stored?'
6. Once med packed is opened, they should be replaced how often?
7. Is tingling under tongue normal?
8. Side effects you must warn about
9. Why should patient change positions slowly?
10. Nitrate can be taken prophylactically how soon before starting an activity/sex?
LONG acting=Tablets, Paste, Transdermal
1. MAIN side effect of all nitrates
2. Advice patients to take what to relieve headache?
3. Due to O.H, when should BP be monitored? When are patients scheduled an 8 hr nitrate-free period?
4. Nitro ointment placed where?
5. Ointment give angina for prophylaxis for 3-6 hours, it is especially useful
6. Transdermal patches have effect that last
7. Patches reach plasma levels how fast?
8. Nurse should wear gloves when giving the med to prevent absorption of med in fingers & tell patient what about viagra?
2. Dilate peripheral BV & Coronary arteries --> O2 demand is ↓
3. 3 minutes, 30-40 mins
4. repeat intake every 5 mins, max 3x & call 911 if s/s dont stop
5. Away from light and heat, always keep close
6. Every 6 months
7. YES, it means drug is working
8. Dizziness, Headache, Flushing
9. Orthostatic hypotension
10. 5-10 mins
1. Headache from dilation of cerebral blood vessels
3. After initial dose, during nigh unless nocturnal angina is present
4. On upper body or arm, over flat muscular area free of hair and scars
5. nocturnal and unstable angina
6. 24 hours
7. In 2 hours
8. DO NOT use viagra, because it can cause MORE vasodilation
Meds: ACE inhibitors
1. Who gets this med?
2. What do these drugs do?
1. This drug reduces myocardial O2 demand by doing what?
2. These patients should start & continue beta blockers indefinitely
3. Side effects
4. Which patients should avoid this drug, and which patients should it be used cautiously in?
5. ↑frequency&intensity of angina attacks if patient does what?
1. Considered high risk for cardiac event (EF 40% or less, or hx of diabetes)
2. Vasodilation & ↓ blood volume, Prevent/Reverse ventricular remodeling
1. ↓ contractility, HR, SVR, BP
2. L.Ventricular dysfunction, ↑BP, Hx of MI
3. Bradycardia, Hypotension, Wheezing, GI, Weight gain, Depression, sexual dysfunction
4. Asthma pts, Diabetes because they mask hypoglycemia
5. Stops taking the drug suddenly
(when b-blockers are contraindicated)
1. Effects of drug
2. What drug to they potentiate the action of?
3. may cause...
2. Digoxin (can toxicity)
3. peripheral edema
1.Steps in patient experiencing angina
2. Observe for pain manifestations such as
3. Supportive, realistic assurance & calm approach help patients in what situations?
4. Teach patients about risk factors, how to avoid them and to decrease weight, exericse should be advised
-Position patient upright & give O2
-Assess vitals & Obtain 12-lead ECG
-Pain relieve first with a nitrate then with opioid if needed
-Auscultate heart & breath sounds
-ECG changes, ↑HR/RR/BP, clutching bed linens, nonverbal cues
3. anxiety during anginal attack
4. walk on flat surface 30 mins p/day, most days of the week
Acute Coronary syndrome includes which disorders?
1. Unstable angina
2. NSTEMI MI
3. STEMI MI
1. ACS occurs when a stable plaque
2. The exposure of intima to blood stimulates what?
3. If a lesion is partially occluded, it is known as
4. If a lesion is totally occluded by a thrombus, it is known as
1. Deteriorates, ruptures and exposes intima to blood
2. Platelet aggregation, vasoconstriction & thrombi formation
3. Unstable angina/NSTEMI MI
4. STEMI MI
Unstable Angina: Unpredictable & AN EMERGENCY
1. In a patient with Chronic stable angina, what will they describe UA as?
2. Patient without previously diagnosed angina will describe pain as..
-change in pattern & ↑ frequency
-Now I have it with no exertion, during sleep or at rest
2. pain that has progressed rapidly in last hours, days, weeks, pain also at rest
Myocardial Infarction: Sustained ischemia, Irreversible cell death (necrosis)
1. what forms in the arteries?
2. what stops in the necrotic areas?
3. Cardiac cells withstand ischemic conditions for 20 mins before what beings to occur?
4. If ischemia persists, how long does it take for the entire thickness of the heart muscle to become necrosed?
5. MIs correlate with location of damage, Inferior wall infcarctions result from occlusion of which artery?
6. Which part of heart is first to feel effects?
7. People with long hx of CAD develop adequate collateral circulation, this helps with what
8. In an attempt to compensate for the infarcted muscle, what happens to the normal myocardium?
2. contraction of heart
3. cell death
4. 4-6 hours
5. Right coronary
7. ↓ the severity of the infarction
8. It hypertrophies and dilates which can cause HF
Clinical Manifestation in UA:
1. How is the chest pain associated with UA?
2. Symptoms that women usually feel
3. Relief of pain from rest or nitrates?
4. Is it possible for a diabetic to feel no pain at all?
1. New in onset, at rest, worsening pattern
2. Fatigue, SOB, Anxiety, Indigestion
1. Relief of pain from rest& nitrates?
2. How will patient describe pain?
3. Where will patient feel the pain?
4. How long does pain last?
5. Older adult may experience...
3. Heavy, Pressure, Burning, Crushing, Tightness, Constriction
3. Epigastric, Substernal, Retrosternal, pain radiating to Back, Neck, Jaw/tooth Shoulder, Arms
4. 20 mins or more
5. ALOC, SOB,PE, Dizzy, Dysrhyth
-Other common s/s
1. N/V, diaphoresis and how is the skin presenting? fever for up to..?
2. ↑ what and ↓ in what?
3. lung sounds? enlargements?
1. N/V, Diaphoresis, pt. skin may be ashen,clammy,cool, Fever for up to a week
2. ↑Pulse/BP & ↓ I/O
4. crackles, murmur, (s3&s4 sounds) hepatic engorgement, peripheral edema, jugular veins may be distended with pulsations
Complications of MI
2. Ventricular fibrillation: how many hours after pain?
3. Heart failure
4. Cardiogenic shock
5. How do you relieve pain when experiencing pericarditis?
1. Disrupted rhythm, bradycardia, tachycardia, life threatening
2. lethal dysrhythmia occuring 4 hrs after onset of pain
3. heart's pumping ability is reduced
4. severe left ventricular failure so inadequate oxygen and nutrients supplied to tissues
5. Lean forward
1. CK-MB: Rise, Peak, Elevated
2. Troponin: Rise, Peak, Elevated
3. UA or NSTEMI do not develop
4. STEMI is associated with
2. -4-6 hrs, 18 hours, 2-3 days
3. -4-6 hours, 10-24 hours, 10-14 days
4. pathologic Q-waves
5. pathologic Q waves seen
What would you do with a patient in an emergency situation?
1. IV & admin Nitro & ASA, morphine IV for pain
2. put on ECG, upright, O2 (↑93%)
3. Bed rest for 12-24 hours
4. UA/NSTEMI= ASA & Heparin
STEMI MI Treatment
-Cath lab within 90 minutes!!!
-Thrombolytics within 30 of arrival if no cath lab & 6 hrs after onset, ECG checked, check for bleeding contraindications
Benefits of Nitro IV: rapid effect
-↓ pain, ↑coronary artery flow,↓ preload and afterload
-easily titrated (↓at night, ↑during day)
-Hypotension is side effect, fluid bolus can help
vasodilator, pain reliever, reducer of anxiety and fear
Care AFTER MI
1. PROMOTION OF:
1. What should you administer to relief pain?
4. Emotional/behavioral care
1. Pain relief, Rest&Comfort, ↓stress&anxiety
2. O2, Nitro/Morphone
2. ECG, vitals, I&O
3. Bed /Chair rest for 12-24 hours, Reliever anxiety
4. cardiac cripple
Drugs that patient will be on
1. B-blockers for ever
2. Nitro (stable drip/titrated)
3. ACE Inhibitors (prevent remodeling, EF <40%)
4. Tx dysrhythmias, ↓ cholesterol, stool softner (NO STRAINING)
-teach patient how to check their own:
-if exercising and SOB occurs, what should I do?
-what is important before and after exercise?
-when can I resume sex?
-teach how to check pulse
-stop exercise if SOB occurs
-warm up and cool down, try 5x or more a week
-okay to resume sex after 7-10 days of uncomplicated MI
-↓ in what?
-what type of meals are not recommended, rest ?
-↓ salt, sat.fat, cholesterol
-no heavy meals, rest 1-2 hrs after if needed
-elective? awake but what?
--synchronized on the
-how many joules and what monitor?
-emergency and what is in progress?
-there is no what, # of joules, patient is ..?
-Often elective, client awake but sedated
-synchronized on the "R" wave
-50-100 joules & ECG monitor
-Emergency, CPR in progress
-NO CO, 120-200 joules, unconscious client
-V-fib, V-tach, ECG monitor
Sudden Cardiac Death
-predictor of what dysfunction?
-usually ventricular fib
-chest pain, palpitations, dyspnea
-may/may not have warning
-LV dysfunction predictor
1. What is provided within this care?
3. Phase One=
4. Phase two=
5 Phase three=
1. Activity & sex rehab, diet & drug education
2. return to vital and productive life
3. Begins in the hospital
4. After discharge, 3x p/week
5. Long term
Heart Failure: Impaired cardiac pumping or filling ability of the heart
1. What is going on in heart failure
2. Heart failure is associated with what diseases?
1. Heart cannot maintain adequate cardiac output to maintain O2 needs of body
2. CAD, Hypertension, MI, advanced age, Diabetes, Smoking, Obesity & ↑ serum cholesterol
-what is weak? impaired what? ↑ in ?
- size ventricle ?
↓ left ventricular EF
1. Weak pump, Impaired contractility (MI), ↑ afterload (hypertension)
2. Dilated, Hypertrophied
Impaired ventricular filling
1. Stiff ventricle, LVH Normal EF, ↓Stroke volume
Most common form of initial heart failure
Left sided failure
-blood backs up into LA & pulmonary veins
-↑ pressure= fluid leakage from pulmonary capillary bed into interstitium and alveoli--> pulmonary congestion & edema
Left Heart Failure
R: Rarles (crackles, wheezes)
N: Nocturnal Paroxysmal dyspnea
I: Increase HR
N: Nagging cough (pink frothy sputum)
G: Gaining weight (2 lbs in 1 day, 5 lbs in 1 week)
What is the primary cause of Right sided heart failure?
Left sided heart failure
-blood back up into the RA & venous circulation
-Venous congestion=peripheral edema, hepatomegaly, splenomegaly, JVD
Right Side HF (cor pulmonale)
-may be secondary to COPD
S- Swelling of arms, legs, jugular venis, liver & spleen
W- Weight gain
E- Edema (pitting)
L: Large neck veins (JVD)
L: Lethargy, anxiety, depression
I: Increased HR
G: GI bloating (ASCITES), Nausea/Anorexia
The overloaded Heart uses compensatory mechanisms to try to maintain adequate CO. The mechanisms are:
1. Sympathetic Nervous system
2. Neurohormonal mechanisms
3. Ventricular dilation
4. Ventricular hypertrophy
Sympathetic Nervous system
1. Often first mechanism in Low CO
2. Release of epi&norepinephrine
3. ↑HR, Contractility & peripheral vasoconstriction
4. Initially, ↑ in myocardial O2 needed
5. Later, this increase problems for heart because it makes the already weak heart keep working harder and harder
1. ↓CO=↓ kidney perfusion
2. Release of renin-> angiotensin II->aldosterone-> Na+&water retention-> peripheral vasoconstriction
3. ↓ cerebral perfusion pressure-> release of ADH from pituitary-> water retention-> vasoconstriction
1. ↑pressured=enlarged chamber
2. Muscle fibers stretch--> then overstretch-->no longer contract effectively--> ↓CO
-↑ muscle mass & cardiac wall thickness
-poor contractility, requires more O2-> prone to dysrhythmias
Natriuretic peptide BNP
1. Enhances, increases what
2. Dilation ?
4. What is it triggered by?
1. Diuresis, increases GFR
2. Venous & Arterial dilation
3. Development of hypetrophy
4. ↑ BP
Acute Heart Failure:
1. ↑ in the pulmonary vascular pressure caused by
2. How will the patient appear (TDC) & (APCO) & what is ↓ & what is ↑?
3. Lungs sounds
1. Left ventricular failure
-Tachypnea, Dyspnea, Cough & Anxious, Pale, Clammy , Orthopnea
3. Crackles, wheezes, rhonchi
2. administer and monitor
3. assess what sounds?
4. ensure that what is in place
5. prepare for administration of
7. what kind of support will you prepare if needed
1. High fowler's
2. O2, vitals&ECG
3. lung sounds
4. IV sites
5. diuretic or morphine sulfate
7. ventilator and intubation
8. event, actions, response
1. ↓ volume
2. ↓ venous return
3. ↓ afterload & vasodilates
4. ↑ gas exchange
5. ↑ cardiac function
-↑ LV function but also ↑ myocardial O2 consumption , only recommended for short term management who have not responded to diuretics, vasodilators and morphine
6. Reduces anxiety
2. iv nitro
5. Positive Inotropes
6. morphine & benzos
1. depends on
2. Early sign & seen after activity
3. S/S (DTENP)
4. skin will look
5. behavioral changes
6. diet changes for patient
7. fluid restriction not needed for mil-moderate HF but moderate-severe is there fluid restriction?
8. what will you say about weight? Rest?
1. ventricle, heart disease, age
3. dyspnea, tachycardia, edema, nocturia, PND
5. confused, ↓ memory, restless
6. ↓ Na (max 2gp/day)
8. weight yourself and notify ↑ 2lbs in 1 day or 5 lbs in 7 days, REST
2. Left ventricular...
3. enlargement of
4. which organ failure?
2. Echo; EF, distinguish between D&S HF
3. catherization & ECG
1. Pleural effusion
2. LV thrombus
-loop (lasix, bumetanide, torsemide)
3. IV nitrates
5. beta blockers
6. positive isotropes
-↓ myocardium conduction speed↓HR for more complete emptying of ventricles,↓volume in ventricles during diastole
-CO increase because of increase SV from the improved
1. -lowest effective dose should be used
-↓ Na& Water
-dry cough, hyperkalemia, amgioedema, OTH, doesn't work as well with aspirin
3. vasodilation of coronary arteries
4. HF african americans
5. block SNS effects
-mask hypoglycemia, not for COPD/Asthma/hypotension, bradycardia, GI distress, Weight gain, wheezing, sexual dysfunction
Care of Chronic Heart failure
3. vitals with activity
4. Bi-ventricular pacing
5. Daily weights
6. Na+ & water restriction
Killip Classification: Post MI
1. Class 1
2. Class 2
3. Class 3
4. Class 4
1. no crackles and S3
2. crackles in lower half of lung, maybe s3
3. crackles more than half way in lungs
4. cardiogenic shock
Treating Congestive HF:
S: ↓ in what food?
-Test (Digoxin level, ABGs, K+)
1. Disorders away from the heart
2. Affect the extremities, VERY severe
Aortic Aneurysm: balloons filled with blood that can leak/break, the larger the greater risk for rupture
-↓ in what?
-Gender and age?
-Major risk factor
-What can cause it?
-↓ in urinary output
-More in male, ↑ with age
-Male, older, smoker
-PAD, CAD, ↑BP,↑ cholesterol, overweight & hx of stroke
Thoracic Aorta Manifestations:
-What type of pain and where does it extend?
-what is decreased to the heart and what happens to the veins??
-Chest pain extending to interscapular area
-↓venous return to heart, distended neck veins, edema of face and arms
Abdominal Aortic aneurysm
1. what type of pain occurs from lumbar nerve compression
2. what occur from bowel compression?
3. pulsating mass in where?
4. bleeding where? what can you auscultate?
1. Abdominal/Severe Back pain
2. epigastric discomfort or altered bowel elimination
3. peri-umbilical area
4. retroperitoneal area & bruit
1. #1 goal
2. Risk factor modifications
3. Growth rates of aneurysms may be lowered with
4. Surgery for is done when they are in what size or in what situations?
5. what is done to treat them
1. to prevent rupture and decreasing blood pressure
2. stop smoking, ↓BP,lipids and annual monitoring of aneurysm with ultrasound, CT or MRI
3. beta blockers, statins and antibiotics
4. 5.5 cm
-have a genetic disorder
-symptomatic or ↑ risk for rupture
5. Resection & Endovascular grafts
Thoracic Dissecting Aneurysm
1. Tear in the...?
2. blood flows between the..
3. Predisposition factors
4. patient will describe pain as...
7. How is this treated?
2. intima and the media of arterial wall
-age, aortitis, aortic surgeries, blunt trauma, trauma
-congenital heart disease, connective tissue disorders
4. tearing or ripping
5. cardiac tamponade, ischemia of organs
6. ↓BP&↓Contractility, relieve pain(beta blockers, ACEIs, morphine)
7. endovascular graft: stent graft placed
Post op Care
1. How should you maintain BP? position of patient?
2. When does myocardial ischemia occur especially?
3. Monitor for:
1. Keep up but not too high to keep graft open & semi fowlers
2. Thoracic aneurysms
-Infections, paralytic ileus, I/O hourly,
-neuro status, peripheral perfusion, sexual dysfunction due to BP meds
Peripheral Arterial Disease
1. Ischemic muscle pain that is caused by exercise, resolves within 10 mins or less with resting
3. Pulse? Drainage
4. sore are...
5. what is found below the foot?
6. anke-brachial index
7. leg hair?
8. ulcers present? nails? when does pallor occur and how is the skin temperature wise?
1. Intermittent claudication
2. No edema
3. No pulse, No drainage
4. round, smooth sores in toes and feet
5. black eschar
8. Ulcers, Thickened nails, Pallor on elevation, Cool skin
Peripheral Venous Disease
1. Patient will describe the pain as
2. Edema in the
3. Pulse? Drainage?
4. how will the sores look?
5. Anke-brachial index
6. skin pigment
7. skin temp.?
2. lower leg
3. Pulse and drainage present
4. sores with irregular borders in ankles
6. bronze, brown
Peripheral Artery Disease
1. Leading cause
2. Where will pain be felt?
4. nerve tissue ischemia causes?
5. Pallor of foot is noted in response to?
6. primary non drug tx
7. Drug therapy
8. Exercise education
9. diet high in
10. what can patient do for any ulcers?
11. Surgery & Radiologic procedure's goals
1. atherosclerosis due to diabetes,↑bp,↑Na+
2. artoiliac (butt) & femoral/popliteal (calf)
3. erectile dysfunction
4. parathesia (numbness&tingling of toes and feet)
5. leg elevation
6. smoking cessation
7. antiplatelets: plavix & ASA
8. walk 30-40 mins per day, 3-5x/week, walk to point of discomfort, rest, and resume walking
9. soy protein, fruits/veggies, whole grains
10. apply dry sterile dressings
11. to maintain circulation
1. After surgical or radiologic intervention what will you check>
2. Loss of palpable pulses or change in doppler sound over pulse requires
3. after patient leaves recovery area, assess for complications such as:
4. numbness, tingling, cold extremity suggest
5. should knees be flexed?
6. If edema develops, position patient
7. patient teaching will include:
1. extremities every 15 mins then every hour checking for:
-color, temp, cap.refill, peripheral pulses, movement sensation
2. immediate attention
4. blockage of graft or stent
5. NO, except in exercise , no prolonged sitting
6. supine and elevate leg above heart level
-Foot care, leg inspection
-Clean comfortable shoes should be worn
s/s of PE
valves in legs are not getting blood back to the heart; not as serious as PE
-brown color along ankles extending to calf, edema & ulcer formation
-sob, chest pain, anxiety, hypoxic
-O2 stats dont recover with O2
1. Why bed rest?
2. Elevate the affected area:
3. What will you apply to reduce venous stasis and assist in the venous return of blood to the hear?
4. What will be prescribed?
5. usually how many hours does it take coumadin to work?
1. prevents clots from moving to lungs; but patient can ambulate after getting thrombolytics
2. above heart level & do not massage affected leg
3. Thigh high compression stockings
4. Heparin after 5 days of symptoms, then admin warfarin (coumadin) when symptoms of DVT have resolved
5. 2-3 days
1. what happened to veins? valves?
2. waste products build up in
3. when will patient wear elastic compression stocking??
4. teaching about sitting, standing, constrictive clothing or crossing legs
5. elevate legs for
1. stretched, damaged
3. during day and evening for 1 hour
4. AVOID prolongation
5. 10-20 mins every few hours p/day