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NCLEX RN Chapter 56 Cardiovascular Disorders
Terms in this set (83)
An elevation of CK-MB (creatine kinase, myocardial muscle) indicates _______ damage. An elevation occur within ___ to ___ hours and peaks ___ to ___ hours following an acute ischemic attack.
4-6 (4 chambers of the heart)
Normal value of CK-MB is __%-___% of total; total CK is 26-174 units/L.
The white blood cell count increases in infectious and inflammatory diseases of the heart and after MI because large numbers of white blood cells are needed to dispose of the ________ tissue resulting from the infarction.
An increase in _______ factors can occur during and after MI, which places the client at greater risk of thrombophlebitis and extension of clots in the coronary arteries.
Hypo______ (electrolyte) causes increased cardiac electrical instability, ventricular dysrhythmias, and increased risk of digoxin toxicity.
Electrolyte and mineral imbalances can cause cardiac electrical instability that can result in life-threatening __________.
_______ is released in response to atrial and ventricular stretch; serves as a marker for heart failure.
Brain natriuretic peptide (BNP)
In this noninvasive test, the client wears a ______ monitor (same as name of test), and an electrocardiograph tracing is recorded continuously over a period of 24 hours or more while the client performs his activities of daily living. This monitor identifies dysrhythmias if they occur.
During the exercise electrocardiography testing (stress test), what kind of clothes should the patient wear?
A _____ subtraction angiography test combines x-Ray techniques and a computerized subtraction technique with fluoroscopy for visualization of the cardiovascular system.
Pre procedure for a digital subtraction angiography: check for allergies to _____, _____, or radio plaque dyes. If allergic, the client may be premeditated with ______ and steroids to prevent reaction.
A client is about to undergo myocardial nuclear perfusion imaging and asks if the radiation is dangerous. What should you tell them?
A small amount of radioisotope will be injected and radiation exposure and risks are minimal.
If client taking _______(drug) is scheduled to undergo a procedure requiring the administration of iodine dye, this drug is withheld 24-48 hours prior because of the risk of _____ _____. The medication is not resumed until directed to do so by the HCP.
Per cutaneous translational coronary angioplasty is an invasive, _____ (surgical or nonsurgical) technique in which one or more arteries are dilated with a balloon catheter to open the vessel lumen and improve arterial blood flow.
Coronary ______ ________ (usually bare metal or drug-eluding) are used in conjunction with PTCA (percutaneous transluminal coronary angioplasty) to provide a supportive scaffold to eliminate the risk of acute coronary vessel closure and improve long-term potency of the vessel.
Atrial fibrillation: multiple rapid impulses from many foci depolarizing in the atria in a disorganized manner at a rate of ____ to _____ times/minute.
Sinus tachycardia is how between how many beats per minute?
Acute _____ is a major concern following a coronary artery stent, and the client is placed on ______ therapy such as ______ and acetylsalicylic acid for several _____ after the procedure. Length of time of anti platelet therapy is determined by the type of stent that has been deployed.
Peripheral arterial __________ is performed to increase arterial blood flow to the affected limb.
After arterial vascularization, monitor for a sharp increase in _____ because this is frequently the first indicator of postoperative graft ______. If signs of graft occlusion occur, notify the HCP immediately.
During a coronary artery bypass graft, are the client's own veins used or someone else's?
The client's own
Atrial fibrillation usually has no definitive ___ wave that can be observed.
Premature ventricular contractions (PVCs): early ventricular complexes result from increased ______ of the ventricles.
Treatment of PVCs depends on the _____, and the RN is notified if PVCs occur.
For the client experiencing PVCs, notify the HCP if the client complains of _____ pain or if the PVCs increase in _______, are multifocal, occur on the T wave (R on T), or occur in runs of ventricular tachycardia.
Ventricular tachycardia occurs because of a repetitive firing of an irritable ventricular ectopic focus at a rate of ______ to _____ beats/min or more and can lead to cardiac _____. Notify the RN if VT occurs.
A stable client with sustained VT (with pulse and no signs or symptoms of decreased cardiac output) will be treated with _____ and _______.
________ is synchronized counter-shock to convert an undesirable rhythm to a stable rhythm.
Cardioversion: defibrillator is synchronized to the client's ___ wave to avoid discharging the shock during the vulnerable period (T wave).
_______ is an asynchronous countershock used to terminate pulseless VT or VF.
Before defibrillating a client, be sure that the _______ is shut off to avoid the hazard of fire and be sure that no one is touching the bed or the client.
An ____ ____ defibrillator is used by laypersons and emergency medical technicians for prehospital cardiac arrest.
An ____ _____ defibrillator monitors cardiac rhythm and detects and terminates episodes of VT and VF. It can sense VT or VF and delivers 25-30 J up to four times if necessary.
Pacemakers: when a pacing stimulus is delivered to the heart, a ______ (straight vertical line) is seen on the monitor or electrocardiogram strip.
____ _____ disease is a narrowing or obstruction of one or more coronary arteries as a result of atherosclerosis, an accumulation of lipid-containing plaque in the arteries.
The goal of treatment for angina is to provide ______ of the acute attack, correct the imbalance between myocardial _____ supply and demand, and prevent the progression of the disease and further attacks to reduce the risk of MI.
Electrocardiography of angina: readings are normal during rest, with ____ depression and/or ___ wave inversion during episodes of pain.
When a patient has angina, it is important to administer what two things to them?
Myocardial infarction occurs when myocardial tissue is _____(how fast) and severely deprived of oxygen.
What are three levels that rise specifically when a person has a myocardial infarction?
total creatine kinase level
______ relief increases oxygen supply to the myocardium. _____ ______ (analgesic) is administered as a priority in managing pain in the client having an MI.
After an MI, patient should maintain bed rest for how long?
_____ ______ is the inability of the heart to maintain adequate cardiac output to meet the metabolic needs of the body because of impaired pumping ability.
Signs of _____ (left or right?)ventricular failure are evident in the pulmonary system. Signs of _____ (left or right?) ventricular failure are evident in the systemic circulation.
What condition is this: sudden failure of the heart to pump adequately, thereby reducing cardiac output and compromising tissue perfusion. Necrosis of more than 40% of the left ventricle, usually as a result of occlusion of major coronary vessels. Goal of treatment: to maintain tissue oxygenation and perfusion and improve the pumping ability of the heart. Caused by a severe heart attack.
_________ is an acute or chronic inflammation of the pericardium. This is a chronic inflammatory thickening of the pericardium, constricts the heart, causing compression.
Pericarditis: pain is grating and is aggravated by breathing (particularly _____), coughing, and _______.
Pericarditis: pain is worse when in the _____ position and may be relieved by leaning ____.
Pericarditis: position the client in the ____ ____ position, upright and leaning ____.
Pericarditis: monitor for signs of cardiac ________(compression of the heart by an accumulation of fluid in the pericardial sac), which include pulsus paradous, jugular vein distention with clear lung sounds, muffled heart sounds, narrowed pulse pressure, tachycardia, and decreased cardiac output.
_______ is an inflammation of the inner lining of the heart and valves.
Endocarditis occurs primarily in clients who are ____ ____ ____, have had _____ replacements, or have mitral valve prolapse or other structural defects.
IV drug abusers
The following is data collection for what condition?: stasis dermatitis or brown discoloration along the ankles and extending up to the calf. Edema, ulcer formation: edges are uneven, ulcer bed is pink, and granulation is present.
A pericardial effusion occurs when the space between the parital and visceral layers of the pericardium fills with fluid. Pericardial effusion places the client at risk for cardiac _______, an accumulation of fluid in the pericardial cavity. Tamponade restricts ______ filling, and cardiac output drops. Distant, muffled heart sounds are heard. ________ tamponade occurs when a small volume (20 to 50 ml) of fluid accumulates quickly in the pericardium.
_________ is a problem after valve replacement with a mechanical prosthetic valve, and a lifetime anticoagulant therapy is required.
red, warm area radiating up the vein of an extremity, pain and soreness, and swelling are all data collection for what?
Calf or groin tenderness or pain with or without swelling, positive Homan's sign may be noted; however, false positive results are common so this is not a reliable measure. Warm skin that is tender to touch. This is all data collection for what?
Interventions for DVT: provide bed rest as prescribed. Elevate the extremity above the level of the ______. Avoid using the knee gatch or ______ under the knees. Do not ______ the extremity.
What condition is this: results from prolonged venous hypertension, which stretches the veins and damages the valves. The resultant edema and venous stasis cause venous stasis ulcers, swelling, and cellulitis.
For venous insufficiency, leg elevation is or is not prescribed?
is, to assist with the return of the blood to the heart.
What is this condition: a chronic disorder in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients. Tissue damage occurs below the level of the arterial occlusion.
Peripheral arterial disease
Data collection for peripheral arterial disease: _______ claudication, decreased or absent _______ pulses. Signs of arterial ulcer formation occurring on or between the _____ or on the upper aspect of the ____ that are characterized as painful.
Should a patient with peripheral arterial disease elevate their extremity?
yes and no
they should elevate it slightly at rest but it should never be elevated above the level of the heart because extreme elevation slows arterial blood flow to the feet.
Peripheral arterial disease: In severe cases of peripheral arterial disease, clients with edema may sleep with the affected limb _______ from the bed, or they may sit upright (without leg elevation) in a chair for comfort.
__________ disease is vasospasm of the arteriolar and arteries of the upper and lower extremities. Attacks are intermittent and occur with exposure to cold or stress. Primarily affects fingers, toes, ears, and cheeks.
______ disease (thromboangitis obliterans) is an occlusive disease of the median and small arteries and veins. The distal upper and lower limbs are affected most commonly. Usually leads to gangrene.
An _____ _____ is an abnormal dilation of the arterial wall caused by localized weakness and stretching in the medial layer or wall of the aorta.
Data collection for a _____ aneurysm: pain extending to neck, shoulders, lower back, or abdomen, syncope, displeasure, increased pulse, cyanosis, weakness, hoarseness/difficulty swallowing because of pressure from the aneurysm.
Data collection for _______ aneurysm: severe abdominal or back pain, lumbar pain radiating to the flank and groin, hypotension, increased pulse rate, signs of shock, hematoma at flank area.
INstruct the client with an aortic aneurysm to report immediately the occurrence of ____ to ____ pain, shortness of breath, difficulty ______, or hoarseness.
What is this: a thoracotomy or median sternotomy approach is used to enter the thoracic cavity. The aneurysm is exposed and excised, and a graft or prosthesis is sewn onto the aorta. Total cardiopulmonary bypass is necessary for excision of aneurysms in the ascending aorta.
Thoracic aneurysm repair
_______ is removal of an embolus from an artery using a catheter.
For a patient who has just had an Embolectomy, it is important to instruct the client about _______ therapy and the hazards associated with these medications.
Vena cava ______: insertion of an intracaval filter (umbrella) that partially occludes the inferior vena cava and traps emboli to prevent pulmonary emboli.
______ of inferior vena cava: suturing or placing clips on the inferior vena cava to prevent pulmonary emboli; performed via abdominal laprotomy.
Postoperative interventions for vena caval filter and ligation of inferior vena cava: maintain a semi-Flower's position, avoid hip _____, postoperative interventions are the same as for _____ectomy.
What values indicate stage 1 hypertension?
What values indicate stage 2 hypertension?
A hypertensive _____ is any clinical condition requiring immediate reduction in BP.
Pg. 700 Q 521, 523, 524, 529, 530, 531, 534
Is the following peripheral arterial disease or venous insufficiency: pain in the legs with dull aching after standing.
In an elective procedure for atrial fibrillation or atrial flutter, the paient should receive ________(medication class) therapy for 4-6 weeks preprocedure and transesophaeal echocardiogram should be performed to rule out _____ in the atria prior to the procedure.
Surgical procedure ___________ (4 letters) is used to compress the plaque against the walls of the artery and dilate the vessel?
Measuring CVP: the zero point on the transducer needs to be at the level of what?
the right atrium (located at the midaxillary line at the fourth intercostal space)
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