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DSCC Cardiovascular
DSCC Cardiovascular Disorders
| Question | Answer |
|---|---|
| What is cardiomyopathy? | A subacute or chronic dz of cardiac muscle |
| Dilated Cardiomyopathy: | Structural abnormality |
| Dilated Cardiomyopathy: | Extensive damage to myofibrils & interferes c myocardial metabolism |
| Dilated Cardiomyopathy: | Ventricular & systolic fx is impaired |
| Causes of Dilated Cardiomyopathy: | -Alcohol abuse -Chemotherapy -Infection/inflammation -Poor nutrition |
| S/S of Dilated Cardiomyopathy: | -Asymptomatic for months-years -DOE -Decreased exercise capability -Fatigue -Palpitations (a-fib c embolism) |
| Dilated Cardiomyopathy meds: | -Diuretics -Vasodilating agents -Cardiac glycosides (increase cardiac OP) -Antidysrhythmic drugs -Beta-blockers (decrease HR) |
| Implantable defibrillators may be needed in what cardiovascular condition? | Dilated Cardiomyopathy |
| Teach pts c Dilated Cardiomyopathy to avoid: | Alcohol or other toxin that could be the cause of the dz |
| Surgical management of Dilated Cardiomyopathy: | Heart Transplant |
| Hypertrophic Cardiomyopathy: | Asymmetric ventricular hypertrophy leads to stiff left ventricle (diastolic filling abnormalities) |
| Hypertrophic Cardiomyopathy: | Single-gene autosomal dominant trait |
| S/S of Hypertrophic Cardiomyopathy: | -May not have S/S -DOE -Dizziness, syncope -Palpitations -Chest pain (occurs @ rest; prolonged & not relieved c nitrates) |
| Hypertrophic Cardiomyopathy meds: | -Inotropic Agents: Cavedilol & Diltiazem (decrease outflow obstruction & decrease HR) |
| Teach pts c Hypertrophic Cardiomyopathy to avoid: | Strenuous exercise |
| Surgical management for Hypertrophic Cardiomyopathy: | Ventriculomyotomy (muscle resection & mitral valve replacement |
| Restrictive Cardiomyopathy: | Very rare |
| Restrictive Cardiomyopathy: | Stiff ventricles that resist filling during diastole |
| S/S of Restrictive Cardiomyopathy: | Similar to S/S of right & left CHF |
| Causes of Restrictive Cardiomyopathy: | Endocardial or myocardial dz |
| Restrictive Cardiomyopathy: | Poor prognosis |
| Arrhythmogenic Right Ventricular Cardiomyopathy: | Results from replacement of myocardial tissue c fibrous/fatty tissue |
| Arrhythmogenic Right Ventricular Cardiomyopathy: | Can have left ventricular involvement |
| Arrhythmogenic Right Ventricular Cardiomyopathy: | Genetic in nature; often affects young adults |
| Surgical replacement of heart c donor heart: | Heart Transplant |
| Heart transplant can be performed c: | -HF -Dilated Cardiomyopathy -End-Stage Heart dzr/t CAD -Valvular dz -Congenital |
| Which New York Association Classification must a pt have in order to receive a heart transplant? | III or IV |
| Criteria for heart transplant: | -Life expectancy < 1 year -Age < 65 -Absence of active infection -Stable psychosocial status -No evidence of current drug or alcohol abuse |
| S/S of pericardial tamponade (bleeding into pericardial sac) after heart transplant: | -Muffled heart tones -JVD -Decreased cardiac OP -paradoxical pulse (pulsus paradoxus:one that markedly decreases in size during inhalation) -Circulatory collapse |
| S/S that transplanted heart is denervated: | -HR 90-110 bpm -Heart responds slowly to exercise, stress or position changes -May have pronounced orthostatic hypotension in immediate post-op phase |
| S/S of heart transplant rejection: | -SOB -Fatigue -Fluid gain (edema & weight gain) -Abd bloating -New bradycardia -Hypotension -A-fib or flutter -Decreased activity tolerance -Late sign=decreased ejection fraction |
| When can the rejection of a heart transplant occur? | Immediately, months or years after |
| What kind of meds are given to prevent rejection of heart transplant? | Immunosuppressive meds |
| Why are bacterial & fungal infections a concern after heart transplant surgery? | -Multiple invasive lines -Prolonged ventilator support -Immunosuppressive therapy |
| Steps to take to avoid infection after heart transplant surgery: | -Good hand washing techniques -Limit visitors -Early ambulation -Strict aseptic technique |
| A thickening or hardening of the arterial wall often associated c aging: | Arteriosclerosis |
| A type of arteriosclerosis caused by the formation of plaque within the arterial wall: | Atherosclerosis |
| Atherosclerosis is the leading risk factor for: | CVD |
| Cause of arteriosclerosis: | -Unknown: believed to occur from blood vessel damage that cause inflammation |
| CAD: | Vessel becomes inflamed, then stable or unstable plaque accumulates & eventually will decrease or block blood flow |
| CAD - Stable: | A white, glistening, fibrous elevation that covers a lipid core (primarily cholesterol) |
| CAD - Stable: | If it ruptures, thrombosis & vessel constriction block vessel |
| CAD - Unstable: | Has a liquid lipid core |
| CAD - Unstable: | If it ruptures, exposed underlying tissue causes a rapid platelet adhesion & thrombus formation -->suddenly blocked vessel |
| Risk factors for CAD: | -Low HDL-C -High HDL -C -Elevated triglycerides -Genetics -Diabetes -Sedentary life-style; obesity -Smoking -Stress -African American or Hispanic |
| CAD dx testing: | -Total cholesterol: <200mg/dL -LDL: <100mg/dL (<70 if diabetic or CVD -HDL: >40mg/dL -Triglycerides: <150 mg/dL |
| Percentage of total fat in an AHA diet: | <30% |
| On an AHA diet, what should be increased? | Fiber to 25-35 g/day |
| What should a pt limit if he/she is on an AHA diet? | Animal fats: meat & eggs |
| These meds end in -statin: | ACE Inhibitors |
| ACE inhibitors are given to pts with CAD because they: | -Lower LDL & triglycerides -Reduce cholesterol synthesis in liver |
| A s/e of Niacin, a drug given to lower LDL and increase HDL, is: | Flushing |
| PVD/PAD occurs when ________ forms in arterial bifurcations: | Plaque |
| Vessel lumen is progressively obstructed, decreasing blood flow to the lower extremities resulting in hypoxia & anoxia: | PVD/PAD |
| S/S of PVD/PAD: | -PAIN (primary symptom) -Intermittent claudication -Rest Pain -Peripheral pulses DECREASED OR ABSENT -LEGS: PALE c ELEVATION; RED when DEPENDENT -SKIN: thin, hairless, discolored areas, may have ulcerations; thickened toenails |
| Intermittent Claudication: | -CRAMPING or ACHING in calves, thighs or buttocks that occurs c predictable level of activity -Is accompanied by weakness & relieved c rest |
| Rest Pain: | -Occurs during periods of inactivity -BURNING sensation in lower legs -Increases c elevation; decreases when dependent -DIMINISHED SENSATION; legs may be COLD & NUMB |
| PVD/PAD Complications: | -Lower extremity ulcers/GANGRENE -Extremity AMPUTATION -Rupture of ABD AORTIC ANEURYSM -Infection/Sepsis |
| PVD/PAD Dx testing: | -Segmental pressure measurements: BP between upper & lower extremities compared; BP may be lower in legs than in arms -Exercise tolerance testing (treadmill): pressure @ ankle may decline, confirming Dx -Ankle-Brachial Index (ABI) |
| Ankle-Brachial Index (ABI): | -Divide ankle BP by the brachial BP -<0.9 is dx of PAD |
| PVD/PAD Management: | -Smoking Cessation -Meticulous foot care -No elastic support hose -Elevate HOB (relieves rest pain) -Regular, progressively strenuous exercise -Control diabetes, HTN & cholesterol |
| What should you teach a pt with PVD/PAD to do when he/she experiences claudication during exercise? | Rest at onset, resume activity when pain resolves |
| Nonsurgical revascularization for PVD/PAD: | -Atherectomy -Percutaneous transluminal angioplasty (PTA) -Laser-assisted angioplasty |
| Removal of plaque from artery: | Atherectomy |
| Balloon angioplasty (stents) to dilate narrowed opening: | Percutaneous transluminal angioplasty |
| Vaporizes occulding material; stent is placed to maintain vessel patency: | Laser-assisted angioplasty |
| Acute Arterial Occlusion: | -Arterial Thrombus -Arterial Embolus |
| A blood clot that adheres to the vessel wall: | Arterial Thrombus |
| Vessel lumen is partially obstructed & its wall damaged & roughened by artherosclerosis: | Arterial Thrombus |
| Sudden obstruction of blood vessel by debris: | Arterial Embolus |
| Debris that could cause an arterial embolus: | -Plaque -Masses of bacteria -Cancer cells -Amniotic fluid -Bone marrow -Air bubbles -Broken IV catheters |
| S/S of Acute Arterial Occlusion: | -Pain -Pallor or mottling -Pulselessness -Parathesia (numbness or tingling) -PARALYSIS -Poikilothermia (cool or cold skin) |
| Meds given for Acute Arterial Occlusion: | -IV Heparin -Intra-arterial fibrinolytic therapy (tPA, streptokinase, urokinase) |
| Surgical tx for Acute Arterial Occlusion: | Embolectomy (within 4-6 hours)-removal of clot |
| Ineffective Tissue Perfusion: Peripheral nursin ginterventions: | -Monitor extremity perfusion, compare affected & unaffected extremity -Assess peripheral pulses, skin temp & color, cap refill, movement & sensation q1-4 hrs -Promptly report c/o increased or unrelieved pain -Maintain IV fluids as ordered |
| Aneurysms: | An abnormal dilation of a blood vessel, commonly at a site of weakness or tear in vessel wall |
| Affects aorta & peripheral arteries d/t high pressure in vessels: | Aneurysm |
| Common causes of aneurysms: | -Arteriosclerosis -Artherosclerosis -HTN |
| Aneurysms are more common in _________ over the age of ________. | Men; 50 |
| Aneurysms are _________ _________ because they are usually ___________. | "Silent killers"; asymptomatic |
| ABDOMINAL AORTIC ANEURYSM: | Associated c HTN & arteriosclerosis & more common in adults over the age of 70 |
| Where do most abdominal aortic aneurysms develop? | Below renal arteries, where abdominal aorta branches to form iliac arteries |
| S/S of Abdominal Aortic Aneurysm: | -USUALLY ASYMPTOMATIC -PULSATING ABDOMINAL MASS -AORTIC CALCIFICATION noted on X-ray -Mild-severe mid abd or lumbar back pain -Cool cyanotic extremities if iliac arteries involved -Claudication (ischemic pain c exercise, relieved c rest) |
| Complications of abdominal aortic aneurysm: | -Peripheral emboli to lower extremities -Rupture/hemorrhage |
| THORACIC Aortic Aneurysm: | Result fr weakening of aortic wall by arteriosclerosis & HTN |
| Causes of Thoracic Aortic Aneurysm: | -Arteriosclerosis -HTN -TRAUMA -SYPHILLIS -FUNGAL infections |
| S/S of Thoracic Aortic Aneurysm: | -USUALLY ASYMPTOMATIC -VARY c LOCATION, SIZE & GROWTH RATE -SUNBSTERNAL, NECK or BACK pain -DYSPNEA, STRIDOR, COUGH -DYSPHAGIA, HOARSENESS -FACIAL & NECK EDEMA -DISTENDED NECK VEINS |
| Complications of thoracic aortic aneurysm: | Rupture/hemorrhage |
| Dx tests for ANEURYSMS: | -Chest X-ray -ABD ULTRASOUND -TRANSESOPHAGEAL ECHO -CT/MRI -Angiography (assess for allergies) |
| Meds for ANEURYSMS: | -Beta-blockers -Anti-hypertensive -NIPRIDE INFUSION (because SBP <120 mmHg or less) -Calcium channel blockers |
| Important when dealing c ANEURYSMS: | MANAGE HTN |
| Surgical tx for ANEURYSMS: | -ENDOVASCULAR STENT GRAFTS -ANEURYSMECTOMY (open surgery) |
| Complications of ABDOMINAL AORTIC ANEURYSM REPAIR: | -MI -Graft Occlusion or rupture -Hypovolemia or RENAL FAILURE -Resp distress -Paralytic Ileus |
| Post-Op care of ABDOMINAL AORTIC ANEURYSM REPAIR: | -Monitor VS closely (arterial catheter & hemodynamic monitoring) -Monitor hourly urine OP (<50 mL=notify MD) -Assess resp rate & depth q hour & monitor lung sounds -Monitor bowel sounds & notify MD when flatus or bowel sounds return |
| S/S of GRAFT OCCLUSION or RUPTURE: | -Change in pulse -Cool/cold extremities BELOW GRAFT -White or blue extremities/flanks -Severe pain -ABD distention -Decreased urine OP |
| Complications of THORACIC AORTIC ANEURYSM REPAIR: | -Hemorrhage -ISCHEMIC COLITIS -CEREBRAL & SPINAL CORD ISCHEMIA (causing paraplegia) -Resp distress -Infection -Dysrhythmia |
| Post-Op care of THORACIC AORTIC ANEURYSM REPAIR: | -Assess VS HOURLY, report any s/s of hemorrhage -Assess for bleeding -Assess for sensation & movement in extremities hourly -Admin IV antibiotics as ordered -Monitor for dydrhythmias |
| LIFE THREATENING!!! | AORTIC DISSECTIONS |
| AORTIC DISSECTIONS: | Caused by a tear in the intima layer of aorta with hemorrhage into the media |
| Hemorrhage DISSECTS or SPITS the vessel wall, forming a blood-filled chamber between its layers | AORTIC DISSECTIONS |
| PROXIMAL AORTIC DISSECTION: | Affects ascending aorta |
| DISTAL AORTIC DISSECTION: | Affects descending aorta |
| Predisposing factor for AORTIC DISSECTIONS: | HTN |
| Risk Factors for AORTIC DISSECTIONS: | -Male gender -Advancing age -Pregnancy -Congenital defects of aorta |
| S/S of AORTIC DISSECTIONS: | -Abrupt, severe, ripping or tearing pain in area of aneurysm -Mild or marked HTN -Weak or absent pulses and blood pressure in upper extremities -Syncope |
| Complications of AORTIC DISSECTIONS: | -Hemorrhage -Renal Failure -MI -Heart Failure |
| Buerger’s Disease: | An occlusive vascular disease in which small and midsize peripheral arteries become inflamed and spastic, causing clots to form |
| Can affect upper or lower extremities, usually affects a leg or foot: | Buerger’s Disease |
| Cause of Buerger's Dz is unknown, however: | Possible autoimmune response |
| S/S of BUERGER'S DZ: | -Pain -Claudication -Rest pain in fingers and toes -Diminished sensation -Skin: thin, shiny, thickened nails -Digits and extremities: pale, cyanotic or ruddy, cool or cold to touch -Distal pulses: difficult to locate or absent |
| Dx testing for Buerger's Dz: | -Doppler studies: locate and determine extent of disease -Angiography and MRI: evaluate the extent of the disease (not used often) |
| Management of Buerger's Dz: | -Smoking cessation -Keep extremities warm -Manage stress -Keep affected extremity in dependent position -Prevent injury to affected tissues -Regular exercise -Amputation: if gangrenous |
| Raynaud’s Disease: | Intense vasospasm in the small arteries and arterioles of the fingers and sometimes the toes |
| Occurs secondary to another disease (scleroderma and rheumatoid arthritis): | RAYNAUD'S PHENOMENON |
| -Affects women between ages 20-40 -Genetic predisposition | Raynaud’s Disease |
| RAYNAUD'S DZ: | -Arterial spasm limits arterial blood flow to fingers -Initially – only tips of one or two fingers -> progresses to all fingers -Occurs intermittently with spasms |
| Known as “blue-white-red” disease: | RAYNAUD'S DZ |
| Raynaud’s Disease: | Initially digits turn blue (decreased blood flow) then white (severe decrease in circulation) then red (spasm resolves) |
| S/S of RAYNAUD'S DZ: | -Numbness, stiffness -Decreased sensation -Aching pain -Ulceration and gangrene can occur |
| Raynaud’s Disease, conservative management: | -Keep hands warm -Avoid unnecessary exposure to cold -Smoking cessation -Measures to avoid injury to hands -Swinging the arms back and forth increases perfusion pressure in smaller arteries |
| Meds for RAYNAUD'S DZ: | -Calcium channel blockers -Vasodilators |
| Disorders of Venous Circulation: | -Venous thrombosis -Deep Vein Thrombosis (DVT) |
| Venous thrombosis: | -Also known as thrombophlebitis -A blood clot (thrombus) forms on the wall of a vein, accompanied by inflammation of the vein wall and obstructed venous blood flow |
| Deep Vein Thrombosis (DVT): | -Occurs in the deep veins -Common complication of surgery and immobility |
| Virchow’s triad: -Venous stasis (sluggish blood flow) -Altered blood coagulation -Damage (inflammation) to blood vessels | Deep Vein Thrombosis (DVT) |
| S/S of Deep Vein Thrombosis (DVT): | -Usually asymptomatic -Dull, aching pain in affected extremity, especially with walking Possible tenderness, warmth, erythema along affected vein Cyanosis of affected extremity Edema of affected extremity May have + Homan’s sign |
| Risk Factors of Deep Vein Thrombosis (DVT): | -Vein inflammation with invasive procedures such as IV therapy -Varicose veins -Hypercoagulation states -Cancers -Cardiovascular disease -Recent surgery or injury -Obesity -Oral Contraceptives |
| Complications of Deep Vein Thrombosis (DVT): | Pulmonary Embolus (usually the 1st indication of DVT) |
| Pulmonary Embolus: | -Occurs when clot fragments break off from vein wall -Clot travels through large veins into right side of heart entering pulmonary circulation -Occludes blood flow to a portion of lungs |
| DVT Prevention: | -Medications: -Low-molecular weight heparin -Oral anticoagulants -Elevate foot of bed with knees slightly flexed -Early mobilization and leg exercises -Elastic stockings and compression boots -NSAIDS–reduce inflammation of veins Naproxen or Ind |
| DVT Treatments: | -Apply warm, moist compresses -Rest extremity -Bed rest is typically ordered -Give anti-inflammatory medications -Do not massage affected extremity |
| DVT Surgery: | -Venous Thrombectomy -Venal cava filters |
| Venous Thrombectomy: | Done when thrombi is lodged in femoral vein and removal is necessary to prevent PR or gangrene |
| Venal cava filters: | -Greenfield filter -Nitinol filter -Captures emboli from pelvis and lower extremities – preventing PE |
| Nursing care for Pulmonary Embolus: | -Frequently assess respiratory status, including rate, depth, ease, and O2 sat levels -Immediately report chest pain, SOB, anxiety, or sense of impending doom. -If s/s of PE, initiate oxygen therapy, elevate HOB, reassure patient -Notify MD immediately |
| DVT Health Promotion: | -Position patients to promote venous blood -Ambulate as soon as possible -Teach ankle flexion exercises -Give preventative meds -Apply elastic stockings & comp. boots -Do not cross legs, avoid prolonged sitting or standing -Avoid tight fitting garm |
Created by:
shall5
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