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Stack #172237
HCC 2008 Cardiovascular Assessment
| Question | Answer |
|---|---|
| Heart Disease is the leading cause of _________ in the ____ | death: US |
| Coronary Artery disease | accumulation of lipids and fibrous tissue in the vessels leading to reduced blood flow to the myocardium |
| Risk factors of Coronary Artery Disease | strong correlation btw lifestyle and cardiovascular health---- smoke drink, overweight, hypertension, diabetes |
| NONmodifiable Cardiovascular risk factors | age (increase w/ age), gender( males higher risk), heredity (family history increases risk), ethnicity (black increase hypertension and increase in strokes) |
| Modifiable Cardiovascular risk factors | high lipid levels, hypertension(the higher the BP the more the heart has to work), tobacco use, physical inactivity, diabetes, elevated cholesterol, LDL and HDL levels |
| Diabetes and Hyper tension increase the rate of _____________ | atherosclerosis |
| quitting smoking decrease risk of heart attack in ____ hrs | 24 |
| quitting smoking decrease the risk of CVD by _________% in 1 yr | 30-50 |
| JACHO provides for smokers ..... | smoking cessation counseling for smokers hospitalized w. Heart failure and community acquired pneumonia |
| Nurses role with pt smokers | educate, times tables, available help, FOLLOW UP |
| Five A's smoking cessation | ASK about smoking or tobacco use, ADVISE all smokers to stop smoking, ASSESS willingness to quit, ASSIST with cessation, ARRANGE for follow-up, Review article |
| what do you do when assisting with cessation? | set quit date, determine triggers and help develop plan to handle triggers, provide resources, discuss pharmacotherapy |
| what do you do to arrange for follow up | monitor progress, quitlines, internet-based cessation programs |
| What are benefits of exercise? | increases HDL and collateral circulation, decreases weight |
| how much and how often should you exercise a wk? | 30 minutes 4-5 times per wk.... this means aerobic exercise sweating and increase normal HR by 50 bpm |
| BMI | body mass index----ratio based on weight and height |
| BMI> 30 = | obesity |
| central obesity and metabolic syndrome | waist circumference> 40 inches for men and > 35 inches for women |
| Stress increases ____ | BP |
| Homocystine | amino acid; elevated levels linked to CAD |
| Health history of a Cardiovascular assessment includes | presenting cardiac S/S, medical history, family history, medications, risk factors and preventative measure, reveiw systems and health patterns |
| Cardiac Signs and Symptoms | chest pain, SOB, dyspnea, edema and weight gain, palpitations, dysrhythmias, fatigue, decrease in activity tolerance, dizziness and syncope(fainting) |
| Angina | chest pain due to lack of oxygen to myocardial cells or myocardial ischemia |
| precipitating factors of angina | stress and physical exertion |
| Locations of angina | substernal most common, may radiate to arms, neck or jaw |
| Some descriptions of angina might be | chest tightness, chocking or burning sensation, feeling of doom |
| Duration of angina | usually 5 to 15 minutes |
| angina may be relieved by | rest, NTG(pill, spray, patch, cream), oxygen |
| if angina is not gone 15 minutes after NTG or Oxygen what should the pt do? | go to the ER |
| Myocardial infarction | death of myocardial cells d/t ischemia |
| when can a myocardial infarction occur | when active at rest asleep or awake |
| where might myocardial infarction pain occur? | substernal, epigastric, my radiate to neck, jaw, arms and back |
| Description of Myocardial infarction | persistent heaviness, pressure, tightness, burning, constriction or crushing |
| Myocardial Infarction pain might last... | > 15 minutes |
| MI pain is not relieved by | rest or NTG |
| Chest pain Interventions | oxygen, IV access, assess and medicate for pain, ECG, cardiac enzymes |
| Women are more likely to present with ________ symptoms | atypical symptoms |
| some examples of atypical symptoms | SOB, fatigue, weakness |
| Elderly and diabetes might not have pain die to _____________ | neuropathies |
| dyspnea on exertion | DOE---activity level and tolerance; fatigue |
| Orthopnea | SOD in lying position |
| Paraoxysmal Nocturnal Dyspnea | sudden attack of SOB occuring during sleep due to heart failure/pulmonary edema |
| Cardiac assessment | edema and wt gain, nutrition, elimination(nocturia, constipation), sexual activity, stressor and coping mechanisms, VS, general appearance and cognition/LOC(cerebral perfusion-hypoxia, anxiety), skin(pallor, cyanosis, turgor, color) |
| peripheral cyanosis | bluish tinge to fingers, lips, toes, ear lobes |
| central cyanosis | tongue, mouth, yellowish plaque along eyelids |
| jugular vein pulsations | observe jugular vein pulsations, pulsations and distention normally observed with patient in supine position |
| Jugular vein distention | distention observed when HOB is elevated 45 degrees or higher is indicative of right-sided failure ----swollen when elevated is BAD |
| S1 "lubb" | loudest at mitral valve, closure of mitral and tricuspid valves |
| S2 "dubb" | loudest at the aortic valve, closure of the pulmonic aortic valves |
| S3 physiological | normal in children, young adults and last trimester of pregnancy |
| S3 pathological | volume overload and heart failure |
| S4 | ventricular hypertrophy and increase resistance to ventricular filling, CAD and Hypertension |
| Cardiac assessment lungs, crackles= | heart failure |
| Hemoptysis is | pink frothy sputum (spitting up blood) |
| hemoemesis | vomiting blood |
| hemoptysis indicates | acute pulmonary edema |
| Nursing responsibilities for diagnostic studies include | preparation and teaching regarding procedure, physical and emotional care during procedure post-procedure care and instructions given before and after |
| Chest X-ray | size, shape and position of heart; lung congestion |
| N/R for X-ray | pt takes off clothes |
| Electrocardiogram | graphic recording of electrical activity of the heart to detect dysrhythmias conduction problems myocardial injury .... electrodes attached to the chest and extremities detect electrical impulses from the heart |
| N/R for Electrocardiograms | provide privacy, correct placement of electrodes, instruct patient to lie still for accurate reading |
| Continuous ECG Monitoring | bedside cardia monitor (hardwire) and Telemetry |
| N/R Continuous ECG | placement of electrodes, monitor equipment and set-up |
| Continuous Ambulatory Monitoring | Holter Monitor---ECG leads attached to portable recorder worn 24 hrs |
| N/R Continuous Ambulatory Monitoring | instruct client to keep detailed log of activities including toileting, eating, medications, symptoms--- CAN NOT shower or bath during test |
| cardiac stress test | non invasive evaluates effect of stress or exercise on myocardial function---exercise stress test:walk/run on treadmill |
| N/R when doing stress test | NPO 4 hrs prior to test, No smoking or caffine prior to test, meds per MD order, wear rubber sole shoes and comfy clothes, No epinephrine or norep drugs before |
| Echocardiogram | 3d view of the heart; studies heart structure and motion using ultrasound, noninvasive tool to evaluate murmurs, heart valves and ventricular wall motion |
| N/I Echocardiogram | painless, gel, place on left side; prepare them |
| Transesophageal echocardiogram(TEE) | endoscope with transducer is inserted into esophagus |
| N/I TEE | NPO for 6 hours prior, per doc order IV sedation and throat anesthetized, VS, SaO2 and ECG monitored, check for gag refles before resuming fluids/food, tell them soar throat ~24hrs and impaired swallowing |
| Radionuclide Imaging/ Nuclear Cardiology | use of radioisotopes to evaluate coronary artery perfusion |
| N/I Radionuclide Imaging/ Nuclear Cardiology | tell pt they wont be radio active, have lie on back with arms above head |
| Cardiac Catherization Coronary Angiogram | radiopaque inserted into left heart via the femoral artery to assess coronary arteries---Requires consent |
| Coronary Angiography | injected of dye to visualize blood flow through coronary arteries |
| N/I Cardiac Catherization Coronary Angiogram | NPO; Meds per MD orders, check for allergy to iodine, check blood work and baseline VS and ECG, teaching re:procedure |
| Cardia Catheterization: Post procedure | assess circulation of extermity used for insertion check peripheral pulses, temp, pain, color and sensation; monitor insertion site for bleeding and swelling(hematoma); keep limb straight do not bend/flex; BEDREST per MD orders/protocol (2-6 hrs with HOB< |
| MRI | allows for detection of localization of area, not used much, provides 3D veiw of MI |
| N/I MRI | No NPO or NPO, no metal objects, oxygen tank can not go w/pt, prosthesis, drugs before if claustrophobic |
| Dyslipidemia | associated with altersclerosis and liver disease; increases risk of CAD with elevated LDL and Chol levels and low HDL levels |
| Cholesterol | synthesized by liver, found in animal products |
| Triglycerides | fatty acids |
| Lipoproteins | transport lipids |
| LDL | low density lipoproteins (BAD)----to arterial walls---more fat than protein |
| HDL | High Density Lipoproteins (GOOD)---to liver for metabolism--- higher HDL better more protein than fat |
| ATP III guidelines | LDL is primary target of therapy (optimal level is <100mg/dl), cholesterol <200 mg/dl, HDL> 40 mg/dl |
| Triglyceride< 150 mg/dl= normal Elevated levels= | obesity, physical inactivity, excessive alcohol, diabetes, after high CHO meals |
| Serum Lipid Profile - | includes cholesterol triglycerides and lipoproteins----instruct client to fat 12hrs prior to blood test, Chol levels only fasting is not required |
| Treatment for Dyslipidemia | begin with Therapeutic Lifestyle Changes (TLC) |
| TLC | diet, weight management, increased physical activity |
| Dylipidemic drugs | prescribed with diet and exercise depending on LDL levels and presence CAD/ risk factors or added if levels remain elevated after 3 months |
| Therapeutic Lifestyle Diet | low chol, low sat fat diet with calorie intake for healthy weight, limit total fat to 25-30% of total calories, limited sat fat to less than 70% of total calories, limited chol to less than 200 mg/d |
| food high in fat and cholesterol: | egg yolks, red meat higher in fat, butter and whole milk, coconut and palm oil, fried food |
| Fiber | whole grains, oats and cheerios; beans |
Created by:
jaed008
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