Adult Health I; Cardio Test 11-12-07
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| Why is it important for someone with peripheral arterial disease to exercise? | it will increase collateral circulation
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| What is the 1st assessment finding indicating occlusion of an aorto-femoral bypass graft? | no pulses below the graft
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| What is the most desired treatment outcome for a client with congestive heart failure? | respiratory status improves, edema reduction, breath sounds clearing
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| What assessment findings indicate left-sided heart failure? | crackles and pink, frothy sputum
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| What is one of the first signs of a DVT? | pain in calf
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| What physical finding does a client with chronic venous disease exhibit? | edema and venous stasis ulcers
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| What is the emergency procedure for V-fib? | Defibrillation; synchronize button OFF; increase charge to 200; this will stop and restart the heart
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| What is the name of the scheduled procedure performed for A-fib? | Cardio version - conscious sedation; synchronize button ON; decrease charge to 50; this will restore normal rhythm
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| What is the BEST indicator that diuretics are working? | Daily weights
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| When Digoxin and diuretics are adminstered to the patient with CHF, what lab test would you check and why? | K+ - because some diuretics cause hypokalemia and hypokalemia can potentiate digitalis toxicity
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| What BP indicates hypertension and when should it be treated? | 140/90; check 3x; drug therapy initiated much earlier
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| What measures should be taken to facilitate patency of a graft following surgical repair of an aneurysm? | maintain systolic BP between 90-130; if it goes above 130, too much pressure and graft will tear; maintain extremities in neutral position
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| How can you verify that the graft is patent through your assessment? | check pulses below the graft
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| What signs indicate a ruptured aneurysm? | Abdominal pain, flank pain, pulsating mass, hypotension, shock
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| Following an abdominal aneurysm repair, the patient complains of severe flank pain and decreased urinary output. Why? | Renal artery embolism
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| How do you ensure that the graft site does not leak or rupture? | Keep the BP under control (systolic below 130)
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| What is the most common initial response for those experiencing chest pains due to a myocardial infarction? | DENIAL; there is a typical 3 hour delay between the onset of pain and going to the hospital
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| Following cardiac catheterization, what would be the signs of retroperitoneal bleeding? | bruising, pressure on the kidneys, back pain
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| Post op - CABG; What should you know about chest tube drainage amounts? | 1 hour post op - 300 cc is normal; 8 hours post-op - 300 cc is ABnormal; when the patient sits up for the 1st time - 300 cc is normal
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| What is the significance of continued chest pain with tPA therapy? | Continued chest pain indicates that tPA therapy is not working; do not give tPA therapy if there has been a recent trauma (tPA is a thrombolytic drug used to dissolve a clot)
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| PCTA does what? | It is a BALLOON that pushes plaque away
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| A STENT does what? | It holds the artery open
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| What is the most significant cardiac marker for MI | Troponin; it is a myocardial muscle protein releases into the bloodstream ONLY if there is cardiac necrosis or MI; any increase in troponin levels indicates cardiac necrosis or MI
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| When is it best to perform a MIDCAB? | When only one or two anterior coronary arteries are involved (such as the left anterior descending artery - LAD)
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| Safety precautions with a TEMPORARY pacemaker include wearing __________ | gloves
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| Your patient is coughing up pink, frothy sputum; what does this indicate? | pulmonary edema
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| The pain associated with angina is typically brought on by _________ and relieved by ________ | brought on by exertion and relieved by resting
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| When a patient is experiencing chest pain (angina pectoris), what is the standard treatment? | give Nitro sublingually and check BP
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| What is preload? | refers to the amount of myocardial fiber stretch at the end of diastole just before contraction; it is determined by the amount of blood returning to the heart from both the venous system and the pulmonary system
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| What is afterload? | the pressure or resistance that the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels
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| What is the treatment for symptomatic bradycardia following an MI? | Atropine 1st, then pacemaker; avoidance of parasympathetic stimulation such as prolonged suctioning or stimulation of the gag reflex
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| What is the most common cause of sudden cardiac death? | ventricular fibrillation (v-fib, VF) usually preceded by ventricular tachycardia (v-tach,VT)
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| What is the most common arrhythmia following MI? | PVC's (premature ventricular contractions)
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| a radial arterial line is placed to measure what? | BP
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| What is arteriosclerosis? | fatty plaque in arterial wall; arteries become narrowed and blood flow decreases
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| What is atherosclerosis? | atheromatous plaques containing cholesterol and lipids on the innermost layer of the walls of large and medium-sized arteries; causes a thickening or hardening of the arterial wall
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| 1 in 4 Americans (about 50 million) suffer from what? | hypertension
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| List some of the symptoms of hypertension. | None at first, then headache, dizziness, visual disturbances and confusion
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| Which classes of drugs are used to treat essential HTN? | diuretics, ACE inhibitors, beta-blockers, calcium channel blockers and vasodialators (apresoline)
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| What does LEAD stand for? | lower extremity arterial disease
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| The drugs Trental, ASA and Plavix are used for the management of what? | peripheral arterial disease (PAD)
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| List some of the Post-Op nursing care responsibilities following a bypass graft | risk for occlusion 1st 24 hours; check pulses every 15 minutes for 1st hour - then every hour with color and temp; mark location of pulses; assess for pain; keep leg straight
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| What is done if there is a graft occlusion? | Immediate surgery; tPA therapy (tissue plasminogen activator); ReoPro (inhibits platelet aggregation)
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| What are the modifiable risk factors for coronary disease? | weight, activity, diabetes, hypertension, smoking, cholesterol
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| What are the non-modifiable risk factors for coronary disease? | age, sex, race, family history
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| The acronym MONA can be used to remember key terms for the management of an MI. What does MONA stand for? | Morphine, Oxygen, Nitroglycerine, Aspirin
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| List some of the contraindications for tPA therapy | active internal bleeding; CVA within previous 2 months; recent spinal or cerebral surgery; cranial neoplasm; prolonged CPR; recent eye surgery
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| What are the key indicators that cardiovascular perfusion has returned? | chest pain abruptly subsides; sudden onset of PVC's; resolution of ST changes; marker of myocardial damage peak @ 12 hours
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| Why is aspirin given following MI? | antiplatelet aggregation
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| Why are beta-blockers given following MI? | to reduce muscle damage
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| Why are ACE inhibitors given following MI? | to reduce CHF
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| Why are calcium channel blockers given following MI? | to enhance myocardial perfusion
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| The surgical intervention performed if one or more coronary arteries are diseased is called a _____________ | CABG (coronary artery bypass graft)
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| The surgical intervention performed if only one or two anterior coronary arteries is diseased is called a ___________ | MIDCAB (minimally invasive direct coronary artery bypass)
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| When you listen over carotid arteries or sometimes over the aorta and you hear a swooshing or blowing sound you are hearing _________ | bruits (brew-ees); a characteristic feature of atherosclerosis
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| Cyanosis of the great toe and dependent rubor of the foot is characteristic of ______________ _______________ | aterial insufficiency
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| What is the procedure called when the plaque is kind of smashed against the arterial walls by inflating a balloon over and over again? | PTA (percutaneous transluminal angioplasty)
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| How often do you check pedal and posterial tibial pulses immediately following an aortal-femoral bypass graft? | Every 15 minutes for the first hour; then hourly along with temp and color
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| Remember the SIX P's when trying to determine if a patient has an arterial occlusion. What are the 6 P's? | Pallor, Pain, Pulselessness, Paresthesia, Paralysis, Poikilothermia
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| long-standing, uncontrolled HTN can cause these; it is just like overinflating a bicycle innertube many times; causes it to become weak and burst | aortic aneurysms
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| a ruptured abdominal aortic aneurysm (AAA) results in internal bleeding so severe that only ____% of victims survive | 20%
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| Most aortic aneurysms are the result of ________________ | atherosclerosis
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| Complications of a DVT would include a _________ ___________ and would necessitate the nurse monitoring closely for signs of ______________ | pulmonary embolism; monitor closely for signs of SOB and chest pain (dyspnea)
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| Sudden cardiac death is caused by __________ ______________ | Ventricular fibrillation
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| Dysrhythmias occur most commonly following a myocardial infarction due to ___________ | irritability of the damaged heart muscle
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| What is the most effective way to reduce one's risk of restenosis of blocked coronary arteries? | lowering LDL
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| Extensive muscle damage following myocardial damage can cause cardiogenic shock which is manifested by heart ___________ | failure
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| Left flank pain and decreased urine output following aneurysm repair of the aorta indicates ______________ | renal artery embolism
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| The pain of angina is preceded by what? | exertion, emotions, elimination, extreme changes in temperature
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| Priority patient care following DVT includes... | bedrest, do NOT massage the legs, be aware of complications of pulmonary embolism
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| left-sided heart failure lungs sound like ________ | crackles
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| Diuretics do what to preload? | decrease preload
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| What helps increase venous return? | walking
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| What happens to the ST segment following a stent and angioplasty? | ST should return to baseline
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| What is used to treat frequent PVC's following MI? | Lidocaine
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| What action is required if you obtain a BP reading of 160/100 at a routine screening (after you recheck it two more times that day)? | Refer the client to their MD for immediate attention
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| a high HDL to LDL ratio indicates what? | low risk for CV disease
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| Uncontrolled atrial fibrillation increases the risk for what? | stroke
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