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intermittent claudication
pain in lower legs
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reynauds effects
digital arteries of hands and lower extremeties
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what two things stimulate and make reynauds worse
cold and smoking
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tx reynauds
- avoid cold temps, adequate protection, no smoking, vasodilators, ntg, ca channel blockers and beta blockers, pain control
- surgery - sympathectomy
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venous thrombosis
s/s
pain, heat, redness, edema, + homans
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venous thrombosis causes
- venous stasis
- damage to endothelial lining of vein
- hypercoagulation
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common sites
ven throm
pelvis and lower extremities
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dx ven throm
s/s and venogram
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tx ven throm
meds, br, compression stockings, elevate legs, ankle/leg exercises, surgery
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what does vein look like
ven throm
warm, red, swollen, painful when down
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Sudden onset of severe pain, extremity is cold, pale or cyanotic, c/o numbness and tingling; pain will be more severe when elevated
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dx art throm
exam for pulses, Doppler, MRI, angiogram
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tx art throm
must be immediate, leg in dependent position, BR, warm wraps, meds, and surgery
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art throm
If you palpate a pulse below the extremity affected
you will not feel a pulse
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: COLD, PALE TO CYNATOIC, NUMBNESS, PAIN WHEN UP
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saphenous vein
- commonly will see clots in, most common varicose vein
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Surgery for varicose veins, why would it be important to elevate early?
Prevent blood clots and stimulate circulation
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inner layer has tear and blood collects between the inner and middle layers or aneurysm
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s/s dis aneurysm
may have pain near structures-if bronchial-difficulty swallowing
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dx diss aneur
exam and pt collapses
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tx diss aneur
bypass, replacement, antihypertensives, Jennifer also stated clipped off or stent
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mi
occlusion of coronary artery
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touchy time for mi pts
- onset to day 3
- risk for dysrhythmias
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angina vs mi
- angina shorter
- mi more sever and longer
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Thrombolytics or Fibrolytics agents
are used to dissolve a clot and reduce effects of MI
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After MI valsulva maneuver is dangerous to the patient can cause
bradycardia
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When patient has dsyrhythmias-
patient has decreased cardiac output, reduced coronary artery blood flow, has an increased oxygen need
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Electrical impulses start at the
sa
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Atrial Fibrillation what happens there?
Atrium quivers so there is rapid atrial activity.
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Complete heart block
atrium and ventricles function independently, without relationship to each other. Atrium and ventricles pump whenever they want
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PVC-.
has no P wave. Only serious when having multiple runs of PVC is when it leads to a serious event
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Cardioversion is usually done with patient
awake just given sedative. Used to terminate rapid dysrhytmias.
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Patient in Ventricular fibrillation, what do they need?
Shocked (DEFRILLATION)
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Endocarditis-
is a microbial infection that affects the lining of the heart and its valves.
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Buerger’s disease in men,
stop smoking and the disease will go away.
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Patient with aortic aneurysm what vital sign would you monitor closely?
Blood pressure will drop due to rapid blood loss
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S/S of angina-
substernal and described as viselike, burning, squeezing or smothering; may radiate into arm, shoulder, jaw, neck, or epugastrium. May have nausea, vomiting, diaphoresis, or dyspnea. Lasts only a few minutes. Relieved by rest or nitroglycerine
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Unstable angina- also called crescendo angina or preinfarction angina. Pain is more severe, occurss at rest or with minimal exertion. Often NOT relieved with nitroglycerine. These patients are at higher risk for myocardial infarction and are often hospitlized for diagnostic workup and treatment
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Key difference between stable and unstable angina is stable goes away with rest unstable doesn’t!
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Diagnosis of MI-
Cardiac Markers-Troponin; Cardiac Enzymes- CK, CK-MB; Myoglobin;
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Electrocardiogram:
Ischemia-
ST depression & inverted T wave
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ecg
Infarction-
ST elevation ( with complete occlusion)
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Q wave- greater than 1/3 height of R wave
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REMEMBER TROPONIN IS A MARKER SPECIFIC TO AN MI !!
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Working with a patient who is having difficulty with Cardiac Output
check pulse before and after activity (bathroom) and if pulse is less than 10 bpm difference patient can continue doing that activity.
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M-Morphine
- O-Oxygen
- N- Nitroglycerine
- A-Apsirin
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Patient that has angina can take up to 3 tablets of nitroglycerien 5minutes apart. If pain is not relieved 15 minutes after that 3Rd tablet they need to seek medical treatment.
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Atropine is used
to increase heart rate for someone in bradycardia
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digoxin
- tx of afib
- hold pulse less than 60
- pt w afib also risk for bld clots
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lidocaine
- tx in mult pvcs
- administered iv
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two dysrhythmias that you can use defibrillation to correct
vfib and pulseless ventricular tachycardia
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pt knows if pacemaker is working?
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stress, anxiety, activity can cause anyone to
tachycardia
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pt having chest pain w meds
o2, nitro, asp, morphine
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way bd helps resupply an area w bld flow?
collateral circulation
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one thing to watch a pt receiving thrombolytics closely for
bleeding
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pt w afib usually takes
baby aspirin to prevent clots
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applying uniboot: extremity turns cold, mottled
impaired circulation
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varicose veins
- distended, protruding veins that appear darkened and tortuous, occurs in anyone, common over 30 yo with prolonged standing, pregnancy, obese, family hx.
- vein wall weaken and dilates, venous pressure incr and valves become defective = veins become tortuous and distended, may c/o pain and feeling of fullness in legs
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s/s of thromboangiitis obliterans
- first claudication in arch of foot,
- claudication in calf and digits,
- pain more severe at night
- shock like pain
- pulses diminished in distal extremeties and may be cool, red, or cyanotic
- diagnosed by arteriogram
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why do we have crash cart
everything is in one place for use in emergency
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method for controlling blding
- always protect yourself w ppe
- direct pressure
- elevation
- pressure point
- tourniquet
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pressure points are at
brachial, femoral, and carotid
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signs of venous blding
steady flow, dark red
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signs of arterial blding
spurting, bright red, large amount
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s/s of internal abd bleeding
bruising, swelling, rigidity, lacerations, pain/tenderness
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s/s of an mi
heavy constrictive pain below or behind the sternum, pain may radiate to arms, back, neck, or jaw, diaphoresis, light-headed, n/v, dyspnea, cold, clammy skin, feelings of impending doom, woman and diabtetics atypical sx
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