Cardio 2

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Cardio 2
2013-10-27 20:50:29
N172 Cardio Lecture

CHF, PVA and PVD, Veins
Show Answers:

  1. What is heart failure?
    • it is a condition of impaired cardiac pumping and filling as a result of other diseases like:
    • HTN
    • CAD
    • MI
  2. Risk factors for heart failure
    • CAD
    • Age
    • HTN
    • DM
    • Cigarette Smoking
    • Obesity
    • High Serum Cholesterol
  3. What is systolic heart failure?
    Caused by (4)?
    an inability of the heart to pump blood cuz ventricles don't contract effectively

    sign-decreased ejection fraction

    • impaired contractile function
    • increased afterload (HTN)
    • cardiomyopathy
    • mechanical abnormalities/valve dysfunction
  4. What is diastolic heart failure?
    impaired ability of the ventricles to fill during diastole that results in decreased stroke volume.

    signs-pulmonary congestion and HTN, ventricular hypertrophy
  5. If a persons in diastolic heart failure what is up with the hearts systolic function and ejection fraction?
    Both are normal
  6. Clinical manifestations of chronic heart failure
    • ventricular hypertrophy
    • fatigue
    • dyspnea
    • tachycardia
    • edema
    • nocturia
    • skin changes
    • behavioral changes
    • angina/chest pain
    • gain weight
  7. How does the skin change with CHF?
    • turns dusky and cool
    • lower extremities are shiny and swollen with absent hair growth
    • brown spots on the lower legs
  8. What are the behavioral changes seen with CHF
    • restlessness
    • confusion
    • decreased attention span and memory
  9. Why are their weight changes with CHF?
    • fluid retention...ascites, hepatomegaly and renal failure
    • *Person loses fat cuz ascites and hepatomegaly cause anorexia and nausea
    • **Accurate weight loss unknown unless edema has subsided (dry weight)
  10. Complications of heart failure
    • pleural effusion
    • dysrhythmias
    • Left Ventricular Thrombus
    • Hepatomegaly
    • Renal Failure
  11. Two kind of dysrhythmias with CHF....and their treatments
    A-fib-numerous atria sites firing spontaneously and uncontrollably.  Stasis blood of the atria can cause thrombosis and emboli

    Treat with anticoagulants to prevent stroke

    Poor Left Ventricle function patients have an EF of <35% and are at risk for a fatal dysrhythmia so on antidysrhythmics
  12. When do you see hepatomegaly with heart failure?
    when it is right ventricle failure...causing the liver lobules to become engorged impairing liver function

  13. How does renal failure occur with CHF?
    decreased CO of CHF can decrease perfusion to the kidneys causing renal insufficiency and renal failure
  14. Chronic Heart Failure Goals
    • treat underlying cause and contributing factors
    • maximize CO
    • alleviate symptoms
    • improve ventricular function
    • improve quality of life
    • preserve target organ function
  15. How much sodium should a person have with CHF?
    2-2.5 g/day

  16. When does a person have fluid restrictions with CHF?
    when they are in severe HF and have renal insufficiency
  17. Weights to report with CHF
    • a gain of 3 lbs over 2 days
    • OR
    • 3-5 lbs gain in 1 week
  18. Why is left sided heart failure the most common?
    causes it causes blood to back up in to the left atrium and in to the pulmonary veins causing pulmonary congestion and edema
  19. What does right sided heart failure cause?
    • it causes a backward flow of blood to the right atrium and venous circulation causing...
    • peripheral edema
    • hepatomegaly
    • splenomegaly
    • vascular congestion of GI tract
    • jugular vein distention
  20. What is the primary cause of right sided heart failure?
    Left ventricule failure
  21. What is peripheral artery disease?

    What is it's main cause?
    • a progressive narrowing of the arteries of the:
    • neck
    • abdomen
    • extremities

  22. When do you typically see PAD?
    btwn 60-80....

    unless you are Hispanic or African American or have DM
  23. What's collateral circulation
    when one vessel gets small from PAD, another one gets big to compensate
  24. Clinical Manifestations of Peripheral Artery Disease
    • Intermittent Claudication
    • Parasthesia
  25. What is intermittent claudication?
    ischemic muscle ache or pain caused by exercise
  26. What is parasthesia?
    nerve tissue ischemia causing numbness/tingling
  27. Changes you will see with PAD...but it all depends on the degree of impaired blood flow to the extremities
    • Diminished or absent pedal/femoral/pop pulses
    • Pallor or blanching of foot
    • Redness of foot
    • Continuous pain where there is insuff blood flow
    • Rest Pain
    • Leg Pain
  28. Describe Rest Pain from PAD
    it occurs at night cuz the person is laying down and there is a decreased CO, so the person will stand up to stop the pain
  29. How does a person with PAD combat leg pain?
    dangles it over the side of the bed at night to use gravity to maximize arterial blood flow
  30. How does a Doppler ultrasound diagnose PAD
    assesses blood flow and outlines the vascular system
  31. If you are doing a Segmental Blood Pressure to dx PAD what is a positive result?
    segmental pressure >30mmHg
  32. What is a normal reading when using the Ankle Brachial Index to dx PAD?
  33. What does an angiography do for dx of PAD?
    it identifies the location and extent of the disease process and provides information on inflow and outflow of vessel for surgery.

    Direct visualization
  34. If a person has PAD what are the modifiable risk factors you can eliminate?
    • decrease hyperlipidemia
    • HTN
    • control DM
  35. What meds do you give a person with PAD?
    Antiplatelets like aspirin or Plavix
  36. What are the 3 meds to treat Intermittent Claudication?
    • Trental
    • Pletal
    • Ginkgo Biloba
  37. 2 things important for interventions for a person with PAD
    • a formal exercise program 30min/day
    • decrease your weight by lowering calories, cholesterol, saturated fat and sodium
  38. People with DM and PAD have this same issue that is very important to manage....
    Leg/Foot care with Critical Limb Eschemia

    • don't injure yourself
    • do skin checks daily
    • keep skin dry and in tact
    • wear good shoes
  39. Interventional Radiology procedures for a person with PAD
    • Percutaneous Transluminal Balloon Angiplasty
    • Atherectomy
    • Cryoplasty
    • Stent
  40. What's artherectomy for PAD and its risk?
    removal of plaque in the artery

  41. What's cryoplasty for PAD?
    combo of balloon angioplasty and cold therapy
  42. Surgical Therapies for PAD
    • Peripheral Arterial Bypass Graft
    • Femoral Popliteal Bypass Graft
    • Endarterectomy
    • Patch Graft Angioplasty
    • Amputation-LAST RESORT
  43. What's Endarterectomy for PAD?
    opening the artery and removing the obstructing plaque at the carotid artery
  44. What is a Patch Graft Angioplasty for PAD?
    • opening the artery
    • removing the plaque
    • sewing a patch to the opening to widen the lumen
  45. Name 3 Peripheral Arterial Diseases that are NOT from Atherosclerosis
    • Acute Arterial Ischemic Disorder
    • Buerger's Disease
    • Raynaud's Phenomenon
  46. What is Acute Arterial Ischemic Disorder (AAID)
    an emergent blood clot of the larger arteries

  47. What is Buerger's Disease?
    an inflammatory disorder of the medium arteries, veins and nerves of the upper and lower extremities
  48. Who typically gets Buerger's disease?
    young men with a long history of tobacco use
  49. What is Raymond's Phenomenon?
    a vasospastic disorder of small cutaneous arteries....usually seen in the fingers and toes.

    Usually seen in women
  50. Clinical Manifestions of AAID
    • 6 P's
    • Pain
    • Pallor
    • Pulselesness
    • Parasthesia
    • Paralysis
    • Poikilothermia
  51. Poikilothermia
    limb takes on the temperature of it's external environment
  52. Clinical Manifestations of Bruegers Disease
    • *Intermittent Claudication of feet
    • Ulcerations as disease progresses
    • *Periodontitis
  53. Clinical Manifestations of Raynaud's Phenomenon
    • Vasospasm induced color changes in the fingers, toes, ears and nose
    • (white-pallor, blue-cyanotic, red-perfusion restored)
    • throbbing, aching, tingling and swelling
  54. What triggers Raynaud's Phenomenon?
    • exposure to cold
    • emotional upsets
    • caffeine
    • tobacco use
  55. Interventions for AAID
    • anticoagulant therapy
    • embolectomy

    without immediate intervention, ischemia can lead to tissue necrosis and gangrene in a few hours
  56. Interventions for Buerger's Disease
    COMPLETE CESSATION OF nicotine replacement products

    **amputation is likely if they continue to smoke**
  57. Interventions for Raynaud's Phenomenon
    • Patient teaching-wear loose/warm clothes and avoid temp. extremes
    • Don't smoke or drink caffeine
  58. Drug therapy for Raynaud's
    Calcium Channel Blockers to relax smooth muscles of the arterioles

    "ine" drugs
  59. How do you get Superficial Thrombophlebitis and DVT's?
    • Virchow's Triad
    • venous stasis
    • damage of the endothelium
    • blood hypercoagulability
  60. Patho of Superficial Thrombophlebitis and DVT
    RBC's, WBC's, platelets and fibrin adhere to form a thrombus that eventually occludes the lumen of the vein. 

    IF it doesn't get detached it under goes lysis
  61. What will cause a thrombus to detach from a vein wall and cause an embolism?
    Turbulent Blood flow
  62. Clinical Manifestations of Superficial Thrombophlebitis
    • Palpable, firm, subcutaneous cordlike vein
    • surrounding area is tender to touch, reddened and warm
    • Mild Leukocytosis
    • Low grade temp
  63. Clinical Manifestations of DVT
    • Unilateral leg edema
    • extremity pain
    • warm, red skin
    • Temp >100.4
    • Tenderness in palpation
    • Positive Homan's sign
  64. Diagnostic studies for Superficial Thrombophlebitis

    Most often caused by....
    Based on physical exam

    caused by cannulation of a vein or IV therapy with HYPERTONIC solutions (anything with Dextrose)
  65. Diagnostic Studies for DVT
    • Platelet count
    • INR APTT
    • Venous Doppler Study
    • Duplex Scan
    • Lung Scan
    • Pulmonary angiogram
    • Spiral CT
  66. Nursing interventions for Superficial Thrombophlebitis
    Remove IV if caused it and elevate that extremity and put moist warm heat on site

    Oral NSAIDS for inflammation for 2 weeks

    Apply elastic compression stockings to lower extremities once acute thrombophlebitis is resolved and walk
  67. Nursing Interventions for DVT
    • Watch for s/s of PE
    • Bed rest
    • Elevate extremity with Warm compress
    • TEDS for 3-6 months
  68. How do you prevent a DVT
    • early ambulation
    • Dorsiflexion if on bed rest
    • TEDS
    • Sequentials
  69. What's the drug therapy for DVT?
    Anticoagulants-Heparin and Warfarin
  70. What is your surgical intervention for a DVT?
    IVC Filter to prevent a PE
  71. Risk factors for any form of a Vein Thrombosis
    • hip surgery
    • heart failure
    • immobility
    • prego
    • oral contraceptives
  72. Clinical Manifestations for any vein thrombosis
    • Calf/groin pain or tenderness with edema
    • Hardness at painful site
    • changes in circumfrance of that area
    • SOB
    • Chest pain
  73. What does Unfractionated Heparin do for vein thrombi?
    given in an IV to prevent formation of other clots and prevent enlargement of the existing clot
  74. What labs do you look at prior to giving Unfractionated Heparin?
    • aPTT
    • Platelets
  75. What is the antidote for Unfractionated Heparin?
    Ensure Protamine Sulfate
  76. What is the Low Molecular Weight Heparin called and how do you give it?
    Lovenox and SubQ
  77. How does Warfarin work? 
    What labs do you look at?
    What's the antidote?
    • inhibits synthesis of vitamin K dependent clotting factors
    • PT and INR
    • Vitamin K
  78. Patient teaching for Warfarin
    • don't eat foods rich in vitamin K
    • Spinach
  79. How does Thrombolytic Therapy work?

    Name 3
    dissolves clots that have already developed.  MUST BE STARTED WITHIN 5 days of DEVELOPMENT OF CLOT.

    • Abciximab
    • Eptifibatide
    • TPA (Tissue Plasminogen Activator)
  80. Complication of Vein Thrombi
    clot becomes mobile and causes a PE
  81. Risk factors for  PE
    • Pelvic or lower extremity surgery within past 3 months
    • Immobility
    • Stroke
    • Paralysis
    • Hx of DVT
    • Malignancy
    • Obesity in women
    • Cigarette smoker
    • HTN
  82. Classic Triad of symptoms for a PE
    • Dyspnea
    • Chest Pain
    • Hemoptysis
  83. DX studies for PE
    • Spiral CT
    • V/Q Scanner
    • D-dimer
  84. What's a spiral CT do for a PE?
    takes a 3D  view of lungs in all areas....rotates
  85. What does a D-Dimer test do for PE
    measures the amount of fibrin fragments during fibrinolysis
  86. Prevention for PE
    • Same as DVT.....
    • Sequentials
    • Early ambulation
    • Prophylactic Anticoagulant meds
  87. Varicose veins
    dilated, tortuous subcutaneous veins (saphenous) that become large and bulging.

    Also have then is esophagus and anorectal area
  88. How do you get varicose veins?
    As veins enlarge their valves get stretched and become incompetent allowing venous blood flow to be reversed......increased venous pressure makes these veins become dilated and torturous
  89. Risk factors for Varicose veins
    • chronic cough
    • constipation
    • family history
    • female
    • oral contraceptives/hormone replacement
    • age
    • obese
    • prego
  90. Who gets varicose veins?
    • Women
    • over 30
    • occupations that stand alot
    • prego
  91. Trendelenberg test for varicose veins
    • pt. lays supine with legs elevated
    • when pt. sits up the veins will fill from PROXIMAL end if variscosities are present
  92. Nursing management for varicose veins
    • PREVENTION by avoid standing or sitting for long periods of time
    • Maintain ideal body weight
    • Participate in daily walking program

  93. How do you get Venous Leg Ulcers?
    from chronic venous insufficiency....and can lead to amputation or death
  94. Patho of venous leg ulcers
    incompetent valves of deep veins cause an increase in hydrostatic pressure in the veins and serous fluid and RBC's leak from the capillaries and venules in to the tissues resulting in edema.
  95. What causes a brownish skin color on lower extremities with venous leg ulcers?
    breakdown of RBC's over time
  96. Clinical manifestations of Venous Leg Ulcers
    • Lower extremity is leathery with a brown appearance
    • Chronic Edema
    • Eczema or stasis dermatitis
    • Pruritis
    • may not cause much discomfort!
  97. Nursing Management for Venous Leg Ulcers
    • Moist environment dressings are recommended
    • Assess nutritional status (protein, calories, Vit. A, C and Zinc)
    • Maintain normal glucose levels if diabetic
    • Debridement with moist saline dressings
  98. What kind of dressing do you put on a patient with venous leg ulcer?
    Occlusive hydrocolloid dressing and leave it on for 3-5 days
  99. If you are doing a chemical debridement for a venous leg ulcer what do you use?
    a topical enzymatic agent
  100. What helps wounds heal?
    • High Protein diet
    • Zinc
    • Iron
    • Vitamin A and C
  101. 2 off label uses for Calcium Channel Blockers
    • Angina/Prinzmetal Angina
    • Raynaud's
  102. Patient teaching for Calcium Channel Blockers
    • Avoid Grapefruit juice
    • Caution with Heart Failure patients
  103. Patient teaching with Beta Blockers
    • Hold if HR is lower than 50bpm
    • don't stop taking abruptly
  104. Patient teaching with ACE Inhibitors
    • Aspirin and NSAID reduce drug effectiveness
    • DONT use with Potassium sparing Diuretic-
    • Aldactone
  105. Patient teaching for Statins
    watch out for hepatoxicity...monitor LFT's
  106. With Zetia you need to watch for this in your patient....
    • Hepatitis-so watch LFT
    • CK-watch for muscle aches and pains
  107. Patient teaching for Niacin
    • Take with food
    • take aspiring 30 min before each dose to prevent facial flushing
    • Monitor LFT, Kidney fxn and Blood Glucose
  108. With Digoxin, positive inotrope, monitor....(2)
    • Serum levels of drug 3.5-5.0
    • watch for hypokalemia so eat more potassium
  109. Patient teaching for Heparin, Lovenox and Warfarin
    • watch for bleeding disorders
    • monitor VS
    • monitor labs-platelets, aPTT