- Shuffle
Toggle OnToggle Off
- Alphabetize
Toggle OnToggle Off
- Front First
Toggle OnToggle Off
- Both Sides
Toggle OnToggle Off
Front
How to study your flashcards.
Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key
Up/Down arrow keys: Flip the card between the front and back.down keyup key
H key: Show hint (3rd side).h key
PLAY BUTTON
PLAY BUTTON
124 Cards in this Set
- Front
- Back
|
If a patient has heart surgery involving a sternotomy, and also with CABG they may need a ______ _____ because of risk of ____ dysrhythmias.
|
If a patient has heart surgery involving a sternotomy, and also with CABG they may need a temporary pacemaker because of risk of atrial dysrhythmias.
|
|
_____ infection has an affinity for the valves of the heart, so it's very important to have a sore throat evaluated.
|
Strep infection has an affinity for the valves of the heart, so it's very important to have a sore throat evaluated.
|
|
A strep infection of a heart valve causes bacterial vegetation that colonizes and creates _____, which can directly interfere with ____ function. The breaking off or losss of portions of these vegetations into circulation results in systemic _______. If enough oxygen deprivation, the patient may have a _____ or need an extremity to be ______.
|
A strep infection of a heart valve causes bacterial vegetation that colonizes and creates lesions, which can directly interfere with valve function. The breaking off or loses of portions of these vegetations into circulation results in systemic embolization. If enough oxygen deprivation, the patient may have a stroke or need an extremity to be amputated.
|
|
Infective endocarditis is an infection of the ________ surface of the heart, which extends to heart _____. It was formally called bacterial endocarditis. The culprit is a causative microorganism of 4 possibilities, what are they?
|
Infective endocarditis is an infection of the endocardial surface of the heart, which extends to heart valves. It was formally called bacterial endocarditis. The culprit is a causative microorganism of 4 possibilities:
Staph aureus Strep viridans Fungi Viruses |
|
Endocarditis is classified as either _____ or _____ and can be based on location, such as PVE-- ____ ____ ____. It can also be based on cause such as ____ IE or fungal endocarditis.
|
Endocarditis is classified as either acute or subacute and can be based on location, such as PVE-- Prosthetic Valve Endocarditis. It can also be based on cause such as IVDA IE or fungal endocarditis.
|
|
Acute endocarditis has _____ and subacute may have no symptoms and a normal ____ count.
|
Acute endocarditis has symptoms and subacute may have no symptoms and a normal WBC count.
|
|
The most commonly occurring valve disorder in the US is ____ ____ ___. It is so common they think it might just be a variation of normal, and it's more common in men/women.
|
The most commonly occurring valve disorder in the US is mitral valve prolapse. It is so common they think it might just be a variation of normal, and it's more common in women.
|
|
In infective endocarditis, blood flow turbulence causes further damage to vegitative lesions (which adhere to endothelial and valve surfaces) they tend to go to the kidney, brain, spleen, and extremities.
anythings that obstructs arterial flow can cause ischemia. It may spread to valves, ____ muscles, cause valve _______ (valves not closing and opening competently, floppy leaflets, or narrowing due to vegetations) and can cause re_______, d________, H___ F____, and may spread to ______. |
In infective endocarditis, blood flow turbulence causes further damage to vegitative lesions (which adhere to endothelial and valve surfaces) they tend to go to the kidney, brain, spleen, and extremities.
anythings that obstructs arterial flow can cause ischemia. It may spread to valves, papillary muscles, cause valve incompetence (valves not closing and opening competently, floppy leaflets, or narrowing due to vegetations) and can cause regurgitations, dysrhythmias, Heart Failure, and may spread to myocardium. |
|
Blood flow turbulence within the heart can cause the causative organism of endocarditis to infect endothelial surfaces or previously damaged heart vales. What are some risk factors for infective endocarditis? What is the main risk factor?
|
Prior endocarditis
Prosthetic heart valves Acquired valve disease (AS- Aortic Stenosis, MVP-Mitral Valve Prolapse etc.) Cardiac lesions Rheymatic heart disease cardiomyopathy congenital heart disease Marfan Syndrome IVDA - main risk factor nosocomial bacteria work exposure invasive proc/implanted devices |
|
What are some clinical manifestations of infective endocarditis?
|
Often nonspecific, multiple systems
New or changing heart murmur Fever chills weakness malaise fatigue anorexia arthralgia myalgia back pain H/A ↓wt. Pathognomonic signs:(definitive) splinter hemorrhages clubbing of nails Osler's nodes Janeways lesions Roth's spots (LOOK at pictures in powerpoint and definitions of each of these characteristics) |
|
How is infective endocarditis diagnosed?
|
Health history (hx IVDA, recent procedure)
Positive blood cultures (may be neg if on antibiotics) Mild leukocytosis New or changed murmur Echocardiogram: vegetation of valves, or visualization of intracardiac mass (TEE or standard echo) Chest X-ray (may show cardiomegaly, possible CHF) ECG- may show problems with conduction Cardiac catheterization |
|
What is the tx for infective endocarditis?
|
#1 Get culture down to lab asap so we can specifically treat that bug! (C & S)
IV antibiotics- weeks or months usually hospitalized initially Get blood levels of certain antibiotics such as vanco Treat fever & Pain-- may need stronger meds than tylenol/nsaids Valve replacement possibly Prophylactic antibiotics for all invasive procedures |
|
Relapses of endocarditis are common/uncommon.
|
common
|
|
Acute pericarditis is an inflammation of the pericardial sac (pericardium) and occurs acutely. There are multiple causes (infectious/ noninfectious). What are the most common causes?
|
Coxsackievirus B group (most common viral cause)
Bacterial (Pneumonococici, staphylococci, streptococci, N. gonorrhea, Legionella pneumophilia, septicemia from gram - organisms) fungal TB uremia (kidney failure compl.) neoplasms/cancer toxoplasmosis Lyme’s disease (bacterial infection caused by a tick bite, treatable because it's bacterial, can effect other parts of body too) Trauma irritate heart and cause pericarditis due to airbags etc Myocardial infarction (acute/Dressler’s) rheumatic fever Rheymatologic disesaes, SLE, RA etc. |
|
The pathophysiology of pericarditis involves an offending agent or cause that triggers the body's inflammatory response. An influx of _______ increases/decreases vascular permeability, fibrin deposits, and there is excessive inflammation of the visceral and parietal pericardium. Fluid collects in _____ sac greater than what is normal and leads to development of _____ in the pericardial space, which may be significant enough to constrict myocardial filling in diastole and ventricular systole, potentially affecting _____ ____. It can lead to cardiac _____ where the BP is not normal the CO is disrupted. This is a life ____ing situation.
|
The pathophysiology of pericarditis involves an offending agent or cause that triggers the body's inflammatory response. An influx of neutrophils increases vascular permeability, fibrin deposits, and there is excessive inflammation of the visceral and parietal pericardium. Fluid collects in pericardial sac greater than what is normal and leads to development of effusion in the pericardial space, which may be significant enough to constrict myocardial filling in diastole and ventricular systole, potentially affecting cardiac output. It can lead to cardiac tamponade where the BP is not normal the CO is disrupted. This is a life threatening situation.
|
|
What are some clinical manifestations of acute pericarditis?
(hint- when is the main symptom worse) |
progressive, frequent chest pain
that is sharp and pleuritic in nature Usually worse pain with deep inspiration and worse when in supine position. Dyspnea Pericardial friction rub |
|
DIagnostic studies/results for acute pericarditis
|
Echocardiogram
ECG: nonspecific or specific and diffuse changes Labwork: leukocytosis, ↑CRP; ↑ESR ð CXR normal or cardiomegaly if ↑effusion CT; MRI Pericardial fluid or tissue biopsy for cause |
|
What are the 2 main complications of acute pericarditis?
|
pericardial effusion
cardiac tamponade (causes serious problems with function of heart) |
|
Treatment of acute pericarditis
|
Identify & treat underlying problem
Antibiotics if bacterial Corticosteroid therapy (esp. prednisone) NSAIDS ð Pain meds Position of comfort; bedrest initially; HOB↑ Pericardiocentesis |
|
Pericardiocentesis is indicated to treat acute pericarditis if what 3 complications or situations occur?
Hemodynamic support for the patient may include adm. of volume expanders and inotropic agents such as ______ and the discontinuation of ______. The procedure is performed rapidly and safely using a percutaneous apporach that is guided by ECG and echo. If drainage is necessary, a 16 - 18 g needle is inserted into the pericardial space to remove fluid for analysis and relieve cardiac pressure. Complications include dysrhythmias, further cardiac tamponade, pneumomediastinum, pneumothorax, myocardial laceration, and coronary artery laceration. |
pericardial effusion w/ cardiac tamponade
purulent pericarditis high suspicion of neoplasm (benign or malignant new growth-- tumor activity can cause effusion with its new growth) Hemodynamic support for the patient may include adm. of volume expanders and inotropic agents such as dopamine (Intropin) and the discontinuation of anticoagulants. The procedure is performed rapidly and safely using a percutaneous apporach that is guided by ECG and echo. If drainage is necessary, a 16 - 18 g needle is inserted into the pericardial space to remove fluid for analysis and relieve cardiac pressure. Complications include dysrhythmias, further cardiac tamponade, pneumomediastinum, pneumothorax, myocardial laceration, and coronary artery laceration. |
|
Valvular heart disease include: Mitral valve stenosis
Mitral valve regurgitation Mitral valve prolapse Aortic valve stenosis Aortic valve regurgitation Tricuspid and pulmonic valve disease Most problems with valves occur on the left / right side? Left/right sided valve disease is most common with IVDA. A valve can have stenosis with regurgitation. In mitral valve proplapse, one of the 3 leaflets prolapses down into the chamber (left atria) this allows blood to leak back into the valve from which it came, this backing up can lead to systemic failure. |
Valvular heart disease include: Mitral valve stenosis
Mitral valve regurgitation Mitral valve prolapse Aortic valve stenosis Aortic valve regurgitation Tricuspid and pulmonic valve disease Most problems with valves occur on the left / right side? Left/right sided valve disease is most common with IVDA. A valve can have stenosis with regurgitation. In mitral valve proplapse, one of the 3 leaflets prolapses down into the chamber (left atria) this allows blood to leak back into the valve from which it came, this backing up can lead to systemic failure. |
|
In your assessment of a patient with a structural or inflammatory heart disorder, do a thorough cardiovascular assessment. For cardiac infection or inflammation ask about ____, ____, and ___ For valve disorders ask if there is any ____ on _____ or at _____, or fatigue.
Look at their H & P. Look at echo results & other test results. Note any abnormal heart sounds such as a murmor or friction rub. Look at tele. WIth infection or inflammation monitor for ____ and elevated ____ count (leukocytosis. With valve disease, look for signs of ___ ___. |
In your assessment of a patient with a structural or inflammatory heart disorder, do a thorough cardiovascular assessment. For cardiac infection or inflammation ask about pain, anorexia, fatigue. For valve disorders ask if there is any dyspnea on exertion or at rest, or fatigue.
Look at their H & P. Look at echo results & other test results. Note any abnormal heart sounds such as a murmor or friction rub. Look at tele. WIth infection or inflammation monitor for fever and elevated WBC count (leukocytosis. With valve disease, look for signs of heart failure. |
|
What are some nursing dx's appropriate for patients with structural or inflammatory heart disorders?
|
pain or altered comfort
activity intolerance decreased cardiac output hyperthermia ineffective therapeutic regimen |
|
For all patients, we want them to understand the disease and comply with the treatment plan. Some goals for treating infectious/inflammatory heart problems are that the patient is a_____, has _____ blood cultures, and incidence of ___ and _____ is decreased.
For valvular dysfunction, some goals are to improve symptoms such as decrease SOB and improve _____ tolerance, as well as to preserve effective cardiac function. |
For all patients, we want them to understand the disease and comply with the treatment plan. Some goals for treating infectious/inflammatory heart problems are that the patient is afebrile, has negative blood cultures, and incidence of relapse andhospitalization is decreased.
For valvular dysfunction, some goals are to improve symptoms such as decrease SOB and improve activity tolerance, as well as to preserve effective cardiac function. |
|
For infective/inflammatory heart disorders...
Instruct in prophylaxis for bacterial endocarditis (antibiotic therapy prior to invasive, dental procedures somewhat controversial Monitor for related complications: ____, _____ , cardiac ____ note if you hear muffled heart sounds, low bp, inability to hear distinctive s and s2 |
Instruct in prophylaxis for bacterial endocarditis (antibiotic therapy prior to invasive, dental procedures somewhat controversial
Monitor for related complications: sepsis, embolization, tamponade. note if you hear muffled heart sounds, low bp, inability to hear distinctive s and s2 |
|
Look at page 12 of Powerpoint and in book about...
|
valve replacement
|
|
Hemorrhagic retinal legion is also known as...
|
Roth's Spots
|
|
A painful red or purple lesion on fingers or toes is known as...
|
Osler's nodes
|
|
Black longitudinal streaks in nail beds are known as...
|
Splinter hemorrhages
|
|
Small hemorrhages in conjunctiva, lips, and buccal mucosa are known as ..
|
petechiae
|
|
Flat, red, painless spots on the palms and soles of the feet are known as..
|
Janeway's lesions
|
|
To measure a pulsus paradox, the nurse determines the difference between the systolic pressure at ______ and the systolic pressure ....
|
To measure a pulsus paradox, the nurse determines the difference between the systolic pressure at expiration and the systolic pressure heard throughout the respiratory cycle.
|
|
A pulsus paradoxus of greater than ___ mm Hg occcurs with cardiac tamponade
|
10
|
|
Acute pericarditis may be diagnosed with ECG showing diffuse ___ _____ elevation
|
Acute pericarditis may be diagnosed with ECG showing diffuse ST segment elevation
|
|
Treatment of chronic constrictive pericarditis may include a ____
|
pericardiectomy
|
|
Valvular stenosis leads to increased/decreased blood flow and ______ of the preceding chamber.
|
Valvular stenosis leads to decreased blood flow and hypertrophyof the preceding chamber.
|
|
Valvular ______ causes a pressure gradient difference across an open valve.
|
Valvular stenosis causes a pressure gradient difference across an open valve.
|
|
The heart valve most commonly affected by stenosis or regurgitation is the ____ valve.
|
mitral
|
|
Sudden onset of cardiovascular collapse is seen with which valvular disease(s)?
|
acute aortic regurgitation
|
|
________ _______ disease may be caused by pulmonary hypertension.
|
tricuspid valve disease
|
|
Rapid development of pulmonary ___ and _____ shock can occur with acute mitral regurgitation hypertension.
|
Rapid development of pulmonary edema and cardiogenic shock can occur with acute mitral regurgitation hypertension.
|
|
Dyspnea is a prominent symptom in _____ stenosis.
|
mitral
|
|
Loud pansystolic or holosystolic murmors are heard with acute/chronic _____ regurgitation.
|
Loud pansystolic or holosystolic murmors are heard with chronic mitral regurgitation.
|
|
Ballooning of valve into left atrium during ventricular systole is seen in ____ valve ____.
|
Ballooning of valve into left atrium during ventricular systole is seen in mitral valve prolapse.
|
|
Characteristic systolic crescendo-decrescendo murmor is heard with ____ _____.
|
aortic stenosis
|
|
"Water hammer pulses" are heard with chronic ____ _______.
|
"Water hammer pulses" are heard with chronic aortic regurgitation.
|
|
Angina and syncope result from decreased ______ ____ in aortic stenosis.
|
CO
|
|
Embolization may result from chronic atrial fibrillation in ___ ____.
|
mitral stenosis
|
|
Major symptoms of ___ ___ ___ are related to elevated systemic venous pressures.
|
tricuspid valve disease
|
|
Rapid onset of acute ___ ____ _____ prevents left chamber dilation.
|
mitral regurgitation hypertension
|
|
Brisk corotid pulses are present with ___ ____ ___
|
chronic mitral regurgitation
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
the hyperdynamic systolic function creates a diastolic failure |
hypertrophic
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
systemic embolization may occur because of stasis of blood in ventricles |
Dilated
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
most uncommon type of cardiomyopathy |
restrictive
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
often requires heart transplant |
dilated
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
about 50% have a genetic basis |
hypertrophic
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
differs from chronic HF in that there is no ventricular hypertrophy |
dilated
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
Echo reveals cardiomegaly with thin ventricular walls |
dilated
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
often results in syncope during increased activitu resulting from an obstructed aortic valve outflow |
hypertrophic
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
often follows an infective myocarditis or exposure to toxins or drugs |
dilated
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
surgery to remove myocardial tissue may be indicated for symptoms refractory to tx |
hypertrophic
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
characterized by ventricular stiffness |
restrictive
|
|
Indicate whether the following characteristic is associated with dilated hypertrophic, or restrictive cardiomyopathy:
characterized by massive thickening of intraventricular septum and ventricular wall |
hypertrophic
|
|
PAD strongly r/t other manifestations of ______ and its risk factors
|
atherosclerosis
|
|
Comorbitities of arterial vascular disease commonly include what 4?
|
DM
CAD CVD HTN |
|
Peripheral Arterial Disease (PAD)
is a pro______ atherosclerotic ____ing of arteries of the ___, _____, and ____ It was previously called peripheral vascular disease Must be thought of as a marker for ______ _____ ______! PAD is subdivided into: |
Peripheral Arterial Disease (PAD)
is a Progressive atherosclerotic narrowing of arteries of the neck, abdomen, and extremities It was previously called peripheral vascular disease Must be thought of as a marker for advanced systemic atherosclerosis! PAD is subdivided into: occlusive disease (PAD, CVD; acute arterial occl) aneurysmal disease (aortic aneurysm & rupture) vasospastic phenomenon (Raynaud’s disease) |
|
true or false: The leading cause of PAD is atherosclerosis.
|
true!
|
|
PAD involves gradual narrowing of ____ of arteries
(extremities, neck, abdomen) d/t deposits of fat & cholesterol, platelets, etc. (occlusive) Narrowing d/t plaque which leads to _____ blood supply, _____ of extremity and/or brain Without intervention, result can be... |
PAD involves gradual narrowing of lumen of arteries
(extremities, neck, abdomen) d/t deposits of fat & cholesterol, platelets, etc. (occlusive) Narrowing d/t plaque which leads to decreased blood supply, ischemia of extremity and/or brain Without intervention, result can be loss of extremities (gangrene), CVA, loss of function, death |
|
What are some risk factors for PAD?
|
most significant:
Cigarette smoking Hyperlipidemia Hypertension Diabetes mellitus Also: Obesity Hypertriglyceridemia Hyperuricemia Family history Sedentary lifestyle Stress |
|
What are the blood vessels most susceptible to PAD?
|
Coronary arteries
Carotid arteries Aortic bifurcation, iliac, common femoral arteries, distal popliteal arteries |
|
What are some clinical manifestations of PAD of the lower extremities? (9)
|
Intermittent claudication
paresthesia: numbness, tingling, neuropathy (not enough blood supply to nerves) Skin changes; Loss of hair on lower legs Diminished or absent pedal, popliteal,femoral pulses Pallor (lack of O2) Blanching of foot (elevation pallor) Reactive hyperemia (dependent rubor) Rest pain Erectile dysfunction |
|
PAD progresses slowly, but…What are some complications of PAD? (3)
|
Prolonged ischemia leads to atrophy of skin/muscle
Delayed wound healing (esp. in DM) Nonhealing arterial ulcers lead to tissue necrosis which leads to gangrene leads to amputation |
|
______ _____ may prevent gangrene
|
collateral circulation
|
|
What is the treatment for PAD of extremities?
|
Risk factor modification
DM- foot care very important Drug therapy- CCB- open arteries (vasodilate) Exercise therapy (improve tolerance) Angioplasty & stenting Surgery (major reperfusion surgeries) |
|
What are some surgeries that can be done for PAD of extremities?
|
Aorto-femoral bypass graft (using synthetic grafts)
Femoral-popliteal bypass graft (using synthetic grafts) Endarterectomy Amputation |
|
Acute arterial ischemia is the s____ i______ in arterial blood supply to _____; will lead to ____ ____ if untreated
There are multiple causes what are they? ______ of a thrombus from the heart or an _____ is most frequent cause of acute arterial occlusion |
Acute arterial ischemia is the sudden interruption in arterial blood supply to extremity; will lead to tissue death if untreated
Multiple causes: thrombosis, embolism, atherosclerotic plaque, or trauma Embolization of a thrombus from the heart or an aneurysm is most frequent cause of acute arterial occlusion |
|
After arterial surgery, be sure to check ______ and peripheral _____.
|
circulation, peripheral pulses
|
|
The pathophysiology of ___ ____ occlusion involves...
Thrombus, embolus, or other cause occludes artery, depriving tissues of oxygen Cell death occurs if prolonged, necrosis of extremity or body part d/t arterial blood supply interruption |
acute arterial occlusion
|
|
A bruit heard over an artery can tell you there might be _____ formation going on
|
plaque
|
|
What are the causes and risk factors of acute arterial ischemia?
|
A CHAMP TIME
Ather. narrowing of artery Cardiomyopathies Hypercoagulabiltity states Atrial fibrillation (chronic) Mitral valve disease Prosthetic heart valves Trauma Invasive Procedures MI Endocarditis (infectious) |
|
What are the clinical manifestations of acute arterial ischemia? Is the onset gradual or abrupt?
|
Abrupt! You have about 6 hours to correct it.
6 P's: Pain Pallor Pulselessness Paresthesia Paralysis Poikilothermia (loss of normal thermoregulation) |
|
Acute arterial occlusion is diagnosed by looking at...
H&P Hx of recent ____ procedures S/S (6 “P’s”) Risk factors and hx of _____ elsewhere ____ ultrasound ____ imaging and ___ graphy |
Acute arterial occlusion is diagnosed by looking at...
H&P Hx of recent invasive procedures Signs and symptoms (6 “P’s”) RFs and history of atherosclerosis elsewhere Doppler ultrasound Duplex imaging Angiography |
|
Mottling is a early/late sign. It means there's inadequate and uneven distribution of o2 at tissue level.
|
late
|
|
Tx of acute arterial occlusion (6)
|
Emergency!
Anticoagulation Thrombolysis Embolectomy Surgical revascularization Amputation |
|
Aortic aneurisms are the out___ing or d_____s of arterial wall in weakened area
____-like protrusion of arterial wall susceptible to _____ Most aortic aneurysms involve: which 3 areas? Which is most common? |
Outpouching or dilations of arterial wall in weakened area
Balloon-like protrusion of arterial wall susceptible to rupture Most aortic aneurysms involve: aortic arch, thoracic artery, abdominal aorta Abdominal aortic aneurysms most common (AAA) |
|
Explain the pathophysiology of aortic aneurysms.
|
Forces cause weakening of intima, media of arterial wall of aorta
Dilation of aortic wall occurs, makes artery vulnerable to rupture Dilated aortic wall becomes lined with thrombi, that can embolize and lead to acute ischemic symptoms in distal (downstream) arteries |
|
____ ______ has major role in aortic aneurisms.
|
atherosclerotic plaque
|
|
What are some causes and risk factors of aortic aneurysms?
|
Atherosclerosis (most common cause)
Smoking HTN DM Male gender Genetics (the weakening of arteries can be genetic) Blunt trauma Inflammatory and infectious causes |
|
What are the clinical manifestations of aortic aneurysms? It's often picked up on routine visits because it's often ....
|
Often asymptomatic
Deep, diffuse chest pain, extending to interscapular area Angina Hoarseness: pressure on laryngeal nerve Dysphagia: pressure on esophagus JVD; edema of hd/arms: if aneurysm presses on SVC decreased venous return weakness/paralysis- (may be what gets them diagnosed) Pulsatile mass in periumbilical area Bruits over aneurysm Back pain bt shoulder blades "Blue toe syndrome" (embolization of plaque) |
|
Angina is seen with which 2 types of aortic aneurisms? The pain of aortic aneurisms may also mimic ____ and ____ disorders
|
ascending aorta & aortic arch aneurism
Pain may mimic abdominal, back disorders |
|
What are some complications of aortic aneurisms?
|
Rupture!
Bleeding-->hemorrhage--> hypovolemic shock and death |
|
True or false: aortic aneurisms have high mortality rate (ruptured AAAs have up to a 94% mortality rate, higher in women, elderly)
|
true
|
|
Diagnosis of aortic aneurism involves...
a simple chest x-ray ECG to r/o ___ (s/s sometimes like angina/MI) Echocardiogram Ultrasound MRI; CT scan and angiography |
Diagnosis of aortic aneurism involves a Simple chest x-ray
ECG to r/o MI (s/s sometimes like angina/MI) Echocardiogram Ultrasound MRI; CT scan and angiography |
|
What is the tx of aortic aneurisms?
Prevent aneurysm from ____ Diagnose existence, size, changes over time Monitor; repair aneurysm when indicated Surgery: aneurysm repair with ____ graft ______ _____ procedure and angiography |
Prevent aneurysm from rupturing
Diagnose existence, size, changes over time Monitor; repair aneurysm when indicated Surgery: aneurysm repair with Dacron graft Endovascular graft procedure and angiography |
|
Aortic dissection is the result of a ___ in the ____ lining of arterial wall, usually of the ___ ___
It is acute/chronic and ___ threatening. An acute aortic dissection without surgery-- mortality rate is 90% |
Aortic dissection is the result of a tear in the intimal lining of arterial wall, usually of the thoracic aorta
It is acute and life-threatening!! An acute aortic dissection without surgery, mortality rate is 90% |
|
Aortic dissection is more common in men or women? What age most effected?
|
Men affected > women
40-70 years most common |
|
For aortic aneurism repairs, look in book about indications for surgery and what the repairs can include...
|
>5cm in women
>5.5 cm in men at this size likely need surgery, but may start to leak or rupture before this level... |
|
The pathophysiology of aortic dissection involves a tear in intima of aorta allows blood to track between _____ and ____ creating ____ lumen of blood flow
As heart contracts, each systolic pulsation leads to pressure on damaged area, which further increases _____ makes splitting greater extending size of false lumen) As bleeding extends, may ____ branches of aorta, cutting of blood supply to organs such as heart, coronary system, upper extremities, brain |
The pathophysiology of aortic dissection involves a tear in intima of aorta allows blood to track between intima and media creating false lumen of blood flow
As heart contracts, each systolic pulsation leads to pressure on damaged area, which further increases dissection makes splitting greater extending size of false lumen) As bleeding extends, may occlude branches of aorta, cutting of blood supply to organs such as heart, coronary system, upper extremities, brain |
|
What are some causes or risk factors for aortic dissection?
|
Destruction of medial layer elastic fibers
Chronic HTN Older age Marfan Syndrome Blunt trauma Genetic, familial |
|
Aortic dissection involves sudden/gradual mild/severe pain in anterior ____ or ____ area radiating to ___ into _______ and ___. Pain is described as ____ or _____. It may mimic excruciating pain of ___. Pain is above and below the ______.
What are some neuro s/s? Also can cause angina, and compress ______ arteries leading to MI without atherosclerosis due to blood flow disruptin, murmor CHF, and altered tissue _____, decreased _____ of upper and lower extremities. |
Aortic dissection involves sudden severe pain in anterior chest or intrascapular area radiating to spine into legs and arms.
Pain is “ripping” or “tearing” & severe! Pain may mimic excruciating pain of MI Pain above & below diaphragm Neuro s/s if aortic arch involved: Altered LOC, dizziness, decreased or absent carotid/temporal arteries Angina, MI, (coronary blood flow disrupt.),CHF, m. Altered tissue perfusion, decreased pulses of upper/lower extremities |
|
What are some complications of aortic dissection?
|
Cardiac tamponade
Aortic rupture Exsanguination and death Paralysis of lower extremities d/t ischemia of spinal cord Renal failure d/t renal ischemia Valve dysfunction MI |
|
Aortic dissection is diagnosed in the same was as an ____ ___.
It involves... Echo:showing... CXR: showing... TEE MRI; CT scan Angiography |
aortic aneurism It involves...
Echo: Left ventricular hypertrophy (HTN) CXR: widening mediastinal silhouette and left pleural effusion TEE MRI; CT scan Angiography |
|
What is the treatment for aortic dissection?
Goals? |
Conservative therapy at first, if pt is without symptoms or complications
Surgical tx: resection and graft placement Control of blood pressure, rest, monitoring for shock Medications for BP control at discharge Goals are to to decrease BP, and decrease myocardial contractility to prevent exacerbation |
|
Venous disorders primarily affect the upper/lower extremities. They are generally categorized into venous _____ and venous _____.
|
Venous disorders primarily affect the lower extremities. They are generally categorized into venous thrombosis and venous insufficiency.
|
|
Venous thrombosis is the formation of a _____ in association with i______of the vein, esp. the ___ veins of the legs (DVT)
Most commonly, ___or ___ veins involved May result in ___ ___ |
Venous thrombosis is the formation of a thrombus in association with inflammation of the vein, esp. the deep veins of the legs (DVT)
Most commonly, iliac or femoral vein involved May result in PE |
|
The pathophysiology of DVT involves damaged endothelium of vein which leads to platelet ______, inflammation, thrombus development
Thrombus may undergo ___ or may detach leading to PE. What is a major factor in the embolization process? |
The pathophysiology of DVT involves damaged endothelium of vein which leads to platelet aggreggation, inflammation, thrombus development
Thrombus may undergo lysis or may detach leading to PE Turbulence of blood flow major factor in embolization, due to constriction of blood vessel, or when it's stagnated, or other factors in blood making in more coagulable. |
|
What are the 3 most important factors in the etiology of DVT? This is known as..
|
Venous stasis
Endothelial damage Hypercoagulability of blood This is called Virchow’s triad |
|
What are some risk factors that cause stasis, endothelial damage, and hypercoagulability of blood which leads to development of DVT?
|
Smoking
Damage, trauma to vein Stasis from immobility Polycythemia HRT (hormone replacement therapy) More (Table 38-7; Ch. 38) |
|
What are the manifestations of DVT?
|
may be asymptomatic
Unilateral leg edema Extremity pain Erythema Warm skin Elevated temperature Calf tenderness, if calf involved |
|
What are the 3 main complications of DVT?
|
Pulmonary embolism (most serious)
Chronic venous insufficiency Phlegmasia cerulea dolens (dark purplish edematous discoloration of extremities distal to site of DVT) |
|
DVTs are diagnosed by doing venous _____ studies
_____ scanning ____gram labwork H & P CC Also ____ sign sometimes |
Venous doppler studies Duplex scanning
Venogram Labwork H&P; CC Homan's sign |
|
For prophylaxis against DVT...
|
dorsiflexion, mobility, SCDs
|
|
Once diagnosed with DVT, what is the tx?
|
Once diagnosed:
early bedrest, antiembolism stockings, elevation; drug treatment Pain management Anticoagulation therapy: Heparin drip, then coumadin PO Monitor for overanticoagulation (Vitamin K is antagonist to coumadin) |
|
Chronic venous insufficiency is when ____in veins are damaged, which leads to _____ venous blood flow, _____ing of blood in legs and periphery, and ____ing. Hydrostatic pressure pushes fluid from vein out into tissues. CVI often occurs as a result of previous DVTs can lead to ____ leg ulcers. These are painful, debilitating conditions which often occur in the _____, people with ___ ___ and if they have previous hx of ___.
|
Chronic venous insufficiency is when valves in veins are damaged, which leads to retrograde venous blood flow, pooling of blood in legs, and swelling. Hydrostatic pressure pushes fluid from vein out into tissues. CVI often occurs as a result of previous DVTs can lead to venous leg ulcers. These are painful, debilitating conditions which often occur in the elderly people with Diabetes Mellitis and if they have previous hx of DVT.
|
|
Rules for dorsiflexion is usually ___ times an hour when awake. Helps get blood back to heart, prevent stasis. Take stockings off ___ per shift.
|
20
once (READ ABOUT COUMADIN) lots of pressure with d/c of IV etc if on blood thinners Avoid too much Vitamin K |
|
The pathophysiology of CVI involves ...
The basic dysfunction is ____ ____ of __ veins. Hydrostatic pressure in veins increases RBCs & serous fluid leak from capillaries into tissues, resulting in edema Then, Enzymes in tissue break down RBCs, causing release of ______ which leads to ____ skin discoloration ____ tissue replaces normal Subcutaneous tissue leads to ____, hardend, ______ skin. |
Basic dysfunction is incompetent valves of deep veins.
Hydrostatic pressure in veins increases RBCs & serous fluid leak from capillaries into tissues, resulting in edema Enzymes in tissue break down RBCs, causing release of hemosidering which leads to brownish skin discoloration (reddish brown) Fibrous tissue replaces normal SC tissue leads to thick, hardened contracted skin. |
|
Causes and risk factors of CVI
|
Vein incompetence
Deep vein obstruction Congenital venous malformation AV fistula Previous episodes of DVT Immobility |
|
Clinical manifestations of CVI
|
brown, leathery skin of lower extremities
“Brawnish” color: reddish brown discoloration Edema Eczema, or stasis dermatitis Itching (pruritus) Warm skin temperature Venous ulcer development |
|
What are some complications of a CVI?
|
Venous ulcers lead to painful, irregular wound margins, with ruddy coloring of surrounding skin
Ulcers may extend deeply & widely May lead to wound infection & cellulitis Recurrent cellulitis may lead to lymphatic destruction and lead to lymphedema, may lead to amputation Pain, increasing with dependent position |
|
Diagnosis of CVI involves venous doppler studies
H & P CC Labwork How CVI treated? |
Compression (key principle): for CVI management venous ulcer healing, & prevention of recurrence
MOIST environment dressings for wound care Nutritional interventions zinc, vit c, protein etc Antibiotic for wound infections Elevation; mobility; avoiding dependent position for extended periods Self-care patient teaching |
|
For ____ and any of these vessels disorders, assessing peripheral pulses very important- do posterior tibial, pedal etc also CMS, skin temperature, CRT
Use doppler if no palpable pulses! Risk factor teaching and control; low fat, low chol diet Medication hx and comorbidities For acute arterial occlusion, carefully monitor pts post procedures accessing ____ or in pts with indwelling lines; fistulas, etc. Peripheral pulses compared bilaterally; appearance |
For PAD and any of these vessels disorders, assessing peripheral pulses very important- do posterior tibial, pedal etc also CMS, skin temperature, CRT
Use doppler if no palpable pulses! Risk factor teaching and control; low fat, low chol diet Medication hx and comorbidities For acute arterial occlusion, carefully monitor pts post procedures accessing groin or in pts with indwelling lines; fistulas, etc. Peripheral pulses compared bilaterally; appearance |
|
Pain for CVI increases with ___ position
|
dependent
|
|
If someone has excruciating back or chest pain, suspect...
|
rupture aneurism or some kind of aortic aneurism
|
|
Review page 26-28 of powerpoint for more about assessment
|
....
|
