What are coumadin and heparin used for?
To inhibit thrombus and clot formation.
What is the necessary lab value to evaluate while a patient is on heparin? What is the normal value?
PTT. Normal= 30 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PTT= 45-75 sec.
What is the antidote for heparin?
Protamine Sulfate
What should you do if the PTT value is 80 for someone on heparin?
D/C the med and call the doctor.
What is the antidote for coumadin?
Vitamin K (aqua myphiton)
What lab value is used to evaluate a patient on coumadin? What is the normal value?
PT. Normal= 12 sec. If on anticoagulants it should be between 1 1/2 to 2 1/2 x the normal value. For PT= 18-30 sec.
What should you do if the PT value is 45 sec?
D/C the med and call the doctor.
What is INR?
International Normalized Ratio measures blood clotting time and compares it to normal values. 1.0=normal. Most people on anticoagulants are 2-3.
What should be done for someone on bleeding precautions?
RANDI= Razor-electric, Aspirin- NO, Needles- small gauge, Decrease-needle sticks, and Injury- protect from. No percodan or NSAIDS, no open toed shoes.
What should you observe for in someone on bleeding precautions?
Hematuria (tea or coca cola colored), nosebleeds, gingival bleeding (no medicated mouth wash, flossing, or lemon glycerin swabs), and bruising (assess for abuse w/o caregiver).
When should bleeding precautions be implemented?
When: using anticoagulants, liver disease, decrease in platelets (less than 150,000), hemophilia, using thrombolytic meds, DIC, CA, HIV, chemo, bone marrow problems, and ASA/NSAIDS.
What landmarks should you be looking for on someone's chest?
Aortic valve, Pulmonic valve, right ventricle, tricuspid valve, and apex or mitral valve.
Where is the aortic valve landmark on the chest?
Second right intercostal space
Where is the pulmonic valve landmark on the chest?
Second left intercostal space
Where is the right ventricle landmark on the chest?
Left sternal border
Where is the tricuspid valve landmark on the chest?
Lower left sternal border
Where is the apex/mitral valve landmark on the chest?
Fourth or fifth intercostal space at or medial to the midclavicular line.
Which jugular veins give a more accurate estimate of the jugular vein pressure and pressure in the right atrium?
The internal jugular veins (external are less reliable).
Where do the internal jugular veins lie?
Deep in the sternomastoid muscle, so look for pulsations in the soft tissue surrounding that area.
What signals an elevated venous pressure based on the internal jugular veins?
Identify the highest point of pulsation and measure from this point to the sternal angle. A measurement of greater than 3 cm= an elevated venous pressure.
How should you palpate the apical pulse?
When not visable, place the patient in the left lateral position, ask them to exhale fully and stop breathing for a few seconds.
How should you palpate the carotid arteries?
One at a time to assess the pulse amplitude and contour.
For which heart sounds should the diaphragm be used?
High pitched sounds like S1 and S2 (pericardial friction rubs, aortic/mitral regurgitation murmurs). DIAPH(high)ragm
For which heart sounds should the bell be used?
Low pitched sounds such as S3 and S4 and the murmur of mitral stenosis. BEL(low)L
What things should you do to assess cardiovascular status?
Inspect pulses on chest, inspect the internal jugular veins, palpate the apical pulse, palpate the carotid arteries, and auscultate the heart sounds.
What is epistaxis?
A nosebleed
What should be done is a patient on anticoagulants suffers from epistaxis for more than 15 mins?
Posterior nasal packing to stop the blood flow. THE LPN CAN DO THIS!
What should you do immediately for someone experiencing anticoagulant induced epistaxis?
Don a protective gown, gloves, and goggles, call Dr, hand pt. emesis basin and raise the HOB 45* (at this angle he can spit out blood and prevent N&V/aspiration, have another nurse firmly press on his nose just below bony part (apply pressure at least 10
What should you teach your patient about an abdominal ultrasonography?
Used to detect an abdominal aortic aneurysm. This noninvasive test takes 15 to 30 mins. They apply conductive gel to your abdomen and move a transducer over abdomen to scan blood vessels. Sound waves bouncing off anatomic structures are translated into gr
What should you teach your patient about angiography (arteriography)?
Used to look at vessels. A local anesthetic is injected and a catheter is inserted into a vessel in the area and advanced as necessary. A contrast medium is injected into the vessel than a series of xrays follow. Any flushing sensation/nausea/ or unusual
Test ending in Gram=?
Iodine
What should you teach someone about iodine?
Feeling warm (fire) or tin can taste is expected and will pass.
How long is contrast media in the body?
Only for a few hours
What should you teach your patient about a cardiac catheterization?
The physician injects a local anesthetic into the site, inserts a catheter, and threads it through the artery into the left side of the heart or through a vein into the right side of the heart to your lungs. Next, a dye is injected which may cause flushin
What should you teach your patient about MRI?
MRI is painless, you must remain still inside a small/noisy space. If you are claustrophobic you may need sedation. Remove all jewelry and other metal objects. If you have any shrapnel, a pacemaker, or any surgically implanted joints, pins, clips, valves,
What should you teach your patient about an electrocardiogram (ECG)?
It is a noninvasive test that takes 15 mins. Electrodes are applied to sites on your body. You must lie still, relax, and breathe normally and remain quiet. Talking or moving distorts the images
What should you teach your patient about an exercise ECG (stress test)?
It is noninvasive. You must not eat, smoke, or drink alcohol for 3 hours before the test. WEAR COMFORTABLE SHOES AND LOOSE LIGHTWEIGHT SHORTS OR SLACKS, YOU MAY GET AN INJECTION OF THALLIUM, after your blood pressure and ECG are monitored for 10-15 mins.
What should you teach your patient about a holter monitor?
This noninvasive test takes 24 hours and causes no discomfort. Electrodes are applied to your body, you need to log your activities for a 24 hour period (walking, sleeping, urinating, physical symptoms, and medications). Don't tamper with the monitor and
What is a chemical stress test (persantine stress test)?
It is a test that examines the hearts response to being stressed by a pharmacologic agent. Persantine and adenosine vasodilate the coronary arteries and cause blood to shunt away from partially occluded coronary vessels. Then dobutamine stresses the heart
What are the indications for a chemical stress test (persantine stress test)?
Patient who are unable to tolerate exercise stress testing.
What is the nursing care associated with chemical stress tests (persantine stress test)?
Explain procedure, stress importance of reporting symptoms. INSTRUCT THE PATIENT NO TO EAT DRINK OR SMOKE AT LEAST 1 HOUR BEFORE THE TEST. EVALUATE PATIENTS HISTORY FOR ANY CARDIAC CONDITIONS OR MEDICATIONS THAT MAY INTERFERE WITH THE TEST!!! (No vasodila
What is CVP? Normal?
A central line placed that measures the right atrial pressure. Normal= 4-10 cm of H20.
What does a swan ganz measure?
The right and left ventricular pressures, cardiac output, arterial venous O2 difference, and pulmonary artery pressure.
What should be done during the insertion of both a CVP catheter and a swan ganz catheter?
Trendelenburg position for insertion. Pt holds breath to prevent air from entering sinus tract.
What are the proper steps to changing a central venous catheter dressing?
It is a sterile procedure so both nurse and patient should wear a mask, arrange sterile field, remove dressing, assess the catheter insertion site for infection, put on sterile gloves, clean the site moving outwardly in a circular motion, apply a skin pre
What should you watch for with PICC lines that have been in place for 6 months?
Air answers (open junctions)
What is a major complication of central line placement?
Pneumothorax and will end up with chest tube to help reinflate lung.
What is important to remember when removing a CVC from a patient?
Have the patient use the val salva maneuver when the line is being removed (bear down/hold breath) to prevent air from entering where the line was and causing a PE.
What should you always assume with a patient who has a central line placed and is experiencing SOB?
Air embolism
What are the S&S of air embolism?
Difficulty breathing, pain in midchest and shoulder, pale, nausea, and light headedness.
What is an air embolism?
When a large air bubble blocks blood flow from the right ventricle into the pulmonary artery.
What should be done immediately if a pulmonary embolism is suspected?
Close the open catheter lumen with the clamp, and place the pt on their left side in trendelenburg to move the air embolus away from the pulmonic valve. If you hear a churning sound in his chest (a classic sign of air embolus) and the patient starts to be
What should you do frequently for someone with a central line to help prevent pulmonary emboli?
Check all junctions frequently to make sure secure, especially before patient gets out of bed, and always use tubing with twist lock connections.
When would a nurse use an external femoral artery compression device?
After a sheath removal to apply consistent pressure and prevent bleeding. (Ex: after swan ganz removal).
What should you do when applying a femoral artery compression device?
Assess and mark the location of the dorsalis pedis and posterior tibial pulses in affected leg, wash hands and put on sterile gloves, gown, and mask, position device, check circulation and make sure good pedal pulse is present, IMMEDIATELY REPORT SEVERE P
Can a femoral artery compression device be assigned to an NA?
NO!!!
What needs to be held during the placement of a femoral artery compression device?
NO NSAIDS or ASA.
What should you suspect for someone who post cardiac cath and percutaneous coronary intervention reporting feeling a pop in her left groin followed by a saturated dressing, swelling around site, palpable 2 inch fullness, and a bruit is present?
A hematoma= bleeding into the soft tissue surrounding the femoral artery access site.
What could happen without immediate intervention for a hematoma?
The patient may suffer significant blood loss or femoral nerve compression.
What should you do immediately if you suspect someone of developing a hematoma?
Using both gloved hands, apply firm pressure just above the skin puncture site and over the hematoma to compress the area. Wait at least 15 mins before removing pressure and reassessing the site. Then notify the health care provider.
What should you tell a patient who developed a hematoma in the hospital and is being discharged?
To report to her healthcare provider if she feels a large bump in her groin, if she has groin pain unrelieved by acetaminophen, or if she develops numbness, tingling, etc. in the affected leg.
What is the proper way to access and implanted venous access port (IVAP) (Mediport)?
Use sterile gloves and aseptic technique, clean skin over port with alcohol or iodine, insert a 21 or 22 gauge HUBER needle (noncoring-won't break apart) attached to syringe or tubing into the middle of the port until rigid back of port is palpable, aspir
What is the maintenance for venous access port that isn't being regularly used?
Must be flushed 1x/month with heparin and between treatments.
Should the tubing for a venous access port be included under the dressing site?
NO because it isn't sterile so keep out.
What is superior vena cava syndrome?
A complication from a venous access device or port. It is a blockage of the superior vena cava preventing superior blood flow from reaching the heart.
What are the S&S of superior vena cava syndrome?
Feeling of fullness in head, tightness around shirt collar, or rings/jewelry that suddenly seem tight, swelling in face, hands, arms, and swollen/cyanotic lips, dyspnea, coughing, hoarseness, chest pain, hemotysis, visable collateral chest wall veins, JVD
What makes the symptoms of superior vena cava syndrome better? Worse?
The symptoms improve when the patient is sitting in upright position that promotes drainage but worsen with the client is lying down.
What is a transthoracic echocardiograph (TTE)?
A NON INVASIVE doppler exam of the heart via the thorax to detect cardiac tamponade.
What is cardiac tamponade? Common causes?
A fluid accumulation in the pericardial space that compromises cardiac function. It is considered a medical emergency and is a hemodynamic consequence of blood or excess fluid accumulation in the pericardial sac. Common causes are surgical or traumatic in
What are the S&S of cardiac tamponade?
SOB, dyspnea, anxiousness, diaphoresis, cool/clammy skin, distended neck veins, mental status changes, narrowed pulse pressure, hypotension, and faint or muffled heart sounds.
If 2 liters of fluid is left in the pericardial sac (cardiac tamponade) and goes untreated what could it cause?
Right sided heart failure
What will the Transthoracic echocardiograph (TTE) show that will indicate cardiac tamponade?
An enlarged space indicates fluid accumulation in the pericardial sac.
What will be the treatment for an acute episode of life threatening tamponade?
A clinician will perform echocardiogram guided pericardiocentesis with a needle or catheter to remove excess fluid in the pericardial sac.
What is you see an NA placing cardiac monitor electrodes on a patient. She is placing (-) on the left and (+) on the right what should you do?
Correct her and tell her that the (+) lead goes on the left and the (-) lead goes on the right side.
What should you do if the patient you are applying cardiac monitor electrodes to is hairy?
Clip the hair to allow good contact between the electrodes and the skin (DONT SHAVE).
What should you do prior to placing cardiac monitor electrodes on the skin (4 things)?
Clip hair if necessary, abrade the skin (use abrader pads or fine sandpaper and lightly rub skin using 2 or 3 brisk strokes-improves tracings), dry skin if necessary, and attach the lead wires to the electrodes before you apply them to the patient.
In what locations should you not place electrodes?
In fatty areas or over major muscles, large breasts, or bony prominences.
What causes essential/primary hypertension?
Idiopathic
What is labile hypertension?
BP is elevated or decreased depending on activity.
What causes secondary hypertension?
Steroid treatment or a pregnant woman who is retaining water.
What factors place you at risk for HTN?
BIRTH CONTROL PILL (LEADING CAUSE OF HTN IN YOUNG WOMEN-45=STILL YOUNG), BLACK MALE (then white male, than black female, then white female), obesity, smoking, stress, high Na diet, lack of exercise, age, sex, race, or noncompliance.
What is the treatments for hypertension?
Decrease in weight, diuretics (watch K loss), aldactone (k sparing but check renal fx), inderal (do NOT give to asthma patients or diabetic patients), more exercise, no smoking, and decreased Na intake.
What is characteristic of atrial fibrillation?
No clearly defined or measurable P waves and an irregular-irregular ventricular response.
What are the nursing interventions for a patient in atrial fibrillation?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
What is the treatment for atrial fibrillation?
Direct current cardioversion and digoxin/propranolol (inderal).
What is characteristic of premature ventricular contractions?
Premature beats that are not preceded by a P-wave, QRS is wide and bizarre, and the T wave of the premature beat is generally large and in the opposite direction of the QRS.
When should you be concerned about premature ventricular contraction?
When they occur >6 per minute or occurring 2 or more in a row (bigeminy or trigeminy=on way out).
What are the nursing interventions for a patient with premature ventricular contractions?
(1st) Assess the client for signs of decreased cardiac output and Notify the physician (2nd).
What is the treatment for premature ventricular contractions?
IV LIDOCAINE BOLUS (50-100 mg) followed by an IV lidocaine drip (suppresses ventricular activity).
What is characteristic of ventricular fibrillation?
Totally disorganized, chaotic pattern, and no discernible waves or complexes.
What nursing interventions are associated with a pt. experiencing ventricular fibrillation?
(1ST) BEGIN CARDIOPULMONARY RESUSCITATION (THE PT. IS DYING) AND NOTIFY PHYSICIAN (2ND).
What is the treatment for someone in ventricular fibrillation?
Direct current shock (defibrillation) and IV anti-arrhythmic drugs (lidocaine, Procainamide, and Bretylium).
What is characteristic of complete heart block?
Ventricular rate is regular at a rate of 40-60 bpm and there is no relationship of P waves to QRS complexes.
What are the nursing interventions for a patient in complete heart block?
(1st) Assess the client for S&S of decreased cardiac output and Notify physician (2nd).
What is the treatment for a patient in complete heart block?
Temporary or permanent transvenous PACEMAKER INSERTION, and if the client is symptomatic and showing S&S of decreased cardiac output, GIVE ATROPINE.
What is characteristic of ventricular tachycardia?
Rapid ventricular rate with no relationship to atrial activity and QRS complex is wide and bizarre.
What are the nursing interventions for a pt. with ventricular tachycardia?
(1st) Assess LOC, (2nd) if unconscious= begin CPR, and (3rd) Notify physician.
What is the treatment for a pt. with ventricular tachycardia?
Awake and alert: IV lidocaine bolus and drip
Unconscious, hypotensive, or S&S of angina/CHF: Direct current cardioversion and IV Lidocaine bolus and drip.
What should happen if someone converts to asystole/flatline?
CPR should be done. No defibrillation bc no rhythm to shock (heart already depolarized).
What are the steps for adult/child 1 rescuer CPR?
Check for response, activate ERS and AED, open airway with head tilt chin lift, checking breathing (5-10 sec), give 2 breaths (1 sec each), check carotid pulse (5-10 sec), locate CPR hand position, deliver first cycle of compressions (30 compression <23 s
What are the steps for infant 1&2 rescuer CPR?
Check for response, activate ERS, open airway head tilt chin lift, check breathing (5-10 sec), give 2 breaths (1 sec) with visible chest rise, checks brachial pulse (5-10 sec), locates CPR finger position, deliver 1st cycle of compressions (30 compression
What are the steps for adult 2 rescuer CPR?
Rescuer arrives with AED, turn AED on, select proper pads and apply, clear victim to analyze, clear victim to shock/press shock, resume chest compressions after 1 shock, delivers cycle of compressions at correct rate, pause to allow other rescuer to give
What are the steps to perform the heimlich maneuver?
Stand behind the victim, wrap arms around waist (IF PREGNANT WRAP ABOVE THE BABY), make a fist with one had and place thumb against abdomen midline, grasp fist with other hand, press into victims abdomen with quick upward thrusts.
If a victim is choking but can cough, speak, or breath what should you do?
Don't interfere!
What is the correct way to insert an oropharyngeal airway?
Gently insert the oropharyngeal airway by turning it upside down (into U shape) and slide it into the mouth. As continue to insert rotate it so the ends of the U turn downward into an arch shape after it transverses the oral cavity and approaches the post
What should you do if you are going to ventilate someone with an ambu bag?
Lower HOB, place patient supine, assess LOC, open airway, assess breathing, get ambu bag, put on gloves, connect tubing from O2 source, adjust flow to 10 to 15 liters. FIRST RESCUER: PLACE APEX OF MASK OVER BRIDGE OF NOSE AND BASE BETWEEN LOWER LIP AND CH
How is the arterial brachial index (ABI) calculated? Who should perform this? What is normal?
It is calculated by checking the brachial BP and the ankle BP. The ankle systolic pressure is divided by the brachial systolic. The NA can perform. 0.97-1 is normal anything below indicates ischemia.
How does the blood flow through the heart? (valves?)
Right atrium, TRICUSPID VALVE (tissue), right ventricle, PULMONIC VALVE (paper), lungs, left atrium, MITRAL VALVE (My), left ventricle, AORTIC VALVE (Assets). TISSUE PAPER MY ASSETS!
What does vasotec (Enalapril Maleate) do/SE?
Lowers BP and makes heart beat stronger. SE: flushed face.
What are the five areas for listening to the heart?
All People Enjoy Time Magazine= Aortic, Pulmonic, ERB's point, Tricuspid, and Mitral/Apex. P(2) E (3) T (4) MA (5) (locations)
Where should you place your stethescope to find the aortic valve?
Second Right intercostal space.
Where should you place your stethescope to find the pulmonic valve?
Second Left intercostal space
Where should you place your stethescope to find the ERB's Point?
(S1, S2) Third left intercostal space
Where should you place your stethescope to find the tricuspid valve?
4th left intercostal space lower sternal border
Where should you place your stethescope to find the mitral (apex) valve?
Fifth left intercostal space medial to the midclavicular line.
What is impedance cardiography?
ICG is a noninvasive way to collect hemodynamic data for assessing patients with heart failure, hypertension, or dyspnea.
What does the device for impedance cardiography consist of?
A monitor with four dual electrodes that are applied to the patients neck and thorax.
How do you prepare a patient for Impedance cardiography monitoring?
Having the patient supine is ideal but any position is acceptable so long as in same position for each monitoring session, locate clean and dry sensor sites on the neck (in line with earlobe) and thorax (midaxillary at xiphoid process), connect leads in B
What should you explain to the patient about an impedance cardiography test?
It will take 5 mins and he/she should remain quiet for about 1 minute without talking or moving.
What is angina? Stable vs. unstable?
Chest pain or discomfort that occurs when your heart doesn't get enough blood and oxygen. Stable: the feeling comes and goes at expected times. Unstable: the pattern of your pain has changed (longer, hurts more, etc.)
What usually triggers angina pain?
It usually occurs when your heart is working harder (ex: exercising, eating large meal, or feeling stress. Also very hot or cold weather).
What should a patient do if they feel chest pain or discomfort?
Stop what they are doing, sit down and rest, if prescribed nitroglycerin tablets place one under tongue, if it still remains take another tablet in 5 mins, and if still in pain take another after an additional 5 mins, if still pain after 3 tablets and 15
What should you tell someone about taking nitroglycerin tablets (SE)?
They may feel a slight stinging under there tongue when they are dissolving, and they should get a HA (if no HA may not be good bc the pills only last for 6 months). Keep with you at all times.
How is angina treated?
Changing the way that you live is the first step. STOP SMOKING!!!! <30% FAT IN DIET (don't avoid all fat), lose weight, exercise, limit salt intake, nitro, Angioplasty (stent insertion) or CABG.
What drugs are most commonly used for angina?
Nitrates, Beta blockers, and Calcium channel blockers
Which type of patient shouldn't take nitrates?
A patient on sildenafil (Viagra), Cealis, or Levitra bc these drugs together can cause very low blood pressure and heart attack.
What should be checked in a patient on a beta blocker?
Pulse before and after giving.
What are examples of calcium channel blockers?
Verapamil (calan), diltiazem (cardizem), nifedipine (procardia), amlodipine (norvasc).
What do calcium channel blockers do?
Open up blood vessels
What SE should you look for with calcium channel blocker use?
Constipation or MAY CAUSE ANKLES TO SWELL (call healthcare provider).
What is the treatment for myocardial infarction?
MONA=Magnesium sulfate, O2, Nitroglycerin, Aspirin (mona has a heart so EKG also if select all that apply).
In what time period is the greatest risk of sudden death from an MI?
IN the first 72 hours!!!!!
What are common risk factors for an MI?
Smoking, elevated cholesterol, diabetes, hypertension, old age, and family hx of coronary artery disease.
What are signs and symptoms of an MI?
Crushing chest pain that lasts 30 mins or longer and may radiate to the neck, shoulders, or jaw, diaphoresis, nausea, and SOB.
What type of EKG change indicates MI?
ST segment elevation (STEMI)
What is the goal of treatment for an MI? Treatment?
Limit the size of the infarction is the goal. Treatment= thrombolytic therapy (tPA) initiated within 6 hours of the first symptoms= standard treatment.
What should you go when applying nitroglycerin ointment for angina?
Put on gloves, remove the previous application paper and use a tissue to remove all ointment from the site to prevent overdose, squeeze the prescribed ointment in a thin layer onto a clean ruled application paper, choose an unused site on the chest back o
What is pericarditis?
An inflammation of the pericardium. It may result in MI.
What is the hallmark clinical finding associated with pericarditis?
Pericardial friction rub: A high pitched squeaking or grating sound during cardiac contraction. It is typically best heard when the patient sits, leans forward, and breaths out.
What are all the S&S of pericarditis?
Pericardial friction rub, chest pain (sharp and aggravated with breathing), abnormal EKG findings, possible fever and tachycardia.
What are the two common complications of pericarditis?
Cardiac tamponade (fluid in pericardial space) and thickening/scarring of the pericardial sac (constrictive pericarditis and possible RHF).
What activity should a patient with pericarditis, who is undergoing treatment, be allowed?
Maintain BED REST
What is pulsus paradoxus?
A drop in systolic BP greater than 12 mm Hg during inspiration indicating a compromise.
What are the S&S associated with right sided heart failure?
Fatigue, JVD, Increased peripheral venous pressure, ascites, anorexia/complaints of GI distress, cyanosis, and dependent edema.
What disease can cause right sided heart failure?
Lung disease
What is a good diagnosis for someone with right sided HF?
Activity intolerance
What should the plan of care include for a diagnosis of activity intolerance r/t right sided HF?
Include rest periods prior to any activity.
What is the treatment for someone with right sided HF? How do you know working?
Diuretic & Digoxin (dig increases force of contraction and increases perfusion). Know working if client is peeing (kidney perfusion) and more alert!
What are the signs and symptoms of left sided HF?
Paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, BLOOD TINGED SPUTUM, cough, orthopnea, exertional dyspnea, cyanosis.
What condition can cause left sided heart failure?
Vascular-artery disease causing fluid to back up into the lungs.
What can result from left sided heart failure if left untreated?
Pulmonary edema
What should you do to treat pulmonary edema?
Give furosemide (lasix) 40-60 mg IV, O2 administration, morphine sulfate 3-5 mg IV, have patient sit up with feet lowered (decreases venous return to the heart), nitroglycerin given sublingual or IV, and rotating tourniquets (can reduce intrathoracic bloo
What is the normal value for arterial pulse? Pulse amplitude? Edema? Reflex?
Arterial pulse: 60-90, Amplitude: 4+=strong and bounding, Edema: 0=none, Reflex 2+
What would make someone more at risk for digoxin toxicity?
Elderly, hypothyroidism, renal dysfunction, dehydration, HYPOKALEMIA, hypomagnesemia, or hypercalcemia. Patients with abnormal potassium levels have a higher risk because hypokalemia makes the heart more sensitive to digoxin.
What body systems are affected by digoxin toxicity? S&S?
GI, neuro, and cardiac. S&S= yellow/green vision, N&V, bradycardia, and anorexia.
What is a therapeutic digoxin level?
0.5-2.0 ng/ml
What should be immediately done for a patient experiencing digoxin toxicity?
Stop the medication, address the factors that may have precipitated the event. If life threatening Digibind ay be indicated.
What is intermittent claudication?
Leg pain that is brought on by exercise and relieved by rest. It is characteristic of peripheral artery occlusion/ arterial insufficiency. It is dull or cramp like and consistently occurs in the same area of the leg and with same amount of distance.
What is the most common cause of arterial insufficiency?
Chronic arteriosclerotic disease.
What will a leg with arterial insufficiency look like?
Hair loss, muscle mass loss, pallor when elevated, dependent rubor, and prolonged cap refill time.
What should you teach someone with arterial insufficiency?
File toe nails, if have new shoes only wear 2 hrs/day d/t neuropathy can't feel if problem. To decrease pain of claudication massage legs to increase circulation.
What is a nursing diagnosis for arterial occlusion? Tx:
Decreased tissue perfusion. Tx: clot busting treatment must start within 6 hours.
What is an acute peripheral arterial occlusion?
The arteries have narrowed, decreased O2 to tissues= hypoxia to cells.
What should you remember while taking care of someone with a peripheral arterial occlusion?
NO TED HOSE, NO SHEETS/BLANKETS, NO COMPRESSION DEVICES, (TEACH NO OPEN TOES SHOES). Lambs wool is okay!
What does an Allen's test determine?
Whether the patients ulnar and radial arteries are patent.
For what disease should you do the Allen's test?
Thromboanglitis obliterans/ Buerger's disease= inflammatory process of arterial wall, veins, and nerves where they become blocked. It is associated with smoking/tobacco use.
True of false? During an Allen's test don't compress one artery before the other.
TRUE
What should you not allow if a patient has a negative Allen's test?
No radial artery punctures if negative
How is the Allen's test done?
Ask patient to make a tight fist, using your index and middle fingers compress both the radial and ulnar arteries to obstruct blood flow to hand, ask pt to relax hand (hand and palm should appear blanched bc flow stopped), release pressure on ulnar artery
What is Raynauds disease? Tx?
Spasms of the arterioles in finger/toes (digits of hands/feet may fall off). Tx: stop smoking, avoid stress & cold, use a vasodilator (calcium channel blocker). No skiing or butcher for career.
What is an aortic dissection?
A life threatening emergency that involves a tear in the aorta's intimal layer allowing blood to flow through a false lumen creating a hematoma or false aneurysm.
What are the S&S of aortic dissection?
Pallor, diaphoresis, tachypnea, severe tearing chest pain radiating to back, PULSES IN ARMS ARE STRONG BUT LEG PULSES ARE WEAK, low SP02.
What places someone at risk for an aortic dissection?
Poorly controlled hypertension
Without prompt surgery for an aortic dissection what is someone at risk for developing?
Stroke, renal or heart failure, paraplegia secondary to compromised blood flow, or death from aortic rupture.
What type of surgery is done for an aortic dissection?
The damaged portion of the aorta is removed and is repaired with a synthetic graft.
What should you teach someone after they have had a pacemaker placed?
Keep clean and dry for 72 hours, DON'T LIFT THE ELBOW OR ARM ON THE INCISION SIDE FOR FOUR WEEKS (CAN'T BRUSH HAIR OR TEECH BC PULLS CAN ROLL MARBLES), DON'T LIFT PUSH OR PULL MORE THAN 10 LBS FOR FOUR WEEKS, take pulse and wt each day, CALL CARDIOLOGIST
What are the 2 types of pacemakers?
Demand: Works PRN (when HR goes below predetermined rate) or Fixed: beats constantly at predetermined rate so no matter what heart does still beats at same rate.
What is cardioversion?
It is an elective procedure, where the client is awake, it is synchronized with "QRS", the patient is sedated, a consent form must be signed prior to, they are placed on an EKG monitor, and they are shocked with 50-200 Joules.
What is defibrillation?
Used in an emergency (Vfib/defib), used with Vfib or Vtach, NO CARDIAC OUTPUT, client is unconscious, EKG monitor, NO CONSENT NEEDED, begin with 200 Joules and up to 360.
What should you know about your recovery period after having an implantable cardioverter defibrillator (ICD)?
For the first month post op, do not lift more than 10 or 15 lbs. And avoid excessive pushing, pulling, or twisting.
When should a patient call 911 after having an implantable cardioverter defibrillator (ICD) placed?
If you feel lightheaded, dizzy, or heart palpitations but feel no shock from the ICD.
When should a patient call their doctor after having an implantable cardioverter defibrillator (ICD) placed?
If feel more than 3 shocks in a row or develop signs of infection at the site.
What are general guidelines to be followed by a patient who has an implanted cardioverter defibrillator (ICD)?
No magnets (cell phone 6 inches away from), DO NOT DRINK CAFFEINATED BEVERAGES, DO NOT ENGAGE IN ROUGH ACTIVITIES (FOOTBALL OR WRESTLING), and no tight clothing over site.
Who would most likely have peripheral venous disease?
Old truck driver or someone on bed rest or with pelvic trauma.
What are the treatments/ S&S of peripheral venous disease?
Varicose veins, elevate legs, weight reduction, brawny in color, ted hose, topical steroids, ulcers, and skin color changes.
What is Deep Vein Thrombosis (DVT)?
A disease in which thrombi trap blood in the deep veins of the pelvis and legs.
What is a assessment finding with DVT?
Positive Homan's sign (calf tenderness on dorsiflexion of the foot).
If you see a NA placing a patient with DVT in sitting position with legs dependent what should you do?
INTERVENE: to control edema and decrease pain patient should be on bed rest with legs elevated six inches above heart level.
What does plan of care include?
Elevated legs, anticoagulation therapy (aggressive: generally IV heparin), Be alert for signs of PE.
What should you teach a patient regarding discharge after a DVT?
Exercise and use graduated compression devices as directed, don't stand for long period of time, to avoid dislodging blood clots don't rub or massage your legs.
What are the four types of pulmonary emboli?
Fat, Air, DVT, or Amniotic
What are the S&S of pulmonary embolism?
Anxiousness, restlessness, tachycardia, tachypneic, 90% SP02, dyspnea, substernal pain, coughing, hemoptysis, and fever.
What should be done immediately for someone with PE?
Administer 100% O2, left trendelenburg position, heparin administered, and oral warfarin started (give heparin and warfarin together for at least 5 days).
What should be taught upon discharge for someone going home on coumadin as a result of a PE?
Need for follow up blood tests, Need to take oral warfarin for at least 3 months, and to reduce current risk encourage weight loss, smoking cessation, and regular exercise.
What is more harmful a lot of little emboli or one large emboli?
One large emboli (smaller=better)
What is the purpose of compression devices?
To reduce a patients risk of DVT and PE. They include graduated compression stockings, vena cava filters, and intermittent sequential external compression devices.
What is important to remember when taking care of patients with compression devices?
You need to maintain use of those devices continually except when the patient is ambulating, bathing, or during physical therapy or skin assessment.