Term
| ______ heart muscle is unable to pump effectively |
|
Definition
HEART FAILURE -->
Inadequate CO
Myocardial hypertrophy
Pulmonary/systemic congestion
Heart is unable to maintain adequate ciruclation to meet tissue needs |
|
|
Term
| ___life threatning accumulation of fluid in alveoli and intersitital space of lung that can result from severe HF |
|
Definition
|
|
Term
Classification of HF
Class I |
|
Definition
| client exhibits no symptoms with activity |
|
|
Term
|
Definition
| Client has symptoms with ordinary exertion |
|
|
Term
|
Definition
| Client displays symptoms with minimal exertion |
|
|
Term
|
Definition
| Client has symptoms at rest |
|
|
Term
|
Definition
| inadequate LV CO and inadequate tissue perfusion |
|
|
Term
L HF:
Systolic Heart ventricular failure |
|
Definition
| ejection fraction below 40% pulmonary and systemic congestion |
|
|
Term
L HR
Diastolic Heart ventricular failure |
|
Definition
| =inadequate relaxation or stiffening prevents ventricular filling |
|
|
Term
|
Definition
| inadequate RV output and systemic venous congestion (peripheral edema_) |
|
|
Term
|
Definition
| low in Na, fluid restrictions |
|
|
Term
|
Definition
HTN
Coronary arty disease, angina, MI
Valvular disease (mitral and aortic) |
|
|
Term
|
Definition
L sided ventricular failure
Right ventricular MI
Pulmonary problems (COPD, ARTDS) |
|
|
Term
| Assessment of High Output HF |
|
Definition
- increased metabolic needs
septicemia -fever
-anemia- hyperthyroidsm |
|
|
Term
|
Definition
1. Dyspnea, orthopnea (SOB while lying down), nocturnal dyspnea
2. Fatigue
3. Displaced apical pulse (hypertrophy)
4. S3 heart sound (gallop)
5. Pulmonary congestion (dysnea, cough, bibasilar crackles)
6. Frothy sputum (can be blood tinged)
7. Altered mental status
8. Symptoms of organ failure, oligura |
|
|
Term
|
Definition
1. jugular vein distention
2. ascending dependent edma (legs, ankles, sacrum)
3. Abdominal distention, ascities
4. Fatigue, weakness
5. Nausea and anorexia
6. Polyuria at rest (nocturnal)
7. Liver enlargment (Hepatomegaly) and tenderness
8. Wt Gain |
|
|
Term
|
Definition
Fatigue, weakness
HF w/ L dilated type. right with restrictive type
Dysrhythmias (heart block)
S2 gallop
Cardiomegaly (enlarged heart) |
|
|
Term
Lab Tests:
Human B-type natriuretic peptide (hBNP) |
|
Definition
Elevated in heart Failure.
*** Used to differentiate dyspnea r/t HF vs resp problems |
|
|
Term
| Human B-type natriuretic peptide (hBNP) levels |
|
Definition
- level below 100pg/mL indicates no heart failure
-level between 100-300 pg/ml suggets
-above 300 - mild HF
-above 600 = moderate
-above 900 severe HF |
|
|
Term
| Dx Procedure - Hemodynamic monitoring |
|
Definition
HF -->
Increased CVP
Increased R artieral P
Increased PAWP
Increased PAP
Decreased CO |
|
|
Term
| Hemodynamic findings for L HF |
|
Definition
CVP/right arterial P - normal or elevated
PAP - elevated
PAWAP - elevated
CO - decreased |
|
|
Term
| Hemodynamic findings for R HF |
|
Definition
| CVP/right arterial P - elevated |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| volume of blood pumped from the left ventricle into the arties upon each beat |
|
Definition
Left Ventricular Ejection Fraction LVEF
normal 55-77% |
|
|
Term
| volume of blood pumped from RV to lungs upon each beat |
|
Definition
Right Ventricular Ejection Fraction (RVEF)
normal 45-60% |
|
|
Term
|
Definition
| cardiomegaly and pleural effusions |
|
|
Term
|
Definition
Diuretics.
loop - Lasix, bumetanide
thiazide diuretics - hydrochlorothiazide
K+ sparing diuretics - spironolactone (Aldactone) |
|
|
Term
|
Definition
| administer IV NO FASTER THAN 20 mg/min |
|
|
Term
| Loop diuretics and thiazide diuretics can cause --- |
|
Definition
hypokalemia
*K supplement
Teach to ingests foods high in K+ |
|
|
Term
| Rx. Afterload-reducing agents |
|
Definition
| - help heart pump more easily by altering the resistance to contractions |
|
|
Term
| Types of afterload - reducing agents: |
|
Definition
1. Angiotensince-converting enzyme ACE inhibitors
- enalapril (Vasotec), captopril (Capotin)
2. Angiotensin receptor II blockers
-losartan (Cozaar) |
|
|
Term
T/F
ACE and ARBS are contraindicated for pts who have renal deficiency |
|
Definition
|
|
Term
|
Definition
-hypotension following initial dose
-angioedema (swelling of tongue and throat)
-increased levels of K=
-can decrease sense of taste or rash on skin |
|
|
Term
|
Definition
1. Can cause dry6 cough
2. Observe for rash or decrease sense of taste
3. Notify HCP if swelling of face or extremeties occurs
4. Remind client BP needs to be monitored for 2 hrs after initial dose to detect hypotension |
|
|
Term
| Drugs to increase contractility and improve CO |
|
Definition
|
|
Term
| types of inotropic agents |
|
Definition
digoxin (Lanoxin
dopamine
dobutamine (Dobutrex)
milironie (Primacor) |
|
|
Term
| Nursing considerations for clients taking Digoxin. |
|
Definition
- take apical HR for 1 min
HOLD if apical pulse is less than 60/min and notify HCP
**observe for N/V ** toxicity |
|
|
Term
| Dopamine, dobutamine, milrinone considerations |
|
Definition
-administered via IV
-ECG, BP, Urine Output must be clearly monitored |
|
|
Term
| TEACH client who are self administering digoxin |
|
Definition
| 1. count pulse 1 min before taking med (if irregular or < 60/min hold and notify HCP |
|
|
Term
| T/F Digoxin must be taking the same time each day |
|
Definition
|
|
Term
| T/F Digoxin may be taken the same time with antacids |
|
Definition
FALSE.
separate meds by at leastw 2 hrs |
|
|
Term
| Signs of digoxin toxcity should be reported |
|
Definition
1. fatigue
2. muscle weakness
3. Confusion
4. loss of appetite |
|
|
Term
| What levels should be regularly checked when taking digoxin? |
|
Definition
|
|
Term
| meds that prevent coronary artery vasospasms and reduce preload and after load -> decreasing myocardial oxygen demand |
|
Definition
|
|
Term
|
Definition
1. nitroglycerin (nitrostat)
2. isosorbide mononitrate (umdur)
to prevent coronary vasospasm and and reduce preload & afterload --> decreasing mycoardial oxygen demand |
|
|
Term
| Nursing considerations for vasodilators |
|
Definition
1. Given to treat Angina and control BP
2.. Use cautisously with other antihypertensive meds
3. Can cause orthostatic hypOtension |
|
|
Term
| TEACH client taking vasodilators |
|
Definition
1. HA is a common s/e of med
2. Encouage client to sit and lie down slowly |
|
|
Term
| used to treat HF by causing natriuresis (loss of Na and vasodilation) |
|
Definition
| Human B type natriuretic peptides )hBNP) |
|
|
Term
|
Definition
|
|
Term
| Nursing considerations of hBNP |
|
Definition
- can cause hypOtension
-Cardiac effects: ventricular tachycardia and bradycardia
-BNP levels will increase while on this med
-ECG, BP, oother parameters must be closely monitored |
|
|
Term
|
Definition
- -client can be asymptomatic with low BP
-remind client to sit and lie down slowly |
|
|
Term
| prescribed for clients with a hx of thrombus formation |
|
Definition
|
|
Term
|
Definition
|
|
Term
| nursing considerations for coumadin |
|
Definition
1. Assess for contraindications:
-active bleeding
-PUD}
-Hx CVA
-recent trauma
2. Monitor bleeding times Pt, aPTT, INR, CBC |
|
|
Term
| TEACH client taking warfarin (Coumadin) |
|
Definition
1. Client is risk for brusing and bleeding while on medication
2 Remind client to have blood monitoried routinely to check bleeding times |
|
|
Term
|
Definition
|
|
Term
| ____ a mechanical pump that assists a heart that is too weak to pump blood through the body. |
|
Definition
| Ventricular Assist Device |
|
|
Term
| VAD is used in clients who are: |
|
Definition
1. eligible for heart transplants
2. or have severe end stage heart failure & not candidates for heart transplants |
|
|
Term
| Treatment of choice for clients who have severe dilated cardiomyopathy |
|
Definition
|
|
Term
| ____ possible option for clients who have end stage heart failure; immunosuppresant therapy is required posttransplantation to prevent rejection |
|
Definition
|
|
Term
| T/F important to get vaccinations (Pneimococcal and yearly influenza vaccine) |
|
Definition
|
|
Term
| Most common cause of cardiogenic factors |
|
Definition
|
|
Term
| Noncardiac pulmonary edema can occur d/t: |
|
Definition
-barbituate or opiate overdose
-inhalation of irritating gases
-rapid administration of IV fluids
-pneumonectomy evacuation of pleural effusion |
|
|
Term
| neurogenic pulmonary edema develops following a |
|
Definition
|
|
Term
| For older adults, increasked risk for pulmonary edema r/t |
|
Definition
|
|
Term
| T/F For older adults, IV infusions must be administered at a slower rate to prevent circulatory overload |
|
Definition
|
|
Term
| Diet for health promotion and disease prevention of pulmonary edema |
|
Definition
| -low in sodium along with fluid restriction |
|
|
Term
| Subjective Data: Pulmonary Edema |
|
Definition
anxiety
inability to sleep |
|
|
Term
| Objective Data: Pulmonary Edema |
|
Definition
1. Persistent cough with pink, frothy sputum (CARDINAL SIGN)
2. Tachypnea, dyspnea, orthopnea
3. Hypoxemia (expected ref range >95%
4. Cyanosis (later stage)
5. Crackles
6. Tachycardia
7. Reduced Urine Output
8. Confusion, stupor
9. S2 heart sound (gallop)
10, Increased pulmonary artery occulsion pressure |
|
|
Term
| Nursing Care for Pulmonary Edema |
|
Definition
1 .Monitor VS q15 min until stable
2. I & O (30ml/hr)
3. Hemodynamic Status
4. Check ABGs, electrolytes, SaO2, Chest X ray
5. Maintain patent airway (suction as needed)
6. Position High Fowler's position, feet & legs dependent or side of bed to DECREASE preload
7. Restrict fluid intake |
|
|
Term
| Medications used for Pulmonary Edema |
|
Definition
1. Rapid acting diureteics (Lasix, bumatanide)
2. Morphine
3, Vasodilators
4. Inotropic agents
5. Antihypertensive (ACE, BB) |
|
|
Term
| meds to promote fluid excretion |
|
Definition
| furosemide (Lasix) and bumetanide (Bumex) |
|
|
Term
| ___ decreases SNS response and anxiety and promotes mild vasodilation |
|
Definition
|
|
Term
| ___ decrease preload & afterload |
|
Definition
|
|
Term
|
Definition
| inotropic agents, digoxin, dobutamine |
|
|
Term
| ACE inibitors and beta blockers |
|
Definition
|
|
Term
|
Definition
1. Cardiomyopathy
2. Acute pulmonary edema
3. Cardiogenic Shock
4. Pericardial Tamponade |
|
|
Term
| Cardiomyopathy is an impaired cardiac function leading to HF |
|
Definition
| -blood circulation is imparied to lungs OR body when cardic pump is compromosed |
|
|
Term
| Three types of cardiomyopathy |
|
Definition
1. dilated
2. hypertrophic
3. restricted
*dilated most common |
|
|
Term
| ____ cardiomyopathy - decreased contractility and increased ventricuar filling pressures |
|
Definition
Dilated d/t
-CAD
-Infection or inflammation of heart muscle
-various CA tx
-prolonged ETOH abuse |
|
|
Term
| T/F Acute pulmonary edema is a life threatening medical emergency |
|
Definition
|
|
Term
| Nursing actions for Acute Pulmonary Edema: |
|
Definition
1. Administer prescribed medications to improve CO
2. Teach measures to improve tolerance to activity (rest) |
|
|
Term
| S/S of Acute Pulmonary Edema |
|
Definition
1. Anxiety
2. Tachycardia
3. Acute respiratory distress
4. Dyspnea at rest
5. Change in LOC
6. Ascending fuild level within lungs
(crackles, cough productive of frothy, blood tinged sputum) |
|
|
Term
| Prompt Response to Acute Pulmonary Edema emergency |
|
Definition
1. High folwer position
2. Oxygen, Positive Airway Presure, itubation
3. IV morphine (decrease anxiety, resp distress, venous return decrease) |
|
|
Term
| Medication for acute pul edema |
|
Definition
-inotropic agents
-diuretics (IV admiistration of Lasix) |
|
|
Term
| _____ serious complication of pump failure that occurs commonly following an MI and injury to greater than 40% of LV |
|
Definition
|
|
Term
|
Definition
1. Tachycardia
2. HypOtension
3. inadequate urinary output
4. Altered level of consciousness
5. Respiratory Distress (crackles, tachypnea)
6. COOL, CLAMMY skin
7. DECREASED peripheral pulses
8. Chest pain |
|
|
Term
| Medications during Cardiogenic shock |
|
Definition
1. IV morphine
2 diuretics/nitroglycerin
4. IV admiinstration of vasopressors and/or positive inotropes |
|
|
Term
| Cardiogenic shock medications to decrease preload |
|
Definition
1. IV adminstration of Morphine
2. Diuretics
3. Nitroglycerin |
|
|
Term
| Cardiogenic medications to increase Cardiac output and maintain organ perfusion |
|
Definition
1. IV administration of vasopressors
2. Positive inotropes |
|
|
Term
| ____result from fluid accumulation in the pericardial sac |
|
Definition
= cardiac tamponade
pericardial tamponade |
|
|
Term
| S/S of Pericardial Tamponade |
|
Definition
1. Hypotension
2. Jugular venous distension
3. Muffled heart sounds
4. Paradoxical pulse (variance of 10 mm Hg or more in systolic BP b/w experiation and inspiration) |
|
|
Term
| T/F IV fluids should be administered during pericardial tamponade |
|
Definition
| TRUE to combat hypotension |
|
|
Term
| Confirmation of pericardial tamponade |
|
Definition
| chest x ray or echocardiogram |
|
|
Term
| patients will undergo a _____ for pericardial tampnade |
|
Definition
|
|
Term
| D/C Teaching for Client with HF |
|
Definition
1. CONSERVE E, rest periods b/w activities
2. Adhere to meds
3. Weigh weekly - notify if wt gain of 2 ln in 24 hrs or 5 lb in one week
4. Influenza vaccine yearly
5. if Digoxin, take pulse for 1 min, notify HCP if below set limit
6. Take diuretics early in AM and early afternooon to allow for uninterrupted sleep
7. Notify HCP of increased dyspnea, orthopnea, inability to wear rings or shoes |
|
|
Term
| A nurse is caring for a client who has HF and reports increased SOB. Nurse increases o2 per protocol. Which of the following actions should the nurse take first? |
|
Definition
High fowler. (ABC)
-decreases venous return to heart (preload) and helps relieve lung congestion
-other impt actions but not priority,:
notify PCP, ascultate the lungs- crackles, check o2 sats) |
|
|
Term
| A nurse caring for a client dx with HF asks how to limit fluid intake to 2000 ml/day. Which of the following responses should the nurse give to the client? |
|
Definition
| 1. Pour amount of fluid you drink into an empty 2 liter bottle to keep record |
|
|
Term
| S/S of digitltis toxicity or risk of |
|
Definition
1. Serum K+ 3.2
(hypoK increases risk of digitlais toxicity; leg cramps possible sign of hypoK)
2. Apical heart rate 54/min
3. Blurred vision
4. Dysrhthmia
5. Leg cramps
6. Anorexia
7. Altered mental status |
|
|
Term
|
Definition
cheese
milk
soy sauce
cured meats (pork) |
|
|
Term
|
Definition
cantalope
cured meats
white potatoes
avacado
bananas
raisin
meats beef, pork, chieckn, veal)
codfish, salmon, tuna |
|
|
Term
|
Definition
1. Cardiac enzyme and lipid profile
2. Echocardiogram
3. Stress testing
4. Hemodynamic monitoring
5. ANgiography
6. Vascular Access |
|
|
Term
| _____ enzymes are released into the bloodstream when the heart muscles suffers ischemia. |
|
Definition
|
|
Term
| ___ provide info regarding cholesterol levels and used for early detection of heart disease |
|
Definition
|
|
Term
| _____ are a specific marker for diagnosis an MI |
|
Definition
|
|
Term
| Indications for Cardiac Enzymes and lipid profile |
|
Definition
Angina
MI
Heart Disease
Hyperlipidemia |
|
|
Term
|
Definition
Creatine kinase MB isoenzyme (CK-MB)
Troponin T
Troponin I
Myoglobin |
|
|
Term
| Cardiac enzyme more sensitive to mycardium |
|
Definition
CK-MB
expected range 0% of total CK
(30-170 units/L)
Elevated levels first detectable following Mycardial injury
4-6
Expected duration of elevated level
3 days |
|
|
Term
| Expected reference range: Troponin 1 |
|
Definition
<0.2 ng/L
Elevated levels 1st detectable following myocardial injury
3-5 hr
Expected duration of elevated levels
14-21 days |
|
|
Term
| Expected Ref Range: Troponin I |
|
Definition
< 0.03ng/L
Elevated levels first detectable following myocardial inury
3 hrs
Expected duration
7-10 days |
|
|
Term
| Expected ref range: Myglobin |
|
Definition
<90 mcg/L
Elevated levels first detectable following myocardial injury
2 hrs
expected duration of elevated levels
24 hr |
|
|
Term
| Purpose of Cholesterol Test |
|
Definition
screening for heart disease
<200mg/dl |
|
|
Term
| "good" cholesterol produced by the liver |
|
Definition
HDL
Female 35-80 mg/dL
Male 35-65 mg/dL |
|
|
Term
| "Bad" cholesterol can be up to 70% of total cholesterol |
|
Definition
|
|
Term
| Evaluating test for atherosclerosis |
|
Definition
|
|
Term
|
Definition
echocardiogram
- used to diagnose valve disorders and cardiomyopathy |
|
|
Term
| indications for echocardiogram |
|
Definition
=cardiomyopathy
=HF
=angina
=MI |
|
|
Term
| Intraprocedure nursing actions for echo |
|
Definition
| Instruct client to lie on LEFT side and remain still |
|
|
Term
| Preprocedure Nursing action: echocardiogram |
|
Definition
| Explain test is pain free and takes up to 1 hr |
|
|
Term
| ____ cardiac muscle is exercised by the client walking on a treadmill. |
|
Definition
Stress Testing.
-provides info regarding workload of the hear
-once client's HR reaches certain rate, test is d/c |
|
|
Term
| The client sometimes become too tired and are unable to finish the test. What can the provider do? |
|
Definition
| reorder the test to e done as a pharmacological stress test. |
|
|
Term
| What is a pharmacological stress test? |
|
Definition
- drug, such as adenosine (Adenocard) is given to stress the heart instead of waling on the treadmil
- if client is disabled or pjyshically challenged |
|
|
Term
| Instructions for Client Preprocedure; stress test |
|
Definition
- client fasts 2-4 hrs before proedure
-avoid tobacco, ETOH, caaffeine |
|
|
Term
| postprocedure nursing actions: stress test |
|
Definition
| - client is monitored by ECG and BP frequntly checked until stable |
|
|
Term
| ____ involves special indwelling catheters to provide info about BLOOD VOLUME and PERFUSION, FLUID STATUS, and HOW WELL HEART IS PUMPING |
|
Definition
|
|
Term
| Hemodynamic status is assessed with several parameters: |
|
Definition
1. Central venous pressure (CGP)
2. Pumonary artery P (PAP)
3. Pulmonary artery wedge pressure (PAWP)
4. Cardiac Output
5. Intraarterial P |
|
|
Term
| ____ indicates balance b/w oxygen supply and demand. |
|
Definition
Mixxed Venous oxgyen saturation (SvO2)
-measured by pulmonary artery cahteter with fiberoptics |
|
|
Term
| Components of Hemodynamic Monitoring Systems: |
|
Definition
1. Pressure transducer
2. Pressure tubing
3. Monior
4. Presssure bag and flush device |
|
|
Term
___ lines are placed in the:
radial (most common)
brachial
femoral |
|
Definition
|
|
Term
_______ provides continuous information about:
-changes in BP
-permit the withdrawal of samples of arterial blood |
|
Definition
arterial lines
* intra-arterial P can differ from cuff pressures |
|
|
Term
| What should be assessed to verify the accuracy of BP readings? |
|
Definition
| Integriy of arterial waveform |
|
|
Term
| T/F Arterial lines can be use for IV fluid infusion |
|
Definition
|
|
Term
| What needs to be monitored with arterial lines? |
|
Definition
circulation
-cap refil
-temp
-color |
|
|
Term
_____ have multiple ports and components that:
-enable a variety of hemodynamic measurements
-collection of blood samples
-infusion of IV fluids |
|
Definition
| Pulmonary Artery Ctheterhs |
|
|
Term
| How is the PA catheter inserted? |
|
Definition
Inserted ino a large vein
-internal jugular
-femoral
-subclavian
-brachial
--> threaded through RA and RV into a branch of the pulmonary artery |
|
|
Term
| _____ lumen of PA catheter can be used to measure R arterial P (CVP), infuse IV fluids and obtain venous blood samples |
|
Definition
|
|
Term
____ lumen can be used to measure pulmonar artery P:
-PA systolic
-PA diastolic
-mean PAP
-PAWP |
|
Definition
Distal.
NOT used for IV fluid infusion |
|
|
Term
| T/F Balloon inflation port is continuously use for PAWP measurements. |
|
Definition
FLASE.
it is intermittenly used
-when not in use --> it should be deflated and in the 'locked' position |
|
|
Term
| _____ measures temperature differences b//w RA & pulmonary artery |
|
Definition
thermistor measures
in order to determine CO |
|
|
Term
| Indications for Hemodynamic Monitoring: |
|
Definition
1. serious or critical ilness
2. HF
3. Post CABG
4. ARDS
5. Acute renal failure
6. Burn victims
7. Trauma victims |
|
|
Term
|
Definition
|
|
Term
| Pulmonary Artery Systolic PAS |
|
Definition
|
|
Term
| Pulmonary Arter Diastolic PAD |
|
Definition
|
|
Term
| Pulmonary Artery Wedge Pressure (PAWP) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Mixed Venous Oxygen Saturation (SvO2) |
|
Definition
|
|
Term
| Intravascular Volume in older adult clients is often reduced, therefore the nurse should |
|
Definition
anticipate LOWR hemodynamic readigns,
particularly if dehydration is a complication |
|
|
Term
| Positioning of Client for line insertion |
|
Definition
|
|
Term
| What point does tranducer need to be levled? |
|
Definition
phlebostatic axis
4th intercostal space, mid-axiellary line
-ZERO systemp with atmospheric P |
|
|
Term
Hemodynamic P lines must be calibrated to read atmospheric P as ______.
Tranducer must be positioned at ____ |
|
Definition
ZERO
RIGHT ATRIUM (phlebostatic axis - 4th intercostal space, mid-axillary line) |
|
|
Term
| Once inital readings are obtained... |
|
Definition
| compare arterial BP to non=invasive cuff pressure |
|
|
Term
|
Definition
Right heart - CVP
Left heart - PAWP |
|
|
Term
|
Definition
Right heart - PVP Pulnoary Vascular Resistance
Left heart- Systemic Vasculrr Resistance (SVR) |
|
|
Term
|
Definition
1. Crackles in lungs
2. Jugular vein distension
3. Hepatomegal
4. Peripheral edema
5. Taut skin turgor |
|
|
Term
| S/S of decreased preload. |
|
Definition
|
|
Term
| S/S of elevated AFTERLOAD |
|
Definition
-cool extremities
-weak peripheral pulses |
|
|
Term
| s/s of decreased AFTERLOAD |
|
Definition
-warm extremities
-bounding peripheral pulsesphe |
|
|
Term
| What should be obtained following the procedure of insertion of line to confirm catheter placement? |
|
Definition
|
|
Term
| What needs to be continuously monitored post procedure of line insertion? |
|
Definition
Respiratory & Cardiac status
-VS, heart rhythm, SaO2
-Observe resp paattern and effor
-compare NIBP to arterial BP |
|
|
Term
Maintain line placement and integrity. How.
* |
|
Definition
1. Observe and document wavewarms
2. Document catheter placement each shift and as needed
3. Monitoring connections /w P tubing, transducers, and catheter ports |
|
|
Term
| What is an indication in change of waveforms? |
|
Definition
| catheter migration or displacement |
|
|
Term
| Prior to recording hemodynamic values, pt must be positioned in |
|
Definition
1. supine. HOB can be levated 15-30 degrees
*level transducer at phlebostatic axis before reading with all position changes
*ZERO systemo to atmospheric P |
|
|
Term
| Important to compare hemodynamic findings to physical assessment. |
|
Definition
TRUE
REMEMBER*
--monitor trends over time |
|
|
Term
| Complications of Hemodynamic Monitoring |
|
Definition
1. Infection/Sepsis
2. Embolism |
|
|
Term
| How can infection at insertion site occur? |
|
Definition
| - if aseptic techniuqe is not used carefully |
|
|
Term
| What should be administered for vasodilation secondary to sepsis? |
|
Definition
|
|
Term
| ___ plaque or clot can be dislodged during the procedure |
|
Definition
|
|
Term
| What type of solution should be used to flush system to prevent embolism? |
|
Definition
|
|
Term
| AVOID introduction of ___ into flushing system to prevent air embolism |
|
Definition
|
|
Term
| T/F there is a risk of pneumothorax with insertion of the line |
|
Definition
|
|
Term
| There is a risk of ___ with insertion/movement of the line |
|
Definition
|
|
Term
| ___ invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage. |
|
Definition
| coronary angiogram or cardiac catheraization |
|
|
Term
| ___ can be done on LE to determine blood flow and areas of blockage |
|
Definition
|
|
Term
| How is Angiography inserted |
|
Definition
insertion of catheter into femoral (sometimes brachial) vessel
--> thread into the right OR left side of the heart.
Coronary artery narrowings and occlusions are idnetified by injfection of contrast media under fluoroscopy |
|
|
Term
| How are coronary artery narrowings/occlusions ID |
|
Definition
| injection of contrast media under fluoroscopy |
|
|
Term
Preprocedure Angiography:
Pt must maintain NPO for at least ___ hrs |
|
Definition
8
-risk for aspiration when lying flat for procedure |
|
|
Term
| What needs to be assessed prior to angiography? |
|
Definition
1. Allergy for iodine/shelfish allergy (d/t ue of contrast media)
2. Renal function prior to introduction of conttarast dies |
|
|
Term
| Medications to be administered prior to angiography |
|
Definition
premedications:
methlprednisone (Solu-Medrol)
diphenhydramine (Benadryl) |
|
|
Term
| Client Education for ANGIOGRAPHY |
|
Definition
1. Pt will be awake and sedated during process.
2. Local anesthetic should be used
3. Small incision made (groin)
4. Client can feel warmth and flushsed when dye is inserted |
|
|
Term
| Instructions for client post procedure |
|
Definition
1. Client must keep affected leg STRAIGH
2. PRESSURE - Sandbag ma be placed on incision to prevent bleeding P |
|
|
Term
| Post ProcedureL Assess VS how often |
|
Definition
VS
q 15 min x 4
q 30 x2
q hr x 4
q 4 hr |
|
|
Term
| Assess groin site at same VS intervals for |
|
Definition
1. Bleeding and hematoma
2. Thrombosis, document pedal pulse, color temp |
|
|
Term
| Position postprocedure for angiography. |
|
Definition
| bedrest in supine position with extremity straight |
|
|
Term
| Older adults undergoing angiograpy may have arrhritis. Therefore, |
|
Definition
-it can make lying in bed for 4-6 hrs after procedure painful
-PCP can be notifed for prescribed meds |
|
|
Term
| Conduct continuous cardiac monitoring for dysrhytmias |
|
Definition
| reperfusio following angioplasty can cause dysrhtthmias |
|
|
Term
| What should be prescribed to prevent clot formation and restenosis? |
|
Definition
antiplatelit or thrombolytic agents
1. asprin
2. clobidogreil (Plavix), ticlopidine (Ticlid)
3. Heparin
4. Low moleecular weight heparin (Enoxaparin, Lovenox)
5. GP IIb/IIa Inhibior (epitfibatide - Integreillin) |
|
|
Term
| Urine output and administer IV fluids for hydration |
|
Definition
TRUE-
contrast media acts a an osmotic diuretic |
|
|
Term
| How to perform/assist with sheath removal from vessel. |
|
Definition
1. Apply P to arterial venous site for prescribed period of tim
2. Observe for vagal response
-hypotension, bradycardia
d/t compression of nerves
3. Apply P dressing |
|
|
Term
| Post angiography Client Teaching |
|
Definition
1. AVOID strenous exercise
2. IMMEDIATELY report bleeding from insertion site
-chest pain
-SOB
-changes in color or temp of extremity
3. Restrict lifiting for prescribed period of time |
|
|
Term
| Teaching for clients with stent placement |
|
Definition
1. Clients will receive anticoagulation therapy for 6-8 weeks
2. Take medication at the same time each day
3. Have reg lab values determine therapeutic levels
4. Avoid activities that could cause bleeding
-use soft toothbrush
-wear shoes when out of bed |
|
|
Term
| Complications of Angiography: |
|
Definition
1. Cardiac Tamponade
2. Hematoma formation
3. Restenosis of Treated vessels
4. Retroperitoneal bleeding |
|
|
Term
| __ can result from fluid accumulation in the pericardial sac |
|
Definition
|
|
Term
|
Definition
1. HypOtension
2. Jugular venous distension
3. Muffled heart sounds
4. Paradoxical Pulse (variance of 10 mm Hg or more in systolic BP b/w expiration and inspiration |
|
|
Term
| Nursing Actions for Cardiac Tamponade: |
|
Definition
1. Notify HCP
2. Administer IV fluids to combat hypOtension
3. Obtain x ray or echo to CONFIRM dx
4. Prepare for pericardicentesis |
|
|
Term
| Prepare for Pericardiocentesis |
|
Definition
1. informed consent
2. gather materials
3. Administer medications as appropriate
*monitor hemodynmaic pressures
* heart rhythm (changes indicate improper positioning of needle
* reoccurence of signs after procedure |
|
|
Term
| ___ blood clots may form near the insertion site |
|
Definition
|
|
Term
| Nursing Actions for hematoma Formation |
|
Definition
1. assess groin at prescribed interval
2. Hld P for uncontrolled ozing/bleeding
3. Monitor peripheral circulation
4. Notify PCp |
|
|
Term
| ___ clot reformation in the coronary artery can occur immediately or several weeks after procedure |
|
Definition
| restenosis of treated vessel |
|
|
Term
| Nursing Action for restenosis of treated vessel |
|
Definition
1. Assess ECG patterns and for occurence of chest pain
2. Notify provider immediately
3. Prepare client for return to the cardiac catherization lab |
|
|
Term
| ___ bleeding into retroperitoneal space (ab cavity behind peritoneum) |
|
Definition
retroperitoneal bleeding
can occur due to femoral artery puncture |
|
|
Term
| Assessment for retroperitoneal bleeding: |
|
Definition
1. Flank pain and hypOtension
2. Notify HCP immediately
3. Administer IV fluids and blood products as prescribed. |
|
|
Term
| T/F age-related loss of skin turgor and poor vein conditions pose challenges to vascular access |
|
Definition
true
*using hand veins is NOT appropriate for older adult pt |
|
|
Term
| ____ are approrpate for any fluids d/t rapid hemodilution in the SVC |
|
Definition
|
|
Term
| Central Catheters require veriffication of placement. |
|
Definition
| X-ray verifies tip placement prior to use |
|
|
Term
| ___ and __ catheters require SURGICAL REMOVAL |
|
Definition
|
|
Term
| Nontunneled Percutaneou central cathether |
|
Definition
1. 15-20 cm in length with 1-3 lumens
Length of use
3 mo
insertion location
subclavian vein
jugular vein
tip of distal third of superior vC |
|
|
Term
| Indications for Nontunneled percutaneous central Catheter |
|
Definition
1. administration of blood
2. Long term administration of chemotherapetuci agents, antibiotics,
3. TPN |
|
|
Term
|
Definition
40-65 cm with single or multiple lument
length of use
up 12 motnths |
|
|
Term
| Insertion location for PICC |
|
Definition
1. Basilic or cephalic vein at leat one finger breadth below or above ntecubital fossa
--> catheter should be advanced until tip is positioned in the lower 1/3 of SVC |
|
|
Term
|
Definition
1. Assess site q 8 hrs
(infection, drainiage) |
|
|
Term
| Use __- ml or larger to flush the line PICC |
|
Definition
|
|
Term
| Obtaining blod samples by PICC |
|
Definition
1. WIthdraw 10 mL of blood and discarding
2. Taking second syringe and withdrawing 10 ml of blood for sample
3. Take third syringe and flush with 10 mL of 0.9% sodium chloride |
|
|
Term
| Complications of Vascular Access |
|
Definition
1. Phlebitis
2. Occlusion
3. Catheter thrombosis/Emboli
4. Infiltration and Extravasation
5. Air Embolism
6. Mechanical Complications |
|
|
Term
___ can be
1. chemical
(osmolarity or pH is different veins too small for subtance)
2. Bacterial
3. Mechanical irritation
(excess IV manipulation) |
|
Definition
|
|
Term
| Monitor for S/S of Phlebitis |
|
Definition
1. Erythemia at site (initial sign)
2. Pain/burning
3. Discomfort when skin over tip is touced
4. Warmth
5. Edema
6. Vein inudrated (hard), red streak, cordlike
7. Slow infusion rate
8. Temp elevation one degree F or more
9. Infection 7-10 days after insertion |
|
|
Term
| ___ catheter requires an intact sterile dressing |
|
Definition
nontunneled
*tunneled catheters do not |
|
|
Term
| ___ blockage in the access device that impedes flow. |
|
Definition
|
|
Term
| Nursing Action for Occlusion |
|
Definition
1. Flush line q 12 hrs to maintain patency
3 mL for peripheral
10 mL for central
** 0.9% NS effective as heparainzed flush to maintain patency |
|
|
Term
| What can be administered to lyse obstructions per protocol? |
|
Definition
|
|
Term
| ___ blood can become coagulated and cause occlusion |
|
Definition
| catheter thormbosis/emboli |
|
|
Term
| Nursing Actions for Catheter thrombosis/Emboli |
|
Definition
1. Flush line per facility
2. do NOT force fluid if resistance encounted
)--> may dislodge thrombis
3. Use large barrel syringe to avoid excess P per square inch that could cause catherer fracture or rupture |
|
|
Term
| ___ fluid leaking into surrounding SQ tissue |
|
Definition
|
|
Term
| __ unintentional infiltration of a vesicant medication that cause tissue damage |
|
Definition
|
|
Term
| Causes of infiltration and extrvastion |
|
Definition
1. improper IV insertion
2. Improper vein selection (too small, fragile, location)
3. Irritating infusates that weaken and rupture the vein wall
4. Over maniplation of VI catheter
5. Improper taping that llows IV catheter movement and vein compromise
8. Tape too tight --> tourniquet |
|
|
Term
| S/S infiltration & extravasation |
|
Definition
1. Sweeling around site and proxminal or distal to IV
2. Edema (puffiness)
3. Skin taugt or rigid with blanching
4. Sensation of coolness |
|
|
Term
| Check client and system for infiltration/extravasation: |
|
Definition
1. Put P on vein beond the tip of catheter should STOP IV flow
--> if FLOW not affected, fluid is probably going into SQ tissue |
|
|
Term
| T/F Blood return is considered a reliable indicator of infilt/extra |
|
Definition
|
|
Term
| do NOT use arm with MLC or PICC for BP, phlebotomy |
|
Definition
|
|
Term
|
Definition
remove using direct P with gauze until bleeding stops
apply cool, compresses
elevation is now considered optional
avoid starting new IV site in same extremity |
|
|
Term
| __ gas bubbles introcued into vascular system |
|
Definition
|
|
Term
| Nursing Actions for air embolism |
|
Definition
1. leave central lines clamped when not in use
2. have client hold brath when tubing is changed
3. if sudden SOB, --> place in trendelen burge on L side, give O2 and notify HCP (to trap and aspirate air) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Why is it imperative that a client lie still for 6 hrs following an angiography? |
|
Definition
| increased risk of bleeding. |
|
|
Term
| administration of 0.9 Na IV at 50 ml/hr can be infused in what lines? |
|
Definition
| Peripheral IV and Proximal CVP lumen |
|
|
Term
| arterial lines and distal lines of pulmonary arteries can be used for fluid administration |
|
Definition
FALSE.
collection of blood samples |
|
|
Term
| hypovolemic shock is characterized by ____ hemodynamic values |
|
Definition
|
|
Term
| ____, _____, & _____ are characteried by elevated hemodynamic values |
|
Definition
HF
Cor pulmonae
Pulmonary HTN |
|
|
