Perfusion Ger unit 11

an arterial ulcer will have a ""

"punched out" appearence. painfull, small in size, covered with slough and necrotic tissue, cold white blueish feet

normal hbg and normal RBC count and normal WBC

12-17.4 and 3.6-5.4 and 5000-10000 (lsp of 1-2 days)

sicklecell disorder is ____ traits, while sickle cell trait is_____

2 defective, 1 defective

cardiac output, what should it be and whats the formula

4-8 liters per minute, HR X stroke volume

when assessing for orthostatic hypotension, youre looking for:

<15, decrease in BP, but and increase in pulse

sinus bradycardia s and s

>60 bpm, hypOthyrodism, increased carotid pressure

You are caring for a client with a cardiac disorder who is prescribed diuretics. What important factor should you include in this client's teaching plan?

A discussion of the signs and symptoms of electrolyte and water loss.

which heart med has a side effectof persistent coughs

ACE INHIBITORS

blood pressure is conrolled by what 3 things

Autonomic Nervous System, kidneys and endocrine glands

A client with heart failure is having a decrease in cardiac output. What indication does the nurse have that this is occurring?

Blood pressure 80/46 mm Hg

A nurse is caring for a client with a low platelet count. The nurse understands that a low platelet count affects which of the following?

Clotting of blood

A nurse in a long-term care facility is caring for an 83-year-old woman who has a history of heart failure and peripheral arterial disease (PAD). At present, the client is unable to stand or ambulate. The nurse should implement measures to prevent what complication?

Deep vein thrombosis

The nurse should advise a client with iron deficiency anema to take which action in order to prevent staining of the teeth?

Dilute liquid preparations of iron with juice and drink with a straw

Which assessment parameter is important for the client diagnosed with congestive heart failure?

Distended veins

if giving iron, how can it be given and what do you do if im?

IV, IM, oral if im do z track for no staining

What response is appropriate when a client with hypertension declines to take prescribed antihypertensive medications because due to the absence of symptoms?

Inform the client that this is why hypertension is known as "the silent killer."

Which term refers to a muscular, cramplike pain in the extremities consistently reproduced with the same degree of exercise and relieved by rest?

Intermittent claudication

A client has a leukocyte count of 3,000/mm3. How would the nurse document the client's condition?

Leukopenia

A nurse is teaching an adult female client about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension?

Obesity and high intake of sodium and saturated fat

A hospitalized client with heart failure puts on the call light and makes the following statement: "I've become very short of breath, and I've been coughing up this pink frothy sputum." The nurse immediately suspects which of the following complications?

Pulmonary edema

A patient with primary hypertension complains of dizziness with ambulation. The patient is currently on an alpha-adrenergic blocker. The nurse assesses postural hypotension. When teaching this patient about risks associated with postural hypotension, what should the emphasis be placed on?

Rising slowly from a lying or sitting position.

The nurse's assessment of an older adult client reveals the following data: Lying BP 144/82 mm Hg; sitting BP 121/69 mm Hg; standing BP 98/56 mm Hg. The nurse should consequently identify what nursing diagnosis in the client's plan of care?

Risk for falls related to orthostatic hypotension

what nodes are in the right atrium

SA and AV nodes

what is the pacemaker of the heart

SA node, this is an SA to Av node conduction

Which type of hemolytic anemia is categorized as inherited disorder?

Sickle cell anemia

A class of beginning nursing students is learning about heart failure in their pathophysiology class. What should the students be taught is the reason for heart failure?

The heart cannot pump sufficient blood to meet the body's metabolic needs.

how to treat pernicious anemia clients

Vitamin B 12 injections, smaller meals and soft bland diet

A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin (Coumadin). Which response by the charge nurse is best?

Warfarin prevents clot formation in the atria of clients with atrial fibrillation."

The nurse is preparing to administer digoxin to a client with heart failure. The nurse obtains an apical pulse rate for 1 minute and determines a rate of 52 beats/minute. What is the first action by the nurse?

Withhold the medication and notify the physician of the heart rate.

Digoxin (Lanoxin) is called what, and does what?, and therefore makes it what?

a cardiac glycoside, it increases cardiac output by slowing heart rate and increasing force of contraction. This is a POSITIVE inotropic action

what keeps fluid in the vascular system

albumin

what is stroke volume

amount of blood out of ventricles with each beat

how to treat a venous occlusion

anticoagulants, complete bedrest,elevate extremity, warm wet packs to area

do NOT elevate with peripheral disease?

arterial

an arterial clot is called what and looks like what

ascemia, sudden pain, distal pulses abs, numb, tingling cramping and grangreous

what are some negative inotropics, and what does this mean

beta blockers and calcium channel blockers, this means that they weaken the force of the heart rate, muscles dont have to work as hard, and decreases O2 demand

what meds treat afib

beta blockers, cal channel blockers and anticoagulants

what do ace inhibitors/angiotension receptor blockers (ARBs) do

block vasoconstriction. the 1st line to decrease afterload and promote fluid and sodium loss. they supress the renin angiotension aldosteron system. Also reduce preload and afterload

The nurse is reviewing a patient's diet. The patient has been diagnosed with hypertension. The nurse recommends reducing or avoiding caffeine for patients with hypertension because:

caffeine increases the heart rate and causes vasoconstriction

contractility is influenced by what and therefore you need to watch what medications

calcium. cal channel blockers therefore need to be used carefully in HF patients

whats a blood pressure formula

cardiac output x peripheral resistence

what all can casue heart failure? (there is 6)

damage from a MI, chronic HTN, damaged valves, hyperthyrodism, cardiomyopathy and viral infections

signs of PE

decreased O2, increased HR, heart attack like pain, short of breath

A nurse is caring for a client with left-sided heart failure. To reduce fluid volume excess, the nurse should anticipate using:

diuretics

when you take calcium channel blockers, dont

drink grapefruit juice

what test sees how the hearts walls are moving, ejection fraction

echo (cardiogram)

s and s of venous unsufficiency

edema that can be weeping, superficial veins dilated, non-uniform skin coloring, brown red dark

right sided heart failure signs and symptoms

edema, engorged liver,decreased kidney function, ascites (from organs getting full) JVD, and even GI tract not good due to it being engorged as well

what is preload

filling pressure right before heart contracts

Which medication is categorized as a loop diuretic?

furosimide

what herb is antiplatelet

ginsing

A student nurse asks if anticipatory anxiety can be reduced in a client undergoing a diagnostic procedure of the cardiovascular system. How should the instructor respond?

give time frame

s and s of primary hypertension, late stages

headaches, fatigue, edema, dyspnea, nocturia, blackouts

how to treat an arterial occlusion

heparin, vasodilator, narcotics, thrombectomy/embolectomy, bypass

sinus tachycardia s and s

hr of 100-150 bpm, extreme emotions, fevers, hpyErthyroidism

management of hemolytic anemia

hydration, blood tranfusions, corticosteriods for immune related is autoimmune, spleen removal

managment of thalassemia

increase folate in diet, blood transfusions, rest, follic acid (no iron in these people)

starlings law of the heart

increase preload =increased stroke volume, (but remember this doesnt apply when the heart got stretched to much, then it cant come back)

venous clots look like

inflammationm hot to touch,fever

signs and symptoms of peripheral arterial disease:

intermittent claudication, limbs cold to touch, numbness and tingling, absent pedal pulses, skin shiny and hair loss, red color in dependent position, no edema, thick toenails, muscle atropy

how do you treat iron def anemia

iron rich foods, potatoes, dried fruits, dark meat, legumes, red meats, dark green veggie, enriv=ched breads

what sided heart failure comes first

left sided, backs up into lungs

how to treat PAD

lose weight, excersize, stop smoking, blood sugar control, pain, femoral bypass surgery, angioplasty or stenting

what anticoag can pregnant women take

lovenox

what is the lubb, then what is the dubb, in a heart beat

lubb is the 1st sound, which is systole, the 2nd sound dubb is diastole

what do we want the ejection fraction to be normally, but what will we see in end stage HF pateints

normal is greater than 55%, 60-70% is what we like, but in end stage HF patients, 10%

s and s of iron def anemia (5)

pallor, reduced energy feel cold all the time, fatigue and dyspnea with activity

s and s of hypovolemic anemia (7)

pallor, tachycardia, hypotenesion, reduced UOP, altered consciousness, headache, dizziness

A nurse presses fingers into a client's skin and quickly draws the fingers away. The nurse notes that indentation remains. What term would the nurse use to describe this finding?

pitting edema

S/S of thalassemia

seen in first year of life, brozing, jaundice, and growth failure

s/S of folic acid def anemia

severe fatigue, sore red tongue, dyspnea, headaches, weakness, lightheadedness

S/S of hemolytic anemia

severe, jaundiced and spleen enlarged, dark urine

what does a venous ulcer look like

shallow, irregular shape, relativly painless, weepy, small amt of exudate present, below the knee, elevate legs for comfort, can be large

S/S or pernicious anemia

stomatitis (inflammation in the mouth, use soft toothbrushes) glossitis (inf tongue) digestive problems, nrevous system damage and if severe dyspnea, jaundice, irritability, LOC changes

the afterload is the: and what meds help:

systolic BP, and is the resistance, any sort of vasoconstriction, medications that help are dilators (nitrates)

what is the ejection fraction

the % of blood ejected from left ventrical

how do calcium channels blockers work and who uses them most

they block calcium ions block calcium ions, dialate heart vessels and therefore decrease the workload of the heart, clients with arrhythmias use these. they increase preload

iorn is usually ordered

tid 30 mins before meals

s and s of sickle cell anemia

tissue pain, ischemia, swelling, fever

what two things counter act with iron

vit d and calcium

A client has been diagnosed with pernicious anemia. During client education, the nurse emphasizes the importance of lifelong intramuscular administration of:

vitamin B12.

what to take with iron?

vitamin c

The nurse assists the client to the bathroom, which is approximately 10 feet from the bed. The client ambulates 3 feet and states, "I cannot catch my breath." How would the nurse document this finding?

walk 3 feet, states out of breath

The nurse is providing discharge teaching to a patient diagnosed with heart failure. What should the nurse teach this patient to do to monitor fluid balance?

weight