ATI Med Surg Exam #2

ATHEROSCLEROSIS - plaque buildup ARTERIOSCLEROSIS - hardened arteries (thickening and stiffening—loss of elasticity) what is the plaque that builds up causing ATHEROSCLEROSIS - LDL particles build up on arterial walls what is LDL cholesterol? - Low-density lipoprotein; otherwise known as bad cholesterol (least desirable lipid) what is HDL cholesterol? - High-density lipoprotein; otherwise known as good cholesterol (Highly Desirable Lipid) range for LDL - less than 100 (lower the number is better) range for HDL - 40-60 (higher the number is better) clinical manifestations of ATHEROSCLEROSIS - - may be no symptoms until critical narrowing occurs RESULTING IN AN EMERGENCY management of ATHEROSCLEROSIS - - identify and control risk factors (elevated cholesterol levels, elevated triglycerides, elevated LDL, and elevated HDL) - medications used to lower lipid levels - surgical intervention is reserved for irreversible manifestations (chest pain and gangrene) - intractable chest pain and coronary artery disease require coronary bypass surgery - gangrene may require amputation what is coronary artery disease? - Characterized by the obstruction of blood flow within the coronary arteries what is the main cause for blood flow obstruction? - Atherosclerosis clinical manifestations of coronary artery disease - silent until its too late what clinical manifestations eventually occur due to coronary artery disease? - - ischemia (which is a lack of blood flow) - angina (chest pain that occurs when there is a lack of blood flow to the heart) what are the types of angina? - -stable -unstable stable angina - chest pain associated with physical activity unstable angina - chest pain that can occur at rest nursing care for stable angina - nitroglycerin (this dilates coronary arteries to improve oxygen rich blood flow to the heart) clinical manifestations of stable angina - - pressure/ache in the chest (squeezing, heaviness, chocking, suffocating) - radiates to neck, jaw, shoulders, and down arm - may see other symptoms like sweating, nausea, dyspnea, or fatigue - lasts only 3-5 minutes nursing care for unstable angina - - TREAT AS AN EMERGENCY - may not be relieved with meds - may require morphine in addition to nitroglycerin - supplemental O2 clinical manifestations for unstable angina - - initial phase of acute coronary syndrome and can be the beginning to MI - symptoms include severe pain, sweating, dyspnea, nausea/vomiting, and fatigue - PROLONGED coronary artery diagnosis - - stress test - coronary angiography coronary artery disease is really common in... - diabetics coronary angiography - - left sided cardiac catheterization - inspect coronary arteries for blockage - Determine location of the plaque, the degree of occlusion, and whether the area can be treated with percutaneous transluminal coronary angioplasty (PTCA). cardiac catheterization nursing care - - NPO after midnight - awake --> asked to turn and cough during procedure - sensation of warmth with dye injection - post procedure --> check sites for signs of hematoma/bleeding - check extremities for circulation - pedal pulses - activity restriction and close observation of catheter insertion site coronary artery disease treatments - - nitroglycerin (vasodilator) *Patients take a SL dose as needed, not to exceed three doses five minutes apart. *Patients should call emergency personnel if pain is not relieved within five minutes of first dose and prior to taking second dose risk factor reduction for coronary artery disease - -exercise - healthy diet and weight - smoking - alcohol consumption what is going to produce a better outcome for coronay artery disease? - early intervention and treatment what is cardiomyopathy? - a disease that weakens and enlarges heart muscles (Affects structure & functioning of heart) nursing care for cardiomyopathy - - call provider with worsening symptoms (especially SOB) - maintain patient positioning (semi to high fowler's reduces preload and ventricle filling and decreases dyspnea) - dietary restrictions of fluid and sodium what is heart failure? - - progressive disease characterized by myocardial cell dysfunction - Inability of the heart to pump enough cardiac output to meet the demands of the body left sided heart failure s/s - ** deals with bringing blood to the lungs - dyspnea - fatigue - crackles - poor color - weak pulses - cool temp. in extremities right sided heart failure s/s - ** deals with things fluid overload (right side brings blood to WHOLE body) - jugular vein distension - edema - hepatomegaly (enlarged liver) - ascites (fluid in abdomen) diagnosing heart failure - - CXR - EKG - Lab Data - Echocardiogram - Stress Test Cardiac Catheterization Heart Failure Nursing Care - - Admin. Meds. - Fluid and Sodium Restriction - Elevate Head of the bed - Daily Weight - O2 Therapy Heart Failure Teachings - - Medication management - Alternate rest and activity periods to decrease workload - Low-salt diet to prevent fluid retention and exacerbation - Daily weight at home - Evaluate fluid retention & need to call provider (2 or more lbs/day) - Symptoms checklist (edema, SOB, fatigue, orthopnea) complications of heart failure - - dysrhythmias: atrial fibrillation **Pooling can result in thrombus formation what is peripheral artery disease? - •Obstruction of blood flow through the large peripheral arteries causes arterial occlusion •Causes include combination of atherosclerosis, inflammation, stenosis, embolus, thrombus •Deprives lower extremities of oxygen and nutrients --> inadequate tissue perfusion --> ischemia and necrosis peripheral artery disease assessment - - pallor on elevation - dependent rubor (redness) - cool temperature - smooth shiny skin - loss of hair - delayed capillary refill - loss of pulses goal of peripheral artery disease treatment - - provide symptom relief - prevent progression - prevent cv complications - improve quality of life treatment methods of peripheral artery disease - - laser assisted angioplasty - bypass surgery - percutaneous transluminal angioplasty nonpharmacologic treatment of peripheral artery disease - - weight reduction - stop smoking - exercise - low fat diet medications for peripheral artery disease - - antihypertensives - aspirin - statins - ACE Inhibitors Deep Vein Thrombosis - •The disease process that includes DVT and/or PE is called venous thromboembolism (VTE). •DVT can detach from the site of formation and circulate in bloodstream. •Circulating clot can move through heart to lungsàblocks artery supplying blood to lungsàpulmonary embolism (PE). •Develops in the deep veins of the calf muscles •Less frequently in the proximal deep veins of the lower extremity or upper arm superficial thrombosis - - Palpable, firm, cordlike and subcutaneous deep thrombosis - - Leg edema, pain, tenderness, dilated superficial veins, warm skin biggest risk factor for DVT - - hospitalization due to bedrest DVT s/s - - pain - swelling - tenderness - warmth - discoloration/redness - Homans' Sign treatment of DVT - - heparin - lovenox - warfarin (longterm nursing care DVT - - warm compress - immobilize legs with elevation - stockings DVT teaching - - Prevention of reoccurrence with early ambulation and active leg exercises - Avoid constricting clothing, sitting with knees bent or crossed for long periods, standing for long periods - Remind patients that long trips can increase the risk of DVT-stay well hydrated, move around, leg exercises - S/S of bleeding such as bruising, bloody stools - Compliance with laboratory monitoring - Safety precautions when taking anticoagulants DVT complications - - DVT to PE - Post Thrombotic Syndrome DVT to PE - - Shortness of breath - Decreased oxygen saturation - Tachycardia, hypotension - Sweating - Sharp chest pain (especially during deep breathing) - Hemoptysis (bloody sputum) Post Thrombotic Syndrome - - Develops in 20% to 50% of patients - Severe PTS, including venous ulcers, will develop in 5% to 10%. - Principal risk factors are anatomically extensive DVT, recurrent ipsilateral DVT, persistent leg symptoms 1 month after acute DVT, obesity, and older age. Varicose Veins - - Superficial veins that have become twisted as a result of incompetent valves - Blood pools in lower extremity and stretches the vessels, placing pressure on the other tissues and skin - May see dark or dark blue veins risk factor of varicose veins - jobs that require standing for a long period of time nursing care varicose veins - - prevention **Leg movement: leg exercises, short walks during day if sedentary job Use of supportive stockings venous ulcers - - located on lower extremities - appearance •Irregular boarders and edges •Shallow wound •Granulation tissue present •Swollen arterial ulcers - - located usually below the knee •End of the toes •Dorsum part of feet •Lateral malleolus - appearance •Little drainage •Little tissue granulation •Deep Wound •Regular boarders and edges venous ulcer treatment - - leg elevation - compression stockings - support dressing - skin graft - debridement arterial ulcers treatment - - medications to increase blood flow - debridement - revascularization - amputation hypertension - high BP what are the two kinds of hypertension? - - essential/primary - secondary essential/primary hypertension - •Elevated BP without an identified cause secondary hypertension - •Elevated BP with a specific cause (renal disease, cirrhosis, apnea, etc) risk factors for hypertension - - age - alcohol - smoking - diabetes mellitus - elevated serum lipids - excess dietary sodium - gender - family history - obesity - ethnicity - sedentary lifestyle - socioeconomic status - stress clinical manifestations of hypertension - referred to as the "silent killer" ** pt. typically goes asymptomatic until target organ disease occurs target organ disease - when the hypertension gets so bad it starts affecting other organs - heart - brain - peripheral vasculature - kidney - eyes hypertensive crisis - - severe increase in BP (greater than 180/120) - Hypertensive emergency who does hypertensive crisis most often occur in? - Often occurs in patients with a history of HTN who have been non-adherent or under medicated hypertensive crisis requires... - hospitalization - IV drug therapy - Monitor cardiac and renal function - Neurologic checks - Determine cause - Education to avoid future crises - Heart failure with pulmonary edema hypertension nursing care and lifestyle modifications - - weight reduction - DASH Diet - reduction in sodium - limit alcohol consumption - @ least 30 mins of physical activity per day - avoidance of tobacco products what is DASH Diet - low in sodium, rich in potassium, magnesium and calcium tuberculosis - slow growing infection in the longs how is tuberculosis transmitted - through airborne droplets airborne infection - - pt. should be placed in a negative pressure room - nurse must wear N95, gown, and gloves what must patient with airborne infection wear when leaving their room - surgical mask TB diagnosis - - sputum culture - skin test - chest x-ray - New Standard s/s of TB - - low grade fever - night sweats - severe weight loss - heamtosis (bloody sputum) TB Medications - drug resistance is a very common problem how do you prevent drug resistance - take multiple medications so you dont become resistant to just the one what is the most common TB medication regimen - - isoniazid - rifampin - pyrazinamide - ethambutol after two months of not becoming resistant to any of the meds what occurs - usually take two away (pyrazinamide and ethambutol w/ ethambutol being the most common one that is taken away) what is a side effect of isoniazid - peripheral neuropathy if peripheral neuropathy occurs due to isoniazid what can be done? - switch it for vitamin B6 (pyridoxine) what is a side effect of rifampin - secretions turn orange TB nursing actions - - isolation (** if TB is suspected place pt. in precautions right away (while waiting on results)) - assessment - oxygen (saturation may be low) - vital signs (pt. may have fever) - Admin Meds (DOT Therapy) - Education (discharge) what is being looked for during TB assessment? - - chronic cough - blood in sputum - fever - weight loss **IF SEEN PUT IN ISOLATION WHILE TESTING