ANRS 216 Exam 2 ATI-Style Comprehensive Review

Comprehensive vocabulary flashcards covering cardiovascular/perfusion, hematology/VTE, digestion/bowel elimination, immunity/sepsis, infection control precautions, and dosage calculation concepts.

Peripheral Arterial Disease (PAD) Etiology

Inadequate tissue perfusion caused by impaired arterial blood flow reaching the extremities.

Chronic Venous Insufficiency Etiology

Inadequate venous return causing blood to pool in the lower extremities.

Intermittent Claudication

Ischemic muscle pain characteristic of PAD that worsens with walking and exertion and is relieved by rest; can advance to rest pain in severe disease.

Chronic Venous Insufficiency Pain

Aching and heaviness in the legs that worsens after prolonged standing and typically improves with leg elevation.

PAD Skin and Temperature Findings

Cool, shiny, thin skin with decreased hair growth, exhibiting pallor on elevation and dependent rubor.

Chronic Venous Insufficiency Skin Findings

Warm or normal extremity temperature with brown hemosiderin staining, edema, and stasis dermatitis.

Hemosiderin Staining

Brownish skin discoloration occurring on the lower legs in chronic venous insufficiency due to red blood cell breakdown in pooled blood.

Dependent Rubor

A reddish-blue discoloration of the extremity when dangling in a dependent position, characteristic of severe peripheral arterial disease.

PAD Pulses and Capillary Refill

Weak, diminished, or absent peripheral pulses accompanied by delayed capillary refill.

Chronic Venous Insufficiency Pulses and Refill

Peripheral pulses are usually present and palpable, and capillary refill is often preserved.

Arterial Ulcer Characteristics

Punched-out, deep, pale, and dry wounds with minimal drainage located on the toes, feet, and bony pressure points.

Venous Stasis Ulcer Characteristics

Shallow, irregular, and moist wounds with substantial drainage located near the medial ankle and lower leg.

PAD Edema Presentation

Minimal to absent swelling unless a coexisting non-arterial cause is present.

Chronic Venous Insufficiency Edema Presentation

Common lower extremity swelling that typically worsens by the end of the day.

PAD Limb Positioning Guideline

Avoid prolonged leg elevation if it worsens ischemic pain; avoid compression therapy unless ordered after arterial status assessment.

Venous Insufficiency Limb Positioning Guideline

Elevate the legs above heart level and apply compression therapy if ordered and arterial perfusion is confirmed adequate.

Compression Therapy Precaution in Arterial Disease

Never apply compression to suspected significant arterial disease without first verifying arterial circulation and ankle-brachial index (ABI).

DVT Massage Contraindication

Never massage a limb with a suspected deep vein thrombosis due to the critical risk of dislodging the clot into a pulmonary embolism.

Peripheral Arterial Disease (PAD) Risk Factors

Smoking, diabetes mellitus, hypertension, dyslipidemia, older age, atherosclerosis, chronic kidney disease, physical inactivity, and family history.

Neurovascular Assessment Components

Bilateral comparison of pain, pallor/color, temperature, pulses (palpation or Doppler), capillary refill, sensation, movement, and swelling.

6 Ps: Pain

Sudden, severe discomfort or pain out of proportion to exam findings indicating acute arterial compromise.

6 Ps: Pallor

Unnatural paleness of the affected limb indicating compromised arterial blood flow.

6 Ps: Pulselessness

Absent or significantly diminished distal pulse indicative of acute arterial occlusion.

6 Ps: Paresthesia

Tingling, numbness, or altered sensation in an extremity indicating ischemic nerve compromise.

6 Ps: Paralysis

Weakness or inability to move an extremity; represents a late, ominous sign of severe arterial compromise.

6 Ps: Poikilothermia

The affected limb becomes cool or cold because it takes on ambient temperature due to absent arterial perfusion.

Acute Limb Ischemia

A vascular emergency characterized by sudden limb pain, cold/pale skin, new numbness/weakness, or absent pulse requiring immediate notification of the provider or rapid response.

PAD Thermal Protection Teaching

Avoid heating pads, hot water bottles, and direct heat sources due to impaired sensation and thermal burn risk; protect extremities from cold exposure.

Ankle-Brachial Index (ABI) Formula

The ankle systolic blood pressure divided by the brachial systolic blood pressure.

Normal Ankle-Brachial Index (ABI) Range

An ABI value generally between $1.00$ and $1.40$.

Ankle-Brachial Index (ABI) Value Supporting PAD

An ABI value less than or equal to $0.90$.

Ankle-Brachial Index (ABI) Value Indicating Noncompressible Arteries

An ABI value greater than $1.40$, suggesting rigid, calcified arteries.

Stable Angina

Predictable chest discomfort induced by exertion or emotional stress that is relieved by rest or prescribed sublingual nitroglycerin, without myocardial necrosis.

Unstable Angina

New, worsening, more frequent, or rest chest pain representing acute coronary syndrome that is not reliably relieved by rest and lacks troponin elevation.

Non-ST-Elevation Myocardial Infarction (NSTEMI)

Myocardial injury manifested by elevated cardiac troponins without persistent ST-segment elevation on a 12-lead ECG.

ST-Elevation Myocardial Infarction (STEMI)

Acute myocardial injury with qualifying persistent ST-segment elevation on ECG, indicating acute coronary occlusion requiring immediate emergency reperfusion.

Myocardial Infarction Red Flags

Substernal pressure or tightness, radiation to arm/jaw/back, dyspnea, diaphoresis, nausea, and unexplained fatigue.

Atypical MI Presentation

Subtle or non-classic symptoms such as unusual fatigue, shortness of breath, or nausea commonly seen in older adults, females, and patients with diabetes.

Suspected ACS Priority First Actions

Activate emergency response/911, assess ABCs and vital signs, obtain a rapid 12-lead ECG, draw troponin, administer aspirin if indicated, and administer targeted oxygen/nitroglycerin per safety parameters.

12-Lead ECG Timing Target in ED

Commonly obtained within $10\,\text{minutes}$ of arrival for patients presenting with chest pain or suspected acute coronary syndrome.

ACS Oxygen Administration Rule

Reserved only for documented hypoxemia, respiratory distress, or specific protocol orders rather than automatic routine administration.

Nitroglycerin Hemodynamic Precautions

Assess blood pressure before and after administration; avoid if severe hypotension is present or in suspected right-ventricular infarction.

Nitroglycerin and PDE-5 Inhibitor Interaction

Strictly contraindicated within recent use of phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil) due to the risk of life-threatening, refractory hypotension.

Heart-Healthy Dietary Guidelines

Reduce saturated and trans fats, sodium, processed meats, and added sugars while emphasizing vegetables, fruits, whole grains, legumes, nuts, lean proteins, and unsaturated fats.

Low-Density Lipoprotein (LDL)

The primary atherogenic lipoprotein targeted in cardiovascular risk reduction therapy.

High-Density Lipoprotein (HDL)

Cardioprotective lipoprotein involved in reverse cholesterol transport from peripheral tissues back to the liver.

Statins (HMG-CoA Reductase Inhibitors) Mechanism

Medications that inhibit cholesterol synthesis in the liver to lower circulating LDL levels and decrease cardiovascular event risk.

Pre-Cardiac Catheterization Nursing Assessments

Verify informed consent, assess iodine/radiopaque contrast allergies, evaluate renal function, document baseline distal pulses and neurovascular status, check vitals, review bleeding history, and verify NPO status.

Metformin and Radiopaque Contrast Precaution

Discontinue metformin prior to or at the time of contrast procedures and withhold per protocol to avoid contrast-induced acute kidney injury and lactic acidosis.

Post-Cardiac Catheterization Assessments

Continuous ECG/vitals monitoring, inspecting access puncture site for bleeding/hematoma, checking distal pulses/color/temperature/sensation, and assessing urine output and chest pain.

Post-Femoral Access Positioning

Enforce strict bedrest with the affected leg kept straight for the prescribed duration to prevent femoral arterial bleeding.

Retroperitoneal Hemorrhage Clinical Signs

Unexplained hypotension, tachycardia, and back or flank pain following femoral cardiac catheterization.

Contrast-Associated Acute Kidney Injury Prevention

Encourage adequate oral or IV hydration before and following cardiac catheterization if not clinically contraindicated.

Left-Sided Heart Failure Clinical Manifestations

Pulmonary congestion symptoms including dyspnea, orthopnea, bilateral pulmonary crackles, cough, hypoxemia, paroxysmal nocturnal dyspnea, and pulmonary edema.

Right-Sided Heart Failure Clinical Manifestations

Systemic venous congestion symptoms including dependent peripheral edema, jugular venous distention (JVD), hepatomegaly, ascites, and rapid fluid weight gain.

Heart Failure with Reduced Ejection Fraction (HFrEF)

Systolic heart failure characterized by impaired ventricular contraction and reduced ejection fraction, commonly $\le 40\%$.

Heart Failure with Preserved Ejection Fraction (HFpEF)

Diastolic heart failure characterized by impaired ventricular relaxation and filling, where ejection fraction is preserved (often $\ge 50\%$) despite clinical congestion.

Left Ventricular Ejection Fraction (LVEF)

The percentage of end-diastolic blood volume pumped out of the left ventricle with each contraction.

Worsening Heart Failure Indicators

Rapid weight gain, worsening peripheral edema, increasing dyspnea/orthopnea, decreasing oxygen saturation, new lung crackles, confusion, decreased urine output, tachycardia, or hypotension.

Acute Decompensated Heart Failure Positioning

Place the patient in an upright, high-Fowler's position to reduce venous return and optimize diaphragmatic expansion.

IV Loop Diuretic Response Evaluation in HF

Measure hourly urine output, daily weight trends, lung sounds, oxygen saturation, resolution of peripheral edema, renal panels, and electrolytes.

Heart Failure Daily Weight Protocol

Weigh every morning immediately upon waking after voiding, using the same scale and similar clothing.

Heart Failure Weight Gain Reporting Thresholds

Notify the provider for a weight gain of $2\text{--}3\,\text{lb}$ in $24\,\text{hours}$ or $5\,\text{lb}$ within one week.

NSAID Precaution in Heart Failure

Avoid nonsteroidal anti-inflammatory drugs because they cause sodium and water retention and attenuate renal function, worsening heart failure.

Diuretic Monitoring Priorities

Assess intake and output, daily weight, blood pressure/orthostasis, potassium, magnesium, sodium, BUN/creatinine, and signs of volume depletion.

Hypertension "Silent Killer" Concept

Chronic elevated arterial pressure causes progressive, asymptomatic vascular damage leading to MI, HF, stroke, nephropathy, and retinopathy.

Hypertensive Emergency

Severe blood pressure elevation accompanied by acute target-organ injury (e.g., encephalopathy, stroke, ACS, pulmonary edema, aortic dissection, or acute renal failure).

Hypertensive Urgency

Severe blood pressure elevation without evidence of acute target-organ damage, requiring prompt evaluation and gradual outpatient/inpatient medication titration.

Hypertensive Emergency Blood Pressure Reduction Goal

Requires monitored, controlled IV medication titration to prevent precipitous drops in perfusion pressure that could cause cerebral or myocardial ischemia.

Metoprolol Pharmacologic Class and Action

Beta-1 selective adrenergic blocker that decreases heart rate, blood pressure, myocardial contractility, and cardiac workload.

Metoprolol Pre-Administration Assessment

Check apical heart rate and blood pressure; hold medication based on specific provider parameters (commonly HR $< 60\,\text{beats/min}$ or systolic BP $< 90\text{--}100\,\text{mm\,Hg}$).

Metoprolol Hypoglycemia Precaution

Beta-blockers can mask classic adrenergic signs of hypoglycemia (e.g., tachycardia, tremors), leaving diaphoresis as the primary recognizable indicator.

Atorvastatin Patient Education and Adverse Effects

Report unexplained muscle pain, tenderness, weakness, or dark/tea-colored urine immediately due to the risk of myopathy or rhabdomyolysis; monitor liver enzymes.

Aspirin Antiplatelet Mechanism

Irreversibly inhibits platelet cyclooxygenase, reducing thromboxane $A_2$ formation and preventing platelet aggregation.

Lisinopril Mechanism of Action

Angiotensin-converting enzyme (ACE) inhibitor that blocks conversion of angiotensin I to angiotensin II, decreasing systemic vascular resistance and afterload.

Lisinopril Adverse Effects and Contraindications

Causes dry persistent cough, hyperkalemia, renal impairment, and angioedema; contraindicated during pregnancy.

ACE Inhibitor Angioedema Presentation

Rapid swelling of the lips, tongue, pharynx, or face representing a life-threatening airway emergency requiring immediate medical intervention.

Losartan Pharmacologic Class and Advantage

Angiotensin II receptor blocker (ARB) that blocks angiotensin II receptors; provides hemodynamic benefits similar to ACE inhibitors with a significantly lower incidence of cough.

Digoxin Mechanism of Action

Cardiac glycoside that exerts positive inotropic effects (increases contractility) and negative chronotropic/dromotropic effects (slows AV node conduction).

Digoxin Pre-Administration Check

Auscultate the apical pulse for one full minute; withhold and contact the provider if the heart rate is below ordered parameters (typically $< 60\,\text{beats/min}$ in adults).

Digoxin Toxicity Clinical Manifestations

Anorexia, nausea, vomiting, fatigue, confusion, blurred vision, green-yellow halos around objects, and cardiac dysrhythmias.

Electrolytes Increasing Digoxin Toxicity Risk

Hypokalemia and hypomagnesemia enhance digoxin binding, significantly increasing the risk of life-threatening digitalis toxicity.

Furosemide Mechanism of Action

Loop diuretic that inhibits the $\text{Na}^+\text{-}\text{K}^+\text{-}2\text{Cl}^-$ cotransporter in the thick ascending limb of the loop of Henle, promoting potent diuresis.

Furosemide Adverse Effects

Hypokalemia, hypomagnesemia, hyponatremia, dehydration, orthostatic hypotension, elevated BUN/creatinine, and ototoxicity with rapid IV push.

Spironolactone Mechanism and Electrolyte Effect

Aldosterone receptor antagonist (potassium-sparing diuretic) that promotes sodium/water excretion while conserving potassium, risking hyperkalemia.

Spironolactone Dietary Precaution

Instruct patients to avoid potassium supplements and potassium-based salt substitutes to prevent dangerous hyperkalemia.

Nitroglycerin Mechanism of Action

Direct nitric-oxide mediated smooth muscle relaxation resulting in peripheral vasodilation, primarily reducing venous preload and myocardial oxygen demand.

Clopidogrel Pharmacologic Class and Clinical Indication

Oral $P2Y_{12}$ platelet adenosine diphosphate (ADP) receptor antagonist used in acute coronary syndromes, coronary stents, PAD, and ischemic stroke.

Clopidogrel Post-Stent Adherence

Do not discontinue clopidogrel prematurely following stent placement without cardiology authorization due to the severe risk of acute stent thrombosis.

Pentoxifylline Mechanism and Indication

Rheologic agent that decreases blood viscosity and improves red blood cell flexibility to enhance microcirculatory flow in intermittent claudication.

Unfractionated Heparin Mechanism

Binds to antithrombin III to accelerate inactivation of factor Xa and thrombin (factor IIa).

Heparin Reversal Agent

Protamine sulfate binds and neutralizes unfractionated heparin and partially neutralizes low-molecular-weight heparin.

Enoxaparin (LMWH) Administration Technique

Inject subcutaneously into the anterolateral or posterolateral abdominal wall; do not massage the site; do not expel the prefilled air bubble prior to injection.

Warfarin Mechanism of Action

Vitamin K antagonist that inhibits hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, X) and regulatory proteins C and S.

Warfarin Reversal Agents

Vitamin K (phytonadione) reverses routine elevated INR; severe or life-threatening hemorrhage requires prothrombin complex concentrate (PCC) or fresh frozen plasma.

Warfarin Dietary Education

Maintain a consistent day-to-day intake of vitamin K-rich foods (green leafy vegetables) rather than eliminating them completely, to prevent fluctuating INR levels.

Cardiac Troponin I and T

The preferred, highly sensitive biomarkers for diagnosing myocardial necrosis; levels rise within hours of injury and can remain elevated for days.

Serial Troponin Testing Rationale

A single early negative troponin does not exclude acute coronary syndrome; sequential trending paired with ECG and clinical symptoms is mandatory.

Creatine Kinase-MB (CK-MB)

Cardiac enzyme marker that rises after injury but returns toward baseline quicker than troponin, making it useful in identifying early reinfarction.

B-Type Natriuretic Peptide (BNP / NT-proBNP)

Neurohormone released from ventricular myocytes in response to increased intracardiac wall tension and volume stretch, supporting HF diagnosis.