NURS 225 exam 3

What is an aneurysm?

An abnormal bulging of an artery due to weakness in the vessel wall.

What is a true aneurysm?

A bulging of an artery involving all three layers of the vessel wall.

What is a pseudo-aneurysm?

A tear in the artery where blood collects between the middle and outer layers.

What causes an abdominal aortic aneurysm (AAA)?

Hypertension, atherosclerosis, smoking, and connective tissue defects.

Why is hypertension a risk factor for AAA?

It increases pressure on arterial walls, weakening them.

Why does atherosclerosis contribute to AAA?

Plaque buildup weakens the vessel wall.

What is a common early sign of AAA?

Often asymptomatic.

What is a classic physical finding in AAA?

Pulsatile abdominal mass.

What is distal embolization in AAA?

Clots break off and travel downstream.

What happens as an AAA enlarges?

Abdominal pain that radiates to the back.

What is the most dangerous complication of AAA?

Rupture causing rapid, life-threatening hemorrhage.

What tests diagnose AAA?

Ultrasound and CT angiogram.

How are small aneurysms managed?

Control blood pressure and monitor.

When is surgery indicated for AAA?

When >5-6 cm (unless not a surgical candidate).

What is endovascular repair?

A minimally invasive repair with a risk of leakage.

What is open repair?

A more invasive surgery with higher mortality risk.

What is the pathophysiology of aortic dissection?

Tear in the intima with blood collecting between intima and media.

What are risk factors for aortic dissection?

Hypertension, Marfan syndrome, elderly age.

What is the classic symptom of aortic dissection?

Tearing chest pain radiating to the back.

What abnormal vital sign may be seen in an aortic dissection?

Unequal blood pressures.

What does a chest X-ray show in aortic dissection?

CXR will show widened mediastinum

What confirms aortic dissection diagnosis?

CT scan

What is the priority treatment for Aortic Dissection?

Rapid blood pressure reduction.

What medications are used for Aortic Dissection?

IV beta blockers (esmolol) and nitroprusside.

What is the definitive treatment for aortic dissection?

Surgical repair

What type of monitoring is required for aortic dissection?

Critical care monitoring.

What is the nurse's role with medications for aortic dissection?

Titrate to control BP.

What other nursing priorities exist for aortic dissection?

Pain management, ongoing assessment, psychosocial support, prep for surgery.

What causes PAD?

Atherosclerosis of peripheral arteries.

What is the main problem in PAD?

Impaired distal perfusion.

What are risk factors for PAD?

Hypertension, smoking, diabetes, hyperlipidemia.

What is intermittent claudication for PAD?

Pain with walking that is relieved by rest.

What neurological symptom may occur for PAD?

Neuropathy.

What happens to pulses in PAD?

They are diminished or absent.

What are trophic changes in PAD?

Skin becomes pale, shiny, hairless, with thick nails.

What severe complications can occur in PAD?

Arterial ulcers and gangrene.

What type of pain occurs in PAD?

Burning or gnawing pain.

What happens to pain when legs are elevated in PAD?

Pain increases (due to ischemia).

What happens to leg color with elevation in PAD?

Pallor (pale).

What happens when legs are lowered in PAD?

Rubor (redness).

What happens to capillary refill in PAD?

Decreased.

What is the temperature of affected limbs in PAD?

Cool.

How are pulses assessed in PAD?

Presence, strength, rate, rhythm (may need Doppler).

What skin findings are common in PAD?

Ulcers, shiny skin, thick nails, hair loss.

What tests diagnose PAD?

Arterial duplex, ankle-brachial index (ABI), angiography.

What is the first step in treatment in PAD?

Risk factor modification

What lifestyle intervention is important in PAD?

Exercise

What medications are used in PAD?

Antiplatelets and lipid-lowering drugs.

What procedures may be needed in PAD?

Angioplasty with stent, bypass surgery, amputation.

What is the most important lifestyle change for PAD?

Smoking cessation

What daily habit is important for PAD?

Inspect feet daily

Why protect feet for PAD?

Prevent injury due to poor circulation.

Who should patients see for PAD?

Who should patients see?

What type of system is the venous system?

Low pressure, high volume.

What helps venous blood flow?

Valves and muscle activity.

What are the three components of Virchow's Triad?

Venous stasis, endothelial damage, hypercoagulability.

What is DVT?

deep clot in the vein

Why is DVT dangerous?

High risk of embolization (can cause PE).

What percentage of surgical patients are affected for DVT?

About 5%.

What are the main symptoms of DVT?

Edema, erythema, pain.

How can DVT be prevented?

Mobilization, ankle pumps, compression devices (SCDs), TEDS, anticoagulation.

How is DVT diagnosed?

Venous Doppler.

How is DVT treated?

Anticoagulation.

What is an IVC filter?

A device to prevent clots from reaching the lungs.

What must nurses monitor for?

Signs of pulmonary embolism (PE).

What causes venous insufficiency?

Incompetent valves causing backflow and edema.

What are key assessment findings for venous insufficiency?

Edema and brown skin discoloration.

How is venous insufficiency treated?

Compression, leg elevation, low sodium diet, skin care.

What is the normal conduction pathway of the heart?

SA node → AV node → Bundle of His → Right & Left bundle branches → Purkinje fibers

What is the function of the SA node?

Acts as the natural pacemaker and initiates electrical impulses

What is the function of the AV node?

Delays conduction to allow ventricles to fill before contraction

What do Purkinje fibers do?

Conduct impulses to ventricles causing contraction

What is the difference between electrical and mechanical events in the heart?

Electrical = conduction of impulses; Mechanical = actual contraction/pumping

Can electrical activity occur without effective mechanical contraction?

Yes (example: ventricular fibrillation)

What are structural causes of arrhythmias?

Accessory pathways, conduction defects, ischemia/infarction, hypertrophy

What are systemic causes of arrhythmias?

Acid-base imbalance, electrolyte imbalance, hypoxia, thyroid disease

What external factors can cause arrhythmias?

Drug toxicity (including antiarrhythmics), alcohol

What is the most important principle when evaluating an arrhythmia?

Treat the patient, not just the monitor

What should you assess to evaluate perfusion?

LOC, vital signs, pulse ox, skin, respiratory status

Why is identifying the underlying cause important for an arrhythmia?

Because treatment depends on correcting the cause

What are the main treatments for arrhythmias?

Correct cause, drugs, electricity, ablation

What is a key principle about antiarrhythmic drugs?

they can cause or worsen arrhythmias

What is atrial fibrillation?

Chaotic atrial electrical activity with no organized contraction

What is lost in atrial fibrillation?

Atrial kick

Why is atrial fibrillation dangerous?

Risk of clot formation → stroke

What conditions can cause atrial fibrillation?

CAD, ischemia, valve disease, COPD, atrial damage

How is atrial fibrillation treated?

Rate control, anticoagulation, antiarrhythmics, cardioversion, ablation

What is a heart block?

Delay or interruption of conduction through the AV node

What happens in 2nd degree heart block?

Some P waves do not conduct to ventricles

What happens in 3rd degree heart block?

No association between atrial and ventricular conduction

What is the treatment for severe heart blocks with low HR?

Pacemaker

What characterizes ventricular tachycardia?

Rapid rate with wide QRS

Can V-tach have a pulse?

Yes or no

What can V-tach deteriorate into?

Ventricular fibrillation

Causes of V-tach?

MI, CAD, electrolyte imbalance, prolonged QT, antiarrhythmics

Treatment of stable V-tach?

Medications

Treatment of unstable V-tach with pulse?

Cardioversion

Treatment of pulseless V-tach?

CPR and defibrillation

What is ventricular fibrillation?

No ventricular contractions and no cardiac output

How quickly do brain cells begin to die in V-fib?

4-6 minutes