4/26 cardiac

mediastinal : 세로칸-, 종격-, 종격동의

lead to : ~로 이어지다

inhibit : 억제하다, 방해하다

contractility : 수축성, 신축성

build up : 보강하다, 확충하다

markedly : 뚜렷한

dependent : 의존하는, 의존적인

kinks : 구부러진 것, 비비 꼬임

sequence : 연속적인 사건들, 순서

presence : (특정한 곳에 ) 있음, 존재(함), 참석, 출현, 등장

dosage : 정량, 복용량

excrete : 배설[분비] 하다

moderation : 적당함, 온건, 절제

gloss over : 속이다, 둘러대다

substituting : 대신하는 사람, 대체물

avoidance : 회피, 방지

missing : 없어진, 빠진

established : 인정받는, 저명한, 설립하다, 수립하다

recognition : 알아봄, 인식, 인정

erythema : 홍진, 홍반

manifestation : 징후

back up : 후진시키다, 지지하다

compensate : 보상하다

release : 방출

inotropic : 근육의 수축을 지배하는

clarify : 명확하게 하다

medial malleolus : 내과

exertion : 노력, 분투, 운동

anethesia : 마취

implement : 시행하다

flushed : 빨간, 상기된

contrast : 대조, 대조시키다, 차이

be awake : 의식이 있다.

hemostasis : 지혈, (부분적인) 울혈

hardened : 굳어진, 경화된

efficacy : (약의 ) 효혐.

popliteal : 오금의, 슬와의

compromised : 면역반응 따위가 제대로 발휘하지 못하는

occlusion : 폐색, 폐쇄

be present : ( 정신과 관심을 ) 온전히 쏟다

doppler : 도플러 검사 ( 초음파로 혈관상태 확인하는 검사 )

etiology : 병인학

correlate : 연관성이 있다.

severity : 심각성

 

Mediastinal chest tubes are used to drain air or fluid from the mediastinal space and/or pericardial cavity (ie, after cardiac surgery).  Obstruction (eg, clot) of the chest tube will result in excess fluid buildup in the pericardium, leading to inhibited cardiac contractility and eventual diagnosis of cardiac tamponade.  Cardiac tamponade is a life-threatening form of obstructive shock marked by decreased cardiac output and eventually obstructive cardiac arrest if untreated.

If chest tube drainage is markedly decreased, the nurse should quickly assess for signs of cardiac tamponade (Option 1) and if no such signs are present should troubleshoot other possible causes of chest tube occlusion.

The chest tube should be kept free of dependent loops and kinks.  This assists with proper drainage and prevents fluid from accumulating and backflowing into the mediastinum.
Stripping (or milking) a chest tube should not be performed, unless specifically prescribed, as it can exert excessively high negative pressure and traumatize tissues within the mediastinum.

An atrioventricular pacemaker (also known as a sequential or dual chamber pacemaker) paces the right atrium and right ventricle in sequence.  The ECG will have 2 pacer spikes, one before the P wave and one before the QRS complex.

* Loop diuretics (furosemide, torsemide, bumetanide) are used to treat fluid retention, such as that found in clients with heart failure or cirrhosis.  When administering loop diuretics, the nurse can expect the client's kidneys to excrete a significant amount of water and potassium.
Excess diuresis can also affect kidneys, and the blood urea nitrogen and creatinine levels can become elevated as well.  Therefore, these levels should be assessed

* a client after his fifth hospitalization for pulmonary edema caused by his congestive heart failure.
Adding potassium to a diet, especially when substituting it for sodium, can decrease blood pressure and fluid retention.  Some diuretics, such as furosemide (Lasix), may also cause low levels of potassium.,,
In congestive heart failure, large changes in clients established dietary habits are necessary to avoid the repeated hospitalizations caused by salt overload.

* Although clients with a DVT may have no symptoms, typical clinical manifestations include unilateral edema, localized pain (eg, calf pain) or tenderness to touch, warmth, erythema, and occasionally low-grade fever

* Cardiomyopathy is a group of diseases in which the heart muscle (ie, myocardium) has a reduced ability to pump blood effectively, placing clients at risk for cardiogenic shock.  Cardiogenic shock is manifested by reduced cardiac output (eg, hypotension, narrow pulse pressure), which can lead to pulmonary edema (eg, tachypnea, bibasilar crackles, decreased oxygen saturation) caused by blood "backing up" into the pulmonary capillaries.  To compensate, catecholamines (eg, epinephrine) and vasopressin are released by the adrenal glands to increase cardiac output.  However, this compensatory mechanism eventually fails, causing decreased perfusion and oxygenation of tissues as well as death.  The client may need additional support with ionotropic agents (eg, norepinephrine) in these situations.
clarify,, 명확하게 해야하는것은? 오답을골라야지 yo!

* A coronary arteriogram (angiogram) is an invasive diagnostic study of the coronary arteries, heart chambers, and function of the heart.  It requires that the client have an intravenous (IV) line started for sedating medications; the femoral or radial artery will be accessed during the procedure.  The client should be instructed:

1. Not to eat or drink anything for 6-12 hours prior to the procedure (depending on the particular health care provider performing the procedure) (Option 4)
2. The client may feel warm or flushed while the contrast dye is being injected (Option 2)
3. Hemostasis must be obtained in the artery that was cannulated for the procedure.  Most commonly, this is the femoral artery.  Compression is applied to the puncture site and the client may have to lie flat for several hours to ensure hemostasis (Option 1)

(Option 3)  If the procedure is just a diagnostic study, the client often goes home the same day.  Hospitalization for 1-3 days may be required if angioplasty or stent placement is performed.

(Option 5)  General anesthesia is not used during coronary angiography.  Sedating medications are given during the procedure.

Clients with pulmonary embolism or deep venous thrombosis are treated with anticoagulant therapy.  Unfractionated heparin is one such agent, and its efficacy is measured through partial thromboplastin time (PTT) levels.  The goal during anticoagulation therapy is a PTT 1.5-2.5 times the normal reference range of 30-40 seconds (ie, therapeutic PTT 46-70 seconds).  A PTT of 127 seconds is much too prolonged, and spontaneous bleeding could occur (Option 4).

* Femoral-popliteal bypass surgery involves circumventing a blockage in the femoral artery with a synthetic or autogenous (artery or vein) graft to restore blood flow.  The nurse performs neurovascular assessments on the affected extremity (ie, pulses, color and skin temperature, capillary refill, pain, movement) and compares the findings with the preoperative baselines.  The client's nonpalpable pedal pulse that is present only with Doppler distal to the graft (ie, post-tibial, pedal) can indicate compromised blood flow or graft occlusion and should be reported to the health care provider immediately.

* Brain (or b-type) natriuretic peptide (BNP) is secreted in response to ventricular stretch and wall tension when cardiac filling pressures are elevated.  The BNP level is used to differentiate dyspnea of heart failure from dyspnea of noncardiac etiology.  The level of circulating BNP correlates with both severity of left ventricular filling pressure elevation and mortality.

A normal BNP level is <100 pg/mL [<28.9 pmol/L].  The nurse would expect a high BNP in a client exhibiting symptoms of acute decompensated heart failure