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ADN002 MED SURG > Week 6 Cardiac > Flashcards

Week 6 Cardiac Flashcards

1
Q

Three layers of the heart

A

Endocardium
Myocardium
Epicardium

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2
Q

4 chambers of the heart

A

Right atrium
Left atrium
Right ventricle
Left ventricle

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3
Q

Atrioventricular valves include

A

tricuspid- right
Mitral- left

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4
Q

Aortic and Pulmonic are

A

Semilunar Valves

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5
Q

Heart has own circulation

A

Coronary arteries

Heart and electricity

Hemodynamics and CArdiac conduction

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6
Q

Order of the valves with the blood flow

A

TPMA
Tricuspid
Palpating
Mitral
Artery

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7
Q

Self stimulating cells located along

A

Autorhythmic cells

SA node- 60-100

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8
Q

Internodal pathways

A

Causes electrical stimulation of atrium

Connection between SA node and AV node

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9
Q

AV Node

A

Secondary pacemaker
40-60

Acts as relay delay to coordinate
contractions between atrium and ventricles filing

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10
Q

Bundle of HIS

A

Atrioventricular Bundle

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11
Q

Purkinje Fibers

A

Causes electrical stimulation

30-40 bpm

use if both av and sa are malfunctioned

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12
Q
A
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13
Q
A
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14
Q
A
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15
Q
A
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16
Q
A
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17
Q

Pressures within the right side of the heart and pulmonary vascular system are

A

Significantly lower than left side of heart and systemic vascular system

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18
Q

Where does venous circulation accumulates?

A

Coronary Sinus

Then dumps back into the right atrium

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19
Q

Ventricular contraction creates what type of blood flow?

A

Upward

through venous coronary circulation

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20
Q

Blood that has been pushed into coronary circulation and is allowed to circulate during diastole

A

Atrial Systole and Ventricular Systole

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21
Q

Management of CAD

A

MONA

Morphine
Oxygen
Nitroglycerin
Aspirin

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22
Q

STEMI

A

ST elevation

Troponin is specific to cardiac muscle damage

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23
Q

Dialysis pt can have slightly elevated

A

Troponin due to inability to filter proteins

View EKG

EKG first
O2
Aspirin
Morphine

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24
Q

Average SV is

A

60-130ml

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25
Q

Preload

A

Volume of blood within the ventricles at the end of diastole, immediately prior to systole

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26
Q

Afterload

A

Resistance of systemic or pulmonary blood pressure; Systemic VAscular resistance- left side of the heart

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27
Q

Pulmonary Vascular Resistance

A

Right side of the heart

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28
Q

Preload and SV have a ______________ relationship

A

Direct

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29
Q

Afterload and SV have a __________________ relationship

A

Inverse

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30
Q

Contractility and SV have a direct relationship

A

Increased by ionotropic drugs and decreased by beta adrenergic blockers

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31
Q

SV

A

Stroke Volume

Amount of blood ejected with each heartbeat

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32
Q

Preload

A

Degree of stretch of cardiac muscle fibers at end of diastole- how much blood fills the ventricles

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33
Q

Afterload

A

Resistance to ejection of blood out of ventricles into arteries -diameter or arteries

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34
Q

Contractility

A

Ability of myocardium to contract in response to electrical conduction impulse

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35
Q

Ejection Fraction

A

Percent of blood that is ejected with each heartbeat

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36
Q

CO

A

Cardiac Output
Amount of blood pumped by ventricles in liters per minute

CO=SVxHR

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37
Q

Normal EFis

A

55% to 65%

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38
Q

CO at rest is

A

4-6 l/min

HR direct relationship with CO

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39
Q

Control of heart rate

A

Autonomic Nervous System

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40
Q

Sympathetic innervation of

A

Beta 1 receptors- increases hr

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41
Q

Parasympathetic Innervation of

A

Stimulation of Vagus nerve which SLOWS HR

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42
Q

Baroreceptors

A

Located in the Aortic Arch and bilateral Internal Carotid artery sinuses

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43
Q

Elevated BP

A

Increases parasympathetic activity

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44
Q

Lowered BP enhances activity

A

Sympathetic Activity

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45
Q

HTN sends impulse to the

A

Cerebral Medulla to activate parasympathetic activity and lower HR

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46
Q

Hypotension causes

A

Decreased amount of signals so that sympathetic responses are enhanced to increase HR and vasoconstriction

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47
Q

The volume of blood in the heart just before the ventricles begin to contract

A

Preload

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48
Q

Low BP baroreceptors trigger

A

Sympathetic nerve fibers to increase HR and vasoconstrict by release of catecholamines

Increases Beta adrenergic receptors

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49
Q

High BP baroreceptors trigger

A

Parasympathetic nerve fibers to decrease HR- vagus nerve and vasodilate

Decrease alpha agonist

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50
Q

Preload is compared with what law

A

Frank Starling Law

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51
Q

Afterload affected

A

By diameter of pulmonary artery and systemic arteries

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52
Q

Greater stretch of cardiac muscle will cause a greater degree of shortening - stronger contraction and increased stroke volume

A

Frank Starling

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53
Q

Preload

A

Degree of stretch on ventricular cardiac muscle = Left Ventricular End Diastolic Pressure

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54
Q

Resistance to eject blood out of ventricles

A

Afterload

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55
Q

Afterload increases….

A

Stroke volume decreases and lowers CO

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56
Q

Increased by catecholamines

A

Epi and Norepi

Contractility

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57
Q

Contractility influencing factors

A

Increased by sympathetic Nervous System
Increased by meds

Decreased by hypoxemia and acidosis

Decreased by some meds

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58
Q

If LVEF is or less the patient has what?

A

40%

Has left ventricular dysfunction and requires tx of HF

Measured by use of echocardiogram

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59
Q

Nursing considerations for Cardiac

A

Cardiac Assessment
Investigative Health History
Clinical Manifestations
Lab tests
Diagnostics Tests

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60
Q

Cardiac Assessment

A

Inspection
Palpitation
Auscultation

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61
Q

Inspection of cardiac

A

General appearance
Skin, nails, and mucous membranes
Anterior chest wall
JVD
Heart Rhythm on monitor

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62
Q

Palpation

A

Pulses
Cap Refill
Skin Turgor
Warmth
Moisture
Edema

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63
Q

Non pitting edema due to

A

Lymphatic disorders and obstruction

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64
Q

Pitting Edema

A

Increased hydrostatic pressure

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65
Q

Excess Fluid

A

Decreased Oncotic Pressure

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66
Q

Edema grading

A

0= no edema
1+= Slight, 2mm
2+= Mild edema, 4mm indentation, disappears in 10-25 seconds
3+= Moderate edema, 4-6mm, disappears over a minute
4+= Severe edema, disappears after several minutes

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67
Q

Relaxation of all 4 chambers

A

Diastole

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68
Q

Systole

A

Contraction of atrium just prior to ventricles

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69
Q

Heart sounds are the valves closing

A

True

70
Q

S1
S2

A

S1- lub- closure of AV valves - marks start of ventricular systole

S2- Dub- Closure of semi- lunar valves marks the beginning of diastole

71
Q

Suggestive of HF
Lub Dub Dub

A

S3

72
Q

S4

A

Occurs in late diastole

Lub Lub dub

Known as gallop

Caused by CAD, cardiomyopathies

73
Q

Opening Snaps

A

Caused by Mitral stenosis

74
Q

Systolic Clicks

A

Opening of a rigid/ calcified semilunar valve

75
Q

Murmurs are

A

Turbulence through heart valves
Structural defects of valves

76
Q

Inflamed pericardial sac
Heard during systole and diastole

A

Heard best with Pt sitting forward - use diaphragm

77
Q

Investigative Health Hx

A

Medical Dx
Surgeries
Medications
Diet and Nutrition
Elimination
Social Hx
Vital Sign s
Activity and exercise
Sleep, rest
Demographic information
Family/ genetic Hx
Cultural/ Social factors

Risk factors
Modifiable- lifestyle, diet
Nonmodifiable- genetics

78
Q

Most common clinical manifestations of cardiac

A

Chest pain
Dyspnea
Peripheral Edema, weight gain
fatigue
Dizziness, syncope, changes in LOC
Headache, agitation `

79
Q

Cardiac Assessment

A

Psychosocial Assessment
Self perception, self concept- Pt understanding of dx treatment and management

Roles, relationships
Sexuality, reproduction
Coping, stress tolerance
Prevention strategies
Family Hx

Be objective with your assessment

80
Q

Lab Tests

A

Cardiac Biomarkers
- CK, CK-MB
Myoglobin
Troponin T and I

Lipid profile
Electrolytes
CBC
COag Factors
BNP
C reactive
Homocysteine

81
Q

Used as a follow up test to an elevated CK in order to determine whether the increase is due to heart damage or skeletal muscle damage

A

CKMB, CK

82
Q

Found in heart and skeletal muscle and not specific to heart damage

A

Myoglobin

83
Q

Specific for myocardial cell damage

A

Troponin T and I

84
Q

Lipid Profile

A

Triglycerides
LDL- Low density - BAD- saturated

HDL- High density- GOOD- monosaturated, polyunsaturated

85
Q

Lab that indicates heart failure

A

BNP

Neurohormone secreted from cardiomyocytes in the ventricles in response to increased Preload

Regulates BP and fluid volume by decreasing afterload -SVR and increasing natriuresis- sodium excretion in urine

86
Q

C Reactive Protein

A

Indicator of systemic inflammation

  • Cause may be atherosclerosis

Elevated levels may indicate risk for CVD

87
Q

Elevated levels may indicate endothelial cell damage and CAD - development of atherosclerosis

A

Homocysteine

88
Q

Amino acid peptide released by ventricular cells due to over stretching

A

BNP

First discovered in the brain

89
Q

ANP

A

Amino acid peptide released by atrial cells due to over stretching

90
Q

Diagnostic Tests

A

Electrocardiography
12 lead EKG
Continuous Monitoring
Continuous Ambulatory monitoring
Transteelphonic Monitoring
Wireless mobile monitoring

91
Q

Cardiac Stress Testing
Exercise Stress Testing
Pharmacological Stress Testing

are all….

A

Diagnostic Tests

92
Q

Diagnostic Tests for Cardiac

A

Chest X ray
Fluoroscopy
CT
MRI
Radionuclide
Myocardial perfusion imaging
Test of ventricular function
PET

93
Q

Type of medical imaging that shows Xray image on a monitor, much like Xray movie

A

Fluoroscopy

94
Q

Invasive procedure study used to measure cardiac chamber pressures, assess patency of coronary arteries

A

Cardiac Catheterization

Requires ECG, hemodynamic monitoring, emergency equipment, must be available

Assess allergies and get blood work

95
Q

Pre Procedure Cardiac Catheterization

A

Fasting for 8 -12 hours
educate procedure and encourage feelingsP

96
Q

Post procedure of cardiac catheterization

A

Bed rest for 2-6 hours
Assess site, hematoma, compression dressing, weight, pulses, cap refill, skin color, temperature, sensation

Monitor for dysrhythmias, assess chest pain, monitor kidney function

97
Q

Use of contrast dye to due what?

A

Narrowing of angiogram

Righ Heart cath- Vein
Left heart cath- Artery

98
Q

Radiotracer, injected to the vein, emits gamma radiation as it decays, A gamma camera scans the radiation area and creates an image

A

Radionuclide Scan

99
Q

CVP is measured on a

A

Central Line - Distal port

Normal CVP- 2-6 mmHg

100
Q

Partially Mechanically ventilated CVP

A

812 mmHg due to positive pressure decreasing preload

101
Q

ED doctor can utilize ultrasound to visualize

A

Inferior Vena Cava and with applying pressure

Can assess amount of collapse of the vein to determine an emergent need for fluid replacement

102
Q

PAWP is used in the

A

ICU

Swan ganz catheter

Pulmonary Artery Wedge

103
Q

Arterial Line

A

Used for critically ill patients
ABGs

Inserted into radial artery

Allen test

Monitoring proximal end of perfusion

104
Q

Phelbostatic Level

A

Use of transducer located at 4th intercostal space- midaxillary line - located near right atrium

105
Q

Gerontological Considerations Cardiac

A

Decreased connective tissues
- Easily palpable pulses
Gradual increase of BP

Orthostatic Hypotension
-Impaired baroreceptors
Prolonged bed rest
Dehydration
Polypharmacy

Murmur development
-60% due to hardening of valves

106
Q

Primary HTN is _________________- cause

A

Unidentified cause

107
Q

Secondary HTN is ________________________

A

Identifies the cause of the HTN

ex: CKD, hyperaldosteronism

108
Q

Blood pressure is the measurement of force applied to the

A

Artery walls

109
Q

BP is the product of CO and x peripheral resistance

A

TRUE

110
Q

Damage to the endothelium walls of the artery initiates

A

Inflammatory response resulting in plaque build on the arterial wall

Slow, gradual process that narrows lumen artery

111
Q

HTN Symptoms

A

Brain- Stroke
Vision- Impaired
Renal- CKD
Cardiac- MI, Heart Failure

Prolonged untreated BP causes damage to the arterial walls and late signs can be seen in damage to critical organs

112
Q

Why do we want slow drop of blood pressure for HTN emergencies?

A

Brain and core organs are used to a certain elevated pressure and lowering BP too quickly can cause decreased perfusion to the core organs.

113
Q

HTN Emergency

A

Blood Pressure > 180/120

Intervention
- Reduced BP 25% in first hour
- Reduce to 160/ 100 over 6 hours
IV Vasodilators
IV labetolol
Frequent monitoring of BP

114
Q

HTN Urgency

A

Blood pressure is very high, no evidence of organ damage

Intervention
- Monitor blood pressure CV status
Assess for potential organ damage
- Fast acting oral agents
Beta Adrenergic blocker, Ace Inhibitors, or alpha2 agonists- Clonidine

115
Q

Principles of Therapy HTN

A

Achieving and maintaining BP < 140/90 mmHg
- If goal not achievable, lowering BP to any extent is beneficial

Lifestyle Modifications
- Weight and sodium intake reduction, DASH diet
Regular physical activity
Moderate ETOH intake
Smoking Cessation

116
Q

HTN Risk Factors

A

Smoking
Obesity
Sedentary Lifestyle
Dyslipidemia
DM
GFR <60 mL/min
Age
Family History

117
Q

What are some complications HTN?

A

Left Ventricular Hypertrophy
MI
HF
TIA
CVA
Renal Insufficiency
Retinal Hemorrhage

118
Q

HTN Assessment

A

History and Physical Examination

Lab Tests
-Urinalysis
- Blood Chemistry
- Cholesterol levels

ECG
Chest Xray

119
Q

Thiazides, Loops, and Potassium sparing are all what?

A

Diuretics

120
Q

Hydrochlorothiazide and chlorthalidone are

A

Thiazides

121
Q

Furosemide and torsemide

A

Loop Diuretics

122
Q

Spironolactone
Triamterene

A

Potassium Sparing

123
Q

HCTZ and spironolactone watch for

A

Watch for HyperK

124
Q

Beta Blockers end in -olol

A

Atenolol
Metoprolol
Labetolol
Timolol
Propanolol
Nebivolol
Acebutolol - Beta 1 and 2
Penbutolol- Beta 1 and 2
Pindolol- Beta 1 and 2

125
Q

Beta 1 blocks

A

Sympathetic Nervous causing lower heart rate and decreased BP

Decreases myocardial demand

126
Q

Beta 1 Blockers are

A

Heart

127
Q

Beta 2 blockers related to the

A

Lungs

128
Q

Beta 2 relaxes

A

Bronchial smooth muscle causing bronchial causing bronchial dilation

129
Q

Glucagon

A

Medication to help reverse overdose of Beta 1 affects

130
Q

Avoid the sudden discontinuation of beta blockers. Why?

A

Common cause orthostatic hypotension in geri population- decreased liver and renal failure

Can cause erectile dysfunction

131
Q

These drugs inhibits Ca influx causing slower cardiac conduction

A

Calcium Channel Blockers

Lowers HR and BP

Reduces afterload

132
Q

Medication for calcium channel blocker overdose

A

Calcium

133
Q

Calcium CHannel blockers commonly used for Afib and Afib with rvr

A

TRUE

134
Q

NonDihydropyridines include

A

Diltiazem
Verapamil

135
Q

Dihydropyridines inhibit influx and cause a

A

Vasodilator effect

Increases oxygen delivery to myocardium

Amlodipine
Felodipine
Nicardipine
Clevidipine

136
Q

Alpha Agonists 1 include

A

Doxazosin
Prazosin
Terazosin

137
Q

Alpha 2 Agonists

A

Methyldopa
Clonidine
Guanfacine

138
Q

Alpha 1 is used when what drug is contraindicated

A

Hydralazine

139
Q

Receptor sites in peripheral vasculature causes

A

Peripheral Vasodilation
- Decreases SVR

140
Q

Alpha 2 receptor sites in brain and decreases in

A

SVR

141
Q

Vasodilators act on

A

Smooth muscle
Decreases SVR
Contraindicated in heart failure and sepsis

Side effect is hypotension

142
Q

Hydralazine
Fenoldopam mesylate
Nitroprusside
Nitroglycerin

A

Vasodilators

143
Q

System that controls blood pressure is the

A

RAAS system

144
Q

What are renin inhibitors ?

A

Blocks conversion of angiotensinogen to angiotensin I

Monitor for hyperkalemia

Ex: Aliskiren

145
Q

Inhibits conversion of angiotensin I to angiotensin II- SVR

A

ACE inhibitors -SVR

146
Q

Common side effect with ACEs is

A

Angioedema

147
Q

Hypotension can be reversed by_____________

A

Fluid Resuscitation

148
Q

Benazepril
Enalapril
Lisinopril
Captopril

A

ACE inhibitors

Commonly used with Pt with renal impairment

149
Q

ARBS do what?

A

Block effects of angiotensin II at receptor sites

Reduces SVR

Monitor for hyperkalemia

Alternative to ACEs

150
Q

Losartan
Valsartan
Candesartan

A

ARBs

151
Q

Potassium sparing diuretic that prevents Na+ reabsorption therefore does what?

A

Increases elimination of water through kidneys

Monitor for hyperkalemia

152
Q

Eplerenone
Spironolactone

A

Aldosterone Antagonist

153
Q

Spironolactone and hydrochlorothiazide
2 diuretics

A

Aldactazide

154
Q

Atenolol and Chlorthalidone
-Beta blocker and diuretic

A

Tenoretic

155
Q

Lisinopril and hydrochlorothiazide
- ACE inhibitors and diuretics

A

Prinzide

156
Q

Hyzaar is

A

Losartan and Hydrochlorothiazide
Angio II and diuretics

157
Q

Lotrel made of

A

Amlodipine and Benazepril
- Calcium channel blockers and ACE inhibitors

158
Q

Alpha 2 Agonist and diuretic

A

Combipres

Clonidine and chlorthalidone

159
Q

Name a few medications that can lower BP

A

Narcotics
Benzo
Sedatives
IV antibiotics

160
Q

Nursing Dx of HTN

A

Deficient knowledge related to Tx or control of disease process

Ineffective health maintenance
Noncompliance of regimen
Decreased tissue perfusion
Decreased cardiac output

161
Q

Problems and Complications - AEB HTN

A

Left Ventricular hypertrophy
Arterial Stenosis
Myocardial Infarction
HF
TIA
CVA
Renal failure or insufficiency
Retinal Hemorrhage

162
Q

Planning and Goals of HTN

A

Understanding Tx and disease process
Participation in self care program
Absence of complications
Maintaining BP below 140/90

163
Q

Interventions of HTN include

A

Pt education
Support Tx adherence
Consultation and collaboration
Follow up care
Emphasize control rather than cure
Reinforce and support lifestyle changes
A lifelong process

164
Q

Evaluation of HTN

A

Reports knowledge of disease management to maintain tissue perfusion

Adheres to self care program

165
Q

HTN gerontological considerations

A

Structural and functional changes of heart and blood vessels
Kidney function diminished
Chronic plaque deposits and calcification in vessels
Impaired vasodilation

166
Q

HTN Gerontological Considerations

A

monotherapy
Understands regimen
Can see information
Access to medications
Expense
Opening the pill bottle
Family/ caregiver

167
Q

What is heart failure?

A

Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients

Characterized by fluid overload or inadequate tissue perfusion

168
Q

Term HF indicates myocardial disease

A

There is a problem with contraction of the heart = Systolic Failure or filing of the heart= Diastolic Failure

169
Q

Most HF is progressive and a _________________ disorder

A

Lifelong

managed with meds and lifestyle change

170
Q
A

ADN002 MED SURG (18 decks)

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