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Adults 1 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

HTN potential complications

A

heart disease, kidney damage, stroke; causes end-organ damage

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2
Q

HTN 3 classifications

A

primary- unknown cause, secondary- caused by another factor and need to target underlying cause, malignant- HTN crisis

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3
Q

when classifying HTN

A

use the higher of either SBP or DBP out of range

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4
Q

prior to administering medications for HTN…

A

encourage lifestyle modifications for 1-3 months like reducing Na Sugar Alcohol fat, exercising, reduce stress

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5
Q

causes of primary HTN

A

aging, family hx, Af-Am, sedentary lifestyle, smoking, alcohol, HLD

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6
Q

causes of secondary HTN

A

resulting from other conditions; cardiovascular disorders, renal disease, endocrine diseases, pregnancy, meds, sleep apnea

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7
Q

assessing HTN

A

History: fam Hx, current meds, perception of disease; Signs/symptoms: dietary pattern, headache, visual changes, neuro assess, lab tests; Physical Exam: obtain 2 BP on both arms supine and standing, compare to prior, weight, JVD, increased HR, dysrhythmias, S3, CXR shows enlarged heart

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8
Q

lab tests for HTN

A

cardiac biomarkers, chem panel for electrolytes and liver, assess for end-organ damage, hypernatremia

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9
Q

common end–organ damage resulting from HTN

A

cerebrovascular damage, vasculopathy, heart disease, nephropathy

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10
Q

cerebrovascular damage resulting from HTN

A

acute HTN encephalopathy (confusion), stroke, vascular dementia, retinopathy (can cause retinal detachment

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11
Q

vasculopathy from HTN

A

atherosclerosis, aortic aneurysm

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12
Q

heart disease from HTN

A

left ventricular hypertrophy, CAD, MI, HF, atrial fibrillation

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13
Q

nephropathy from HTN

A

proteinuria, renal failure

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14
Q

non-pharmacological interventions for HTN

A

weight reduction, dietary sodium restriction (2g/day), reduce alcohol and caffeine, exercise, smoking cessation, stress reduction, monitor BP often

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15
Q

older adult considerations

A

isolated systolic HTN d/t age related loss of elasticity to carotid and aorta, difficult to treat d/t low DBP, medication issues because of failure to remember/polypharm/expensive/increased incidences of orthostatic hypotension

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16
Q

why does orthostatic hypotension occur

A

when standing up, all blood flows out of head due to gravity causing drop in BP

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17
Q

HTN urgency

A

BP >180/120, no evidence of end-organ damage, pharmacologic interventions are used to normalize BP within 24-48 hours

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18
Q

coronary atherosclerosis

A

fatty plaque accumulates on artery walls blocking off/narrowing vessels reducing blood flow to myocardium; plaques can rupture; symptoms arise d/t enough blockage to cause ischemia

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19
Q

when do symptoms of cardiac ischemia occur

A

left main artery reduced by 50%, any vessel reduced by 75%

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20
Q

coronary artery disease

A

narrowing/obstruction of 1 or more coronary arteries d/t atherosclerosis; causes inadequate perfusion and oxygenation of myocardial tissue

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21
Q

coronary artery disease can lead to

A

HTN, angina, dysrhythmias, MI, heart failure, death

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22
Q

collateral circulation

A

vascular system is generated around the obstruction/plaque to bypass; takes about 10 years to form

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23
Q

modifiable risk factors for CAD

A

BMI > 30, DM, HTN, alcohol use, high hDL and low LDL, tobacco use

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24
Q

non-modifiable risk factors for CAD

A

65+, Fam HX or genetic predisposition

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25
Q

LDL cholesterol

A

brings plaques into the arteries

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26
Q

HDL cholesterol

A

removes lipids from the arteries

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27
Q

CAD manifestations

A

early is asymptomatic, chest pain, dyspnea, syncope, cough/hemoptysis, palpitations, excessive fatigue

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28
Q

diagnosing CAD

A

EKG: ischemia = ST depression, infarction = ST elevation; Lipid: cholesterol is elevated (LDL vs. HDL), stress tests, Cardiac cath.

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29
Q

cardiac catheterization

A

angiogram used to diagnose CAD; injection of dye into arteries to identify atherosclerotic plaques blocking off blood flow (plaques do not light up)

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30
Q

treatment of CAD

A

tobacco cessation, manage HTN, low cal sodium cholesterol fat and increased fiber diet, control DM, stress reduction, alcohol reduction, pharmacological management

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31
Q

angina pectoris

A

chest pain d/t ischemia from lack of oxygen; can be caused by obstruction or spasm

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32
Q

variant angina (prinzmetal)

A

caused by coronary vasospasm commonly caused by smoking or cocaine

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33
Q

symptoms of prinzmetal angina

A

occurs at rest without provocation, triggered by smoking, transient ST elevation during pain, associated with AV block or ventricular arrythmias, occurs with or without CAD

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34
Q

treatment of prinzmetal angina

A

smoking cessation, calcium channel blockers

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35
Q

stable angina

A

caused by myocardial atherosclerosis

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36
Q

stable angina symptoms

A

caused by exertion and usually last 5-10 minutes, aggravated by cold exposure or stress, stable onset duration severity and relieving factors, relieved by rest

37
Q

stable angina treatment

A

nitrates, beta blockers, calcium channel blockers, aspirin

38
Q

unstable angina (pre-infarction)

A

due to ruptures or thickened plaque with platelet and fibrin thrombus

39
Q

unstable angina symptoms

A

angina of increasing intensity frequency or duration, occurs at rest or with minimal activity, lasts > 15 min, pain unresponsive to NTG

40
Q

unstable angina treatment

A

oxygen, pain meds, nitrates, beta blocker, clopidogrel, aspirin (antiplatelet), statins, tPA (dissolves clot)

41
Q

angina manifestations

A

pain, dyspnea, pallor, sweating, dizziness/syncope, palpitations/tachycardia, HTN, digestive disturbances

42
Q

tests to diagnose angina

A

EKG (normal in stable angina), cardiac enzymes, stress test, cardiac catheterization

43
Q

acute management of angina

A

pain assess and management, IV access, O2, continuous vitals, EKG q10min, NTG, rest semi-fowler, reduce anxiety

44
Q

long term management of angina

A

lifestyle modifications similar to CAD, medication adherence, understanding the disease

45
Q

medications for angina

A

nitrates, beta blockers, calcium channel blockers, antiplatelet therapy

46
Q

older adult cardiac considerations

A

diminshed pain that may effect symptoms, recognize chest pain like symptoms such as weakness, indigestion, fatigue, pharmacologic testing for operation clearance, monitor med doses cautiously

47
Q

Percutaneous coronary intervention (PCI)

A

balloon angioplasty- balloon expands inside artery to open up plaque; intracoronary stenting- can be done with or without balloon pre-dilation (mesh to hold artery open); atherectomy- removing plaque

48
Q

coronary artery bypass graft (CABG)

A

taking artery from one spot of body and placing it in different area to bypass plaque or obstruction

49
Q

cardiac procedures

A

cardiac catheterization, PCI, CABG

50
Q

peripheral arterial disease

A

reduced blood flow to peripheral vessels leading to decreased oxygenation; results in oxygen demand exceeding the supply and can lead to ischemia then necrosis (then gangrene)

51
Q

gangrene

A

wide spread tissue death

52
Q

what causes decreased blood flow in PAD

A

atherosclerotic plaque leading to narrowing of vessels

53
Q

symptoms of peripheral arterial disease (PAD)

A

ischemic ulcers, diminished/absent pulses, sharp stabbing pain, cramping (claudication), loss of hair, dry scaly skin, cold gray/blue skin, dependent rubor (reddish-gray) skin

54
Q

venous insufficiency due to

A

prolonged venous HTN that stretched and damaged valves decreasing blood flow back toward heart

55
Q

symptoms of venous insufficiency

A

venous congestion/stasis, edema, brown discoloration along ankles up to calf, stasis ulcers, cellulitis, pulses present

56
Q

if pulses are diminished in venous insufficiency, then due to…

A

edema

57
Q

ankle brachia index

A

test used to determine if individual has peripheral arterial disease; if brachial pressure > ankle pressure = PAD; value should be about 1

58
Q

ankle-brachial index formula

A

ankle pressure/brachial prsssure = 1; if lower than 1 = PAD

59
Q

nursing interventions of PAD

A

refrain from elevating above heart, walk until claudication (cramp) then rest then repeat, avoid crossing legs, avoid caffeine and tobaccos,

60
Q

PAD treatment medications

A

antiplatelet therapy: ASA, clopidogrel; phosphdiesterase III inhibitor: cilstazol; HMG CoA reductase inhibitors: high dose statins

61
Q

PAD treatment endovascular

A

angioplasty with/without stent; balloon; atherectomy

62
Q

PAD surgical management

A

bypass grafts

63
Q

venous insufficiency nursing interventions

A

compression stockings, avoiding prolonged standing, avoid constructive clothing, elevate legs above heart (10-20 minutes every few hours); sequential compression device; if user present the compression stocking over dressing

64
Q

arterial ulcer

A

punched out, deep, round shape, thin shiny skin, dry; d/t inadequate oxygen supply

65
Q

venous ulcer

A

leg swelling, dark red purple brown hardened skin, torn skin near ankle, scaling and redness around wound, usually wet; d/t pooling of deoxygenated blood

66
Q

treatment of ulcers

A

pharmacological: anti-septic, antibiotic; compression; cleansing and debriding, topical therapy: petroleum jelly to surround tissue; wound dressing (semi/occlusive to avoid fluid loss); skin graft; hyperbaric chamber; negative pressure (wound vac.)

67
Q

nursing intervention for ulcer

A

restore skin, improve mobility, promote adequate nutrition (high protein, VitC, VitA, iron, zinc)

68
Q

lymphangitis

A

acute inflammation of lymphatic channels; red streak up arm

69
Q

lymphadenitis

A

lymph node infected; large red and tender; can become necrotic; present in groin, axilla, cervical (neck)

70
Q

lymphedema

A

can be primary (no known cause) or secondary (d/t increased lymph); increase in lymph d/t obstruction of vessel

71
Q

treatment of lymph edema

A

ambulatory-compression stockings, manual drainiage, physiotherapy, skin care

72
Q

types of heart failure

A

left ventricular failure (most common), right ventricular failure (often result of left vent. failure), systolic failure (HFrEF), diastolic failure (HFpEF)

73
Q

systolic heart failure (HFrEF) vs. diastolic failure (HFpEF)

A

systolic failure is heart failure with reduced ejection fraction meaning problem with contraction and ejection; diastolic failure is heart failure with preserved ejection fraction meaning problem with relaxing and filling

74
Q

systolic HF

A

decreased ventricular output d/t decreased contraction; low output causes baroreceptors to stim. SNS to vasoconstrict and increase contraction (increase HR and contractility); heart tries to compensate with natriuretic peptides (diurese and vasodilate)

75
Q

end result of sytolic HF

A

workload of heart increases, contractility decreases, increased end diastolic blood volume, then ventricular dilation

76
Q

diastolic HF

A

cardiac cells die during systolic HF and muscle becomes fibrotic which can lead to diastolic HF (decreases stretch and filling); stiff ventricles resist filling causing less blood in ventricles and decreases CO; low CO causes increased workload for heart causing HF to become worse

77
Q

in simple terms, systolic or HFrEF…

A

impairs contractility leading to low ejection fraction from weak and thin heart muscle

78
Q

in simple terms diastolic or HFpEF…

A

impairs filling and relaxation of heart due to stiff and thick heart muscle; diastolic has normal EF

79
Q

diagnosing HF

A

history and physical, echocardiogram to show EF and ventricle size, chest Xray to show cardiomegaly, EKG, labs- cardiac enzymes/BNP, stress test, catheterization

80
Q

congestive heart failure

A

pulmonary congestion due to diastolic heart failure; increase pressure of pulmonary venous blood volume forcing fluid into pulmonary tissue and impairing gas exchange

81
Q

manifestations of congestive HF

A

dyspnea, crackles, low O2 sat, S3 heart sound (ventricular gallop = extra sound)

82
Q

managing HF

A

avoid caffeine, low soidum/low fat/low cholesterol diet, flluid restriction, potassium rock foods if taking K wasting diuretic, balance activity and rest, monitor weight gain and signs of fluid retention, lifestyle change, medis (ACEI, diuretics, digoxin, BB)

83
Q

right sided HF manifestations

A

peripheral venous congestion: JVD, hepatomegaly, cardiac cirrhosis, renal failure, peripheral edema, ascites; commonly caused by cor pulmonale or Left sided heart failure

84
Q

left sided HF manifestations

A

increased venous pulmonary pressure: pulmonary edema (dyspnea, orthopnea, paroxysmal nocturnal dyspnea), hypoxic ischemia, encephalopathy

85
Q

EF range (normal)

A

echocardiogram shows around 55-70%

86
Q

signs/symptoms of low cardiac output

A

decreased activity tolerance, muscle wasting/weight loss, weakness, anorexia/nausea, lightheadedness, AMS/confusion, tachycardia at rest, oliguria, pallor/cyanosis,

87
Q

gerontologic cardiac considerstions

A

may have atypical signs such as fatigue, weakness, somnolence; have decreased renal function

88
Q

risk factors for developing HF

A

old age, cigarette smoking, obesity, poorly managed diabetes, metabolic syndromes, CKD, HTN, CAD

Adults 1 (10 decks)

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