Cardiac Flashcards Preview

NCLEX > Cardiac > Flashcards

Flashcards in Cardiac Deck (68):
1

preload

the amount of blood returning to the right side of the heart and the muscle stretch that the volume causes. ANP is released when we have this stretch.

2

afterload

the pressure in the aorta and peripheral arteries that the left ventricle has to pump against to get the blood out

3

with HTN there's even more ____ for the left ventricle to pump against. that's why ____ can eventually lead to HF and pulmonary edema, because high afterload ____ CO and ____ forward flow. plus, it wears your heart out

resistance
HTN
decreases
decreases

4

stroke volume

the amount of blood pumped out of the ventricles with each beat

5

CO= ____

HR times SV

6

less pressure = ___ CO
more pressure = ___ CO

decrease
increase

7

If you CO is decreased,
will you perfuse properly?
brain: LOC will go ___
heart: client reports of ___
Lungs: SOB? Lung sounds?
Skin:
Kidneys: UO ___
peripheral pulses:

No
down
chest pain
yes and lungs sound wet
cool and clammy
down
weak and thready

8

what are 3 arrhythmias that are a big deal?!

1. pulseless vtach
2. vfib
3. asystole

9

chronic stable angina

decreased blood flow to the myocardium---ischemia--temp. pain/pressure in the chest

pain comes on by low o2 usually due to excretion

rest relieves pain or nitro

10

nitroglycerin:
____ preload and afterload.
take 1 every ___ , __ doses
okay to swallow?
renew how often?

decreases
5 mins, 3 doses
no
3-5months, spray 2 yrs

11

what should you do before giving beta blocker?

check HR and BP!!!

12

what is beta blocker?

[propanolol,metoprolol,]
for prevention of angina
-decrease BP,HR, myocardial contractility
-decreases the workload of the heart

13

calcium channel blockers?

[verapamil,amlodipine]
prevention of angina
-decreases BP
-causes vasodilation
-decrease afterload and increase o2 to the heart muscle

14

aspirin

use to keep platelets from sticking together
-dose it determined by the physician (81-225mg)

15

treatment for chronic stable angina

-nitro
-beta blocker
-calcium channel
-asa

16

the 5 p's

pulselessness
pallor
pain
paresthesia
paralysis

17

preprocedure for cardiac cath:

ask if they are allergic to shellfish or iodine
also check kidney function (because you excrete dye through the kidney)

18

post procedure for cardiac cath:
bed rest, leg straight for ___ hours
watch for bleeding
5 p's extremity distal to puncture site
major complication?___
if the client is on metformin, you should?

4 to 6 hours
hemmorage
hold the medicine for 48 hours post procedure. we are worried about the kidneys

19

what is the women triad of symptoms for acute MI?

GI S/S
epigastric complaints
pain between the shoulders
aching jaw
choking sensation

20

when a patient is having an STEMI, this indicates that the client is having a heart attack and the goal is ___

is to get them to the cath lab for PCI in less than 90 mins

21

what increases with damage to the cardiac cells?

when does it elevate?

CPK-MB
(cardiac specific iso-enzyme)

3-12 hours and peaks in 24 hours

22

troponin elevates within ____ and remains elevated for ___.

cardiac biomaker with high specificity to myocardial damage.

3-4 hours
3 weeks

23

myoglobin increases within ____ hours and peaks in __ hours.

1 hour
12 hours
(negative results are a good thing)

24

which cardiac biomarker is the most sensitive indicator for an MI?

troponin

25

which enzymes or markers are most helpful when the client delays seeking care for an MI?

tropinin

26

what untreated arrhythmias will put the client at risk for sudden death?

pulseless v-tach
vfib (dfib the vfib!)
asystole
bradycardia

27

if the first shock doesn't work and the client remain in vfib, what is the first vasopressor we give?

epinephine

28

lab value for troponin

T less than 0.10. I less than 0.03

29

____ is an anti-arrthythmic and is used when v-fib and pulseless VT are resistant to treatment, also for fast arrhythmias

amiodarone (drug of choice)

30

what anti-arrhythmic drugs are commonly given to prevent a second episode of v-fib?

amirodarone and lidocaine

31

lidocaine toxicity: _____

any neuro changes

32

amiodorone is _____.
important side effect is ____.

the first anti-arrhythmic of choice
hypotension

33

what drugs are used for chest pain when they get to theED?

oxgyen
ASA (chewable, absorbs faster)
nitro
morphine (if pain isnt relieved)

head up position.. because decreases workload on the heart and increases CO

34

what are the fibrinolytics drugs?
how soon after the onset of myocardial pain should these drugs be administered?

-dissolves the clot that is blocking the blood flow to the heart muscle----decreased the size of the infarction

streptokinase,alteplase

within 6-8hours
(exception to this is CVA, time loss is brain loss! 3hr with CVA)

35

what is the widow maker (sudden death)?

left main coronary artery occulsion

36

left side heart failure

the blood is not moving forward into the aorta and out to the body.... IF it does not move forward, then it will go backwards into the LUNGS!

37

s/s of left side heart failure

left=lungs!!
pulmonary congestion
dyspnea
cough
blood tinged frothy sputum
restlessness
tachycardia
S-3
orthopnea
nocturnal dyspnea

38

right side heart failure

the blood is not moving forward into the lungs...IF it does not move forward then it goes backwards into the VENOUS system

39

s/s of right side heart failure

right=venous thing
distended neck veins
edema
enlarged organ
weight gain
ascities

40

systolic heart failure

heart cant contract and eject

41

diastolic heart failure

ventricles cant relax and fill 

42

BNP (b-type natriuretic peptide):

-secreted by the ventricular tissue in the heart when the ventricular volumes and pressure in the heart increased
-sensitive indicator
-can be positive for HF when the CXR does not indicate the problem
-if the pt is on nesiritide, turn it off 2 hr prior to drawing BNP

43

how do you diagnose heart failure?

BNP
CXR
echocardiogram

44

what is the standard medication for HF?

ACE inhibitors and ARBs

45

ACE inhibiotors:

drug of choice for HF
suppress the renin angiotensin system
prevent conversion of angiotensin 1 to angiotensin 2
results in the arterial dilation and increased SV

46

ARBs

-block angiotenin 2 receptors, and cause a decrease in arterial resistance and decreased BP

47

ace inhibitors and ARBS block ____.

aldosterone. when we block aldosterone, we lose sodium and water and retain potassium.

48

digoxin is used with ....

sinus rhythm or afib and accompanying chronic HF.

makes contractions stronger
slows HR down
CO up
kidney perfusion UP

49

normal digoxin level

0.5-2

50

s/s of digoxin toxicity

early: anorexia, N/V
late: arrhythmias and visual changes (halos around the lights)

51

_____ + digoxin= toxcity

hypoglycemia

52

diuretic decrease ___.
when should you give diuretic?

preload
in the morning

53

loss of capture with pacemaker

no contraction will follow the stimulus

54

who is at risk for pulmonary edema?

any person :
receiving IV fluid really fast
very young and very old
any person with history of heart or kidney disease

55

what is pulmonary edema?

fluid is backing up into the LUNGD. the heart is unable to move the volume forward.
pulmonary edema usually occurs at night, when the client goes to lie down.

56

s/s of pulmonary edema?

sudden onset
breathless
restless/anxious
severe hypoxia
productive cough (pink frothy sputum)

57

tx for pulmonary edema?

diuretics
nitro
morphine
nesiritide

58

furosemide, you should give _____ to prevent hypotension and ototoxicity

40 mg IV push slowly over 1-2 mins

59

bumetanide can be given _____ to provide rapid fluid removal.

should be given ___ over 1-2 mins

IV push or as a continuous iv infusion

1-2 mg IV push

60

remember to turn the nesiritide infusion OFF ..... when?

2 hrs before drawing a BNP level

61

cardiac tamponade

-blood ,fluid, or exudate have leaked into the pericardial sac resulting in compression of the heart
-this can happen if the client has had a motor vehicle collision, right ventricular biopsy, and MI, pericarditis, or hemorrhage post CABG/s of c

62

s/s of cardiac tamponade

decreased CO
cvp will go UP
BP will drop
(hallmark is increase cvp, decrease bp)
heart sounds will be muffled or distant
neck veins distended
pressure in all 4 chambers are the same
shock
narrowed pulse pressure (bp 120/80...pule pressure is 40)

63

narrowed pulse pressure think:
widened pulse pressure think:

cardiac tamponade

increased intracanial pressure

64

tx for cardiac tamponade

pericardiocentesis to remove blood from around the heart
-surgery

65

intermittent claudication is hallmark sign for __.

arterial disorders

66

postion:
we ELEVATE ___
we DANGLE ___

veins
arteries

67

s/s of dissecting aorta

severe burning back pain, unlike anything
may feel pulsation

68

if vein problems, dont answer with an ____.

oxygen!