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NUR720 FNP Review > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

MI s/s

A

male: heavy chest, left shoulder/jaw pain, clammy
women: unusual fatigue, back pain, n/v

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2
Q

AAA (dissecting abd aortic aneurysm)

A

elderly white male
pulsating sensation in abdomen or low back
impending rupture- “sudden” sharp pain to chest/low back.

high risk: HTN/smoker

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3
Q

CHF

A

elderly pt c/o sob, “dry cough”, swollen ankles, increase weight
crackles
s3 heart sound
hx: cad, prior MI

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4
Q

bacterial endocarditis s/s

A

check their fingers/toes
janeway lesions- tender red spots on the palms/soles
splinter hemorrhage- splinter hemorrhage on nailbed

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5
Q

pregnant PMI

A

located upward on the left side

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6
Q

Deoxygenated blood

A

SVC, right atrium, tricuspid, right ventricle, PULMONIC VALVE, lungs, alveoli (RBC pick p02 and release co2)

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7
Q

oxygenated blood

A

left atria, mitral valve, left ventricle, , AORTIC VALVE, aorta, general circulation

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8
Q

s1 sound

s2 sound

A

closure of mitral/tricuspid valve
3 leaflets

s2- aortic/pulmonic valves
semilunar valves- 2 leaflets

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9
Q

s3

A 
CHF! or heart failure
occurs during "early diastole" 
aka" ventricular gallop"
alway abnormal if >35yo
normal in young children and athletes if no other s/s

In older individuals it indicates the presence of congestive heart failure. The third heart sound is caused by a sudden deceleration of blood flow into the left ventricle from the left atrium.

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10
Q

s4

A

LVH
stiff left ventricle
The fourth heart sound (S4), when audible, is caused by vibration of the ventricular wall during atrial contraction. This sound is usually associated with a stiffened ventricle (low ventricular compliance), and therefore is heard in patients with ventricular hypertrophy, myocardial ischemia, or in older adults.

aka “atrial gallop” or “atrial kick”

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11
Q

summation gallop

A

s1-s4 heart

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12
Q

benign split s2

A

best heard over pulmonaic area (left sternum). normal finding if it occurs during inspiration, disappears expiration

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13
Q

bengin s4 in elderly

A

if no s/s of heart/valvular disease it is normal

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14
Q

MR ASS

A

mitral regur- best heart apex. axilla, high pitched (use diaphragm to listen)

aortic stenosis- radiates to neck
noisy murmur- use bell

systolic murmurs- loud, radiate to neck or axilla

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15
Q

MS. ARD

A

mitral stenosis- use diaphragm
aortic regurg- use bell
diastolic

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16
Q

heart murmur grading

A

I-VI

IV- louder murmur, first time a thrill is present “palpable mur mur”

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17
Q

ALL diastolic (MS AR)= abnormal

all benign mumurs occurring during systole (s1)
benign murmur do NOT have a thrill

A

true

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18
Q

Mitral valve location

A

apex of the heart
apical area
5th ICS on the left side of the sternum medial to the midlclavicular line

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19
Q

only systolic murmur radiate

A

mitral regurg- axilla

aortic stenosis- neck

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20
Q

s3 is a sign of what

A

CHF

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21
Q

s4 is a sign of what

A

LVH

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22
Q

s2 split heard best heard where

A

pulmonic area

23
Q

afib tx

A 
use CHADs2 score (2 or more requires anticoag)
C (CHF)
H (HTN)
A (>75yo)
D (DM)
S (hx Stroke/TIA)
2 (2 or more)

classic case: pt c/o heart palpitations, sob, chest pain, syncope.
tx: ecg, tsh, electrolytes, 24 hr holder, digoxin level, echo (r/o vavular pathology)

lifestyle: avoid stimulants and alcohol

24
Q

afib medications

A

rate: CCB, BB or dig
rhythm: amiodaron (cordarone) . black box: pulmonary and liver damage

**SIMVASTATIN with AMIODARONE”= rhabdo

anticoag with warfarin, baseline INR and CBC

patient education -eat Vit K in food

25
Q

paroxysmal atrial tachy

A

peaked qrs.

ie: abrupt onset palpitations, sob, anxiety, HR 150-250
management: hold one’s breath, carotid massage, splash ice cold water (valsalva maneuvers)

26
Q

pulsus parodoxus (paradoxical pulse)

A

pericarditis
cardio effusion

apical pulse heard, radial pulse no longer palpable

27
Q

jnc 8 blood pressure

A

> 60 yo, 18 yo with CKD or DM

28
Q

HTN medications for blacks

A

CCB or thiazaide (BB cause angioedema)

29
Q

HTN medications with CKD

A

ace/arb

30
Q

rule out organ damage in HTN

A

eyes: silver/copper wire arterioles, AV junction nicking, flame shaped hemorrhages, papilledema

kidneys: microalbumin, proteinuria
elevated creatine, gfr, edema

heart: s3 (CHF), s4 (LVH)
carotid vruits

31
Q

CCB medications

A 
"pine"
nifedipine ( procardia)
amlodipine (norvac)
verapamil (calan)
dilt (cardizem)
32
Q

thiazide diuretics

A 
good for osteoporosis
hyperglycemia
hyperuricemia 
hypokalemia
hyper triglyceriemia ( check lipids)

don’t use if allergic to sulfa

33
Q

side effects of spironolactone

A

gynecomastia

34
Q

left ventricular failure

A

Left = L (lungs)

crackles, cough, sob

35
Q

right ventricular failure

A

GI

JVD (normal mvd is 4cm or less)
enlarged spleen, enlarged liver, lower extremity edema

36
Q

tx for CHF

A

lasix 20mg, nitro, ace/arb

37
Q

DVT assessment

A

positve humans sign (pain with dorsiflexion of the foot)

gold standard- contract venography

38
Q

PVD or PAD gold standard dsg

A

angiography

low tech- ankle/brachial BP before and after exercise

39
Q

raynauds tx

A

CCB (vasodilate)- nifedepine, amlodipine
avoid BB, vasoconstriction drugs (decongestants, amphetamines), smoking cesession

  • think american flag, red/white/blue
40
Q

if triglicerides >500

A

priority before lowering LDL dt risk of acute pancreatitis
tx with niacin or vibrate
low fat dient (

41
Q

statin interactions

A

increase risk for rhabdo:

grapefruit juice
fibrates ( except fenofibrate)
antifungals! (intraconazole, ketonazole)
macrolide
amiodarone
CCB (dilt, amloidipine, verapamil)
42
Q

tx plan for high cholesterol

A

lifestyle (weight loss, exercise most days, smoking cession ), dash (low salt, low sat fat)
soluble fiber (inulin, guar gum, fruit, veges)
beneficial stanols and sterols (benecol, smart balance margarine)
** If not changes 6 months of lifestyle, consider anti lipid drugs if more than 2 risk factors

43
Q

risk factors for heart disease (CHD)

A 
htn
family hx of premature heart disease (women with MI 45, women>55)
smoking
BMI>30
microalbuminuria
CAD, PVD
44
Q

albuminuria values

A

ln a single urine specimen, a level of more than 30 mg of albumin per gram of creatinine is considered positive.

For a 24-hour urine collection, 30 to 300 mg of albumin means albuminuria.

CA: >1:30

45
Q

agents to HDL (no impact on LDL)

A

nicotinic acid (niacin) OTC, niaspan

fibrates: fenofibrate (tricor)
alternate: bile acide séquestrants

high trig- avoid junk food
low HDL- exercise

46
Q

rhabo labs

A

> CK: 10,000-25,000
proteinuria in up to 45% LFT
pain, weakness, dark urine

47
Q

advice if low HDL

A

aerobics
niacin OTC
or tx niacin (niaspan) or fibrates

48
Q

waist circumference in obese

A

females: >35 inches or 88cm
males: >40 or 102cm

49
Q

metabolic syndrome critieria

A

3 must be present;
abdominal obesity (>40 male, >35 females)
HTN
hyerlipidemia

hypertension: fasting glucose >100, triglerides >150,

50
Q

trigleride level normal

A

less than 150

51
Q

increase triglerceride level can cause

A

fatty liver (steatosis) aka nonalcoholid fatty liver disease

look for >ast/alt, negative hep a, b, c.

educate: decrease simple carbs

52
Q

bmi calculations

A

weight divided by height

53
Q

PEF calculations

A

hag,

height, age, gender

NUR720 FNP Review (24 decks)

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