Cardiovascular Flashcards

(88 cards)

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
LDL cholesterol
brings plaques into the arteries
26
HDL cholesterol
removes lipids from the arteries
27
CAD manifestations
early is asymptomatic, chest pain, dyspnea, syncope, cough/hemoptysis, palpitations, excessive fatigue
28
diagnosing CAD
EKG: ischemia = ST depression, infarction = ST elevation; Lipid: cholesterol is elevated (LDL vs. HDL), stress tests, Cardiac cath.
29
cardiac catheterization
angiogram used to diagnose CAD; injection of dye into arteries to identify atherosclerotic plaques blocking off blood flow (plaques do not light up)
30
treatment of CAD
tobacco cessation, manage HTN, low cal sodium cholesterol fat and increased fiber diet, control DM, stress reduction, alcohol reduction, pharmacological management
31
angina pectoris
chest pain d/t ischemia from lack of oxygen; can be caused by obstruction or spasm
32
variant angina (prinzmetal)
caused by coronary vasospasm commonly caused by smoking or cocaine
33
symptoms of prinzmetal angina
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
34
treatment of prinzmetal angina
smoking cessation, calcium channel blockers
35
stable angina
caused by myocardial atherosclerosis
36
stable angina symptoms
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
stable angina treatment
nitrates, beta blockers, calcium channel blockers, aspirin
38
unstable angina (pre-infarction)
due to ruptures or thickened plaque with platelet and fibrin thrombus
39
unstable angina symptoms
angina of increasing intensity frequency or duration, occurs at rest or with minimal activity, lasts > 15 min, pain unresponsive to NTG
40
unstable angina treatment
oxygen, pain meds, nitrates, beta blocker, clopidogrel, aspirin (antiplatelet), statins, tPA (dissolves clot)
41
angina manifestations
pain, dyspnea, pallor, sweating, dizziness/syncope, palpitations/tachycardia, HTN, digestive disturbances
42
tests to diagnose angina
EKG (normal in stable angina), cardiac enzymes, stress test, cardiac catheterization
43
acute management of angina
pain assess and management, IV access, O2, continuous vitals, EKG q10min, NTG, rest semi-fowler, reduce anxiety
44
long term management of angina
lifestyle modifications similar to CAD, medication adherence, understanding the disease
45
medications for angina
nitrates, beta blockers, calcium channel blockers, antiplatelet therapy
46
older adult cardiac considerations
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
Percutaneous coronary intervention (PCI)
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
coronary artery bypass graft (CABG)
taking artery from one spot of body and placing it in different area to bypass plaque or obstruction
49
cardiac procedures
cardiac catheterization, PCI, CABG
50
peripheral arterial disease
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
gangrene
wide spread tissue death
52
what causes decreased blood flow in PAD
atherosclerotic plaque leading to narrowing of vessels
53
symptoms of peripheral arterial disease (PAD)
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
venous insufficiency due to
prolonged venous HTN that stretched and damaged valves decreasing blood flow back toward heart
55
symptoms of venous insufficiency
venous congestion/stasis, edema, brown discoloration along ankles up to calf, stasis ulcers, cellulitis, pulses present
56
if pulses are diminished in venous insufficiency, then due to...
edema
57
ankle brachia index
test used to determine if individual has peripheral arterial disease; if brachial pressure > ankle pressure = PAD; value should be about 1
58
ankle-brachial index formula
ankle pressure/brachial prsssure = 1; if lower than 1 = PAD
59
nursing interventions of PAD
refrain from elevating above heart, walk until claudication (cramp) then rest then repeat, avoid crossing legs, avoid caffeine and tobaccos,
60
PAD treatment medications
antiplatelet therapy: ASA, clopidogrel; phosphdiesterase III inhibitor: cilstazol; HMG CoA reductase inhibitors: high dose statins
61
PAD treatment endovascular
angioplasty with/without stent; balloon; atherectomy
62
PAD surgical management
bypass grafts
63
venous insufficiency nursing interventions
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
arterial ulcer
punched out, deep, round shape, thin shiny skin, dry; d/t inadequate oxygen supply
65
venous ulcer
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
treatment of ulcers
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
nursing intervention for ulcer
restore skin, improve mobility, promote adequate nutrition (high protein, VitC, VitA, iron, zinc)
68
lymphangitis
acute inflammation of lymphatic channels; red streak up arm
69
lymphadenitis
lymph node infected; large red and tender; can become necrotic; present in groin, axilla, cervical (neck)
70
lymphedema
can be primary (no known cause) or secondary (d/t increased lymph); increase in lymph d/t obstruction of vessel
71
treatment of lymph edema
ambulatory-compression stockings, manual drainiage, physiotherapy, skin care
72
types of heart failure
left ventricular failure (most common), right ventricular failure (often result of left vent. failure), systolic failure (HFrEF), diastolic failure (HFpEF)
73
systolic heart failure (HFrEF) vs. diastolic failure (HFpEF)
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
systolic HF
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
end result of sytolic HF
workload of heart increases, contractility decreases, increased end diastolic blood volume, then ventricular dilation
76
diastolic HF
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
in simple terms, systolic or HFrEF...
impairs contractility leading to low ejection fraction from weak and thin heart muscle
78
in simple terms diastolic or HFpEF...
impairs filling and relaxation of heart due to stiff and thick heart muscle; diastolic has normal EF
79
diagnosing HF
history and physical, echocardiogram to show EF and ventricle size, chest Xray to show cardiomegaly, EKG, labs- cardiac enzymes/BNP, stress test, catheterization
80
congestive heart failure
pulmonary congestion due to diastolic heart failure; increase pressure of pulmonary venous blood volume forcing fluid into pulmonary tissue and impairing gas exchange
81
manifestations of congestive HF
dyspnea, crackles, low O2 sat, S3 heart sound (ventricular gallop = extra sound)
82
managing HF
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
right sided HF manifestations
peripheral venous congestion: JVD, hepatomegaly, cardiac cirrhosis, renal failure, peripheral edema, ascites; commonly caused by cor pulmonale or Left sided heart failure
84
left sided HF manifestations
increased venous pulmonary pressure: pulmonary edema (dyspnea, orthopnea, paroxysmal nocturnal dyspnea), hypoxic ischemia, encephalopathy
85
EF range (normal)
echocardiogram shows around 55-70%
86
signs/symptoms of low cardiac output
decreased activity tolerance, muscle wasting/weight loss, weakness, anorexia/nausea, lightheadedness, AMS/confusion, tachycardia at rest, oliguria, pallor/cyanosis,
87
gerontologic cardiac considerstions
may have atypical signs such as fatigue, weakness, somnolence; have decreased renal function
88
risk factors for developing HF
old age, cigarette smoking, obesity, poorly managed diabetes, metabolic syndromes, CKD, HTN, CAD