Cardiovascular Flashcards
(134 cards)
1
Q
atrioventricular valves control blood flow from the _________ and they are the __________
A
atria to ventricle; mitral (left) (bicuspid) and tricuspid (right)
2
Q
semilunar valves control flow from ________ and are the ________
A
ventricles to pulmonary artery or to the aorta; pulmonic semilunar valve and septic semilunar valve
3
Q
blood flow through the heart/body
A
vena cava -> right atria -> tricuspid valve -> right ventricle -> pulmonary valve -> through pulmonary artery and to lungs -> returns from lungs as oxygenated blood and comes back into the left atria through the pulmonary veins -> mitral valve -> left ventricle -> out aorta and to the rest of the body
4
Q
systole is the
A
ventricle contracting and sending blood out to the body
5
Q
diastole is the
A
ventricles relaxing and filling up with blood from the atria
6
Q
action potential is
A
the explosion of electrical activity created by depolarize event which is how the heart knows when to contract and relax. Depolarization = contraction (systole) Repolarization = relaxation (diastole)
7
Q
order of electrical conduction system
A
SA node -> AV node -> bundle of His -> bundle branches R and L -> purkinje fibers
8
Q
primary pacemaker of heart is the
A
SA node
9
Q
secondary pacemaker of the heart
A
AV node
10
Q
preload
A
amount of blood returning to R side of heart
11
Q
after load
A
pressure against which the L ventricle must pump to eject blood
12
Q
compliance
A
how easily the heart muscle expands when filled with blood
13
Q
contractility
A
strength of contraction of heart muscle
14
Q
stroke volume
A
volume of blood pumped out of the ventricles with each contraction
15
Q
cardiac output
A
amount of blood heart pumps through circulatory system in a minute
16
Q
autonomic nervous system control of the heart
A
sympathetic - increase electrical conductivity and myocardial contraction (epi and norepi)
parasympathetic - slow conduction of action potentials through the heart, reduce strength or contraction (acetylcholine)
17
Q
Beta adrenergic receptors
A
B1 - in heart: increase HR and contractility (chronotropy and intropy)
B2 - in lungs: causes bronchodilation
18
Q
ejection fraction
A
amount of blood ejected per heartbeat - should be 55% or higher; indicated ventricular function
19
Q
stroke volume is determined by
A
preload, after load, contractility
20
Q
cardiac output equation
A
CO = SV x HR
21
Q
why is CO important?
A
tissue perfusion
end organ function
delivery of oxygen and nutrients
22
Q
S&S or poor CO
A
decreased LOC
chest pain, weak peripheral pulses
SOB, crackles, rales
cool, clammy, mottled extremities
decreased urine output
23
Q
causes of decreased CO
A
bradycardia, arrhythmias, hypotension, MI, cardiac muscle disease
24
Q
causes of increase CO
A
sometimes increased blood volume and tachycardia, medications including ACE inhibitors, ARBS, nitrates, inotropes
25
normal CO
4-8 L/min
26
Central venous pressure
2-6 mmHg
27
MAP define
average arterial pressure throughout one cardiac cycle - systole and diastole
28
MAP normal
70-100 mmHg
29
MAP must be at least ____ for adequate perfusion of vital organs
60 mmHg
30
systemic vascular resistance define and normal
resistance exerted on circulating
blood by the vascular of the body
800-1200
31
antihypertensives
ACE inhibitors, ARBs, Calcium channel blockers, beta blockers, arterial and venous dilators
32
ACE inhibitors
reduce after load by acting on RAAS - blocks conversion of angiotensin (less volume = less pressure), increases renin levels, decreased aldosterone leading to vasodilation
33
Nursing considerations ACE inhibitors
dry cough (discontinue), monitor BP, angioedema, contraindicated during pregnancy
34
ACE inhibitors end in
-pril
35
ARBs end in
-sartan
36
ARBs
inhibits vasoconstrictive properties of angiotensin
37
ARBs nursing considerations
monitor BP, monitor fluid levels, monitor renal and liver status, contraindicated during pregnancy
38
Calcium channel blockers end in
-ipine or -pril
39
Calcium channel blockers
block transport of calcium into muscle cells inhibiting excitation and contraction (cause Ca acts as a sedative so by blocking it we are doing the opposite) inhibits excitation and contraction, causes peripheral vasodilation
40
nursing considerations for calcium channel blockers
avoid grapefruit, monitor bp (orthotic hypotension), can cause gingival hyperplasia
41
arterial dilators
cause decreased BP, arterial vasodilation, reduction in after load, increased CO
Hydralazine and minoxidil
42
venodilators
reduce preload, reduce venous returns to the heart, dilates arteries at higher doses
nitrates
43
betablockers end in
-lol
44
betablockers
antiarrhythmic; blocks beta 1 and 2 adrenergjc receptors which slow the heart rate
can also help with htn
45
beta blocker nursing considerations
do not discontinue abruptly, can mask signs of hypoglycemia, can potentially cause bronchospasm (caution with asthma and COPD)
46
by influencing the electrolytes going in and out of the heart we can control the __________________
electrical activity
47
amiodarone
potassium channel blocker, antiarrhythmic, stops potassium from leaving cells and prolongs rest period
48
amiodarone nursing considerations
dizziness, tremors, ataxia, pulmonary fibrosis, bradycardia, heart block, blue gray skin discolouration, has iodine and can disturb thyroid, not given in pregnancy
49
Adenosine is used for
SVT
50
adenosine is the medication version of _______________
cardioversion
51
Nursing considerations for adenosine
there will be a period of asystole
needs to be a rapid push or it will not work
client will feel "like they have been kicked in the chest"
52
adenosine needs to be used with caution in pts with _____________
asthma
53
Atropine is use for
excessive scretions (anticholinergic), sinus bradycardia, heart block
54
atropine needs to be avoided in pts with
glaucoma
55
atropine increases the _________ and causes _____________ which _________ secretions
heart rate; bronchodilation; decreasing
56
pts on atropine need to monitored for
urinary retention and constipation
57
the drug that is a cardiac glycoside is
digoxin
58
digoxin is given for
HF, afib, aflutter, CHF, cardiogenic shock
59
digoxin increases ________ and decreases ____________
contractility; rate
60
increase in heart contractility is also called a
positive inotrope
61
decrease in heart rate is also called a
negative chronotropy
62
early S&S of digoxin toxicity
n/v, anorexia, vision changes - yellow/green halos
63
late S&S of digoxin toxicity
bradycardia
arrhythmias
64
risk factors for digoxin toxicity
hypokalemia
loop diuretic
licorice extract (acts like aldosterone)
hypomagnesemia
hypercalcemia
elderly; decreased renal and liver function
65
should hold a digoxin dose when
the heart rate is less 60
66
antidote for digoxin is
digoxin immune fab
67
inotropes ___________ and examples
increase contractility of heart; dopamine, dobutamine, milrinone
68
vasopressors ________ and examples
cause constriction of blood vessles helping to increase bp; norepi, epi, vasopressin, phenylephrine
69
vasopressors are commonly given when
pt is hypotensive and we need to increase the preload to increase the cardiac output
70
Peripheral vascular disease (PVD)
inadequate venous return over a long period causing pathologic ishcemia; blood flow back to heart is affected
71
PVD S&S and Tx
brown disocoloration, uneven wound edges around ankle, swelling, pedal pulse will still be present
Tx: elevate legs, proper wound care
72
DVT
clot that remains attached to the vascular wall; caused by venous stasis, vein wall damage, hypercoaguable states
73
DVT tx
anticoagulants
prevent by promoting venous return
74
Superior Vena Cava Syndrome
tumor compressing SVC - blood cannot drain from upper body; will most commonly be seen in oncologic pts
75
Superior vena cava syndrome S&S
headache, blurry vision, non-pulsatile distended neck veins, distention of thoracic veins, facial plethora, glossitis, dyspnea, upper extremity edema
76
Atherosclerosis
inflammatory disease; plaque builds up an causes decrease blood flow to the areas they are located
77
atherosclerosis is the most common cause of
coronary artery disease and CVA
78
Hypertensive crisis is a bp over
>180 / >120
79
htn S&S
often asymptomatic until severe - dizziness, headaches, vision chnages, angina, nose bleeds, SOB
80
htn medications
ACE inhibitors
beta bockers
Calcium channel blockers
diuretics (get rid of fluid to take pressure off of heart)
81
orthostatic hypotension
BP drops when client changes from lying to sitting to standing; client may faint; falls can cause serious injury
82
Aneurysm
localized dilation of a vessel wall - most common is aorta
83
causes of aneurysm
atherosclerosis, htn, smoking, hx
84
AAA S&S
gnawing, sharp pain
abdominal and back pain
85
thoracic aortic aneurysm S&S
back pain, hoarseness, struggling to swallow, SOB
86
rupture of an aneurysm causes a
hemorrhage
87
embolism
clot that dislodges and is mobile and can occlude the vasculature
88
at riks clients for an embolism
pregnancy (hypercoaguable, amniotic fluid can be forced into blood stream), a fib, long bone fracture (pelvis and femur)
89
substance an embolism can be
fat, air, bacteria, blood clot, amniotic fluid
90
high risk for air embolism are pts with
CVC or arterial catheter
91
position pt with air embolism or to prevent one when removing CVL in ______________ and why?
durant's maneuver - left lateral trendelenburg; prevents air embolism from lodging into lungs
92
fat embolism S&S
hypoxia, dyspnea, tachypnea, confusion, altered LOC, petechial rash (sometimes) - symptoms dependent on where it is lodged and treatment depends on symptoms and location
93
fat embolisms are most likely to occur from
long bone and pelvic fractures
94
Peripheral artery disease (PAD)
atherosclerosis of arteries that perfuse the limbs (especially lower); causes decrease perfusion to area
95
S&S PAD
pallor, pulselessness, hairlessness, intermittent claudication - pain occurs in legs while walking and gets better with rest
96
treatment for PAD
dangle legs
antiplatelet therapy
97
PAD vs PVD
PAD blood flow back to lower extremities is affected (cannot get to tissues); PVD blood flow back the heart is affected
98
coronary artery disease
occlusion of coronary arteries; most often resulting from atherosclerotic plaques
99
CAD can cause
MI, chronic stable angina (reversible)
100
chronic stable angina
caused by narrowing of arteries and plaque build up; periods of decrease blood flow to heart
101
decreased blood flow and O2 to heart leads to
ischemia
102
________ causes the chest pain in angina
ischemia
103
chronic stable angina the pain is
predictable and goes away with rest or nitro
104
treatment for chronic stable angina
nitro - open veins and arteries (dilation) -> decrease afterload -> increased CO
105
nitro doses
1 Q5 min x 3doses; no more than this unless bp being closely monitored because it can tank the bp
106
expected side effect of nitro and why
headache; b/c of massive dilation
107
unstable angina
does not go away with rest or nitro; reversible myocardial ischemia
108
if unstable angina is not treated quickly it will progress to
MI
109
MI
prolonged decrease blood flow to heart resulting in irreversible damage to the heart muscle; STEMI (more severe) or non-STEMI
110
MI S&S
crushing chest pain radiating to L arm or jaw or between shoulder blades, epigastric discomfort, fatigue, SOB, vomiting, elevated trops
women and elderly more likely to have GI symptoms
111
MI tx
cath lab within 90min; in the mean time oxygen, nitro, thrombolytic (if appropriate), antiplatelets (aspirin), monitoring, EKG to assess heart activity
112
MONA correct order
oxygen (only if sats low)
nitro
morphine (pain and decrease workload of heart limiting ischemic damage), aspirin (decrease chance of forming clots)
113
Pericarditis
inflammation of pericardium; caused by infection, tumor, drugs
114
pericarditis S&S and Tx
sharp chest pain, tachypnea, fever, chill, weakness
tx: NSAIDs
115
pericardial effusion
collection of fluid in pericardial sac; impairs cardiac function if severe and can lead to obstructive cardiogenic shock
116
pericardial effusion S&S and tx
chest pain, MUFFLED HEART SOUNDS
tx: pericariocentesis
117
cardiac tamponade
blood, fluid, or exudate has leaked into pericardial sac
118
cardiac tamponade S&S and tx
chest pain, SOB, decreased CO, muffle/distant heart sounds, JVD, narrowed pulse pressure (<40)
tx: pericardiocentesis and sx
119
cardiomyopathies
disease of myocardial tissue
120
types of cardiomyopathies
dilate - makes it harder for heart to pump blood to rest of body, wall of heart is too big and stretchy = poor contractility
restrictive - too stiff, cannot relax and fill with blood; decreased preload and CO
hypertrophic - wall too thick, poor contractility
121
S&S and tx of cardiomyopathies
both dependent on type and cause
122
stenosis of heart valves is the
narrowing
123
regurgitation of the heart valves is
them not closing properly causing backflow
124
endocarditis
infection and inflammation of endocardium; affects the valves
125
endocarditis can lead to and Tx
valve stenosis and regurgitation, poor CO, bacteremia , bacteria emboli
tx: abx
126
dysrhythmias are caused by
SA node generating abnormal rate and impulses not be conducted properly
127
Heart failure
the inability of the heart muscle to pump enough blood to meet the body's needs for blood and oxygen
128
number one cause of HF is
htn
129
Left sided HF
cannot move blood forward to the body and is backing up in the lungs
130
Left sided HF S&S
dyspnea, cough, orthopnea, S3, pulmonary congestion, wet lung sounds, blood-tinged sputum, weakness, cyanosis, confusion
131
right sided HF
right side of heart cannot move blood forward to the lungs and backs up in the body
132
right sided HF S&S
ascites, weight gain, fatigue, anorexia, JVD, dependent edema, hepatomegaly, splenomegaly
133
HF treatment
decrease workload of the heart
ACE inhibitors, ARBs, digoxin, diuretics
134
