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NCLEX > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

atrioventricular valves control blood flow from the _________ and they are the __________

A

atria to ventricle; mitral (left) (bicuspid) and tricuspid (right)

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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

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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

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4
Q

systole is the

A

ventricle contracting and sending blood out to the body

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5
Q

diastole is the

A

ventricles relaxing and filling up with blood from the atria

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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)

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7
Q

order of electrical conduction system

A

SA node -> AV node -> bundle of His -> bundle branches R and L -> purkinje fibers

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8
Q

primary pacemaker of heart is the

A

SA node

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9
Q

secondary pacemaker of the heart

A

AV node

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10
Q

preload

A

amount of blood returning to R side of heart

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11
Q

after load

A

pressure against which the L ventricle must pump to eject blood

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12
Q

compliance

A

how easily the heart muscle expands when filled with blood

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13
Q

contractility

A

strength of contraction of heart muscle

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14
Q

stroke volume

A

volume of blood pumped out of the ventricles with each contraction

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15
Q

cardiac output

A

amount of blood heart pumps through circulatory system in a minute

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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)

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17
Q

Beta adrenergic receptors

A

B1 - in heart: increase HR and contractility (chronotropy and intropy)

B2 - in lungs: causes bronchodilation

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18
Q

ejection fraction

A

amount of blood ejected per heartbeat - should be 55% or higher; indicated ventricular function

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19
Q

stroke volume is determined by

A

preload, after load, contractility

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20
Q

cardiac output equation

A

CO = SV x HR

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21
Q

why is CO important?

A

tissue perfusion
end organ function
delivery of oxygen and nutrients

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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

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23
Q

causes of decreased CO

A

bradycardia, arrhythmias, hypotension, MI, cardiac muscle disease

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24
Q

causes of increase CO

A

sometimes increased blood volume and tachycardia, medications including ACE inhibitors, ARBS, nitrates, inotropes

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25
Q

normal CO

A

4-8 L/min

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26
Q

Central venous pressure

A

2-6 mmHg

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27
Q

MAP define

A

average arterial pressure throughout one cardiac cycle - systole and diastole

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28
Q

MAP normal

A

70-100 mmHg

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29
Q

MAP must be at least ____ for adequate perfusion of vital organs

A

60 mmHg

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30
Q

systemic vascular resistance define and normal

A

resistance exerted on circulating
blood by the vascular of the body

800-1200

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31
Q

antihypertensives

A

ACE inhibitors, ARBs, Calcium channel blockers, beta blockers, arterial and venous dilators

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32
Q

ACE inhibitors

A

reduce after load by acting on RAAS - blocks conversion of angiotensin (less volume = less pressure), increases renin levels, decreased aldosterone leading to vasodilation

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33
Q

Nursing considerations ACE inhibitors

A

dry cough (discontinue), monitor BP, angioedema, contraindicated during pregnancy

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34
Q

ACE inhibitors end in

A

-pril

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35
Q

ARBs end in

A

-sartan

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36
Q

ARBs

A

inhibits vasoconstrictive properties of angiotensin

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37
Q

ARBs nursing considerations

A

monitor BP, monitor fluid levels, monitor renal and liver status, contraindicated during pregnancy

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38
Q

Calcium channel blockers end in

A

-ipine or -pril

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39
Q

Calcium channel blockers

A

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

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40
Q

nursing considerations for calcium channel blockers

A

avoid grapefruit, monitor bp (orthotic hypotension), can cause gingival hyperplasia

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41
Q

arterial dilators

A

cause decreased BP, arterial vasodilation, reduction in after load, increased CO

Hydralazine and minoxidil

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42
Q

venodilators

A

reduce preload, reduce venous returns to the heart, dilates arteries at higher doses

nitrates

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43
Q

betablockers end in

A

-lol

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44
Q

betablockers

A

antiarrhythmic; blocks beta 1 and 2 adrenergjc receptors which slow the heart rate

can also help with htn

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45
Q

beta blocker nursing considerations

A

do not discontinue abruptly, can mask signs of hypoglycemia, can potentially cause bronchospasm (caution with asthma and COPD)

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46
Q

by influencing the electrolytes going in and out of the heart we can control the __________________

A

electrical activity

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47
Q

amiodarone

A

potassium channel blocker, antiarrhythmic, stops potassium from leaving cells and prolongs rest period

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48
Q

amiodarone nursing considerations

A

dizziness, tremors, ataxia, pulmonary fibrosis, bradycardia, heart block, blue gray skin discolouration, has iodine and can disturb thyroid, not given in pregnancy

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49
Q

Adenosine is used for

A

SVT

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50
Q

adenosine is the medication version of _______________

A

cardioversion

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51
Q

Nursing considerations for adenosine

A

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”

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52
Q

adenosine needs to be used with caution in pts with _____________

A

asthma

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53
Q

Atropine is use for

A

excessive scretions (anticholinergic), sinus bradycardia, heart block

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54
Q

atropine needs to be avoided in pts with

A

glaucoma

55
Q

atropine increases the _________ and causes _____________ which _________ secretions

A

heart rate; bronchodilation; decreasing

56
Q

pts on atropine need to monitored for

A

urinary retention and constipation

57
Q

the drug that is a cardiac glycoside is

A

digoxin

58
Q

digoxin is given for

A

HF, afib, aflutter, CHF, cardiogenic shock

59
Q

digoxin increases ________ and decreases ____________

A

contractility; rate

60
Q

increase in heart contractility is also called a

A

positive inotrope

61
Q

decrease in heart rate is also called a

A

negative chronotropy

62
Q

early S&S of digoxin toxicity

A

n/v, anorexia, vision changes - yellow/green halos

63
Q

late S&S of digoxin toxicity

A

bradycardia
arrhythmias

64
Q

risk factors for digoxin toxicity

A

hypokalemia
loop diuretic
licorice extract (acts like aldosterone)
hypomagnesemia
hypercalcemia
elderly; decreased renal and liver function

65
Q

should hold a digoxin dose when

A

the heart rate is less 60

66
Q

antidote for digoxin is

A

digoxin immune fab

67
Q

inotropes ___________ and examples

A

increase contractility of heart; dopamine, dobutamine, milrinone

68
Q

vasopressors ________ and examples

A

cause constriction of blood vessles helping to increase bp; norepi, epi, vasopressin, phenylephrine

69
Q

vasopressors are commonly given when

A

pt is hypotensive and we need to increase the preload to increase the cardiac output

70
Q

Peripheral vascular disease (PVD)

A

inadequate venous return over a long period causing pathologic ishcemia; blood flow back to heart is affected

71
Q

PVD S&S and Tx

A

brown disocoloration, uneven wound edges around ankle, swelling, pedal pulse will still be present
Tx: elevate legs, proper wound care

72
Q

DVT

A

clot that remains attached to the vascular wall; caused by venous stasis, vein wall damage, hypercoaguable states

73
Q

DVT tx

A

anticoagulants
prevent by promoting venous return

74
Q

Superior Vena Cava Syndrome

A

tumor compressing SVC - blood cannot drain from upper body; will most commonly be seen in oncologic pts

75
Q

Superior vena cava syndrome S&S

A

headache, blurry vision, non-pulsatile distended neck veins, distention of thoracic veins, facial plethora, glossitis, dyspnea, upper extremity edema

76
Q

Atherosclerosis

A

inflammatory disease; plaque builds up an causes decrease blood flow to the areas they are located

77
Q

atherosclerosis is the most common cause of

A

coronary artery disease and CVA

78
Q

Hypertensive crisis is a bp over

A

> 180 / >120

79
Q

htn S&S

A

often asymptomatic until severe - dizziness, headaches, vision chnages, angina, nose bleeds, SOB

80
Q

htn medications

A

ACE inhibitors
beta bockers
Calcium channel blockers
diuretics (get rid of fluid to take pressure off of heart)

81
Q

orthostatic hypotension

A

BP drops when client changes from lying to sitting to standing; client may faint; falls can cause serious injury

82
Q

Aneurysm

A

localized dilation of a vessel wall - most common is aorta

83
Q

causes of aneurysm

A

atherosclerosis, htn, smoking, hx

84
Q

AAA S&S

A

gnawing, sharp pain
abdominal and back pain

85
Q

thoracic aortic aneurysm S&S

A

back pain, hoarseness, struggling to swallow, SOB

86
Q

rupture of an aneurysm causes a

A

hemorrhage

87
Q

embolism

A

clot that dislodges and is mobile and can occlude the vasculature

88
Q

at riks clients for an embolism

A

pregnancy (hypercoaguable, amniotic fluid can be forced into blood stream), a fib, long bone fracture (pelvis and femur)

89
Q

substance an embolism can be

A

fat, air, bacteria, blood clot, amniotic fluid

90
Q

high risk for air embolism are pts with

A

CVC or arterial catheter

91
Q

position pt with air embolism or to prevent one when removing CVL in ______________ and why?

A

durant’s maneuver - left lateral trendelenburg; prevents air embolism from lodging into lungs

92
Q

fat embolism S&S

A

hypoxia, dyspnea, tachypnea, confusion, altered LOC, petechial rash (sometimes) - symptoms dependent on where it is lodged and treatment depends on symptoms and location

93
Q

fat embolisms are most likely to occur from

A

long bone and pelvic fractures

94
Q

Peripheral artery disease (PAD)

A

atherosclerosis of arteries that perfuse the limbs (especially lower); causes decrease perfusion to area

95
Q

S&S PAD

A

pallor, pulselessness, hairlessness, intermittent claudication - pain occurs in legs while walking and gets better with rest

96
Q

treatment for PAD

A

dangle legs
antiplatelet therapy

97
Q

PAD vs PVD

A

PAD blood flow back to lower extremities is affected (cannot get to tissues); PVD blood flow back the heart is affected

98
Q

coronary artery disease

A

occlusion of coronary arteries; most often resulting from atherosclerotic plaques

99
Q

CAD can cause

A

MI, chronic stable angina (reversible)

100
Q

chronic stable angina

A

caused by narrowing of arteries and plaque build up; periods of decrease blood flow to heart

101
Q

decreased blood flow and O2 to heart leads to

A

ischemia

102
Q

________ causes the chest pain in angina

A

ischemia

103
Q

chronic stable angina the pain is

A

predictable and goes away with rest or nitro

104
Q

treatment for chronic stable angina

A

nitro - open veins and arteries (dilation) -> decrease afterload -> increased CO

105
Q

nitro doses

A

1 Q5 min x 3doses; no more than this unless bp being closely monitored because it can tank the bp

106
Q

expected side effect of nitro and why

A

headache; b/c of massive dilation

107
Q

unstable angina

A

does not go away with rest or nitro; reversible myocardial ischemia

108
Q

if unstable angina is not treated quickly it will progress to

A

MI

109
Q

MI

A

prolonged decrease blood flow to heart resulting in irreversible damage to the heart muscle; STEMI (more severe) or non-STEMI

110
Q

MI S&S

A

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
Q

MI tx

A

cath lab within 90min; in the mean time oxygen, nitro, thrombolytic (if appropriate), antiplatelets (aspirin), monitoring, EKG to assess heart activity

112
Q

MONA correct order

A

oxygen (only if sats low)
nitro
morphine (pain and decrease workload of heart limiting ischemic damage), aspirin (decrease chance of forming clots)

113
Q

Pericarditis

A

inflammation of pericardium; caused by infection, tumor, drugs

114
Q

pericarditis S&S and Tx

A

sharp chest pain, tachypnea, fever, chill, weakness
tx: NSAIDs

115
Q

pericardial effusion

A

collection of fluid in pericardial sac; impairs cardiac function if severe and can lead to obstructive cardiogenic shock

116
Q

pericardial effusion S&S and tx

A

chest pain, MUFFLED HEART SOUNDS
tx: pericariocentesis

117
Q

cardiac tamponade

A

blood, fluid, or exudate has leaked into pericardial sac

118
Q

cardiac tamponade S&S and tx

A

chest pain, SOB, decreased CO, muffle/distant heart sounds, JVD, narrowed pulse pressure (<40)
tx: pericardiocentesis and sx

119
Q

cardiomyopathies

A

disease of myocardial tissue

120
Q

types of cardiomyopathies

A

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
Q

S&S and tx of cardiomyopathies

A

both dependent on type and cause

122
Q

stenosis of heart valves is the

A

narrowing

123
Q

regurgitation of the heart valves is

A

them not closing properly causing backflow

124
Q

endocarditis

A

infection and inflammation of endocardium; affects the valves

125
Q

endocarditis can lead to and Tx

A

valve stenosis and regurgitation, poor CO, bacteremia , bacteria emboli
tx: abx

126
Q

dysrhythmias are caused by

A

SA node generating abnormal rate and impulses not be conducted properly

127
Q

Heart failure

A

the inability of the heart muscle to pump enough blood to meet the body’s needs for blood and oxygen

128
Q

number one cause of HF is

A

htn

129
Q

Left sided HF

A

cannot move blood forward to the body and is backing up in the lungs

130
Q

Left sided HF S&S

A

dyspnea, cough, orthopnea, S3, pulmonary congestion, wet lung sounds, blood-tinged sputum, weakness, cyanosis, confusion

131
Q

right sided HF

A

right side of heart cannot move blood forward to the lungs and backs up in the body

132
Q

right sided HF S&S

A

ascites, weight gain, fatigue, anorexia, JVD, dependent edema, hepatomegaly, splenomegaly

133
Q

HF treatment

A

decrease workload of the heart

ACE inhibitors, ARBs, digoxin, diuretics

134
Q
A

NCLEX (23 decks)

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