Cardiovascular Flashcards
(132 cards)
1
Q
What is perfusion
A
Getting blood to tissues
2
Q
What factors affect perfusion
A
Gender
Age
Genetics
Alterations in perfusion (Clotting/Bleeding disorders, Congenitatl heart defects, CAD)
3
Q
Circulatory Blood Flow
A
Vena cava > Right Atrium > Tricuspid valve > Right Ventricle > Pulmonic Valve > Pulmonary Artery > Lungs > Pulmonary Vein > Left Atrium > Mitral Valve > Left Ventricle > Aortic Valve > Aorta > Body
4
Q
Lifespan considerations (Pregnancy)
A
- Increased circulating volume = increased cardiac workload
- Venous stasis in lower extremities = Peripheral edema, varicose veins, hemorrhoids, postural hypotension
- Increased fibrin and clotting factors = DVT risk
5
Q
Lifespan considerations (Pediatrics)
A
- Apical pulse until 2-3 years
- Systolic BP = 70+(2 x age)
- Obtain BP last
- High HR and CO to meet high metabolic rate
- Decreased O2 = Decreased HR
- Cardiac arrest usually secondary to hypoxemia
6
Q
Cardiac conduction pathway
A
- SA Node
- AV Node
- Bundle of His
- Bundle branches
- Purkinje Fibers
7
Q
Nursing considerations for perfusion
A
GOAL: Promote circulation and cardiopulmonary function
- Input & Output (Lines/drains/tubes)
- Pressure support
- EKG Monitoring
- Compression devices
- Psychosocial support
8
Q
Cardiac perfusion/Diagnostics
A
- Pulse Oximetry
- BP
- Chest XR
- CBC
- Cardiac enzymes (Troponin, CKMB, Myoglobin)
- Lipids/Cholesterol
- EKG
- ECHO
- Cardiac Catheterization
9
Q
Cardiac Enzymes
A
Troponin
- Peaks on Second Day
Myoglobin
- Peaks early on first day after onset of AMI
CKMB
- Peaks before first day is over
10
Q
Automaticity
A
The ability of the cardiac cells to generate an electrical impulse spontaneously and repetively
11
Q
Excitability
A
The ability of non-pacemaker cells to respond to an electrical impulse and to depolarize
12
Q
Conductivity
A
The ability to send an electrical stimilus from cell membrane to cell membrane
13
Q
Contractility
A
The ability of musclec cells to shorten and to contract forcefully
14
Q
Depolarization
A
Conduction of an impulse to contract
15
Q
Repolarization
A
Recharging to contract again
16
Q
P wave
A
Atrial depolarization (Contraction of the atria)
17
Q
PR interval
A
Time from atrial depolarization to ventricular depolarization (0.12-0.2 seconds)
18
Q
QRS complex
A
Ventricular depolarization (Contraction of ventricle)
- Hides atrial repolarozation
- 0.06-0.1 seconds
19
Q
ST segment
A
Represents period of time between the end of ventricuolar depolarization and the beginning of ventricular repolarization
- Normal appearance: Isoelectric (Flat) and in line with baseline
20
Q
T wave
A
Represent ventricular repolarization (recovery of the ventricles to their resting state)
Nomal Appearance: Upright in most leads, smooth, and rounded
- May see abnormal T wave in electrolyte imbalance or ischemia
21
Q
5 steps for EKG interpretation
A
1.) Rythym - regular/irregular
2.) Rate
3.) Assess P waves
4.) Assess PR interval
5.) Assess QRS
22
Q
How to determine rhythm
A
Look at is it regular or irregular
Measure R wave to R wave (Regular = No more than 3 small boxes off)
23
Q
Assess P waves
A
1 P wave before every QRS
Samee size and same shape
23
Q
Assess PR interval
A
PR interval extends from the beginning of the P wave to the beginning of the QRS complex
Important to determine if there is heart block or conduction system disease
24
Assess QRS Complex
Tall and skinny
All look the same
25
Quick steps for EKG interpretation
Rate: Fast, Normal, Slow
P wave before every QRS
QRS: Tall and skinny
Assess client
26
What causes dysrhythmias
1.) Disturbance in impulse formation
2.) Disturbance between electrical conductivity and mechanical response
3.) Disturbance in impulse conduction
4.) Combination of issues
27
Types of Dysrhythmias
Sinus
Atrial
Ventricular
28
Types of sinus dysrhytmias
Bradycardia
Tachycardia
Supraventricular tachycardia
29
Sinus Bradycardia
HR < 60 bpm
Causes
- Athletes
- Hypoxia
- Beta-blockers
- Digoxin
- Increased ICP
- Valsava maneuver
30
Bradycardia symptoms and treatments
Symptoms
- Syncope
- Hypotension
- Confusion
- SOB
- Chest pain
Treatment
- IV fluids
- Oxygen
- Atropine
- Pacing
31
Sinus Tachycardia
HR > 100
Causes
- Fever
- Dehydration
- Pain
- Exercise
- Drugs
- Anemia
32
Sinus tachycardia symptoms and treatment
Symptoms
- Palpitations
- Cool skin
- Syncope
- Hypotension
- Chest discomfort
- Restlessness and anxiety
Treatment
- Address the problem
33
Superventricular tachycardia (SVT)
Rhythm: Regular
Rate: 100-280 BPM
P waves: Cannot see
PR interval: Cannot calculate
QRS: Tall and skinny but narrow
patient can be stable or unstable
34
Superventricular tachycardia (SVT) treatment
- Vagal maneuver
- Adenosine
- Cardioversion
35
Atrial Dysrhythmias
- Premature atrial contractions
- Atrial fibrillation
- Atrial Flutter
36
Premature Atrial contractions (PAC)
Originates with atrial tissue
- Atrial tissue fires before next sinus impulse is due
37
Atrial fibrillation (Afib)
P waves: non-distinguishable
QRS: Tall and skinny
38
A fib heart disease cause
- Hypertension
- HF
- CAD
- Some infections
39
Symptoms and main concerns of Afib
Symptoms
- Dependent on ventricular response
Main concern
- Thrombus formation
40
A fib treatment
- Anticoagulants
- Medications for rate control
(Beta blockers, amniodarone, Diltiazem)
- Cardioversion
41
Atrial flutter
P waves: Saw-tooth pattern
QRS: Tall and skinny
Concerns/treatment/symptoms: Same as Afib
42
Ventricular Dysrhythmias
- Premature Ventricular Contractions (PVC)
- Ventricular tachycardia
- Ventricular Fibrillation
- Torsades de Pointes
43
Premature Ventricular Contractions
Originates with the ventricles - Ventricle tissue fires before receiving sinus impulse
44
Ventricular tachycardia (VTach)
P waves: None
QRS: Tall and Wide
LIFE-THREATENING
45
VTach Treatment
CPR
Defibrillator
46
Ventricular Fibrillation (VFib)
P waves: None
QRS: Not discernable
No pulse because no cardiac output
47
V fib Treatment
CPR
Defibrillate
48
Torsade de Pointes
Classic Twist - Polymorphic ventricular tachycardia
Deadly rhythm - needs Magnesium
49
Asystole
No electrical activity
Assess your patient
50
Pulseless Electrical Activity (PEA)
Electrical activity with NO PULSE
- Assess your client
51
Cardioversion
- Synchronized shock
- Used with emergencies for unstable tachydysryhtmias and stable tachydysrhythmias that do not respond to medical therapies
52
Defibrillation
- Asynchronous shock
- Only Vtach without a pulse and V fib
53
Cardiac Arrest
Main point: Risk for anoxic brain injry
54
Stenosis valvular infection
Narrow Valve Opening
55
Regurgitant valvular dysfunction
"Leaky", does not close completely
56
Causes of valve dysfunction
- Congenital
Acquired
- Degenerative disease (Aging, HTN, Atherosclerosis)
- Rheumatic diseases (Gradual fibrotic changes and calcification)
- Infective endocarditis (Streptococcal infections destroy valves)
57
Aortic or Mitral valve dysfunction can cause
- LVH
- Decreased CO
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Fatigue and weakness
- Dysrhythmias
- JVD
58
Mitral Stenosis
Diastolic Murmur
- Blood cannot flow freely from LA to LV
59
Mitral insufficiency/Regurgitation
Systolic Murmur
- Blood backflows from LV to LA
60
Aortic Stenosis
Systolic Murmur
- Blood cannot flow freely from LV to aorta
61
Aortic insufficiency/Regurgitation
Diastolic murmur
- Blood backflows from the aorta to LV
62
How to diagnose valvular disoders
Main: Echocardiogram (TEE, TTE)
others:
- CXR
- EKG
- Exercise stress test
63
Patient care/assessments valvular condition
- Monitor weight
- Heart rhythm
- Administer O2
- Administer medications
- Monitor vital signs
- Energy conservation techniques
- Medications (Diuretics, inotropic agents, anticoagulants)
64
Percutaneous balloon valvuloplasty
Use of a catheter to go into the heart and open up stenotic valves
65
Valve replacements
Mechanical
- Requires anticoagulants for life
Bioprosthetic
- needs more frequent replacement
66
Layers of the heart
- Fibrous pericardium
- Parietal pericardium
- Pericardial cavity
- Epidcardium
- Myocardium
Endocardium
67
Pericarditis S/S
Infection of the pericardial sac
- Chest Pain
- Pain worse while lying down, breathing, coughing, swallowing (Improves while sitting forward)
- Dyspnea
- Pericardial friction rub
68
Pericarditis Causes
Respiratory Infection, MI, systemic connective tissue disease
69
Pericarditis Treatment
- Antibiotics
- Prednisone
- NSAIDs
- Pericardiocentesis as indicated
70
Myocarditis S/S
Infection of the heart muscle itself
- Chest Pain
- Can be asymptomatic
- Tachycardia
- Heart Murmur
- Dysrhythmias
- Cardiomegaly
71
Myocarditis causes
- Infection
- Inflammatory diseases (Crohn's)
72
Myocarditis Treatment
- Antibiotics
- Prednisone
73
Endocarditis S/S
Infection of the heart valve
- Fever
- Myalgia
- Heart Murmur
- Petechiae/Rash
74
Endocarditis Causes
Strep infection (rheumatic); infection due to drug use, implanted cardiac devices, invasive procedures
75
Endocarditis Treatments
- Antibiotics
- Prednisone
- Valve debridement as indicated
76
Cardiac Tamponade
Fluid accumulation in the pericardial sac - EMERGENCY
77
Cardiac Tamponade Presentation
- Hypotension
- Muffled heart sounds
- JVD
- Pulsus paradoxus (SBP decrease > 10 mmHg during inspiration)
78
Diagnostics for Inflammatory conditions
Blood cultures
- Infective Disorders
Throat Swab
- Rheumatic endocarditis
Cardiac enzymes
- Pericarditis
Inflammatory markers
- ESR, CRP
Others
- Echo
- EKG
79
Patient care for inflammatory
Cardiac assessment
- Heart sounds
Oxygen
Monitor vitals
Medications (Antibiotics, NSAIDs (pericarditis), Prednisone)
Procedures
- Pericardiocentesis if fluid sounds in the heart
- Valve debridement (Endocarditis)
80
Mitral Prolapse
Systolic Murmur
Blood backflows from LV to LA
81
What to know about prostaglandins
Prostaglandins keep Patent Ductus Arteriosus open
- Prostaglandin inhibitors (NSAIDs) Close PDA
82
Coarctation of the Aorta
- Pinch of the aorta
- Obstructs blood flow to the body
Treatment
- Prostaglandins to Keep ductus open
83
Patent Ductus Arteriosus (PDA)
Increased pulmonary blood flow
Ductus doesn't close
- Left to Right Shunting
Treatment
- NSAIDs
84
Tetralogy of Fallot
- Decreased Pulmonary Blood flow
- Right to left shunting
Combination of Pulmonary Stenosis, Thickened right ventricle wall, Ventricular septal defect, Aorta overrides septal defect
85
Atrial septal defect
Increased pulmonary blood flow
Left to right shunting
Surgery to treat
86
Ventricular septal defect
Increased pulmonary blood flow
Left to right shunting
Surgery to treat
87
Heart Failure
When the heart is not able to pump effectively and is unable to maintain adequate circulation to meet tissue needs
88
Causes of Heart Failure
- Systemic Hypertension
- MI
- Pulmonary Hypertension (R sided)
- Dysrhythmias
- Valve problems
- Pericarditis
- Cardiomyopathy
89
Left Sided Heart Failure
The left side cannot pump blood forward
- Forward Effects: Less blood can reach the tissue --> Decreased tissue perfusion
- Backwards Effects: Blood backs up --> Fluid builds up in the lungs (Pulmonary Congestion)
90
Left-sided heart failure pressentation
- Dyspnea
- Orthopnea
- Fatigue
- Displaced apical pulse (Hypertrophy)
- S3 gallop
- Pulmonary congestion
- Frothy pink tinged sputum
- Altered mental status
- Nocturia
91
Right-sided heart failure
The right side of the heart fails in its job as a pump
- If occurring by itself it may be a respiratory problem ( Cor Pulmonale)
- Blood cannot move forward and it accumulates in the body (Venous congestion)
91
Right-sided HF presentation
- JVD
- Dependent Edema
- Ascites
- Fatigue/Weakness
- Nausea
- Anorexia
- Polyuria
- Hepatomegaly and tenderness
- Weight gain
92
Lab values (BNP)
Moderate HF: Greater than 600 pg/mL
Severe HF: Greater than 900 pg/mL
93
Nursing care for HF - Actions
Place in High Fowlers
Administer O2
Practice energy conservation
Low sodium Diet
Possible Fluid Restriction
93
Nursing care for HF - Meds
- Diuretics
- Afterload reducing agents
- Inotropic Agents
- Beta-blockers
- Vasodilators
- Human B-type natriuretic peptides
Do not Take NSAIDs
94
Cause of HF in infants
CHD
Arrhythmias
Acidosis
Severe anemia
Cardiomyopathy
95
HF presentation in Infants
Impaired cardiac function
Pulmonary congestion
96
HF Treatment in infants
Identify cause (treat if possible)
- Support cardiac function
- Promote oxygenation
- Adequate nutrition and rest
97
Care for infants with HF
Medications
- Furosemide, ACEi, Digoxin
Maintain oxygenation and cardiac function
Nutrition
- Small frequent meals, upright for feedings, supplement with gavage feedings, increased caloric needs
98
Complication of HF
Acute Pulmonary Edema
- LIFE THREATENING-MED EMERGENCY
Expected findings
- Anxiety, Tachypnea, Acute respiratory distress, dyspnea at rest, Change in LOC, Evidence of fluid in the lungs
99
Treatment for Acute pulmonary Edema
- Positioning
- High flow O2
- IV morphine
-IV rapid-acting loop diuretics
- Frequent monitoring
- Labs (ABGs, Electrolytes)
- Fluid restriction
100
Hypertension expected findings
"Often silent"
- Headache
- Facial Flushing
- Dizziness
- Fainting
- Retinal changes
- Nocturia
101
Pharmacological treatment for HTN
- Diuretics
- Calcium channel blockers
- ACEs/ARBs
- Aldosterone receptor agonists
- Beta blockers
- Central A2 agonist
- Alpha-adrenergic antagonists
102
Nonpharmacological Treatment for HTN
Nutrition
- Low sodium, low fat and cholesterol, limit alcohol
- Weight reduction
- Smoking cessation
- Stress reduction
103
Hypertensive Crisis
Extremely high BP (180/120)
Severe headache
Blurred vision, disorientation, dizziness
Epistaxis
104
Hypertensive Crisis Treatment
IV antihypertensives
Monitor BP every 5-15 mins
Assess Neuro status
105
Coronary artery disease
Leading cause of death in the US
Umbrella term
- Angina
- ACS (Acute coronary syndrome)
- AMI (Acute Myocardial Infarction)
106
Modifiable risk factors for CAD
- Hyperlipidemia
- Cigarette use
- HTN
- Obesity
- Diabetes
- Physical activity level
- Stress
- Diet
- Renal disease
- OCP/HRT
106
CAD Clinical manifestations
Chest pain
- Crushing/Squeezing/Tight
Dyspnea
Tachycardia
Pallor, Mottling, Diaphoresis
N/V
Anxiety/fear/sense of doom
107
Stable Angina
Pain relieved with rest and nitroglycerine
108
Unstable ungina
Pain is NOT relieved with rest or Nitro
EKG changes and No positive cardiac markers
109
Goals for CAD Therapy
Relive chest pain
Reduce extent of myocardial damage
Maintain cardiovascular stability
Decrease cardiac workload
Prevent complications
110
Pharmacology for CAD
Reduce oxygen demand, increase O2 supply (Beta-blockers, calcium channel blockers, Nitrates)
Lower cholesterol (Statins)
Pain control (Nitro, morphine)
Reduce clotting (Thrombolytics, anticoagulants, antiplatelets)
Antidyryhtmics and vasopressors (Amiodarone, propanolol, etc)
111
Non pharmacological therapy for CAD
- PCI/PCR
- CABG
- Intra-aortic balloon pump
- Ventricular assist device
112
Cardiac Catheterization
Diagnostic and therapeutic
Non-surgical intervention (PCI)
Access through radial or femoral artery
Balloon or stent placement
Atherectomy
113
Cardiac catheterization: Nursing care
Before Cath: Fasting 12 hrs
After Cath:
4-6 hrs bed rest
Monitor hemodynamic status
Apply pressure to site
maintain client arm/leg straight
- Pain control
- Monitor I & Os
114
CABG
Therapeutic
Surgical intervention
Graft vessels from leg or synthetic vessel, bypasses blocked in the new circulatory pathway, Less prefered that PCI unless contraindicated
115
CABG nursing care
Pre-op
- Consents
- IV access
Post-op
- Chest tube management
- Pain control
- Monitor Hemodynamic status
- Monitor for infection
- Monitor I&Os
- IS, Splinting for coughing
115
Peripheral arterial disease
Results from arteriosclerosis > Hardening of the vessels
116
Peripheral venous disorders
Venous thromboembolism > DVT
Venous insufficiency
Varicose Veins
117
PAD- Peripheral arterial disease / Symptoms
Disorder involving arteriosclerosis of the extermities artery
S/S
- Intermittent claudication
- Palpabale coolness
- Pallor
- Parasthesia
- Thick toenails
- Loss of hairs
Common problem for diabetics
118
Arterial ulcers
- Ischemic skin wounds develop gradually
- Extremity may be pale and pulseless
- Wounds are often "DRY"
- Pain increases when extremity is elevated
119
Nursing care- PAD
- Gradually increase exercise
- Promote vasodilation, avoid vasoconstriction
- Do not wear restrictive clothing
- Medications (Statins, Antiplatelet)
- Procedures: Percutaneous transluminal angioplasty, atherectomy, grafts
119
Compartment syndrome
Acute arterial complication
- Tissue pressure within a confined space that restricts blood flow
6 Ps
- Pain
- Pressure
- Paralysis
- Paresthesia
- Pallor
- Pulselessness
Treatment
- Fasciotomy
120
Deep vein thrombosis
3 components of the Virchows triad
- Endothelial injury, Stasis, Hypercoagulability
Stasis of venous blood in lower extremities can lead to thrombus formation
Thrombus can travel to lungs and cause PE
121
S/S of DVT and treatment
Redness over vein
Warmth over vein
Tenderness over a vein
ropiness over a vein
swelling of calf
treatment
- Anticoagulation : heparin
- Surgery
- Filter placement
122
Venous insufficiency
Results from periods of prolonged venous hypertension cause back of blood in the deep veins
Cause
- Sitting or standing in one position too long
- Obesity
- Pregnancy
- thrombophlebitis
Presentation
- Stasis dermatitis (brown knee sock)
123
Varicose Veins
Abnormally dilated superficial vein
High pressure is known to occur in prolonged standing or sitting, as well as pregnancy and obesity
Presentation
- Cramping, muscle aches, pain after sitting, pruritis
124
Venous ulcers
Caused by trauma or pressure on the lower limb
skin breakdown: Tissue damage and necrosis occur because of lack of venous circulation
Tend to be "WEEPY" compared to arterial ulcers
125
Nursing care for venous insufficiency
- Elevate legs
- Compression stockings
Procedures
- Laser procedures
- Sclerotherapy
- Vein stripping
Ulcers
- Wound care
126
Are diabetics going to get a PCI or a CABG
CABG
