Cardiovascular Flashcards
(98 cards)
1
Q
What is HF?
A
the inability of the heart to provide sufficient blood to meet the O2 needs of tissues and organs
2
Q
Etiology of HF
A
Decrease in CO
3
Q
Which factors affect CO?
A
- preload
- afterload
- myocardial contractility
- HR
4
Q
List the primary causes of HF
A
- HTN
- CAD
- Rheumatic heart disease
- congenital heart defects
- pulmonary HTN
- cardiomyopathy
- hyperthyroidism
- valvular disorders
- myocarditis
5
Q
What are the primary RFs for HF?
A
- HTN
2. CAD
6
Q
What are the contributing factors of HF?
A
- Advanced age
- diabetes
- tobacco use
- obesity
- High serum cholesterol
7
Q
What does the term precipitating causes mean?
A
these causes aggravate and decrease workload causing a decrease cardiac fxn
8
Q
List the precipitating causes of HF
A
- anemia
- infxn
- thyrotoxicosis
- hypothyroidism
- dysrhythmias
- bacterial endocarditis
- obs. sleep apnea
- PE
- hypervolemia
- nutritional deficiencies
9
Q
What is the most common form of HF?
A
Left-sided HF
10
Q
Left-sided HF results from the inability of the LV to do what? (2)
A
- empty adequately during Sys or fill adequately during Dia
11
Q
What is the patho of left-sided HF?
A
The LV loses its ability to generate enough pressure to eject blood forwards through the aorta overtime becoming dilated and hypertrophied
12
Q
Causes of SYS left-side HF
A
- impaired contractile fxn
- increased afterload
- Cardiomyopathy
- mechanical abnormalities
13
Q
Define EF
A
amt of blood ejected from the LV w/ each contraction
14
Q
What is the normal EF
A
55%-60%
15
Q
What % is considered to be Sys HF?
A
<40%
16
Q
If the blood cannot be pumped by the LV effectively what occurs to blood when LV fails?
A
the blood backs up the LA which then goes back to the lungs causing pulmonary congestion and edema
17
Q
What is Dia left-side HF?
A
Impaired ability of the ventricles to relax and fill during Dia resulting in decreased SV and CO
18
Q
Causes of Dis left-side HF
A
- HTN
- Age
- female gender
- diabetes
- obesity
19
Q
List SI/SX of left-sided HF
A
- frothy sputum (can be serosanguenous)
- dyspnea, orthopnea
- fatigue
- hypertrophy
- pulmonary congestion
- alt. mental status
- Sis of organ failure (oliguria)
20
Q
List Si/Sx of right- sided HF
A
- JVD
- Peripheral edema
- fatigue, weakness,
- ascites
- nausea and anorexia
- nocturia
- hepatomegaly
- weight gain
21
Q
What are some ways to prevent HF?
A
- Exercise regularly
- Consume a low-sodium diet
- fluid restriction
- smoking cessation
- take meds as prescribed
22
Q
Which 2 hormones are released by the heart? State location
A
- ANP- atria
2. BNP- ventricles
23
Q
When is BNP released? ANP?
A
both are released as a response to increased blood vol in the heart
24
Q
What effects do the natriuretic peptides have?
A
- increased GFR rate
- diuresis
- excretion of sodium
(natriuresis) - vasodilation
- decreased BP
- inhibition of aldosterone and renin secretion
- interference w/ ADH release
25
What is the purpose of obtaining an echo?
an ECG shows L&R ventricular EF, provides structure and fxn of valves
26
What is the purpose of a chest X-ray for HF?
reveals cardiomegaly and pleural effusions
27
What is the purpose of an ECG, cardiac enzymes, electrolytes, and ABGs?
assess factors contributing to heart failure and/or impact of heart failure
28
What is the outcome or expectation if you give your patient a diuretic?
1. decrease preload
2. reduce edema, pulmonary venous pressure
3. promote sodium and eater excretion
29
What are the 3 types of diuretics?
1. loop
2. K+ sparing
3. thiazide
30
What are the 2 prototype loop diuretic?
1. furosemide (Lasix)
| 2. bumetanide (Bumex)
31
What is the prototype for K+ sparing diuretic?
aldactone (Spironolactone)
32
What is the prototype for thiazide diuretic?
hydrochlorothiazide (Novo-hydrazide)
33
If you give Lasix IVP, how fast should you push?
no faster than 20 mg/min
34
What are your nursing considerations for a pt on a diuretic?
1. daily weight
2. I&Os
3. Obtain K+ serum levels
4. Hearing screenings
5. monitor BP closely
6. assess males for gynecomastia (spironolactone)
35
What are some pt teachings for a pt on a diuretic?
1. take meds as prescribed = same time qd
2. eat foods and drinks high in K+ (except in spironolactone)
3. change positions slowly due to orthostatic hypotension
4. take in the am to prevent nocturia
5. check weight
6. check blood glucose levels
36
What are some foods and drinks high in K+?
1. Bananas
2. spinach
3. salmon
4. avocados
5. lentils
6. sweet potatoes
7. oranges
8. dried apricots
37
What is the normal range of K+?
3.5-5.0
38
Si/Sx of hypokalemia
1. decreased BP
2. thready weak pulse
3. alt mental status
4. lethargy
5. weakness
6. hypoactive bowel sounds possible paralytic ileus
7. N/V
8. abdominal distention
39
Si/Sx of hyperkalemia
1. slow irregular pulse
2. hypotension
3. restlessness
4. irritability
5. weakness
6. oliguria
7. increased motility
8. diarrhea
9. hyperactive bowel sounds
40
What is the primary drug of choice for sys HF?
ACE inhibitors
41
MOA ACE inhibitors
1. dilate venules and arterioles
2. improve renal blood flow
3. relieve Sx of HF
4. Promote reverse remodeling
5. decrease morbidity and mortality
6. improve renal blood flow
42
What are some examples of ACE inhibitors?
1. captopril (Capoten)
2. Benazepril (Lotensin)
3. Enalapril (Vaotec)
43
What are some nursing considerations for ACE inhibitors?
1. monitor for hypotension and hyperkalemia
| 2. monitor for angioedema
44
Side effects of ACE inhibitors
1. intractable cough
2. renal insufficiency
3. symptomatic hypotension
45
What type of pts are ACE inhibitors contraindicated?
pts w/ renal problems
46
What are some pt teachings for ACE inhibitors?
1. Inform pt can cause a dry cough
2. Notify provider if swelling of the face or extremities occur
3. Notify provider if there is a rash or decreased sense of taste
4. Monitor BP
47
MOA of beta blockers
block the negative effects of the SNS by lowering the HR and reducing myocardial contractility
48
List the Beta blockers
1. carvedilol (Coreg)
2. bisoprolol (Zebata)
3. metoprolol (Toprol)
49
What are some nursing considerations when taking beta blockers?
1. monitor blood pressure, pulse, activity tolerance, and orthopnea
2. check orthostatic blood pressure readings
3. obtain standing BP 1 hr after dosing to assess tolerance
50
What are some pt teachings for beta blockers?
1. weigh themselves daily
2. monitor bp regularly
3. follow the med regimen as prescribed
4. do not stop med abruptly
51
List adverse effects of beta blockers
1. sweating
2. palpitations
3. headaches
52
What is the difference between inotropes and chrontropes?
inotropic meds affect contractility and chronotropic meds affect HR
53
Which agents are inotropic?
1. digoxin
2. dobutamine- short-term
3. dopamine
4. milrinone
54
What is the therapeutic serum level of digoxin?
0.5-0.8 ng/ml
55
What level is considered dig toxicity?
>1.8-2.0
56
Si/Sx of dig toxicity
1. fatigue
2. weakness
3. vision changes (halo)
4. GI effects
57
What are some interventions for dig toxicity?
1. Stop dig and K+ sparing meds immediately
2. Monitor K+ levels
3. treat dysrthymias with phenytoin or lidocaine
4. treat bradycardia w/ atropine
5. administer antidote digoxin immuneFab (Digibind)
58
What are some pt teachings for a pt taking Dig?
1. advise the pt take med as prescribed
2. check the apical pulse for a full 1 min
3. take at the same day and same time
4. report signs of toxicity
5. regularly have K+ and dig levels checked
59
What type of pts or meds is dix contraindicated?
1. antacids must be separated by 2 hrs
2. decrease dig levels if taken with verapamil
3. sympathomimetic
4. thiazides
5. ACE inhibitors
60
What are the 2 types vasodilators?
1. Nitroglyercin
| 2. isosorbide monoitrate
61
MOA OF vasodilators `
dilates veins which reduces circulating blood vol and improve coronary artery circulation
62
What are some nursing considerations for vasodilators?
1. used to treat angine and help control blood pressure
2. use cautiously with other anihtnsive meds
3. change positions slowly to pevent orthostatic hypotension
4. administer aspirin or acetaminophen and relaxation therapy to relieve headache
63
What are some pt teachings for vasodilators?
1. remind the pt that a headache is a common side effect
| 2. encourage the pt to sit and lie down slowly
64
According to ATI when are anticoagulants prescribed?
if the pt has a history of thrombus formation
65
What are some nursing considerations for anticoagulants?
1. assess for active bleeding, PUD, history CVA, and recent trauma
2. Monitor bleeding times: PT, aPTT, INR, and CBC
66
Normal PT range
11-12.5 sec
67
Normal aPPT range
1.5-2.5x the control value (heparin) 30-40 sec (normal)
68
Normal INR range
2-3
69
Pt teachings for anticoagulants
1. remind the pt the risk of bruising and bleeding
2. routinely monitor bleeding times
3. electric razors
4. be careful when flossing
70
What is the purpose of acronym FACES?
to recognize the SI/Sx of HF
71
What does FACES stand for?
```
Fatigue
Activities limitations
Chest congestion
Edema
SOB
```
72
After cardiac transplant, what is monitored?
1. acute rejection
2. infxn
3. malignancy
4. accelerated cardiac vasculopathy
5. sudden cardiac death
6. immunosuppressive therapy
73
What are some nursing care focuses?
1. promoting pt adaptation to the transplant process
2. monitoring cardiac fxn
3. managing lifestyle changes
4. Providing ongoing teaching
74
What type of test is used to detect rejection fro heart transplant?
EMB- endomyocardial biopsies
75
What are nursing actions for heart transplants?
1. prepare the pt for procedure: NPO and informed consent
| 2. Monitor postOP
76
What are some pt teachings for heart transplant?
1. take meds as prescribed
2. take diuretics in the am and afternoon
3. maintain fluid and sodium restriction diet
4. increase dietary intake of Kt
5. Check weight daily and notify 2lbs in 24 hrs or 5 lbs in 1 week
6. Get vaccinations
77
SI/Sx of pulmonary edema
1. anxiety
2. tachycardia
3. ARD
4. dyspnea at rest
5. change in LOC
6. crackles during auscultation
7. frothy sputum
78
Nursing actions for pulmonary edema
1. administer meds to improve CO
2. teach pt how to improve tolerance to activity
3. Position in high-Fowlers
4. Administer O2
5. IV morphine
6. IV Lasix
79
Si/Sx of cardiogenic shock
1. tachycardia
2. hypotension
3. decreased urine output
4. alt LOC
5. crackles and tachypnea
6. cool and clammy skin
7. decreased peripheral pulses
8. chest pain
80
Nursing actions for cardiogenic shock
1. monitor breath and heart sounds
2. administer O2, intubation and ventilation
3. administer IV morphine, diuretics, and/or nitro or vasopressors
4. continuous hemodynamic monitoring
81
Si/Sx of cardiac temponade
1. hypotensions
2. JVD
3. muffled heart sounds
4. paradoxical pulse
82
Nursing actions for cardiac temponade
1. notify provider immediately
2. administer IV fluids to combat hypotensions
3. obtain chest x-ray or echo
4. prepare pt for pericardiocentesis
5. monitor for hemodynamics, heart rhythm, and reoccurrence
83
Describe angina
reversible myocardial ischemia
84
What is the cause of angina
it caused by the increased demand for O2 or decreased O2 supply
85
What is the most common reason for angina to develop?
narrowing of one or more coronary arteries by atherosclerosis, typically >75%
86
What is the difference between an MI and angina?
1. pain unrelieved by rest or nitroglycerin and lasting for more than 15 min differentiates.
2. MI is irreversible damage and angina has reversible interruption of oxygen
3. MI there is a STEMI and angina have NSTEMI
87
What is the relationship between ischemia and infarction?
ischemia can lead to tissue necrosis (infarction) if blood supply and oxygen are not restored.
88
What can trigger angina?
1. physical exertion
2. stress
3. emotional upset
89
How can an individual prevent angina?
1. maintain an exercise regimen
2. have cholesterol level and BP checked regularly
3. consume a diet low in sat fats and Na+
4. promote smoking cessation
90
What are the 3 types of angina?
1. Stable/ exertional
2. Unstable/Preinfarction
3. Variant/Prinzmetal's
91
List some clinical manifestations of angina
1. pressure/ache
2. squeezing, heavy choking, or suffocating sensation
3. rarely sharp or stabbing
4. does not change w/ position or breathing
5. indigestion or burning at epigastric region
92
Where is the pain most experienced with angina?
substernal
93
Where does the pain radiate in the angina?
1. jaw
2. shoulder
3. down the arms
94
What is the first line of therapy in chronic stable angina?
short-acting nitrate- Nitroglycerin
95
MOA of nitroglycerns
1. dilate peripheral blood vessels
| 2. dilate coronary arteries and collateral vessels
96
What are 2 routes Nitroglycerin can be given?
1. SL: nitrostat
| 2. spray: nitrolingual
97
When should you call the provider regarding nitroglycerin?
- if no relief in 5 mind call EMS
| - if SX do not improve, repeat q5mins for max of 3 doses
98
Pt. teaching for nitroglycerin
1. place tab under tongue and allow to dissolve
2. causes a tingling sensation
3. Warn of side effectsL headache, dizziness, flushing, and orthostatic hypotension
