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Fundamentals 2 Exam 3 Flashcards > Cardiovascular Panopto Flashcards (Part 2) > Flashcards

Cardiovascular Panopto Flashcards (Part 2)

1
Q

Preload, Contractility, & Afterload all affect-

A

Your Stroke Volume (Even if your HR is unchanged)

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2
Q

What is Contractility?

A

The ability of heart fibers to shorten/contract

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3
Q

What increases myocardial workload?

A

Increased Preload, Poor Contractility, Increased Afterload

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4
Q

If the heart has an increased workload, then it needs more-

A

Oxygen

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5
Q

The more myocardial fibers are stretched (within limits), the greater the-

This is an example of-

A

Force of the contraction.

Frank Starling’s Law, or the “Rubberband Law”.

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6
Q

The stretching force in the ventricles during Diastole =

A

Preload (Because preload is the amount of blood that fills the ventricles during Diastole)

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7
Q

What is Preload determined by?

A

The amount of blood returning to the heart from circulation.

The amount of blood in ventricles at the end of Diastole, before contraction.

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8
Q

What does Preload determine?

A

The amount of stretch on myocardial fibers

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9
Q

Why do the ventricles stretch during Diastole?

A

Because the ventricles are stretching with blood

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10
Q

Normally:

More Preload = More Stretch =

A

Stronger Contraction = More SV = More Cardiac Output

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11
Q

Exercise is a good factor for Preload. Why?

A

Because it helps with Veinous Return (More blood volume returning to the heart)

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12
Q

Hypovolemia is a bad factor for Preload. Why?

A

Because it causes there to be less blood volume returning to the heart (This results in less blood filling the heart)

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13
Q

Diuretics and Nitroglycerine both-

A

Lower Preload

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14
Q

What things increase Preload?

A

Prescribed Volume Expansion (IV Fluid)

Prescribed Meds (Dopamine, Vasoconstrictors)

Illnesses (Hypervolemia, Stenosis, Myocardial Infarction)

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15
Q

What is Stenosis?

A

When the Aortic Valve narrows and blood can’t flow normally

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16
Q

Both Chronic Excessive Preload and Low Preload will cause a -

A

Poor Cardiac Output

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17
Q

Increased Preload means that the heart has to work-

A

Harder

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18
Q

Excess Preload over time =

A

Over stretched ventricles = Chronic overwork of heart = Weak force of contraction = Eventual failure of left or right side of the heart

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19
Q

The Right Ventricle can meet resistance from-

A

The Pulmonary Artery

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20
Q

The Left Ventricle can meet resistance from-

A

Arterial Circulation

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21
Q

What is Afterload determined by?

A

Condition of Aortic Valve
Blood Viscosity
Arterial BP
Systemic Vascular Resistance (SVR)
Pulmonary Vascular Resistance (PVR)

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22
Q

Increased Afterload causes-

A

Increased Cardiac Workload + Cardiomyopathy + Left Ventricular Hypertrophy

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23
Q

What is Cardiomyopathy?

A

An Enlarged Heart

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24
Q

What can Cardiomyopathy cause?

A

Left Ventricular Hypertrophy

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25
Q

What is Left Ventricular Hypertrophy?

A

An increase in the size of the heart muscle without an increase in the size of the chambers

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26
Q

Left Ventricular Hypertrophy leads to a-

A

Decreased CO

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27
Q

Ventricles can overwork and-

A

Enlarge

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28
Q

A patient receives a drug to decrease Afterload. To evaluate the patient’s response to this drug, what is most important for the nurse to assess?
A.) HR
B.) Lung Sounds
C.) BP
D.) JVD

A

C

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29
Q

Ejects blood to the aorta + Systemic Circulation =

A

Left Ventricle

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30
Q

Systemic Resistance will affect the Left Ventricular Afterload. How?

A

It will cause a Higher Blood Pressure (Which is More Work)

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31
Q

Which side of the heart works harder?

A

The Left works harder than the Right

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32
Q

Pulmonary Congestion can cause-

A

Left Sided Heart Failure (Because the blood isn’t getting to the Left side of the heart like it should)

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33
Q

What ejects blood to the pulmonary circulation?

A

The Right Ventricle

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34
Q

Which one is stronger, Pulmonary Resistance or Systemic Resistance?

A

Pulmonary Resistance is less powerful than Systemic Resistance

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35
Q

Can Left Sided Heart Failure cause Right Sided Heart Failure?

A

Yes

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36
Q

What Pulmonary Edema caused by? How?

A

Left Sided Heart Failure.

This occurs because the the heart isn’t pumping enough blood out. If the left side of the heart can’t pump enough blood out, then the blood goes backwards (Regurgitates) backwards into the Pulmonary Arteries.

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37
Q

What are the characteristics of Left-Sided Heart Failure?

A

Increased Afterload.
Left Ventricle is Overworked and Stretched.
The blood regurgitates into the pulmonary system (Pulmonary Edema).

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38
Q

What are the characteristics of Left-Sided Heart Failure?

A

Increased Afterload.
Right Ventricle is overworked and fails.
Blood Regurgitates into the Systemic Circulation (Bodily Edema).

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39
Q

Will Left-Sided Heart Failure cause a higher or lower SV & CO?

A

Lower

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40
Q

Left ventricular overstretch =

A

Left-Sided Heart Failure

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41
Q

Pulmonary Edema causes there to be blood or fluid in the -

A

Alveolia. This means that there should be an impaired gas exchange.

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42
Q

What can you expect to see whenever Veinous Blood backing up into the body?

A

Bodily Edema (JVD, Peripheral Edema)

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43
Q

To try to simplify Heart Failure, Heart Failure is all about-

A

The chambers getting to overworked and filled with blood to be able to pump out all of it. The blood doesn’t have anywhere else to go but backwards.

Right Sided means it’ll go backwards into the body.
Left Sided means it’ll go backwards into the pulmonary arteries and alveoli.

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44
Q

Clinical Manifestations of Right Sided Heart Failure?

A

Dependent Edema (Legs & Sacrum)
JVD
Abdominal Distention
Hepatomegaly
Splenomegaly
Anorexia
Nausea
Weight Gain
Nocturnal Diuresis
Swelling of Hands & Fingers
Increased BP (from Fluid Excess) or Decreased BP (from Pump Failure)

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45
Q

Clinical Manifestations of Left Sided Heart Failure?

A

Signs of Pulmonary Congestion
Dyspnea
Tachypnea
Crackle Sounds
Dry, Hacking Cough
Paroxysmal Nocturnal Dyspnea
Increased BP (from Fluid Excess) or Decreased BP (from Pump Failure)

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46
Q

How does Right Sided Heart Failure cause Weight Gain?

A

Well, the deoxygenated blood is going backwards into the circulation, and so it’s not getting sent to the Kidneys like it should be. This means that your deoxygenated blood is holding onto its waste for longer and that waste buildup is what causes the extra weight gain.

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47
Q

Causes of Left-Sided Heart Failure include-

A

Cardiac Disease + Hypertension

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48
Q

Name some Early Clinical Signs of Left-Sided Heart Failure:

A

Tissue Hypoxia
Fatigue
Light-Headedness
Confusion

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49
Q

Name some Late Clinical Signs of Left-Sided Heart Failure:

A

Pulmonary Congestion
Dyspnea
Abnormal Lung Sounds

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50
Q

Decreased function of the left ventricle causes =

Decreased function of the right ventricle causes =

A

Left-Sided Heart Failure.

Right-Sided Heart Failure.

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51
Q

Name some Clinical Signs of Left-Sided Heart Failure:

A

Weight Gain
JVD
Peripheral Edema
All Signs/Symptoms of Hypervolemia

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52
Q

What is the number 1 choice for the treatment of Heart Failure?

A

Diuretics are the number 1 choice

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53
Q

Name some of the meds that you can use for the treatment of Heart Failure:

A

Diuretics, Lanoxin (Digoxin)

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54
Q

What is Lanoxin?

A

The brand name for Digoxin

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55
Q

What is Hepatomegaly?

A

Enlarged Liver

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56
Q

What is Splenomegaly?

A

Enlarged Spleen

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57
Q

SOB that causes the patient to wake up after one or two hours of sleep. This is usually relieved in an upright position =

A

Paroxysmal Nocturnal Dyspnea

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58
Q

The nurse is caring for a patient with left-sided heart failure. Which clinical manifestations would the nurse expect with this diagnosis?
Select all that apply:

A.) Pulmonary Crackles
B.) Respirations 26 per minute
C.) Weight gain
D.) Jugular vein distention
E.) Dry hacking, cough

A

A, B, E

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59
Q

Before administering Digoxin, how long would you assess the patient’s apical and radial pulse?

A

1 Minute

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60
Q

When should you hold an order of Digoxin, not give it to your patient, and contact the HCP?

A

If their HR is below 60 BPM

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61
Q

What are are Digoxin lab results given in?

A

Nanograms per mL

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62
Q

Digoxin toxicity can cause-

A

Anorexia, Nausea, Vomiting, Neurological Symptoms

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63
Q

The normal Digoxin level range =

A

0.8 or 1 to up to 2 Nanograms per mL

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64
Q

You have a patient who is taking Digoxin. What do you need to monitor for?

A

Heart Dysrhythmias, Respiratory Congestion, Peripheral Edema.

Monitor Weight Daily, Regulate/Monitor I&O, Give Regular EKG’s.

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65
Q

Orders for Digoxin must be taken off by how many RN’s?

A

2

66
Q

How much does it take to overdose with Digoxin?

A

It is a high risk med. A decimal place can cause a huge overdose.

67
Q

The nurse provides home care instructions to a parent of a child with heart failure. The patient is being discharged home on digoxin. Which statement by the parent indicates a need for further instruction?
A.) “I will not mix the digoxin with my child’s food.”
B.) “If more than one dose is missed, I will call the pediatrician.”
C.) “I will count my child’s pulse before administering the digoxin.”
D.) “If my child vomits after I administer the digoxin, I will repeat the dose.’

A

D

68
Q

If a dosage of Digoxin is missed, then it should not be administered until-

A

4 Hours Later

69
Q

What are some major Factors that cause decreased CO:

A

Heart Failure
Loss of blood flow to the myocardium (Ischemia or Infarction)
Effects of irregular heartbeat (Tachycardia or Bradycardia)
Hypervolemia / Hypovolemia
An increased Workload (Hypertension, Atherosclerotic Heart Disease)

70
Q

Decreased CO =

A

Insufficient amount of blood ejected from the heart to systemic and pulmonary circulation to meet the oxygen demands of the body

71
Q

What is Atherosclerotic Heart Disease?

A

Thickening and Hardening of the walls of the Coronary Arteries

72
Q

Quality of blood flow + it’s ability to oxygenate and nourish tissues at the cellular level =

A

Tissue Perfusion

73
Q

List some conditions that interfere with Tissue Perfusion:

A

Any condition that obstructs/narrows blood vessels (Hypertension, Diabetes, Atherosclerosis. These are the most common cause.) Nicotine & High Lipids in the blood also have an impact on Tissue Perfusion.

Conditions that impair peripheral circulation (Arterial Spasms, Blood Clots, Peripheral Vascular Disease)

Conditions that impair cell nutrition like Edema.

74
Q

Manifestations of Arterial Ineffective Tissue Perfusion:

A

Decreased Peripheral Pulse, Cool Extremities, Pallor, Activity Intolerance

75
Q

Manifestations of Veinous Ineffective Tissue Perfusion:

A

Incompetent Valves, Blood Pools in Veins, Peripheral Edema, Phlebitis, Increased Risk of Thrombosis Formation (A Blood Clot)

76
Q

Inflammation of vein walls=

A

Phlebitis

77
Q

Estrogen has a protective effect from-

A

Cardiovascular Problems

78
Q

What are some nice cardiac changes to make for someone with cardiac problems?

A

Decrease the fat & sodium in their diet + Replace saturated fats with poly-unsaturated fats + Eat foods that are rich in fiber + Eat Whole-Grains, Fresh Fruits, Vegetables, Lean Meats (Like Chicken) + Avoid foods high in cholesterol (Liver, Eggs, Animal Fats like Veal & Pork) + Eat Low Cholesterol Foods (Fish, Low-Fat Dairy Products, Oils other than Vegetable Oil, Iron-Rich Foods) + Avoid Caffeine

79
Q

Iron-Rich foods are helpful with people who have Anemia. This is because Iron-Rich Foods help with-

A

Red Blood Cell Production

80
Q

How much Exercise is recommended?

A

30 - 60 Minutes (Daily)

81
Q

Exercise gives us a-

A

Low Pulse Rate, Low BP, Decreased Cholesterol Levels, Increased CO

82
Q

Subjective symptoms of cardiac problems include:

A

Chest Pain, Palpitations, Dyspnea, Fatigue, Impacted ADL’s

83
Q

Hypoxia is caused by-

A

Not enough CO

84
Q

If you smoke and take oral contraceptives, this puts you at an increased risk for-

A

Blood Clots

85
Q

Clinical Signs of Heart Problems can be different from Men & Women.

Name off the signs for Men:

A

Discomfort or Tingling in the Arms, Back, Neck, Shoulder, or Jaw.
Chest Pain.
SOB.

86
Q

Clinical Signs of Heart Problems are different from Men & Women.

Name off the signs for Women:

A

Heart-Burn Like Feeling.
Sudden Dizziness.
Cold Sweat.
Unusual Tiredness.
Nausea or Vomiting.

87
Q

What are your palpation sites again?

A

Carotid, Brachial, Radial, Ulnar, Femoral, Popliteal, Posterior Tibial, Dorsalis Pedis

88
Q

What are some observations that you can make from a patient with heart problems?

A

Skin Color (Pallor?)
Cough & Sputum? (Left-Sided Heart Failure)
Peripheral Vascular Disease? (Cold Feet, Weak Pulses, Shiny Hairless Shins, Edema due to Poor Venous Return,
Arterial Ulcers due to No Blood Perfusion
Venous Ulcers (Phlebitis, Waste Build-Up)

89
Q

What are some auscultations that you’d look out for on a patient with heart problems?

A

BP & Apical HR
Auscultation Points
Check Carotid Arteries for Bruits
Lung Sounds (Especially those that can be cause by Pulmonary Congestion)

90
Q

A bruit can indicate-

A

Atherosclerosis & Narrow Arteries

91
Q

Your BP on your left and right sides, should be within how many mm Hg of each other?

A

Within 10 mm Hg of each other

92
Q

What palpation sites should you compare?

A

Your Proximal and your Distal Sites

93
Q

What is Venous Stasis?

A

This is when blood pools in your veins

94
Q

What does exercise prevent?

A

Veinous Stasis

95
Q

You should avoid exercise in-

A

Cold Weather

96
Q

Stress Management is helpful for people with cardiac problems because it helps prevent-

A

The Systemic Response of Vasoconstriction

97
Q

Processed foods are loaded with-

A

Sodium

98
Q

Nicotine increases your heart rate by increasing your-

A

Blood Pressure

99
Q

Smoking causes:

A

An Instant & Long-Term Rise in BP + An Instant & Long-Term Increase in HR + Reduces the Blood Flow from the Heart + It Reduces the Amount of Oxygen that reaches the Body Tissues + Increases Risk of Blood Clots + Damages Blood Vessels + Doubles the Risk of Stroke (Because of Reduced Blood Flow to the Brain) + Linked to Depression & Stress

100
Q

How do you promote Veinous Circulation?

A

Keep legs elevated to promote Veinous return.
Avoid knee flexion with pillows.
Promote leg exercises, especially with immobility.

101
Q

How do you promote Cardiac Circulation?

A

Position the pt into a Semi- or High- Fowler’s Position to reduce Preload.

AVOID legs up with Congestive Heart Failure because it increases Preload.

102
Q

How do you prevent Veinous Stasis?

A

Positioning & Leg Exercises
Antiembolic Stockings (TEDs)
Sequential Compression Devices

103
Q

What are things that you’d measure for TED’s?

What would you do next after taking these measurements?

A

You’d measure from the heel to the gluteal fold.
You’d measure the circumference of each calf and thigh at the widest point.

You’d compare these measurements to a size chart, obtain 2 different sizes if there is a significant difference between the two measurements.

104
Q

What are things that you’d measure for knee-high TED’s?

A

You’d measure from the heel to the popliteal space.

105
Q

How often can you remove TEDS? For how long?

A

For 30 Minutes, 1-3 Times a Day for Skin Care + Inspection

106
Q

How long does it take for permanent heart, brain, and tissue damage to occur?

A

4 - 6 Minutes

107
Q

Cardiac Rehab Programs include:

A

Exercise Training, Education on Heart-Healthy Living, Counseling to Reduce Stress + Help you return to Active Life

108
Q

Cardiac Rehab Programs are for people who have experienced-

A

Heart Attacks
Coronary Artery Disease
Angina
Heart Failure

A Coronary Artery Bypass Graft

A Percutaneous Coronary Intervention (Coronary Angioplasty)

Valve Replacement

Pacemaker

Implantable Cardioversion Defibrillator

109
Q

A Coronary Artery Bypass Graft =

A

Open Heart Surgery

110
Q

Balloon Angioplasty =

A

Coronary Angioplasty

111
Q

What enzyme does the MB Blood Test look for?

A

It looks for the cardiac enzyme called Creatine Kinase (CK).

112
Q

A patient takes the MB Test, what are they testing for?

A

Myocardial Cell Injury

113
Q

High levels of CK is indicative of-

A

Myocardial Infarction (A Heart Attack)

114
Q

The CK in a MB Blood Test is what you’d call a-

A

‘Marker’ for Myocardial Damage

115
Q

After a Heart Attack occurs, your CK should increase within-

When should the CK peak?

When should the CK return to normal again?

A

3 to 6 Hours.

12 to 24 Hours.

Should return to normal again in 2 Days.

116
Q

What is Troponin?

A

It is a Protein-Based cardiac enzyme that has 3 different types. It’s used as a ‘marker’ specifically for Cardiac Disease

117
Q

Which type of Troponin has a high affinity for Myocardial Injury?

A

Troponin 1

118
Q

What are the three different types of Troponin?

A

Troponin 1

Troponin C

Troponin T

119
Q

What are the normal values for Troponin 1?

A

Normally Very Low (Less than 0.35 Nanograms per mL)

120
Q

How long does it take for Troponin 1 to rise after a Myocardial Cell Injury/Myocardial Infarction (MI)

How long does it persist for?

A

Rises within 3 hours of the MI.

Up to 7 to 10 Days.

121
Q

The normal lab value for Troponin T is-

A

Less than 0.1 Nanograms per L

122
Q

A rise of Troponin T can indicate-

A

Myocardial Cell Injury

123
Q

What does a Troponin Test measure?

A

Troponin 1 + Troponin T proteins in the blood

124
Q

What is the normal value for the CK-MB (Can also be called the CK-2) Blood Test if your patient is a Male?

A

2-6 Nanograms per mL

125
Q

What is the normal value for the CK-MB (Can also be called the CK-2) Blood Test if your patient is a Female?

A

2-5 Nanograms per mL

126
Q

What is Myoglobin?

A

An oxygen binding protein found in Cardiac + Skeletal Muscle

127
Q

Is Troponin-C a cardiac marker?

A

Nope, because it’s not a cardiac-specific enzyme. It’s increased presence can mean a lot of things that are non-cardiac related, so it’s not measured for anything cardiac related

128
Q

When do Myoglobin levels begin to rise after myocardial cell death?

When does it have a rapid decline?

A

Within 2 Hours

After 7 Hours

129
Q

Is Myoglobin Cardiac Specific?

A

No

130
Q

So, what are the cardiac specific Cardiac Enzymes?

A

Creatine Kinase (CK)
Troponin 1
Troponin T

131
Q

Is Myoglobin still considered a cardiac enzyme even though it isn’t cardiac specific?

A

Yes

132
Q

Remember,
LDL =
HDL =

A

LDL = Bad Fats

HDL = Good Fats

133
Q

Name some example of Serum Lipids =

A

Cholesterol
Triglycerides
Phospholipids

134
Q

What’s a desirable Fasting Total Cholesterol lab value? (Important)

A

Below 200 mg/dl

135
Q

Cholesterol & Triglycerides are both-

A

LDL’s (Bad Cholesterol)

136
Q

Increased Cholesterol or Triglycerides puts the pt at risk for-

A

Coronary Artery Disease

137
Q

What is LDL short for?

What is HDL short for?

A

Low-Density-Lipoprotein

High-Density-Lipoprotein

138
Q

Are HDL’s Protective?

A

Yes

139
Q

What foods would you want to eat in a low cholesterol diet?

A

Salmon & Other Fish, Sweet Potatoes, Whole Grains, Legumes, Avocados & Other Fruits, Legumes, Vegetables, Leafy Greens, Nuts, Rice, Oils that aren’t Vegetable Oil, Fat-free or Low-Fat Dairy Products, Soy, etc.

140
Q

What does Hypokalemia cause?

A

Increased Cardiac Instability + Ventricular Dysrhythmias + Increased Risk of Digoxin Toxicity

141
Q

If a patient has Hypokolemia, then what should their EKG look like?

A

It should show flattening & Inversion of the T Wave.
Should show the appearance of a U Wave.
Should show ST Depression.

142
Q

What does Hyperkalemia cause?

A

Asystole + Ventricular Dysrhythmias

143
Q

What is Asystole?

A

Whenever your heart’s Conductive System (Electrical System) fails entirely, which causes Systole to completely stop

144
Q

What might a ECG look like for patient’s with Hyperkalemia?

A

Tall, Peaked T Waves.
Widened QRS Complexes.
Prolonged PR Intervals.
Flat P Waves.

145
Q

The Serum Sodium Level decreases with the use of-

A

Diuretics

146
Q

When does the Serum Sodium Level decrease?

What does this drop of Serum Sodium indicate?

A

During Heart Failure.

Indicates Water Excess (Hypervolemia).

147
Q

What can Hypocalcemia cause?

A

Ventricular Dysrhythmias.
Prolonged ST & QT Intervals.
Cardiac Arrest.

148
Q

What can Hypercalcemia cause?

A

Shortened ST Segment
Widened T Wave
Atrioventricular Block
Tachycardia or Bradycardia
Digitalis Hypersensitivity
Cardiac Arrest

149
Q

How should Phosphorus Level be interpreted?

Why?

A

With Calcium Levels.

Because the Kidneys retain + Excrete one electrolyte in an inverse relationship to the other.

150
Q

What can Hypomagnesemia cause?

A

Ventricular Tachycardia + Fibrillation

151
Q

What is Atrial Fibrillation?

A

A buncha signals fire from different locations around the upper layers of the heart. This causes the heart to beat fast and chaotically.

152
Q

What ECG changes might you observe in a patient who is experiencing Hypomagnesemia?

A

Tall T Waves.
Depressed ST Signals.

153
Q

What can Hypermagnesemia cause?

A

Muscle Weakness, Hypotension, Bradycardia

154
Q

What ECG changes might you observe in a patient who is experiencing Hypomagnesemia?

A

Prolonged PR Interval.
Widened QRS Complex.

155
Q

When is the BUN elevated?

A

In heart disorders like heart failure + Cardiogenic shock that reduces renal circulation

156
Q

What can elevate a pt’s blood glucose level?

A

An Acute Cardiac Episode

157
Q

When is B-Type Natriuretic Peptide (BNP) released?

A

In response to Atrial + Ventricular Stretch

158
Q

What does BNP serve as a ‘Marker’ for?

A

Heart Failure

159
Q

What should BNP Levels be less than?

A

Under 100 ng/mL (Less than 100 mcg/L)

160
Q

The higher the BNP Level, the-

A

More Severe the Heart Failure is

161
Q

What is Digitalis?

A

A type of drug that is used to treat congestive heart failure

Fundamentals 2 Exam 3 Flashcards (10 decks)

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