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Flashcards in Chronic Cardiac (adults) Deck (61):
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systolic heart failure

inability of the ventricle to contract
EF < 40%

1

diastolic heart failure

ventricle cannot relax and fill

EF > 40%
Often > 60%

Appear (CO down but still pumping all blood out)

2

causes of left-sided heart failure

- htn
- valve disease
- coronary disease

3

left-sided heart failure interventions

- body positioning
- breathing
- education (fluids, safety, compliance)

4

left-sided heart formerly known as...

CHF

5

cor pulmonale

right-sided heart failure caused by pulmonary disease

6

right-sided heart failure

- coronary disease
- left-sided failure
- pulmonary hypertension (not necessarily extension of systemic)

7

left-sided heart failure nursing implications

ALWAYS SAFETY
- afterload management
- activity intolerance
- airway clearance
- fluid management

8

right-sided heart failure nursing implications

ALWAYS SAFETY
- nutrition
- infection
- ventilation
- comfort

9

evaluation of heart failure: blood work

- organ function
- BNP
- anemias

10

evaluation of heart failure: diagnostics

- EKG
- echocardiogram
- chest x-ray

11

Class I heart failure

- patients with cardiac disease but without resulting limitations of physical activity

- ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or a anginal pain

13

Class II heart failure

- patients with cardiac disease resulting in sight limitation of physical activity

- they are comfortable at rest

- ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain

14

Class III heart failure

- patients with cardiac disease resulting in marked limitation of physical activity

- comfortable at rest

- less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain

15

Class IV heart failure

- patients with cardiac disease resulting in inability to carry on any physical activity without discomfort

- symptoms of cardiac insufficiency or of the anginal syndrome may be present, even at rest

- if any physical activity is undertaken, discomfort is increased

16

medical therapies for heart failure (x3)

- cardiac resynchronization therapy
- ventricular assist device
- myocardia reduction surgery

17

myocardial reduction surgery why & how

- indicated for altering ventricular size
- alcohol ablation
- surgical resection of LV and/or septum

18

mitral stenosis is...

- fibrotic or calcified valve
- can't open
- incomplete filling

19

mitral stenosis common cause

rheumatic fever

20

mitral regurgitation

- fibrotic or calcified valve
- can't close
- backflow of blood

21

mitral regurgitation common cause

endocarditis

22

mitral prolapse is...

- valve is enlarged
- leaflets don't come together well
- more common in younger

23

aortic stenosis is...

- "wear and tear" of aortic valve
- fibrotic or calcified valve
- obstructs outflow
- huge afterload increase can cause obstructive shock

24

aortic regurgitation why/how/result

- valvular leaflets can't come together
- fibrosis or calcification
- LV dilation

25

aortic regurgitation common cause

endocarditis
congenital

26

non-invasive valve repair (x2)

- balloon valvuloplasty
- mitral clip

27

transcatheter aortic valve replacement is...

- for high risk clients
- non-emergent
- medically stable

28

nursings implications for valve replacement

- drug therapy (anticoag, afterload reducer)
- plan activities
- surgical site
- client education
- assess for: vital sign trends, mental status, chest pain, edema, syncope, cyanosis, dyspnea

29

arteriosclerosis

hardening of the arterial wal

30

atherosclerosis

plaque formation
risks!!
- intimal layer damage
- hyperglycemia
- hyperlipidemia
- hypercholesterolemia
- hypertension

31

hypertension: normal

SBP < 120
DBP < 80

32

pre-hypertension

SBP 120-139
OR
DBP 80-89

33

Stage 1 hypertension

SBP 140-159
OR
DBP 90-99

34

Stage 2 hypertension

SBP > 160
DBP > 100

35

arterial baroreceptors

carotid sinus receptors (internal) - stim by sinus nerve to nerve IX
aortic arch receptors - stim by vague nerve X

36

RAAS problems (x2)

renal artery stenosis
renal disease

37

causes of RAAS problems

- hyperthyroidism
- hyperaldosteronism
- Cushing's Syndrome
- pheochromocytoma

38

peripheral artery disease stages (I-IV)

I - asymptomatic
II - claudication
III - rest pain
IV - necrosis/gangrene

39

claudication

too little blood flow after exercise

40

PAD assessment findings

- decreased capillary refill
- decreased pulses (palpable, doppler)
- cool/pale skin

41

PAD non-surgical interventions

- warmth (not hot!!)
- minimize exposure
- minimize vasoconstriction (pharm and non)

42

PAD surgical interventions

- angioplasty
- stent
- atherectomy
- revascularization (vascular bypass)

43

arterial aneurysm is...

- can occur in any artery
- weakening of vascular wall (aorta, cerebral arteries)

44

aneurysm presentations (x4)

- pulsatile mass
- aching, "gnawing" pain
- "tearing" (possible radiation)
- bruit

45

aneurysm non-surgical management

monitor
bp management
stress management

46

aneurysm surgical management

endograft
clipping
coiling

47

aneurysm post-procedure care

- bleeding/infection
- neuromuscular function
- graft/vessel occlusion (heart, brain, abdominal cavity, spinal cord, limb)
- client education

48

peripheral venous disease

- venous thromboembolism (DVT, phlebitis, thrombophlebitis)

49

PVD non-surgical interventions

- pharmacologic (antiplatelet, anticoag, thrombolytic)
- elevate extremity
- SCDs

50

PVD surgical interventions

- thromboectomy
- inferior vena cava filter

51

PVD nursing implications

- prevention
- improve venous return
- DON'T RUB
- hydration
- remove causative factors
- warm compresses
- pharm management

BOOM BOOM!

52

sinus bradycardia presentation

- dizzy
- nausea
- diaphoretic

some people have normally low HR (athletes, elderly) but can be related to lower CO and very symptomatic esp. 60-70

53

sinus tachycardia presentation

- dizzy
- fluttering in chest
- heart pounding

HR up, heart has less time to fill. elderly: decreased ability to compensate = severe presentation

54

a fib and a flutter presentation

- fluttering in chest
- heart racing
- chest pain

no benefit from atrial kick, so decrease in CO -> fatigue and chest pain

55

atrial kick

when atria contracts, it adds 25% more blood to ventricle than via passive filling

56

v tach presentation

- syncopal
- chest pain
- palpitations
- dizziness
- pulseless

LETHAL ARRHYTHMIA

57

v tach intervention

defibrillation: pulseless, unconscious, unstable
cardioversion: awake, some kind of heart beat, BP
- timed with R wave

LETHAL ARRHYTHMIA

58

Torsades or V fib presentation

- pulseless
- lifeless
- pale
- cyanotic (no circulating blood volume)

59

Torsades or V fib treatment

- defibrillation STAT
- epinephrine
- mg (Torsades specific: diminish electrical excitability)

60

asystole presentation

pulseless

61

asystole interventions

- CPR
- epinephrine (increase vascular tone)
- atropine (minimuze vagus nerve on systolic rhythm)

NO SHOCKING. no beats.

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