Circulation & Perfusion Flashcards by Kaylie Krauzyk

Is how the blood flows to a capillary membrane to provide nutrients and oxygen that the tissues and organs need

Perfusion

How well did you know this?

Not at all

Perfectly

Is the flow of blood throughout the heart and vessels

Circulation

How well did you know this?

Not at all

Perfectly

Anatomy of the Heart

* Heart

Muscle encased by ___
4 chambers
2 atria
2 ventricles

pericardium

How well did you know this?

Not at all

Perfectly

The Heart

Is a muscle encased by the pericardium which is a sack of connective tissue and it’s located inside the chest cavity

Made up of 4 chambers

2 atria : ___ -walled that receive blood into the heart

2 ventricles : ___-walled that pump blood out of the heart

thin-

thick-

How well did you know this?

Not at all

Perfectly

Valves are located between the heart chambers, and they open to allow blood to flow easily and without turbulence from one chamber to another AND they close tightly to prevent backflow of the blood or regurgitation

Base of the heart houses the atria and faces upward whereas the apex of the heart or the tip of the heart houses the ventricles and faces downward

How well did you know this?

Not at all

Perfectly

Deoxygenated blood from organs and tissues flows through the venous system (superior and inferior vena cava) into the __ side of the heart and then into the pulmonary arteries and lungs

External gas exchange occurs at the ___-___ membrane

Oxygenated blood then flows from the lungs through the pulmonary veins into the ___ side of the heart and out into the arterial circulation through the ___

right

alveolar-capillary

left / AORTA

How well did you know this?

Not at all

Perfectly

The Cardiac Cycle

Cardiac Cycle

* Contraction of atria

* Followed by contraction of ventricles

The Cardiac Cycle

Electrical Conduction

* Sinoatrial node (SA node)

> Pacemaker

> 60-100 beats/min

* Atrioventricular node (AV node)

* Bundle of HIS

* Right and left bundle branches

* Up the Purkinje fibers

How well did you know this?

Not at all

Perfectly

Cardiac cycle

Includes the contraction of the 2 atria followed by contraction of the ventricles

The electrical activity of the ___ regulates the cardiac cycle

myocardium

How well did you know this?

Not at all

Perfectly

Electrical conduction

The heart has areas of specialized nerve tissues that initiate electrical impulses without external nervous system stimulation

? - is the pacemaker of the heart and it is located in the right atrium; is going to initiate an impulse that triggers each heartbeat

Impulse travels rapidly down atrial conduction system and both atria contract as a unit

The ___ node receives that impulse - delays it for a second - and then sends that impulse into the right and left bundle of HIS and into the Purkinje fibers to the ventricles and lead to the contraction of the ventricles

sinoatrial node

atrioventricular

How well did you know this?

Not at all

Perfectly

Electrical conduction cont’d

If there are any defects in this electrical system - impulses are going to travel more slowly or in some areas may even be blocked and this will lead to ineffective heart pumping and a decrease in cardiac output

The ___ node is in charge and initiates a rate of 60-100 bpm

If this node fails, then the atrioventricular node takes over the impulse but at a slower rate

If both of these nodes fail, the conduction fibers in the myocardium can initiate impulses - ___ conduction is at a very slow rate, usually less than 40 bpm

ventricular

How well did you know this?

Not at all

Perfectly

Systemic & Pulmonary Blood Vessels

All vessels - lined smooth endothelial layer

* Promotes nonturbulent blood flow

* Prevents platelets from sticking to walls & clotting

Arteries

* Thick elastic - allow for stretch & recoil

Arterioles

* Thinner walls

Systemic & Pulmonary Blood Vessels

Capillaries

* Connect arterioles with venules

* One cell thick allowing for gas exchange

Venules

* Thinner walls

Veins

* Thinner muscular walls, inelastic & collapse easily

How well did you know this?

Not at all

Perfectly

Vascular system is composed of 3 types of vessels: ___, ___, and ___

All vessels are lined with smooth endothelial layer that promotes nonturbulent blood flow and prevents platelets from sticking to the sides of the walls and clotting

arteries, veins, capillaries

How well did you know this?

Not at all

Perfectly

Have thick, elastic walls that allow them to stretch during muscle contraction = systole and to recoil when the heart relaxes = diastole

Arteries

How well did you know this?

Not at all

Perfectly

Are smaller branches of the arteries made up of smooth muscle and thinner walls - they are controlled by the sympathetic nervous system (SNS)

Arterioles

How well did you know this?

Not at all

Perfectly

Are microscopic vessels - connect the arterial and venous systems and carry blood from arterioles to venules - they are only one cell thick and this is why gas exchange is facilitated along with nutrients and waste between tissue cells and the blood

The venous system returns ___ blood to the heart

Capillaries

deoxygenated

How well did you know this?

Not at all

Perfectly

___ and ___ have thinner muscular, inelastic walls that collapse easily - the walls contract or relax in response to feedback from the SNS

So when the blood volume is low, ___ contract to provide a smaller space for smaller volume of blood - when the blood volume is high, ___ are going to relax and enlarge to accomodate the increased volume of blood

veins; venules

veins x2

How well did you know this?

Not at all

Perfectly

Coronary Arteries

* Supply blood to heart muscle

* Right coronary artery

* Left coronary artery

Left circumflex artery
Left anterior descending artery

How well did you know this?

Not at all

Perfectly

Transport of O₂ & CO₂

* Adequate circulation & effective cardiovascular function regulation

Circulate oxygenated blood to tissues and deoxygenated blood to lungs
Hemoglobin reservoir for O₂
CO₂ as product of aerobic tissue metabolism

In order to maintain or circulate oxygenated blood to organs and tissues and return deoxygenated blood to the lungs – blood flow – requires adequate circulation and effective regulation of the cardiovascular function

Hemoglobin is a reservoir for oxygen

How well did you know this?

Not at all

Perfectly

97% of blood oxygen is bound to hemoglobin at the tissue level

Oxygen leaves hemoglobin and becomes dissolved in the blood and passes through the capillary membrane into the tissues

CO₂ is a waste product of normal aerobic tissue metabolism

CO₂ defuses through cellular & alveolar capillary membranes only in its dissolved state

CO₂ can be carried in the blood; dissolved in the plasma (7%), attached to hemoglobin (23%), or converted into bicarbonate ions (70%)

How well did you know this?

Not at all

Perfectly

Cardiovascular Function Regulation

* Autonomic Nervous Center (ANS)

Regulates cardiac function by:

Cardiac rate
Cardiac muscle contractility
Vascular tone

How well did you know this?

Not at all

Perfectly

* Heart

___ fibers - heart beats faster and contracts stronger

___ fibers - slow heart rate (no effect on contractility)

* Vascular system

Sympathetic control

> Maintains partial state of contraction

> Constrict or dilate vessels in response to body needs

Sympathetic

Parasympathetic

How well did you know this?

Not at all

Perfectly

Brainstem Centers

___

> Sense low pressure - brainstem centers stimulate sympathetic nervous system to increase heart rate & induce vasoconstriction

> Located in walls of heart and blood vessels; sensitive to pressure changes

___

> Main function to regulate ventilation

> Located in aortic arch and are sensitive to changes in blood, pH, O₂ & CO₂ levels

Baroreceptors

Chemoreceptors

How well did you know this?

Not at all

Perfectly

Vascular System

Sympathetic control maintains the blood vessels in a constant baseline state of partial contraction tone which allows a stable blood pressure and blood flow at rest or when a patient is sleeping
Sympathetic stimulation above and beyond baseline tone varies in response to body needs
So when there’s increased sympathetic stimulation it leads to constriction of vessels

e.g.

The skin, GI tract, and kidneys and dilation of other vessels like skeletal muscle - shunts blood flow to the skeletal muscle for a fight-or-flight response

How well did you know this?

Not at all

Perfectly

Brainstem centers

The ___ center controls sympathetic stimulation of heart and vascular system

The ___ center controls parasympathetic slowing of the heart rate

vasomotor

cardioinhibitory

How well did you know this?

Not at all

Perfectly

Factors That Influence Cardiovascular Function Developmental Stage \* Young & middle adults - Poor nutrition (too busy to prepare or eat high fat, high sugar foods) - Lack of exercise - Substance abuse (especially tobacco) - Family history (of CVD)

\* Older adults - Efficiency gradually declines \> Loss of contractile strength \> Valves become thicker & rigid \> Peripheral vessels become less elastic - creates more resistance - More prone to _orthostatic hypotension_ **Heart becomes less able to respond to increased oxygen demands**

Factors That Influence Cardiovascular Function Stress \* Release of catecholamines (from SNS) = increased HR, contractility, vasocontriction, ↑ blood clots Allergic reactions & air quality \* Allergic reactions include release of HISTAMINE & PROTEASE \> Vasodilation - ↑ blood flow, ↑ capillary permeability, more fluid leakage

Altitude \* Increase altitude - drop in O₂ pressure - affects alveoli and tissue Heat & cold \* Heat \> Vasodilation - ↑ cardiac output and oxygenation \> Increases metabolism (people sedentary in hot weather) \* Cold \> Vasocontriction and slow HR, metabolism \> Prolonged exposure leads to frostbite, loss of hypothalamic temperature regulation, and eventually death

Factors That Influence Cardiovascular Function Lifestyle Pregnancy \* ↑ demands (on O₂, maternal metabolism, volume, iron requirements) Nutrition \* Balance of proteins, carbs, fats, & nutrients \* Low-fat, low cholesterol, low sodium diet = heart healthy diet \* DASH diet - dietary approaches to stop HTN \* Especially iron and protein are important to prevent anemia which reduces blood O₂ carrying capacity \* Green tea consumption has been associated with reduced mortality d/t CVD

Obesity \* Atherosclerosis & HTN = increase workload of heart Exercise \* Improves circulation & oxygenation \* Regular aerobic exercise strengthens heart muscles - as heart becomes stronger, it becomes more efficient pump Tobacco use \* **Risk of coronary artery disease is 4x higher in cigarette smokers than non-smokers cigarette smoking** Substance abuse \* Depression of respiratory, cardiac, vasomotor centers in brain

? Is a fatty buildup in the arteries that leads to HTN and decreased HDL (the good cholesterol)

Atherosclerosis

Factors That Influence Cardiovascular Function - Lifestyle - DASH diet - Dietary approaches to stop HTN - Based on a 2000-kilocalorie diet \* Grains 6-8 daily servings (whole wheat bread, cereal, oatmeal) \* Vegetables 4-5 daily servings (tomatoes, broccoli, carrots, peas, kale, spinach, beans) \* Fruits 4-5 daily servings (bananas, strawberries, oranges, prunes, raisins)

\* Low-fat or nonfat dairy foods 2-3 daily servings (skim or 1% milk, low-fat cheese, low-fat yogurt) \* Meats, poultry, & fish 6 or fewer servings (lean meat, broil/roast, remove skin) \* Nuts, seeds, & legumes 4-5 servings per week \* Fats & oils 2-3 servings per day

Factors That Influence Cardiovascular Function - Medications \* Improve cardiac output and tissue oxygenation \* Slow HR or reduce the force of myocardial contraction \* Ease the workload of the heart \* Dilate blood vessels & reduce blood pressure in pulmonary & systemic circulation \* Remove excess fluid accumulation \* Block abnormal heart rhythms

\_\_\_ regimen helps prevent cardiovascular disease (CVD) \> Blocks prostaglandins (substances that activate the formation of blood clots, signal injuries, & trigger pain) - Reduction of risk of heart attack or stroke \> Recommended dose - Adults over 50 who have a risk of CVD - 1 baby ASA 81 mg per day

Aspirin

Medications that PROMOTE Circulation \* Vasodilators (angiotensin-converting enzyme (ACE) inhibitors, angiotension II receptor blockers (ARBs), nitrates) \* Beta-adrenergic blockers \* Calcium-channel blockers \* Positive inotropic agents (cardiac glycosides [Digoxin]) \* Diuretics (thiazide diuretics (HCTZ), loop-diuretics (furosemide), potassium-sparing diuretics (spironolactone)

Factors That Influence Cardiovascular Function - Pathophysiological Conditions Cardiovascular Abnormalities \* Structure, function, & regulation \* Heart failure \* Cardiomyopathies \* Cardiac ischemia

\* Coronary artery disease \* Dysrhythmias \* Valve abnormalities \* Peripheral vascular abnormalities \* Oxygen transport abnormalities

Cardiovascular abnormalities results from problems that occur with structure, function, and regulation of the cardiovascular system & they're going to interfere with the flow of oxygenated blood to organs & tissues

Major abnormalities include heart failure (HF) which leads to an ineffective pump; includes right-sided HF, left-sided HF, or both right and left-sided HF

? Has to do with the heart muscle; a disorder that leads to an enlargement of the heart & impaired cardiac contractility \_\_\_ if it results from a genetic disorder \_\_\_ if it results from another cardiovascular disease

Cardiomyopathy Primary Secondary

\_\_\_ occurs when oxygen requirements of the heart are not met so prolonged ___ can lead to myocardial infarction where parts of the heart muscle start to die from lack of O₂

Cardiac ischemia; ischemia

? Is the transient chest pain (CP) d/t MI wherein tissue becomes injured but doesn't necrose

Angina pectoris

\_\_\_ is ischemic CP that has worsened in frequency, severity, or duration & if it is not relieved by usual measures & left untreated, can lead to MI

Unstable angina

\_\_\_ is a predictable pattern of ischemic chest pain that is precipitated by known triggers like activity, large meals, temperature extremes, cigarette smoking, stimulants, sexual activity, strong emotions, & circadian rhythm patterns Usually alleviated by rest & medications

Stable angina

Heart valve abnormalities create turbulent flow leading to a decrease in cardiac output & compromise tissue oxygenation = heard as a murmur = most common ones affect ___ & ___ valves valve ___ is a narrowing = blood flows through a constricted opening in order to pump blood flow through that narrow valve; leads to increased workload of the heart & hypertrophy of the chamber that precedes that stenotic valve valve ___ (insufficiency) - refers to the incomplete closure of the valve which leads to regurgitation of the blood back into the chamber from where it came - regurgitation leads to extended, increased workload of the chamber ejecting the blood

mitral; aortic stenosis incompetence

Peripheral vascular abnormalities have to do with impaired blood flow to & from organs & tissues \_\_\_ abnormalities disrupt blood return to the heart & S/S would be edema, brown skin discoloration, & tissue dysfunction r/t stasis ulcers \_\_\_ abnormalities disrupt flow of oxygenated blood to the tissues & S/S would be pallor, pain, weak or absent pulses, poor capillary refill, cool skin, & tissue dysfunction

venous arterial

Oxygen transport abnormalities - ___ which is abnormal low levels of red blood cells, hemoglobin, CO when CO is inhaled, it binds tightly to hemoglobin actually at the O₂ receptor sites making it impossible for hemoglobin to carry O₂

anemia

Types of Cardiomyopathy

Normal Heart vs Mitral Valve Stenosis

Mitral Regurgitation

PAD vs. PVD: Test Tips & Memory Tricks (Video)

Nursing Process: Assessment Assess Risk Factors Anxiety Physical Examination \* Weight, height, waist circumference \* Inspection - Signs of distress (i.e. CP) - Skin & mucuous membranes (signs of DVT; dyspnea)

\* Palpation - Pulses, skin temp, edema, tenderness \* Auscultation - Heart sounds, vascular sounds, BP, LS (i.e. rales may signify ↓ cardiac output) \* Assess pain (location/duration/frequency/radiation); typically doesn't change with inhalation & exhalation

Assess for fatigue = is subjective; a common sx of oxygenation prolems including pt's who have anemia or HF; scale 0-10

Weak pulses, cool feet, lack of hair, & shiny skin on lower legs & feet usually are r/t PVD Skin ulcers can be seen w/severe venous or arterial disease Edema of feet & ankles can indicate HF Assess for clot in veins (DVT) & signs = pain, warmth, redness & swelling of the leg

Nursing Process: Diagnostic Testing \* Blood oxygenation - Oximetry, capnography, ABG's \* Lab tests - Cholesterol, lipid panel, c-reactive, blood glucose \* Cardiac monitoring - Continuous ECG (3-5 electrodes placed on skin of chest) - Resting ECG (uses 12 leads for 12 views of the heart)

Lipid panel - Testing for total cholesterol, HDL, LDL, & triglycerides is recommended every 5 yrs for adults over the age of 20 - For adults, total cholesterol \>200 mg/dL C-reactive protein (CRP) - Appears to be the most reliable marker for arterial inflammation \* Purpose of cardiac monitoring is to identify the pt's baseline rhythm & rate; recognize significant changes in the baseline rhythm & rate in recognizing life-threatening arrhythmias that require immediate intervention

APE To Man Aortic, Pulmonic, Erbs Point, Tricuspid, Mitral These locations are optimal for listening to the 4 valves of the heart. Erb's point is the best location listen for S2. At each location you should listen for any murmur for the associated valve.

Nursing Process: Diagnostic Testing cont'd Cardiac Cycle - ECG P wave - Atrial depolarization - contraction QRS complex - Ventricular depolarization - contraction

Nursing Process: Diagnostic Testing cont'd Cardiac Cycle - ECG T wave - Ventricular repolarization - relaxation U wave - r/t electrolyte imbalance - r/t medications - Digitalis - Inverted U can be r/t ischemia of cardiac muscle

Nursing Process: Diagnostic Testing cont'd Cardiac Rhythms \* Dysrhythmias - Heart rate/rhythm \> tachy-dysrhythmias \> brady-dysrhythmias \> ectopy

Nursing Process: Diagnostic Testing cont'd Cardiac Rhythms \* Site of origin \> Supraventricular \> Junctional \> Ventricular **All dysrhythmias can lead to decreased cardiac output resulting in hypotension & tissue hypoxia**

? \_\_\_ wave represents the firing of the SA node and the conduction of the impulse through the atria leading to atrial contraction or ATRIAL DEPOLARIZATION

P (wave)

? The ___ represents VENTRICULAR DEPOLARIZATION and leads to ventricular contraction

QRS complex

? The ___ wave represents the return of the ventricles to a relaxed state or resting state so that they can again be stimulated in; this is VENTRICULAR REPOLARIZATION

T (wave)

? The ___ wave is not always seen but if seen it can be r/t an electrolyte imbalance like a hypokalemia or hypercalcemia or in response to certain medications like digitalis or epinephrine An inverted ___ wave may occur w/ischemia to cardiac muscle

U (wave)

Dysrhythmias or abnormal heart rhythms They are categorized as ____ if rates are above 100 bpm \_\_\_ if rates are less than 60 bpm or \_\_\_, extra beats

tachy-dysrhythmias brady-dysrhythmias ectopy

They can also be classified by their site of origin \_\_\_ if they occur above the ventricles \_\_\_ if they occur within the AV node or ___ if they occur in the ventricles

Supraventricular Junctional ventricular

Nursing Process - Analysis/Nursing Diagnosis - Decreased cardiac output - Risk for impaired cardiac tissue perfusion - Risk for impaired cerebral, gastrointestinal, or renal tissue profusion - Impaired peripheral tissue perfusion - Risk for shock - Activity intolerance risk acute pain - Anxiety

Nursing Process - Planning Outcomes - No dyspnea or shortness of breath - Heart rate in expected range 60-100 bpm - Peripheral pulse is strong and equally bilaterally - Brisk capillary refill less than 2 seconds

Nursing Process - Planning Interventions/Implementation \* Manage anxiety - Anxiety activates sympathetic nervous system (SNS) & triggers stress response ⇒ hormone changes HR & force of contraction; vessels constrict, blood clots easier - Hormone changes including release of aldosterone that's going to lead to fluid retention & increases BP

! Anxiety reduction is a priority intervention

Nursing Process - Planning Interventions/Implementation \* Promote circulation both venous & arterial - Promote venous return & prevent clot formation **Adequate circulation ensures that oxygenated blood gets to the tissues & organs and venous blood returns to the heart**

Promote venous return (meaning that blood returns from all the areas of the body up through the vena cava (superior & inferior vena cava) and into the right side of the heart) - Elevate legs (above level of heart as gravity helps w/venous return) - Do not cross legs - Early & frequent ambulation (contraction of legs moves blood upward) - ROM exercises - Antiembolism stockings - Sequential compression devices (aka pneumatic compression devices; inflate & deflate to promote venous return)

\* Promote peripheral arterial circulation - Smoking cessation - Foot care - Comfortable fitting shoes - Regular exercise - Proper leg positioning - Medication (NEVER apply direct heat) - Warmth; AVOID cold - Graft bypass surgery/angioplasty

Arterial disease is usually found in the legs & feet and it occurs when tissues do not receive enough blood flow to keep up with the demand of O₂ May be caused by build-up of fatty tissues or plaque within the arteries OR ATHEROSCLEROSIS

? Pain with exercise - when arteries that supply blood in the legs are narrowed, leg pain occurs because of the lack of O₂; this is called \_\_\_

intermittent claudication

? Warmth leads to ___ AND ALSO prevents long periods of exposure to cold Never apply direct heat to a limb b/c it increases the risk of burns \_\_\_ or angioplasty is the introduction of a mesh stent to create a path for blood to flow around the damaged area

vasodilation graft bypass surgery

Arterial vs. Venous **Arterial** Cool to touch Thin, dry/scaly skin Hairless Thick toenails "**Dr**. **EP**" **D**angle legs = **R**ubor (flushing) **E**levate legs = **P**ale

Arterial vs. Venous **Venous** Warm to touch Thick, tough skin Brownish color

Prevent Clot Formation - Reposition frequently - Sterile technique with IV therapy - Dilute IV medications properly - Hydration - Smoking cessation - Medications

? A ___ is a clot that travels in the bloodstream A ___ is a stationary clot that adheres to the inside wall of the vessel; these can form after injury to the vessel or in response to hypercoagulability

embolus thrombus

Administer Cardiovascular Medications - Drugs That Affect Blood Pressure **Antihypertensive Medications** - Angiotensin converting enzyme inhibitors (ACE inhibitors) - Angiotensin II receptor blockers (ARBs) - Calcium channel blockers - Vasodilators - Diuretics - SNS drugs → beta-blockers

**Antihypotensive Medications** - Sympathetic adrenergic agonists or vasopressors → epinephrine

**ACE Inhibitors** - "PRILs" - Benazepril, Captopril, Enalapril, Lisinopril, Prinivil - Prevent conversion of angiotensin I into angiotensin II - vasoconstrictor & stimulator of aldosterone release - Leads to ↓ BP, ↑ serum K, and ↓ serum Na - Used to treat HTN & HF - Oral - Metabolized in liver & excreted in urine & feces

- Adverse effects; \> Tachycardia, CP, HF, arrhythmias, GI ulcers, constipation, liver injury, renal insufficiency, renal failure, proteinuria, rash, alopecia, dermatitis, photosensitivity \> Unrelenting nonproductive cough possibly from effects on the lungs Monitor Na & K levels

**Angiotensin II receptor blockers (ARBs)** - "SARTANS" - Losartan, valsartan - Bind with angiotensin II receptors & block vasoconstriction and the release of aldosterone = lower BP - Used to treat HTN & HF - Can be given orally - Well-absorbed & metabolized in the liver, excreted in the feces & urine

- Adverse effects; \> Headache, dizziness, syncope, weakness, diarrhea, abdominal pain, nausea, dry mouth, tooth pain, cough, rash, dry skin, & alopecia

**Calcium Channel Blockers** - ↓ BP, cardiac workload, & myocardial O₂ consumption - affect cardiac workload - Used to treat angina & HTN - Immediate release \> Amlodipine (Norvasc) & nicardipine (Cardene) - Sustained release or extended-release \> Diltiazem (cardizem CD), nifedipine (procardia XL), verapamil (calan SR)

- Orally - Well absorbed, metabolized in the liver, excreted in urine, crosses placenta & enters breast milk - Adverse effects - dizziness, lightheadedness, HA, fatigue, N/V, change in taste perception, hypotension, bradycardia, peripheral edema, heart block, skin flushing, rash & mouth sores - Calcium channel blockers interact with grapefruit juice - increase medication toxicity

Calcium Channel Blockers - **Therapeutic Action** Calcium channel blockers inhibit the movement of calcium ions across the membranes of the myocardial & arterial muscle cells, altering the action potential in blocking muscle cell contraction This is going to lead to a depression of the myocardial contractility, slowing down of cardiac impulse formation in the conductive tissues, & relaxes & dilates arteries, causing drop in BP & decreases in venous return

Calcium Channel Blockers ***V**ery **N**ice **D**rugs* Verapamil, Nifedipine, Diltiazem

**Vasodilators** - Severe HTN, malignant HTN, or hypertensive emergencies - Hydralazine & nitroprusside (nitropress) - Vasodilation & drop in BP - Nitroprusside - IV - Hydralazine - oral, IV, IM - Metabolized in the liver, excreted in the urine, crosses the placenta & enters breast milk

- Adverse effects - dizziness, anxiety, HA, reflex tachycardia, HF, CP, edema, skin rash, lesions, abnormal hair growth, N/V - Cyanide toxicity may occur w/nitroprusside: dyspnea, HA, vomiting, dizziness, ataxia, LOC, imperceptible pulse, absent reflexes, dilated pupils, pink color, distant heart sounds, shallow breathing

Diuretics - Increases excretion of sodium & water from the kidney - Treatment for HTN often used to treat mild HTN - Monitor serum sodium levels and blood volume - Thiazide or thiazide-like diuretics are considered the first line medications to treat HTN \> Thiazide & thiazide-like diuretics include: chlorothiazide (Diuril), hydrochlorothiazide (HydroDiuril) - Potassium-sparing - amiloride (Midamar), spironolactone (Aldacterone), triamterene (Dyrenium)

Beta-Adrenergic Agents : Beta-Blockers - "*LOL*" Atenolol, metoprolol, propanolol - Block vasoconstriction, decrease HR, decrease cardiac contraction, increase blood flow to kidneys - Control HTN - Monitor HR & BP prior to administration

**Medications Used to Treat Heart Failure - Positive Inotropes or cardiac glycosides** - Digoxin (lanoxin) \> Increase force of contraction - slows HR - decreases conduction velocity through AV nodes Oral : onset 30-120 min / IV : onset 5-30 min Excreted in urine - monitor renal function

Adverse effects - HA, weakness, drowsiness, vision changes - a yellow halo around objects, GI upset & anorexia Digit toxicity - anorexia, n/v, malaise, depression, irregular heart rhythms Digoxin antidote - digoxin immune fab rapidly treats digoxin toxicity

- Interactions ⇒ Quinidine, erythromycin, tetracycline, cyclosporin, amiodarone, & verapamil may **_increase_** therapeutic effect - Thyroid hormones, metoclopramide, St. John's wort, psyllium may lead to **_reduced_** effects - Oral digoxin may not be absorbed when taken with antacids, bleomycin, or methotrexate - do not take at same time but 2-4 hrs apart - Monitor AP for one full minute before administering \> Hold the dose if the pulse is less than 60bpm in an adult (or \< 90bpm infants) \> Check dose carefully

- Avoid administering the oral drug w/food or antacids to avoid delaying absorption - Give small frequent meals; if given IV administer over 5 minutes - Serum digoxin levels should be between 0.5-2 ng/mL

**Medications Used to Treat Angina - Nitrates** - Isosorbide denitrate (isordil), nitroglycerin (nitrobid, nitrostat) - Nitrates relax & dilate veins, arteries, & capillaries allowing for an increased blood flow through the vessels & lowering the systemic BP - decreases cardiac workload - Prevent & treat attacks of angina pectoris - Sublingual tablet, translingual spray, IV solution, transdermal patch, topical ointment or paste, or transmucosal agent

- Rapidly absorbed, metabolized in the liver, excreted in the urine; crosses placenta & enters breast milk - Adverse effects - HA, dizziness, weakness, n/v, incontinence, hypotension, reflex tachycardia, syncope, angina, flushing, pallor, increased perspiration

- Do not combine nitrates with sildenafil, tadalafil, or vardenafil - hypotension & cardiovascular events - Lay down or sit prior to administration d/t low blood pressure causing lightheadedness or dizziness - Sublingual - under the tongue, patient should feel a fizziness or burning sensation which indicates potency - Sublingual - can be repeated in 5 min if relief is not felt to a total of 3 doses 5 min apart - If topical application is required rotate sites to decrease risk of skin abrasion & breakdown

**Anticholesterol Medications - Statins** - Atorvastatin, pravastatin, rosuvastatin, simvastatin - Blocks action of HMG-CoA reductase enzymes & leads to lower serum cholesterol & LDL levels & higher serum HDL levels - Absorbed from GI tract - first pass metabolized in liver, excreted in urine & feces - Crosses placenta & breast milk - Peak effect : 2-4 weeks taken at night

- Adverse effects - flatulence, abdominal pain, cramps, n/v, constipation, HA, dizziness, blurred vision, insomnia, fatigue, cataract development, increased concentrations of liver enzymes, acute liver failure may be reported w/atorvastatin and Fluvastatin - Rhabdomyolysis may occur - Toxicity increases if taken with grapefruit juice, digoxin, & warfarin - Used in conjunction w/diet to treat hypercholesterolemia & CAD

? \_\_\_ is an enzyme in the synthesis of cellular cholesterol If this enzyme is blocked, serum cholesterol & LDL levels decrease b/c more LDL's are absorbed by the cells for processing into cholesterol On the other hand, HDL levels increase

HMG-CoA

? Is a breakdown of muscles w/waste products that can injure the glomerulus & cause acute renal failure The risk for this increases if statins are taken w/erythromycin, cyclosporin, gemfibrozil, niacin, or antifungal drugs

Rhabdomyolysis

**Drugs Affecting Blood Coagulation - Antiplatelet** - Decrease formation of platelet plug & inhibit adhesion & aggregation to vessel walls - ASPIRIN, clopidogrel (Plavix) - Treat cardiovascular disease prone to thrombus - Adverse effects: bleeding, HA, dizziness, weakness, n/v, rash \* Acute aspirin toxicity w/hypercapnia possible leading to fever, coma & cardiovascular collapse; nausea, dyspepsia, heartburn, epig discomfort, GI bleeding, occult blood loss, dizziness, tinnitus, difficulty hearing & anaphylactoid reaction

**Drugs Affecting Blood Coagulation - Anticoagulant** - Interfere with normal clotting process - Heparin, coumadin (Warfarin), dabigatren (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) \* Warfarin (oral) causes decrease in Vitamin K-dependent clotting factors - EXTENDS CLOTTING TIMES - maintains anticoagulation \* Absorbed in GI tract; metabolized in liver; excreted in urine & feces \* Onset 3 days, effects last 4-5 days \* Antidote - Vitamin K

\* Stomach bloating, cramps, loss of hair & skin rash, orange-yellow discoloration of the urine \* Report: any bleeding, black tarry stools, cloudy or dark urine, sore throat, fever, chills, severe HA or dizziness \* Wear medical bracelet \* PT/INR labs - 1.5 - 2.5x control

**Drugs Affecting Blood Coagulation - Anticoagulant cont'd** Anticoagulant - Heparin blocks formation of thrombin - Treats acute venous thrombosis, pulmonary embolism, atrial fibrillation - IV or SC - usually inpatient acute (oral for outpatient) - Immediate onset, excreted in urine - APTT 1.5 - 3 times the control value

Thrombolytic - Urokinase - Breakdown thrombus Low-Molecular-Weight Heparins - Enoxaparin (Lovenox) - Block clotting factors II & X - Usually used after surgery & prolonged bedrest to prevent clot formation - Continued 7-14 days post-op

Warfarin-Sodium (Coumadin)

Heparin

Bleeding Precautions *RANDI* R = Razor → electric A = Aspirin → NO! N = Needles - small gauge D = Decrease needle sticks I = Injury - Protect from

Implement when: Using anticoagulants Liver disease present Platelets ↓ 150,000 Hemophilia present Using thrombolytic meds Observe for hematuria, nosebleeds, gingival bleeding, bruising

Cardiopulmonary Resuscitation \_\_\_ - cessation of heart function; pale grayish skin; absence of femoral or carotid pulses, apnea, pupil dilation Brain is damaged by lack of O₂ within 4-6 min CPR - cardiopulmonary resuscitation \> Effective, uninterrupted chest compressions \> Push hard, push fast in center of chest \> Administer 100 compressions per minute \> 30 compressions to 2 breaths (for all victims except newborns)

Cardiac arrest

? \_\_\_ or ___ arrest is the cessation of breathing; it can be caused by blocked airway or it can occur after cardiac arrest; be sudden or preceded by increased, labored breathing

Respiratory (or) pulmonary

Decreased Cardiac Output - Decreased ability for heart to pump - S/S : confusion, agitation, decreased LOC, cool/clammy/mottled extremities, delayed capillary refill, diminished peripheral pulses, hypotension, tachycardia @ first then bradycardia, thready pulse, JVD, increased RR, breathlessness, orthopnea, edema

- Assessment : skin, LOC, HR, RR, & BP, fluid balance & weights, edema, orthopnea, reports of fatigue - Diagnostic Testing; \> ABGs, CBC, electrolytes, kidney function (creatinine & BUN), cardiac biomarkers (CK, LDL, AST), chest x-ray, ECG

Nursing Interventions - Record I&O - Limit fluid & Na⁺ - Small frequent meals _ fatigue - Auscultate: heart sounds - rate/rhythm/S1,S2,S3,S4 - Monitor bleeding - Monitor anxiety (speak calmly & quietly; do not leave patient alone; give clear info)

Nursing Interventions cont'd - Position: Semi-Fowler's; no crossing legs; frequent ambulation - Administer O₂ & medications - Schedule nursing care to allow rest & minimize fatigue - ROM exercises - Antiembolism stockings (TED hose) [thrombo-embolus deterrent] - Sequential compression devices (SCDs)

Preload & Afterload Preload - Volume of blood in ventricles at end of diastole (end diastolic pressure) Increased in : hypervolemia, regurgitation of cardiac valves, HF

Afterload - Resistance left ventricle must overcome to circulate blood Increased in : hypertension, vasoconstriction ↑ afterload = ↑ cardiac workload

Picture a balloon... You are filling the balloon with water. Preload would be the amount of water in the balloon once you fill it Now hold the filled balloon by the top and squeeze the top gently; then with your other hand hold the balloon in your hand and try squeezing the water out of the balloon while maintaining the top squeezed... afterload would be the amount of force you would need to squeeze all the water out of the balloon

Circulation & Perfusion Flashcards

(95 cards)