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Module 3 (MedSurg 1) > CVPV > Flashcards

CVPV Flashcards

1
Q

What is the amount of blood pumped in one minute called?

A

cardiac output

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2
Q

Lower cardiac output means

A

poor perfusion

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3
Q

Hypertension is the cause of

A

every other heart problem
1/8 death in the world
3rd leading cause of death

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4
Q

Hypertension BP is usually

A

140/90 or higher

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5
Q

What is the most common primary diagnosis in the US?

A

Hypertension

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6
Q

What is the most common modifiable risk factor for CV disease?

A

Hypertension

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7
Q

As hypertension gets higher, the cardiovascular disease

A

it gets worse

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8
Q

Hypertension Crisis

A

180/120
- a lot of concern (stroke, perfusion)

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9
Q

Why is there more and accelerating hypertension in the US?

A

obesity (poor diet and exercise) - sitting

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10
Q

Causes of hypertension

A
  • increase in cardiac output (too much fluid)
    increase heart rate and stroke volume
  • increase peripheral resistance (hypothermia/stress)
    increase viscosity, vasoconstriction
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11
Q

Vasoconstriction

A

decrease in vessel diameter (shrink)

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12
Q

Vasodilation

A

increase in vessel diameter (expand)

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13
Q

Primary hypertension

A

not caused by identifiable disease/cause
- overactive sympathetic nervous system (RAAS, too much sodium)

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14
Q

Secondary hypertension

A

caused by another disease, stress
- renal vascular disease
- valve disorders
- sleep apnea
- pregnancy
- thyroid disorders
- drugs (oral contraceptives, antihistamines, corticosteroids)

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15
Q

If a patient has secondary hypertension, how should it be treated?

A

treat the cause

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16
Q

Secondary hypertension can be caused by what types of drugs?

A

oral contraceptives
antihistamines
corticosteroids

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17
Q

What does continued HTN do to the blood vessels?

A

Hypertrophy (enlarge)
Hyperplasia (replicate)
inflammatory

due to stress and stretching of vessels causes damage
macrophages will come to help but only narrow the vessels

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18
Q

Hypertrophy

A

enlargement of cells

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19
Q

Hyperplasia

A

replicate

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20
Q

What 2 things happen to the cells during the inflammatory response?

A

Hypertrophy
Hyperplasia

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21
Q

Risk factors Hypertension and cardiovascular disease

A

family hx
cig smoking
obesity
- high sodium, low potassium, calcium, and magnesium
heavy alcohol consumption
African American and age
diabetes

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22
Q

Men are at a higher risk factor of hypertension in what age range?
Women?

A

early to middle adulthood
over 50

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23
Q

What is considered the “silent killer”?

A

hypertension
- early stage no s/s other than gradually increasing B/P
- only noticed in crisis

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24
Q

S/S of hypertension

A

asymptomatic
HA
blurry vision
chest pain
dizzy
epistaxis
flushed face

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25
Q

Epistaxis

A

nose bleeds

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26
Q

Complicated Hypertension

A

sustained hypertension effects beyond hemodynamics organ involvement

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27
Q

What 2 major mechanisms of tissue damage can occur with having complicated hypertension?

A

Ischemia (decrease O2 to certain areas)
Edema (swelling of tissues/organs and fluid seeps out)

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28
Q

If we have decreased blood flow, we also have

A

decreased O2

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29
Q

Complicated HTN occurs commonly in

A

Kidneys (renal disease) - uncontrolled HTN
Brains - Strokes and vision
Heart (myocardium and coronary arteries)
Lower extremity vessels

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30
Q

When the ventricle’s walls thicken then

A

less blood goes into the heart
heart now has to work harder to pump out more blood

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31
Q

What lab/test can evaluate hypertension?

A

none
- looking for underlying reason but not dx

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32
Q

When is hypertension usually dx?

A

when pt comes in for something else
Log of BP for a month to see a trend and come back
Hx - smoking, diet, listen to lungs

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33
Q

If you see a patient who has one high BP, do you dx them now?

A

no, only after several months of BPs

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34
Q

What is the most accurate way of evaluating BP

A

auscultation manual
sit/laying down quietly for 5 mins
arm at heart level
appropriate size

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35
Q

White Coat Syndrome

A

BP will be high in a Dr’s office

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36
Q

Hypertension Treatment

A

fix the systolic, then the diastolic will follow
Goal is 130/80
- treat preexisting conditions
1st - lifestyle modifications (DASH)
- moderate exercise and alcohol consumption
- stop smoking

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37
Q

What diet should Hypertensive patients be on?
- rich in fiber and potassium, low in dietary sodium and saturated fats including fruits and veggies, low in dairy and total fat and carbs
- encourages the intake of whole grain products, fish, poultry, and nuts
- limits red meats and sweets recommended

A

DASH (Dietary Approaches to Stop Hypertension)

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38
Q

Any drugs used to treat the patient are also accompanied by the nurse

A

educating the pt on lifestyle modifications
- combine with diet and exercise

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39
Q

Antihypertensive Drugs

A

Ace Inhibitors
Beta Blockers
Calcium Antagonists

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40
Q

ACE Inhibitors end in

A

pril

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41
Q

Beta Blockers end in

A

olol

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42
Q

Calcium Antagonists have what in the name

A

Ca

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43
Q

Alpha-Adrenergic Antagonists (Alpha - Blockers)
Side Effects

A

orthostatic hypotension
vertigo
tachycardia
sexual dysfunction

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44
Q

Alpha Blockers end in

A

osin

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45
Q

Furosemide is also known as

A

Lasix

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46
Q

How long can furosemide stay in the body

A

LA sts SIX hours
usually during the day (if night, get up often for bathroom)

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47
Q

Side effects of Furosemide

A

Dysrrhthmias
due to a decrease K
decrease BP
increase blood glucose
sunburn very easily

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48
Q

Furosemide is used for

A

too much fluid
(edema, hypertension, ascites)

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49
Q

Hydrochlorothiazide is used

A

diuretic used to lower BP (mild diuretic)

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50
Q

What is the downside of HCTZ?
Important nurse assessment?

A

electrolyte loss
Monitor electrolyte balance

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51
Q

Which diuretic is used mainly for hypertension but a mild version of a diuretic than furosemide?

A

HCTZ

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52
Q

Hypertension Nursing Interventions

A

daily weight
I&O accuracy
Urine output
BP response
Electrolytes
Pulses
Ischemic Episodes (TIA)
4 C Complication

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53
Q

TIA means

A

Transient Ischemic Attack

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54
Q

4 C’s Complications of hypertension

A

Coronary Artery Disease
Chronic Renal Failure
Congestive Heart Failure
Cerebral Vascular Accident (stroke)

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55
Q

Success in Tx for Hypertension depends on

A

compliance (tell them to continue meds despite fatigue)
6 weeks and give them power by checking BP

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56
Q

Orthostatic Hypotension is also known as

A

Postural Hypotension

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57
Q

Orthostatic Hypotension is considered

A

Systolic = drop of 20 mmHg or greater
Diastolic = drop of 10 mmHg or greater
when standing up

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58
Q

Acute Orthostatic Hypotension reasons

A

Altered electrolytes
New med
Prolonged immobility
starvation
physical exhaustion
vol depletion
venous pooling
elderly - esp. falls**

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59
Q

Chronic Orthostatic Hypotension

A

Secondary to specific disease
- endocrine, metabolic, CNS, PNS

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60
Q

Idiopathic

A

no known cause

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61
Q

Idiopathic Orthostatic Hypotension

A

generalized degeneration of the CNS
1/3 of elderly affected (postprandial - after meals)

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62
Q

Orthostatic Hypotension has a significant

A

fall risk

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63
Q

S/S of orthostatic hypotension

A

dizzy
blurred loss of vision
syncope
fainting
after meals in elderly

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64
Q

Monitoring Orthostatic BP

A

lying/sitting/standing BP
3-4 times a day
more than 20

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65
Q

How do you diagnose orthostatic hypotension?

A

tilt table test

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66
Q

Tx of Orthostatic hypotension

A
  • PRIMARY FALL PRECAUTIONS
  • assist pt when moving and repositioning
  • supportive devices
  • eliminate the cause (meds, volume, electrolyte)
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67
Q

T/F: Vasoconstriction leads to increased blood pressure readings.

A

True

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68
Q

Orthostatic hypotension is defined as a drop of __________ or more when going from supine to standing. Select all that apply.
a. 10 mmHg systolic
b. 20 mmHg systolic
c. 10 mmHg diastolic
d. 20 mmHg diastolic

A

b. 20 mmHg systolic
c. 10 mmHg diastolic

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69
Q

The coronary artery supplies blood to the

A

heart muscle

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70
Q

Preload

A

stretch of the heart filling up with blood
caused by the pressure created by the volume of blood within the ventricle

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71
Q

Afterload

A

the amount of resistance to the ejection of blood from the ventricle

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72
Q

In terms of a slingshot, explain preload and the afterload

A

Preload is the stretch before the shot
Once let go the afterload kicks the blood out

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73
Q

Atherosclerosis

A

accumulation of lipid (fatty substance) in vessel walls
- inflammatory response
- fibrous cap forms
- ischemia

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74
Q

Atherosclerosis is more common in what vessels

A

coronary arteries
bc of tiny turns

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75
Q

In simple terms, explain atherosclerosis

A

A tiny injury attracts cells to fix it
Inflammation occurs and plaque causes narrowing
Blood clots cause complicated lesions when caught into the injury

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76
Q

preload increases in

A

hypervolemia
regurgitation of cardiac valves

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77
Q

Post-catheter femoral pt what do you do with a dressing

A

Look and palpate (hematoma) at the site
Check pulse distal to the site (pedal)
If you see bleeding, circle
2-6 hours leg straight
HOB at or less than 30 degrees
fluid to flush dye out

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78
Q

In a Post-op FEM-POP bypass graft surgery patient, how often do you check the foot’s pulse, color, temp, and Doppler?

A

every hour for 8 hours
then every 4 hours for the rest of the 24-hour period

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79
Q

Why do you not give asthma pts Beta blockers?

A

cause bronchospasms or make theirs worse

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80
Q

What Beta blocker would you give an asthma pt?

A

Metoprolol (less of bronchospasms)

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81
Q

ST depletion is a sign of

A

ischemia

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82
Q

ST elevation is a sign of

A

infarction or injury

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83
Q

When discharge teaching a pt with CHF, what is the most important thing they should check?

A

daily weight (call if over 3 pounds in a day)

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84
Q

How often do you check VS on a pt post-op from surgery?

A

1st hour = every 15 mins
2nd hour = every 30 mins
3-4th hour = every hour

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85
Q

What does infarction mean?

A

lost blood flow to the area so lost O2 content

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86
Q

In myocardial ischemia, what should you do regarding Oxygen

A

give them O2 to make the heart work more effectively and slowly
- such as ACE and Metoprolol

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87
Q

Intermittent claudication is associated with what disease?

A

Peripheral Artery Disease

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88
Q

Pre-op on a FEM-POP bypass, how should the patient sit?

A

dangling legs
help blood flow

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89
Q

Post-op on a FEM-POP bypass, how should the patient’s leg be situated?

A

elevated
decrease pressure

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90
Q

If you see blood on a dressing after a patient is post-op from surgery, what should the nurse do?

A

reinforce with dressing
DO NOT REMOVE
make a circle and palpate for hematoma

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91
Q

What lab is the most specific to identifying myocardiac damage

A

Troponin

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92
Q

Diagnostic test for angina

A

stress test (Thalium)

  • also with an Echo (dye shows block)
  • possible Cath Lab
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93
Q

What test is used to monitor heparin?

A

AntiXa every 6 hours

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94
Q

Non-modifiable risk of atherosclerosis

A

age
gender
family hx
ethnicity

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95
Q

Modifiable risk factors of atherosclerosis

A

Obesity (High cholesterol and inactivity)
smoking
hypertension
hyperglycemia
stress

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96
Q

What type of cholestrol is good to be high?

A

HDL

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97
Q

What types of cholesterols need to be low?

A

LDL, total, and triglycerides

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98
Q

What is the #1 killer of women?

A

Coronary Artery Disease
- >55 y/o CAD is equal to men

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99
Q

Myocardial Ischemia pathology

A

interfere with blood flow through the coronary arteries
not enough O2
narrowing of vessels = not enough blood flow/O2

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100
Q

What are the 3 possible causes of Myocardial Ischemia

A

vasoconstriction
atherosclerosis
thrombus formation
- narrowing by 50% greater risk

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101
Q

Myocardial Ischemia either has

A

decreased supply
increase demand
of blood flow/O2

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102
Q

In Myocardial Ischemia, the demand _________ supply.

A

exceeds

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103
Q

After ___ secs, the heart will become ischemic due to coronary occlusion, and after a few ________ the heart cells lose the ability to contract
What needs to be done before that time?

A

10 secs; minutes
- get blood flow/O2 back to the area

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104
Q

Heart cells only remain viable for ____ mins in an ischemic condition.

A

20 (Time is Muscle)

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105
Q

If perfusion is not restored, then ___________ will begin after 20 mins

A

infarction

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106
Q

Angina pectoris is just

A

chest pain

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107
Q

Angina Pectoris is caused by

A

myocardial ischemia(not enough O2 to heart)

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108
Q

Turbulent blood makes it more likely for

A

blood to stick and bounce off walls and cause blood clots
- leads to myocardial infarction

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109
Q

Factors causing anginal pain

A
  • physical exertion
  • exposure to cold
  • eating heavy meal
  • stress
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110
Q

Stable angina

A

predictable pain on exertion
- lasts 3-5 mins with pain relieved at rest/nitrates
- no damage if blood flow restored

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111
Q

Prinzmetal Angina

A

unpredictable caused by vasospasm
- at rest

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112
Q

Prinzmetal angina is treated with

A

Calcium channel blockers (CA in name)
help with spasms of the vessel walls

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113
Q

Silent ischemia is a type of

A

angina

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114
Q

Silent ischemia is known by

A

EKG changes with no pain or symptoms
- ST changes indicating MI

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115
Q

Unstable angina is also known as

A

preinfarction

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116
Q

Unstable angina occurs

A

at rest or minimal activity
increasing severity or frequency

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117
Q

Unstable angina could be with exertion but

A

does not stop the pain when sitting or treating

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118
Q

Unstable angina (20%)can lead up to

A

MI (myocardial infarction)

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119
Q

What treatment could possible treat stable angina

A

nitrates

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120
Q

What pain would we expect pts to feel leading up to a heart attack?

A

Unstable angina

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121
Q

Modifiable risk factors for coronary artery disease include which of the following?
Select all that Apply.

High cholesterol
Hyperglycemia
Ethnicity
Physical inactivity
Smoking

A

High cholesterol
Hyperglycemia
Physical inactivity
Smoking

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122
Q

What is the preventative actions and treatment options of angina?

A

Diet
Exercise (realistic goals and stop with chest pain)
Medications
Tobacco cessation
Managing HTN
Controlling DM
Managing stress

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123
Q

Evaluation of chest pain includes

A

cardiac assessment (auscultation, when started, rapid or extra sounds)
EKG
Labs

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124
Q

S/S of angina

A

indigestion
choking or heavy pressure on the sternum
radiate pain to neck, jaw, arms(left)
weak or numb in the upper extremity
SOB, pale, sweating, dyspnea
Dizzy, N/V

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125
Q

Angina/MI pts symptoms can vary greatly with

A

elderly and women
DIABETICS (neuropathy)

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126
Q

Elderly pts will complain of what s/s of angina AND MI

A

dyspnea

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127
Q

Women will complain about what s/s of angina and MI

A

Fatigue (major)

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128
Q

Acute Coronary Syndrome

A

umbrella term for unstable angina and myocardial infarction

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129
Q

What is used to diagnose ST elevation (myocardial ischemia) or depression (myocardial infarction)?

A

12 Lead EKG

130
Q

Diagnose and evaluate CHF

A

BNP - released with overstretched ventricular tissue

131
Q

If a pt shows up in the ED, c/o chest pain (angina). What lab should you anticipate being done?
If the lab is high?

A

Troponin (want it to be 0 or close to it)
If high, indicates progressing to MI

132
Q

CK-MB stands for

A

Creatinine and kinase myocardial band

133
Q

Troponin stays in the body for

A

up to 14 days

134
Q

Cholesterol does what

A

transport system to walls and into cells
fried and fatty foods

135
Q

HDL is primarily

A

hereditary (protective to excrete to livers)

136
Q

Triglycerides are stored

A

unused ingested calories in the fats cells
later used as energy
sweets and carbs

137
Q

Lipid Lowering Drugs (Manage cholesterol)

A

Statins (atorvastatin)
Niacin
Fibrates (gemfibrozil)

138
Q

Statins purpose

A

decrease significantly elevated LDL and triglyceride levels
Raise the HDL

139
Q

What do you need to monitor with statin drugs?

A

Liver function tests

140
Q

Statins can cause what to the body as a side effect and need to stop taking

A

muscle tenderness or weakness
hepatotoxicity

141
Q

Niacin purpose

A

B vitamin for minimal cholesterol levels or with statin

142
Q

What is the big side effect of Niacin?

A

flushing of redness or hotness in the face
but take aspirin 30 mins before helps

143
Q

Fibrates purpose

A

decrease LDL by stopping synthasis

144
Q

When starting someone on cholesterol medicine, have them come back every

A

6 weeks for the 1st six months or until goal reached

145
Q

Fibrates purpose

A

decrease LDL by stopping synthesis

146
Q

When should you take your Statin drugs during the day?

A

an evening meal or at bedtime

147
Q

Which of the following laboratory values needs to be closely monitored in a patient taking atorvastatin?

Liver function tests
Renal panel
White blood cell count
Troponin

A

Liver function tests

148
Q

Echocardiogram shows

A

effective pump and enough cardiac output

149
Q

Nusing Interventions and Tx for angina

A

make the heart work smarter, not harder
- OXYGEN 1st
- Pain assessment
- VS
- Respiratory
- 12 Lead
- Nitroglycerin

150
Q

What would you give the 1st thing to give pt to treat angina?

A

give supplemental O2

151
Q

If a patient has angina, what medication would we give to treat that?

A

Nitroglycerin

152
Q

How does giving O2 help tx angina?

A

The pt has angina because not enough O2 is getting to the heart causing the heart to work harder
But giving the O2 causes the heart to work efficiently not intensely (decreases BP, P, and left ventricular vol and helps with the contractibility)

153
Q

ALWAYS initiate ____ at the onset of chest pain

A

O2
- monitor pulse ox, rate and rhythms

154
Q

If a patient comes in with chest pain, what system do you always assume is affected until proven otherwise?

A

cardiac

155
Q

Nitroglycerin does what to the body

A

decrease BP, pulse, and left ventricular volume
assist with contractility
reduces myocardial O2 consumption
= decreases ischemia and relieves pain

156
Q

What is a commonly known nitrate

A

nitroglycerin

157
Q

If Nitroglycerin does not sting when SL, then

A

it is expired

158
Q

Nitroglycerin is very sensitive to

A

sun light

159
Q

If pain persists after 3 tablets of Nitroglycerin at 5-minute intervals, then

A

call 911

160
Q

If pain persists while giving the pt Nitroglycerin, what is the protocol for at home?

A

3 tabs at 5 minute intervals
if still persists 911

161
Q

If you take this drug, you can not have nitroglycerin

A

erectile dysfunction

162
Q

Nitroglycerin is a potent

A

vasodilator opens all the blood vessels

163
Q

A side effect of Nitroglycerin

A

Headache almost always
flushing

164
Q

Beta Blockers

A
  • smarter not harder
  • tx chest pain
  • help slow down the heart (hr, bp, and contractions) to have an effective contract by reducing myocardial O2 consumption
165
Q

What medication do you never stop abruptly and if NPO still give with ice chips or little water?

A

Metoprolol
- or rebound hypertension could occur

166
Q

If a pt has had an MI before, they are

A

at an increased risk of another MI

167
Q

Beta-blockers can alternatively affect

A

blood glucose (hypoglycemia mimics)

168
Q

Beta-blockers can be used for

A

BP decrease
chest pain
CHF
test anxiety/high-stress situations
valve issues

169
Q

If a patient heart rate is below 60, would you give metoprolol?

A

no, unless written otherwise

170
Q

A patient with a new prescription for metoprolol is told it should never be stopped abruptly. Why?
Stopping a beta blocker abruptly can cause hypoglycemia.
Stopping a beta blocker abruptly can cause rebound hypertension.
Stopping an ace inhibitor abruptly can cause an irritating cough.
Stopping a calcium channel blocker abruptly can cause a rapid decrease in heart rate.

A

Stopping a beta blocker abruptly can cause rebound hypertension.

171
Q

T/F: Nitroglycerin primarily dilates veins but at higher doses dilates arteries as well?

A

True

172
Q

Calcium Channel Blockers

A
  • slows electrical impulses, pulse, and O2 demand
    relaxes blood vessels (improve perfusion)
  • great for Prinzmetal angina and invasive coronary
173
Q

Do not take ___________ _______ with a calcium channel blocker.
Why?

A

grapefruit juice
increases Calcium Channel Blocker levels

174
Q

calcium Channel Blockers Names (Very Nice Drugs)

A

Verapamil
Nifedipine
Diltiazem

175
Q

Calcium Channel Blockers is not a good choice for patients with

A

Heart failure

176
Q

Aspirin

A

prevents platelet activation
prevent blood clots
81 baby and 325 full of cardiac issue

177
Q

clopidogrel (Plavix)

A

bleeding and GI upset with both
antiplatelet

178
Q

What is the number 1 concern for a pt with antiplatelet drugs?

A

bleeding out

179
Q

Watch platelet counts for what meds

A

Heparin
Enoxaparin

180
Q

Heparin is monitored by what test

A

AntiXa (for specific dose)

181
Q

Enoxaparin
What pts should probably not get it?

A

low molecular wt heparin
- do not have to monitor lab
not good for kidney pts

182
Q

HOw do patient’s manage angina at home?

A
  • reduce painful activities
  • avoid temp extremes
  • monitor BP
  • avoid antihistamines
  • stop smoking
  • take ASA and beta blockers
  • Carry Nitro at all times in original container and bag
183
Q

T/F: Prinzmetal angina is predictable pain that is relieved by rest.

A

False
vasospasm occurring at rest

184
Q

Myocardial Infarction (MI)

A

abruptly deprived of O2
- cells begin to necrose after 20 mins of occlusion
-longer occluded more extensive damage to the heart

185
Q

S/S of Myocardial Infarction

A

sudden onset of chest pain with no response to rest or nitro
SOB, dyspnea
N/V
decrease urine output
cool, clammy, sweaty, and pale
anxiety, restless, fear

186
Q

What system is a direct indicator of heart cardiac output unless a specific disease?

A

urine output

187
Q

The urine output should have how many mL of fluid per hour?

A

30 mL/hr

188
Q

What nursing care should be done for a MI pt?

A

bed rest
stool softeners to not strain
educate diet, caffeine, stop smoking, exercise
S/S of recurrent MI

189
Q

The goal of managing MI

A

minimize damage and preserve function

PTCA and meds

190
Q

PTCA

A

percutaneous transluminal coronary angioplasty
- stent

191
Q

What are the medications to give for an MI? MONA

A

Morphine - decreases the workload
Oxygen - #1
Nitrates - vasodilator
Asprin - antiplatelet

ALSO
ACE inhibitor
Beta-blockers

192
Q

Cardiac Rehab

A
  • extend and improve quality of life
    lifestyle modifications
    limit atherosclerosis
    prevent another attack
193
Q

If a patient asks after having an MI, when I can have sex again what do you say?

A

when they can do light exercise and a conversation at the same time

194
Q

Which of the following is not included in the characteristic assessment of chest pain?

A. When did the pain begin?
B. Where is the pain?
C. What type of pain is it? Stabbing, crushing, etc
D. How quickly is intervention taken (i.e. nitro given, O₂ applied?)

A

D. How quickly is intervention taken (i.e. nitro given, O₂ applied?)

195
Q

Cath Lab reason

A
  • usually radial or femoral
  • insert dye to find a blockage
  • if blockage then stent and balloon
196
Q

Nursing Care Pre-Op Cath Lab

A

NPO 8-12 hours
consent
good IV access (Versed)
prepare expectations (surgeons)

197
Q

Post-Op Cath Lab

A

look and palpate the site for bleeding or hematoma
check distal pulse, color, temp
monitor dysrhythmias
Bed rest 2-6 hours
leg straight
HOB not higher than 30 degrees
encourage fluids to flush out dye

198
Q

The patient returns to the unit shortly after cardiac catheterization. What important teaching should occur during this time of recovery? Select all that apply.

Drink a lot of fluids
Call the nurse if feel a pop or dampness at the catheter insertion site
Notify the nurse if chest pain occurs.
Keep affected extremities straight
Ambulate to the restroom if needed

A

Drink a lot of fluids
Call the nurse if feel a pop or dampness at the catheter insertion site
Notify the nurse if chest pain occurs.
Keep affected extremities straight

199
Q

What is the minimum time to hold pressure on an insertion site when the catheter is removed from the cath lab?

A

20 mins

200
Q

CABG

A

Coronary Artery Bypass Graft
- goes around the occlusion

201
Q

After a CABG, what precautions need to be in place?
Why?

A

turning and lifting precautions
fear of tearing sternal wires

202
Q

Which urinary output demonstrates to the nurse renal perfusion is being maintained following cardiac surgery?

A

30 mL/hr

203
Q

Mitral Valve Prolapse

A

leaflets go upward into the atrium
- most common valve disorders

204
Q

S/S of Mitral Valve prolapse

A

often asymptomatic
fatigue/lethargy
murmurs
dyspnea
weak
chest pain

205
Q

If a mitral valve prolapse, then avoid

A

hypovolemia
bc volume is needed to help perfusion

206
Q

Tx mitral valve prolapse

A

regular physician assessments
avoid hypovolemia
if more severe valve replacement

207
Q

Stenosis

A

valve is stiff, blood is trickle through
constricted or narrowed
blood flow through valve **not efficiently*

208
Q

Regurgitation

A

leaflets fail to close completely
blood backflow

209
Q

Both stenosis and regurgitation can cause

A

hypertrophy of muscles
damage to myocardium
tightened walls
impairs fill time

210
Q

How to manage valve disorders (regurgitation and stenosis) with what meds?

A

diuretics
cardiac glycoside (digoxin)
beta-blockers
prophylactic antibiotics

valve replacement (xeno, homo, auto)

211
Q

If the patient has a valve replacement, you should watch closely for the development of

A

heart failure

212
Q

The nurse is assessing a client recovering from heart surgery. What elements can be used during bedside assessment to assess cardiac output?

auscultation of heart sounds, monitor level of pain
fluid intake, serum sodium and potassium values
proper body positioning, presence of bruising
strength of pulses, skin temperature, urine output

A

strength of pulses, skin temperature, urine output

213
Q

A client is being evaluated for chest pain. Which of the following lab values is most reliable in evaluating damage to cardiac muscle?

A

Troponin

214
Q

A patient is presenting with aortic valve stenosis. The nurses understand this means the aortic valve is

A

so stiff is doesn’t open completely

215
Q

Heart failure in summary is

A

inability to pump sufficient blood to meet the needs of tissues

216
Q

Heart Failure is caused by

A

stress on heart
CAD
HTN
Valve disorders
systemic issues

217
Q

Heart failure is treatable but not

A

curable

218
Q

Left Heart Failure

A

pulmonary congestion
- dyspnea on exertion
- dry cough to bloody
- decrease O2, crackles
- extra sound
- orthopnea
- Paroxysmal nocturnal dyspnea (sudden gasp while resting)
- low urine output
- decrease LOC

219
Q

Left Sided Heart Failure typically lay in the

A

RECLINER

220
Q

left sided heart failure is more commonly

A

pulmonary symptoms

221
Q

Pulomonary edema is found through the

A

lung assessment

222
Q

In CHF pts prioritize what system

A

respiratory assessments every 4 hours
dyspnea, dry cough, fatigue, wt gain

223
Q

Right-sided heart failure

A

JVD
Dependent edema - hallmark
Hepatomegaly (large liver)
Ascites
weak, anorexia, wt gain

224
Q

Right-sided heart failure is mostly __________ symptoms

A

systemic

225
Q

What test confirms congestive Heart Failure?

A

Echocardiogram
- give ejection fraction and heart function (below 50 worry)

226
Q

What is the go-to lab for congestive heart failure?

A

BNP

226
Q

The higher the BNP, the higher

A

the failure/damage

227
Q

The nursing management of CHF

A

Daily weight same time and the same scale
I&O accurate
Lung assessment
elevate edema and pressure ulcers
- possible fluid restriction

228
Q

If a patient has gained more than ___ pounds a day, then contact HCP

A

3

229
Q

Medications for CHF

A
  • ACE: promote vasodilation and diuresis
  • ARB: if intolerant to ACE
  • Beta-blockers: with ACE, bradycardia, hypoglycemia
  • Digoxin
  • Diuretics
  • Anticoagulants
  • Low sodium diet
230
Q

ACE inhibitors are a

A

vasodilator and diuretic

231
Q

When should you contact the HCP on an ACE inhibitor?

A

dry presistent cough

232
Q

A patient with heart failure is beginning therapy with captopril, an ACE inhibitor. What nursing intervention is indicated prior to giving the first dose?

A. Provide the medication 1 hour before meals
B. Offer the medication with food
C. Review recent lab values for hypokalemia
D. Instruct the patient to call for assistance when getting out of bed

A

D. Instruct the patient to call for assistance when getting out of bed
Dizziness and orthostatic hypotension

233
Q

Afib and flutter cause the

A

atria to quiver and blood pools and clots

234
Q

Digoxin

A

cardiac glycoside used for systolic heart failure a fib and flutter
- increase contraction and cardiac output
- promotes diuresis

235
Q

Afib and flutters have no what on an EKG

A

P wave with irregular rhythm

236
Q

What is common in heart failure pts?

A

a fib

237
Q

With Digoxin Toxicity, what lab needs to be monitored

A

Potassium

238
Q

What needs to be checked for digoxin?
If lower than 60,

A

apical pulse
don’t give

239
Q

What is an antidote for Digoxin Toxicity?

A

Digibind

240
Q

S/S of Digoxin Toxicity

A

fatigue, depression, malaise
N/V, anorexia
PVCs

241
Q

Treating CHF UNLOAD FAST

A

Upright position
Nitrates
Lasix
Oxygen
ACE inhibitors
Digoxin

Fluids (decrease)
Afterload (decrease)
Sodium restrict
Test (BNP)

242
Q

A heart failure client is being discharged home. How should the nurse instruct the client to assess fluid balance?

A

Daily weight

243
Q

CHF pts physical activity is

A

warm up cool down
talk during exercise
stop if SOB

244
Q

A patient is experiencing fluid volume excess with dependent edema. The health care provider places the patient on a 1,500ml/day fluid restriction. Which nursing intervention is most important?

Provide frequent oral care
Assess amount of edema each shift
Weigh patient every Monday
D. Keep the legs lower than the heart

A

Assess amount of edema each shift

245
Q

P wave

A

atria

246
Q

QRS

A

ventricles

247
Q

T wave

A

rest and start again

248
Q

There should be ___ P wave before one QRS in a normal sinus rhythm

A

1

249
Q

PVCs

A

premature ventricular contractions

250
Q

PVCs need to have what monitored

A

electrolytes

251
Q

Bigeminal

A

PVC on every 2nd beat

252
Q

Trigeminal

A

PVC on every 3rd beat

253
Q

When do PVCs become a problem?

A

frequency increases and becomes regular

254
Q

Which of the following are symptoms of left heart failure? Select all that apply.
Paroxysmal nocturnal dyspnea (PND)
Peripheral edema
Jugular venous distention (JVD)
Crackles in the lungs
Shortness of breath upon exertion

A

Paroxysmal nocturnal dyspnea (PND)
Jugular venous distention (JVD)
Crackles in the lungs
Shortness of breath upon exertion

255
Q

Which of the following are symptoms of right heart failure? Select all that apply.

Jugular venous distention (JVD)
Hepatomegaly
Wheezing
Ascites
Shortness of breath on exertion

A

Jugular venous distention (JVD)
Hepatomegaly
Ascites

256
Q

PAD

A

Peripheral Artery Disease
- narrowing and blood flow decreases in atherosclerosis

257
Q

What sign is associated primarily with PAD

A

Intermittent claudication

258
Q

PAD S/S

A

Intermittent Claudication- pain in legs
pain in extremities with exercise
relieved by rest

259
Q

If have PAD, then relieve the pain by

A

dangling legs
increase perfusion

260
Q

If the patient has calf pain from PAD reflect on

A

femoral or popliteal artery ischemia

261
Q

Appearance of PAD

A

cool and pale
white blanched
intermittent claudication
no pulse, drainage, or edema
round smooth sores
toes and feet eschar
cyanosis
loss of hair and brittle nails
dry, shiny, scaly
ulcerations or bruits
doppler to detect flow

262
Q

Factors of PAD

A

smoking
high lipids
HTN
diabetes
stress
obesity

263
Q

Interventions for PAD

A

LOWER EXTREMITY
- proper foot care
avoid cold
- med for vasodilation

264
Q

PVD and PAD most also have

A

diabetes
antiplatelets
and cholesterol meds

265
Q

Surgeries for PAD

A

Bypass grafts (FEM-POP)

266
Q

Post-op on Fem-Pop bypass assess

A

pulse
color
temp
doppler

267
Q

How long do you monitor for a post-op fem-pop bypass

A

every hour for 8 hours
then every 4 hours for remaining 24

268
Q

What is the primary nursing intervention when caring for a patient after peripheral artery bypass surgery?

Encourage bed rest for the first three days post surgery

Encourage dangling of legs to promote circulation to the new peripheral vessel grafts

Assess and document pulses every hour for the first 8 hours after surgery

Encourage fluids to flush out radiopaque dye

A

Assess and document pulses every hour for the first 8 hours after surgery

269
Q

Signs and symptoms of peripheral arterial disease (PAD) include which of the following? Select all that apply.

Rubor in dependent extremities

Strong, regular pulses

Intermittent claudication

Dry, tight, shiny skin on extremities

Non-healing, painful ulcers

A

Rubor in dependent extremities

Intermittent claudication

Dry, tight, shiny skin on extremities

Non-healing, painful ulcers

270
Q

When assessing a client with peripheral arterial disease, the nurse anticipates signs and symptoms of ischemia, including

Warm, pink extremities
Intermittent claudication
Increased pulse pressure
Increased hair production on affected extremities

A

Intermittent claudication

271
Q

When assessing a client with peripheral arterial disease, the nurse anticipates signs and symptoms of ischemia, including

Warm, pink extremities
Intermittent claudication
Increased pulse pressure
Increased hair production on affected extremities

A

Intermittent claudication

272
Q

PVD S/S

A

chronic venous stasis - backflow from valves
edema
brownish discoloration (venule rupture)
pain

273
Q

PVD Management

A

ELEVATE EXTREMITIES
pump foot
compression stockings
assessment of peripheral neurovascular and skin integrity

274
Q

Appearance of PVD

A

EDEMA lower leg
dull achy
ankles sores with irregular borders
yellow slough
redness

275
Q

DVT Virchow’s triad (perfect storm)

A

venous stasis
vessel wall injury
altered blood coagulation

276
Q

Assessment of DVT

A

LIMB PAIN IN CALF
swelling
tenderness
difference in leg size
venous doppler

277
Q

High risk for DVTs

A

major surgery, trauma
oral contraceptives
diabetics, smoking, sedentary, travels
recurrent DVTs

278
Q

DVTs pts are on

A

bedrest

279
Q

Prevention of DVTs

A

compression stockings
leg exercises
ambulation
TCDB
enoxaparin or heparin
bed rest

280
Q

The antidote of heparin IV infusion

A

protamine sulfate

281
Q

Enoxaparin platelet levels need to be above

A

100,000

282
Q

Antidote for Warfarin

A

Viatmin K (not potassium) or FFP (fresh frozen plasma)

283
Q

Monitor what for Warfarin

A

PT/INR every day before dose

284
Q

For Warfarin and Heparin need to be careful about

A

bleeding
OTC, alcohol, dont stop

285
Q

Warfain education

A

avoid food with excessive Vitamin K (green and leafy)
avoid alcohol, OTC
don’t stop unless directed
ID bracelet

286
Q

T/F: The antidote for heparin is protamine sulfate.

A

True

287
Q

A patient presents to the cardiac clinic 3 weeks post-op aortic valve replacement to monitor PT/INR for warfarin therapy. The nurse can assume the client had which kind of valve replacement?

Homograft
Allograft
Tissue
Mechanical

A

Mechanical
have to be on anticoagulant for rest of their lives

288
Q

T/F: The lab value used to monitor the efficacy of warfarin is the partial thromboplastin time (PTT).

A

False, PT/INR

289
Q

DVT procedure

A

Greenfield filter to catch the clot
cause easily clot

290
Q

What is the amount of blood pumped in one minute

A

cardiac output

291
Q

The most common primary dx in the US

A

HTN

292
Q

What is it called when HTN is not caused by another disease process

A

Primary HTN

293
Q

This is when HTN has caused damage to other organs

A

ComplicatED HTN

294
Q

Which part of the heart pushes blood to the rest of the body

A

Left ventricle

295
Q

Side effects of this medication include orthostatic hypotension, sexual dysfunction, vertigo, and tachycardia

A

Alpha Blockers

296
Q

It is especially important to monitor Potassium levels with this med

A

Furosemide

297
Q

What is a diuretic that is used primarily treat HTN?

A

HCTZ

298
Q

What is problem when blood pressure decreases by more than 20 systolic or more than 10 diastolic when standing

A

Orthostatic HTN
- PREVENT FALLS

299
Q

T/F: Vasoconstriction can lead to increase BP

A

True

300
Q

Accumulation of lipid or fatty substances in the vessel walls is called

A

Atherosclerosis

301
Q

What are age, gender, and ethniciety?

A

Non-modifiable risk factors

302
Q

What cholestrol level do we want to be high?

A

HCL

303
Q

Inadequate blood flow or O2 content
If cut off completely

A

Ischemia
Infarction

304
Q

Predictable chest pain on exertion

A

Stroke angina

305
Q

EKG finding of injury or infarction

A

ST elevation
- want to catch at depression ischemia

306
Q

Most specific lab indicates cardiac injury

A

Troponin

307
Q

Most specific lab test for heart failure

A

BNP

308
Q

Diagnostic test used to look at heart wall motion

A

Echo

309
Q

Common side effects of Nitroglycerin

A

HA give tylenol

310
Q

Do not give if the patient has recently taken an erectile dysfunction med

A

nitroglycerin

311
Q

What lab is monitored when giving enoxaparin

A

platelet

312
Q

Acronym used to guide tx of MI

A

MONA

313
Q

Pt’s output is how many mL/hr if not call HCP

A

30

314
Q

When a heart valve never really closes and blood continues to flow even when the valve is not supposed to be open

A

Regurgitataion

315
Q

Vitamin K antidote for what med

A

Warfarin

316
Q

Classic signs of this issue focus on pulmonary issues

A

Left sided HF

317
Q

Classic sign of right sided heart failure

A

edema

318
Q

Asthma pts should avooid cardiac med

A

Beta Blockers

319
Q

If a heart failure client is being discharged how would you instruct the pt to monitor fluid balance

A

daily weight

320
Q

Leg pain induced by walking and subsides at rest

A

Intermittent claudication (PAD)

321
Q

This med puts pts at risk of DVT

A

Oral contraceptives

Module 3 (MedSurg 1) (12 decks)

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