Exam 2 Flashcards
1
Q
Heart Failure
A
Inability of the heart to pump sufficient blood to meet the demand of the body
2
Q
Signs of Heart Failure
A
Exercise intolerance, very fatigued with activity, most cases are related to MI damage and chronic HTN
3
Q
Clinical Manifestations of Heart Failure
A
Fatigue, Dyspnea, Orthopnea, PND, Tachycardia, Edema, Nocturia, Behavioral changes, chest pain, weight cahnges
4
Q
Classifying Left Ventricular Failure
A
Left ventricle has weak pump, backs up into the left atrium and into the lungs
Causes: HTN, CAD, Vascular Disease
5
Q
Classifying Right Ventricular Failure
A
Right ventricle weak, unable to pump into the lungs, symptoms come from back up into the systemic system, edema!
Causes: LV Failure, RV infarct, Pulmonary HTN
6
Q
Bi-Ventricular Failure
A
Usually RV secondary to LV failure
7
Q
Acute vs Chronic Failure
A
Acute= immediate, usually LV, following acute MI Chronic= Long term, less immediate
8
Q
Systolic vs Diastolic Failure
A
Systolic = Reduced ejection fraction Diastolic= decreased filling
9
Q
Low output vs High Output Failure
A
Low= Reduced pumping, more common High= fever, hyperthyroidism, pregnancy
10
Q
Compensatory mechanisms for Heart Failure
A
Increased HR and Increased SV (to maintain output)
Arterial vasoconstriction (to increase perfusion and BP)
Sodium and H2O retention (non-therapeutic)
Myocardial hypertrophy
11
Q
Diagnosing Heart Failure
A
CXR= show cardiomegaly, fluid in lungs ECHO= EJ calculation Angiography= visualize heart PA Catheter= Evaluate pressure EKG= conduction abnormalities
12
Q
B-type natriuretic peptide (BNP)
A
Plasma levels may correspond to the severity of underlying cardiac dysfunction, provides prognostic information, elevated plasma BNP indicates a high risk of morbidity and mortality in patients with chronic heart failure or acute coronary syndrome. Should be <100.
13
Q
Functional Classifications of Heart Failure
A
Class 1=No limitation
Class 2= Slight limitation
Class 3= More severe
Class 4= Inability to carry on any activity
14
Q
ACE Inhibitors
A
Reduce workload of heart, increase renal function
15
Q
Diuretics
A
Pulling off fluid, many will also have K+ replacements
16
Q
Beta Blockers
A
Overall longevity, make the heart work less
17
Q
Aldactone
A
Potassium sparing diuretic
18
Q
Digoxin
A
No longer top drug, lowers work of the heart, can have toxic levels and nasty side effects
19
Q
Nitrates
A
Dilate blood vessels
20
Q
Rational Polypharmacy
A
Balancing beneficial and adverse drug effects and monitoring how such drug regimens affect each patient with heart failure
21
Q
Focus of Heart Failure Therapy
A
Improve survival, relieve symptoms
22
Q
Clinical Manifestations of Acute LV heart failure
A
Respiratory distress; crackles, increased HR, S3 gallop rhythm, restlessness
23
Q
Pulmonary Edema
A
Life threatening LV failure; given IV diuretics, MSO4, NTG, Nitroprusside (dilates blood vessels), position in high fowlers, oxygen, and foley catheter
24
Q
Rheumatic Carditis
A
Affects 40% of patients with RF, group A beta-hemolytic streptococci (basic strep throat), Impairs pumping function, muscle tissue, pericardium, and valves.
basically Inflammation of cardiac valves related to strep throat
25
Valvular Heart Disease
Congenital or acquired dysfunctions, valvular stenosis, insufficiency or regurg
26
Mitral Stenosis
Usually from rheumatic carditis, valve is thickened by fibrosis and calcification. Sx: Dyspnea with exertion, fatigue, orthopnea, neck vein distention
PE: diastolic murmur
27
Mitral Regurgitation
Caused by RHD, LA and LV dilate and hypertrophy, may be symptom free for decades; common complaints are anxiety, chest pain, and palpitations. Other Sx include fatigue, weakness, and dyspnea, and orthopnea
PE: holosystolic murmur
28
Mitral Valve Prolapse
Valvular leaflets enlarge and prolapse into the LA during systole, usually benign and asymptomatic
PE: Systolic Click
Familial occurence usually, associated with marfans syndrome- cardiac disease, visual problems, very long arm span, most common in young to middle aged thin women
29
Aortic Stenosis
Increased resistance to ejection during systole, leading to LV failure and eventually RV failure. Sx: dyspnea, angina, syncope. PE= systolic murmur
Most common in aging populations, majority men
30
Aortic Regurgitation
Creates dilation of LV, asymptomatic for many years untilc LV failure occurs, usually from non-RHD: endocarditis, congentital, HTN, marfans syndrome, men Sx: DOE, orthopnea, PND
PE= Diastolic Murmur - second intercostal space on right side
31
Cardiomyopathy
Enlarged cardiac muscle, decreased pumping, irreversible, often unknown etiology, could be etoh,
32
Dilated Cardiomyopathy
Damage myofibrils, decreased CO
Sx: fatigue, DOE, gallop rhythms
More common in men of middle age
33
Hypertrophic Cardiomyopathy
LVH with obstruction in LV outflow, abnormal stiffness of LV, genetic usually, often cause of sudden death in young athletes, gallop rhythms, a.fib
34
Restrictive Cardiomyopathy
Rarest, LV filling is restricted, Sx: dyspnea, fatigue, right sided HF, gallop rhythms
35
Infective Endocarditis
Infection of valves and endothelial surface of heart cause by direct invasion of bacteria, usually r/t valve replacements, structural cardiac defects, or IV drug abuse. Sources: Oral cavity, skin lesions, infections, invasive procedures.
36
Patient with the following should receive antibiotics before dental procedures
Prosthetic cardiac valves
Previous bacterial endocarditis
Certain congenital cardiac malformations
Cardiac transplantation
37
The following no longer require antibiotics prophylaxis
```
Rheumatic Valve Dysfunction
Mitral valve prolapse
Previous CABG
Heart Murmurs
Cardiac Pacemakers and defibs
```
38
Infective Endocarditis 2
```
pt c/o chills, fever, flu like symptoms
PE=new onset of murmur
Oslers nodes and Janeways lesions
petechiae
Splinter hemorrhages
arterial embolic complications
```
39
CO: SV X HR
4-6L/min is normal
40
HR
60-100 beats/min is normal
41
SV
73ml/contraction is normal
42
Preload
5-12 mmHg is normal
43
Cancer is...
The second leading cause of death in the US. Cancer accounts for nearly one-quarter of all deaths in the US.
44
Highest Estimated new cases in males and females
Prostate for males
Breast for females
Second for both is lung and bronchus
45
Highest estimated deaths related to cancer
Lung and bronchus cause the most deaths, followed by prostate and breast
46
Cancer disparity between african americans and whites
African americans are 10% -20% less likely to survive cancer, this is due to less likely to recieve cancer diagnosis at and early stage, unequal access to medical care, and tumor characteristics not related to early detection
47
Individual Actions to Prevent Cancer
- Maintain healthy weight
- Physical Activity
- Consume healthy diet with plants
- Limit alcohol consumption
- Stop smoking
- Limit sun exposure
- Protect yourself from toxic substances
48
CAUTION
```
Change in bowel/bladder habits
A sore
Unusual bleeding/discharge
Thickening/Lump
Indigestion or swallowing issues
Obvious change in wart or mole
Nagging cough/hoarseness
```
49
Unmodifiable Risk Factors for Cancer
Family history, Age, Gender, Impaired immunity
50
Prognostic Factors for Cancer
Performance status: Karnofsky Scale, ECOG Scale, Staging: TMN Classification, Grading
51
Karnofsky Scale
A person's functional status, their ability to care for themselves and carry out normal activities of daily living. 100 = highest living 0= dead
52
TMN Classification
T=The extent of the primary tumor
N= Lymph Node presence?
M= Distance Metastasis?
Subscripts: X= unknown, 0= none, 1-4 =extent of disease
53
Grading
Looks at characteristics and behavior of cancer cells. If it looks and behaves more like normal cells they are usually less aggressive.
54
Ploidy
Chromosome number and appearance. Normal human ploidy = 23. Cancer can cause addition or loss of a chromosome. More or less than 23= aneuploidy = more malignant
55
Shock
A conditions in which systemic blood pressure is inadequate to deliver oxygen and nutrient to support vital organs and cellular function
56
Inadequate tissue perfusion leads to...
if untreated cell death will happen
| it can lead to anaerobic metabolism which leads to build up of lactic acid and metabolic acidosis
57
3 optimally performing components needed to ensure adequate tissue perfusion:
Adequate cardiac pump
Effective and intact vasculature
Sufficient blood volume
58
Mean Arterial Pressure
Average pressure at which blood moves through the circulatory system, normal = 70-110 mm Hg, need a minimum of 60 mm Hg for perfusion of coronary arteries, kidneys, and brain
59
MAP
CO X Peripheral vascular resistance
60
Calculated MAP
Diastolic BP + 1/3 Pulse Pressure
61
Baroreceptors
Respond to dropping BP, stimulate SNS, epinephrine and norephinephrine released from adrenals, increase HR and vasoconstriction
62
Chemoreceptors
Respond to changes in oxygen and carbon dioxide concentrations
63
Kidneys role in RP regulation
Vasoconstriction, retention of sodium and water, ADH for further water retention, increased blood volume and BP, takes hours and days to respond
64
Compensatory stage of Shock
```
BP=Normal
HR= >100 bpm
RR= >20
Skin= Cold Clammy
Urinary Output= Decreased
Mentation= Confused
Acid Base Balance= Respiratory Alkalosis
```
65
Medical Management of Compensatory stage
Identify and treat cause of shock, support successful physiologic adaptations, replace fluid, meds
66
Nursing Management of Compensatory Stage
```
PREVENT BP DROP!
Ongoing systematic assessment
Urinary output
Skin
Lab Values: Sodium and blood glucose increase
```
67
Progressive Stage of Shock
```
BP= Systolic 150
RR= Rapid, shallow, crackles
Skin= Mottled, petechiae
Urinary Output= 0.5 ml/kg/hr
Acid Base Balance= Metabolic Acidosis
```
68
Progressive Stage Prosnosis
All systems on the verge of failure: Kidneys, liver, GI, Resp, CV, Heme
69
Medical Management of Progressive Stage of Shock
Fluids and Meds
Restore intravascular volume
Support pumping of the heart
Improve competence of vascular system
70
Nursing Management of Progressive Stage of Shock
```
Understand Shock
Significance of Changes
ASSESS
Prevent complications- aseptic technique
Promote rest and comfort
Support family
```
71
Irreversible Stage of Shock
```
BP= Requires support
HR= Erratic and asystole
RR= Intubation
Skin= Jaundice
Urinary Output+ Anuric, dialysis
Mentation= Unconsious
Acid Base Balance= Profound acidosis
```
72
Irreversible Stage Diagnosis
Only made retrospectively, continue intervening until no response to treatment, nursing management is focus on comfort and support to patient and family
73
Management Strategies of Shock
Fluid Replacement
Vasoactive meds- restore vasomotor tone and improve cardiac function
Nutritional support
74
Fluid Replacement in Shock
Crystalloid Fluids- electrolytes move freely between intravascular and interstitial spaces
Colloidal Fluids- large molecule fluids
Blood components
75
Crystalloid Fluid
Isotonic (Expand ECF volume)
0.9% Normal Saline
Lactated Ringer's
76
Colloids Fluid
Albumin
| Dextran
77
Vasoactive Meds
Inrease cardiac contactility, Regulate HR, Reduce myocaridla resistance, Initiate vasoconstriction
All work by stimulating alpha- and/or beta- adrenergic receptors
78
Nursing Management of Vasoactive Meds
VS at least q15 mintues
Administer through central venous catheter
Always use IV pump and monitor closely
Titrate dosage based on patient parameters
NEVER stop abruptly
79
Nutritional Support for Shock
Glycogen stores depleted in first 8 hours of shock, even with people with large fat stores, muscle is selectively broken down as an energy source, loss of skeletal muscle greatly prolongs recovery time, >3000 kcal/day high protein, enteral and parenteral
80
Hypovolemic Shock
Hemorrhage, Trauma, Surgery, Dehydration, Burns
81
Cardiogenic Shock
Coronary (MI), Non-coronary (Cardiomyopathies, valve damage, cardiac tamponade, dysrhythmias)
82
Circulatory Shock
```
Septic Shock: Sepsis and hypotension
Immunosuppression
Extremes of age
Malnourishment
Chronic Illness
Invasive procedures
```
83
SIRS
Systemic Inflammatory Response Syndrome
| Physiological alterations and organic dysfunctions seen with bacterial infections
84
Sepsis
Systemic infection occurs in 1-2:100 hospitalized patients
55% in critical care units
85
Circulatory Shock: Neurogenic Shock
```
Massive Vasodilation
Spinal cord injury
Spinal anesthesia
Depressant Action of meds
Glucose deficiency
```
86
Circulatory Shock: Anaphylactic
```
Vasodilation and capillary leakage
PCN sensitivity
Transfusion reaction
Bee sting allergy
Latex Sensitivity
Food Allergies
```
87
EKG's
Graphic representations of the ELECTRICAL activity within the heart. They can tell about electrical function: Rhythm disturbances, and conduction disturbances.
88
EKG's cannot...
tell about mechanical function: Structural disorders and perfusion disorders
89
The sodium pump: Polarization
Steady State, "Chillin", K+ inside the cell, Na+ outside the cell "Ready State"
90
The sodium pump: Deplorization
by an electrical impulse, sodium rushes into the cell, potassium rushes out, stimulates the contraction "Discharge State"
91
The sodium pump: Repolarization
Potassium goes back in and sodium comes back out "recovery state"
92
What do you need in order for the heart to function properly?
Good electrical system
Good blood flow system
Good muscular system
93
Inherent Rates of the heart
Sinus Node: 60-100 beats/min
AV junction: 40-60 beats/min
Ventricles: 20-40 beats/min
94
Pacemaker Rule
Pacemaker site with the fastest rate will generally control the heart. SA node should always trump the others paces because it should be fastest.
95
"Irritability"
A site along the conduction pathway becomes irritable and speeds up, thus overriding higher pacemaking sites for control of the heart. Magnesium is a critical electrolyte to have stable to prevent arrhythmias.
96
"Escape Mechanism"
The normal pacemaker slows down or fails, and a lower pacing site assumes pacemaking responsibility.
97
Rule of electrical flow
Electricity flowing toward positive electrode produces upright pattern. Negative to positive electrode - lead two.
98
Artifact
looks funny on the EKG strip. can be muscle tremors, patient movement, or lose electrodes on the patient's chest, or it can be an electrical interference
99
Digoxin
Anti-arrhythmia, increases force of contraction, increasing output and slowing heart rate
100
Sudden Arrthythmic Death Syndrome (SADS)
Sudden death in healthy individuals, genetic (long QT syndrome, Marfans) vs. Acquired (Meds). If someone has exercise related fainting, its the best predictor. DxL Cardiac MRI Rx: Implantable defibrillators
101
Ventricular Tachycardia
| Life Threatening
Pulseless or pulse
Pulseless patients need to be defibrillated
Sustained or unsustained
Stable or unstable
Unstable: SBP 120, Chest pain, Heart failure
Meds: Amiodarone, anti-arrythmics, vasopressors
102
Pulseless VT
DEFBRILLATE
103
Stable VT
Amiodarone, Procainamide, CV
104
Torsade de Pointe
Mg, BB, Amiodarone
105
Ventricular Fibrillation
Ventricle quivering, this is the worst possible heart rhythm, completely chaotic activity, never a pulse, clinically dead, need to be defibrillated
106
V Fib Treatment
Early Defib
Oxygen, CPR, Intubation, Epinephrine, Vasopressin
Prevent Re-Fib: Amiodarone, rocainmide, BB, Lidocaine
Adjust metabolic imbalances
107
Idioventricular Rhythm
Slow slow slow, dying heart, sinus tach to sinus to sinus brady, to junctional to idioventriculars
atropine is used to speed up a little.
108
Asystole
Not a healthy rhythm, harder to get out of than Vfib, Barely ANY electrical activity
109
Prophylactic Surgery
Preventative
| Example of removing both breasts if they are at risk for breast cancer
110
Diagnostic Surgery
To see what kind of surgery to do
| Example of Biopsies
111
Curative Surgery
Removing all cancerous cells, thyroid cancer example, can use this for a lot of solid tumors
112
Control Surgery
Clean out as much as we can, while preserving function, give chemo. Look again, take out more, reduce tumor mass so chemo will be more effective.
113
Palliative Surgery
Diverting around the tumor, keeping patient more comfortable, and not be so sick
114
"Second Look" Surgery
After chemo, go in and take another look, and clean out more
115
Reconstructive/Rehabilitative
Example of breast reconstruction after mastectomy
116
Communicating Cancer Diagnosis to the Patient
Nursing responsibilities: Be aware, be there, listen, ask questions for the patient, try to structure meeting time with physician (Family present, privacy)
117
Goals of Treatment
Cure, Control (Goal is to slow down the growth, and keep patient more comfortable), Palliation (Bony metastasis, reduce pain, and increasing strength of the bone)
118
Teletherapy
None invasive, position might be uncomfortable but no pokes or anything
119
Brachytherapy
source of radiation is implanted into the tumor or area around the tumor
120
Teletherapy part 2
External beam radiation, most common, go everyday, emitted from a source external to the body, linear accelerator, not radioactive, just like having an xray
121
Brachytherapy part 2
Emitted form a source placed within the body or body cavity, sealed source placed within or near tumor (Wires, ribbons, tubes, needles, seeds, capsules)
122
Sodium Iodide (I 131)
```
Hyperthyroidism (Cure)
Thyroid carcinoma (Cure, control, and palliation)
```
123
Sodium Phosphate (P 32)
Myeloproliferative Disorders
- Polycythemia vera
- thrombocytosis
- Too many RBC
124
Strontium Chloride (Sr 89)
Painful bony metastasis (Palliation)
125
Starting cancer Therapy
Determining appropriateness, need tissue diagnosis, not all tumors are radiosensitive
Need to know position of the tumor in relation to other organs, don't want to radiate the heart or other important organs.
