Exam 3 Flashcards
(167 cards)
1
Q
these supply blood to the heart
A
coronary arteries
2
Q
this is the volume of blood in ventricles at end of diastole, also known as the diastolic pressure.. this is the stretch placed on the cardiac. muscle at the end of diastole
filling the water balloon and the water balloon is stretching (the amount it’s going to stretch) .. .more water means more stretch of water balloon
A
preload
3
Q
When is the preload increased?
A
in hypervolemia, regurgitation of cardiac valves, heart failure
4
Q
this is known as the resistance, left ventricle must overcome to circulate blood…. this is the force of pressure at which the blood is ejected from the ventricle
how much you’re actually getting out of it. It’s the squeezing against the resistance.. The more squeeze, the better .. How hard it has to push to get the water out! (wide nozzle aka small afterload will flow out easer)
A
afterload
(increased after load = increased cardiac workload)
5
Q
when is the afterload increased?
A
in hypertension and vasoconstriction
(increased after load = increased cardiac workload)
6
Q
s/s of CVD
A
-chest pain / discomfort
-pain/discomfort in other areas of upper body (shoulders, arms, epigastric, h/a, back, neck, jaw pain)
-SOB aka dyspnea
-peripheral edema, wt gain, distended abd
-palpitations
-unusual fatigue
-dizzy, syncope, changes in LOC
7
Q
what do women feel instead of crushing chest pain?
A
feel more fatigued
8
Q
what to assess for past medical hx
A
-meds
-diet
-bowel/bladder habits
-activity & exercise
-sleep & rest
-self perception
-roles & relationships
-sexuality
-coping
9
Q
what to do if pt has JVD?
A
keep HOB greater than 30 degrees
**this is r. sided HF
10
Q
important labs for cardiac pts
A
-lipid profile (cholesterol, triglycerides)
-BNP (elevated –> indicator of HF)
-CRP (elevated –> indicator for inflammation)
homocysteine (risk for CAD, 12hr fasting prior to lab)
11
Q
when does the stress test end?
what does the nurse need to educate pt on?
how does pharmacologic stress test work?
A
test ends when target heart rate is reached or experiences symptoms
educate pt to fast 3 hrs prior, avoid stimulants, wear clothes suitable for exercise, explain how test is done
pharmacologic stress test works w/ vasodilating agents like IV dipyridamole & adenosine … educate about side effects of vasodilating agents … also educate to fast 3 hours prior, avoid stimulants, educate about side effects
of vasodilating agents
12
Q
what procedure involves:
Moderate sedation, topical anesthetic
Nurse educates pt: NPO 6 hrs prior, informed consent, IV placement
post: HOB 45 degrees, bed rest, check for gag reflex, educate pt may have sore throat for 24hrs
A
TEE (Transesophageal echo)
(vs. TTE aka transthoracic echo where it’s done at bedside to look at heart)
13
Q
pre op for heart Cath
A
-fast 8-12 hrs prior
-IV meds to keep comfortable but awake (conscious sedation so they can tell us how they feel/symptoms)
-make sure they’re not allergic shellfish
-let them know symptoms may be feeling fast HR, need to cough, feel hot or flushed from dye
13
Q
post op for heart Cath
A
-assess site for bleeding/hematoma
-assess peripheral pulses q 15 min x 1hr then q 30 min x 1hr then q 4 hr til discharge
-evaluate temp, color, cap refill or extremity
-assess for pain/numbness, assess feeling of distal site
-cardiac monitoring (tele for rate/rhythm)
-bed rest 2-6hr, affected leg straight, HOB no greater than 30 degrees
-give pain meds
-oral & IV hydration to flush contrast, monitor BUN
14
Q
this is direct pressure monitoring such as CVP, pulmonary artery pressure, intra-arterial BP monitoring
***Biggest risk is infection, hand hygiene is important
A
hemodynamic monitoring
(pt should be on tele, lay flat if had it femoral, assess pulses, cap refill, temp)
done after CABG procedure
15
Q
how to monitor a pt w/ intra-arterial blood pressure (art line)
A
Continues BP measurements with severe hypo or hypertension, draw ABGs
16
Q
this is the disorder of the electrical impulse of the heart
it’s identified by site of origin & mechanisms of conduction
A
dysrhythmias
17
Q
this is electrical stimulation; systole
A
Depolarization
(squeezing the water balloon aka pushing blood out)
18
Q
this is electrical relaxation; diastole
A
Repolarization
(letting water balloon fill back up)
19
Q
depolarization vs repolarization
A
Depolarization = electrical stimulation; systole
Repolarization = electrical relaxation; diastole
20
Q
SNS
A
fight or flight
21
Q
PNS
A
rest and digest
22
Q
increases HR, conduction through AV node, force of myocardial contraction
constricts peripheral blood vessels –> increases BP
A
sympathetic
23
Q
reduces HR, AV conduction, force of atrial myocardial contraction
dilation of arteries –> lowers BP
A
parasympathetic
24
the P wave is the contraction of....
atria
it's also atrial depolarization aka contracting
25
this rhythm has no p wave
atrial fibrillation
26
this rhythm has a p wave that is saw-toothed shape
atrial flutter
27
Ventricular tachycardia (VTACH) vs Ventricular fibrillation (VFIB)
VTach = tombstones, fast.. can lead to Torsades de Pointes (party streamer outline) .. Vtach needs cardioversion or Magnesium
VFib = irregular / all over the place.. **Vfib needs Defib.. CPR!
28
this rate is a flat line
Asystole
29
this rhythm looks like tombstones, fast.. can lead to Torsades de Pointes (party streamer outline)
Ventricular tachycardia (VTACH)
30
this rhythm looks like irregular / all over the place
Ventricular fibrillation
**Vfib needs Defib.. CPR!
31
medical management of heart blocks
increase HR to maintain CO
based on symptoms
IV atropine
pacemaker
32
this test is used to assess the presence of coronary artery disease, identifies the root cause of chest discomfort, gauges the functional capacity of the heart post MI or cardiac surgery, evaluates the efficiency of abtianginal/antiarrhythmic medications, detect occurrences of dysrhythmias
cardiac stress test
33
what MAP is needed to perfuse major organs?
60-70 (65 is ideal)
34
ischemia vs infarction
ischemia = reversible, reduced blood flow
infarction = cell death / tissue necrosis due to lack of black flow
35
this assesses the left ventricular function, diagnoses etiology of shock, evaluates response to medical interventions
(evaluates left ventricular preload & monitors waveform)
pulmonary artery pressure
36
this measures pressure in the vena cava or right atrium, also reflects right ventricular preload
central venous pressure
(normal 2-6mmHg)
37
what is a contraindication for performance of MRI diagnostic study?
client has a pacemaker
38
nurse is teaching a client who is scheduled for coronary angiography (heart Cath), what should the nurse tell the pt?
"you will need to keep your affected leg straight following the procedure"
39
good labs for HDL, LDL, cholesterol, triglycerides
HDL: >45mg/dL (M); 55mg/dL (F)
LDL: <130mg/dL
cholesterol: <200mg/dL
triglycerides: 40-160mg/dL(M) 35-135mg/dL (F)
40
good labs for BNP, troponin, CPK-MB
BNP <100 pg/mL or <100 ng/L
Troponin <0.1 ng/mL
CPK-MB 0%
41
how to know if a pt has an aterial ulcer vs a venous stasis ulcer?
if the client experiences claudication, it's arterial ulcer '
**claudication is when pain with activity, relieves at rest
42
what should a nurse expect to find in a pt w/ pericarditis
friction rub
43
elevated BNP means what
Heart failure
43
3 types of pacing
atrial pacing- Used with SA node failure
ventricular pacing- Use with complete AV block
AV pacing- used with SA node failure and complete AV block
44
pacemaker vs. ICD (implantable cardioverter defibrillator)
pacemaker = for slower than normal impulse formation or symptomatic AV or ventricular disturbance
ICD = Responds to 2 criteria: a rate that exceeds a predetermined level & a change in the isoelectric line segments (ST elevation)
45
this is an abnormal accumulation of lipid & fibrous tissue in the lining of the arterial blood vessel walls, an Inflammatory response
atherosclerosis
leads to ischemia, angina, sudden cardiac death
46
nonmodifiable vs modifiable risk factors for atherosclerosis
non modify- family hx of CAD, men over 45, women over 55, gender, race (more common in AA), hx of premature menopause or preeclampsia
modifiable - hyperlipidemia, smoking, htn, diabetes, obesity, physical inactivity
47
Episodes of paroxysms (sudden attack) of pain or pressure in the anterior chest
angina pectoris
usually caused by atherosclerotic disease
48
what factors are associated with atherosclerotic disease?
> physical exertion
> exposure to cold
> eating a heavy meal
> stress or emotion-provoking situation
49
this represents the firing of SA node and depolarization (contraction) of atria; <0.11 in duration
p wave
50
this represents ventricular depolarization and atrial repolarization; <0.12 secs
QRS complex
51
this represents ventricular repolarization (ventricular les relaxing and filling up, recharging)
T wave
52
this represents repolarization of the purkinje fingers; rare, occurs with pts with hypokalemia, htn, or heart disease
U wave
53
this represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization
PR interval
54
this represents early ventricular repolarization
ST segment
55
this represents the total time for depolarization and repolarization of the ventricles
QT interval
56
measured from the end of the T wave to the beginning of the next P wave; an isoelectric period
TP interval
57
measured from the beginning of one P wave to the beg of the next P wave; used to determine atrial rate and rhythm
PP interval
58
measured from one QRS to the next QRS; used to determine ventricular rate and rhythm
RR interval
59
this is the number of RR intervals in 6 seconds and multiply by 10
this is the number of small boxes within an RR interval ad divide by 1,500 by that number
HR determined from ECG
60
this contains the tricuspid valve and mitral valve
AV valves (atrioventricular)
61
this contains the pulmonic and aortic valves
semilunar valves
62
what does it mean is MAP is low?
not perfusing everywhere!
63
what provides alternate routes for blood flow?
collateral circulation
64
this is the electrical activity of the heart?
what's the order?
EKG / ECG
SAAV His Bundle of PJs
65
this is the percentage of the total amount of blood in your heart that's pumped out with each heart beat
ejection fraction
we want greater than 55%
66
what to check when pt comes in w/ heart problems
EKG
get trops
electrolytes (Na/K)
BNP (higher = HF)
C-reacgive protein (marker for inflammation)
67
conductivity vs. contractility
conductivity = ability to send an electrical stimulus from cell membrane to cell membrane
contractility = the mechanical activity of the heart
68
what to give for pt sinus bradycardia
atropine to increase HR
give fluids depending on the cause
give O2
put on tele
69
what to give pt if sinus tachycardia
adenosine (stops the heart for a second then will start back up)
only med you push fast!
70
this often occurs in healthy young people, especially women
it's the rapid stimulation of atrial tissue occurs at rate of 100-280bpm
VERY RAPID HR
Massively SOB, feel terrible, dizzy, weak, chest pain, hypotensive, look terrible … could be asymptomatic tho!!!! This is non sustained (jumps in then goes away)
Use vagal maneuver (bear down and stop) or give adenosine med (always bring the Code cart in when giving this med) remember push fast!
SVT (supraventricular tachycardia)
71
what are you at risk for w/ A-Fib?
how will the pt present?
what to give/how to treat pt?
PE (pulmonary embolism)
SOB, chest pain, low O2
put on heparin (monitor PTT, Xa factor)
give cardizem (calcium channel blocker, others include verapamil, diltiazem) to lower HR
might have to cardiovert
72
paroxysmal means what?
sudden, onset
...with termination that occurs spontaneously or after an intervention, lasts less than 7 days, but may recur
(ex: paroxysmal atrial fibrillation)
73
verapamil and diltiazem are given for what?
what kind of meds are these
channel blocker to treat and prevent paroxysmal atrial arrhythmias
73
amiodarone, dofetilide, dronedarone, ibutilide are given for what?
given to prolong repolarization,
amiodarone treats & prevents ventricular and atrial arrhythmias, especially in pts with ventricular dysfunction
the rest treat & prevent atrial arrhythmias
74
this med is used to treat ventricular tachycardia and ventricular fibrillation... it blocks cardiac sodium channels shortening the action potential
lidocaine and mexiletine
75
these are early contraction of ventricles
PVC (premature ventricular contraction)
75
if you seem tombstones (vtach), what do you do?
Assess! Is there a pulse? (if no pulse then defibrillate aka use AED)
apply O2. give anti dysrhtymic meds. get 12 lead EKG.
hang magnesium to stablize cardiac
if pt has pulse, cardiovert aka shock them on QRS (vs defibrillate where shocks at any time aka AED)
76
this is life threatening, needs to start CPR immediately and start defibrillating
V Fib (electrical chaos of ventricles)
77
defibrillation vs cardioversion
defibrillation - unsynchronized , shock whenever like an AED, used for V-Fib and pulseless Tach
cardioversion- synchronized, shock on QRS
78
how to treat pt post op pacemaker
don't raise arm above shoulder for 2 weeks
don't exercise til cleared
don't drive bc seatbelt goes there
avoid heavy lifting (nothing over 10lbs)
monitor for infection
monitor HR daily
no MRIs, only X-Ray
78
what should family know if pt has wearable cardioverter defibrillator
know CPR!! bc pt could go into lethal rhythm, this shocks them when it gets out of pace
79
these symptoms are caused by myocardial ischemia and related to the location and degree of vessel obstruction
angina is most common manifestation
epigastric distress, pain that radiates to jaw or left arm, SOB, atypical symptoms in women
MI, HF, Sudden cardiac death
CAD (Coronary artery disease)
80
6 types of lipid lowering agents for CAD
3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) aka the “statins"
Nicotinic acids
Fibric acids (or fibrates)
Bile acid sequestrants (or resins)
Cholesterol absorption inhibitors
Omega-3 acid-ethyl esters
81
types of angina
stable angina - relieved by rest or nitro
unstable angina- not relieved with rest or nitro, also called pre infarction angina
prinzmetals' angina- pain at rest, reversible ST elevation, also called variant angina
82
meds for angina
nitro
beta adrenergic blocking agents (metoprolol, atenolol)
calcium channel blockers (amlodipine, diltiazem)
antiplatelet (aspirin, clopidogrel) & anticoagulants (heparin)
glycoprotein agents
83
initial management for MI
MONA!
beta blokcer
heparin or platelet inhibiting agents
then PCI (percutaneous coronary intervention) aka coronary angioplasty during heart Cath where they place a stent to open blockage
84
complications from PCI (percutaneous coronary intervention)
MI
hematoma
arterial occlusion (can't feel pulses)
pseudo aneurysm formation
AV fistula formation
AKI
85
most common type of cardiac surgery where occluded coronary arteries are bypassed w/ the pt's own venous or arterial blood vessels or synthetic grafts
CABG (coronary artery bypass graft) ... always done when pt doesn't respond to medical management of CAD .. not the first line treatment
will come out w/ chest tube... monitor for cardiac tamponade.. pain is huge, pt will be intubated
86
leading cause of CVD
atherosclerosis (lipid accumulation) that leads to the narrowing of arteries aka CVD
87
why do we give cardizem aka a calcium channel blocker like verapamil, diltiazem)
lower HR
88
what is silent CAD
silent chest pain like weakness, fatigue, tired intermittently
do stress test or heath Cath to further look into this
89
antiplatelet vs anticoagulant
anti-platelet = prevention of platelet aggregation .... aspirin, clopidogrel, ticlopidine, prasugrel, ticagrelor
anticoagulant = prevention of thrombus formation ... heparin, enoxaparin, dalteparin... rivaroxaban (xarelto)
90
these prevent platelet aggregation
ASPIRIN, CLOPIDOGREL, TICLOPIDINE, prasugrel, ticagrelor
antiplatelet
91
these prevent thrombus formation
heparin, enoxaparin, dalteparin... rivaroxaban (xarelto)
anticoagulant
92
this is the protein in myocardial cells
troponin
(Leaks into blood stream which shows the elevated troponin)
93
this is found in cardiac cells, will elevate, good indicator of MI
CK (creatine kinase) or CK-MB
93
this is found in cardiac muscles, helps transport oxygen, used to rule out MI if negative result
myoglobin
94
normal BUN and creatinine levels
BUN 10-20 mg/dL
Creatinine 0.5-1.1mg/dL
95
normal BNP level
less than 100
96
this is a procedure where a balloon goes into coronary vessel and resolves ischemia, usually stent is placed as well and done in the Cath lab... contrast is used so check kidney function and shellfish allergy!
PCTA (percutaneous transluminal coronary angioplasty)
97
what is nitro?
how to take it
vasodilator that opens up there arteries
decreases pre & after load
take every 5 mins, up to 3 times max.
SE = h/a
98
female has epigastric pain that radiates to arm.. also feels like elephant is sitting on her chest.. SOB, doesn't feel well, dizzy
MI!
99
what 4 things to give pt coming in w/ MI
Morphine
Oxygen
Nitro
Aspirin (chewable!!!!)
100
what doe calcium do
helps heart pump! used for our muscles. it can increase HR fast if you don't push slowly.
it decreases work load for the heart
101
what does morphine do besides decrease pain
decreases pre load
102
meds to treat A-Fib and A-Fib RVR
amiodarone, sotalol, or cardizem (lowers HR)
103
treatment for VTach
amiodarone, lidocaine
cardiovert, unless pulseless then DEFIBRILLATE!
can place an ICD (implantable cardioverter defibrillator) if EF less than 35%
104
complication of pacemaker
hiccups
they keep the HR above 60!
105
this is an emergency situation, characterized by an acute onset MI that results in myocardial death if no interventions. it's unstable angina, STEMI, NSTEMI
ACS (acute coronary syndrome)
106
The valve does not open completely, and blood flow through the valve is reduced (NARROWING!!!)
stenosis
107
Valvular leaflets enlarge and prolapse into the left atrium during systole (the work!!)
MVP (mitral valve prolapse)
most ppl are asymptomatic or can report Fatigue, SOB, lightheadedness, syncope, palpitations, CP, anxiety
108
this is caused by mitral valve prolapse, rheumatic heart disease, infective endocarditis, MI, connective tissue diseases, dilated cardiomyopathy
It progresses slowly; patient may be symptom-free for decades
Symptoms include: fatigue, dyspnea, chronic weakness, anxiety, atrial fibrillation, respiration changes
Mitral Regurgitation = valve doesn’t close properly, so back flow happens, this is an insufficiency
109
this is usually caused by rheumatic endocarditis/Rheumatic fever
symptoms include symptoms may include dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, palpitations, dry cough
mitral stenosis
110
how to prevent mitral stenosis
& how to treat?
Tx bacterial infections; prevent rheumatic fever
treat w/ Anticoagulants, cardiovert or use beta-blockers, digoxin, Ca channel blockers; possible surgery
avoid any strenuous activity that increases HR!!
111
this results from nonrheumatic conditions
May be asymptomatic for years
Symptoms include exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea,
aortic regurgitation
treatment- aortic valve replacement
Avoid exertion, limit Na, treat HTN
112
this is the disease of "wear and tear"
pt will complain of Exertional dyspnea, orthopnea, pulmonary edema, angina, dizziness, syncope
can hear murmur
medical management includes: Surgical replacement of aortic valve, Meds for dysrhythmias
aortic stenosis
**PE can happen bc blood flow from lungs builds up into lungs
113
this is a series of progressive events that culminates in impaired cardiac output
Na retention, fluid overload, then HF
cardiomyopathy
Assessment/Diagnostics:
Tachycardia, S3 or S4, murmurs
Crackles, JVD, pitting edema, enlarged liver
Echocardiogram, Xray, MRI, ECG
rest w/ legs down to get perfusion! don't want it coming back up to lungs
114
this occurs most often in school-age children after group A beta-hemolytic streptococcal pharyngitis
need to promptly recognize and treat “strep” throat to prevent rheumatic fever
Rheumatic endocarditis
115
This usually develops in people with prosthetic heart valves or structural cardiac defects
Also, occurs in patients who are IV drug abusers and in those with debilitating diseases, indwelling catheters, or prolonged IV therapy
Infective endocarditis
116
these are s/s of what?
Murmur
Development of heart failure
Arterial embolization
Petechiae
Splinter hemorrhages
Osler nodes (on palms of hands and soles of feet)
Janeway lesions
Roth spots (Hemorrhagic lesions that appear as round or oval spots on the retina)
Infective Endocarditis
117
what to do if pt has endocarditis
need blood culture
get ECHO or TEE
Antimicrobials IV for 4-6 weeks.
Ideal: Penicillin's or Cephalosporins
Good oral hygiene !!!
Prophylactic antbx
Monitor temp daily for 6 weeks
surgical: remove or repair infected valve, drain abscess
118
this is the Inflammation or alteration of the pericardium
Associated w/
Infective organisms (bacteria, viruses, or fungi..usually respiratory)
Post–MI syndrome (Dressler's syndrome)
Post-pericardiotomy syndrome
Acute exacerbations of systemic connective tissue disease
Super inflamed = puts too much pressure on heart so it won’t pump properly… cardiac tamponade will occur !!!
pericarditis
119
these are s/s of what:
Substernal precordial pain radiating to left side of the neck, shoulder, or back
Grating, oppressive pain, aggravated by breathing (on inspiration), coughing, swallowing
Pain worsened in the supine position; relieved when the patient sits up and leans forward
Pericardial friction rub (scratchy, high-pitched sound)
Mild fever, elevated WBCs
pericarditis
*pain worsens w/ deep big breath
*friction rub heard
*worse when they lay flat
need to take fluid off aka paracentesis
120
how to treat pericarditis
relieve pain
NSAIDS
steroids if no relief
treat the cause
promote comfort (sit upright & slightly forward)
antbx if bacterial pericarditis
watch for pericardial effusion that can lead to cardiac tamponade
121
this is an extreme emergency due to pericarditis side effect that lead to pericardial effusion which is leading to this ... fluid accumulation which puts pressure on heart and sudden decrease in CO
s/s = DISTANT HEART SOUND
JVD
PARADOXICAL PULSE (bp rises 10mmHg by inhalation and returns to baseline w/ exhale)
also....
SOB
Restless
Complain of chest pain and dizzy
cardiac tamponade
122
Clinical Manifestations of this include:
JVD
Paradoxical pulse (pulse pressure changes in A line)
Tachycardia
Muffled heart sounds
Hypotension
cardiac tamponade
123
these are risk factors of what
CAD
HTN
Obesity
Smoking
DM
Valvular disease
Cardiac infections and inflammation
Substance abuse
Sleep Apnea
HF
124
cause of LHF vs cause of RHF
left causes: Hypertension
Coronary artery disease
Valvular disease
right causes: Right ventricular failure
Right ventricular MI
Pulmonary hypertension
125
what side HF is this
Sink overflows back into the pipes back into lungs, causes are htn, CAD, valvular dz
heart is not pumping well, blood goes back into the lungs leading to
SOB, crackles, resp issues, wheezing, rapid respiration, rapid, confused, cough, fatigue, weakness, arm heaviness, pulmonary edema – pink frothy sputum when HF becomes severe .. life threatening emergency!
LHF
126
what side HF is this
receives blood from body and pushed into lungs. So this pushed back into the body leading to edema in body, swelling
***Need to diuresis the pt
***Fluid restriction, low sodium diet is needed
JVD, increased abdominal firth, ascites, enlarged liver and spleen, anorexia, GI issues, weight gain, OVERLOAD
causes of this-
R. ventricular failure
R. ventricular MI
Pulmonary htn
RHF
127
what to do when pt comes in w/ HF
o Electorlytes
o H&H
o UA
o ABGs
o BNP
o Imaging
use diuretics as first line of choice, then vasodilators like nitro, Ace inhibitor like prills, Arbs like statins, morphine for pain, digoxin as positive inotropic agent to increase heart contractility
128
these meds end in prills
help w/ arterial dilation & increase SV (used for HF)
ace inhibitors
Enalapril
Captopril
Fosinopril
Ramipril
129
these meds are the statins, they decrease arterial resistance and allow dilation in arteries
ARBs (angiotensin II blockers losartan, valsartan)
130
these meds are new, decrease angiotensin, help dilate
ARNIs (Sacubitril aka entrestol combination of ACE and ARBs)
131
this med is a positive inotropic agent that increase contractility in the heart, therapeutic level is 0.5 - 2.0
digoxin
(other inotropic drugs include dobutamine, milrinone, and dopamine)
132
s/s of dig toxicity
Tired, blurred vision, mental status change in older adults, arrythmias like bradycardia, see halos around eyes, hypokalemia increases digtoxicity !!!! check potassium !
133
this is a complication of HF, happens more often in LHF
can be avoided or caught early
Pulmonary edema
134
s/s of pulmonary edema and how to treat?
s/s=
frothy, blood-tinged sputum
wheezes
coughing
crackles / wheezes
increased HR
agitation and confusion
pale, possible cyanosis
RR over 30, w/ accessory muscle use
tx: Sit up right, dangle feet, monitor RR and O2, asses lungs throughout the day, noticed increased weight
**we want to decrease pre load and after load, help their anxiety, improve gas exchange
*give diuretics, foley catheter, IVFs, morphine ... If not, cardiac arrest could happen!
135
Arteriers vs veins
arteries - carries oxygenated
veins- carries deoxygenated
136
this is pain when walking, usually in lower leg. feels better w/ rest
intermittent claudication (hallmark symptom of PAD)
137
arteriosclerosis vs atherosclerosis
Arteriosclerosis = Thickening or hardening of arterial wall
Atherosclerosis = formation of plaque within arterial wall
138
hallmark symptom of PAD (peripheral artery disease)
intermittent claudication
139
how to manage PAD (w/ intermittent claudication)
-controlled exercise program (mod art of walking)
-position legs down (PVD legs go up, PAD legs go down) **make A w/ finger aka points down
-cilostazol (petal) which is vasodilator that inhibits platelet aggregation
-antiplatelets, statins
140
this is a permanent localized dilation of an artery, enlarging the artery to twice its normal diameter
aneurysm (also known as buldging of the aorta)
141
what happens if aneurysm ruptures?
hemorrhage or hypovolemic shock... give blood and go to OR ASAP
142
s/s of thoracic aorta aneurysm
medical management?
back pain
SOB
hoarseness or difficulty swallowing
**sudden excruciating back or chest pain = thoracic rupture
medical management = Betablockers and ARBs
Nitroprusside (Nipride)
SBP 90-120 mm Hg
MAP 65-75
Endovascular grafts-surgery
143
s/s of AAA
Asymptomatic
Pain steady gnawing may last for hours or days
Pain in abdomen, flank, or back
Abdominal mass is pulsatile
**Rupture is the most frequent complication and is life threatening.
144
what is pt at risk for after end-vascular graft
DVT
rupture
hemorrhage
**lay flat for 6 hrs, then slowly increase HOB, continuous vitals, assess pulse & graft site
145
this may be caused by a sudden tear in the aortic intima, opening the way for blood to enter the aortic wall
Pain described as tearing, ripping, and stabbing
EMERGENT
aortic dissection
146
3 factors that expose you to VTE (DVT, PE)
virchow's triad:
endothelial damage
venous status (altered blood flow)
altered (hyper) coagulation
147
thrombus vs phlebothrombosis vs thrombophlebitis
Thrombus- blood clot
Phlebothrombosis- thrombus without inflammation
Thrombophlebitis- thrombus with inflammation
148
meds to treat venous thromboembolism
anticoagulant = heparin (measure PTT!!!), aka enoxaparin, lovenox
anticoagulant = warfarin (measure PT, INR!!!!)
**heparin antidote = protamine sulfate
**warfarin antidote = vit k
149
these cause dull aches, muscle cramps, increased muscle fatigue, ankle edema, heaviness in legs
varicose veins
(can prevent by avoiding activities that cause venous stasis; exercise) can treat by ligation/stripping, thermal ablation, sclerotherapy
150
blood pressure >180/120
hypertensive emergency
symptoms = h/a, blurred vision, dyspnea, uremia aka urine in blood
can lead to stroke and aortic dissection
meds: IV vasodilations such as sodium NITROPRUSSIDE, NICARDIPINE, LABETALOL, NITROGLYCERIN, fenoldopam mesylate, enalaprilat,
151
pt w/ HF and fluid volume overload may have low what?
Na bc it may become diluted
152
this med is an antiplatelet like aspirin
cardiprogel
153
what to avoid on warfarin
leafy green bc VIT k is the antidote!
154
this med prevents heart failure... SE = dry cough or swelling of lips/tongues
lisinopril (Ace inhibitor)
155
what makes a pt taking digoxin more at risk for digtoxity
hypokalemia
156
what do thrombolytics do (Alteplase, reteplase, tenecteplase)
dissolves thrombus (clots!)
157
avoid these if HF pt is confused
restraints bc they will resist them and cause more workload to heart
158
this valvular heart disease has an apical diastolic murmur
mitral stenosis
159
this valvular heart disease has neck vein distention and S3 heart sound
mitral insufficiency
160
this valvular heart disease has narrowed pulse pressure
aortic stenosis
161
