Med Surg 2- Cardiac Exam Flashcards
(140 cards)
1
Q
Preload
A
Stretch just before systole
2
Q
Afterload
A
blood ejected from ventricle
3
Q
S1
A
mitral/tricuspid closing
4
Q
S2
A
aortic/pulmonic closing
5
Q
Cardiac cath performed for R side
A
PE, vagal response
6
Q
Cardiac cath performed for L side
A
MI, stroke, bleeding
7
Q
Cardiac cath perform for L and R side
A
edema, cardiac tamponade, hematoma
8
Q
Cardiac cath post-op
A
bed rest, watch insertion site, VS, bleeding, pulses (pedal)
9
Q
Troponin
A
protein released when heart is damaged
0-0.04
increased means that there is damaged muscle
10
Q
BNP
A
released by ventricles in response to fluid overload
Over 900 is severe!
11
Q
HF RF
A
CAD, HTN, smoking, obesity, sleep apnea
12
Q
HF Compensatory mechanisms
A
Sympathetic NS, RAS activation, BNP increased, myocardial hypertrophy
13
Q
HF labs
A
hypovolemia, check K, increased BNP, urinalysis (protein in urine), ABG’s (hypoxemia)
14
Q
HF DX
A
Echo- shows blood flow, how the heart is doing
CXR- fluids
15
Q
L sided HF
A
used to be called congestive HF, affects the lungs!
16
Q
L sided HF causes
A
HTN, CAD, valvular disease
not all types have fluid accumulation
17
Q
L sided HF S/S
A
dyspnea, fatigue, weakness, arm heaviness, CP, palpitations, cough worsened at night, tachypnea, cyanosis, pulmonary congestion
18
Q
L sided HF severities
A
Severe L HF leads to pulmonary edema (crackles, dyspnea at rest, confusion)
Pink, frothy sputum is a life-threatening emergency!
19
Q
R sided HF
A
R ventricle can’t empty completely
20
Q
R sided HF causes
A
L ventricular failure, R ventricle MI, pulmonary HTN
21
Q
R sided HF s/s
A
Peripheral edema, increased abd girth/ascites, dependent edema, hepatomegaly, JVD, weight gain
22
Q
R sided HF interventions
A
Take a daily weight in the morning
O2, Is, TCDB, sit pt up with pillows underneath arms, reposition frequently, never massage pt’s legs
23
Q
ACE and ARBS
Lisinopril, Valsartan
A
Lowers BP
major s/s to stop is swollen lips, can cause coughing
Get pt up slowly due to hypotension, avoid pregnancy
24
Q
Beta Blockers
A
Lowers HR and BP
Start slowly for HF and don’t stop abruptly
25
Calcium CB
Nifedipine, Cardizem
Lowers HR and BP
26
Digoxin
Lowers HR
Therapeutic levels -.5-2.0
Hypokalemia leads to toxicity
s/s- blurred vision, mental changes, fatigue, anorexia
27
Dilators- Nitroglycerin
Lowers BP
Common s/s is headache, low NP
NO Viagra
28
Diuretics
Lasix, Spironolactone
Lowers BP
Spironolactone SPARES K, furosemide WASTES K
29
HF education
Diet- low sodium, 2L fluid/day
Risk for falls, change positions slowly
BP and BNP should not increase
Elevate legs with pillows
Daily Weights in morning
Sex only if 2 flights of stairs no SOB
Stockings daily
No canned/packaged foods or OTC
30
Acute pulmonary edema
LV fails to eject sufficient blood, increased pressure in lungs
fluid leaks across pulmonary capillaries (lungs airway)
31
Acute pulmonary edema s/s
crackles, dyspnea, SOB, tachycardia, cough with frothy, blood-tinged sputum, confused, cyanotic, agitating, increased RR, lethargic
32
Acute pulmonary edema interventions
High Folwer's with feet dangling, hemodynamic monitoring, IVF's, foley
33
Acute pulmonary edema meds
morphine sulfate
sublingual nitro q5min, max 3 doses
furosemide/ bumetanide IV push over 1-2 min
VS q30min-1hr
34
Cardiomyopathy
chronic disease of heart
Dilated, hypertrophic, restrictive
35
Cardiomyopathy s/s
orthopnea, crackles, edema, dyspnea on exertion, nocturnal dyspnea, a-fib in som
36
Cardiomyopathy interventions
palliative care, possible heart transplant, digoxin, diuretics, vasodilators, ACE
37
Cardiac Tamponade
fluid accumulation in pericardium that puts pressure on heart, sudden decrease in cardiac output
Medical emergency!
38
Cardiac Tamponade s/s
JVD, paradoxical pulse, tachycardia, muffled heart sounds, hypotensions
39
Pericardiocentesis
removes fluids and relieves pressure on the heart
40
Mitral Stenosis
narrowing of valve L-side
rheumatic fever!
41
Mitral Stenosis s/s
orthopnea, dyspnea on exertion, dry cough, palpitations, paroxsymal nocturnal dyspnea
42
Mitral Regurgitation
opening/valve that doesn't flow, blood goes back into atrium
43
Mitral Regurgitation causes
mitral valve prolapse, rheumatic heart disease, MI, endocarditis
44
Mitral Regurgitation s/s
fatigue, extra heart sound, chronic weakness, anxiety, A-fib, RR changes
45
Mitral valve prolapse
valve leaflets enlarge and prolapse into L atrium during systole
confirmed by echo
46
Mitral valve prolapse s/s
Most people asymptomatic
CP, palpitations, exercise intolerance, late systolic murmur at apex
47
Aortic stenosis
narrowing of aortic valve, disrupts flow from L ventrilce
disease of "wear and tear"
can develop R sided HF
48
Aortic regurgitation
backflow into L ventricle, results from rheumatic conditions
49
Aortic regurgitation s/s
Can be asymptomatic for years
dyspnea, angina, tachycardia, palpitations, fatigue, syncope on exertion, orthopnea, murmur
50
Aortic regurgitation DX
CXR, echo, ECG
51
Aortic regurgitation meds
Prophylactic antibiotic, diuretics, beta blockers, digoxin, O2
52
Aortic regurgitation management
Nonsurgical- drug therapy, rest, anticoagulant
Surgical- heart valve replacement, autograft
53
Endocarditis
Inflammation INSIDE the heart
54
Endocarditis causes
Dirty needles, dental visits, heart surgery, untreated strep throat
55
Endocarditis s/s
Clos in heart/brain, development HF, splinter hemorrhages (clots under fingernails)
Lungs have fluid (crackles)
Overheated (fever)
Too little O2/cardiac output, clubbing fingers
Roth spots (in retina), Osler's nodes (palms/soles), Janeway lesions (nontender red spots)
56
Endocarditis treatment
Antibiotics (PICC)- penicillin, cephalosporins
Valve repair/replacement/drain
Chordae tendineae
57
Endocarditis education
Monitor for infection- temp for 6 wks
Oral care
Let all providers know (dentist)
Dentist- antibiotics
58
Endocarditis DX
Blood cultures, echo, TEE, new murmur,
59
Pericarditis
inflammation OUTSIDE the heart
60
Pericarditis causes
Acute exacerbations
Heart attack
Autoimmune disorders
Infection
Renal failure
61
Pericarditis s/s
oppressive pain aggravated by breathing (inspiration), coughing, or swallowing, pain in L side of neck/shoulder worse lying down or inhaling
Acute: increased WBC, ST elevation, A-fib
Chronis- s/s of R sided HF
62
Pericarditis treatment
treat cause!
NSAIDs, steroids if no relief in 48-72hrs
Sit up/forward
Pericardiocentesis
63
HTN
chronic high BP, usually 140/90
Malignant/HTN crisis- emergency!
64
HTN causes
Stress, smoking, sedentary lifestyle
Obesity, oral BC
Diet, disease
African men and age
65
HTN s/s
Achy had/ abd bruit
Blurred vision
Chest pain
Dizziness
HTN crisis- morning headaches, uremia, blurred vision, dyspnea
semi-fowler's, BP q5-10min, EKG, IV meds, O2
66
HTN DX
Echo, ECG, EKG, urinalysis- protein, RBC, BUN, creatinine, increased BNP and cholesterol
67
HTN education
Diet- low sodium/calories/cholesterol
Reduce alc and caffiene
Exercise- walking 30min/day
Stop smoking/alc
Stress reduction
68
HTN meds
HTN crisis- labetalol, calcium channel blockers, dilators, ICU
anticoagulants, lovastatin (no grapefruit)
69
Arteriosclerosis
thickening/hardening of arterial wall associated with aging
70
Atherosclerosis
type of arteriosclerosis with plaque formation within arterial wall, leading RF of cardiovascular disease
71
Arteriosclerosis monitoring s/s
monitor BP in both arms, palpate major sites of body, extremity temp, long cap. refill, bruit, cholesterol
72
Arteriosclerosis meds
statins, ezetimibe (lower cholesterol), combo drugs, PCSK9 inhibitors
73
PAD
alters natural flow of blood through arteries/veins, plaque unstable more lower extremities
74
PAD s/s
Stage 1- bruit/aneurysms, pedal pulses absent
Stage 2- claudication: muscle pain, cramping/burning during exercise relieved by rest
Stage 3- pain resting at night, pain relieved putting extremity in dependent position
Stage 4- ulcers/blackened tissue on toes
75
PAD DX
Labs- lipids, HDL/LDL
MRA- best assess blood flow
ABI, Doppler, stress test
76
PAD interventions
gradually/slowly increase exercise, warmth/heat (NOT DIRECT), prevent long cold exposure, no smoking/alc/tight clothes
77
PAD management
HANG FEET DOWN
Non-surgical- axillofemoral bypass
Surgical- Angioplasty with stents
Post-op- warmthness/redness/edema expected, pain 1st sign of occlusion
Nurse check pulses before transfer to another floor!
78
PAD meds
anticoagulants, antiplatelets
reduce MI/stroke, vascular death
79
Acute Arterial Insufficiency
embolus most common cause
Thrombectomy or Embolectomy
80
Acute Arterial Insufficiency s/s
6 P's
81
Acute Arterial Insufficiency drugs
TPA (clot bluster), 1:1, watch adverse signs
82
Acute Arterial Insufficiency management
monitor for compartment syndrome --> fasciotomy
83
Varicose Veins
distended, protruding veins that appear darkened and tortuous, can be caused by vein wall weaking/dilating
84
Varicose Veins treatment
compression socks, exercise, elevation, surgical removal of veins
85
Abd Aortic Aneurysm s/s
asymptomatic; pain steading gnawing may last for days or hours in abd/flank/back, abd mass pulsatile
86
Abd Aortic Aneurysm management
monitor growth of aneurysm, maintain normal BP to reduce risk of rupture, frequent US/CT to monitor size
Resection of aneurysm- high mortality risk!
87
Abd Aortic Aneurysm post-op
VS, don't raise bed higher than 45 to decrease pressure, watch occlusion/rupture, renal failure b/c they clamp off kidneys during surgery
88
Thoracic Aortic Aneurysm s/s
back pain, SOB b/c aorta can't pump blood, hoarseness/difficulty swallowing, sudden excruciating back/chest pain = rupture!
89
Thoracic Aortic Aneurysm interventions
managing rupture (hypovolemic shock, give fluids), BP/HR
90
Thoracic Aortic Aneurysm repair
watch VS, complications, cardiac dysrhythmia, resp. distress
91
Aortic Dissection
EMERGENCY- sudden tear in aortic intimia, opening way for blood to enter aortic wall
Pain-tearing/ripping/stabbing
IV fluids, beta blockers, eliminate pain, going to surgery
92
Normal Sinus rhythm
60-100
Continue to monitor, document
93
Supraventricular tachycardia
100-280
Sustained- CP, palpitations, SOB, anxiety, syncope
Nonsustained- asymptomatic, occasional palpitations
Treatment- adenosine (N/V, bradycardia, pauses), follow with NS bolus
94
Sinus Bradycardia
Less than 60
Causes- meds, hypoglycemia, blockage causing MI
S/S- cyanotic, cool, clammy, SOB, dizziness, CP, confusion
Interventions- O2, fluids, atropine, possible pacemaker, IVF
95
Sinus Tachycardia
Greater than 100
Causes- caffeine, stress, anxiety, meds, pain, electrolyte imbalance
S/S- chest pressure/pain, SOB, dizziness leading to syncope, dehydration
Interventions- O2, treat underlying
96
A-Fib
Atria quivering, increased risk stroke/clots
RF- HTN, TIA
Causes- congestive HF, mitral valve, rheumatic heart disease, CAD
S/S- palpitations, anxiety, CP, dizzy, SOB
Interventions- cartizem (prevent CP), anticoag, cardioversion
97
Ventricular Tachycardia
140-180, fatal 3-5 min, spikt tombtone EKG
Pulse- O2, assessments, EKG, cardioversion, amiodarone
Pulseless- CPR, shock, epinephrine, lidocaine IV (treats arrythmia)
98
Ventricular Fibrillation
Tombstone EKG, fatal 3-5 min
Causes- MI< trauma, overdose, electrolyte imbalance
S/S- pulseless, not awake
Interventions- CPR, epinephrine, defibrillation
99
Asystole
flatline
Interventions- check pt 1st, CPR, epinephrine
100
DVT
clot in a deep vein
101
DVT s/s
Calf pain/cramping
One sided swelling
Wwarm and red, localized edema
SOB and chest pain -call doctor
102
DVT treatment
Don't walk, elevate
Surgery- thrombectomy, IVC fiter
103
DVT education
Calf exercises
Hydration
Ambulate
No long sitting
Ted hose/SCDs
104
DVT meds
Heparin- PTT 20-40sec
Antidote protamine sulfate
Complications- bleeding, walk with assistance
Lovenox
Coumadin- INR 0.8-1.1
Antidote Vitamin K
No leafy greens b/c of vit. K
105
DVT DX
US, doppler, elevated D-Dimer
106
Buerger's Disease
caused by smoking!
recurring inflammation of intermediate and small arteries/veins of extremities
results in thrombus/ vessel occlusion
107
Buerger's Disease s/s
Black fingers/toes, claudication in feet and lower extremities worse at night, decreased pulses, cool/cyanotic in dependent positons, gangrene
108
Buerger's Disease education
Avoid cold, stop smoking, drugs for vasodilation
109
Chronic Venous Insufficiency
result of prolonged venous HTN that stretches veins and damages valves
can lead to leg edema, ulcers, dermatitis
110
Chronic Venous Insufficiency treatment
elevate legs 4-5times/day q20 min, wear compression socks, don't cross legs sitting or standing
111
CAD
included chronic stable angina, acute coronary syndromes
Development
Fatty Streak- can happen at age 15
Raised Fibrous Plaque- can happen at age 30
Complicated Lesion stage
112
Ischemia
insufficient O2 is supplied to meet requirements of myocardium
113
Infarction
Necrosis or cell death that occurs when severe ischemia is prolonged and decreased perfusion causes irreversible damage to tissue
114
Angina s/s
substernal chest pain, radiates to Larm (Rarm in women), relieved by NTG or res, lasting less than 15 minutes
115
Stable angina
chronic stable angina, classic angina
Paroxysmal, occurs with physical exertion
Relieved by rest or nitroglycerin
116
Stable angina
preinfarction(cell death) angina or new onset
More prolonged and severe
Needs to be treated immediately
Chest pain when resting
117
Variant angina
Prinzmetal’s angina, vasospastic angina
Occurs at rest
Result of spasm
118
MI s/s
substernal chest pain/pressure, radiates to L-arm, pain or discomfort in jaw, back, shoulder or abd, longer than 30 minutes, N/V, clutching of sternal/substernal chest, SNS stimulation, elevated temp, JVD, crackles, women gastro pain
119
MI lab
troponin, chest x ray, echo, EKG, stress test
120
MI goals
decrease pain, decrease myocardial oxygen demand, and increase perfusion (Myocardial oxygen supply)
121
MI interventions
pg. 757, Morphine, Oxygen, Nitroglycerin(3 times q5 min, no Viagra), Aspirin 325 mg chewable tablets as first med given (take 3 if at home and having)
122
NSTEMI
non ST elevated heart attack
Can have ischemia
Slightly elevated troponin
123
STEMI
ST elevated MI, emergency!
Rupture of fibrous atherosclerotic plaque leading to platelet aggregation and thrombus formation at the site of rupture
Thrombus causes an abrupt 100% occlusion to coronary artery- emergency!
Heart catheterization
124
MI RF
AA/Hispanic, sex, hyperlipidemia, smoking, stress, HTN, physical inactivity, metabolic syndrome, obesity- women waist greater than 35 inches, men greater than 40 inches, DM
125
PTCA/Stent
Reopen the clotted coronary artery and restore perfusion
Goal-> performed within 90 min of acute STEMI
Post op- bleeding, cardiac monitor
Complications- acute closure of artery, bleeding- apply pressure and call RR, pain, ST elevation, hypotensions, dysrhythmia
126
CABG
pg. 769 open heart surgery!
Occluded coronary arteries are bypassed with the pt own venous or arterial blood vessels or synthetic grafts
Indicated when pt does not respond well to medical management of CAD
127
CABG pre-op
shower with chlorhexidine, antibiotics q1hr before surgery, BG less than 200, VS/labs, EKG, consent, echo
128
CABG post-op
intubated in ICU afterwards, ventilator 3-6 hours, mediastinal tubes, pleural chest tubes, pacer wires (decrease arrhythmias), cardiac tamponade huge compilation (HTN, JVD, muffled heart sounds), pain control
129
CABG complications
arrhythmia. F&E imbalance, bleeding, hypotension/ hypertension, hypothermia, confused, (check LOC 30-60 min until awake then q2-4 hours), respiratory problems
130
Cardiac rehab
Phase 1- diagnosis during admission, activity tolerance, education
Phase 2- after discharge 4-6wks, education/support/diet/exercise
Phase 3- maintain cardio stability and long-term conditioning
131
CABG discharge
prevent further risks, anxiety, meds (nitro, beta blockers, ASA, ACE), exercise/cardiac rehab, no sex 4-6wks, NSAIDS increase chance of MI/stroke, activity should be tapered (intermidite claudication), diet, RF
132
Cardiogenic shock pg. 733 chart, 765 drug alert/critical rescue
heart muscle isn’t healthy, can’t get perfusion b/c heart can’t pump as well (impaired)
Necrosis of more than 40% of Lventricle
133
Cardiogenic shock s/s
Tachycardia, hypotension, BP <90 or 30 less than pt baseline, urine output less than 30mL/hr, cool, clammy, SOB, hyperventilation, decreased pulses, confusion, restless/agitated, pressure/chest pain, pulmonary congestion
134
Cardiogenic shock interventions
elevate legs to get blood back at heart, ABC’s, fluid replacement- use PA catheter for PAWP, Vasopressor- constrict to pump blood (Dopamine, Dobutrex), HCO3 if ph <7.3 (buffers the acid), treat arrhythmias quickly, diuretics PRN, balloon pump to help the aorta do its job
135
Digoxin
decreases heart rate by increases myocardial contractility
Given for heart failure, A-FIb
RF dig toxicity- hypokalemia, advanced age, imparired renal function
s/s- N/V, diarrhea, anorexia, syncope, bradycardic, diaphoresis, hypotension, mental status changes, blurred vision, diplopia
Monitor potassium
Normal digoxin level 0.5-2
136
Nitrates
Vasodilation dilation, decreases blood pressure
Mechanism of action- vasodilation, reduces preload and afterload, decreases myocardial oxygen demand
Give for CP, MI, angina
S/s- Orthostatic hypotension, dizziness, headache
Routes
PO- regular management
Sublingual- needs to be dissolved (Can take 3 times q5 min)
Transdermal- clean/hairless skin, take off when defibrillating, take off patch after 12-14 hours, rotate sites
IV- Slow infusion then titrate until pain is gone, check B/P every 3-5 minutes
Do not give to people on Viagra
Take on first onset of chest discomfort
Call 911 if no relief after 3 doses
Pg 775
137
Beta-Blockers
block epinephrine and norepinephrine
Assess HR and BP before giving
Decreases stress on heart
First choice for treatment for stable angina
Drug interactions
Nitrates, anti-diabetics, antacids, antidysrhythmics, calcium channel blockers, anti-hypertensives
138
Calcium channel blockers
allows heart to relax
Allows blood vessels relax
Give to patients with Afib and CAD
Decreases afterload and increased myocardial oxygen supply, decreases angina
Helps relax heart and increase perfusion
139
Heparin
prevents blood clots, thrombus formation,
Monitor PTT, normal 25-35
Antidote protamine sulfate
Always follow heparin protocol
Get lab values, PTT q6hr, CBC you want platelets, tell provider critical labs
IV pump must be used for infusion
Watch s/s of bleeding, stop infusion
140
Coumadin
prevents blood clots/PE
Monitor INR 0.8-1.1, PT 11-12.5
Expected INR to be higher b/c you’re thinning their blood
Antidote vitamin K
Discharge instructions- assess bleeding/bruising, electric razor, hold pressure if bleeding, help when walking, take at same time everyday, tell dentist about med, don’t stop abruptly
Avoid NSAIDs, oral contraceptives, antidepressants, herbs - ginger, garlic, ginseng, St. John's wort, ginkgo, high-fat and vitamin K-rich foods
