NURS 1250 > Perfusion > Flashcards

Perfusion Flashcards

(114 cards)

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1
Q

What causes Angina?

A

Reduced coronary blood flow. Identified by a identifiable event. Relieved by rest

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2
Q

Types of Angina (3)

A

Stable: caused by physical exertion, stress, or exposure to cold. most common.

prinzmetal (variant): caused by coronary vasospasm

Unstable: Caused by transient formation and dissolution of a blood clot.

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3
Q

What does decreased coronary blood flow cause?

A

Vasospasm, fixed stenosis (althersclerosis), thrombosis (blood clot)

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4
Q

What does increase need for O2 cause?

A

Increased heart rate, increased contractility, increased preload/afterload

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5
Q

What are the clinical manifestations of myocardial infarction?

A

sudden, continuous chest pain that lasts 15-20 mins.
pain that radiates to shoulder, neck, arms, jaw
chest pain that gets worse

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6
Q

What is the pathopysiology of myocardial infarction?

A

plaque formation –> plaque rupture –> endothelial cell injury and inflammation –> decreased blood supply and increased O2 demand –> myocardial ischemia –> myocardial cell necrosis

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7
Q

Ischemia Definition

A

Blood flow is restricted or reduced

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8
Q

Myocardial Ischemia Signs & Symptoms

A

BF to portion of cardiac muscle is completely blocked.

angina, hypoxia, tachycardia, extra heart sound (S3)

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9
Q

Acute Coronary Syndrome

A

Unstable angina, NSTEMI, STEMI

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10
Q

Difference between CAD, angina, and heart attack

A

CAD: plaque builds up in an artery
Angina: plaque makes it harder for blood to get through an artery
Heart Attack: plaque cracks and a blood clot blocks the artery

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11
Q

CAD Risk Factors

A

Age, gender, race, ethnicity, family history, DM, hyperlipidemia, HTN, smoking, inactivity, obesity, unmanaged stress

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12
Q

Electrocardiogram

A

Performed and interpreted within 10 min. Most common. Repeat ECG every 10-15 minutes if first time with angina

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13
Q

Tropinin

A

Protein found in muscles of heart.
hs-cTn should be <14 if >14 ICU
Check troponin at 0-2-6 hours

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14
Q

Echocardiogram - Normal EF

A

Checks how heart chambers and valves are pumping blood

Normal EF is 50-70%

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15
Q

Stress Echocardiogram

A

Treadmill test and echocardiogram. Dobutamine test for pt. who cannot excercise

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16
Q

Nuclear scan-myocardium perfusion imaging

A

shows how well blood flows to the heart.
3-part test
lexiscan dilates BV

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17
Q

CAD Treatment Goals

A

Relieve chest pain, reduce extent of myocardial damage, maintain cardiovascular stability, manage risk factors

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18
Q

Statins

A

Lower cholesterol by increasing LDL excretion from circulation

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19
Q

Nitrates

A

Treat angina. Produce coronary artery and peripheral vasodilation. Take 3.

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20
Q

Beta Blockers

A

Manage stable angina. “lol” suffix. Blocks the effect of epinephrine.

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21
Q

Non-Pharmocological Therapy (2)

A
  • Percutaneous Coronary Intervention prev. known as angioplasty w/ stent
  • Coronary Artery Bypass Grafting - use veins or artery to create connection to construct a detour around blocked portion of artery
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22
Q

What is a good diet for somebody with CAD?

A

Low-fat diet rich in antioxidants. Foods containing bioflavinoids. Supplement C, E, B6, B12, Folic Acid

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23
Q

What is HTN a risk factor for?

A

CHD, heart failure, stroke, renal failure

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24
Q

Elevated BP category

A

120-129, <80

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25
Stage 1 HTN
130-139 or 80-89
26
Stage 2 HTN
> 140 or >90
27
hypertensive crisis
BP > 180/120
28
HTN risk factors
age, ethnicity, smoking, high salt intake, health problems, inactive lifestyle, alcohol, high stress, obesity
29
HTN complications
Stroke, heart failure, sexual dysfunction, vision loss, heart attack, kidney disease
30
Primary HTN symptoms
Usually asymptomatic headache, confusion, nausea/vomiting, visual distrubances (most common), nocturia
31
Treating HTN - Diuretics
First drug of choice. Thiazide. Watch K+ levels
32
Treating HTN: Beta Blockers
metoprolol, atenolol. For newly diagnosed pt.
33
Treating HTN: ACE inhibitors
lisinopril, benazepril, Block angiotensin, which causes BV to open
34
Treating HTN: Angiotensin 2 receptor blockers
losartan, valsartan
35
Treating HTN; Calcium Channel Blockers
diltiazem, amlodipine. block CA from entering smooth muscle cells of heart.
36
Treating HTN: Alpha Blockers
not common. doxazosin, prazosin. reudce the arteries resistance
37
Treating HTN: alpha 2 receptor agents
clonidine, methyldopa.
38
Treating HTN: combined alpha and beta blockers
carvedilol, labetalol
39
vasodilators
last effort. hydralazine. for HTN emergency
40
Drug regime for HTN
1 antihypertensive medication given at low dose and slowly increased until optimal BP reached.
41
What is a good diet for somebody with HTN?
Low calorie, low fat, low sodium
42
What is preload?
Stretch of vesicle. Amount of blood in vesicles at end of distole
43
What is afterload?
Relaxation. The resistance left ventricle must overcome to circulate blood.
44
Left Sided Heart Failure
Prevents delivery of oxygenated blood. Main cause of right sided heart failure. There are 2 types: systolic heart failure, diastolic heart failure
45
Left sided heart failure symptoms
* paroxysmal nocturnal dyspnea (most common) * cough, * pulmonary congestion: cough, crackles, wheezes, blood tinged sputum, tachapnea * restlessness * confusion * tachycardia * exertional dyspnea * fatigue * cyanosis
46
Systolic Heart Failure
* pumping problem * reduced ejection fraction * inability of heart to contract enough to push blood foward * stretch and thin chambers 0 heart gets bigger * increased afterload * impaired contrile ability * incompetent valves * cardiomyopathy
47
Diastolic Heart Failure
* filling problem * preserved ejection fraction - it could remain normal * inability of left ventricle to relax, resulting in fluid backing up into lungs * increased preload * left ventriclular hypertrophy
48
Right Sided Heart Failure
* Oxygen depleted blood * heart loses ability to move o2 depleted blood into lungs * Caused by left sided heart failure
49
Right sided heart failure symptoms
* edema * ascites * fatigue * enlarged liver and spleen * distended jugular vein * anorexia and GI distress * weight gain
50
heart failure risk factors
atherosclerosis, HTN, DM, fautly heart valves/muscles, smoking, alcohol, obesity
51
HF Compensatory Mechanism: Nervous System
* Catecholamines released (help body respond to stress) * alpha and beta effects activated - lead to increased HR, increased BP, increased cardiac output * baroreceptors stimulated: sense pressure change by response to changes in tension in arterial wall
52
HF Compensatory mechanism: hormones
Renin - decreases fluid eliminated as urine Angiotensin: narrows BV to increase BP Aldosterone: sends signals to organs to regulate sodium they send to the blood stream
53
HF Compensatory mechanisms: Cardiovascular System
* Ventricular Dilation: initial cardiact response to pump more blood * myocardial hypertorphy: stronger, thicker muscles * Frank Starling Mechanism: hypertrophy of L ventricle
54
PRO BNP normal value
<100. Detects hormone released from the ventricles in response to increased wall tension
55
Ejection Fraction Values
Normal: 55-70% Less blood is ejected: 40-54% Mild heart failure: 35-39% Severe Heart Failure: <35%
56
Managing HF: ACE Inhibitors
Lisonopril, benzepril
57
Managing HF: beta Blockers
Metoprolol, atenolol
58
Managing HF: diuretics
Furosemide, HCTZ
59
Managing HF: Vasodilators
hydralazine
60
Managing HF: Cardiac Glycoside
Digoxin (monitor for toxicity. Arrythmia, visual disturbances, tiredness, loss of appetite, confusion) Lanoxin
61
Goals of HF Therapy
improve cardiac output, reduce pulmonary and systemic congestion, prevent complications, improve quality of life, educate pt. and family
62
Abdominal Aortic Aneurism
arterial walls weak, enlarged
63
Types of aneurisms
* Fusiform: bulge on all sides * Saccular: 1 side has bulge * pseudo: BV injured and leak
64
AAA Etiology
altherosclerosis, hypertension, BV disease (CVD, MI, ANGINA), Trauma, Genetic diseases
65
AAA risk factors
High BP, High Cholesterol, Smoking, sedentary, family history
66
AAA clinical manifestations
Back, leg, abdominal pain pulsing sensation in abdomen IF RUPTURED: clammy, sweaty skin. dizziness. fainting, tachycardia, dyspnea, nausea/vomiting
67
When is surgical management recommened for AAA?
when it's 4-5 cm
68
6 P's of peripheral vascular disease
``` Pain Paresthesia poikilothermia paralysis pallor pulselessness ```
69
Peripheral Artery Disease
Narrow, weak, blocked arteries Result of build up of fat and cholesterol Arterioslerosis Atheroslecrosis
70
PAD Patho
athermatous plaque formation in intima of vessel --> calcification of medial layer and loss of elasticity --> inadequate blood supply to tissues leads to tissue hypoxia
71
PAD manifestations
Claudation rest pain ulceration gangrene
72
PAD Risk Factors
``` CAD/PAD Diabetes HTN obesity smoking > 50 ```
73
PAD Risk Factor Modifaction
``` Antiplatelet Therapy Lipid lowering agents glycemic control BP control smoking cessation lifestyle modication heart healthy diet Excercise ```
74
CVI (DVT)
vein blockage or valve leakage in leg veins, blood flows back and pools in legs DVT most common
75
DVT patho
hemdynamic changes/veno status --> endothelial injury/dysfunction --> hypercoagulability
76
CVI/DVT manifestions
edema, vericous veins, skin changes/discoloration, skin ulceration
77
DVT Risk Factors
``` > 50 obesity smoking family history hormonal fluctuation poor lyfestyle choices ```
78
DVT nursing management
``` avoid long periods of sitting or standing elevate legs exercise regularly lose weight hygiene ```
79
Vessel Differation DVT
Ateriole: dangle legs, pain sharp and worse at night, intesne pain, intermittent claudation, skin cool to touch, skin thin/dry/scaly/hairless, rubor, poor or absent pulse, edema not common, located toes/feet/shin Venous: elevation of legs, aching, throbbing, pain worse when sitting/standing/dangling/walking, skin warm to touch, skin thick/tough/leathery, pulse present, edema present, located over ankle
80
Diabetes Patho
Food is broken down into glucose, the pancrease produces insulin. Type 1 no insulin is produced due to damage of B cells. Type 2, over production of insulin so body becomes desnsitized.
81
Diabetes Type I etiology
``` Autoimmune Juvenile DM Insuin Dependent Exposure to virus Climate (oceanic) ```
82
Type I Diabetes Manifestations
3 P's : polyuria, polydipsia, polyphagia
83
Diabetes Type II Clinical Manifestations
Increased urination, increased thirst, increased hunger, fatigue, blurred vision, frequent infections, erectile dysfunction, pain/tingling in hands and feet
84
Increased BP Risk for Diabetes
130/85 or higher
85
High Triglycerides for Diabetes
150 mg/Dl or above
86
Large Waistline Risk for Diabetes
Men: 40" or more Women: 35" or more
87
LOW HDL risk for diabetes
Men: <40 Women: <50
88
Elevated Fasting BS Risk for Diabetes
100 or more
89
C-Peptide Test
0.5-2.7 NG/mL. Increased in Type 2 DM, insulinoma, cushings, kidney disese decreased in Type 1 DM, Addisons disease, liver disease
90
Hemoglobin A1C
<5.7 normal | >6.5 diabetes
91
Fasting Blood Sugars
70-100 normal 100-125 risk of diabetes 126 or higher diabetes
92
Glucose Tolerance Test
200 or above
93
Hypoglycemia Symptoms
45-60 mg/DL sweating, pallor, irritability, hunger, lack of coordination, sleepiness
94
Hypoglycemia Management
15 g fast acting carb. Avoid protein it slows absorption of sugar Wait 15 min. If Blood glucose <70 repeat
95
Hyperglycemia Symptoms
180-200 Dry mouth, increased thirst, weakness, headache, blurred vision, frequent urination
96
HHS
``` Common in Type II Dm BS >600 Osmality >340 Shallow breaths ALOC Dehydration Develops slowly ```
97
DKA
``` Type I Diabetes Common BS >300 Osmality >340 Kassumauls respiration Abdominal pain Nausea/vomiting Develops quickly ```
98
Hyperglycemia Etiology (8 I's)
``` Infection Infarction Infraction (non-compliant) Ischemic Illegal Iatrogenic Idiopathic ```
99
DKA/HHS management
* maintain airway * decrease blood glucose * Blood glucose monitor every 1-2 hours * improve dehydration
100
Acute Diabetes Complications
DKA, HHS
101
Microvascular Diabetes Complications
Retinopathy Nephropathy Neuropathy
102
Macrovascular (Chronic) Diabetes Complications
Atherosclerosis Cardiovascular/Peripheral Vascular Cerebrovascular
103
Retinopathy
Microvascular damage and occulsion of retinal capillaries due to changes in retina. Have eyes dilated every year
104
Nephropathy
Albumin in urine | Detioration of kidney function to overfiltering of glucose
105
Peripheral Neuropathy
numbness/tinling in lower extremities.
106
Managing Diabetes: Biguanides
Control hepatic glucose production | Metformin. Do not use in pt. with kidney, liver, or heart failure. Cautious with contrast medium
107
Sulfonylureas
stimulate pancreas to make more insulin. Glyburide, glizipizide, glimepiride, take with meals, watch for hypoglycemia
108
Glucose Inhibitors
Slows the absorption of starches/CHO. Best used for those with normal FBS, but elevated post prandial blood sugars. Arcabose, miglitol
109
Incretin Mimetics
Insulin pen. Do not use with insulin. May combine with oral agents
110
Rapid Acting Insulin
Bolus. Lispro (humalog)
111
Short-Acting Insulin
Bolus/Prandial. Regular Insulin (humulin R)
112
Intermediate acting insulin
NPH (humulin N)
113
Long-Acting Insuin
Basal. Lantus
114
Diabetes Dietary Recommendation
Non Starchy Veggies, grains and starchy foods, protein, high fiber, non fat dairy

NURS 1250 (6 decks)

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