Quiz Units 2 & 3 Flashcards
1
Q
Name the 3 pacemaker sites within the heart and give a rate range for each.
A
SA node 60-100 bpm. AV node 40-60 bpm. Perkinje fibers 20-40 bpm.
2
Q
Name each structure of the heart in order that blood flows through them, including the vessels.
A
Vena Cava, right atrium, tricuspid valve (and chordae tendinae), right ventricle, pulmonic valve, pulmonary arteries, pulmonary veins, left atrium, bicuspid (mitral) valve, left ventricle, aortic valve, aorta
3
Q
What is defined as, “The degree of myocardial stretch at the end of diastole, just before contraction of the ventricles?”
A
Preload
4
Q
How would you define heart contractility?
A
The force of contraction independent of preload
5
Q
What is afterload?
A
Pressure (leftover from the last cycle) that the ventricle must overcome to open the semilunar valves.
6
Q
When referring to the heart, what is impedance?
A
This is afterload, plus the systemic resistance of the vessels, the viscosity of the blood, vessel constriction, and all other factors that make it harder for the aortic valve to open.
7
Q
Name 3 risk factors for cardiovascular disease in women.
A
Abdominal obesity, postmenopausal, DM
8
Q
The _____ nervous system slows the heart rate, while _____ stimulation increases it.
A
Parasympathetic. Sympathetic
9
Q
What class of drugs increases heart rate and contractility?
A
CAtecholamine’s such as epinephrine and norepinephrine.
10
Q
T/F. A healthy heart can adapt to stress, infection, and hemorrhage.
A
True
11
Q
What is pulse pressure?
A
The difference between diastolic and systolic
12
Q
What primarily determines diastolic blood pressure?
A
Peripheral vasoconstriction
13
Q
Diastolic BP must be at least _____ mm Hg to maintain flow through the coronary arteries.
A
60
14
Q
What is pallor indicative of?
A
Anemia
15
Q
How would you find the ankle-brachial index?
A
Apply a BP cuff to the lower extremity and use Doppler to assess the systolic pressure at the dorsalis pedis and posterior tibial pulses
16
Q
How would you find arterial insufficiency in a lower extremity?
A
Palpate peripheral arteries in a head to toe fashion, comparing pulses side to side
17
Q
What abnormal heart sound is common in older adults?
A
S4
18
Q
What is S4 indicative of?
A
Ventricular hypertrophy
19
Q
When auscultating heart sounds, you find that the point of maximum impact (PMI) has moved more than 1 intercostal space. What is this indicative of?
A
Left ventricular hypertrophy
20
Q
What are some s/s of angina?
A
Sudden onset, substernal, may spread across chest/back/arms, usually lasts less then 15 min
21
Q
What are s/s of a MI?
A
Sudden onset/often early AM, substernal, may spread across chest/back/arms, intense stabbing vice-like pain
22
Q
What are some s/s of pericarditis?
A
Sudden onset, intermittent/relieved by sitting upright, substernal, may spread across chest/back/arms, sharp stabbing/moderate to severe
23
Q
What are some s/s of anxiety?
A
Dull ache to sharp stabbing pain. May be in response to stress
24
Q
What are some s/s of pleuropulmonary chest pain?
A
Moderate ache/worse on inspiration, continuous
25
How does esophageal/gastric chest pain differ from heart related chest pain?
Can be substernal, but spreads to abdomen and shoulders. It is a squeezing feeling and is variable in severity
26
What s/s of CHF would you teach a client to look for?
Weight gain of 1-2 lbs in 1-2 days, notify physician if rings/shoes feel tight, it is possible to gain 10-15 lbs before edema develops
27
Name 3 movements that can cause syncope in an aging client.
Turning the head, doing Valsalva maneuvers, and shrugging the shoulders
28
How is the severity of orthopnea measured?
By the number of pillows it takes to relieve it
29
What common nursing measures can decrease myocardial contractility, further decreasing cardiac output in a CVD client?
Endotracheal suctioning that causes hypoxemia
30
What is intermittent claudication? What is done for it?
Muscle pain, usually in the legs, that occurs during exercise, caused by lack of blood flow to the affected area. It is tx by resting with the legs in a dependent position
31
What is considered a normal triglyceride level?
Less than 150 mg/dl
32
What is considered a normal total cholesterol level for older adults?
144-280 mg/dl (122-200 mg/dl is normal for younger pts)
33
What should the HDL-LDL ratio be?
3:1
34
At what level should HDLs be maintained?
Greater than 45 mg/dl
35
At what level should LDLs be maintained?
Less than 70 mg/dl for high risk CVD pts, <130 mg/dl for the rest
36
What conditions would prompt regular testing for microalbuminuria?
Hypertension, DM, and metabolic syndrome
37
What tests are run for Coumadin therapy?
PT and INR
38
What measures are taken to prepare a client for an echocardiogram?
IV access and NPO for 3-6 hours
39
Do echocardiograms require informed consent?
No
40
What is an MPI (MNPI)?
Myocardial nuclear perfusion test. It can detect MI and decreased myocardial blood flow
41
What instructions are given to a pt before a stress test?
Wear comfy clothes/shoes, avoid alcohol/smoking/caffeine the day of the test, light meal at least 2 hours before the test
42
What ECG parameter would indicate a need to stop a stress test?
Depressed ST segment
43
What is a technetium scan used for?
To detect the size and location of an MI
44
What is a thallium scan used for?
To assess myocardial scarring and perfusion, size and location of an MI, CABG graft patency, and to evaluate anti-anginal therapy, thrombolytic therapy, and balloon angioplasty
45
Is multigated blood pool scanning invasive or non-invasive?
It is a non-invasive test to look at cardiac blood flow
46
Where do you put the transducer for a Pulmonary artery wedge pressure (PAWP), also called pulmonary artery occlusive pressure (PAOP)? Where is the catheter placed?
At the phlebostatic axis. In the pulmonary artery
47
During hemodynamic monitoring via a pulmonary catheter, what would a normal range be, and what does it mean if the reading is high?
1-8 mm Hg. High means right-sided heart failure
48
What is SVO2 and what is considered a normal reading?
It is venous oxygen saturation. The amount of oxygen that isn't used by the body and is returned to the heart. Normal is 60-80, meaning that 20-40% of the oxygen was used
49
Name 3 uses for an angiogram.
To identify arterial narrowing, blockages, and aneurysms
50
What is assessed after cardiac catheterization?
The site for bleeding/hematoma, bedrest 2-6 hrs, supine (HOB elevated up to 30 deg), peripheral pulse/color/temp of affected extremity, vitals q15/1st hr, q30/2 hrs, q4. Of course this is all per facility policy!
51
After taking a PAWP reading, what 2 things should the nurse do?
Ask the pt to cough and assist them to change positions.
52
What are some complications of a pulmonary artery catheterization?
Pulmonary infarction, infection, and ventricular dysrhythmias.
53
Describe the waveform associated with a 3rd deg heart block. Why is it like this? What causes it?
The P wave is usually regular and 60-80 bpm. The R wave is only 40 bpm. The signal is being delayed or blocked after the P wave is produced. In a complete block, there is no correlation btwn the P & R waves timings It may be caused by an MI or Lyme's disease
54
How is a 3rd degree heart block treated?
Pacemaker
55
What's the difference btwn cardioversion and shocking someone?
In cardioversion, there is an R wave so you must sync it first. If no R wave, then you just shock them
56
What is done for bradycardia?
Pacing Always Ends Danger. Pacing comes 1st, while waiting, consider Atropine, Epi, Dopamine
57
What is the acronym for V-Tach?
SCREAM. Shock (q2min if necessary). CPR (2 min - Do NOT check pulse/rhythm). Rhythm (q2mins). Epi. Anti-Arrythmic Medications (Epi, Lidocaine, Mag Sulfate)
58
What is the acronym for the treatment of asystole?
PEA. Pacing (CPR). Epi. Atropine
59
What is of greatest concern with Afib and how is it treated? How do you tx the Afib?
Emboli, so tx with Coumadin, Cardizem, and maybe cardioversion
60
What is a concern with SVT and what is the tx for it? How is the SVT treated?
Clots/anticoagulants. Adenosine/tx
61
How is V-tach treated? What drugs?
Sync and cardiovert @ 200/300/360 joules. Amiodarone and lidocaine
62
What can cause V-tach?
MI, K+, Mag, stress
63
What can cause sinus tachycardia?
Bundle branch block
64
How is sinus tach treated?
Tx underlying cause
65
What is the acronym for STEMI tx?
MONA. Morphine. O2. Nitrates. Aspirin. (send to cath lab)
66
What is it called if there is a long delay between the P wave and the QRS complex? How is that tx?
1st deg block (Blocked btwn the SA and AV nodes). Usually not tx
67
If there is a straight line going up or down on the tracing it is caused by what? If the tracing has 2 of these, it is called an _____ _____ _____.
A pacemaker. An AV sequential, which paces the atria and the ventricles.
68
What do we look for in the tracing with a pacemaker?
Fire and capture with each pulse
69
If sinus bradycardia is symptomatic, what is done for it? Non-symptomatic?
Atropine. Ask more questions
70
What are 2 types of PVCs?
Unifocal and multifocal
71
What can cause PVCs?
CHF, Anemia, electrolytes
72
What is the tx for PVCs?
Amiodorone, lidocaine
73
If you get a 4 beat run of VT, what may be happening?
It may be an MI in the making if it is maintained
74
What might cause a 4 beat pattern of VT and how would you tx it?
MI, mag, K+. Amiodorone, lidocaine
75
Why can't you sync with V-Fib?
The waves are so small they can't really be defined as true waves
76
What will the pt look like if he is in V-Fib?
Dead. Blue. Cells are dying causing anaerobic respiration which causes lactic acidosis
77
What is the tx for V-Fib?
Epi, lidocaine, amiodorone. Shock at 200/300/360 joules
78
What labs are needed with Coumadin?
PT & INR
79
What labs are needed with Heparin?
PTT/APTT
80
What is the antidote to Heparin?
Protamine sulfate
81
How long is a normal PR interval?
.12-.20 sec
82
How long is a normal QRS complex?
.04-.10 sec
83
What are the 4 questions you ask yourself when looking at an EKG tracing?
Is there a P wave? Is every P wave followed by a QRS complex? Is the rate fast/slow? Is the rhythm regular?
84
What is the antidote to Coumadin?
Vitamin K
85
How do ACE inhibitors work?
Inhibit conversion of Angiotension1 and Angiotension 2, which lowers arterial resistance and increases vascular capacity. It also increases renin, thereby reducing aldosterone levels, which causes the kidneys to release sodium and water, reducing blood volume
86
What is the major effect that must be monitored for when administering Beta Blockers, ACE inhibitors, anti-arrhythmics, and calcium channel blockers?
Bradycardia
87
What dysrhythmia does lidocaine treat?
PVCs, VT and VF
88
What is atropine used for?
Bradycardia
89
What is done for SVT?
Adenosine (adenocard) 6/12/12 Slam it in! Lay flat
90
What is amiodarone used for?
Afib and life threatening ventricular dysrhythmias
91
What is digoxin used for?
Afib/flutter/PSVT
92
What is done for sinus tachycardia?
We treat the underlying cause
93
How do you assess for a pulse deficit?
Take the apical and radial pulses for a full minute and see if there is a difference
94
Which of these instructions to a UAP would help prevent a vagal response? Don't raise the pts arms over her head. Don't use a rectal thermometer. Keep the pt supine.
Instruct them to avoid raising the pts arm over her head
95
What is ejection fraction and what is its normal range?
EF is the stroke volume divided by the End Diastolic Volume. SV/EDV. 50-75% 36-39 is very bad!
96
What is the tx for V-Tach?
Amiodorone. Hang a drip. Weight based
97
How do you identify an MI on a trace and what is the PRIORITY goal?
ST elevation. Tombstone. Cath Lab. Must be done within 90 minutes
98
What are Urokinase and Tissue Plasminogen Activator?
Clot busters. UPA and TPA
99
What is Bumex (bumetandine)?
A loop diuretic often used in heart failure
100
At what point is surgery the option of choice for blocked arteries?
70% blocked, or less in heart failure
101
What is the difference between stable and unstable angina?
Stable is predictable. Exercise/pain/take nitro/relief. Unstable happens at rest
102
Besides relieving pain, why is morphine used for MI?
It is also a vasodilator
103
What disease process blocks coronary arteries? Describe this process.
Atherosclerosis. Plaque builds up under the interior lining of the arteries. (cholesterol/triglycerides/Etc.) When it breaks through that lining (a lesion), the body attacks with an immune response (platelets/t-cells/WBCs), closing off the artery
104
What is "The Widowmaker"?
Left anterior descending (LAD)
105
When is balloon angioplasty not an option in the LAD?
When it is a high lesion in the LAD
106
What is the protocol for home use of nitroglycerin?
3 max, 5 minutes apart, call 911 if the 3rd doesn't work
107
What is integrelin?
An antiplatelet drug
108
What priority nursing measures must be done every shift for a pt with an invasive temporary pacing?
Change the battery q shift, check rate and amplitude of the pacing pulse
109
What is the tx protocol for PVCs?
Amiodorone/lidocaine if symptomatic, usually for multifocal PVCs
110
What is "high output failure"?
It is a prolonged condition of high volumetric output due to high diastolic pressure. This causes circulatory overload and pulmonary edema. It can be caused by anemia, sepsis, hyperthyroidism, or anything that increases metabolic states
111
Name some catecholimines? How do they affect blood vessels?
Epinephrine, nor-epi, dopamine. Vasoconstrictors
112
What often causes right sided HF?
The left ventricle is unable to relax enough to allow proper filling, often caused by infarct
113
How does the body's natural mechanisms cause HF to worsen?
Low output causes the CNS to increase the HR and constrict the vessels to maintain perfusion. At the same time, it causes the renin angiotensin cascade to produce more aldosterone increasing fluid volume. This increases preload and afterload stretching the muscle and causing loss of contractility over time
114
What are some s/s of right-sided HF?
JVD, edema, ascites, hepatomegaly
115
What are some s/s of pulmonary edema?
Difficulty breathing, pink/frothy sputum, sweating, anxiety, pale, orthopnea, SOB
116
What are some s/s of left-sided HF?
Tachypnea, rales/crackles, cyanosis
117
What is the tx acronym for pulmonary edema?
MAD DOG. Morphine, airway, digitalis, diuretic, O2, Gasses (ABGs)
118
What are the s/s of dig toxicity?
Hypokalemia, confusion, anorexia, NVD, yellow/green halos, dizziness, agitation/depression
119
What nursing measures are a priority with pulmonary edema?
VS hourly. ABGs (they will be acidotic). PAO2 will determine if vent is needed
120
What is BNP? What is it for?
B type natriuretic peptide. It is only produced during heart failure and is used to stage it
121
What is Natrecor (Nesiritide)?
An artificial BNP (diuretic) used to treat HF and reduce pulmonary edema
122
What is LVEDP and how is it measured?
Left Ventricular End Diastolic Pressure. It is calculated by measuring wedge pressure in the pulmonary artery. Normal wedge pressure is 12-20
123
What type of MI do women prefer?
Non-STEMI
124
What blood test peaks 24 hours after an MI?
CK-MB
125
Explain systole and diastole.
There is actually atrial systole/diastole and ventricular diastole/systole. Our BP is measured by the max (systolic) & min (diastolic) pressure on the arteries. Within the heart, ventricular or atrial systole was contraction (when the greatest force is observed) & diastole is at max stretch, before the muscle contracts
126
Explain the stages of HF.
Stage A: Pts at high risk for developing HF but currently have no functional or structural deficits. Stage B: Structural disorder but no s/s. Stage C: Previous or current s/s of HF in the context of an underlying structural heart problem, but managed with medical tx. Stage D: Advanced disease requiring hospital based support or palliative care
127
Explain the classes of HF.
Class I: No limitations or s/s. Class II: Slight/mild limitations. Pt is comfortable at rest or with mild exertion. Class III: Marked limitations. Pt only comfortable at rest. Class IV: S/S at rest
128
What are acute coronary syndromes?
Unstable angina and MI (most serious)
