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adult health 1 > test 3 > Flashcards

test 3 Flashcards

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1
Q

why is left ascending artery the widow maker

A

supplies to left ventricle. If left ventricle doesn’t get enough oxygen… deadly.

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2
Q

Major causes of CAD

A

atherosclerosis- cholesterol plays a major role, as well as endothelial injury causing obstruction

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3
Q

what does a high CRP indicate

A

inflammation. typically elevated in CAD patients

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4
Q

collateral circulation

A

small arteries are built around the blocked artery in CAD, but they don’t deliver much oxygen and are only temporary solution, as chronic ischemia will soon occur

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5
Q

non modifiable risk for CAD

A

age, gender, genetics, ethnicity, family history

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6
Q

modifiable risk factors of CAD

A

Lipid levels, HTN, smoking, physical inactivity, obesity, diabetes, metabolic syndrome, psychological states, substance abuse

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6
Q

modifiable risk factors of CAD

A

Lipid levels, HTN, smoking, physical inactivity, obesity, diabetes, metabolic syndrome, psychological states, substance abuse

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7
Q

common symptoms in CAD

A

edema, clubbing, chest pain with exertion, dizziness, nausea, dysrhythmias, low o2 sat

  • diabetes patients may not feel chest pain or any pain as there nerves could be damaged
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8
Q

CAD diagnostics

A

Lipid panel, cholesterol, A1C, ECG, stress test, echocardiogram, chest x ray, bruits

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9
Q

drugs for CAD

A

> antihypertensives (beta blockers- lol, CCB- pine, Ace inhibitors - pril). monitor bradycardia and hypotension

> antianginals (nitroglycerine)

> lipid lowering (statins -monitor liver damage and myopathy)

> decrease cholesterol absorption - Ezetimibe (zetia)

> anticoagulants (heparin, warfarin) monitor for bleeding and thrombocytopenia (low platelets)

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10
Q

Coronary artery bypass graft (CABG)

A

take artery/vein from other place in body and attach to heart
2 wound- chest and where it was harvested
assess platelets, perfusion assessment of all organs, wound care, pain
Go into depression screening- link between getting CABG and depression

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11
Q

PTCA (percutaneous transluminal coronary angioplasty)

A

balloned catheter supresses plaque, allowing more space for blood to flow. stent may also be placed to prevent it from happening again

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12
Q

angina

A

intermittent chest pain usually occurring with the same pattern and intensity over period of time usually caused by CAD.
not enough oxygen. we want to decrease o2 demand and/or increase oxygen supply

happens when artery is 70% blocked or left main artery is 50% blocked

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13
Q

risk factors for angina

A

same as CAD, but oral contraceptives are added as well as menopausal women

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14
Q

short acting nitrates

A

dilates peripheral and coronary blood vessels
- given sublingually or by spray
can take up to 3 doses; 5 mins apart
- for angina

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15
Q

long acting nitrates

A

to reduce angina incidence
side effects- headaches, orthostatic hypotension

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16
Q

stable angina diagnostics

A

chest x ray
12 lead ecg
lab studies
echocardiogram
exercise stress test
EBCT or CCTA (test that look for plaque using IV contrast)

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17
Q

cardiomyapthies

A

diseases that directly affect myocardial structure or function
- makes it hard for blood to be delivered to body

primary: idiopathic, only partially affected muscle
secondary- caused by known primary disease

can be ischemic - MI (reduced EF), CAD
or nonischemic - dilate, hypertrophic, restrictive

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18
Q

ejection fraction

A

Percentage of blood and volume left ventricle pushes out, normal is 55% and above

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19
Q

preload

A

volume coming into ventricle

increased in hypervolemia, regurgitation of valves

diuretics can help

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20
Q

afterload

A

resistance left ventricle must overcome to push blood

increased in HTN or vasoconstriction
- creates more workload

vasodilators can help

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21
Q

hypertrophic cardiomyopathy

A

thickened left ventricular wall, becomes stiff
- contraction isn’t weakened, but filling is impaired

can be genetic, or can happen in athletes

blood backs up into lungs

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22
Q

dilated cardiomyopathy

A

enlargement of left ventricle
- most common one
poor systolic function
decreased EF

as disease progresses, atrial enlargement

blood stays in LV… worry about clots

no specific cause,,, alcohol, epstein barr, radiation

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23
Q

restrictive cardiomyopathy

A

rigid ventricular walls: impaired filling and stretch
- least common type
etiology unknown
EF may be normal
heart tissue replaced by fibrosis. could lead to HF or dysrhythmias

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24
signs/symptoms of cardiomyopathies
angina, SOB, fatigue, HF, irreg rate, edema, pulm congestion, enlarged liver, sleepiness, cough, loss of appetite, syncope
25
cardiomyopathies diagnosis
chest x-ray echocardiogram ECG Cardiac MRI blood test: BNP (secreted due to stretching of ventricle) renal/liver function
26
cardiomyopathy meds and med management
nitrates- decrease preload bc it opens veins diuretics- decrease fluid ACE inhibitor- Decrease resistance in artery so L vent doesn’t have to work as hard, decreasing afterload Beta blockers for neurohormones antidysrhythmics anticoagulants reduce symptoms, slow progression, prevent clots, surgeries, meds, safety, control edema, control fatigue, manage indigestion and nutritional issues (GI is slowed). manage stress low sodium diet, no alcohol, avoid diet pills and cold meds
27
what regulates valvular diseases
SNS- fight or flight- arteries constrict hormones- epinephrine, NE, angiotensin histamine - inflammation
28
what is a valvular disorder
disturbance in blood flow that eventually results in damage to tissues the #1 cause is atherosclerosis, but can also be from raynaud's, buerger disease, smoking, diabetes, hyperlipidemia, inflammation, HTN, obesity and age
29
peripheral arterial disease (PAD)
progressive narrowing and degeneration of arteries in upper and lower extremities, typically from atherosclerosis typically goes unnoticed for a long time until symptoms appear in 60s-80s symptoms- intermittent claudication (muscle pain that resolves w rest), paresthesia (due to lack of blood flow), thin, shiny, taunt skin, loss of hair on legs, absent or diminished peripheral pulses, pain aggravated by limb elevation, leg pain, pallor diagnosed by doppler, ABI, angiography, duplex imaging
30
common sites of PAD
Iliac artery femoral artery popliteal artery tibial artery peroneal artery
31
PAD complications and care
complications can include poor wound healing, wound infection, tissue necrosis, ulcers, amputation avoid HTN, stop smoking, manage hyperlipidemia and diabetes, exercise, eats fruits and veggies and low cholesterol, fat and salt Meds- vasodilators - ramipril (altace) : specific to PAD. improved blood flow and walking distance antiplatelets cilostazol and pentoxifylline- helps intermittent claudication surgery- balloon angioplasty, bypass with vein or sympathetic graft main goal: improve arterial perfusion - evaluate by skin color, temp, pulse
32
thromboangiitis obliterans
also called Buergers, a inflammatory disorder of small/medium arteries/veins in upper or lower extremities - common in men under 45 with history of smoking ischemic ulceration in fingers, autoimmune markers in lab interventions- stop smoking, avoid cold temps, walk, antibiotics if ulcers infected, sympathectomy, bypass, pain management
33
raynauds phenomenon
vasospastic small cutaneous arteries, common in fingers in toes in women ages 15-40. triggered by exposure to cold, emotional upsets, tobacco and caffeine use causes color changes of ears, nose, toes, fingers, - thick skin, brittle nails, small hole ulcers 2 phases: vasoconstrictive- skin white then blue. feeling of coldness but skin numb hyperemic phase- throbbing, aching, swelling . because of vessels open and blood returns quickly wear warm clothes, avoid temp extremes, no smoking, avoid caffeine, avoid vasoconstriction meds
34
peripheral venous disease (PVD)
Blood isn't returning to heart well, from incompetent valves or inadequate pumping symptoms- cool, brown skin, edema, ulcers, pain and redness around vein, pulses may be decreased or normal. deep muscle tenderness. risk for clots. elevate legs above heart, take anticoagulants, avoid extreme temps, monitor pulses, avoid sitting/standing for long periods
35
venous ulcers
type of PVD caused by venous infufficency. causes breakdown of RBC releasing hemosiderin. Fibrous tissue replaces skin. chronic inflammation, edema, eczema, leathery skin, typically above medial malleolus (ankle), pain, wound may end up in bone causing osteomyelitis wear compression, do wound care, good nutrition, antibiotics, pentoxifylline (wbc activation drug), skin graft
36
varicose veins
dilated superficial veins primary cause- pregnancy, obesity, heart disease, family history secondary- injury could be congenital may have pain after prolonged standing, itching use compression and elevation
37
most common cause of HF in women
HTN
38
most common cause of HF in men
CAD, MI
39
HF risk factors
CAD, HTN, DM, age, tobacco, obesity, metabolic syndrome, valve disorders, infection. could be congenital
40
HF stages
at risk pre HF- cardiac issue but no symptoms HF- symptoms advanced HF- palliative care
41
Left sided diastolic HF
heart cant fill. chambers are thick and stiff, contracts okay so EF is fine Blood backs into L atrium and lungs Usually caused by HTN
42
left sided systolic HF
Too much stretch in chambers, they're thin. EF is reduced. can't pump fluid backs into L atrium and lungs caused by valve issues, increased afterload, CAD
43
Right sided HF
does not pump effectively, blood backs into body organs and tissues most common cause is L sided HF, but can also be right ventricle infarction
44
compensatory mechanisms
When output goes down, HR tries to increase, lowering BP, kidneys think dehydration and increase renin to hold on to fluid, sodium and water
45
drugs for HF
Drugs to order- Ace inhibitors (pril) / arbs (statin), diuretics and beta blocker (lol) Also nitrates, vasodilators, RAAS, positive inotopes like dopamine, MRA, SGLT (Sodium glucose)
46
Atrial natriuretic peptide (ANA), b-type natriuretic peptide (BNP)
Released due to Increased blood flow in heart - Causes diuresis (lots of urine), vasodilation, and lowered BP
46
Atrial natriuretic peptide (ANA), b-type natriuretic peptide (BNP)
Released due to Increased blood flow in heart - Causes diuresis (lots of urine), vasodilation, and lowered BP
47
Diagnostics for HF
*BNP, echo Chest x-ray, ecg, nuclear imaging, cardiac cath
48
caring for HF
treat underlying cause PT/OT pacemaker palliative care monitor vitals o2 therapy semi fowlers I&O alternate rest w activity monitor edema *DAILY WEIGHTS AND RESTRICT SALT TO 2G/DAY. call Dr if gain 2lbs a day or 3-5 in week
48
caring for HF
treat underlying cause PT/OT pacemaker palliative care monitor vitals o2 therapy semi fowlers I&O alternate rest w activity monitor edema *DAILY WEIGHTS AND RESTRICT SALT TO 2G/DAY. call Dr if gain 2lbs a day or 3-5 in week
49
Right HF symptoms
fatigue ascites enlarged liver/spleen JVD anorexia/ GI complaints weight gain dependant edema
50
Left sided HF symtoms
paroxysmal nocturnal dyspnea cough crackles in lung tachypnea tachycardia restlessness fatigue cyanosis confusion exertional dyspnea
51
Best drug to give for a patient w CAD
statin (for hyperlipidemia) because CADs most common cause is atherosclerosis
52
cardiac output
stroke volume and HR
53
Defibrillation
only for dead. For V-fib. Shocks them
54
cardioversion
less amount of energy to shock, can shock more dysrhythmias
55
Ability to initiate an impulse spontaneously and continuously
automaticity
56
Ability to be electrically stimulated
excitability
57
Ability to transmit an impulse along a membrane in an orderly manner
conductivity
58
Ability to respond mechanically to an impulse
contractility
59
ANS control of heart
parasympathetic- decreases rate of SA node, slows impulse conduction of AV node sympathetic- increases rate of SA node, increases conduction of AV node, increases cardiac contractility
60
ECG
most accurate monitoring HR and rhythm. Waveforms
61
telemetry
continuous monitoring, machine has memory. Not as informative as ECG
62
counting HR on ECG
Usually 6 seconds, count QRS, multiply by 10 for 60 secs to get BPM
63
artifact
what is shown when not getting good reading of monitoring due to electrodes being old, not sticking, or low battery. Patient may be shivering or have hiccups, something causing wires to move
64
dysrhythmias assessments
dizziness, syncope, chest pain, N/V, rate and rhythm, vitals
64
dysrhythmias assessments
dizziness, syncope, chest pain, N/V, rate and rhythm, vitals
65
What can cause nausea and vomiting with cardio issues
Blood pressure issues
66
what is P wave
atrial depolarization
67
what is QRS complex
ventricular depolarization
68
what is T wave
ventricular repolarization
69
Normal Sinus Rhythm
starts in SA node, reg rate and rhythm. rate in between 60-100
70
Sinus bradycardia
starts in SA node, reg rhythm, but rate is below 60 can happen if your an athlete, or in sleep, or from conditions such as Hypothermia, vagal stimulation, ocular pressure, hypothyroidism, hypoglycemia, or meds- beta blocker, CCB, This may be normal for some people, but for others symptoms include hypotension, pale, cool skin, weakness, angina, dizziness, SOB, confusion treated by stopping drugs that cause it, atropine or pacemaker
71
sinus tachycardia
starts in SA node, normal rhythm, but rate is 101-200 May be caused by sympathetic stimulation or stressors such as Exercise, pain, fever, hypotension, HF, hypovolemia, fear, hyperthyroidism Drugs can also increase rate- such as caffeine, cold meds, etc symptoms include dizziness, dyspnea, hypotension, angina possibly treatment depends on cause. Beta blockers, vagal maneuver
72
Premature Atrial Contraction (PACs)
starts somewhere in the atrium but not the AV node, irregular rhythm, rate varies. Can happen whenever, may not be a issue if it only happens occasionally. It distorts P waves. Can be caused by stress, fatigue, tobacco, alcohol, hypoxia, electrolyte imbalances, diseases such as hyperthyroidism, CAD Patient will feel palpitation or heart skipping a beat treatment is for more serious dysrhythmias, B blockers
73
Atrial Flutter
starts in single ectopic focus in right atrium. There is not a P wave, and it looks as a saw tooth pattern. The atrial rate is 200-350, and vent rate is around 150, a ratio of 2:1. It is associated with a disease, such as HTN, CAD, mitral valve disorder. Clotting is common, so patients need to be on anticoagulant. Treatment can be pharmacological agents, electrical cardioversion, or radiofrequency ablation (burning)
74
Atrial Fibrillation
loss of effective atrial contraction. Atrial rate can be 350-600. vent. rate varies controlled Afib- under 100 uncontrolled or rapid Afib- over 100. action need taken. P wave is all over the place, chaotic waves. This usually occurs secondary to a prior heart issue. It is the most common dysrhythmia. It can occur from other issues as well such as hyperkalemia or after cardio surgery with AFib, there is decrease in CO and increase of risk for stroke Goals- oxygenate (despite pulse ox), anticoagulation, try to get back to normal rhythm.
75
what does thyroid gland do
secrete thyroxine (T4), triiodothyronine (T3), regulates energy metabolism, growth and development issues are more common in women (age 20-40) and smokers
76
goiter
enlarged thyroid; may result in over or underactive thyroid may be caused by lack of iodine surgery can remove
77
autoimmune disorder that affects thyroid causing hypothroidism
hashimoto thyroiditis
78
autoimmune disease causing hyperthyroid
graves disease
79
hypothyroidism
fatigue, memory impairment, depression, myxedema, weight gain, constipation, dry skin, slowed heart rate, enlarged thyroid, shaggy hair, low sex drive
80
hyperthyroidism
nervousness, weight loss, diarrhea, hunger, fragile fingernails, warm skin, broken hair, enlarged thyroid, increased HR, muscle cramps, exophthalmos diagnosed by TSH levels under .4, if TSH low, it hyperthyroidism, if it's high than its hypo
81
thyroid storm
severe health crisis when large amount of hormones released, causing severe tachycardia, death
82
treatment of hyperthyroidism
block effects of excess hormones or suppress over secretion antithyroid- propylthiouracil and methimazole radioactive iodine beta blockers thyroidectomy high calorie diet for weight loss - Don't stop meds abruptly
83
primary hypothyroidism causes
destruction of thyroid tissue or defective hormone synthesis
84
secondary hypothyroidism causes
pituitary disease w decreased TSH secretion or hypothalamic dysfunction with decreased TRH secretion
85
what causes myxedema
sugar molecules under skin, causing puffiness
86
levothyroxine
synthetic hormone for hypothyroidism, starts with low dose and increased every 4-6 weeks. Must take for the rest of life - better to take on empty stomach
87
parathyroid
4 glands that sit behind the thyroid - makes PTH to regulate body's blood level of calcium and phosphorus excess PTH associated with high calcium- constipation, kidney stones, muscle weakness inadequate PTH associated with low calcium- numbness, tingling, tetany
88
what does adrenal gland produce and secrete
glucocorticoids- cortisol is stress hormone androgens (sex hormone) mineralocorticoids- aldosterone regulates Na and K
89
cushing syndrome
from chronic exposure to excess glucocorticoids, usually from steroids, or ACTH secreting pituitary adenoma may have moon face, acne, excessive hair growth, increased body hair, weight gain, slow wound healing, buffalo hump, thin extremities due to fat being in stomach and back, purple striae diagnosed CT or MRI treatment depends on cause- surgery, or decrease steroid dose correct hypertension and hyperglycemia correct hypokalemia high protein diet avoid exposure to extreme temps, infections and emotional (causes increased cortisol)
90
addison's disease
lack of cortisol and aldosterone symptoms- bronze skin, changes in hair distribution, GI disturbances, weakness, hypoglycemia, postural hypotension, weight loss symptoms don't typically show until 90% of adrenal cortex is destroyed diagnosed by ACTH stimulation women will need androgen replacement as well as cortisol and aldosterone because they get their aldosterone from adrenal, men get it from testi
91
issues of long term steroids
osteoporosis, insomnia, anger, muscle weakness, protein depletion, increased glucose, delayed wound healing make sure to gradually stop steroid

adult health 1 (5 decks)

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