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Med Surg II > test one > Flashcards

test one Flashcards

1
Q

What is the treatment for chronic ischemia?

A

aspirin 81 mg for prevention and a statin

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2
Q

What is the treatment for stable angina?

A

statin, aspirin, NTG, and maybe ACE inhibitor

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3
Q

ACS (unstable angina or MI) treatment is…

A

MONABC
morphine, O2, nitro aspirin, bb, ccb
*in order: O2, EKG, assess CP, NTG, Morphine, aspirin, BB, CCB, lab work

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4
Q

What should you do before giving NTG?

A

check BP and HR (don’t give if BP is less than 90, HR less than 60)

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5
Q

What are some other types of pain in the chest? (not related to heart pain)

A

anxiety, muscle pain, heart burn, pulmonary related pan, carditis pain, valve problem

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6
Q

What does morphine do (MI)?

A

reduce anxiety, reduces O2 demand, reduces sympathetic response, reduce HR, etc

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7
Q

What do BB do?

A

block sympathetic response, decrease O2 demand, decrease HR, decrease workload of the heart and decrease preload

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8
Q

What do CCB do??

A

dilate coronary arteries which decreases heart workload

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9
Q

What K levels do you want heart patients to be at?

A

4.0!

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10
Q

What are the 3 options for cardiac cath. procedures? (MI)

A

clot, balloon, stent

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11
Q

What are the 2 thrombolytic options? (MI)

A

altraplase and strepokinase

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12
Q

Once a pt with a MI is in the door, they have _____mins to PCI or thrombolytic therapy

A

30-90 minutes

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13
Q

MONA-BC is only used for….

A

chest pain

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14
Q

What is a normal CK range? (male and female)

A

30-135 female

55-170 male

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15
Q

What are the s/s of endocarditis?

A

splinter hemorrhages, nodes, lesions on hands, abd. pain, fever, murmur, pleuritic CP, back pain, weight loss, clubbing

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16
Q

What are the s/s of Pericarditis?

tx?

A

pleuritic chest pain (on inspiration), pericardial rub, Narrow Pulse Pressure
-fever, dyspnea and dyspahsia

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17
Q

What are the s/s of myocarditis?

A

Gallop rhythm, reflects HF, fever and flu-like symptoms, wheezing, SOB fever, peripheral edema

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18
Q

When would a pt get a medical induced stress test?

A

PVD, neuropathy, severe COPD, amputation

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19
Q

What are the 2 main conditions of HF?

A

stenosis and regurgiation

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20
Q

what are some symptoms of aortic stenosis?

A

narrowed pulse pressure, increased pulmonary hypertension (b/c it’s getting backed up), and pulmonary edema

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21
Q

Pulmonary edema (increases/decreases) CO2?

A

increases CO2–> met, acidosis

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22
Q

What is the normal range for Pulmonary arterial pressurees?

A

LOOK IT UPPPPPP

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23
Q

Left regurgitation (mitral valve) leads to what kind of heart failure?

A

right sided HF (reduced CO–> pulmonary hypertension –> right sided HF)

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24
Q

Right tricuspid stenosis means blood stays in the right atria –> …?

A

peripheral edema, low CO, activate RAAS system, water retension

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25
Q

How does smoking lead to hypertension/HF?

A

causes vasoconstriction–>peripheral resistance

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26
Q

How does cocaine lead to HF?

A

increases BP –> vasoconstriction __> increased HR (sympathetic NS)

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27
Q

What is the value for BNP to be considered CHF?

A

over 700

you also need to have s/s and high BNP to be considered CHF

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28
Q

What is the best type of diagnostic test for CHF?

A

echocardiogram

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29
Q

What does an echocardiogram do?

A

looks at the function of the heart, valve function, and ejection fraction

30
Q

What is the normal CO range?

A

2-6 L

31
Q

What is the normal ejection fraction?

A

50-70%

32
Q

What rhythm is this? narrow QRT, T wave, but no P-wave, very fast

A

SVT, no p wave b/c it’s too covered b/d too fast, low CO leads to MI and reduced organ perfusion

33
Q

What do you give (med) when pt has SVT?

A

adenosine (antidysrhythmic, slows the HR), want to slow it down to see the underlying rhythm (a-flutter can reflect at SVT)
-CCB: slows SVT but doesn’t treat it

34
Q

If a pt is in F-fib but has a pulse, what do you do?

without a pulse?

A

synchronized cardioversion, defib if no pulse

35
Q

What do you give if it’s a true SVT?

A

cardizem (but check HR and BP first)

36
Q

Can you defib a flutter?

A

yes, synchronize defib.

37
Q

Paced atrial rhythm means the spike occurs…

A

right before the P-wave

38
Q

Paced ventricular rhythm means spike occurs…

A

right before QRS

39
Q

What is the force against which heart has to pump (peripheral resistance) to eject blood from LV?

A

afterload

40
Q

What is the normal PAWP?

A

pulmonary artery wedge pressure, 4-12

decrease=hypovolemia, increase=hypervolemia

41
Q

What is the normal pulse pressure?

A

30-40

42
Q

Where is the SA node?

A

right atrium (60-100 bpm)

43
Q

AV node produces ___ bpm?

A

40-60 bpm

44
Q

pukinje fibers (beneath ventricular endocardium) produces ___ bpm

A

20-40 bpm

45
Q

What does the right main coronary artery supply?

A

right atrium, right vent, inferior left vent, posterior septal wall, SA and AV nodes

46
Q

What does the left anterior descending artery supply?

A

anterior wall of Left vent, anterior septum and apex of LV

47
Q

What does the circumflex artery supply?

A

left atrium, and lateral and posterior surfaces of LV

48
Q

Which coronary artery supplies the SA and AV nodes?

A

right main coronary artery

49
Q

When does CK-MB elevate after MI? how long does it last for?

A

within hours, peaks 18 hrs after

50
Q

When does troponin I elevate? how long does it last for?

A

within 3 hrs, lasts 7-10 days

51
Q

What happens to coagulation values during and after MI?

A

they increase causing increased risk for clot

52
Q

What is an echocardiography?

A

ultrasound of the heart

53
Q

What does a stress test detect and evaluate?

A

CAD

54
Q

What are the 3 drugs used for IV stress test?

A

adenosine,dipyridamole. and dobutamine hcl

55
Q

What is a PTCA?

A

percutaneous transluminal coronary angioplasty

-one or more arteries are dilated with a bool catheter to open the vessel (take ASA permanently)

56
Q

What is an atherectomy?

A

removes plaque from coronary artery (rotor rooter), also used in PAD to improve blood flow to ischemic limbs)

57
Q

What is transmyocardial revascularization?

A

used if too many for balloon catheterization, so a laser creates 24 channels through LV muscle leading to oxygenated LV

58
Q

What is peripheral arterial revascularization?

A

bypass arterial occlusion, to increase arterial blood flow to affected limb

59
Q

Why do you have 2 p-waves after a heart transplant?

A

b/c a portion of atria to anchor new heart, 2 unrelated P-waves

60
Q

100-180 bpm is…

A

sinus tach

61
Q

A fib: atria beat ___bpm, quiver–> ____, p waves?

treatment?

A

350-600 bpm, quiver–> thrombi, no definitive p-waves

-tx: O2, anticoags, meds, cardioversion

62
Q

PVCs: ___ QRS

tx?

A

early QRS

tx: O2 if needed, check electrolytes (hypoKalmeia can cause PVCs)

63
Q

V. Tach: ___ bpm

tx: stable with pulse, unstable with pulse, pulseless?

A

140-250 bp, repetitive firing of ventricle

tx: -stable with pulse: O2, antidysrhythmic meds
- unstable with pulse: O2, antidysrhythmic meds, synchronized cardioversion, cough CPR
- Pulseless: defib and CPR

64
Q

V. Fib: description? tx?

A

impulses from irritable ventricle in disorganized manner, ventricle quiver (no CO), fatal if more than 3-5 minutes
-tx: CPR, defib, CPR, O2, antidysrhythmics

65
Q

What is cardioversion?

A

synchronized chock for ventricular dysrhythmias, lower amount of energy used than with defibrilation, synchronized to the R-wave (avoid the T wave)

66
Q

What happens if you cardiovert on a T wave?

A

it could lead to V-fib

67
Q

What is the difference between synchronous and asynchronous pacemakers?

A

synchronous: paces only if pt HR falls below certain rate
Asynchronous: paves at certain rate regardless of pt rhythm

68
Q

-prils=?

A

lisinopril, ACE inhibitor

69
Q

-pine=?

A

CCB!, vasodilator

70
Q

Pericarditis can lead to…

A

cardiac tamponade (constricts the heart)

71
Q

s/s of..?

decreased CO, muffled heart sounds, narrowing pulse pressure, pulses paradoxus, increased CVP

A

cardiac tamponade

72
Q

Valves can’t fully open: ___

Valves can’t fully close: ____

A

stenosis

regurgitation/insufficiency

Med Surg II (5 decks)

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