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Week 2 (exam 2) Flashcards

Cardiac

1
Q

Heart failure

A
  • The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
  • A syndrome characterized by fluid overload or inadequate tissue perfusion
  • The term heart failure indicates myocardial disease, in which there is a problem
    with the contraction of the heart (systolic failure) or filling of the heart (diastolic
    failure).
  • Some cases are reversible.
  • Most HF is a progressive, lifelong disorder managed with lifestyle changes and
    medications.
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2
Q

Clinical manifestations of RIGHT sided heart failure

A

Viscera and peripheral
congestion
 Jugular venous distention
(JVD)
 Dependent edema
 Hepatomegaly
 Ascites
 Weight gain

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3
Q

Clinical manifestations of LEFT sided heart failure

A

 Pulmonary congestion,
crackles
 S3 or “ventricular gallop”
 Dyspnea on exertion (DOE)
 Orthopnea
 Dry, nonproductive cough
initially (possibly coughing up. blood)
 Oliguria
 Cyanosis
 Increased RR
 Elevated pulmonary capillary wedge pressure

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4
Q

Medical Management of HF: Medication

A

 Angiotensin-converting enzyme inhibitors
 Angiotensin II receptor blockers
 Beta-blockers
 Diuretics
 Digitalis
 Intravenous infusions
-Dobutamine
-Milrinone
 Other medications
- Hydralazine
- Isosorbide

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5
Q

medical management of HF includes

A

Nutritional therapy
- Following a low sodium (no more than 2 g/day) diet and avoiding excessive fluid intake
(p.803)
Supplemental O2
ICD
Cardiac resynchronization therapy
Elevate HOB

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6
Q

Acronym for congestive HF

A

Up-right position
Nitrates
Lasix
Oxygen
Ace Inhibitors
Digoxin

Fluids
Afterload decreases
Sodium restriction
Test (dig levels, ABGs, and Potassium levels)

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7
Q

HF complications

A

Pulmonary edema
Cariogenic shock
Thromboembolism
Pericardial Effusion and Cardiac Tamponade

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8
Q

Pulmonary edema manifestations

A
  • Pink frothy sputum
  • SOB / difficulty breathing
  • crackly lungs
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9
Q

Pulmonary edema assessments and diagnostics

A
  • listen to lungs
  • are they having difficulty maintaining O2 status
  • chest x-ray
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10
Q

Pulmonary edema prevention

A
  • Diuretics (in-between giving blood)
  • sit them up in bed
  • have them dangle their feet
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11
Q

Pulmonary edema medical management

A

O2 therapy (non-rebreather, oxy mask, BiPap)
Diuretics
Vasodilators

both diuretic and vasodilator will impact blood pressure

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12
Q

Patho of cariogenic shock

A

Cardiac output is compromised → BP falls and tissue profusion is decreased → Blood supply for tissues and organs and for the heart muscle itself is inadequate → this impaired tissue profusion weakens the heart and impairs its ability to pump → the ventricle does not fully eject its volume of blood during systole → fluid accumulates in the lungs

this can occur suddenly or over a period of days
(p. 287)

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13
Q

Intra-Aortic Ballon Pump

A

If cardiac output does not improve, the IABP is a catheter with an inflatable balloon at the end. The catheter is usually inserted through the femoral artery and threaded toward the heart, and the balloon is positioned in the descending thoracic aorta. It inflates during diastole, and deflates just before systole.
(p. 289)

Takes workload off the heart

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14
Q

Cardiac Tamponade

A

Compression of the heart resulting from fluid or blood within the pericardial sac
- looks like RHF
- muffles heart sounds
- Hypotensive
- Diastolic and systolic BP get closer together

DX: echo
Tx: pericardialcentesis or pericardial window

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15
Q

Medications Used in
Cardiopulmonary
Resuscitation

A

 Epinephrine
 Vasopressin
 Norepinephrine
 Dopamine
 Atropine
 Amiodarone
 Sodium bicarbonate
 Magnesium

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16
Q

Acute coronary artery syndrome

A
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17
Q

Myocardial Infarction

A
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18
Q

Factors affecting heart rate

A

Autonomic intervention (medications, lifestyle changes, and wearing compression garments)
Hormones
Fitness level
Age

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19
Q

Factors affecting stroke volume

A

Heart size
Fitness level
Gender
Contractility
Duration of contractility
Preload
Afterload

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20
Q

Stroke volume = ___________ - _____________

A

End Diastolic Volume - End Systolic Volume

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21
Q

Invasive modalities of Hemodynamics monitoring ANDDDD possible complications

A

CVP
Pulmonary Artery Pressure (Swan Ganz catheter)
Intra-arterial pressure

Infection
pneumothorax
Ari embolism

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22
Q

Minimally invasive hemodynamics monitoring devices

A

Pulse Pressure Analysis
Esophageal Doppler
Probes
Fick Principle

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23
Q

Central venous pressure shows the…

normal pressure is…

A

pressure of the right atrium, normal pressure is 2-6
if it is above 6 they have fluid volume overload
if it is below 2 they have fluid volume deficit

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24
Q

Pulmonary Artery Catheter

A

Sits in the pulmonary artery and provides pulmonary artery pressure and wedge pressure.
Shows Left Ventricle function
Normal range is 15-25/8-15

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25
Pulmonary Artery Occlusion pressure normal is (PAOP)
8-12
26
An increase in PAP (pulmonary arterial pressure) indicates what?
A decrease in left sided heart function
27
Treatment for Increased PAP
Dolbutomine and diuretics
28
Tx for decreased PAP
Fluids, vasopressors
29
Dythrhythmias
disorders or the formation, conduction, or both of the electrical impulses in the heart they can cause disturbances of rate rhythm or both can alter blood flow and cause hemodynamics changes diagnosed by EKG
30
Potential complications/collaborative problems of dysrhythmias
Cardiac arrest Heart failure Thromboembolic event, especially with atrial fibrillation
31
Cardioversion and defibrillation
Treat tachydysrhythmias by delivering an electrical current that depolarizes a critical mass of myocardial cells. When cells repolarize, the sinus node is usually able to recapture its role as heart pacemaker. In cardioversion, the current delivery is synchronized with the patient’s ECG.  In defibrillation, the current delivery is unsynchronized.
32
Possible complication of pacemaker use
 Infection  Bleeding or hematoma formation  Dislocation of the lead  Skeletal muscle or phrenic nerve stimulation  Cardiac tamponade  Pacemaker malfunction get chest x-ray to make sure leads are placed in the correct spot
33
Invasive methods to diagnose and treat recurrent dysrhythmias
Electrophysiological studies Cardiac conduction surgery Maze procedure Catheter ablation therapy
34
Electrophysiological studies
cardiac catheter that assesses the function or dysfunction of the SA and AV nodal areas and identifies the location of the conduction issue
35
Maze procedure
open heart surgical procedure for refractory atrial fibrillation. Because the procedure requires significant time and cardiopulmonary bypass, its use is reserved only for those patients undergoing cardiac surgery for another reason
36
Catheter ablation therapy
Catheter ablation destroys specific cells that are the cause of a tachyarrhythmia
37
Cariogenic shock
occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and the tissues. fluid accumulated in the lungs
38
Cariogenic shock symptoms
angina pain arrhythmias fatigue feelings of doom signs of hemodynamics instability (P.287)
39
Cardiac Tamponade
compression of the heart resulting from fluid or blood within the pericardial sac pericardiocentesis can be done to treat
40
Causes of cardiac arrest can be
MI Arrythmias Progressive bradycardia Hypothermia Medication overdose Pulmonary Embolism Hyperkalemia Sever Hypoxia
41
Signs of cardiac arrest
Unresponsive, no pulse, no breathing
42
Agents for cardiac arrest
Epinephrine Vasopressin Norepinephrine Dopamine Atropine Amiodarone Sodium bicarbonate Magnesium Sulfate
43
Treatment of Acute Coronary Syndrome(MI)
Nitro Aspirin/Plavix (if you can't give nitro due to low BP) Morphine/Fentanyl Oxygen (only if O2 sat below 94%) Anticoagulants Beta Blockers (within 24 hours) PCI (60 min door to balloon) Thrombolytic agents (30 min door to needle)
44
Three zones of damage with Acute Coronary Syndrome(MI)
Infarction, injury, ischemia
45
aortic valve is best heard...
at the second intercostal space to the right of the sternal boarder
46
Pulmonic valve is best heard...
over the second intercostal space to the left of the sternal border
47
Tricuspid valve is heard over...
the 5th intercostal space to the lower left sternal border
48
Mitral valve is heard over...
Apex, 5th intercostal space
49
Infarction
MI, cells are dead beyond hope of recovering those cells but you can attempt to stop the spread of necrosis
50
Injury
Some recovery is possible can still perfuse and restore it to become viable
51
Ischemia
Full recovery is possible
52
Valvular Stenosis Valvular Regurgitation Valvular Prolapse
Stenosis - narrowing of the vessel blood will become backed up (LHF) Regurgitation- backwards flow of blood (can be result of a prolapse) Prolapse - Leaflets do not close properly allowing blood to flow backwards
53
Dilated cardiomyopathy
most common – ventricles enlarge and weaken and it primarily effect systolic function
54
Hypertrophic cardiomyopathy
ventricles and septum enlarge and thicken which effects diastolic function and also restricts blood outflow
55
Restrictive cardiomyopathy
ventricles become stiff and rigid which restricts filling during diastole
56
S&S of cardiomyopathy
SOB Fatigue Dizziness Arrthmias Murmurs
57
Dx for cardiomyopathy
Echo EKG Chest MRI Chest X-Ray
58
Medications given for cardiomyopathy
Diuretics Digoxin Antidysrhythmic agents Antihypertensive agents
59
Procedures done for cardiomyopathy
Procedures Septal myectoy –part of heart muscle is removed Septal ablation Pacemake or LVAD Heart transplant
60
Abdominal aortic aneurysm S&S
Abdominal or back flank pain Pulsating abdominal mass (bruit over the area as well) Do not palpate the area
61
Thoracic aortic aneurysm S&S
Severe back or chest pain SOB Difficulty swallowing and a cough

Med Surge 3 (11 decks)

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