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Med- Surg > 17, 18 > Flashcards

17, 18 Flashcards

1
Q

volume of blood that the heart pumps out per minute

A

stroke volume

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2
Q

stroke volume determined by three things

A

preload
afterload
contractility

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3
Q

the volume of blood returned to the right side of the heart

A

preload

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4
Q

the force that the heart has to overcome to eject blood into systemic circulation (think pressure)

A

afterload

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5
Q

preload, afterload and contractility all influence the cardiac output how

A

by affecting the stroke volume

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6
Q

% of blood that is ejected from the left ventricle during systole
normal %

A

ejection fraction
50-70%

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7
Q

what kinds of problems can occur with decreased ejection fraction; what would decrease ejection fraction

A

can cause a backup of blood into the pulmonary vessels
tissue perfusion diminishes

heart failure

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8
Q

problems with too much blood in ejection fraction

A

increase pressure in the pulmonary vessels can cause pulmonary edema

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9
Q

largest veins in the body; where do they empty blood

A

superior and inferior vena cave
right atrium

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10
Q

three layers of artery wall tissue

A

outer: tunica adventitia: ct
middle: tunica media: smooth muscle
inner: tunica intima: endothelial cells

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11
Q

the force that the blood exerts against the walls of the aorta and its branches

A

blood pressure

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12
Q

blood pressure greatest during what

A

ventricular contraction / systole, when blood is ejected into the aorta

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13
Q

if blood volume decreases, kidneys secrete what

A

renin enzyme into the blood

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14
Q

renin acts on certain proteins to produce

A

angiotensin 1

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15
Q

angiotensin I is converted to angiotensin II by

A

angiotensin-converting enzyme from lungs

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16
Q

angiotensin II acts directly on what
what is the outcome
What does angiotensin II stimulate
what does this cause

A

blood vessels
causing constriction and raising blood pressure

adrenal gland to release aldosterone
causing sodium and water retention by the renal tubules- increasing blood volume- increasing bp elevation and improved cardiac output

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17
Q

sympathetic nervous system’s role in regulating vessel diameter (releases what)

A

prompts release of norepinephrine and epinephrine that cause vasoconstriction

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18
Q

cardiovascular age-related changes:
what happens to the actual heart and the contractility; resulting in what

A

becomes stiffer and contractile ability decreases, resulting in decreased stroke volume

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19
Q

cardiovascular age-related changes:
coronary arteries, cardiac valves

A

ca: become tortuous and dilated, areas of calcification

cv: thicken, murmurs are common

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20
Q

cardiovascular age-related changes:
SA node
aorta

A

SA: loses about 40% of its pacemaker cells over time, predisposing to cardia dysrhythmia or SA node failure

aorta: stiffer, contributing to increase in bp due to left ventricle pumping against greater pressure

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21
Q

Cardiovascular disease:
includes what kind of issues

A

congenital or acquired, heart failure, stroke, hypertension, dysrhythmias, infection and inflammation, DM, metabolic syndrome, obesity, sedentary lifestyle, and stress

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22
Q

Cardiovascular disease:
causes

A

coarctation ( narrowing of the aorta)
arteriosclerosis (thickening and loss of elasticity)
atherosclerosis (buildup of plaque)
aneurysms
stenosis (inflammation of the valve structure causing narrowing)
insufficiency (incomplete closure) of heart valves
hypertrophy (thickening of myocardial muscle)
hypertension
pulmonary hypertension
valve problems
ischemia
infarct
endocarditis (inflammation within the lining and valves)
pericarditis ((inflammation of the surrounding sac)

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23
Q

Cardiovascular disease:
modifiable risk factors

A

obesity
high cholesterol
hypertension
diabetes
smoking
sedentary lifestyle
excessive stress
excessive alcohol
drug use

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24
Q

common diagnostic tests & purpose:
electrocardiography
holter monitor
loop recorder
exercise ECG stress test
chemical stress test

A

e: record impulses of the heart to determine rate, rhythm, site of pacemaker, and presence of injury at rest

h: correlates normal daily activity with electrical function of heart to determine whether activity causes abnormalities

l: continuously records ECG to determine if an arrhythmia is the cause of symptom (syncope, palpitations, or dizziness)

e: records electrical activity of the heart during exercise; insufficient blood flow and oxygen can be identified by the abnormal waveforms they produce

c: used for those who cannot exercise for an ECG stress test

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25
Q

common diagnostic tests & purpose:
echocardiography
stress echocardiogram
venous ultrasoud of the legs
impedance plethysmography
nuclear imaging

A

e: evaluate size, shape, and position of structures and movement within heart
test of choice for valve problems
can evaluate blood flow through the heart and determine ejection fraction

s: detects differences in left ventricular wall motion before and after exercise

v: assesses occlusion or thrombosis in a vein

i: estimates blood flow in a limb based on electrical resistance present before and after inflating a pneumatic cuff placed around the limb
detects deep vein thrombosis

n: evaluates blood flow in various parts of the heart
determines areas of infarction

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26
Q

common diagnostic tests & purpose:
multiple-gated acquisition (MUGA) scan

computed tomography (CT) scan
CT angiography

magnetic resonance imaging (MRI)
magnetic resonance angiography
(MRA)

position emission tomography

A

m: determines area and extent of myocardial infarction
assesses left ventricular function

c: determines size and condition of aortic aneurysm
coronary vessels may be imaged

m:evaluates cardia tissue, integrity, detects aneurysms, determines ejection fraction, and determines patency of proximal coronary arteries

p: evaluates myocardial perfusion

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27
Q

common diagnostic tests & purpose:
transesophagel echocardiogram (TEE)

angiogram (venogram)

arteriogram

cardiac catheterization

electrophysiology studies

hemodynamic monitoring

A

t: provides images of the wall
thickness, heart valve structure and function, atrial septum, and presence of clots, and can calculate ejection fraction

a: identifies thrombi within the venous system
rarely used because noninvasive images provide adequate information

art: visualizes arterial anatomy and vascular disease in carotid, vertebral, aorta, renal, coronary, and peripheral arteries

c: assesses size and patency of coronary arteries and presence of collateral circulation
identifies pressure gradients for the aortic and mitral valves
assesses pumping action of the left side of the heart by measuring the ejection fraction of the left ventricle

e: measure and record electrical activity from within the heart to determine the area of origin of the dysrhythmia and the effectiveness of the antidysrhythmic drug for the particular dysrhythmia

h: determines pressure, flow, and oxygenation within the right side of the heart and pulmonary vessels

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28
Q

diagnosing a vascular problem: history, physical examination, and what kind of tests

A

-CBC
-urinalysis
-blood lipid and cholesterol assessment (including HDL and LDL)
-sequential multiple analyzer (SMA, metabolic panel) screening liver and kidney function, electrolytes, blood glucose
-doppler flow studies
-angiography
-nuclear medicine scans

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29
Q

diseases that elevate blood pressure

A

hyperthyroidism
cushing syndrome
pheochromocytoma
nephrosclerosis
renal arterial stenosis

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30
Q

ankle-brachial index

A

-evaluate arterial status in the lower extremities
-reg bp cuff is placed above the malleolus, another cuff placed above brachial artery
a doppler probe used to check the systolic endpoint at the dorsalis pedis and the
posterior tibial sites
-bp measured
-ABI calculated by dividing the systolic ankle by the systolic brachial
-normal: 1 or more
-intermittent claudication

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31
Q

Physical assessment for CVD

A

abnormal or extra heart sounds
crackles in lungs
pink frothy sputum (indicating pulmonary edema)
chest pain (if present, further assess using PQRST)
bluish cast to skin
pallor or diaphoresis
clubbing of fingers
pitting edema of feet, ankles, or sacral area
distended jugular veins

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32
Q

to detect bruits (a whooshing or purring sound made either when blood passes through a area of an artery that has ben patially obstructed OR when blood is flowing rapidly) listen with the bell over

A

lightly over the carotid arteries, abdominal aorta and femoral arteries

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33
Q

characteristics of skin chroniclly malnourished because of blood supply

A

smooth, shiny, and thin, little or no hair, nails are thick and yellow

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34
Q

common problems of patients with cardiovascular disorders

A

fatigue and dyspnea
edema
pain
altered tissue perfusion
impaired tissue integrity

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35
Q

crieteria used to determine whether a cardia patient is tolerating an activity

A

-heart rate does not rise more than 20 bpm over the baseline rate
-systolic bp does not drop
-there is no complaint of chest pain, dyspnea, or severe fatigue
-no abnormal heart rate or rhythm

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36
Q

elastic stockings are not used for pt’s with

A

arterial disorders

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37
Q

amount of cardiac output depends on:

A

heart rate
venous return (amount of blood returning to the heart)
strength of contraction
resistance to the ejection of blood (pressure in the arterial system)

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38
Q

common diagnostic tests & purpose:
multiple-gated acquisition (MUGA) scan

computed tomography (CT) scan
CT angiography

magnetic resonance imaging (MRI)
magnetic resonance angiography
(MRA)

position emission tomography

A

m: determines area and extent of myocardial infarction
assesses left ventricular function

c: determines size and condition of aortic aneurysm
coronary vessels may be imaged

m:evaluates cardia tissue, integrity, detects aneurysms, determines ejection fraction, and determines patency of proximal coronary arteries

p: evaluates myocardial perfusion

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39
Q

early warning signs of heart disease in women

A

chest pain
pain in neck and jaw
upper back pain
pain in upper abdomen
nausea
fatigue
shortness of breath
general weakness
changes in skin color (grayish skin)
sweating

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40
Q

metabolic syndrome components

A

-elevated waist circumference: men >40 inches, women >35 inches
-elevated triglycerides >150mg/dL
-reduced high-density lipoprotein cholesterol: men <40mg/dL, women <50mg/dL
-elevated blood pressure at or above 130/85mm Hg
-elevated fasting glucose indicating insulin resistance; glucose 100mg/dL

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41
Q

cardiac enzyme test
myoglobin
troponin
creatinine phosphokinase (CPK)
AST
creatinine kinase (CK-MB)
LDH

A

-myoglobin: initial rise <2hrs, peak 6-9hrs, back to norm 1day
-troponin: initial rise <4hrs, peak 14-24hrs, back to norm 3-5 days
-creatinine phosphokinase (CPK)
-AST: initial rise after CPK, peak 48hrs, back to norm 4-5 days
-creatinine kinase (CK-MB): initial rise 3-6hrs, peak 12-24hrs, back to norm 2-3 days
-LDH: initial rise 24-48hrs, peak 2-3 days, back to norm 5-10 days

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42
Q

scale for grading pulse quality

A

0: absent
+1: weak, thready
+2: light volume
+3: normal volume
+4: full, bounding

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43
Q

common problems of pt’s with cardiovascular disorders

A

-fatigue and dyspnea
-fluid overload: weight gain of 2-3lbs or more in 2-3 days or less - signs of hypokalemia
-pain: anginal pain or palpitations
-altered tissue perfusion: warm environment
-impaired tissue integrity

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44
Q

how is hypertension classified

A

primary (no other factors, genes, environment, insulin, glucose, and lipoprotein abnormalities related to metabolic syndrome)
secondary (renal, vascular, and endocrine disorders, stress, excessive alcohol, sickle cell disease, arteriosclerosis, coarctation of the aorta, eclampsia of preg, neurologic disorders, NSAID use, amphetamine use, alcohol taken with MAOIs, smoking, female hormone therapy)

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45
Q

pathophysiology of hypertension

A

when bp increases, the heart works harder to pump blood to perfuse the body- this is ideal for fight or flight but the heart can not keep this up in a constant state, ending with complications due to hypertension

-smaller diameter of blood vessles
-increase in volume or viscosity of fluid in the blood
-stress can stimulate the sympathetic nervous system
-excess renin secreted by the kidneys

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46
Q

complications of hypertension

A

-signs may only appear in late stages
-kidneys: renal ischemia and nephrosclerosis
-brain: arteriosclerosis and microaneurysm
-aorta: aortic aneurysm
-eyes: retinal damage
-heart: left ventricular hypertrophy and reduced cardiac output
-pts may complain of: dizziness, headache, blurred vision, blackouts, irritability, angina, dyspnea, or fatigue

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47
Q

hypertension:
treatment goals

A

reduction of high bp
long-term control to decrease the risk of stroke, heart attack, loss of vision, and kidney disease

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48
Q

hypertension:
treatment for mild, moderate, and severe

A

-mild: stop smoking, lose weight, sodium restriction, alcohol restriction, exercise, low-fat diet, stress control, diuretic or antihypertensive medication

-moderate: all of the above, with other medications added

-severe: above and more than two drugs, increasing dose as needed to achieve the desired bp level, unless side effects occur

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49
Q

how to differentiate between venous and arterial insufficiency during a physical assessment

A

v:
-pulse: strong and symmetric, may be difficult to palpate if edema is present
-skin: mottling with brown pigmentation at ankles, veins may be visible, legs or feet bluish when dependent, dermatitis, warm at ankle
-edema: present, particularly around ankle and foot
-ulceration: at bones of ankle
-necrosis and gangrene: unlikely
-pain: aching, cramping, particularly when dependent, may have nocturnal cramps
-nails: normal
-hair: normal

a:
-pulse: diminished, weak, or absent
-skin: pallor, dependent rubor; thin, dry, shiny, cool, maybe cellulitis
-edema: absent or mild
-ulceration: on toes or at pressure points of feet
-necrosis and gangrene: likely
-pain: intermittent claudication when walking, sharp, stabbing, gnawing, lessens when at rest
-nails: thick, brittle (normal in older adults)
-hair: hair loss distal to area of occlusion (hair loss normal in older adults)

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50
Q

-pulse: strong and symmetric, may be difficult to palpate if edema is present
-skin: mottling with brown pigmentation at ankles, veins may be visible, legs or feet bluish when dependent, dermatitis, warm at ankle
-edema: present, particularly around ankle and foot
-ulceration: at bones of ankle
-necrosis and gangrene: unlikely
-pain: aching, cramping, particularly when dependent, may have nocturnal cramps
-nails: normal
-hair: normal

s/s of arterial or venous disease

A

venous

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51
Q

-pulse: diminished, weak, or absent
-skin: pallor, dependent rubor; thin, dry, shiny, cool
-edema: absent or mild
-ulceration: on toes or at pressure points of feet
-necrosis and gangrene: likely
-pain: intermittent claudication when walking, sharp, stabbing, gnawing, lessens when at rest
-nails: thick, brittle (normal in older adults)
-hair: hair loss distal to area of occlusion (hair loss normal in older adults)

s/s of arterial or venous disease

A

arterial

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52
Q

complications of uncontrolled hypertension

A

-can cause damage to arteries, making them less elastic, placing an increased workload on the heart that could cause an MI, left ventricular hypertrophy, aortic aneurysm, and congestive heart failure
-small vessel damage to the brain disrupts circulation and may lead to dementia, transient ischemic attacks (TIAs), and ischemic strokes
-may cause an already weakened area in a blood vessel to rupture, may cause an intracranial bleed (hemorrhagic stroke)
-may cause damage to small vessels of the kidneys and may lead to kidney failure
-damages arteries of the eye, causing the formation of clots or occurrence of hemorrhage that may lead to blurred vision or blindness

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53
Q

how do antihypertensive drugs work

A

-reduce bp by decreasing blood volume, cardiac output, or peripheral resistance
-reverse or block conditions causing elevated blood pressure
-diuretics address fluid volume
-most blockers work by stopping a progression of a process resulting in vasoconstriction

54
Q

assess pt’s taking an antihypertensive for:

A

dizziness
confusion
syncope
restlessness
drowsiness

55
Q

hypertensive emergency, s/s, why
vs
hypertensive urgency, s/s, why

A

e:
-life-threatening, bp rises higher than 180/120, indication of target organ damage

s/s:
-severe headache, blurred vision, seizures, nausea, and change in loc

why:
-pt has most likely stopped taking their antihypertensive medication, or it may be secondary to another disease process.
-pt would be placed in ICU and treated with IV emergency drugs: IV sodium nitroprusside (Nipride), nicardipine (Cardene IV), nitroglycerin, or labetalol (Normodyne) to lower bp
-a reduction of bp to 160/100 is desired over the first 2 hours
-bp is monitored every 5 -15 min
-medication is adjusted to reduce pressure slowly to prevent renal, cerebral, or coronary ischemia

u:
occurs when bp rises to 180/110, but there are no signs or symptoms of target organ damage
-pt observed in ED and treated with oral medication

56
Q

why monitor potassium levels in ACE inhibitors

A

it suppresses the release aldosterone, increasing potassium retention

57
Q

what to monitor when pt is taking clonidine, why

A

liver function, may cause liver damage in some pt’s

58
Q

what to monitor when pt is taking hydralazine, why

A

renal function, may cause renal impairment

59
Q

pt’s may experience this after abruptly quitting antihypertensives

A

rebound hypertension

60
Q

notify prescriber if a persistent dry cough develops after starting on this

A

ACE inhibitor

61
Q

stress:
stimulates-
actions of the body-
causing-
increasing-

A

sympathetic nervous system

heart rate increases
cardiac contractility increases
vasoconstriction increases

increases peripheral vascular resistance
increases cardiac output

bp

62
Q

renin released by kidneys:
stimulates-
actions of the body-
causing-
increasing-

A

angiotensinogen-angiotensin I- angiotnesin II

arteriole constriction
aldosterone secretion

increasing peripheral resistance
retention of sodium and water
increasing blood volume

bp

63
Q

hypertension:
older adult considerations

A

-stiffening of arteries
-baroreceptors become less sensitive
-lack of elasticity of the vessels and decrease sensitivity = risk for orthostatic hypotension

64
Q

arteriosclerosis:
definition
etiology

A

d:
hardening of the arteries, causing blood flow to slow

e:
-thickening of the artery walls that progresses to hardening as calcium deposits form
-DM speed development
-hypertension is a major factor
-occurs with aging

65
Q

atherosclerosis:
definition
etiology

A

d:
artery narrowing due to lipids

e:
-lipids are deposited within the vessel walls and -combine with cells, fibrin, and cell debris to form plaques
-DM speed development

66
Q

where is atheromatous plaque with thrombi primarily formed

A

larger arteries: aorta, femoral, carotid, and coronary arteries

67
Q

s/s of embolus or thrombus occlusion: 6 p’s

A

pain
pulselessness
poikilothermia
pallor
paresthesias
paralysis

68
Q

arterial embolus commonly caused by

A

thrombus formed in the heart by atrial fibrillation

69
Q

treatment of PAD
goal

A

g: increase blood flow through peripheral arteries and decreasing risk of clot formation

reg exercise
stop smoking
antiplatelet agent and platelet inhibitors
percutaneous transluminal angioplasty
femoropopliteal bypass
aspirin and clopidogrel (plavix)

70
Q

aneurysm:
etiology
pathophysiology

A

e:
outpouching of the wall of an artery resulting from a structural defect in the layers of the arterial wall

p:
-can occur along any artery
-once developed, it continues to grow larger and may rupture
-usually result of plaque formation, genetic predisposition, or hypertension
-occur in areas weakened by trauma or surgical procedures

71
Q

aneurysm:
s/s
treatment

A

s:
-no obvious symptoms
-abdominal aortic aneurysm may report back pain or a feeling of pressure and may have a visible pulsation of the abdomen
-aortic aneurysm in the thoracic area may cause substernal or tracheal pressure and difficulty with breathing

t:
surgery
focus- lower bp and treat the pain

72
Q

carotid artery disease:
s/s
treatment

A

s:
-carotid bruit, confusion, transient vision loss, fainting, extremity weakness

t:
-carotid endarterectomy or carotid artery angioplasty

73
Q

major nursing care goals for pt’s with PAD

A

-maintaining arterial blood flow to the lower extremities
-protecting tissues from further injury from pressure and constriction of blood flow
-preventing wound infections

74
Q

thromboangiitis obliterans Buerger disease:
etiology and pathophysiology
s/s
diagnosis
treatment
nursing management

A

e and p:
-a primary condition not caused by atherosclerosis but involves inflammation and thickening of small and medium-sized arteries
-condition may be primary disorders or caused by other diseases

s:
-occlusion of the hands and feet usually noted first
-numbness and tingling of the toes or fingers in cold weather
-pain in the feet, and intermittent claudication that progressively becomes more severe, pain is intense
-ulcerations and gangrene may occur

d:
made through pt history, symptoms, and angiography

t:
cessation of smoking
exercise

n:
-pt teaching and reinforcement of the need to stop smoking
-assessment of the extremities for skin impairment is essential
-pain management is needed due to the ischemic pain

75
Q

Raynaud disease and Raynaud phenomenon
etiology and pathophysiology
s/s
diagnosis and treatment
nursing management

A

e and p:
-characterized by spasms of the arteries of the upper and lower extremities
-can be a primary disorder or may occur secondary to another disease (lupus, RA, scleroderma)
-phenomenon occurs on only one side of the body

s/s:
-affected body part changes color
-when spasm stops, typically there is burning pain and throbbing

d and t:
-evaluation of pt symptoms
-labs: antinuclear antibody (ANA) to determine the presence of autoimmune disorders
-stress control, avoidance of exposure to cold, and smoking cessation
-calcium channel blockers
-synthetic prostaglandin iloprost (Ventavis)

n:
-teach pt to protect extremities and prevent injury
-teach pt to avoid cold temps when possible, manage stress and stop smoking
-caffeine intake should be limited

76
Q

superficial thrombophlebitis
causes
s/s
treatment

A

c:
-vessel trauma, venous stasis (or turbulence), and abnormal coagulability
-in pt’s receiving IV therapy may caused by chemical or mechanical irritation of the vessel (if not identified and treated, bacteremia may occur, resulting in septic thrombolitis)

s:
-redness and tenderness along the course of the vein accompanied by swelling
- labs: for hypercoagulability and to check inflammation status, WBC will help id infection
-ultrasound demonstrating thickened, inflamed, and noncompressable veins confirms diagnosis

t:
depends on severity (IV: remove and change locations, severe IV: elevate and add heat)
primarily symptomatic
analgesics
elastic support hose

77
Q

deep vein thrombosis:
etiology and pathophysiology
s/s
treatment

A

e:
-prolonged surgeries, orthopedic surgeries, spinal cord damage and paralysis, and chronic failure all contribute to venous stasis
-immobility with the legs dependent in car or airplane travel for extended periods also promotes venous stasis
-trauma or external pressure or internal pressure from hypertension may damage the endothelium
-smoking, female hormone replacement, estrogen-based contraceptives, corticosteroids, and various blood disorders are contributing factors to blood hypercoagulability
-DM, lung disease, blood disorders, PVD, sepsis, or cancer

s:
pain, swelling, redness, edema

t:
-IV heparin
-low-molecular-weight heparin (LMWH), like enoxaparin (Lovenox)
-oral anticoagulation
-thrombolytic therapy
-compression stockings
-vena cava filter

78
Q

s/s of pulmonary embolism in pt’s with known DVT

how to know if treatment is working

A

dyspnea
hemoptysis (bloody sputum)
tachypnea
tachycardia
chest pain
decreased O2 stat
a feeling of impending doom
cyanosis
possibly coughing and altered mental status

t:
decreased swelling, redness, and pain

79
Q

when is thrombolytic therapy used

A

used to dissolve thrombus if vessel obstruction is severe

80
Q

pt’s at risk for DVT:
each shift assesses for s/s including

A

-observation of the extremity for asymmetric size
-areas of warmth and redness over a vein
-calf pain/tenderness
-pitting edema of the affected extremity
-measurement of calf circumference
-body temp >100.4
-pulse of affected extremity

81
Q

varicose veins:
what is it
etiology and pathophysiology
s/s
treatment

A

w:
enlarged and tortuous veins that are distorted in shape by accumulations of pooled blood

e and p:
absence of or damage to the valves in the veins

s:
chronically swollen legs; thick, brownish skin around the ankles; and itchy, scaly skin

t:
knee-high elastic support stockings and elevation of the legs whenever possible

82
Q

venous stasis ulcer:
who is most at risk for this
treatment

A

w:
diabetic pt’s with venous insufficiency due to compromised circulation in extremities and a slow rate of healing
t:
-leg elevation, a moist dressing, and compression
-dressing to be used depends on the condition of the ulcer and the amount of exudate produced

83
Q

noncompliance with medical regimen for hypertension can result in

A

MI

84
Q

what is the most common cause of PVD

A

athrosclorosis

85
Q

the best treatment for arterial insufficiency is

A

exercise

86
Q

hypertension and this are long-term factors in the development of aneurysm

A

athrosclorosis

87
Q

pt’s bp is 200/100 and is having symptoms of blurred vision and seizures and change in LOC, diagnosis is

A

hypertensive crisis

88
Q

the etiology of Raynaud’s disease is an exaggerated response to _ and _

A

cold, and stress

89
Q

treatment of carotid stenosis includes

A

stints

90
Q

thrombophlebitis is the development of a _ and _ of a vein

A

inflammation and thrombus

91
Q

treatment of varicose veins are _, _ and _

A

exercise, elevation and support hose

92
Q

pt with PAD has been scheduled for this procedure

A

femoral bypass

93
Q

which diagnostic test provides the most detailed information regarding heart function

A

cardiac catheterization

94
Q

when preparing pt for cardiac catheterization assess:

A

assess renal function
assess allergy status, especially related to iodine

95
Q

which effect on bp occurs when peripheral vascular resistance rises

A

increases

96
Q

blood pressure determined by _ x _

A

cardiac output x peripheral vascular resistance

97
Q

systolic bp of _ to _ classified as stage 1 hypertension

A

140 - 159

98
Q

systolic bp of _ to _ classified as prehypertensive

A

130-139

99
Q

systolic bp of >_ classified as stage 2 hypertension

A

160

100
Q

which prescribed antihypertensive med would prompt the nurse to monitor serum glucose levels for a pt who is diabetic

A

Atenolol - beta blocker

101
Q

target reading for controlling bp

A

120/80

102
Q

what symptoms might a hypotensive pt who is taking antihypertensive meds exhibit

A

dizziness
restlessness

103
Q

what is the drug for hypertensive emergency

A

sodium nitroprusside

104
Q

smoking is directly linked to what disease progression

A

Buerger disease
thromoangiitis obliterans

105
Q

medication classes used to control hypertension

A

loop diuretic
calcium channel blocker
direct-acting vasodilator
angiotensin-converting enzyme inhibitor

106
Q

calcium channel blockers are like _ for your heart

A

valium

107
Q

negative inotropic, chronotropic, dromotropic
like _ for your heart; what do they do to the heart; called what

A

valium; they calm the heart down; cardiac depressants

108
Q

positive inotropic, chronotropic, dromotropic do what for the heart; called what

A

speed up the heart; cardiac stimulant

109
Q

what do the negatives treat?
A AA AAA

side effects:
H & H

A

Antihypertensives: relax the heart and decreases bp

AntiAnginal drugs: relaxes heart, using less O2, decreases O2 demand

AntiAtrialArrythmia: treats atrial flutter, atrial difibliration, supraventricular tachycardia

Headache: vasodilation in the brain
Hypotension: lowers too much

110
Q

names of calcium channel blockers:
anything ending in -depine (dip-ine in the calcium channel blockers) & verapamil and cardizem-
which is continuous IV drip; hold if systolic is under _

A

Cardizem; 100

111
Q

medication prescribed to correct multiple premature ventricular contractions (PVCs)

A

lidocaine is used to treat atrial and ventricular dysrhythmias by slowing the sodium channel. prolonging the time of depolarization and increasing the refractory period

112
Q

which alteration in cardiac rhythm is the most serious type of arrhythmia

A

ventricular fibrillation;
-medical emergency that will result in death if left untreated
-ventricles are quivering with disorganized electrical and mechanical activity

113
Q

use of what is related to the development of HF

A

toxins: cocaine, excessive alcohol, certain chemo drugs, NSAIDs, and thiazolidinediones used for DM

infection
anemia
myocarditis
dilation from blood backup behind diseased valves
damage from MI

114
Q

cardiomyopathy

A

poor prognosis; disease of the heart muscle

115
Q

a short-term treatment of heart failure that allows the heart to rest after a MI or open-heart surgery

A

intra-aortic balloon pump

116
Q

digitalis toxicity s/s

A

yellow-green halos around lights
nausea
diarrhea
confusion

117
Q

v fib results in:

A

no cardiac output
requires cpr and defibrillation to correct

118
Q

tests to rule out MI

A

troponin I
ECG
CPK
CK_MB
Myoglobin

119
Q

if ischemia is prolonged and not quickly reversed, acute coronary syndrome (ACS) occurs, what does ACS include:

A

-unstable angina
-non-ST-elevation myocardial infarction (NSTEMI)
-ST-elevation myocardial infarction (STEMI)

120
Q

what is the drug of choice for pt with acute myocardial infarction

A

morphine

121
Q

temporary pacemaker maybe used to treat what

A

cardiac dysrhythmia, persistent bradycardia

122
Q

sign indicates pt who is recovering from MI may be developing pericarditis

A

friction rub on auscultation and chest pain that worsens with movement

123
Q

temporary pacemaker may be inserted to treat which cardiac dysrhythmia for a pt who has experienced a myocardial infarction

A

persistent bradycardia

124
Q

ACE inhibitors (-prils) prevent:

A

vasoconstriction

125
Q

loops (furosemide, bumetanide) remove:

A

excess fluid, waste k+

126
Q

potassium sparing:

A

triamterene, amiloride

127
Q

thiazides (hydrochlorothiazide metolasone) remove:

A

excess fluid, waste k+

128
Q

angiotensin-receptor blockers (losartan, valsartan, irbesartan) produce and remove:

A

produce vasodilation, excrete salt and water

129
Q

beta-blockers function

A

reduce bp, slow heart rate

130
Q

calcium channel blockers function

A

vasodilation, reduce hr

131
Q

digitalis increases:

A

cardiac contractility

Med- Surg (8 decks)

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