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Nursing Acutely Ill > Acute Coronary Syndrome / Circulatory system general > Flashcards

Acute Coronary Syndrome / Circulatory system general Flashcards

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1
Q

What is a pulse

A

Expansion and recoil of artery walls in response to the pressure of the blood travelling round the circulatory system, that occurs following each contraction of the left ventricle.

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2
Q

Normal heart rate value. Female and male HR values.

A

60-100bpm. Females 72-80bpm > males 64-72bpm.

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3
Q

Definition of tachycardia

A

High/fast HR of >100bpm

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4
Q

Definition of bradycardia

A

Low/slow HR of <60bpm.

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5
Q

pH value for acidaemia

A

<7.35

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6
Q

Causes of academia

A

Overproduction of metabolic acids in diabetic ketoacidosis
Carbon dioxide retention leading to respiratory acidosis
Retention of metabolic acids due to AKI

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7
Q

pH value for alkalosis

A

> 7.45

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8
Q

Causes of bradycardia

A 
Increased vagal activity
Athletic heart 
Cardiac conduction defects 
Raised ICP 
Drugs eg beta blockers, calcium channel blockers
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9
Q

General causes of tachycardia

A 
Exercise
Pain/ anxiety
Pyrexia 
Cardiac arrhythmias 
Compensation for low BP due to hypovalaemia, MI, left ventricular failure 
Chonotropic drugs
Inotropic drugs
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10
Q

Normotensive BP definition

A

BP within normal range 60-100/40-90mmHg

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11
Q

Hypotension definition

A

BP <100mmHg

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12
Q

General causes of hypotension

A 
Myocardial disfunction 
Low ICP 
Antihypertensive medication 
Heart failure 
Acute coronary syndrome 
Physiological shock 
Haemorrhage
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13
Q

Hypertension (sys value)

A

Sustained, elevated arterial systolic BP of >140mmHg

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14
Q

Ways to assess organ perfusion

A 
Urine output- kidney perfusion 
Stool output- small and large bowel perfusion 
Level of consciousness- brain perfusion
Chest pain- heart perfusion 
Nausea- stomach and intestine perfusion
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15
Q

Examples of central pulses

A

Carotid artery

Femoral artery

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16
Q

Examples of peripheral pulses

A 
Radial artery (wrist)
Brachial artery (elbow)
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17
Q

Definition and function of blood pressure

A

Pressure exerted by the blood against the inner walls of the vessels containing it. Responsible for maintaining blood circulation between heartbeats.

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18
Q

Cause/equation for blood pressure

A

BP=COxSVR

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19
Q

Definition of systolic blood pressure

A

Pressure in the arteries when the left ventricle is fully contracted.

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20
Q

What 3 things determine/are reflected into systolic BP?

A

Force of ventricular contraction.
Degree of systemic vascular resistance.
Compliance of the arteries.

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21
Q

Definition of diastolic blood pressure

A

Pressure exerted on the arteries when the left ventricle is relaxed in diastole.

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22
Q

What 3 things determine/are reflected in diastolic BP?

A

Velocity of the run off blood from the aorta.
Elasticity of arterial walls.
Degree of vasoconstriction.

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23
Q

Definition of pulse pressure and normal value

A

Difference between the systolic and diastolic pressures usually 35-45mmHg

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24
Q

Narrowing of pulse pressure is an indication of…

A

Reduced CO which may be covered by compensatory mechanisms such as vasoconstriction to increase SVR.

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25
Q

Primary hypertension definition

A

Underlying cause if hypertension, often lifestyle factors, such as obesity, physical inactivity, high salt intake, stress or hereditary

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26
Q

Secondary hypertension definition

A

Acute anatomical or physiological conditions such as raised ICP, adrenal/renal/aortic disease

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27
Q

Mean arterial blood pressure calculation

A

1/3 systolic BP + 2/3 diastolic BP

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28
Q

Cholesterol normal values

A

3.0-5.0mmol/L

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29
Q

Common abnormalities prior to cardiac arrest

A 
Hypoxaemia 
Increased RR 
Hypotension 
Hypoperfusion
Metabolic acidosis 
Metabolic acidosis 
Tissue hypoxia
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30
Q

In a hypokalaemic pt which method and how fast would you replace potassium?

A

IV potassium over 2hrs, when <2.5mEq/L, reassessment, continuous ECG monitoring and repeat serum potassium levels

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31
Q

In acidosis pt would bicarbonate stores be high or low? And why?

A

Low after stores used up to compensate for low pH

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32
Q

What is a hypertensive crisis?

A

Increased, sudden surge in diastolic BP

BP of 180/120

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33
Q

What is the treatment for hypertensive crisis?

A

Prescription and administration of calcium channel blockers, beta blockers, ACE inhibitors

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34
Q

What is agonal breathing and when does it occur?

A

Agonal breathing occurs following an miocardial infarction (MI) where the pt appears to be breathing but gaseous exchange isn’t actually occurring.

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35
Q

Definition of CO

A

Volume of blood ejected from the left ventricle per minute

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36
Q

What is the equation for cardiac output (CO)/what two factors directly influence CO?

A

CO= HRx SV

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37
Q

What is the normal volume for CO?

A

4-8L/min

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38
Q

What is the average volume for CO at rest?

A

5.25L (75bpmx70ml)

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39
Q

Which nervous system (ANS/CNS) controls HR?

A

Autonomic

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40
Q

What stimulates the sympathetic nervous system in terms of circulation?

A

Fall in BP, HR, CO, SV

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41
Q

What effect does sympathetic nervous stimulation have on HR?

A

Increased HR, atrioventricular conduction and myocardial contractility.

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42
Q

What causes stimulation of the parasympathetic nervous system in terms of circulation?

A

Increase in HR, BP, CO, SV

43
Q

What effect does parasympathetic nervous stimulation have on HR?

A

Decreased HR and atrioventricular conduction with NO effect on myocardial contractility.

44
Q

What 4 factors effect stroke volume?

A

Preload
Afterload
Contractility
Distensibility

45
Q

What is the definition of preload?

A

Volume of blood in the ventricle following diastole

46
Q

What is the definition of afterload?

A

Resistance against which the ventricle must eject blood volume = BP

47
Q

What is the definition of contractility?

A

Myocardial contractile strength which enables complete ventricular emptying

48
Q

What is the definition of distensibility?

A

Myocardial relaxation which enables complete ventricular filling

49
Q

What 6 things determine BP?

A 
Cardiac output. 
Circulating blood volume. 
Systemic vascular resistance. 
Venous return. 
Elasticity of arterial walls. 
Viscosity of the blood.
50
Q

What are the two most important mechanisms controlling blood volume?

A

Fluid intake and urine output.

53
Q

In response to decrease in BP, what do impulses sent from the cardiac vasomotor centre to the sympathetic nervous system stimulate do to compensate?
(Which chemical, which receptor, locations of receptor, effect of chemical release from each location)

A

Noradrenaline.
Released from beta 1 receptors.
Located in the sinus node, atrioventricular node, myocardium and atrial walls.
Sinus node- increase in HR.
AV node- increase impulse conduction from atria to ventricles.
Myocardium- increase force of contractions.
Atrial walls- vasoconstriction, increasing systemic vascular resistance and thus BP.

54
Q

What are catecholamines? Where are they released from? What are some examples? Why are they released?

A

Hormones produced by the adrenal glands located above the kidney.
Such as dopamine, adrenaline, nor adrenaline.
Released in times of physical or emotional stress.

55
Q

What do catecholamines stimulate in the liver? And what does this result in?

A

The conversion of glycogen to glucose resulting in hyperglycaemia.

56
Q

Where in the brain are osmoreceptors located?

A

Hypothalamus

57
Q

Due to compensatory mechanisms, how many mls of blood loss can occur whilst a normal BP is maintained?

A

1500mls

58
Q

What percentage of blood volume is lost at the point that progressive shock begins?

A

30-40%

59
Q

What is the name for the receptors that detect decrease in BP? And where are they located?

A

Baroreceptors in the aortic arch and carotid sinus detect a decrease in BP.

60
Q

Where is the cardiac vasomotor centre located in the brain? What is it responsible for?

A

Located in the medulla oblongata.

Responsible for accelerating/inhibiting heart beat.

61
Q

What does CVP reflect?

A

The pressure of the blood within the right atrium of the heart. Usually reflects the venous return/ preload.

62
Q

Which enzyme is looked for in blood tests to indicate a MI?

A

Troponin.

63
Q

What is the average volume of circulating blood?

A

5 L

64
Q

What do altered levels of calcium, sodium, potassium and magnesium effect the contraction of?

A

Myocardium and smooth muscle.

65
Q

Elevated potassium levels is known as?

A

Hyperkalaemia

66
Q

What do elevated potassium levels or low calcium levels result in?

A

Cardiac dysarrhythmias.

67
Q

Where is the bicuspid/mitrial valve located?

A

Between the left atrium and ventricle

68
Q

Where is the tricuspid valve located?

A

Between the right atrium and ventricle

69
Q

What are the 3 cardiac disorders that fall under the classification of ACS/CHD?

A

Stable angina
Unstable angina
Myocardial infarction

70
Q

What are the 6 types of cardiac disorder?

A 
ACS
Valve disease
Electrical disorders 
Cardiomyopathy
Coronary heart disease  
Heart failure
71
Q

What are the two types of heart failure?

A

Left ventricular failure

Congestive cardiac failure

72
Q

What are the 7 stages of angina?

A 
Atherosclerotic narrowing 
Plaque rupture 
Platelet aggregation aka white clot 
Partial occlusion 
Restriction of blood and O2 supply 
Ischaemic myocardium 
Pain on exertion continuing into rest
73
Q

What is angina also known as? (general term)

A

Ischaemia

74
Q

In terms of pain, what is a symptom indicative of angina?

A

Pain on exertion and rest

75
Q

What are the 8 stages of MI?

A 
Atherosclerotic narrowing 
Plaque rupture 
Platelet aggregation 
Thrombus formation aka red clot 
Total occlusion 
Ischaemic myocardium 
Injured myocardium 
Infarcted myocardium
76
Q

What are the differences in the mechanism of damage between MI and angina?

A

MI results in infarcted myocardium; angina ischaemic myocardium
MI results in thrombus formation (red clot); angina results in platelet aggregation (white clot)
MI results in total occlusion; angina results in partial occlusion

77
Q

What do both angina and MI start from?

A

An atherosclerotic narrowing and plaque rupture

78
Q

What are 8 modifiable risk factors for CHD?

A 
Smoking 
High lipid profile (high LDL, low HDL) 
Physical activity 
Obesity 
Hypertension 
Stress
Diabetes mellitus 
Insulin resistance/ metabolic syndrome
79
Q

What are 4 examples of non-modifiable risk factors for CHD?

A

Age
Male in gender
Ethnicity
Genetic

80
Q

What is the definition of acute coronary syndrome?

A

All conditions caused by sudden impairment of blood flow in a coronary artery leading to ischaemia/infarction of myocardium

81
Q

What are the 3 ACSs that can result from stable angina?

A

Unstable angina
Non ST elevation MI (NSTEMI)
ST elevation MI (STEMI)

82
Q

3 criteria indicating stable angina? (pain, ECG, troponin)

A

Pain on exertion
?ECG changes on exercise tolerance test
-ve troponin

83
Q

3 criteria indicating unstable angina? (pain, ECG, troponin)

A

Pain on rest
?ECG changes
-ve troponin

84
Q

3 criteria indicating NSTEMI? (pain, ECG, troponin)

A

?Pain
ECG changes
+ve troponin

85
Q

3 criteria indicating STEMI? (pain, ECG, troponin)

A

?Pain
ECG changes
+troponin

86
Q

What are 8 associated symptoms of ACS?

A 
Breathless ?rest/exertion
Nausea/vomiting 
Sweating, pale, cold, clammy 
Restless 
Palpitations 
Syncope 
Oedema 
Cyanosis
87
Q

What is the assessment tool used to assess chest pain in ACS?

A

SOCRATES

88
Q

What does SOCRATES stand for?

A 
Site 
Onset 
Character 
Radiation 
Associated symptoms 
Time 
Exacerbation 
Severity
89
Q

What are the letters of the ECG wave complex

A

PQRST

90
Q

What is the chemical marker for ACS?

A

Troponin

91
Q

What is the main interventions for ACS?

A 
Asprin- anti-platelet 
Nitrate- vasodilator
Opiate- pain relief 
IV antiemetic 
Bed rest 
High flow O2 therapy 
Reassurance
92
Q

What is the surgical intervention for STEMI?

A

Primary Coronary Intervention

93
Q

When should troponin blood tests be taken?

A

At 2 hrs and 12 hrs post ACS.

94
Q

What does +ve troponin indicate?

A

NSTEMI

95
Q

What does -ve troponin indicate?

A

?unstable angina

PMHX

96
Q

What is the indicator of a diagnosis of stable angina?

What action should be taken?

A

Troponin T of <0.1.

Discharge or conduct exercise tolerance test

97
Q

What is an indicator of unstable angina?

A

Troponin T <0.1

98
Q

What is an indicator of NSTEMI?

A

Troponin T>1.5

99
Q

What is an indicator of STEMI?

A

Troponin T>1.5

100
Q

What is involved in the preparation for PCI?

A 
Antiplatelet 
Subcutaneous low molecular weight heparin 
NBM 
Shave groin
Name bands, informed consent
101
Q

What is primary coronary intervention?

A

Angioplasty followed by advancement of a arterial catheter to site of block to insert a stent

102
Q

Following primary coronary intervention what is involved in nursing care?

A 
Bed rest 
Nurse at 45 degree angle 
12 ECG with pain 
Interarterial BP 
4hrly obs
Fluid balance chart
103
Q

What is the nursing care following primary coronary intervention using radial approach?

A

Remove T band at 2 hrs

Check pulse, BP, pedal pulse and puncture site every 30 minutes for 4 hours

104
Q

What is the nursing care following primary coronary intervention using femoral approach?

A

At 4 hours remove arterial sheath
Nurse flat
Check pulse, BP, pedal pulse every 30 mins for 4 hours or until stable

105
Q

What are the possible ongoing complications of ACS?

A 
On going chest pain 
Arrythmias 
Conduction defects 
Cardiac failure 
Bleeding 
Hospital acquired infection 
Urinary retention

Nursing Acutely Ill (11 decks)

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