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Med surg 2 > Blood Pressure Alterations and Cardiac Alterations > Flashcards

Blood Pressure Alterations and Cardiac Alterations Flashcards

1
Q

what ejects blood out of the heart

A

the muscles

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2
Q

what do the muscles in the heart respond to

A

electrical conduction

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3
Q

if the heart muscles didn’t listen to the electrical conduction what would happen

A

death

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4
Q

what do the valves of the heart do

A

open/close to keep blood flowing forward

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5
Q

what is preload

A

The stretch of the ventricles - volume of blood/pressure in the chamber

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6
Q

what is afterload

A

the slingshot- what the heart is having to pump against

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7
Q

what is another name for what the heart is having to pump against

A

systemic vascular resistance

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8
Q

How much blood/pressure is needed to go through the right atrium into the right ventricle for preload and why

A

0-5mmhg because it only has to fill up enough to get to the lungs

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9
Q

how much blood/pressure is needed to go through the left atrium into the left ventricle for preload and why

A

6-12mmhg because it has to fill up enough to go to the entire body

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10
Q

what is systolic blood pressure

A

the top number - maximum pressure the heart exerts while contracting

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11
Q

what is the goal for systolic blood pressure

A

90-120

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12
Q

what is diastolic blood pressure

A

the bottom number - residual pressure in the arteries

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13
Q

what is the goal for diastolic blood pressure

A

60-80

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14
Q

what is the mean arterial pressure

A

average pressure in the arterial system

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15
Q

what is the mean arterial pressure goal

A

60-90

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16
Q

what is cardiac output

A

amount of blood ejected from the heart in liters/min

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17
Q

what is cardiac output goal

A

4-6L/min

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18
Q

what is the equation for cardiac output

A

HR x Stroke volume

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19
Q

what is stroke volume

A

volume of blood pumped out of the left ventricle of the heart during each contraction.

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20
Q

what is normal blood pressure

A

below 120 / below 80

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21
Q

what is an elevated blood pressure

A

130-139 / over 80

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22
Q

what is high blood pressure stage 1

A

130-139 / 80-89

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23
Q

what is high blood pressure stage 2

A

140 or higher/ 90 or higher

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24
Q

what should someone do immediately if they are having an hypertensive crisis

A

call the doctor

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25
Q

what is the hypertensive crisis range generally

A

higher then 180 / higher then 120

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26
Q

what is a hypertensive crisis for people over 60

A

150/90

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27
Q

what is a hypertensive crisis for people younger then 60

A

below 140/90

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28
Q

according to the joint national committee people who dont reach the goals should be treated with….

A

drugs

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29
Q

what does hypertension do to the body and arteries

A

damage to organs, thickening of the arteries

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30
Q

what is orthostatic hypotension

A

sitting to standing decrease of 20 of systolic or increase in HR by 20 bpm

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31
Q

what is essential hypertension caused by

A

no specific cause for most cases

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32
Q

what is secondary hypertension cause by

A

a cause that can be identified and treated

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33
Q

what is another name for malignant hypertension

A

hypertension crisis

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34
Q

what is malignant hypertension (hypertension crisis )

A

severe hypertension that rapidly progresses

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35
Q

what is malignant hypertension (hypertension crisis ) range

A

over 180/120

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36
Q

what is a hypertension urgency

A

over hours or days may be managed outpatient

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37
Q

what is a hypertensive emergency

A

hypertensive urgency + target organ damage and requires hospitalization

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38
Q

what could hypertensive emergency cause

A

head bleed, heart failure, heart attack, renal failure, dissecting aneurysm

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39
Q

what are some common risk factors for essential hypertension

A

obesity, smoking, stress, family history

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40
Q

what are some common risk factors for secondary hypertension

A

renal disease, primary aldosterone (retaining fluid so high sodium and low K), pheochromocytoma (tumor on adrenal medulla causing excretion of epinephrine and norepinephrine leading to h, Cushing’s syndrome (high cortisol levels=retain fluid), medications

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41
Q

what do they call the silent killer

A

hypertension

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42
Q

what are the common ss of hypertension

A

fatigue, dizziness, palpitations, angina, dyspnea

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43
Q

what are the ss of malignant hypertension (hypertension crisis )

A

headaches and nose bleeds

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44
Q

when measuring someones blood pressure what should they not do prior

A

caffeine, smoke, exercise for at least 30 minute prior

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45
Q

what labs would you take to diagnosis hypertension

A

BMP, lipid panel, TSH, ECG, home monitoring

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46
Q

what are some lifestyle modifications someone can make for hypertension

A

lose weight, change diet (DASH - less red meats, salt =, and sweets and low sodium), decrease ETOH (alcohol), dont smoke, reduce stress, excersise

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47
Q

how much sodium should someone with hypertension consume

A

2300mg/day

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48
Q

how much alcohol should someone with hypertension consume

A

1-2 drinks/day

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49
Q

what are some 1st line drug therapies for hypertension

A

ACE-1, ARBs, CCB, Diruretics

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50
Q

can you take ACE-1 and ARBs together

A

NO

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51
Q

what doe ACE-1 end in

A

pril

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52
Q

what do ARBs end in

A

sartan

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53
Q

what are some calcium channel blockers

A

end in dipine or diltiazem, verapamil

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54
Q

what is a common side effect of calcium channel blockers

A

peripheral edema

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55
Q

who should avoid taking calcium channel blockers

A

CHF

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56
Q

what should you avoid with when taking calcium channel blockers

A

grape fruit juice

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57
Q

what are some common side effects of ACE

A

dry cough (lisinopril), hyperkalemia, decreased HR

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58
Q

what are some 2nd line medications for hypertension

A

beta-blockers, potassium-sparing diuretics, direct vasodilators, adrenergic inhibiting agents

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59
Q

what do beta blockers end in

A

lol

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60
Q

what are some cardio-selective beta blockers

A

bisoprolol, metoprolol, esmolol

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61
Q

what are some non-cardio selective beta blockers and where does it work on

A

propranolol -lungs

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62
Q

since propanolol is working on the lungs who should not take it

A

COPD/asthma

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63
Q

what are some side effects of beta blockers

A

mask hypoglycemia increased HR

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64
Q

what is a common side effect for non-cardio selective beta blockers

A

bronchospasm

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65
Q

what should you avoid when taking hypertensive meds and why

A

NSAIDs because it may cause renal damage and retains fluid

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66
Q

how many drugs does someone with hypertension normally take

A

2 drugs for 2 different classes - titrate 1st one to correct dose before adding the other one

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67
Q

what are some mixed cardioselectvity beta blockers

A

carvedilol and labetalol

68
Q

what are some potassium sparing diuretics

A

spironolactone and eplernone

69
Q

what are some direct vasodilators

A

hydralazine, nitroglycerin, sodium nitroprusside

70
Q

what is a adrenergic inhibiting agent medication

A

clonidine - last resort

71
Q

what are some risk factors for malignant hypertension (hypertension crisis )

A

non-compliant, head injury, pheochromocytoma, illegal drugs, preeclampsia

72
Q

what is the goal for malignant hypertension (hypertension crisis ) – MAP and DBP

A

decrease in MAP by 20% or diastolic bp 110-115 with IV antihypertensives in the first 2-6 hours

73
Q

what are some vasodilators used for malignant hypertension (hypertension crisis )

A

sodium nitroprusside, nicradipine, labetalol, and esmolol

74
Q

what are the interventions for malignant hypertension (hypertension crisis )

A

monitor BP and HR every 5-15 minutes, UOP hourly, bedrest semi fowlers, O2, neuro status

75
Q

what can happen to the heart because of hypertension

A

coronary artery disease, left ventricular hypertrophy, and heart failure

76
Q

what can happen to the brain because of hypertension

A

stroke and elevated intracranial pressure

77
Q

what can happen to the peripheral vascular because of hypertension

A

claudication, aortic aneurism, aortic distension

78
Q

what can happen to the kidneys because of hypertension

A

chronic kidney disease,

79
Q

what are the values for chronic kidney disease cause by hypertension

A

Creatine over 1.5 and proteinuria

80
Q

what can happen to the eyes because of hypertension

A

retinal damage - retinal hemorrhage, blurry vision, and loss of vision

81
Q

what is the p wave on an ECG

A

the SA (sinoatrial) node

82
Q

what is the SA node

A

electrical impulses 60-100 beats/min

83
Q

what is the PR segment on an ECG

A

the av (atrioventricular) node

84
Q

what is the AV node

A

contraction know as the atrial kick - pushing blood into the ventricles

85
Q

what is happening for the QRS on ECG

A

when the heart pushes the blood from the ventricles up to the aorta or pulmonary

86
Q

what is the T wave on an ECG

A

the recovering of the ventricles

87
Q

what determines heart rate

A

beats/min

88
Q

how do you measure PR interval

A

how long for energy to travel through atrium to make it contract

89
Q

what is included in the autonomic nervous system

A

parasympathetic (decrease) and sympathetic (increase)

90
Q

what is the normal pacemaker of the heart

A

SA node 60-100 bpm

91
Q

what are the secondary pacemakers of the heart

A

AV node (40-60bpm)
his-purkinje fibers (20-40bpm)

92
Q

what is sinus bradycardia

A

SA node is firing at less then 60bpm

93
Q

what is sinus tachycardia

A

SA node is firing faster because of vagal inhibition or sympathetic stimulation

94
Q

what could be come causes for sinus bradycardia

A

normal in athletes, hypothermia, vagal stimulation, beta clockers, and calcium channel blockers, HYPOthyroidsm, increased intracranial pressure myocardial infarction

95
Q

what could be some causes for sinus tachycardia

A

stressors (exercise, pain, low BP or fluid, heart failure, HYPERthyroidsm ), drugs (norepinephrine, epinephrine, caffeine, theo-durr, hydralazine OTC cold remedies

96
Q

what could be some ss of bradycardia

A

hypotension, pale, cool skin, weakness, angina, dizziness, confusion, SOB

97
Q

what could be some ss of tachycardia

A

dizziness, dyspnea, hypotension, angina with patients with CAD

98
Q

what drug could be used for sinus bradycardia

A

Atropine (1mg every 3-5 minutes for a total dose of 3mg)

99
Q

what are some other interventions besides medications that could be used for sinus bradycardia

A

pacemaker (temporary or permanent ), stop offending drugs

100
Q

what is tachycardia treatment guided by

A

by cause do decrease fever pain stress

101
Q

what are some other interventions for tachycardia

A

vagal maneuver (bear down)

102
Q

what are some medications that can decrease HR in sinus tachycardia

A

beta blockers and calcium channel blockers

103
Q

what is paroxysmal supra-ventricular tachycardia

A

abrupt onset and ending starting above the bundle of his where a reexcitation of the atria

104
Q

what is the HR normally for paroxysmal supra-ventricular tachycardia

A

150-220bpm

105
Q

who is at risk for paroxysmal supra-ventricular tachycardia

A

FEMALE (healthy young women)

106
Q

what could be some common causes for paroxysmal supra-ventricular tachycardia

A

overexertion, emotional stress, stimulants such as caffeine and tobacco

107
Q

what are the ss of paroxysmal supra-ventricular tachycardia

A

feeling unwell, weak, fatigue, heart racing,

108
Q

what are the ss for prolonged paroxysmal supra-ventricular tachycardia

A

hypotension, dyspnea, angina

109
Q

how would you diagnosis paroxysmal supra-ventricular tachycardia

A

12 lead ECG

110
Q

what are some vagal stimulants for paroxysmal supra-ventricular tachycardia

A

carotid massage, valsalva, coughing

111
Q

what is the 1st drug of choice for paroxysmal supra-ventricular tachycardia how dose dosing wrk

A

IV adenosine 6mg-12mg-12mg flush 20ml continous monitoring on ECG

112
Q

what are some common side effects of IV adenosine

A

flushing, dizziness, chest pain

113
Q

what are some other drugs you could use for IV adenosine

A

beta blockers, calcium channel blockers, amiodarone

114
Q

if someone is hemodynamically unstable and has IV adenosine what would the treatment be

A

dirrect current (DC) cardioversion

115
Q

what is atrial flutter

A

recurring, sawtooth-shaped flutter waves originates from a SINGLE ectopic focus in the atrium (atrial and ventricle rhythm is regualr)

116
Q

what is atrial fibrillation

A

disorganized of atrial activity caused by MULTIPLE ectopic focus = ineffective atrial contraction

117
Q

how does atrial fibrillation look on an ECG

A

no clear P waves, no atrial contractions, loss of atrial kick and irregular ventricle response

118
Q

if something is persistent how long is it lasting

A

more then 7 days

119
Q

atrial fibriliation usually develops _____ with…

A

acutely with thyrotoxicosis, alcohol intoxication, caffeine use, heart surgery, and electrolyte imbalances

120
Q

what is the most common dysrhythmia in the world

A

a fib

121
Q

why is there in an increase risk of stroke in atrial flutter and a fib

A

irregular cardiac rhythm, blood stasis

122
Q

how do you rate control for atrial flutter and a fib

A

calcium channel blockers, and beta blockers

123
Q

how do you rhythm control for atrial flutter and a fib

A

antidysrhythmic drugs,

124
Q

if complete AV node ablation occurs in atrial flutter and a fib they must be on a

A

anticoagulant

125
Q

what are some procudures done for a fib

A

maze procedure with cryoblation, left atrial appendage occlusion

126
Q

if someones on an anticoagulant what should you be checking

A

INR PT

127
Q

if someone is experiencing a fib or flutter for 48 hours how long are they going to take anticoagulants

A

3-4 weeks before cardioversion and then several weeks after that

128
Q

what procedure can be done to see if there are any clots in the atria

A

transesophogeal echocardiogram

129
Q

for long term anticoagulants what is the drug of choice

A

warfarin

130
Q

what is a 1st degree AV block

A

every impulse is conducted to the ventricles but the conduction is prolonged after it moves through the AV node it is normal again

131
Q

what are the risks for 1st degree AV block

A

cardiac drugs drugs or disease - if multiple cardiology consult

132
Q

what are the ss of 1st degree AV block

A

asymptomatic

133
Q

how do you diagnosis 1st degree AV block

A

ECG, TSH, BMP, consider causative factors

134
Q

what is the treatment for 1st degree AV block

A

monitor

135
Q

what is a 2nd degree AV block type 1

A

gradual lengthening of PR interval - because the prolonged AV conduction making atrial not conduct and QRS is blocked since the QRS is missing the another p will start

136
Q

what is 2nd degree AV block type 2

A

p wave is non conducted without progressive lengthening of PR interval but still missing QRS

137
Q

what drugs are used for 2nd degree AV block type 1

A

digoxin or beta blockers

138
Q

what is the treatment for symptomatic 2nd degree AV block type 1

A

atropine to increase HR and temp pacemaker especially is experienced MI

139
Q

what is the treatment for asymptomatic 2nd degree AV block type 1

A

monitor, transcutaneuous pacemaker on standby

140
Q

what are the ss of 2nd degree AV block type 2

A

decreased cardiac output, hypotension, myocardial ischemia

141
Q

what is the treatment for 2nd degree AV block type 2

A

transcutaneous pacing to permanent pacemaker

142
Q

can you use atropine for 2nd degree AV block type 2

A

not effective

143
Q

does type 1 or 2 2nd degree AV block usually progressive to 3rd degree

A

type 2

144
Q

what is a 3rd degree AV block

A

no impulses from atrium are conducted to the ventricles (2 no QRS)

145
Q

what is the treatment for 3rd degree AV block

A

pacemaker

146
Q

what is a temporary drug measure for 3rd degree AV block

A

epinephrine and norepinephrine to increase HR and supoprt BP

147
Q

what is a premature ventricular contraction

A

QRS is happening to soon

148
Q

what are the risks for premature ventricular contraction

A

stimulants (caffeine, alcohol, nicotine), electrolyte imbalances, hypoxia, fever, exercise, stress, cardiac disease

149
Q

what are the ss of premature ventricular contraction

A

not harmful with normal heart
heart disease: CO reduction, angina, HF

150
Q

how do you treat premature ventricular contraction

A

treat cause

151
Q

what is a complication of premature ventricular contraction

A

Ron T Phenonomenon QRS happening on T wave when the heart is recovering can cause ventricular tachycardia and ventricular fibrillation aka no pulse

152
Q

what is ventricular fibrillation

A

run of three or more PVCs can be stable (pulse) or unstable (no pulse)

153
Q

what is monomorphic ventricular fibrillation

A

has QRS that is same shape size and direction

154
Q

what is polymorphic ventricular fibrillation (torsades de pointes)

A

when QRS gradually change back and forth from one shape and size to another

155
Q

what is a ventricular fibrillation sustained and nonsustained

A

sustained loner then 30 seconds
non sustained less then 30 seconds

156
Q

what are the ss of ventricular fibrillation

A

hypotension, pulmonary edema, decreased cerebral blood flow, and cardiopulmonary arrest

157
Q

what is monomorphic ventricular fibrillation treated with

A

antidysrhythmias

158
Q

what is polymorphic ventricular fibrillation (torsades de pointes) treated with

A

beta blockers, aminodarone, procainamide, magnesium

159
Q

what is ventricular fibrillation

A

irregular wave forms of varying shape and sizes firing of multiple ectopic folci no pulse it is deadly so treat quick

160
Q

what should you do if someone has ventricular fibrillation

A

d fib them asap

161
Q

what is pulseless electrical activity

A

you can see electrical activity but no mechanical activity is evident aka no pulse

162
Q

what are some risk factors for pulseless electrical activity

A

hypovolemia, hypoxia, acidosis, hyper/hypokalemia, hypoglycemia, hypothermia, toxins, tamponade, thrombosis, tension pneumothorax, trauma

163
Q

what is the treatment for pulseless electrical activity

A

CPR intubation and epinephrine

164
Q

what is asystole

A

no electrical activity no contraction

165
Q

most sudden cardiac death result from what

A

ventricular dysrhythmias

Med surg 2 (12 decks)

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