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101a Vocab > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Stable Angina

A

predictable and consistent
pain with exertion
relieved by rest/Nitro/both

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2
Q

Unstable Angina

A

“preinfarction”

episodes increase in frequency and severity, happens for no reason, may not be relieved by rest and Nitro

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3
Q

Intractable/Refractory Angina

A

severe and incapacitating, nothing relieves it

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4
Q

Variant (Prinzmetal) Angina

A

pain at rest due to coronary artery vasospasm

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5
Q

Silent ischemia

A

objective EKG evidence of ischemia with no CP or other s/s

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6
Q

s/s may accompany angina

A

anxiety, dyspnea/SOB, dizziness, n/v

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7
Q

leads to collateral development

A

chronic ischemia, genetics

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8
Q

atypical s/s of myocardial ischemia in these groups

A

elderly (maybe only dyspnea and fatigue d/t decreased SNS response)
Women (get more GI s/s)
DM (neuropathy)

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9
Q

Three effects of smoking that make it a RF for CAD

A

increased CO2 decreases oxygenation
Nicotine stimulates catecholamines, which increase HR, BP, and demand on heart
Increased plt aggregation increases risk of thrombus

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10
Q

elevated lipids are a well establish RF of

A

CAD
cholesterol over 200
TGA over 200

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11
Q

Metabolic syndrome

A 
cluster of metabolic abnormalities that are a major RF for CVD (3 more more)
DM obestiy
dyslipidemia
HTN
increased fibrinogen level
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12
Q

4 things that increase injury to arterial endothelium

A

smoking
HTN
DM
genetics

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13
Q

Coronary arteries are perfused at this time, so…

A

During diastole when resistance is low
So, and increased HR shortens diastole, which can decrease myocardial perfusion
Need diastolic BP of at least 60 for good perfusion

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14
Q

Coronary arteries

A

Right CA

Left Main CA-branches into LAD and Circumflex

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15
Q

leading COD in US, all ages and races

A

CVD

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16
Q

leading cause of CVD

A

CAD

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17
Q

HR is determined in the heart by

A

myocardial cells with fastest firing rate
SA node : 60-100
AV node: 40-60 some ppl will show s/s, some not
Ventricular pacemaker sites: 30-40 too slow

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18
Q

PNS influences HR

A

via vagus nerve

slows HR by affecting SA node

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19
Q

SNS influences HR

A

increases HR by increasing circulating catecholamines from adrenal gland

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20
Q

HR is controlled by (4)

A

ANS
CNS
baroreceptors
pacemakers

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21
Q

Specialized nerve cells in aortic and carotid arches that are sensitive to increased BP

A

Baroreceptors
when stimulated by increased BP they signal the medulla to increase PNS stimulation of heart, which inhibits SA node and inhibits SNS influence, lowering HR and BP

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22
Q

Three factors that affect Stroke Volume

A

Preload
Afterload
Contractility

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23
Q

Preload

A

Degree of stretch in ventricular muscle fibers at the end of filling (diastole)
Determined by volume of blood in LV

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24
Q

Frank-Starling Law

A

As volume of blood returning to heart increases, muscle stretch increases, resulting in a stronger contraction and greater SV

increased stretch=increased degree of shortening
As preload increases, SV increases
UNTIL physiologic limit is reached

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25
Q

Base of heart is at the

A

top

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26
Q

Apex of heart is at the

A

bottom

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27
Q

normal SV

A

70 ml/beat

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28
Q

normal CO

A

5L/min

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29
Q

atrial and ventricular systole are not simultaneous because

A

this allows ventricles time to fill passively and receive “atrial kick” prior to ejecting blood

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30
Q

the only veins that carry oxygenated blood

A

pulmonary veins

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31
Q

apical impulse (PMI) is located

A

5th intercostal space and left midclavicular line

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32
Q

These valves are open during diastole and close in response to contraction

A

AV valves:
Tricuspid (Rt)
Mitral (Lft)

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33
Q

These valves open during systole

A

Pulmonic and Aortic valves

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34
Q

Heart uses the % of O2 delivered

A

80%, most organs use 25%

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35
Q

If HR rises above this level, increase risk MI due to shortened diastole

A

100, especially in CAD pt

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36
Q

Two cell types in heart

A

Electrical–initiate and conduct impulse

Mechanical–contract in response to stimulation

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37
Q

Job of AV node

A

coordinates incoming impulse from atria and after a slight delay relays impulse to ventricles

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38
Q

Impulse relayed to ventricles from AV node to

A

Bundle of His (AV bundle) to
Right and Left Bundle Branches, to
Purkinje fibers

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39
Q

Purkinje fibers are specialized to

A

rapidly conduct impulse through thick wall of ventricles

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40
Q

In Resting state of myocytes, ions distribution

A

K higher inside cell (— charge)

Na higher outside cell (+++)

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41
Q

Repeated cycle of depolarization and repolarization of cardiac myocytes

A

Cardiac Action Potential

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42
Q

Depolarization

A

Na and Ca enter cell, make inside cell more +++

K goes out of cell, makes outside more —

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43
Q

Repolarization

A

Ions revert to resting state

must be complete before cell can depolarize again correctly (refractory period)

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44
Q

Effective refractory period

A

cell is completely unresponsive, cannot depolarize early

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45
Q

Relative refractory period

A

if impulse is stronger than normal, cell may depolarize prematurely
early depolarization of atria cause premature contractions and dysrhythmias

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46
Q

Why is Vfib or Vtach dangerous

A

not enough time for ventricles to fill properly or eject, blood pools, clots form, decreased perfusion, can lead to asystole

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47
Q

PVC + myocardial ischemia can trigger

A

Vtach or Vfib

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48
Q

P wave signifies

A

atrial depolarization

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49
Q

QRS complex signifies

A

Ventricular depolarization (atrial repolarization is hidden under wave)

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50
Q

T wave signifies

A

Ventricular repolarization (relaxation and filling)

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51
Q

chamber pressures are measured in

A

hemodynamic monitoring

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52
Q

Cardiac Output

A

Volume of blood pumped out of heart in L/min

=SV x HR

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53
Q

to increase preload, you need to

A

increase blood return to the heart

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54
Q

Afterload

A

resistance of ejection of blood from the ventricle

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55
Q

As afterload increases, SV

A

decreases

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56
Q

Contractility

A

force generated by contracting myocardium; ability of muscle fibers to shorten in response to electrical impulse; related to number and state of myocardial cells

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57
Q

Contractility is increased by

A

circulating catecholamines
SNS influence
certain meds

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58
Q

Contractility is decreased by

A 
hypoxemia
acidosis
certain meds (Beta Blockers)
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59
Q

Percentage of End Diastolic Volume ejected with each beat; used as a measure of myocardial contractility and LV function

A

Ejection Fraction

normal LV: 55%-65%

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60
Q

decreased LV function, heart failure are signified by EF of

A

less than 40%

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61
Q

s/s of CAD

A 
CP
n/v
cool extremities
diaphoresis
xanthelasma
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62
Q

Cholesterol deposits around eyes often seen in CAD patients

A

xanthelasma

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63
Q

CP is caused by

A

myocardial ischemia

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64
Q

s/s fo myocardial ischemia besides CP

A

Dyspnea, exertional dyspnea, PND
weight gain and dependent edema
syncope
fatigue

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65
Q

Goal of angina treatment

A

Decrease demand on heart and increase O2 supply to heart, reduce other complications

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66
Q

myocardial injury

A

Reversible–increasing O2 and nutrients can save area, no intervention, area will become necrotic
ST segment elevation on EKG

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67
Q

myocardial ischemia

A

Still Reversible

ST segment depression on EKG

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68
Q

Myocardial necrosis

A

Irreversible, dead heart tissue in area of infarct

begins 20-30 min from time of occlusion

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69
Q

Nitroglycerin serves to

A

vasodilate coronary arteries

decrease O2 consumption by myocardium

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70
Q

store nitro

A

in dark glass bottle, away from light and moisture

good for 6 months from opening

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71
Q

touching nitro to skin can cause

A

HA and decreased BP

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72
Q

MI results from

A

reduced blood flow in a coronary artery, usually d/t both a plaque and a thrombus

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73
Q

Acute Coronary Syndrome includes

A

Unstable angina and MI (same process at different points on a continuum)

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74
Q

check thyroid tests with CP because

A

hyperthyroidism can cause CP

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75
Q

CK-MB

A

Creatine kinase
Enzyme in cardiac cells that is released when they die
no longer evident after 3-4 days
false + by exercise from skeletal muscle

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76
Q

Myoglobin

A

protein in cardiac cells, short lived and not always elevated

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77
Q

Troponin 1

A

protein in cardiac cells

Top marker for acute MI, no longer evident after 7 days

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78
Q

Troponin T

A

protein in cardiac cells

evident for up to 21 days

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79
Q

Beta Blockers overall function

A

reduce workload of heart
decrease HR and BP, and contractility
improved LV diastolic function

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80
Q

give morphine for acute MI because

A

helps relax heart and decrease CP

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81
Q

AE of nitroglycerin

A

HA, decreased BP, decreased HR

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82
Q

Acute MI treatment (

A 
EKG in 10 minutes
O2
aspirin
nitroglycerin
morphine
beta blockers 
ACE inhibitor in 24h
blood thinners
bed rest
stool softeners
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83
Q

These meds decrease risk of re-infarction after MI and increase survival rate after MI

A

Beta Blockers

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84
Q

why stool softeners after MI

A

avoid straining, increased pressure can signal baroreceptors to lower BP, cause syncope

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85
Q

Prevent a clot from becoming larger

A

antiplatelet meds

aspirin, plavix

86
Q

Inhibit new clot formation

A

Anticoagulants

Coumadin, heparin

87
Q

Angioplasty aka

A

Percutaneous Coronary Intervention

balloon, place stents

88
Q

After Cardiac Cath care

A

Watch bleeding at site, pressure dsg
Contrast dye can be lethal to kidneys, Mucomyst can protect kidneys from dye
Watch for dysrhythmias (from cardiac manipulation)

89
Q

these veins often used for bypass graft procedures

A

Greater and lesser saphenous veins of leg

90
Q

Triple vessel disease requires

A

open heart surgery, CABG

91
Q

lipitor is best cholesterol reduction med but

A

can damage liver, need to watch liver function

92
Q

What raises HDL?

A

Exercise, moderate alcohol consumption, estrogen (in women, cholesterol can begin to rise at menopause)

93
Q

81 mg ASA

A

protective from MI, same as 325 mg

minimum effective dose bc ASA can be hard on stomach lining

94
Q

Fastest to slowest absorption for injections

A

IV, IM, SC

94
Q

Omega 3

A

Provides essential fatty acids, decreases inflammation

95
Q

Angles and gauge for typical SC

A

45, 3/8-5-8 inch

96
Q

SC sites

A

Upper arms, abd, ant and lat thighs

97
Q

Complication of sc injection

A

Sterile abcess

98
Q

SC insulin

A

Insulin syringe
90 deg
28 gauge

99
Q

To mix insulin

A

Draw up clear, then cloudy

100
Q

Hold for 10 sec after insulin SC injection

A

To prevent hematoma and ensure absorption of viscous med

101
Q

Lovenox dose is based on

A

Weight

102
Q

Before giving heparin or lovenox you should know

A

Platelet count

103
Q

Gauge and Needle length for IM injections

A

1 to 1 1-2 inches

20-23 gauge

104
Q

Gauge selection depends on

A

Viscosity of medication

Larger number, smaller bore

105
Q

Tuberculin syringe used to

A

Measure doses less than 1 mL

106
Q

Filter needle used when

A

Withdrawing fluid from and ampule

Change before injecting

107
Q

Main fluid will hang

A

Lower than minibag

108
Q

Secondary solution set tubing is connected

A

At the Y port ABOVE the pump

109
Q

Aortic area

A

Right side of sternum

2nd ICS

110
Q

Pulmonic area

A

Left side of sternum

2nd ICS

111
Q

Erb’s Point

A

Left 3rd ICS

Hear S1 and S2

112
Q

Tricuspid area

A

Lower left sternal border

4th ICS

113
Q

Mitral area

A

Left 5th ICS, medial to MC line

114
Q

S1 “Lub”

A

Sound of AV valves closing

Beginning of systole

115
Q

S2 “Dub”

A

Sound of aortic and pulmonic valves closing

Beginning of diastole

116
Q

Murmurs caused by

A

Turbulent blood flow due to narrowed valves or other defect; or normal process (pregnancy, fever, hyperthyroid)

117
Q

Difference between apical and radial pulses

A

Pulse deficit, signifies arrhythmia

118
Q

CIWA

A

Clinical Intoxication Withdrawal Assessment

MD may have SO for benzodiazepines based on positive findings

119
Q

Death can occur from abruptly stopping use of these drugs

A

Alcohol
Benzodiazepines
Barbiturates

120
Q

Different drugs have a specific syndrome that results from their withdrawal, and the s/s are due to

A

Effect of the substance on the CNS

121
Q

Alcohol absorbed by the

A

Mouth, stomach, and SI

122
Q

Normal alcohol metabolism is 10 mL in

A

90 minutes

123
Q

Metabolic tolerance

A

Increased drug-metabolizing enzyme in the liver

124
Q

Sign of drug dependence

A

Tolerance/withdrawal

125
Q

BA of .05% to .15

A

Disinhibition and impaired judgement, euphoria

1-2 drinks

126
Q

Slurred speech, staggering gait, and double vision occur at BA of

A

.15 to .25

127
Q

Severe respiratory depression and coma (alcohol poisoning) can result from BA of

A

.40-.50%

128
Q

Why does alcohol affect Brain before spinal column? (Disinhibition before unsteady gait)

A

Alcohol rapidly crosses BBB

129
Q

Women are more easily intoxicated than men, Asians more easily than other races, because?

A

They have less alcohol dehydrogenase

130
Q

A person who fails to fulfill role due to Substance use, has legal problems and yet continues to use, and uses dangerously and yet has not met criteria for dependence, their problem is defined as

A

Substance abuse

131
Q

Criteria for drug dependence

A

Tolerance and withdrawal

132
Q

Drug tolerance

A

Need to use more to get same effect

133
Q

Physical tolerance

A

Tissue adaptation

Changes in cells of NS so more drug is needed

134
Q

Cross tolerance

A

Need more of drugs like the drug you depend on also ex-alcohol dependence and benzodiazepines

135
Q

Behavioral tolerance

A

Ability to mask behavioral effects of intoxication

136
Q

Tolerance is never developed to

A

Effects of respiratory depression ( can stop breathi g I. Sleep)

137
Q

Substance withdrawal

A

Substance specific syndrome due to cessation or reduction in use

138
Q

Minor alcohol withdrawal

A

Hangover (6-12 hours after last drink)

Irritable, agitated

139
Q

Alcohol withdrawal

A

24 hours after last drink
Tachycardia, increased BP–can go very hi, needs treatment
Diaphoresis , n/v, hallucinations

140
Q

Major alcohol withdrawal

A

48-72 hours after last drink
Seizures
Delerium tremens

141
Q

Deletion tremens

A

Hallucinations from major alcohol withdrawal- bugs crawling over you, pt can be terrified

142
Q

Nsg care during alcohol withdrawal

A

Monitor VS closely

Safety

143
Q

Management of alcohol withdrawal

A 
Early detection
Safety
Fluids
Benzodiazepines
MgSO4 and Dilantin for seizures
B vitamin replacements
144
Q

Why B vitamin supplements for alcohol withdrawal

A

Alcohol decreases B vitamins and PTA often don’t eat we’ll. needed for nerve conduction.

146
Q

Wernicke-Korsakoff Syndrome

A

Irreversible alcohol encephalopathy
Amnesia, confabulation, peripheral neuropathy
more likely to develop in women

147
Q

Wernicke Korsakoff syndrome results from

A

Poor nutrition, especially inadequate thiamin and niacin and from neurotoxicity of alcohol

148
Q

physical effects of alcohol

A

CNS selective anesthetic and depressant, cytotoxic and toxic to organs (cirrhosis, cardiomyopathy, pancreatitis, gastritis, psoriasis, increased cancer risk)

kills brain cells, blackouts
auditory hallucinations
dementia
peripheral neuritis, muscle weakness, ataxia
delirium tremens
149
Q

Delerium tremens

A

extreme motor agitation, visual and tactile hallucinations, and seizures

150
Q

very dangerous to combine alcohol with

A

other CNS depressants (benzos, opiates)

151
Q

FAS

A

Fetal Alcohol Syndrome: alcohol inhibits fetal development in first trimester.
Only preventable mental retardation

152
Q

most addictive drug

A

cigarettes, then heroin

153
Q

endorphin agonists that relieve pain and reduce anxiety

A

opioids: Morphine, oxycodone, heroin, Fentanyl, methadone, Demerol, diluadid, codeine

154
Q

Heroin has highly addictive because

A

readily crosses BBB

155
Q

death from opioid abuse is caused by

A

respiratory depression

156
Q

AE of opioid use

A 
resp depression
constipation
decreased GI secretions
reduced pupil size
Hypotension
157
Q

opioid antidote

A

naloxone (Narcan) Blocks neuroreceptors affected by opioids. Give for suspected OD, wont hurt pt if its not an OD

158
Q

Examples of stimulants

A

Cocaine, amphetamines (Meth), crack

159
Q

Withdrawal from stimulants

A

physical withdrawal mild, not life threatening; psychological withdrawal is severe, with intense cravings

160
Q

Mode of action of stimulants

A

deplete monoamine NTs associated with depression, are highly pleasurable

161
Q

Due to difficult psych withdrawal from cocaine, pts are

A

high suicide risk

162
Q

presentation and withdrawal very similar to alcohol

A

benzodiazepines

163
Q

Examples of benzodiazepines

A

Versed, Ativan, valium, Xanax, Rohypnol

164
Q

HIghes risk of inhalant abuse

A

kids and poor

165
Q

Inhalant abuse causes

A

CNS depression
hilarity, asphyxiation
some lipid soluble, can have prolonged effect on brain

166
Q

Examples of hallucinogens

A

marijuana, mescaline, mushrooms, LSD, PCP. Ecstacy

167
Q

Effect of hallucinogens

A

altered sense of reality, hallucinations, panic, confusion, paranoia
No withdrawal but effects can last a long time

168
Q

Effects of marijuana

A

sense of well being
altered perception
increase hunger, antiemetic (THC)
impaired balance
impaired short term memory and concentration
harms lungs, weakens heart contraction, immunosuppression, reduces sperm count

169
Q

depression increases risk of poor outcomes in

A

cardiac disease due to decreased compliance

170
Q

2 most prevalent causes of death and disability worldwide

A

CV disease and depression

171
Q

To be a depressive illness, s/s have to last for at least

A

2 weeks

172
Q

anhedonia

A

Hallmark of depression: loss of interest in things you used to enjoy

173
Q

Depression-decrease in NTs

A

serotonin and NE

174
Q

with physical illness, risk for MDD increases

A

50%

175
Q

medications associated with depression

A

Beta Blockers and other anti-HTN meds
steroids
CNS depressants: benzodiazepines, alcohol, opioids
amphetamines, when coming down

176
Q

depression in elderly probably arises from

A

multiple losses

177
Q

this group is high risk for substance abuse and underreported depression

A

elderly

178
Q

to asses a client with depression use

A 
Mental Status Exam:
Appearance (Hygeine? eye contact? affect?)
Behavior (slowed?)
Mood (subjective-ask)
Thoughts (psychomotor retardation?)
Interactions (Isolative?)
Hx
179
Q

Most common med for depression

A

SSRIs

Celexa, Lexapro, Paxil, Zoloft, Prozac, Luvox

180
Q

Tricyclic antidepressants-try to avoid due to

A

anticholinergic AEs

181
Q

Danger of MAOI use

A

dietary restrictions (could cause Hypertensive crisis if eat aged cheese)

182
Q

Bipolar Affective Disorder is characterized by

A

pathological mood swings from mania to depression

183
Q

NT imbalance in Bipolar

A

decreased serotonin

increased NE

184
Q

Bipolar 1 disorder

A

alternate MDD to mania (at least one episode of each)

185
Q

Bipolar II disorder

A

alternate MDD to hypomania

186
Q

Mirror image of depression

A

mania

187
Q

s/s of mania

A

intrusive, restless, frenzied, rapic speech, loose associations, irritable to hostile, delusional, graindiose, no fear, engages in risky behavior

188
Q

drug of choice for bipolar

A

lithium

189
Q

manic pt high risk for suicide due to

A

impulsivity and lows experienced after

190
Q

Therapeutic zone for lithium

A

0.6-1.2 mEq/L

191
Q

s/s of lithium OD

A 
Diarrhea
Ataxia
Blurred vision
BAD
Higher--coma and death
192
Q

Do not use lithium with these pts

A

cardiac diseases
renal diseases
pregnancy
hypothyroid

193
Q

Anticonvulsant mood stabilizers

A

Tegretol, Depakote

194
Q

Drugs for bipolar

A

Mood stabilizers:

  1. Lithium
  2. Anticonvulsants
  3. Atypical antipsychotics
195
Q

low lethality, low intent/planning, little physical damage

A

suicide gesture

196
Q

Best place to hear s1 and s2

A

.

197
Q

SAD PERSONAS

A 
Sex
Age
Depression History
Past Attempts
Etoh
Rational Thinking Loss
Social supports lacking
Organized plan
No spouse
Availability of means
Sickness
198
Q

CAP-color and agent

A

Strep Pneumoniae

Rust colored sputum

199
Q

HAP-color and agent

A

yellow-green sputum

Staph, Klebsiella, Pseudomonas

200
Q

latent TB infection

A

test positive by ppd but do not have active tb disease because immune system fights it off

201
Q

bronchiectasis often results from

A

chronic repeated respiratory infections, pneumonias, and CF

202
Q

lung abcess often secondary to

A

aspirations

203
Q

occupation lung disease r/t dust particle inhalation

A

pneumoconiosis

204
Q

lung cancer with poor prognosis, linked to smoking, occurs centrally in lungs

A

small cell

oat cell

205
Q

fluid in pleural space

A

pleural effusion

206
Q

inflmn of both layers of pleura

A

pleurisy

207
Q

alveolar collapse due to sticky secretions and mucus plugs

A

atelectasis

208
Q

dx of chronic bronchitis

A

productive cough for 3 months each year for two consecutive years

209
Q

flattened diaphragem and barrel chest

A

emphysema

210
Q

often first sign of emphysema

A

DOE

211
Q

often first sign of asthma

A

chest tightness

101a Vocab (9 decks)

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