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Hesi PN > cardiac > Flashcards

cardiac Flashcards

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1
Q

What is preload

A

the amount of blood returning to the right side of the heart

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2
Q

what is afterload

A

the pressure in the aorta and peripheral arteries that the left ventricle has to pump against to get the blood out
pressure is resistance

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3
Q

why does hypertension lead to HF and pulmonary edema

A

with hypertension there is more resistance for the left ventricle to pump against

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4
Q

what is stroke volume

A

the amount of blood pumped out of the ventricles with each beat

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5
Q

factors that affect cardiac output

A

heart rate and certain arrhythmias
blood volume
decreased contractility

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6
Q

how does blood volume affect cardiac output

A

less volume= decreased CO
more volume= increased CO

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7
Q

what decreases cardiac contractility

A

MI
medication
cardiac muscle disease

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8
Q

medication to help preload

A

diuretics
nitrates

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9
Q

how do medications help preload

A

vasodilator or diurese to reduce preload

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10
Q

how do medications help afterload

A

vasodilator to reduce afterload

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11
Q

medications to help afterload

A

ACE inhibitors (enalapril, Posinopril, Catopril)
ARBS (losartan, irbesartan)
hydralazine
nitrates

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12
Q

what drugs improve contractility

A

inotropes (dopamine, dobutamine, milrinone)

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13
Q

what medication control heart rate

A

beta blockers, LOLs
calcium channel blockers (diltiazem, verapamil, amlodipine
digoxin

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14
Q

what drugs control rhythm

A

antiarrhythmics (amiodarone)

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15
Q

Cardiac output assessment

A

if CO is decreased poor perfusion
LOC will go down
chest pain
wet lungs, short of breath
cool and clammy
low urine output
weak peripheral pulses

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16
Q

arrhythmias that are always a big deal

A

pulsless vtach
v-fib
asystole

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17
Q

what is coronary artery diesease

A

broad term that includes, stable chronic angina and acute coronary syndrome

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18
Q

what is chronic stable angina

A

intermittent decrease blood flow to the myocardium leading to ischemia that can lead to temporary pain or pressure in chest,

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19
Q

what causes pain in chronic stable angina

A

low O2 usually due to exertion

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20
Q

what relieves pain in chronic stable angina

A

rest, nitro

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21
Q

how does nitro help chronic stable angina

A

causes vaso and arterial dilation decreasing pre and afterload
causes dilation of coronary arteries increasing flow to actual heart

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22
Q

how often do you take nitro

A

1 every 5 min x 3

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23
Q

side effects of nitro

A

may burn or fizz
headache

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24
Q

how often do you replace nitro

A

every six months, spray 2 years

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25
Q

what happens to bp after administering nitro

A

drops

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26
Q

what do beta blockers due to MP, P and myocardial contractility, CO

A

decrease

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27
Q

what happens when you decrease the workload on the heart

A

the need for oxygen is decreased, increasing angina,

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28
Q

what do calcium channel blockers do

A

cause vaso dilation of the arterial system including coronary arteries, increase afterload and o2 to a heart muscle

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29
Q

What is another name for asprin

A

acetylsalicylic acid

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30
Q

pt education for chronic stable angina

A

rest frequently
avoid over eating
avoid excess caffeine or any drugs that increase HR
wait 2 hours after eating to exercise
dress warmly in cold weather
take nitro prophylactically
smoking cessation
lose weight
avoid isometric exercise (weight lifting)
reduce stress

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31
Q

cardia catheterization pre procedure requirements

A

ask if allergic to iodine or shelfish
check kidney function
take acetylcysteine pre procedure to protect kidneys
warm fluttery feeling and palpitations are normal

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32
Q

post cardiac catheterization

A

monitor VS
watch puncture site (bleeding, hematoma)
assess extremity distal to site
bed rest, flat, extremity straight 4-6 hours
report bleeding asap
hold metformin 48 hours post procedure

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33
Q

what happens with acute coronary syndrome

A

decreased blood flow to myocardium leading to ischemia and necrosis
does not need to do anything to precipitate
nitro will not help

34
Q

signs and symptoms of acute coronary syndrome

A

pain (crushing, elephant sitting on Chet, pressure radiating to the left arm and jaw,
nausea and vomiting
pain between shoulder pain
cold clammy
bp drops
cardiac output is down
ECG changes
vomiting

35
Q

MI symptoms in women

A

epigastric discomfort
pain between shoulder blades
aching jaw
choking sensation
unusual fatigue
unable to catch breath

36
Q

what is CPK-MB

A

cardiac specific iso enzyme
increased with damage to cardiac cells
elevates within 2-6 hours and peaks in 12-24 hours

37
Q

what is troponin

A

cardiac biomarker with high specificity to myocardial damage
elevates wishing 3-4 hours and remains elevated up to 3 weeks

38
Q

troponin lab values

A

troponin T <0.10ng/ml
troponin I < 0.03ng/ml

39
Q

medications used for chest pain in ED

A

Oxygen
ASA
intro
morphine
elevated HOB

40
Q

What do thrombolytics do

A

dissolve the clot that is blocking blood flow of the heart decreasing risk of infarction

41
Q

complication of thrombolytics

A

bleeding

42
Q

what is included in bleeding precautions

A

watch for gum bleed
hematuria
black stools
use electric razor and soft tooth brush
no IMs

43
Q

medications requiring bleeding precautions

A

abciximab
acetaminophen
acetylsalicylic acid
apixaban
clopidogrel
dabigartan
enoxaparin sodium
eptifibatide
heparin rivaroxaban
warfarin

44
Q

what is percutaneous coronary intervention (PCI)

A

includes all interventions such as PTCA and stents

45
Q

major complication of an angioplaty

A

MI
client may bleed from heart Cath site or they could reocclude
if any problems go to surgery

46
Q

signs of reoccluding

A

chest pain after procedure

47
Q

when is a coronary artery bypass

A

with multiple vessel disease or left main coronary artery occlusion

48
Q

what does left main coronary artery supply

A

entire left ventricle

49
Q

what happens with left main coronary artery occlusion

A

sudden death

50
Q

cardiac rehabilitatin

A

smoking cesations
increase activity gradually
low fat, low salt, low cholesterol
no isometric exercise (increases work load)
no valsalva (will bottom out)
no straining
resume sex in one week to 10 days
morning is safest time for sex
best exercise is walking

51
Q

signs and symptoms of heart failure

A

weight gain
ankle edema
shortness of breath
confusion

52
Q

causes of heart failure

A

complication of cardiomyopathy, valvular heart disease, endocarditis, acute mi and hypertentsion

53
Q

what happens with left sided heart failure

A

blood is not moving forward into the aorta and to body and backs into the lungs

54
Q

signs of left sided heart failure

A

pulmonary congestion
dyspnea
cough
blood tinged frothy sputum
restlessness
tachycardia
S-3
orthopnea
nocturna dyspnea

55
Q

what is right sided heart failure

A

distended neck veins
edema
enlarged organs
weight gain
ascites

56
Q

what does systolic HF mean

A

hear cannot contract and eject

57
Q

what does diastolic hf mean

A

ventricles can’t relax and fill

58
Q

standard medications for HF

A

ace inhibitors
ARBS

59
Q

what do ACE inhibiters do for HF

A

suppress renin angiotensin system
prevent conversion of angiotensin 1-2
results in arterial dilation and increased stroke volume

60
Q

what do arbs do

A

block angiotensin 2 receptors and cause a decrease in arterial resistance and decreased BP

61
Q

when is digoxin used

A

when the client is in sinus rhythm or A-fib and has accompanying chronic H

62
Q

what does digoxin do

A

makes contraction stronger
slows heart rate(ventricles have more time to fill)
cardiac output goes up
kidney profusion goes up

63
Q

normal digoxin levels

A

0.5-2 ng/ml

64
Q

symptoms of digoxin toxicity

A

early: anorexia, nausea, vomiting
late arrhythmias and vision changes

potassium effects it most

65
Q

examples of diuretics

A

furosemide
hydrochlorothiazide
bumetanide
triamterene
spriolactone

66
Q

when do you give diuretics

A

morning

67
Q

what do low sodium diets do

A

decrease fluid retention and decrease preload

68
Q

what is a consideration when using salt substitutes

A

contain excess potassium

69
Q

What is the natural pacemaker

A

SA node

70
Q

what happens if hr drops below 60

A

cardiac output is decreased

71
Q

what do you do post-procedure for permanent pacemaker

A

monitor inceision
immobilize arm
assisted passive range of motion to prevent frozen shoulder
keep the client from raising the arm higher than right shoulder

72
Q

most common complication of permanent pacemaker

A

electrode displacement

73
Q

cardiac pacemaker client education

A

check pulse daily
ID card or bracelet
avoid electromagnetic fields
avoid MRI’s

74
Q

signs of acute arterial occlusion

A

numbness and pain
cold extremity
no palpable pulses
more symptomatic in lower extremities
intermittent claudication -hallmark sign
pain at rest

75
Q

treatment of arterial disorders

A

dangle vein
angioplasty or endarterectomy

76
Q

Pain artery vs chronic venous insufficiency

A

artery-intermittent claudication progresses to rest pain
vein- none to aching pain or depending on dependency of area

77
Q

pulses arterial vs venous insufficiency

A

artery- decreased or absent
vein- normal

78
Q

color

A

artery-pale when elevated red with lowering of leg
vein- normal (may see petechiae or brown pigmentation with chronic condition)

79
Q

temperature arterial vs venous insufficiency

A

artery- cool
vein-normal

80
Q

edema artery vs venous insufficiency

A

artery absent or mild
vein present

81
Q

skin changes arterial vs venous insufficiency

A

artery- thin, shiny, loss of hair over foot, toes, nail thickening
vein- brown pigmentation around ankles possible thickening of skin, scarring may develop

Hesi PN (24 decks)

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