Cardiac

Question 1

Cardiac Output Importance s/s

Answer 1

Tissue perfusion!
● End organ function
● Delivery of oxygen and nutrients to each and every cell in the body!
● Poor cardiac output??
○ Decreased LOC (not enough blood flow to the BRAIN)
○ Chest pain, weak peripheral pulses (not enough blood flow to the HEART)
○ SOB, crackles, rales (not enough blood flow away from the LUNGS)
○ Cool, clammy, mottled extremities (not enough blood flow to the SKIN)
○ Decreased UOP (not enough blood flow to the KIDNEYS)

Question 2

Deep Vein Thrombosis (DVT)

Answer 2

Thrombus - A clot that remains attached to the vascular wall
● Causes
○ Venous stasis
■ Immobility
■ Age
■ LHF
○ Vein wall damage
○ Hypercoagulable states
■ Pregnancy, oral contraceptives, malignancy
● Prevention
○ Assess at-risk individuals
○ Promote venous return
■ SCD’s, ted hose, encourage mobility
● Treatment
○ Anticoagulants

Question 3

Peripheral vascular disease

Answer 3

Inadequate venous return over a long period
● Causes pathologic ischemia
○ Blood flow back to the heart is affected
○ Brown discoloration
○ Uneven wound edges around ankle
○ Swelling
○ Pedal pulse IS present
● Treatment
○ Elevate legs
○ Focus on proper wound care

Question 4

Superior Vena Cava Syndrome

Answer 4

Tumor compressing SVC
headache, blurry vision, facial plethora, dyspnea, non-pulsitile distended neck veins, upper extremity edema, glossitis, puffy face/neck, stridor, nasal congestion

Question 5

Diseases of the Arteries

Answer 5

Atherosclerosis
● Hypertension
● Orthostatic (postural) hypotension
● Aneurysm
● Embolism
● Peripheral arterial disease
● Coronary artery disease
● Chronic stable angina
● Acute coronary syndromes
○ Unstable angina
○ Myocardial infarction

Question 6

Atherosclerosis

Answer 6

● Inflammatory disease
● Begins with endothelial injury
● Evolves into a fibrotic plaque
● Plaques build up and decrease blood flow to the areas they are located
● Plaques can rupture and cause:
○ Thrombosis
○ Vasoconstriction
○ Ischemia
● Most common cause of coronary artery disease and cerebrovascular disease

Question 7

HTN Assessment findings

Answer 7

dizziness, angina, headache, vision changes, SOB, nosebleeds

often asymptomatic until severe

Question 7

Blood pressure ranges

Answer 7

normal <120/80
elevated 120-129/80
hypertension >130/>80
hypertensive crisis >180/>120

Question 8

HTN complications

Answer 8

stroke, MI, renal failure, heart failure, vision loss

Question 9

HTN treatment and education

Answer 9

Treatment & Education
● Medications
○ ACE inhibitors
○ Beta Blockers
○ CCB
○ Diuretics
● Diet
○ DASH
○ Low salt
○ Avoid caffeine and alcohol
○ Weight loss
○ Smoking cessation
● Lifestyle
○ Less sitting more walking

Question 10

Aneurysms

Answer 10

Localized dilation of a vessel wall

○ Most common - aorta
● Causes
○ Atherosclerosis
○ HTN
○ Smoking
○ Family history

Abdominal Aortic Aneurysm (AAA)
● Most common
● Abdominal, back pain
● Gnawing/sharp pain

Thoracic Aortic Aneurysm
● Shortness of breath
● Hoarseness/struggling with swallow
● Back pain

Rupture -
● Life threatening
● Severe pain
● Do not palpate pulsating mass

Question 11

Embolism types

Answer 11

● Embolus - clot that dislodges and is mobile and can occlude the vasculature
● Can be made of many substances
○ Air
○ Bacteria
○ Fat
○ Blood clot
○ Amniotic fluid
● At-risk clients: ○ Pregnancy
■ Hypercoagulable - can form a thrombus that dislodges and causes embolism
■ Amniotic fluid can be forced into the bloodstream during labor causing an
○ A-fib embolism
■ Clot can form in the blood pooling in the atria and be dislodged ○ Long bone fracture
■ Fat can be released from the bone marrow after trauma

Question 12

Air embolism

Answer 12

● Air embolism:
○ Air bubble enters a vein or artery
○ Very rare
○ Complication of surgical procedure
■ High risk: placement of CVC or arterial catheter
● If your client suddenly desaturates during one of these procedures - suspect an
air embolism!
● Positioning:
○ Durant’s maneuver
■ Left lateral trendelenburg
○ This should prevent an air embolism from lodging in the lungs - will stay in the right heart

Question 13

Fat embolism

Answer 13

Symptoms:
▪ Hypoxia
▪ Dyspnea
▪ Tachypnea
▪ Confusion
▪ Altered level of consciousness
▪ Petechial rash (does not always occur)
Associated with orthopedic fractures such as long bone and pelvic fractures

Question 14

Peripheral Arterial Disease

Answer 14

● Atherosclerosis of arteries that perfuse the limbs
○ Especially the lower extremities

● Causes decreased perfusion to the lower extremities

● Assessment findings:
○ Pallor
○ Pulselessness
○ Hairlessness
○ Intermittent claudication
■ Pain that occurs in legs when walking
■ Pain gets better with rest

● Treatment
○ Dangle legs
○ Antiplatelet therapy

Question 15

Coronary Artery Disease

Answer 15

● Occlusion of the coronary arteries
● Most often results from atherosclerotic plaques
● Risk factors:
○ Advanced age
○ Hypertension
○ Dyslipidemia
○ Smoking
○ Obesity
○ Sedentary lifestyle

● Can cause myocardial ischemia
○ Chronic stable angina - reversible

Question 16

Myocardial infarction

Answer 16

● Prolonged decreased blood flow to the heart results in irreversible damage to the muscle of the heart
● Goal is to act quickly and limit the damage
● Subendocardial infarction
○ No ST-segment elevation ○ Non-STEMI
● Transmural infarction
○ ST-segment elevations on EKG
○ STEMI
○ Require immediate intervention

Question 16

Chronic Stable Angina

Answer 16

● Chronic disease caused by narrowing of coronary arteries and plaque build up
● There are periods of decreased blood flow to the heart muscle
● Decreased blood flow leads to
decreased oxygen and ischemia
● Ischemia causes chest pain
● Pain is predictable and goes away
with rest or nitroglycerin

Treatment
● Nitroglycerin
○ Venous and arterial dilation → decreased afterload → increased CO
○ Given sublingual
○ Administer 1 pill q5 minutes for 3 doses
○ Do not swallow
○ Keep in a dark bottle in dry, cool place
○ Expected side effect = headache

Education
● DECREASE THE WORKLOAD OF THE HEART!
○ Rest
○ Do not overeat
○ No caffeine
○ Avoid temperature extremes
○ No smoking
○ Promote weight loss
○ Reduce stress

Question 17

Unstable Angina

Answer 17

● Pain DOES NOT go away with rest or nitroglycerin
● Reversible myocardial ischemia
● If not treated very quickly, will progress to a myocardial infarction

Question 18

MI Assessment

Answer 18

Assessment
● Chest pain
○ Crushing
○ Radiating to left arm or jaw
○ Between shoulder blades
● Epigastric discomfort/indigestion
● Fatigue
● SOB
● Vomiting
● Elevated troponin

Question 19

MI Treatment

Answer 19

Treatment
● Cath lab within 90 minutes for PCI ○ Especially important if it’s a STEMI!
● ON-TIME
○ O: Oxygen
○ N: Nitroglycerin
○ T: Thrombolytics (if appropriate)
○ I: Antiplatelets (e.g., aspirin or other medications)
○ M: Monitoring and Medical care
○ E: EKG to assess heart activity

Question 20

MI Education

Answer 20

Education
● Quit smoking
● Diet
○ Low fat
○ Low salt
○ Low cholesterol
● Exercise
○ Avoid isometric exercises
○ Walking is a good choice

Question 21

Disorders of the heart wall

Answer 21

● Pericarditis
● Pericardial effusion
● Cardiomyopathies ○ Dilated
○ Restrictive
○ Hypertrophic
● Valve disorders
● Endocarditis

Question 21

Pericarditis

Answer 21

Pericarditis
● Inflammation of the pericardium
● Causes
○ Infection
○ Tumor
○ Drugs

● Assessment findings
○ Sharp chest pain
○ Tachypnea
○ Fever, chills
○ Weakness

● Treatment
○ NSAIDs

Question 22

Pericardial Effusion

Answer 22

Pericardial Effusion
● Collection of fluid in the pericardial sac
● Impairs cardiac function if severe
○ Obstructive cardiogenic shock
● Assessment findings
○ Chest pain
○ Muffled heart sounds
● Treatment
○ Pericardiocentesis

Question 23

Cardiac tamponade

Answer 23

Cardiac tamponade
● Blood, fluid, or exudate have leaked into pericardial sac

● Causes: MVC, R ventricular biopsy, pericarditis, CABG

Assessment
● Chest pain
● Shortness of breath
● Decreased CO
● Muffled/distant heart sounds
● JVD
● Narrowed pulse pressure (<40)

Treatment - pericardiocentesis and surgery!

Question 24

Cardiomyopathies

Answer 24

● Disease of the myocardial tissue
○ Dilated
○ Restrictive
○ Hypertrophic

Question 24

Disorders of the heart valves

Answer 24

Types of heart valves
● Tricuspid ● Mitral
● Aortic
● Pulmonic
Stenosis
Narrowing, blocks blood flow
Regurgitation
Valves don’t close properly causing backflow

Question 25

Endocarditis

Answer 25

● Infection and inflammation of the endocardium
○ Valves

● Can lead to:
○ Valve abnormalities
■ Stenosis
■ Regurgitation
○ Poor cardiac output
○ Bacteremia
○ Bacterial emboli

● Treatment:
○ Antibiotics

Question 26

Complications of Heart Disease

Answer 26

Dysrythmias, HF

Question 27

Dysrhythmias

Answer 27

● Dysrhythmia = Arrhythmia
○ Disturbance of heart rhythm
● Range in severity from occasional missed beats or rapid beats to disturbances that impair myocardial contractility and are life-threatening
● Caused by:
○ SA node generates abnormal rate
○ Impulse is not conducted properly.
Arrhythmias:
● Sinus Bradycardia
● Sinus Tachycardia
● Heart Blocks
● A-fib
● A-flutter
● Supraventricular Tachycardia (SVT) ● V-tach
● V-fib

Question 28

Heart failure

Answer 28

The inability of the heart muscle to pump enough blood to meet the body’s needs for blood and oxygen
● Often results as a complication of other diseases
● #1 cause of HF is hypertension
● Other causes:
○ Cardiomyopathy
○ Endocarditis ○ MI
● Two types: Left and Right

Question 29

Left-sided Heart Failure

Answer 29

Left-sided Heart Failure
Left side of the heart cannot move blood forward to the body. Blood is backing up in the LUNGS.
Assessment:
● Pulmonary congestion
● Wet lung sounds
● Dyspnea
● Cough
● Blood tinged sputum
● S3

Question 30

Left-sided Heart Failure

Answer 30

Fatigue
Orthopnea
Rales/restlessness
Cyanosis/confusion
Extreme weakness
Dyspnea

Question 31

Right Heart Failure

Answer 31

Right side of the heart cannot move blood forward to the lungs. Blood is backing up in the BODY.
Assessment:
● Jugular venous distention
● Dependent edema
● Hepatomegaly
● Splenomegaly
● Ascites
● Weight gain
● Fatigue

Question 32

Right HF Symptoms

Answer 32

Bloating
Anorexia
Cyanosis
Oliguria
Nausea
Edema
Distended neck vein JVD

Question 33

HF Tx

Answer 33

Treatment
● DECREASE THE WORKLOAD OF THE HEART!
● Primary strategy is to decrease afterload:
○ ACE Inhibitors
■ Arterial dilation→ decreased afterload → increased stroke volume
○ ARBs
■ Decrease BP → decreased afterload → increased CO
● Increase contractility
○ Digoxin
● Diuresis
○ Client needs help reducing excess fluid