Cardiac 2 Flashcards
What 3 issues cause left sided heart failure?
Hypertension, cad, valvular disease
Etiology: 75% of all heart failure cases come from what?
Systemic hypertension
What type of left sided heart failure is described by the heart not pumping enough blood out?
Systolic heart failure
What type of left sided heart failure is described as insufficient filling of the chambers and a stiffening of the left ventricle?
Diastolic heart failure
What type of heart failure is described by: the heart backing up into the lungs
Left sided heart failure
What is the term for the percentage of blood ejected from the heart during systole? And what is normal?
Ejection fraction. 60-75%
What is this process? Abnormal relaxation and stiffness of heart-elevated left ventricle filling pressure-elevated pulmonary pressure-reduced exercise tolerance.
Diastolic dysfunction
What 3 things cause right sided heart failure?
Left sided heart failure, right side mi, pulmonary hypertension
What happens when the right ventricle cannot fully empty causing an increase in Volume and pressure in the venous system resulting in peripheral edema?
Right sided heart failure
True or false: all compensatory mechanisms add to increase need for o2
True
Name the disease: clinical manifestations –weakness, confusion, sob, pulmonary congestion, no urine output
Left sided heart failure
Name the disease: clinical manifestation- dependent edema, weight, distended neck veins, hepatomegaly, ascities
Right sided heart failure
How many lbs of water must a person gain before putting edema sets in?
10-15 lbs
What does a bnp lab test tell?
How much fluid overload is in the body
Sob + elevated bnp=
Heart failure
Sob + normal bnp =
Pulmonary cause
What are the goals of interventions for impaired gas exchange?
Increased pulse of and reduce o2 given
What medicine is the first line of defense for decreased cardiac output?
Ace inhibitor
What medication do you use to enhance contractility of the heart?
Beta blocker
What is the widespread abnormal cellular metabolism that occurs when human need for o2 and tissue perfusion is not met for function?
Shock
What are the 3 classifications for shock?
Cardiogenic, hypovolemic, and distributive
What are the 4 causes of shock?
Fluid loss, hypo-perfusion, injury, weakened cardiac contractility
What are the 3 components of the cascade of metabolic metabolism?
Hypothermia, coagulopathy, acidosis
True or false: manifestations of shock are similar regardless of what starts the process.
True
What measures tissue perfusion?
Mean arterial pressure
What is the normal range for MAP?
75-110mmHg
How do you calculate MAP
(2 x diastolic + systolic) / 3
What factors influence MAP?
Total blood volume, cardiac output, sz of vascular bed
True or false: Increased blood volume, cardiac output, and vasoconstriction increases MAP
True
True or false: decreased blood volume and cardiac output with vasodilation cause decreased MAP
True
What 4 factors determine the severity of hypovolemic shock?
Co-morbidity, age, time before treatment, venous vs arterial
What are the four stages of shock?
Initial- early
Non-progressive- compensatory
Progressive- immediate stage
Refractory- irreversible
In what stage of shock does shunting occur?
Non-progressive compensatory
What is shunting?
Blood is used for important organs first
What is the goal of compensatory shock?
Keep volume in central blood vessels
True or false: a person can stay In the non-progress phase for hours and not have lasting damage.
True
Name the state of shock: compensatory is working but not enough 02 for organs, anoxic cell death, life threatening
Progressive immediate
Name the state of shock: rapid loss of confusion, non palpable pulses, cold mottled skin, cell/tissue death, depressed heart, can lead to MODS
Refractory - irreversible
Name the disease: massive release of toxins, trigger small clots, blocks tissue oxygenation, damage more cells
MODS
What are the odds of surviving progressive shock?
50/50
True or false: you can have more than one type of shock at the same time
True
What is the triad of shock
Coagulopathy, hypothermia, acidosis
What determines the amount for transfusion for a pt?
Amount loss in 24 hrs
What is the best monitor for tissue perfusion?
Pulse ox
What is interesting about BP in hypovolemic shock?
Systolic decrease diastolic increase
What is a lactate test?
Determines how much lactic acid is in the blood. Lower the better
True or false: 02 should remain around 95% to ensure safety. Any higher can cause organ and lung damage
True
What are synthetic plasma expanders?
Used by military, no cross match needed
What do you use to pre medicate before a transfusion?
Antipyretic and anti inflammatory
What is the only solution that can be a primary with a blood transfusion?
Normal saline only
What disease will a pt present with kussmaul breathing?
Dka
What disease will a patient present with biots breathing pattern?
Neuro issues
Breath sound= high pitched, narrowing, musical sound
Wheeze
Breath sound: crowing in trach and upper airway
Stridor
Breath sound: fluid in lungs, light popping sound, not musical
Crackles
What monitors co2 and ph
Brain stem
What is the name for the constant change of o2 and co2?
Diffusion
What is the most common cause of hypoxemia?
Abn ventilation to perfusion rate
What patients get hypercapneia ( too much co2)?
Unconscious pt, drug overdose, copd
What is atelectasis?
Complete collapse of alveoli
What does carbonic acid regulate?
Regulates ph
What is aat relating to copd?
Protein that protects the lungs
Name the disease: abn permanent enlargement of air space, loss of lung elasticity, alveoli wall fibrosis, hyperinflation/distension of alveoli, flattened diaphragm
Emphysema
What is an avelolar bleb?
When it bursts open
What is an avelolar bullae?
Collapse of alveola
Poor gas exchange in lungs leads to vasoconstriction that leads to pulmonary hypertension. Right ventricle fails die to pumping against high pressure in lungs . Right sided failure
Cor pulmonale
