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Cardiac Flashcards

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1
Q

What do arteries carry?

A

Oxygenated blood

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2
Q

What do veins carry?

A

Deoxygenated blood

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3
Q

What is the one artery that carries deoxygenated blood?

A

Pulmonary artery

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4
Q

What is the one vein that carries oxygenated blood?

A

Pulmonary vein

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5
Q

What delivers deoxygenated blood into the RA?

A

Inferior and superior vena cava

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6
Q

What carries oxygenated blood from the LV to the body?

A

Aorta

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7
Q

Preload

A

Amount of blood returning to the right side of the heart and the muscle stretch that the volume causes.

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8
Q

What is released with the stretch of preload?

A

ANP

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9
Q

Afterload

A

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

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10
Q

Stroke volume

A

Amount of blood pumped out of the ventricles with each beat

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11
Q

CO formula

A

HR * SV

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12
Q

How does tachycardia decrease CO?

A

When you heart beats too fast, the ventricles don’t have enough time to fill

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13
Q

S/S of decreased CO

A 
Decreased LOC
Chest pain
SOB, wet lung sounds
Cold/clammy
Decreased UOP
Weak pulses
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14
Q

LV = ?

A

CO

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15
Q

Coronary artery dz includes what?

A

Chronic stable angina and acute coronary syndrome

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16
Q

Patho of chronic stable angina

A

Decreased blood flow to the myocardium leads to ischemia which causes temporary pain and pressure in the chest

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17
Q

What causes pain with stable angina?

A

Low O2, usually due to exertion

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18
Q

What relieves the pain caused by stable angina?

A

Rest, nitro

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19
Q

What are the 3 arrhythmias that are a big deal because they decrease CO?

A

Pulseless v tach
V fib
Asystole
*They’ll need CPR

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20
Q

How does nitro work?

A

Causes venous and arterial dilation which decreases preload and after load. Dilation of coronary arteries will increase blood flow o the myocardium
Decreases BP

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21
Q

How to take nitro

A 
1 every 5 minutes x 3 doses
(Take one, after 5 min if pain is still there or worse, activate emergency response)
May or may not burn/fizz
Do not swallow, put under tongue
*Never leave unstable client
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22
Q

How to store nitro

A

In the dark, glass bottle, dry, cool

Don’t mix, don’t open bottle often

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23
Q

How often do you renew nitro?

A

Every 3-5 months

Spray every 2 years

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24
Q

What is the main SE caused by nitro?

A

HA-don’t call doc cause you expect this, not life threatening

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25
Q

Examples of Ca channel blockers for angina

A

Nifedipine, verapamil, amlodipine, diltiazem

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26
Q

If you take nitro prophylactically, what should you do after taking?

A

Sit down for a while bc BP will decrease

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27
Q

How do Ca channel blockers work?

A

Decrease BP by causing vasodilation of the arterial system. They decrease after load and increase the oxygen to the heart muscle

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28
Q

Average aspirin dose for angina

A

81-325mg
-Keeps blood flowing from keeping platelets from sticking together, doesn’t treat pain directly, will result from increased oxygen with increased blood flow

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29
Q

Client education for chronic stable angina

A

Wait 2 hours after eating to exercise
Dress warmly in cold weather (warm or cold temp extremes can cause an attack)
Take nitro prophylactically
Stop smoking
Avoid isometric exercise (make muscles squeeze and tense up, increases workload of heart)

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30
Q

Cardiac Catheterization

A

Procedure used to diagnose heart dz, most definitive, also most invasive

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31
Q

What do you ask the client if they’re allergic to pre cardiac cath?

A

Iodine/shellfish

-Iodine based dye is used

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32
Q

What function do you check before cardiac cath?

A

Kidneys, that’s how they excrete the dye. Acetylcysteine (mucomyst) is ordered to help protect the kidneys

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33
Q

Hot shot

A

Warn, while injecting dye, iodine causes warmth and flushing, palpitations are also normal

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34
Q

What do you watch the puncture site for post heart cath?

A

Bleeding/hematoma formation

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35
Q

Positioning post heart cath

A

Bed rest, flat, leg straight for 4-6 hours

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36
Q

How do you assess extremity distal to puncture site post heart cath?

A

5 P’s

  • Pulselessness
  • Pallor
  • Pain
  • Paresthesia
  • Paralysis
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37
Q

Major complication of heart cath

A

Hemorrhage

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38
Q

Is pain normal after heart cath?

A

No, could mean hemorrhage, report immediately

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39
Q

How med do you stop 48 hours before heart cath?

A

Metformin. We are worried about the kidneys

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40
Q

Unstable chronic angina = ?

A

Impending MI

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41
Q

Patho of unstable angina

A

Decreased blood flow to myocardium leads to ischemia and necrosis. Client doesn’t have to be doing anything to bring this pain on, nitro will not relieve the pain

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42
Q

S/S of unstable angina/MI

A

Pain-crushing, elephant sitting on chest, pressure radiating to the left arm and left jaw, in between shoulder blades
N/V-Acute pain stimulates vomiting center in brain, when they vomit the vagus nerve is stimulated-decreased HR and CO
Cold/clammy
BP drops-CO is decreasing
ECG changes

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43
Q

Common time for MI

A

Morning, coming out of dreams, getting up leads to increased HR and BP

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44
Q

Pain for women for MI

A

GI s/s, epigastric pain or pain between shoulders, aching jaw, choking sensation

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45
Q

1 sign of MI in elderly

A

SOB, acute behavior change

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46
Q

STEMI

A

ST segment elevation MI indicates the client is having a heart attack and the goal is to get them to the cath lab for PCI in less than 90 minutes

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47
Q

CPK-MB

A

Cardiac specific isoenzyme
Increases with damage to cardiac cells
Elevates 3-12 hours and peaks in 24 hours

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48
Q

Troponin

A

Cardiac biomarker with high specificity to myocardial damage

Elevates within 3-4 hours and remains elevated for up to 3 weeks

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49
Q

Normal lab values for Troponin T

A
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50
Q

Normal lab values for Troponin I

A
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51
Q

Myoglobin

A

Increases within 1 hour and peaks in 12 hours

Negative results are a good thing

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52
Q

Which cardiac biomarker is the most sensitive indicator for an MI?

A

Troponin

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53
Q

Which enzymes or markers are most helpful when the client delays seeking care?

A

Troponin

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54
Q

Priority treatment for V-Fib

A

Defibrillate, do CPR in between shocks until you get an effective heart beat

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55
Q

If the first shock doesn’t work and the v fib client remains in v fib, what is the first vasopressor we give?

A

Epi

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56
Q

Amiodarone

A

Anti-arrhythmic, used in v fib or pulseless v tach when shocks and epi do not work, and also for fast arrhythmias

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57
Q

What anti arrhythmic drugs are commonly given to prevent a second episode of v fib?

A

Amiodarone and lidocaine (decreases irritability of heart)

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58
Q

Sign of lidocaine toxicity

A

Neuro changes

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59
Q

Important SE of amiodarone?

A

Hypotension, can lead to further arrhythmias

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60
Q

What drugs are used for chest pain when the client gets to the ED?

A

O2
Aspirin (165-325, chewable, if not given before arrival)
Nitro
Morphine

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61
Q

What position do you keep the MI patient in?

A

Head up, decreased workload on the heart and increases CO

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62
Q

Goal of fibrinolytics

A

Dissolve clot that is blocking blood flow to the heart muscle which decreases the size of the infarction

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63
Q

Fibrinolytic meds

A

Streptokinase, alteplase, tenecteplase, reteplase

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64
Q

How soon after the onset of myocardial pain should these drugs be administered?

A

Within 6-8 hours, sooner the better

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65
Q

Door to drug time for fibrinolytic?

A

30 minutes

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66
Q

Time is what?

A

Brain

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67
Q

Major complication of fibrinolytic?

A

Bleeding

68
Q

Which fibrinolytic are people allergic to most often?

A

Streptokinase, will have to treat them for their allergy also but still give it

69
Q

Absolute contraindications of fibrinolytic therapy

A

Massive hemorrhage, intracranial neoplasm, intracranial bleed, pregnancy, suspected aortic dissection, internal bleeding

70
Q

Bleeding precautions

A

Watch for bleeding gums, hematuria and black stools, electric razor, soft toothbrush, no IMs, no ABGS-too much bleeding

71
Q

Draw blood when for bleeding precautions?

A

When starting IV, decrease amount of puncture sites

72
Q

Follow up therapy of fibrinolytic

A

Antiplatelets (acetylsalicylic acid, clopidogrel

73
Q

Where do you give fibrinolytic?

A

Peripheral site you can compress in case of hemorrhage (not a place like jugular, you can hold pressure on that)

74
Q

PCI

A

Percutaneous coronary intervention. Incledes PTCA (angioplasty) and stents. Can be done in any artery in body, not just heart

75
Q

What are you trying to do with PCI

A

Open up coronary artery, restore blood flow to heart

76
Q

Major complication of angioplasty

A

MI. Don’t forget the client may bleed from the heart cath site, or they could re occlude

77
Q

If any problems occur during PCI?

A

Go to surgery.

78
Q

Chest pain after PCI?

A

Call doc at once, they are re occluding

79
Q

Anti platelet meds

A

Aspirin, clopidogrel, abciximab, eptifibatide

80
Q

When is a CABG indicated?

A

Multiple vessel dz or left main coronary artery occlusion

81
Q

Left main coronary artery

A

Supplies blood to the entire left ventricle

82
Q

Left main coronary artery occlusion-think what?

A

Sudden death, widow maker

83
Q

Activity after CABG

A

Increase gradually, no isometrics, no valsalva (vagal nerve stimulation will bottom out their HR), no straining/suppository/docusate

84
Q

Diet after CABG

A

Low fat, low salt, low cholesterol

85
Q

When can sex be resumed after CABG?

A

When they can walk around the block or up a flight of stairs with no discomfort (usually within 1 week to ten days)

86
Q

What is the safest time for sex after CABG?

A

Morning when the client is well rested

87
Q

Best exercise for MI client

A

Walking

88
Q

Left side heart failure

A

The blood is not moving forward into the aorta and out to the body, if it doesn’t move forward, it goes backward into the lungs

89
Q

S/S of left side heart failure

A 
Blood tinged frothy sputum
Restlessness/tachycardia
S-3
Nocturnal dyspnea/orthopnea
Pulm congestion/dyspnea/cough
90
Q

Right side heart failure

A

The blood is not moving forward into the lungs, it it doesn’t more forward into the lungs, it goes backwards into the venous system

91
Q

S/S of right side heart failure

A 
Distended neck veins
Edema
Enlarged organs
Weight gain
Ascites
92
Q

BNP for diagnosis of heart failure

A

Secreted by the ventricular tissues in the heart when ventricular volumes and pressures in the heart are increased
Sensitive indicator
Can be positive for HF when the CXR doesn’t indicate a problem
*If client is on nesiritide, turn off for 2 hours prior to drawing a BNP

93
Q

What can cause right side heart failure

A

PE, hypoxia #1 cause of pulm htn, workload of right side of heart is increased
Left sided heart failure

94
Q

What do you look at on a CXR to diagnose heart failure

A

Enlarged heart, pulmonary infiltrates

95
Q

What can diagnose heart failure besides CXR and BNP

A

Echo

96
Q

Swan-Ganz catheter

A

Balloon flotation catheter is inserted into the right side of the heart and pulmonary artery. It provides info to rapidly determine hemodynamic pressures, CO and provides access to mixed venous blood sampling

97
Q

DOC fo rHF

A

ACE inhibitors

98
Q

Most common site for arterial line

A

Radial artery

99
Q

A lines purpose

A

Continuous intra-arterial BP monitoring and allows for related ABG samples to be collected without sticks

100
Q

ACE inhibitor action

A

Suppress renin angiotensin system, prevents conversion of angiotensin I to angiotensin II
Results in arterial dilation and increased stroke volume

101
Q

ARBS

A

Block angiotensin II receptors and causes a decrease in arterial resistance and BP
May be used before ACE inhibitors due to the SE of nagging dry cough of ACE inhibitors

102
Q

ACE inhibitors and ARBs both block aldosterone. What do you monitor the client for?

A

Hyperkalemia

103
Q

Why is it standard practice for HF client to be sent home on ACE inhibitor and/or beta blocker?

A

In combination they decrees the workload on the heart by prevention vasoconstriction (decreasing after load)
This increases CO and keeps blood moving forward out of the heart

104
Q

Digoxin

A

Makes contractions stronger, decreases HR. When the HR is slowed, this gives the ventricles more time to fill with blood, CO and kidney perfusion will increase

105
Q

Why is digoxin used less today?

A

High risk of toxicity, especially in elderly

106
Q

IS diuresis a good thing or bad thing for HR client?

A

Good, we always want to diaries them, they can’t handle fluid

107
Q

Normal Dig level?

A

0.5-2 ng/mL

108
Q

How do you know dig is working?

A

CO goes up

LOC goes up, skin is warm/dry, clear lungs, not SOB, palpable/increase pulses, increased UOP, no chest pain

109
Q

Is it smart to give HF client whole blood?

A

No, throw them into pulmonary edema

110
Q

S/S of dig toxicity

A

Early: anorexia, n/v
Late: arrhythmias and vision changes (not just halos around lights, any changes)

111
Q

What do you do before administering dig?

A

Check the apical pulse

5th intercostal space, left midclavicular line, can move around in some people

112
Q

First few doses of dig are what?

A

Larger than maintenance dose they’ll be sent home on. Digitalizing (loading) dose builds them up on the drug

113
Q

Which electrolytes do you monitor with dig?

A

All, but K is the one that causes the most trouble

Decreased K + Dig = toxicity

114
Q

Diuretics

A

Decreases preload by increasing diuresis

115
Q

When do you administer diuretics?

A

In the morning

116
Q

Low Na diet with HF client

A

Decreases preload, watch salt substitutes bc they can contain excessive K, OTC meds can also have a lot of salt

117
Q

Weigh HF client daily, report what?

A

Gain of 2-3 lbs

118
Q

Fluid retention, think what first?

A

Heart problems

119
Q

Natural pacemaker

A

SA node/sinus node

Sends out impulses that make the heart contract

120
Q

When are pacemakers used?

A

To increase HR with symptomatic bradycardia

121
Q

What do pacemakers do to the heart muscle to make a contraction occur?

A

Depolarize them, electricity goes through the muscle

122
Q

Repolarization

A

Ventricles are resting and are filling up with blood

123
Q

Set rate of pacemaker

A

Always know the set rate, and worry if it drops BELOW the set rate

124
Q

Demand pacemaker

A

Kicks in only when the client needs it to, when the demand is turned on

125
Q

Fixed rate pacemaker

A

Fire at a fixed rate constantly

126
Q

Is it okay for a pacemaker rate to increase?

A

Yes, but never decrease

127
Q

Post-procedure care for permanent pacemakers

A

Immobilize arm
Assisted passive range of motion to prevent froze shoulder
Keep client from raising arm higher than shoulder height
*Can also be implanted in abdomen

128
Q

Most common complication of pacemaker placement post op?

A

Electrode displacement, monitor the incision

129
Q

S/S of pacemaker malfunction

A

Loss of capture

This is when no contraction follows the stimulus

130
Q

Cause of loss of capture

A

Could not be programmed correctly
Electrodes can dislodge
Battery may be depleted

131
Q

What do you watch for when monitoring for loss of capture?

A

Decreased CO or rate

132
Q

Client teaching for pacemaker

A

Check pulse daily
ID card
Avoid electromagnetic fields (cell phones on opposite ear, large motors)
Avoid MRIs
Avoid contact sports
They will set off alarms at airport-shouldnt go through machines, be patted down-dont use want above waist, it is a magnet

133
Q

ICD

A

Implantable cardiac device

May be used to pace the heart or to defibrillate people in V-Fib

134
Q

Post op care for ICD placement

A

Same as for a pacemaker

135
Q

Who is at risk for pulmonary edema?

A

Any person receiving IV fluids really fast, the very young and very old, any person with a history of heart or kidney dz

136
Q

When does pulmonary edema usually occur

A

At night when the client goes to bed. During the day the fluid is in your extremities

137
Q

S/S of pulmonary edema

A 
Sudden onset
Breathless
Restless/anxious
Severe hypoxia
Productive cough (pink frothy sputum)
138
Q

Tx for pulmonary edema

A

Oxygen-high flow, titrate to keep sats above 90%

139
Q

Furosemide for treatment of pulmonary edema

A

Causes diuresis and vasodilation which traps more blood out in the arms and legs and reduces preload and afterload
40mg IV push slowly over 1-2 minutes to prevent hypotension and ototoxicity

140
Q

Bumetanide for tx of pulm edema

A

Can be given IV push or as cont IV infusion to provide rapid fluid removal
1-2 mg IV push given over 1-2 minutes

141
Q

Nitro for tx of pulm edema

A

Vasodilation decreases afterlaod, which lead to increased CO because the heart is pumping against less pressure, and more blood can be moved forward

142
Q

Morphine for tx of pulm edema

A

2 mg IV push for vasodilation to decrease preload and afterload

143
Q

Nesiritide for tx of pulm edema

A

IV infusion, short term therapy, not to be given for more than 48 hours
Vasodilates veins and arteries and has a diuretic effect

144
Q

Positioning for pulm edema

A

Upright with legs down to improve CO and promote pooling or blood in lower extremities

145
Q

Prevention of pulm edema

A

Check lung sounds and avoid fluid volume excess

146
Q

Cardiac tamponade

A

Blood, fluid, or exudates have leaked into the pericardial sac resulting in compression of the heart
Can happen if the client has had a motor vehicle collision, right ventricular biopsy, an MI, pericarditis, or hemorrhage post CABG

147
Q

S/S of cardiac tamponade

A 
Decreased CO
CVP increases bc heart is squeezed
BP drops bc CO is dropping
Heart sounds muffled or distant
Distended neck veins
Pressures in all 4 chambers are the same
Shock
Narrowed pulse pressure from baseline
148
Q

Hallmark sign of cardiac tamponade

A

Increasing CVP with decreasing BP

149
Q

Pulse pressure

A

Difference between systolic and diastolic pressures

150
Q

Narrowed pulse pressure think what?

A

Cardiac tamponade

151
Q

Widened pulse pressure think what?

A

Increased intracranial pressure

152
Q

Tx of cardiac tamponade

A

Pericardiocentesis or sx

153
Q

Pericardiocentesis

A

Removes blood from around the heart

Doc inserts needle into pericardial space to remove fluid

154
Q

If you have atherosclerosis in one place, what does this mean?

A

You have it everywhere

155
Q

Acute arterial occlusion

A

Numb, pain, cold, no palpable pulse
More symptomatic in lower extremities
Medical emergency

156
Q

Hallmark sign of acute arterial occlusion

A

Intermittent claudication

157
Q

Bruit

A

Turbulent blood flow

158
Q

Patho of acute arterial occlusion

A

Arterial blood isn’t getting to the tissue which leads to coldness, decreased peripheral pulses, atrophy, burst, skin/nail changes, ulcerations

159
Q

Pain at rest means what?

A

Severe arterial obstruction

160
Q

Since arterial blood is having problems getting to tissues with acute arterial occlusion, will elevating the extremity increase or decrease the pain?

A

Increase, dangle affected limb to increase perfusion

161
Q

How to treat vein problems?

A

Elevate

162
Q

How to treat arterial problems?

A

Dangle

163
Q

How do you treat arterial disorders of the lower extremities?

A

Angioplasty or endarterectomy to enhance perfusion

164
Q

How do you know if a carotid endarterectomy was a success?

A

Carotids feed brain, therefore the LOC should go up
Shiny hair, increased temporal pulses, or follow verbal commands. Which is correct?
Most important is brain (LOC) so follow verbal commands

165
Q

Abdominal aortic aneurism how do you know if it was successful?

A

Check pulse from waste down, starting at femoral, should feel warmer as you go, monitor UOP

166
Q

Dissecting aorta major complaint

A

Severe burning back pain, with each beat the aorta is tearing apart so pulsatile back pain

167
Q

Small pain in leg when walking after heart surgery

A

Lean against wall, take weight off of it, wheel to room, elevate leg, then call doc

NCLEX (14 decks)

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