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NCLEX > Cardiac > Flashcards

Cardiac Flashcards

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1
Q

preload

A

the amount of blood returning to the right side of the heart and the muscle stretch that the volume causes. ANP is released when we have this stretch.

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2
Q

afterload

A

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

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3
Q

with HTN there’s even more ____ for the left ventricle to pump against. that’s why ____ can eventually lead to HF and pulmonary edema, because high afterload ____ CO and ____ forward flow. plus, it wears your heart out

A

resistance
HTN
decreases
decreases

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4
Q

stroke volume

A

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

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5
Q

CO= ____

A

HR times SV

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6
Q

less pressure = ___ CO

more pressure = ___ CO

A

decrease

increase

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7
Q 
If you CO is decreased, 
will you perfuse properly?
brain: LOC will go \_\_\_
heart: client reports of \_\_\_
Lungs: SOB? Lung sounds?
Skin: 
Kidneys: UO \_\_\_
peripheral pulses:
A 
No
down
chest pain
yes and lungs sound wet
cool and clammy
down
weak and thready
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8
Q

what are 3 arrhythmias that are a big deal?!

A
  1. pulseless vtach
  2. vfib
  3. asystole
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9
Q

chronic stable angina

A

decreased blood flow to the myocardium—ischemia–temp. pain/pressure in the chest

pain comes on by low o2 usually due to excretion

rest relieves pain or nitro

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10
Q 
nitroglycerin:
 \_\_\_\_ preload and afterload.
take 1 every \_\_\_ , \_\_ doses
okay to swallow?
renew how often?
A

decreases
5 mins, 3 doses
no
3-5months, spray 2 yrs

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11
Q

what should you do before giving beta blocker?

A

check HR and BP!!!

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12
Q

what is beta blocker?

A

[propanolol,metoprolol,]
for prevention of angina
-decrease BP,HR, myocardial contractility
-decreases the workload of the heart

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13
Q

calcium channel blockers?

A 
[verapamil,amlodipine]
prevention of angina
-decreases BP
-causes vasodilation
-decrease afterload and increase o2 to the heart muscle
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14
Q

aspirin

A

use to keep platelets from sticking together

-dose it determined by the physician (81-225mg)

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15
Q

treatment for chronic stable angina

A
  • nitro
  • beta blocker
  • calcium channel
  • asa
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16
Q

the 5 p’s

A 
pulselessness
pallor
pain
paresthesia
paralysis
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17
Q

preprocedure for cardiac cath:

A

ask if they are allergic to shellfish or iodine

also check kidney function (because you excrete dye through the kidney)

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18
Q 
post procedure for cardiac cath:
bed rest, leg straight for \_\_\_ hours
watch for bleeding
5 p's extremity distal to puncture site
major complication?\_\_\_
if the client is on metformin, you should?
A

4 to 6 hours
hemmorage
hold the medicine for 48 hours post procedure. we are worried about the kidneys

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19
Q

what is the women triad of symptoms for acute MI?

A 
GI S/S
epigastric complaints 
pain between the shoulders
aching jaw
choking sensation
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20
Q

when a patient is having an STEMI, this indicates that the client is having a heart attack and the goal is ___

A

is to get them to the cath lab for PCI in less than 90 mins

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21
Q

what increases with damage to the cardiac cells?

when does it elevate?

A

CPK-MB
(cardiac specific iso-enzyme)

3-12 hours and peaks in 24 hours

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22
Q

troponin elevates within ____ and remains elevated for ___.

A

cardiac biomaker with high specificity to myocardial damage.

3-4 hours
3 weeks

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23
Q

myoglobin increases within ____ hours and peaks in __ hours.

A

1 hour
12 hours
(negative results are a good thing)

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24
Q

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

A

troponin

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25
Q

which enzymes or markers are most helpful when the client delays seeking care for an MI?

A

tropinin

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26
Q

what untreated arrhythmias will put the client at risk for sudden death?

A

pulseless v-tach
vfib (dfib the vfib!)
asystole
bradycardia

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27
Q

if the first shock doesn’t work and the client remain in vfib, what is the first vasopressor we give?

A

epinephine

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28
Q

lab value for troponin

A

T less than 0.10. I less than 0.03

29
Q

____ is an anti-arrthythmic and is used when v-fib and pulseless VT are resistant to treatment, also for fast arrhythmias

A

amiodarone (drug of choice)

30
Q

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

A

amirodarone and lidocaine

31
Q

lidocaine toxicity: _____

A

any neuro changes

32
Q

amiodorone is _____.

important side effect is ____.

A

the first anti-arrhythmic of choice

hypotension

33
Q

what drugs are used for chest pain when they get to theED?

A

oxgyen
ASA (chewable, absorbs faster)
nitro
morphine (if pain isnt relieved)

head up position.. because decreases workload on the heart and increases CO

34
Q

what are the fibrinolytics drugs?

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

A

-dissolves the clot that is blocking the blood flow to the heart muscle—-decreased the size of the infarction

streptokinase,alteplase

within 6-8hours
(exception to this is CVA, time loss is brain loss! 3hr with CVA)

35
Q

what is the widow maker (sudden death)?

A

left main coronary artery occulsion

36
Q

left side heart failure

A

the blood is not moving forward into the aorta and out to the body…. IF it does not move forward, then it will go backwards into the LUNGS!

37
Q

s/s of left side heart failure

A 
left=lungs!!
pulmonary congestion
dyspnea
cough
blood tinged frothy sputum
restlessness
tachycardia
S-3
 orthopnea
nocturnal dyspnea
38
Q

right side heart failure

A

the blood is not moving forward into the lungs…IF it does not move forward then it goes backwards into the VENOUS system

39
Q

s/s of right side heart failure

A 
right=venous thing
distended neck veins
edema
enlarged organ
weight gain 
ascities
40
Q

systolic heart failure

A

heart cant contract and eject

41
Q

diastolic heart failure

A

ventricles cant relax and fill 

42
Q

BNP (b-type natriuretic peptide):

A
  • secreted by the ventricular tissue in the heart when the ventricular volumes and pressure in the heart increased
  • sensitive indicator
  • can be positive for HF when the CXR does not indicate the problem
  • if the pt is on nesiritide, turn it off 2 hr prior to drawing BNP
43
Q

how do you diagnose heart failure?

A

BNP
CXR
echocardiogram

44
Q

what is the standard medication for HF?

A

ACE inhibitors and ARBs

45
Q

ACE inhibiotors:

A

drug of choice for HF
suppress the renin angiotensin system
prevent conversion of angiotensin 1 to angiotensin 2
results in the arterial dilation and increased SV

46
Q

ARBs

A

-block angiotenin 2 receptors, and cause a decrease in arterial resistance and decreased BP

47
Q

ace inhibitors and ARBS block ____.

A

aldosterone. when we block aldosterone, we lose sodium and water and retain potassium.

48
Q

digoxin is used with ….

A

sinus rhythm or afib and accompanying chronic HF.

makes contractions stronger
slows HR down
CO up
kidney perfusion UP

49
Q

normal digoxin level

A

0.5-2

50
Q

s/s of digoxin toxicity

A

early: anorexia, N/V
late: arrhythmias and visual changes (halos around the lights)

51
Q

_____ + digoxin= toxcity

A

hypoglycemia

52
Q

diuretic decrease ___.

when should you give diuretic?

A

preload

in the morning

53
Q

loss of capture with pacemaker

A

no contraction will follow the stimulus

54
Q

who is at risk for pulmonary edema?

A

any person :
receiving IV fluid really fast
very young and very old
any person with history of heart or kidney disease

55
Q

what is pulmonary edema?

A

fluid is backing up into the LUNGD. the heart is unable to move the volume forward.
pulmonary edema usually occurs at night, when the client goes to lie down.

56
Q

s/s of pulmonary edema?

A 
sudden onset
breathless
restless/anxious
severe hypoxia
productive cough (pink frothy sputum)
57
Q

tx for pulmonary edema?

A

diuretics
nitro
morphine
nesiritide

58
Q

furosemide, you should give _____ to prevent hypotension and ototoxicity

A

40 mg IV push slowly over 1-2 mins

59
Q

bumetanide can be given _____ to provide rapid fluid removal.

should be given ___ over 1-2 mins

A

IV push or as a continuous iv infusion

1-2 mg IV push

60
Q

remember to turn the nesiritide infusion OFF ….. when?

A

2 hrs before drawing a BNP level

61
Q

cardiac tamponade

A
  • blood ,fluid, or exudate have leaked into the pericardial sac resulting in compression of the heart
  • this can happen if the client has had a motor vehicle collision, right ventricular biopsy, and MI, pericarditis, or hemorrhage post CABG/s of c
62
Q

s/s of cardiac tamponade

A 
decreased CO
cvp will go UP
BP will drop
 (hallmark is increase cvp, decrease bp)
heart sounds will be muffled or distant
neck veins distended
pressure in all 4 chambers are the same
shock
narrowed pulse pressure (bp 120/80...pule pressure is 40)
63
Q

narrowed pulse pressure think:

widened pulse pressure think:

A

cardiac tamponade

increased intracanial pressure

64
Q

tx for cardiac tamponade

A

pericardiocentesis to remove blood from around the heart

-surgery

65
Q

intermittent claudication is hallmark sign for __.

A

arterial disorders

66
Q

postion:
we ELEVATE ___
we DANGLE ___

A

veins

arteries

67
Q

s/s of dissecting aorta

A

severe burning back pain, unlike anything

may feel pulsation

68
Q

if vein problems, dont answer with an ____.

A

oxygen!

NCLEX (14 decks)

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