Cardiac Flashcards
1
Q
Which part of the pericardium of the heart is the contractile portion?
A
The myocardium
2
Q
What type of circulation is that which goes through the heart?
A
Coronary circulation
3
Q
Where do the AV node, SA node and the bundle of His receive blood supply from?
A
The right coronary artery
4
Q
Where does the left ventricle receive it’s blood supply from?
A
The left coronary artery
5
Q
Describe the electrical pathway of the heart
A
SA node → Atria contract → AV node → Bundle of His → Right and Left Bundle Branches → Purkinje Fibers → Ventricles contract
6
Q
Describe the flow of blood through the vasculature starting with arteries and ending with veins
A
Arteries → Arterioles → Capillaries → Venules → Veins
7
Q
Name 8 places where you can palpate a pulse
A
8
Q
What are the 5 names and locations of the APETM heart auscultation assessment?
A
9
Q
What does the S1 heart sound indicate?
A
The closure of the tricuspid and mitral valves.
10
Q
What does the S2 heart sound indicate?
A
The closure of the Aortic and Pulmonic Valves
11
Q
What does an S3 heart sound indicate?
A
An abnormal early diastolic sound during period of rapid ventricular filling.
12
Q
What does an S4 heart sound indicate?
A
An abnormal late diastolic sound during atrial systole
13
Q
What part of blood pressure is the S1 or “lub” sound part of?
A
Systolic
14
Q
What part of blood pressure is the S2 or “dub” sound part of?
A
diastolic
15
Q
What is happening in the heart during systole?
A
Blood is being pumped out of the heart
16
Q
What is happening in the heart during diastole?
A
The heart is filling with blood
17
Q
How can a patient’s hair give a clue that there might be a cardiac problem?
A
Brittle and dry hair might indicate poor nutrition possibly due to cardiac or vascular insufficiency
18
Q
How can a patient’s eyes give a clue that there might be a cardiac problem?
A
Vascular changes may be a result of ↑ BP.
Blue tinged conjunctiva is possible cyanosis.
Raised yellow/orange plaque under eyelids may indicate chronic serum cholesterol elevation.
19
Q
How can a patient’s lips or tongue give a clue that there might be a cardiac problem?
A
If they are blue → cyanosis.
If they are dry → dehydration.
20
Q
How can a patient’s jugular vein give a clue that there might be a cardiac problem?
A
If distended at a 45 degree angle → hypervolemia, right sided heart failure, pericardial tamponade, or constrictive pericarditis
21
Q
How can a patient’s chest give a clue that there might be a cardiac problem?
A
If crackles or rales are auscultated → left sided heart failure
22
Q
How can a patient’s abdomen give a clue that there might be a cardiac problem?
A
Fluid accumulation or enlarged tender liver indicates right sided heart failure.
A pulsating mass may indicate an abdominal aortic aneurysm.
23
Q
How can a patient’s skin give a clue that there might be a cardiac problem?
A
Dry and cool → Poor nutrition
Blue → Cyanosis
Pallor → ↓Circulation
24
Q
Where will you check for edema in a bedridden patient?
A
The sacrum
25
How can a patient's nail give you a clue that there might be a cardiac problem?
Clubbing → Chronic low O2 saturation as seen in congenital cardiac or pulmonary disease
Thick nails → Poor nutrition or impaired O2 delivery
26
What is absence of hair on the legs an indicator of?
Poor circulation
27
When doing a focused cardiac assessment on the legs, ankles and feet, what 4 things will you check for?
1. Edema
2. ↓ Pulse
3. ↓ Sensation
4. Pressure sores
28
What blood pressure range is considered prehypertension?
120/80 - 139/89
29
What blood pressure range is considered Stage 1 hypertension?
140/90-159/99
30
What blood pressure range is considered Stage 2 hypertension?
\>160/100
31
What is the difference between primary hypertension and secondary hypertension?
With primary, the cause is not known. With secondary, the cause is known.
32
What 5 things does having hypertension put you at risk for?
1. Myocardial infarction
2. Heart failure
3. Cerebral vascular accident
4. Renal failure
5. Dementia
33
What is the formula for calculating cardiac output?
Cardiac output = Stroke Volume x Heart Rate
34
What is stroke volume?
The amount of blood in the left ventricle per beat.
35
What is the formula for calculating Arterial BP?
Arterial BP = Cardiac output x Systemic vascular resistance
36
What type of medications can decrease stroke volume?
Diuretics
37
Hypertension is due to an increase in what?
Either cardiac output or systemic vascular resistance
38
What are 7 signs and symptoms of hypertension?
1. Asymptomatic (known as the "Silent Killer")
2. Fatigue
3. Reduced activity tolerance
4. Dizziness
5. Palpitations
6. Angina
7. Dyspnea
39
Name 5 organs that can be damaged by hypertension.
Damage to the:
1. Heart
1. Coronary artery disease
2. Left ventricular hypertrophy
3. Heart failure
2. Cerebrovascular disease
3. Peripheral Vascular disease
4. Kidneys
1. Nephrosclerosis
5. Eyes
1. Retinal damage
40
9 Bloodwork results to look for with hypertension
1. Urinanalysis
2. BUN
3. Serum creatinine
4. Serum electrolytes
5. Blood glucose
6. CBC
7. Serum lipid profile
8. Serum uric acid
9. TSH
41
3 Diagnostic studies for hypertension
1. Blood pressure measurement
2. 12 lead ECG
3. Echocardiogram
42
What is the leading cause of death in Western Culture?
Coronary Artery Disease (CAD)
43
What is the major cause of CAD?
Atherosclerosis
44
8 things that cause endothelial injury and can lead to atherosclerosis
1. Hypertension
2. Tobacco use
3. Hyperlipidemia
4. Hyperhomocysteinemia
5. Hemodynamic factors
6. Diabetes
7. Infections
8. Immune reactions
45
What is collateral circulation?
When the vessels create a bypass to go around a blocked portion of the vessel.
46
Signs and symptoms of CAD?
Asymptomatic until the coronary artery is too blocked to provide sufficient blood flow to the heart. Then, angina due to ischemia.
47
When does angina happen?
When the need for oxygen to the myocardium exceeds supply.
48
What is stable angina?
Predictable, only on exertion.
49
What is unstable angina (aka preinfarction angina)?
Symptoms are unpredictable and not relieved by rest or nitroglycerin.
50
What is variant angina (aka Prinzmetal's angina)
When the coronary artery spasms shut, causing temporary ischemia. Not due to atherosclerosis, but rather due to fluctuating estrogen levels.
51
What is silent angina?
Absence of any subjective symptoms.
52
What is Intractable angina (aka Refractory)
Severe, incapaciting chest pain which is unresponsive to interventions.
53
12 Clinical manifestations of angina.
1. Mild indigestion
2. Choking
3. Heavy sensation in upper chest
4. Discomfort to agonizing pain
5. Apprehension
6. Feeling of impending death
7. Weakness or numbness in arms, wrists, hands
8. Shortness of breath
9. Pallor
10. Diaphoresis
11. Dizziness
12. Nausea/Vomiting
54
In which veins is a DVT most common?
Iliac and femoral veins.
55
What is deep vein thrombosis (DVT)?
The formation of a thrombus or clot in association with inflammation of the vein.
56
What is the main concern with a DVT?
Embolization of the thrombus to the lungs.
57
What is a venous thromboembolism (VTE)?
A deep vein thrombosis (DVT) + a pulmonary embolism (PE).
58
What is Virchow's Triad?
Etiology of a DVT or VTE including:
1. Venous stasis
2. Vessel wall damage
3. Hypercoagulability of blood
59
What are the 6 clinical manifestations of DVT?
1. Edema
2. Pain
3. Warm skin
4. Erythema
5. Tenderness on palpation
6. Elevated temperature
60
What is venous insufficiency?
Stretched veins and damaged valves resulting from prolonged venous hypertension.
61
What 4 conditions result from venous stasis?
1. Edema
2. Venous stasis ulcers
3. Swelling
4. Cellulitis
62
What is peripheral arterial occlusive disease (PAOD)?
Advanced systemic atherosclerosis
63
Which artery in the body does not form plaque?
Internal mammary artery
64
What is Raynaud's disease
A vasospastic disorder of the small cutaneous arteries mostly involving the fingers and toes.
65
What is Buerger's disease (aka thromboangiitis obliterans)?
A recurrent inflammatory vasoocclusive disorder of the medium size arteries and veins and nerves of the upper and lower extremities.
66
What EKG rhythm is this?
Sinus rhythm
67
What EKG rhythm is this?
Sinus tachycardia
68
What EKG rhythm is this?
Sinus bradycardia
69
What sinus rhythm is this?
Atrial fibrillation
70
What is the normal PR interval on an EKG?
0.12-0.2
71
What is the normal QRS on an EKG?
0.04-0.11
72
What is the normal QT interval on an EKG?
0.36-0.44
73
What does the PR interval represent and what is happening?
The depolarization of the atrias.
The atria are contracting.
74
What does the QRS interval represent and what is happening?
The depolarization of the ventricles.
The ventricles are contracting.
75
What does the T wave represent?
The repolarization of the ventricles.
76
What does the U wave represent?
Repolarization of the purkinje fibers.
77
8 Nursing diagnoses for hypertension
1. Ineffective health maintenance
2. Deficient knowledge
3. Anxiety
4. Sexual dysfunction
5. Ineffective therapeutic regimen management
6. Noncompliance
7. Disturbed body image
8. Ineffective tissue perfusion
78
4 patient goals for hypertension
1. Understanding of hypertension
2. Understanding of treatment
3. Participation in self-care program
4. Absence of complications
79
What should a nurse educate a patient with hypertension on?
1. BP measurement/monitoring
2. Nutritional therapy
3. Physical activity
4. Drug therapy
5. Tobacco cessation
80
What are 4 medications that may be used for treating hypertension?
1. Thiazide diuretic
2. Ace inhibitors (end in "pril")
3. Calcium channel blockers (always end in "dipine")
4. Beta blockers (end in "olol")
81
What 5 side effects might be seen with calcium channel blockers?
1. Hypotension
2. Peripheral edema
3. Flushing
4. Headache
5. GI upset
82
What 5 side effects may be seen with beta-blockers?
1. Hypotension
2. Bradycardia
3. CHF
4. Bronchospasms
5. Impotence
83
7 diagnostic studies for CAD/Angina
1. ECG
2. Cardiac Enzyme and Troponin levels
3. Echocardiography
4. Exercise stress test
5. Cardiac catheterization
6. Percutaneous coronary intervention (PCI)
7. Percutaneous transluminal coronary angioplasty (PTCA)
84
Where is creatine kinase (CK) found and when is it released into the blood stream?
In skeletal muscle, heart muscle, brain and lungs.
With tissue death
85
What CK is specifically found in cardiac muscle?
CKMB
86
Where is troponin found and when is it released into the bloodstream?
Cardiac muscle.
Tissue death.
87
Three cardiac markers to test for tissue death.
1. Troponin
2. CKMB
3. Myoglobin
88
What is echocardiography?
An ultrasound of the heart.
89
3 Appropriate nursing interventions for echocardiography.
Educate the patient to:
1. To lie still
2. Lie on their left side
3. Breath normally
90
What is a pharmacological stress test?
Vasodilators are injected to dialate coronary arteries and then an ECG and BP is performed.
91
6 types of medications used for CAD/Angina Therapy
1. Nitrates
2. Calcium Channel Blockers
3. Ace Inhibitors
4. Beta Blockers
5. Cholesterol Lowering
6. Antiplatelet
92
Which should be high and which should be low? LDL or HDL?
LDL should be low
HDL should be high
93
Causes of hyperlipidemia?
1. Excessive dietary intake
2. Genetics
94
Normal ranges for total cholesterol, LDL and HDL
Total cholesterol \< 200
LDL 100-129
HDL 40-60
95
Levels that are consider "high" for total cholesterol, LDL, and HDL.
Total cholesterol \>239
LDL \>159
HDL \>59
96
What 3 types of drugs are given for high cholesterol?
1. Antihyperlipidemic agents
2. HMG-CoA reductase inhibitors (ends in "statin")
3. Niacin
97
If a patient is on Atorvastatin, a HMG-CoA reductase inhibitor, what food could increase risk of rhabdo?
Grapefruit juice
98
9 Nursing interventions for a patient taking Atorvastatin?
1. Vital signs
2. Lipid panel
3. Liver function test
4. CK for baseline
5. For pregnancy
6. Monitor for GI upset
7. Monitor urine
8. Administer at night with food.
9. Educate to report muscle tenderness or weakness.
99
How does an antiplatelet medication work?
To break up a platelet plug
100
How do anticoagulants work?
They interfere with the clotting cascade and thrombin formation.
101
What is the best known antiplatelet medication?
Acetylsalicylic Acid (Aspirin)
102
Nursing interventions for the patient on antiplatelet therapy
1. Observe for signs of bleeding
2. Education
1. Do not mix with alcohol
2. Do not mix with anticoagulants
3. Notify all MDs about use
4. Take with fluids and food
5. Notify physician immediately if GI distress
6. Report tinnitis, headache, dizziness, GI symtoms, visual changes, seizures
103
5 nursing diagnoses for DVT/VTE
1. Acute pain
2. Ineffective health maintenance
3. Risk for impaired skin integrity
4. Potential complication: bleeding
5. Potential complication: pulmonary embolus
104
9 ways a nurse can prevent DVT/VTE in their patient.
1. Early ambulation
2. Active and passive range of motion (AROM/PROM)
3. Apply Ted/SCD hose as prescribed
4. No crossing legs
5. Proper leg positioning with pillows
6. Encourage 3L of water day
7. Monitor IV lines
8. Low molecular weigh heparin (LMWH)
9. Encourage lifestyle changes
105
nursing interventions for the patient with DVT/VTE.
1. Bed rest
2. Elevate affected extremity
3. Avoid pillow under knee
4. Do not massage extremity
5. Intermittent warm compresses
6. Palpate site gently for warmth or edema
7. Measure and record leg circumference
8. Adminster diuretics, analgesics, or anticoagulants as prescribed
106
3 commonly used anticoagulants
1. Heparin
2. Enoxaparin (Lovenox)
3. Warfarin Sodium (Coumadin)
107
What is heparin used for?
The prevention of blood clots
108
What will the nurse monitor for the patient on Heparin?
1. Vital signs
2. PTT and aPTT (specific to heparin)
3. Platelet count
4. Bleeding
109
Which medication is a low molecular weight heparin?
Enoxparin (Lovenox)
110
What is Warfarin (Coumadin) used for?
Prevention of blood clotting
111
Foods with what vitamin should be avoided while taking warfarin? Examples?
Vitamin K
Dark leafy greens,
112
What should nurses assess for the patient on warfarin?
1. Baseline PT/INR
2. Medication history
113
2 nursing diagnoses for the patient on warfarin
1. Risk for injury
2. Ineffective tissue perfusion
114
What is dabigatran (Pradaxa) used for?
An anticoagulation medication used for blood thinning.
115
nursing interventions for patients with venous insufficiency
1. Elevation of legs
2. Sleep with foot of bed elevated
3. Encourage walking, no prolonged standing or sitting
4. Avoid pressure to the popliteal area
5. Graduated compression stocking
6. Protect extremities from trauma
7. Good skin care
116
Nursing interventions for patients with PAOD
1. Assess pain
2. Monitor extremities for 6 Ps
1. Pain
2. Pallor
3. Pulselessness
4. Paresthesia
5. Poikilothermia
6. Paralysis
3. Assess for ulcer formation and gangrene
4. Walk/rest/walk
5. Avoid leg crossing
6. Avoid exposure to cold
7. No heating pad to extremities
8. Good skin care
9. Avoid tobacco and caffeine
10. Administer and educate medications.
117
3 Classes of drugs with examples used for PAOD.
1. Antiplatelets
1. Clopidogrel (Plavix)
2. Aspirin
2. ACE inhibitors
1. ends with "pril"
3. Intermittent Claudification drugs
1. Cilostazol (Pletal)
2. Pentoxifylline (Trental)
118
What is the action of cilostazol (Pletal)
Platelet aggregation inhibitor
119
What is the action of pentoxifylline (Trental)
Blood thinner
120
