Cardiac Flashcards

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1
Q

normal blood flow through the heart

A
RA
RV
PA
lungs
PV
LA
LV
Aorta
Body
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2
Q

the amount of blood returning to the right side of the heart and the muscle stretches that the volume causes

A

preload

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3
Q

_____ is released when the heart stretches

A

ANP

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4
Q

is the pressure in the aorta and peripheral arteries that the LV has to pump against to get the blood out

A

afterload

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5
Q

after load is referred to as ____

A

resistance

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6
Q

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

A

stroke volume

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7
Q

___ ____ is dependent on adequate cardiac output

A

tissue perfusion

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8
Q

factors that affect CO

A

heart rate
blood volume
decreased contractility

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9
Q

meds to decrease preload

A

furosemide

nitro

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10
Q

meds to decrease afterload

A

ACE inhibitors
ARBS
hydralazine
nitrates

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11
Q

meds to improve contractility

A

inotropes (dopamine, dobutamine, milrinone)

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12
Q

meds for rate control

A

BB
CCBs
Digoxin

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13
Q

meds for rhythm control

A

anti-arrhythmics (amiodarone)

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14
Q

3 arrhythmias that are always a big deal

A

pulselessl v. tach
v. fib
asystole

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15
Q

the most common type of cardiovascular disease

A

coronary artery disease

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16
Q

coronary artery disease is a broad term that includes which 2 things?

A

chronic stable angina

acute coronary syndrome

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17
Q

chronic stable angina has pain that is brought on by?

A

low O2 on exertion

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18
Q

what relieves pain with chronic stable angina

A

rest and/or nitro

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19
Q

nitro causes venous and arterial _____

A

vasodilation

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20
Q

can you swallow nitro?

A

NO

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21
Q

where do you keep nitro?

A

in a dark glass bottle

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22
Q

most common sx of nitro

A

HA

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23
Q

renew nitro how often?

A

every 3-5 months

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24
Q

what to BB do to BP, HR, and myocardial contractility?

A

drops!

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25
Q

CCBs dilate the _____ arteries

A

coronary

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26
Q

2 benefits of CCBs are that they ?

A

decrease after load and increase Oxygen to the heart muscle

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27
Q

avoid what type of exercises for chronic stable angina?

A

isometric

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28
Q

pre-procedure for cardiac cath need to ask?

A

iodine/shellfish allergy

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29
Q

check ____ function before heart cath?

A

kidney

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30
Q

_____ is a med most HCP order prior to heart cath to protect the kidneys

A

acetylcysteine

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31
Q

main priority concern post op heart cath

A

bleeding

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32
Q

assess for the 5Ps post op heart cath

A
pulselessness
pallor
pain
paresthesia
paralysis
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33
Q

unstable chronic angina = impending _____

A

MI

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34
Q

acute coronary syndrome is also known as ____ and ___ ____

A

MI

unstable angina

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35
Q

does acute coronary syndrome have ischemia, necrosis or both?

A

both

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36
Q

does the client with acute coronary syndrome have to be doing anything to bring this pain on?

A

NO

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37
Q

will rest or nitro fix the pain with acute coronary syndrome?

A

NO

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38
Q

sx of acute coronary syndrome

A
pain
cold/clammy/BP drops
decreased CO
ECG changes
vomiting
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39
Q

with acute coronary syndrome they may describe pain as ____

A

crushing

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40
Q

1 sign of an MI in elderly?

A

SOB

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41
Q

this indicates that the client is having a heart attack

A

STEMI

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42
Q

the goal with STEMI is to get them to the cath lab for PCI in less than ____ minutes

A

90

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43
Q

cardiac specific isoenzyme

increases with damage to cardiac cells

A

CPK-MB

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44
Q

CPK-MB elevates within __-__ hours and peaks in __-__ hours

A

3-6

12-24

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45
Q

cardiac biomarker with high specificity to myocardial damage

A

troponin

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46
Q

troponin elevates within ___-___ hrs and remains elevated for up to ____ weeks

A

3-4 hrs

3 weeks

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47
Q

troponin T level

A

<0.10

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48
Q

troponin I level

A

<0.03

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49
Q

increases within 1 hour and peaks in 12 hours

A

myoglobin

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50
Q

with myoglobin ____ results are a good thing

A

negative

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51
Q

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

A

troponin

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52
Q

which enzyme or biomarker are most helpful when the client delays seeking care?

A

troponin

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53
Q

treatment for V. fib

A

shock

defib the v.fib

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54
Q

if the first shock for v. fib doesn’t work….give?

A

epi

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55
Q

an anti-arrhythmic used when v. fib and pulseless VT are resistant to treatment, and also for fast arrhythmias

A

amiodarone

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56
Q

how to monitor for lidocaine toxicity

A

neuro changes

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57
Q

the first antiarrythmic of choice

A

amiodarone

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58
Q

important side effect for amiodarone?

A

hypotension

59
Q

what meds are used for chest pain when they get to the ED?

A

O2
aspirin
nitro
morphine

60
Q

goal for thrombolytic therapy

A

dissolve the clot that is blocking blood flow to the heart muscle

61
Q

example of thrombolytics

A

streptokinase
alteplase
tenecteplase
reteplase

62
Q

thrombolytics should be administered within __-__ hours of an MI

A

6-8

63
Q

with a stroke…time is _____

A

brain

64
Q

major complication with thrombolytic therapy

A

bleeding

65
Q

absolute contraindications for thrombolytics

A

intracranial neoplasm
intracranial bleed
suspected aortic dissection
internal bleeding

66
Q

antidote for thrombolytics

A

idacrucizumab

67
Q

Percutaneous Coronary Intervention (PCI) includes all interventions such as ____ and ____

A

angioplasty and stents

68
Q

major complication of an angioplasty is a ____

A

MI

69
Q

if there is chest pain after PCI

A

call Dr

70
Q

what could it mean if they have pain post op PCI?

A

reoccluding

71
Q

used with multiple vessel disease or left main coronary artery occlusion

A

CABG

72
Q

the ____ _____ coronary artery supplies the entire left ventricle

A

left main

73
Q

when there is left main coronary artery occlusion think what????

A

SUDDEN DEATH

it’s the widow maker

74
Q

diet changes for cardiac rehabilitation

A

decreased fat, salt, and cholesterol

75
Q

why can’t cardiac patients do isometric exercises?

A

they increase workload of the heart

76
Q

when can sex be resumed after a heart issue?

A

when they can walk around the block or up a flight of stairs with no discomfort

77
Q

what is the safest time of day for sex?

A

morning

78
Q

best exercise for MI client?

A

walking

79
Q

teach sx of HF

A

weight gain
ankle edema
SOB
confusion

80
Q

HF is a complication that can result from problems such as ?

A
cardiomyopathy
valvular heart disease
endocarditis
acute MI
HTN
81
Q

in LHF the blood is not moving forward into the aorta and out to the body….if it does not move forward, then it will go backward into the ______

A

lungs

82
Q

sx of LHF

A
pulmonary congestion
dyspnea
cough
blood tinged frothy sputum
restlessness
tachycardia
S3
orthopnea
nocturnal dyspnea
83
Q

RHF is when the blood is not moving forward into the lungs….if it does not move forward then it goes backward into the ____ system

A

venous

84
Q

sx of RHF

A
distended neck veins
edema
enlarged organs
weight gain
ascites
85
Q

term that means the heart can’t contract and eject

A

systolic heart failure

86
Q

ventricles can’t relax and fill

A

diastolic heart failure

87
Q

secreted by ventricular tissues in the heart when ventricular volumes and pressures in the heart are increased

A

BNP

88
Q

BNP can be positive for HF when the ____ doesn’t indicate a problem

A

CXR

89
Q

if the client if the client is on nesteritide, turn if off ____ hrs before drawing a BNP

A

2 hours

90
Q

the CXR shows what with HF

A
enlarged heart 
pulmonary infiltrates (edema)
91
Q

looks at the pumping action or ejection fraction of the heart.

A

Echocardiogram

92
Q

an ECG can also give you information about ____ and ___ ____

A

back flow and valve disease

93
Q

is a balloon flotation catheter that can be floated into the R side of the heart and pulmonary artery.

A

swap-ganz catheter

94
Q

standard medication therapy for HF is ___ and ____

A

ACE inhibitors and ARBs

95
Q

ACE inhibitors and ARBs both block ______.

A

aldosterone

96
Q

when we block aldosterone we do what?

A

lose Na and water and retain K+

97
Q

med used when the client is in sinus rhythm or a. fib and has accompanying chronic HF

A

digoxin

98
Q

what does digoxin do to contraction of the heart and the heart rate

A

stronger contraction

slows down the HR

99
Q

normal dig level

A

0.5-2.0

100
Q

how do yo know the dig is working?

A

the CO goes up

101
Q

early sx of dig toxicity

A

anorexia
nausea
vomiting

102
Q

lare sx of dig

A

arrhythmias

vision changes

103
Q

before you admin dig check?

A

apical pulse 1 min

104
Q

digoxin + _____ = toxicity

A

hypokalemia

105
Q

diuretics decrease ____

A

preload

106
Q

when do you give diuretics?

A

morning

107
Q

low Na diet decreases fluid retention and helps decrease _____

A

preload

108
Q

salt substitutes can contain excessive ___-_

A

K+

109
Q

your natural pacemaker is the ___ ___

A

SA Node

110
Q

if you heart rate drops to 60 or below cardiac output can ______

A

decrease

111
Q

pacemakers are used to increase the heart rate with _______ bradycardia

A

symptomatic

112
Q

_______ is when the ventricles are resting and are filling up with blood

A

repolarization

113
Q

a _____ pacemaker kicks in only when the client needs it to

A

demand

114
Q

most common complication post-op with permanent pacemakers?

A

electrode displacement

115
Q

you need to make sure to do passive ROM to prevent what after permanent pacemakers?

A

frozen shoulder

116
Q

can’t raise your arm higher than ___ ____ after pacemaker placement

A

shoulder height

117
Q

what is it called when no contraction follows the stimulus

A

loss of capture

118
Q

what is it called when the pacemaker fires at inappropriate times

A

failure to sense

119
Q

what can cause loss of capture, failure to sense or any malfunction?

A

not programmed correctly
electrodes can dislodge
battery may be depleted

120
Q

will they set of alarms at airports with pacemakers?

A

YES

121
Q

may be used to pace the heart, or it might be used to defibrillate people in v-fib

A

ICD

122
Q

who’s at r/f pulmonary edema

A

receive IV fluids very fast
very young and very old
hx of heart or kidney disease

123
Q

pulmonary edema usually occurs at ____, when the client goes to bed

A

night

124
Q

sx of pulmonary edema

A
sudden onset
breathless
restless/anxious
severe hypoxia
pink frothy sputum
125
Q

the priority nursing action is to administer ____ to the patient with pulmonary edema

A

high flow oxygen

126
Q

meds for pulmonary edema

A

diuretics
nitro
morphine
nesiritide

127
Q

an IV infusion used for short term therapy with pulmonary edema

vasodilates veins and arteries and has a diuretic effect

A

nesiritide

128
Q

remember to turn off the nesiritide infusion ____ hrs before drawing a BNP

A

2

129
Q

never give nesiritide for longer than ____ hrs

A

48

130
Q

positioning for pulmonary edema

A

upright position

legs down

131
Q

________ is when blood, fluid, or exudates have leaked into the pericardial sac resulting in compression of the heart

A

cardiac tamponade

132
Q

cardiac tamponade can happen if the client had

A

a motor vehicle collision, right ventricular biopsy, an MI, pericarditis, or hemorrhage post CABG

133
Q

sx of cardiac tamponade

A
narrowed pulse pressure
decreased CO
CVP increased
BP drops
distended neck veins
134
Q

hallmark signs for cardiac tamponade

A

increased CVP

decreased BP

135
Q

treatment for cardiac tamponade

A

pericardiocentesis

surgery

136
Q

narrowed pulse pressure: think ???

A

cardiac tamponade

137
Q

widened pulse pressure: think???

A

increased intracranial pressure

138
Q

it is a medical emergency if you have an acute arterial _____

A

ooclusion

139
Q

with an arterial disorder the patient will report?

A

numbness/pain
cold extremity
no pulse

140
Q

hallmark sign of arterial disorders

A

intermittent claudication

141
Q

with arterial disorders….pain at rest means _____ obstruction

A

severe

142
Q

treatment of arterial disorder

A

dangle the legs

143
Q

_____ the veins

A

elevate