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Thursss > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Preload

Afterload

High afterload decreases

Stroke volume is the amount of blood volume pumped with each beat

CO = HR x SV

A

The amount of blood returning to right side of heart

Afterload is the pressure in the aorta and peripheral arteries that the left ventricle has to pump against

Cardiac output and decreases forward flow

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2
Q

Medications that affect cardiac output:

Preload ( DN)

Afterload (HAAN)

Improve contractility

Rate control (BCD)

Rhythm control

A

Diuretics(furosemide) and Nitrates(nitroglycerin)

Hydralazine
Ace inhibitors (enalapril,captopril,fosinopril)
ARBS (losartan, irbesartan)
Nitrates

Inotropes (dopamine, dobutamine, milrinone)

Beta blockers(cardevilol,propanolol)
Calcium channel                                                                                    blockers( amlodipine,diltiazem,verapamil)
Digoxin

Antiarrhythmics (amiodarone)

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3
Q

3 arrhythmias that are always a big deal

A

Pulseless V-Tach
V-fib
Asystole

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4
Q

Coronary artery disease is

It includes

A

Most common type of cardiovascular disease

Chronic stable angina and Acute coronary syndrome( unstable angina, MI)

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5
Q

Chronic stable angina

Patho

  • what brings this pain?
  • what relieves the pain?
Treatment: 
Medications
-Nitroglycerin
-Beta blockers
-calcium channel blockers
-acetylsalicylic acid
A

Intermittent decreased blood flow is going to the heart which leads to ischemia resulting to pain.

  • low oxygen due to exertion
  • rest and/or nitroglycerin

Nitroglycerin:
- causes venous and arterial dilation which decreases preload and afterload,also causes CORONARY dilation which increase blood flow to the actual heart muscle
-must be taken sublingually, 1 every 5 mins x 3 doses,if not relieved activate emergency response
-must be kept in dark,glass bottle,dry cool
-HEADACHE is expected
Renew an average of 6 months and 2 years for SPRAY

Beta blockers:
-prevention of angina by decreasing workload on the heart because it blocks beta cells(the receptor sites for catecholamines) norepi and epi
-but we could decrease the cardiac output and
BP too much with these drugs

Calcium blockers:

  • cause vasodilation of the arterial system which decreases blood pressure
  • 2 benefits are they decrease afterload and increase oxygen to the heart muscle
  • they also dilate coronary arteries

Acetlysalicylic acid:

  • aspirin, keeps blood going
  • dose is determined by primary HCP
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6
Q

Rule:

NEVER LEAVE

Do everything you can

A

AN UNSTABLE CLIENT

To decrease the workload on the heart

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7
Q

Ranolazine does not increase

has adverse effect of

A

BP or HR

Chronic constipation

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8
Q

Client teaching for chronic stable angina

Rest frequently
Avoid
Diet
Lose
Wait 2 hours
Reduce
Dress warmly
Take nitro
A

Overeating and excess caffeine and isometric exercises
Diet should be low fat and high fiber
Weight
After eating to exercise
Stress
To avoid precipation of attack especially in cold weather
Nitroglycerin prophylactically

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9
Q

Cardiac catheterization

Pre procedure:
Allergic to and kidney function
Acetylcysteine

Post procedure:
V/S
Puncture site for
Assess 5P's distal to site
Extremity should be
Major complication
Methformin (glucophage)
A

Must ask if allergic to shellfish or Iodine because a dye is used and also check kidney function because the dye is excreted to the kidneys
Acetylcysteine is prescribed pre procedure to protect the kidneys, hot shot or palpitations are normal

V/S should be monitored
Watch puncture site for bleeding and hematoma formation
Assess for pulselessness,pallor,paresthesia,pain and paralysis(also include skin temp and capillary refill)
Straight and flat for 4 to 6 hours, and bed rest
Hemorrhage
If client is taking methformin(glucophage) must hold for 48 hours because we are trying to protect the kidneys

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10
Q

Acute coronary syndrome (unstable angina,MI)

Patho

S/S:
Pain describe as
In women they 
Triad symptoms of women
Number 1 sign in elderly
A

Decreased blood flow to the heart causing ischemia leading to necrosis and pain. The pain will be sudden, it is not caused by client activity. And this pain will not be relieved by nitroglycerin

CRUSHING, an elephant sitting on chest,radiating to left arm and left jaw or pain between shoulder blades
Present with GI signs and symptoms,epigastric discomfort, aching jaw or choking sensation
-Triad-
Indigestion or feeling of fullness
Unusual fatigur
Inability to catch ones breath
Shortness of breathe

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11
Q

STEMI

NON-STEMI

Worry about the

ECG changes in MI

A

ST Segment Elevation Myocardial infarction
- indicates that the client is having Heart Attack and Goal is ti get them to cath lab in less than 90 minutes

Non-ST segmentt Elevation Myocardial Infarction- these are less worrisome

Worry about the STEMI client

St segment elevation
St segment depression
Abnormal Q wave
T wave inversion

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12
Q

Diagnostic Lab Work in acute coronary syndrome

CPK-MB

  • specific
  • elevates and peaks

TROPONIN

  • specific
  • elevates and remains

MYOGLOBIN

  • elevates and peaks
  • negative

Biomarker most sensitive indicator for MI?

A

Cardiac specific isoenzyme
Elevates in 3 to 6 hours and peaks 12 to 24 hours

Most specific and most sensitive in detecting cardiac damage
Elevates 3 to 4 hours and remains elevated for up to 3 weeks

Elevates in 1 hour and peaks in 12 hours
Negative result is a good thing

Troponin

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13
Q

Priority treatment for V-fib

If defib does not work?

Amiodarone (cordarone)

  • used when
  • Important side effect

What antiarrhythmic drugs given to prevent 2nd episode of V-fib?

Lidocaine toxity =

A

Defibrillation between CPR

Give epinephrine, this is the first medication we give

An anti-arrythmic drug and is used when V-fib and pulseless V-tach are resistant to treatment(defib and vasopressor drugs). This is also the first anti-arrythmic of CHOICE
HYPOTENSION, which could lead to further arrhythmias

Amiodarone and Lidocaine

Any neuro changes

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14
Q

Treatment for acute coronary syndrome

Meds used for chest pain at the ED?
- OANM-must give these meds in order

Thrombolytics (-ase)

  • Goal
  • how soon after onset of pain
  • major complication
  • draw blood when starting IV
A

Oxygen- if less than 90%
Aspirin - chewable is faster
Nitrogylcerin
Morphine

Goal is to restore blood flow by dissolving the clot
Must be given 6 to 8 hours, the sooner the better because TIME IS BRAIN
Bleeding so must do bleeding precautions before and after
To decrease number of Puncture sites

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15
Q

Medical interventions for Acute coronary syndrome

PCI (percutaneous coronary intervention):
Includes all intervention such as
Major complication of angioplasty
This opens up
Heart cath site
Reocclude

Coronary Artery Bypass Graft (CABG)
Indicated for
Scheduled or
Aka

Left main coronary artery is the

A

PTCA(percutaneous coronary angioplasty) and stents
MI
The coronary artery
Must monitor for bleeding
Chest pain after procedure means its reoccluding and must notify primary HCP

Multiple vessel disease or Left main coronary artery occlusion.
This can be an emergency procedure or scheduled
Aka open heart surgery

Widowmaker because this artery supplies the Left ventricle

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16
Q

Cardiac rehab in acute coronary syndrome

Smoking
Stepped care plan
Diet
Avoid what exercise
Best exercise
No "VSS"
When can sex be resumed
Safest time to have sex
A

Cessation
Increase activity gradually
Low,low salt,low cholesterol
Isometric exercises because it increases workload
WALKING
No Valsalva, Straining and Suppository (Docusate)
About 1 week to 10 days
In the morning around 8am because during REM sleep is where people usually have an MI

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17
Q

Heart Failure is a complication of

Left sided

Right sided

A

Cardiomyopathy, valvular heart disease, endocarditis, acute MI and HPN (which is the leading cause of HF)

Blood is not moving forward and will go backward to lungs

Blood is not moving forward to lungs so it backs up to Venous system

18
Q

S/S of Left HF

Left =Lungs

BROD S-3

S-3 is an

  • normal in
  • heard using
  • kentucky
A 
Blood tinged frothy sputum
Restlessness
Orthopnea
Dyspnea
S-3

Extra heart sound
Normal in adults and children but can be Abnormal in the elderly
Heard by using the bell
The sound is described as kentucky

19
Q

S/S Right HF

“WADEE”

A 
Weight gain
Ascites
Distended Neck Veins
Edema
Enlarged organs
20
Q

Diagnosis of HF

BNP

If on NESIRITIDE?

CXR

Echocardiogram

New york heart association classification

A

B type natriuretic peptide is secreted by ventricular tissues when there is increase pressure and ventricular volume in heart
Sensitive indicator
If CXR does not indicate a problem, BNP can be Positive

turn it off 2 hours prior to drawing because it might give false positive

Enlarged Heart, pulmonary infiltrates and edema

Looks at the pumping action or ejection fraction of the heart and also give information about backflow and valve disease

Class 1 to 4, the higher the number the worse the HF is

21
Q

Swan Ganz (Pulmonary Artery)

Arterial Lines
Placed in
ABG and blood pressure

A

Balloon flotation catheter that can be floated to right side of heart and pulmonary artery
It provides info to rapidly determine hemodynamic pressures and cardiac output

Multiple arteries but most common is radial artery
It allows to collect repeated ABG samples without injury and continuous monitoring of intra artherial blood pressure

22
Q

Treatment for HF

Medications:
Ace inhibitors
-DOC
-suppresses
-Prevents conversion
-dilates

ARBS

  • maybe used first
  • blocks

Beta blockers

  • in addition
  • relax and decreases

Ace and arbs both block

Client will be sent home with HF while on

A

Drug of choice for heart failure
Supresses renin angiotensin system (RAS)
Angiotensin I to angiotensin II
Dilates arteries and increases stroke volume

Maybe used first insted of ACE inhibitors due to nagging dry cough with ACE inhibitors
Blocks Angiotensin II receptors and causes decrease artery resistance and decrease BP

Prescribed in addition with ACE inhibitors
Vessels and decreases BP,afterload,Workload

Both block Aldosterone, which decreases Na and H2O, but retaining Potassium, so watch out for Hyperkalemia

Ace inhibitors and beta blockers by preventing vasoconstriction by decreasing afterload

23
Q

Digoxin given in HF

Used when

Heart rate? “CR”

Heart contraction? “IC”

When the heart is slowed thos gives

C.O will go
Kidney perfusion will go

A

Sinus rhthym or atfial fib has accompanying chronic HF

Slow it Down (negative chronotropic)

Stronger contraction (positive Inotropic)

Ventricles more time to fill with blood

Up
Up

24
Q

Troponin I

Troponin T

A

Less than 0.03 ng/mL

Less than 0.10 ng/mL

25
Q

Systolic HF

Diastolic HF

A

Heart cant contract and eject

Ventricles cant relax and fill, they become stiff

26
Q

Nursing considerations in Digoxin (HF)

Before administering
Diurese
Whole blood
-exception is
How to know digoxin is working?
S/S for dig toxicity:
Early-VAN
Late-AV
Electrolyte imbalance monitoring
Antidote
A

Check Apical Pulse
We want to always diurese these clients to lessen the pressure of fluid
Must not be given, it can cause pulmonary edema. But an exception is Autologous blood donation like hip surgery
Cardiac Output is increased
Early: vomiting, anorexia and nausea
Late: arrhythmias and vision changes(halo and yellow color)
Any electrolyte imbalance can cause digoxin toxicity but Hypokalemia causes the MOST trouble
Digibind

27
Q

Diuretics

Action
When to give

A

Diurese and decreases Preload

Morning

28
Q

Salt substitutes contain

in HF, report weight gain of

A

Excessive POTASSIUM

2-3 lbs and weigh daily

29
Q

PVC ECG readings

A

Wide QRS and No Pwaves. There is no contraction in the myocardium

30
Q

Patients with Implantable Cardioverter Defibrillator (ICD) can the significant other be concerned if it delivers shock while having sex?

A

No, because it is designed to deliver shock at a lower power compared to external defib. It can be felt but will not cause harm

31
Q

Pacemaker

Natural pacemaker is the

Pacemakers are used to increased heart rate with

Pacemakers may be temporary or permanent
ALWAYS worry if the heart rate drops to
They maintain a minimal heart rate aka
Demand pacemaker kicks in
Fixed pacemaker
A

SA node

SYMPTOMATIC bradycardia

Invasive or non-invasive
Below the set rate
Set rate
Kicks in when it is needed.
While a fixed pacemaker fires constantly at a fixed rate
32
Q

Post procedure fir permanent pacemakers

Incision
Most common complication
ARM must be
Assisted passive ROM
Dont raise arm above
A 
Monitor incision site
Electrode displacement
IMMOBILIZED
To prevent FROZEN SHOULDER
SHOULDER HEIGHT because wires could be pulled out
33
Q

Pacemaker fires at inappropriate times
Pacemaker cant cause contraction after stimulus

Reasons why these malfunction happen:
Programmed
Electrodes
Battery

Decreased CO or HR can mean

Client teaching:
Pulse
Id card
Avoid

A

Failure to Sense
Failure to Capture

May not be programmed correctly
Electrodes may be dislodged
Battery may be depleted

There is a problem

Pulse must be monitored daily
ID csrd or bracelet should be worn
Avoid electro magnetic fields like phones which shoild NOT be carried over the implanted site and must be used on opposite ear, large mofors
-MRI should be avoided because it could turn off the setting or change it. (It wont be pulled out of the body like you imagine)

34
Q

Pulmonary Edema
(Dont confuse with Pulmonary Embolism)

Patho

S/S
Sudden
Breathless
Severe Hypoxia
Cough
Treatment:
Oxygen
Meds
-Diuretics (furosemide and bumetanide)
-nitrates
-morphine sulfate
-nesiritide (turn off 2 hours prior BNP drawing)

Position

A

Fluid is backing up into LUNGS. The heart is unable to move the VOLUME forward. It usually occurs at Night when the client goes to bed.

Sudden onset
Breathless due to too much fluid going to the lungs
Hypoxia because the lungs cant function well and organ perfusion is decreased. Hypoxia leads to Restlessness or Nervousness( always think Hypoxia first)
Productive cough with pink frothy sputum

Treatment:
High flow oxygen is the PRIORITY nursing action
Must be kept at above 90%
Meds:
Furosemide reduces preload and Bumetanide provide rapid removal of fluid, these can be given IVP SLOWLY
NITROGLYCERIN decreases afterload which then increases CO due to decreased peripheral resistance
Morphine Sulfate decreases afterload and preload. It calms patient,decrease agitation
Nesiritide; iv infusion and for only short term therapy NOT more than 48 hours. Dilates veins and arteries, has diuretic effect

Upright with legs down improves CO and pooling of blood in lower extremeties

35
Q

Cardiac Tamponade

Patho

Causes:
Accident
Biopsy
MI

S/S:
Hallmark signs
Muffled
Pressure in chambers
Shock
Narrowed Pulse Pressure

Treatment:
Pericardiocentesis
Surgery

A

Blood, fluid or exudates have leaked into pericardial sac and compresses the Heart.

Causes can be to motor accidents, right ventricular biopsy, MI or hemorrhage post CABG

Increased CVP and Decreased BP
Muffled heart sounds
Pressure in 4 chambers will be the same
Shock due to decreased CO
This is the difference of diastolic and systolic

Pericardiocentesis is the removal of fluid around the heart.inserted in pericardial sac

36
Q

Narrowed pulse pressure Think:

Widened pulse pressure Think:

A

Cardiac Tamponade

Increased ICP

37
Q

Arterial Disorders

Patho

If you have atheroscloris in one place

Acute Arterial Occlusion this is a

Extremity will be

No palpable

Hallmark sign

Treatment:
If you elevate extremity, will pain increase or decrease?
Angioplasty or endarterectomy

A

Arterial blood is not getting into the tissues which leads to coldness, numbness, decreased Peripheral Pulses(PRIORITY),atrophy, bruit, skin/nail changes and ulcerations

You have it everywhere

Medical Emergency

COLD. And more symptomatic in LOWER EXTREMETIES

Pulse

Intermittent claudication is the hallmark sign but only in artery problems

Treatment:
Increase. We elevate Veins and Dangle Arteries
To increase perfusion

38
Q

Venous disorders

Veins carry

What can occur in venous disorders?

Could develop

We elevate

A

Deoxygenated blood

Inflammation and chronic ulcers

DVT

We elevate Veins and dangle Arteries

39
Q

Chronic arterial insufficiency

Pain
Pulses
Color
Temperature
Edema
Skin changes
Ulceration if present
Gangrene
Compression
A

Intermittent claudication, progresses to pain at rest
Decreased or may be absent
Pale when elevated and red when lowering leg
Temperature is COOL
May be mild or absent
Thin, shiny loss of hair over foot or toes, nail thickening
On toes or feet which is painful
Gangrene may develop
Not used

40
Q

Chronic venous insufficiency

Pain
Pulse
Color
Temp
Edema
Skin changes
Ulceration if present
Gangrene
Compression
A 
None to aching pain
Pulse may be difficult to palpate due to edema
May see brown pigmentation or petechia or may be normal
Temperature is Normal
Edema is present
Brown pigmentation, thickening of skin
Sides of ankles
Does not develop gangrene
Conpression is used

Thursss (17 decks)

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