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SET 2 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Explain how blood flows through the heart

A

deoxygenated blood goes from superior and inferior vena > ra> rv>and goes into pulmary artery. then the blood goes to the lungs and becomes oxygenated >pulmonary veins > left atrium> left ventricle (big guy)> aorta to the rest of our body.

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2
Q

What is preload

A

amount of blood returning to the right side of the heart causing to stretch ANP assist

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3
Q

Afterload is?

A

Pressure in the aorta + peripheral arteries (resistance). i.e. when there’s hypertension more resistance can cause HF or p.edema

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4
Q

Stroke volume?

A

The amount of blood from ventricles with each beat

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5
Q

Cardiac output

A

Tissue perfusion. It is CO= HR X SV

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6
Q

What affects C/O

A

Blood volume, decreased contractility

pathophys:
decreased LOC 
Heart - Chest pain
Lungs - Wet
SOB 
Skin Cold / clammy
Kidneys UO down
peripheral pulses - weaker
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7
Q

Three concerns arrythmias

A

pulselessness v.tach
fib
asystole

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8
Q

CAD

A

Broad term for chronic stable angina and acute coronary syndrome

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9
Q

Chronic stable angina s/s , treatment

A

Ischemia pain/pressure on chest
Caused low O2, exertion

Txt: Rest and nitro SL
dilation of arteries and venous
decrease preload
1 nitro every 5 mins x 3 doses (kept in dark bottle), renew every 6 months, spray 2 years
may burn
headache
BP is likely to drop so continue to monitor

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10
Q

Betablockers - Lol’s

A

Angina Prevention
Decreases BP, P decreases workload and block Beta cells the epi and nor, contractility myocardial
CO decreases, but this can cause too much decrease in CO

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11
Q

Calcium channel blockers - Pine’s

A

Prevents angina
Bp decreases
Calcium c. blockers vasodilator arterial system
Vasodilates - coronary arteries

Increase oxygen and decrease afterload

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12
Q

ASA

A

Aspirin - keeps platelets from sticking together 81mg or 325 mg

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13
Q

What to teach to chronic stable angina?

A

Rest frequently, avoid overeating, avoid caffeine or anything increasing HR, wait 2 hrs after eating to exercise, dress warmly, lose weight, stop smoking, avoid iso workouts, reduce stress, take nitro prophylactic.

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14
Q

Meds and Treatments for Chronic angina

A

Beta, Cal blockers, Asa, Surgery Cardiac Cath

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15
Q

Pre-procedure Cardiac Catherization

A

*Must ask if they are allergic to iodine and shellfish
Look at kidney function, ask for Mucomyst to protect kidney if so.

Symptoms they’ll feel
Hotshot
Palpitations

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16
Q

Post op Cardiac Cath

A 
Monitor VS
Watch puncture site
Look for bleeding , assess distally 5ps.
Pallor
Paraesthesia
Pain
Pulseness 
Paralysis 
Check baseline
Lay flat, extremely straight bed rest 4-6hrs

Major Complication is - hemorrhage
Report immediately for pain
Hold metformin for 48hrs

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17
Q

What is Unstable angina-(Acute Coronary Syndrome) -> LEADS TO MI

A

Ischemia and Necrosis occurs
Nitro won’t help

S/s Crushing pain on chest, n/v, pain between shoulders, women present with GI symptoms or epigastric pain triad symptoms SOB, fatigue

#1 sign for elderly is SOB
Cold Clammy
Cardiac output down
ECG Changes - PVCs 
Vomitting - vagus nerve down HR
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18
Q

Stemi Client

A

Stemi ST elevation indicates heart attack and into cath lab less than 90 minutes
NSTEMI - no st elevation

19
Q

Diagnostic lab work for Unstable angina

A

CPK-MB increases showing damage
Elevates 3-6 hrs, peaks 12-24hrs

Trops - most sensitive and specific
Cardiac biomarker, myocardial damage
Elevates 3-4 hrs, remains 3 weeks

Myoglobin
Increases 1 hr peaks in 12, negative results are a good thing

20
Q

Treatment for Major arrythmia

A

De-fib for Vfib and CPR
give 1st med if does not work eps (vast)
Amiodarone - if fast arrhythmia, and pulselessness , can cause hypotension
Lidocain, but can cause neuro changes - toxicity

21
Q

Chest pain treatment in ED

A

oxygen
aspirin - if not given prior to entering hospital , chewable
nitro
morphine
Head up, never flat to decrease workload and increase CO

22
Q

What is thrombolytics

A

To dissolve clot within 30 minutes decreasing infarction
Meds : plase’ , given within 6-8hrs, time is brain, stroke has a smaller window

major complications
bleeding, know hx. 
Absolute contra
intracranial neoplasm, intracranial bleed, aortic dissection, internal bleeding
bleeding precautions always

Use large bore sites, antecubital
No need for ABGS

23
Q

What are bleeding precautions

A

Changes in stool, bleeding gums, hematuria

24
Q

What is the medical intervention for Unstable angina

A

PCI - opens up coronary artery
major complication is a MI , problems occur requires surgery
chest pain notify MD

Antiplatelet meds:
Asa
clopidogrel

C. Bypass Graft
- Scheduled or Emergency
left c.artery supplies entire left ventricle. , occlusion can cause sudden death or widow maker.

25
Q

Cardiac Rehab

A 
Stop smoking
low fat, low salt, low cholesterol
no iso workout
no valsava
no straining 
Sex resume 10 days , safe morning 
exercise walking
Teach for HF symptoms
Weight gain
Ankle Edema 
SOB 
Confusion
26
Q

What is Heart Failure

A

Results from heart problems usually leading by hypertension

27
Q

Describe differences of left/ right HF?

A 
Left- moving backward into lungs
left=lungs
pulmonary congestion
dyspnea
cough
tinged sputum
restlessness
tachy
s-3 
orthopnea
noc. dyspnea
RHF
Goes back in to venous system 
Distended neck
edema
enlarged organs
weight gain 
ascites
28
Q

Diagnosis of CHF

A

BNP , ventricular volume and pressure increases , can be positive when CXR shows nothing. Turn off nesiritide can give false high.

CXR will be enlarged
Echocardiogram , to see pump and ejection of heart / ECG, Swan Cath

29
Q

Treatment meds for CHF

A

Ace inhibitors *DOC
Supress Angiotensin 1 from 2 > Arterial dilation and increase stroke volume.
S/E - Nagging cough

Arbs
Block 2 , decrease arterial resistance and BP

Beta
First line therapy to ace
relax , decrease bp, afterload, workload.

Both ace and arbs block aldosterone - we lose sodium and water and retain potassium!

Digoxin (0.5-2)
for sinus rythm
in combo with Ace, arbs, beta, diuretics
contraction stronger, hr slower, co up, kidney perfusion up.

30
Q

Client going home with CHF meds will always be

A

ACE and beta to decrease workload and vasoconstriction, keeping blood work forward

31
Q

Nursing consideration for CHF

A

Diurese is good, digoxin works when CO is up.
Toxicity is anorexia, vomitting, nausea. arrhythmia and vision changes.

Before administering check apical pulse
electrolytes - as hypokal with dig = toxicity

Diuretics , MIDE/NIDE, THIAZIDE
To decrease preload, give in morning

32
Q

What to do for severe HF

A

IV inotropes : milrinone
Vasodilators nitroprusside,nitro
Low sodium diet to decrease preload, salt subs, elevate HOB, Report gain of 2-3 lbs.

Fluid Retention - think heart problems
Report recurring signs of heart failure.

33
Q

What is a pacemaker?

A

SA node is your natural pacemaker, that makes the heart contract
below 60, pacemakers will be used when showing symptomatic bradi. make be temp or permanent.

Set rate, fix rate is at a set rate constantly, never decrease. worry if it drops below set rate

34
Q

Post op care for permanent pacemaker

A

Monitor incision common complication is electrode displacement. immbolize arm, active passive range to prevent frozen shoulder do not pass shoulder height

35
Q

S/s of malfunction pacemaker

A

No contraction and stimulus - loss of capture
Inappropriate firing - failure to sense

This means:
no programmed correctly
dislodged
battery depleted look at decreased rate

36
Q

Client Education for pacemaker

A

Check pulse daily
Id Card
avoid electromagnetic fields
avoid MRI

37
Q

Who is at risk for Pulmonary Edema and their s/s?

A

Those receiving IV fluids
young and old
those with heart or kidney disease

Patho
Fluid is unable to go forward, going to lungs
Occurring at night

s/s 
sudden onset
breathless
anxious 
hypoxia 
pink froth
Txt
High flow oxygen titrate above 90%
Nitro
Nesiritide 
Morphine
Butanide 
furosemide - Diuretics
38
Q

Meds for PE

A

Diuretics - Furosemide 40 mg IV push 1-2 minutes
watch for hypotention and ototoxicity
Bumetanide , iv push, 1-2 min
Nitro - Decrease afterload
increases CO moving blood forward
Morphine 2mg IV push
Nesiritide - IV short term no more than 28hrs, turn off 2 hrs before drawing BNP levels

39
Q

Positioning for PE

A

Upright legs down prevents ppling increases CO

40
Q

Prevention for PE

A

Check lung sounds, avoid FVE

41
Q

What is Cardiac Tamponade, s/s, treatment

A

Blood, fluid, exudate leaking into pericardial sac compressing heart

S/S
CVP up
Decreased CO
Bp drop *hallmark signs
Muffled or distant heart sounds
neck distended
Narrowed pulse pressure from baseline

Txt: surgery remove fluid from heart pericardiocentesis

42
Q

Arterial Disorders

A

Atherosclerosis everywhere, acute version can cause occlusion
reporting of numbness and pain, cold, 5P’s
Lower extremities more symptomatic
intermittent claudication * hallmark sign, decreased peripheral pulses, skin/ nail changes, hairless
pain at rest is severe obstruction

Txt:
Elevating would increase pain - harder to pump
Treated with angioplasty or endarcarterectomy

43
Q

Venous Disorders

A

Veins carry deoxygenated blood
inflammation and chronic ulcers
Developing into DVT

SET 2 (16 decks)

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