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NCLEX > cardiac > Flashcards

cardiac Flashcards

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1
Q

blood flow of heart

A

superior and inferior vena cava (deoxygenated)–R atrium–R ventricle–pulmonary artery–goes to lungs and becomes oxygenated–pulmonary veins (oxygenated now)– L atrium–L ventricle–aorta– body

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2
Q

preload

A 
blood returning to the R side of the heart
muscle stretch (strength) that the volume causes
ANP released during stretch

increased preload = increased strength (workload)

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3
Q

afterload

A

pressure in aorta and PERIPHERAL arteries that the L ventricle has to pump against to get blood out

aka resistance

high afterload = low cardiac output and low forward flow

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4
Q

stroke volume

A

amount of blood pumped out of the ventricles with each beat

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5
Q

cardia output

A

HR x SV

tissue perfusion is dependent on adequate CO

CO changes according to body’s needs

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6
Q

factors that affect CO

A

HR
arrhythmia (brady and tachy)
blood volume (less volume = less CO) (more volume = more CO)
decreased contractility

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7
Q

meds that affect preload

A

vasodilator/diurese to decrease preload

diuretics (furosemide)
nitrates (nitroglycerin)

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8
Q

meds that affect afterload

A

vasodilator to decrease afterload

ACE inhibitors (enalapril) “pril”
ARBS (losartan) “sartan”
hydralazine
nitrates (nitroglycerin)

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9
Q

meds that improve contractility

A

inotropes (dopamine) “amine”

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10
Q

meds that control rate

A 
beta blockers (propranolol) "olol"
calcium channel blockers (diltiazem, verapamil, amlodipine)
digoxin
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11
Q

meds that control rhythm

A

antiarrhythmics (amiodarone)

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12
Q

patho of low CO

A 
will not perfuse properly 
LOC goes down
chest pain
crackles
SOB
cold and clammy
urine output goes down
weak peripheral pulses
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13
Q

arrhythmias that are always a big deal

A

pulseless vtach
vfib
asystole

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14
Q

coronary artery disease

A

broad term

chronic stable angina
acute coronary syndrome

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15
Q

chronic stable angina patho

A

intermittent decreased blood flow
ischemia so pain/pressure in chest
low O2 r/t exertion
rest or nitro to relieve pain/pressure

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16
Q

chronic stable angina treatment

A

nitroglycerin
beta blockers
calcium channel blockers
acetylsalicylic acid (aspirin)

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17
Q

nitroglycerin

A

causes venous and arterial dilation
decreased preload and afterload
dilation of coronary arteries which increases blood flow to the heart muscle (myocardium)

take 1 q 5min x 3doses

DONT SWALLOW
keep in dark, glass bottle, dry, cool
will get a headache
renew every 6 months
renew spray every 2 years

BP drops so make them sit when taking

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18
Q

beta blockers

A

prevention of angina

check BP and pulse before giving
“olol”

decrease BP, pulse, and myocardial contractility
decreases workload of heart
CO decreases

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19
Q

calcium channel blockers

A

prevention of angina

"pine"
nifedipine
verapamil
amlodipine
diltiazem

decrease BP
vasodilate arterial system
dilate coronary arteries
decrease afterload and increase O2 to the heart muscle

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20
Q

acetylsalicylic acid

A

aka aspirin

dose determined by provider

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21
Q

teaching for chronic stable angina

A 
rest
avoid overeating
avoid excess caffeine
avoid drugs that increase HR
wait 2 hours after eating to exercise
dress warm in cold weather
nitro prophylactically 
smoking cessation
weight loss
isometric exercise
reduce stress
*****do everything you can to decrease the workload of the heart
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22
Q

cardiac catheterization

A

ask if they are allergic to iodine or shellfish

check kidney function because dye is excreted through the kidneys

hot shot (warm, flush, sweaty)
palpitations are normal
get baseline VS and 5Ps

after:
monitor VS
watch puncture site **for bleeding and hematoma formation
assess extremity distal to puncture site (5 Ps)
puleslessness
pallor
pain
paresthesia
paralysis
temp CRT
bedrest– flat, extremity straight x4-6hours
***major complication is bleeding/hemorrhage
report pain ASAP
hold metformin 48hours after

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23
Q

unstable chronic angina

A

impending MI

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24
Q

acute coronary syndrome patho

A

aka MI
aka unstable angina

decreased blood flow to myocardium– ischemia and necrosis
can happen at any time
rest and nitro do NOT relieve pain

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25
Q

acute coronary syndrome symptoms

A

pain (crushing)
pressure radiating to the L arm and L jaw
N/V
pain between shoulder blades

women:
GI s/s
epigastric discomfort
pain between shoulders
aching jaw or choking sensation 
unusual fatigue
inability to catch a breath
****SOB is the number one sign for elderly 
cold, clammy
BP drops
CO down
ECG changes
vomiting
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26
Q

labs for troponin isomers

A

troponin T <0.10

troponin I <0.03

27
Q

stemi vs nstemi

A

*****worry about stemi client

stemi:
ST segment elevation myocardial infarction
having a heart attack
get them to cath lab for PCI (percutaneous coronary intervention) in less than 90min

nstemi:
non-st segment elevation myocardial infarction
less worrisome

28
Q

labs for acute coronary syndrome

A

CPK-MB
cardiac specific isoenzyme
high w/ damage to cardiac cells
elevates within 3-6hours and peaks in 12-24 hours

troponin:
cardiac biomarker w/ high specificity to myocardial damage
elevates within 3-4 hours and remains elevated for up to 3 weeks

myoglobin:
increases with 1 hour and peaks in 12 hours
negative results are a good thing

troponin is the most sensitive for an MI or delays seeking care

29
Q

untreated arrhythmia that can kill

A

pulseless vtach
vfib
asystole

30
Q

vfib

A

treatment:
defibrillate
epinephrine or vasopressor
amiodarone or lidocaine

31
Q

lidocaine toxicity

A

neuro changes

32
Q

amiodarone

A

anti-arrhythmic of choice

SE: hypotension

33
Q

meds used for chest pain in ED

A

O2 if less than 90
aspirin (chewable)
nitro
morphine

Head up to decrease workload and increase CO

34
Q

thromboyltics

A

used to dissolve a clot that is blocking blood flow to the heart muscle and decrease the size of the infarction

alteplase
tenecteplase
reteplase
streptokinase

should be given within 6-8 hours after onset of pain

**bleeding is a major complication
obtain bleeding hx
bleeding precautions during and after administration

draw blood when starting IVs to decrease pokes
do not do ABGs r/t high risk for bleeding

35
Q

common meds that require bleeding precautions

A 
abciximab
acetaminophen
acetylsalicyclic acid
apixaban
clopidogrel
dabigatran
enoxaparin sodium
eptifibatide
heparin rivaroxaban
warfarin
36
Q

PCI (percutaneous coronary intervention)

A

percutaneous transluminal coronary angioplasty
stents

angioplasty complication: MI

if any problems– surgery

chest pain after procedure– call provider r/t reoccluding

37
Q

antiplatelet meds

A 
acetylsalicylic acid
clopidogrel
prasugrel
abciximab
eptifibatide
38
Q

coronary artery bypass graft

A

aka open heart surgery
used for multiple vessel disease or coronary artery occlusion
L main coronary artery supplies the entire L ventricle

**L main coronary artery occlusion– think sudden death or widow maker

39
Q

cardiac rehab

A 
smoking cessation
stepped care plan (increase activity gradually)
low fat
low salt
low cholesterol
no isometric exercise
no valsalva
no straining 
no suppository
sex resumed 7-10days 
safest time for sex is 8-9am
walk
teach s/s of HF (weight gain, ankle edema, SOB, confusion)
40
Q

heart failure causes

A 
complication from cardiomyopathy
valvular heart disease
endocarditis
acute MI
*****hypertension
41
Q

left sided heart failure s/s

A

blood not moving forward into aorta and go back into lungs

pulmonary congestion
dyspnea
cough
blood tinged frothy sputum
restlessness
s-3
orthopnea
nocturnal dyspnea
42
Q

R sided heart failure s/s

A

not moving into lungs
back into venous system
causes: normally a disease in lungs (PE, COPD)

distended neck veins
edema
enlarged organs
weight gain
ascites
43
Q

systolic heart failure

A

heart can’t contract and eject

44
Q

diastolic heart failure

A

ventricles can’t relax and fill

45
Q

heart failure diagnosis

A

BNP:
sensitive indicator
if on Nesiritide turn off for 2hr prior to drawing
secreted by ventricular tissues in the heart when ventricular volumes and pressures are increased

CXR:
enlarged heart
pulmonary infiltrates (fluid/edema)

echocardiogram:
looks at pumping action or ejection fraction of heart

New York Heart association functional classification of persons with HF:
class 4 is the worse
"can they complete activities of daily living test"
46
Q

meds for HF

A 
ace inhibitors: 
drug of choice
suppress RAS
prevent conversion of angiotensin 1 to 2
results in arterial dilation and high SV
SE: dry, naggy cough

ARBs:
block angiotensin 2 receptors
cause low arterial resistance and low BP

beta blockers:
first line therapy
relax vessels
decrease BP
decrease afterload
decrease workload of heart

ACE and ARBs both block aldosterone so we lose Na and H2O and retain K

most likely sent home on ace inhibitor and/or beta blocker because they decrease workload on the heart and prevent vasoconstriction to increase CO and keep blood going forward

digoxin
monitor for toxicity
sinus rhythm or afib and has accompanying chronic HF
makes contractions stronger
slows HR (gibes ventricles more time to fill with blood)
high CO
high kidney perfusion

good to diurese r/t HF pts cannot handle extra fluid
**HF pts should not get whole blood– only give what they need (RBCs, platelets)

diuretics:
furosemide
hydrochlorothiazide
bumetanide
spironolaction
decreases preload 
give in AM

severe HF:
IV inotropes (milrinone, dobutamine)
vasodilators (nitroprusside, nesiritide, nitroglycerin)

47
Q

digoxin nursing considerations

A 
good to diuresis
working when CO goes up
s/s of toxicity:
early-- anorexia, N/V
late-- arrhythmias and vision changes (yellow halos)

check apical pulse (5th ICS mid clavicular line) before giving

monitor electrolytes (hypokalemia + dig = toxicity)

48
Q

normal dig levels

A

0.5-2

toxicity if over 2

49
Q

other treatment for heart failure

A

low Na diet:
decreases fluid retention and helps decrease preload
watch salt substitutes (contain excess K)

elevate HOB
daily weight (report 2-3lbs)
s/s of recurring failure
pacemaker

50
Q

pacemaker

A

“natural” = SA node or sinus node
sends impulses to make heart contract
used to increase HR with symptomatic bradycardia
**always worry if HR drops below set rate
demand pacemaker sets in only when they need it
fixed rate fire at a fixed rate constantly
rate should never decrease–okay to increase

post procedure
monitor incision
common complication: electrode displacement
immobilize arm
assisted passive ROM to prevent frozen shoulder
don’t raise arm higher than shoulder

s/s of malfunction
capture: no contraction follows stimulus
sense: fires at inappropriate times
may not be programmed right
electrodes can dislodge
battery may be dead
watch for s/s of low CO or low HR
teaching: 
check pulse daily
ID card/bracelet
avoid electromagnetic fields
avoid MRIs
51
Q

pulmonary edema patho

A

risk factors:
IV fluid fast
young/old
hx of heart or kidney disease

fluid backing into the lungs
heart cannot move the volume forward
usually occurs at night during bed

52
Q

pulmonary edema s/s

A 
sudden onset
breathless
restless/anxious
hypoxia
productive cough
53
Q

pulmonary edema treatment

A

O2– keep above 90

upright position
legs down
improves CO
promotes pooling in lower extremities

prevention:
lung sounds
avoid FVE

54
Q

meds for pulmonary edema

A

diuretics:
furosemide
diuresis & vasodilate and traps more blood out in the arms and legs and reduces preload

nitroglycerin:
vasodilation
decrease afterload = increase CO because heart is pumping again less pressure and more blood moved forward

morphine
decrease preload and afterload

nesiritide
IV infusion
short term– no more than 48hours
vasodilates veins and arteries and has a diuretic effect
turn off infusion 2 hours before drawing BNP

55
Q

cardiac tamponade patho

A

blood, fluid or exudates leak into pericardial sac results in compression of the heart

56
Q

cardiac tamponade s/s

A 
low CO (ventricle is being squeezed)
*****high CVP
*****low BP
muffled or distant heart sounds
distended neck veins
pressure in all 4 chambers
shock
narrowed pulse pressure (difference between systolic and diastolic reading)
57
Q

narrow vs wide pulse pressure

A

narrow: cardiac tamponade
wide: increased ICP

58
Q

cardiac tamponade treatment

A

pericardioentesis to remove blood from the heart

surgery

59
Q

arterial disorders patho

A

if you have atherosclerosis in one place you have it everywhere

medical emergency if occluded
numbness and pain
cold extremity
no palpable pulse
more symptomatic in lower extremities
****intermittent claudication (arteries only)
arterial blood isn't getting to the tissue--> coldness, numbness, ***Decreased peripheral pulses, atrophy, bruit, skin/nail changes, and ulcerations
pain at rest means severe obstruction

***artery issues = something is not getting O2

60
Q

arterial disorder treatment

A

pain will increase if you elevate legs
angioplasty
endarterectomy

61
Q

venous disorders

A

**arteries carry oxygenated blood
**veins carry deoxygenated blood
inflammation and chronic ulcers can occur
could develop a DVT

V: elevate veins
A: dangle arteries

62
Q

chronic arteria insufficiency s/s

A

intermittent claudication pain (pain progresses at rest)
decrease or absent pulses
pale when elevated
red with lowering of leg
cool
mild or absent edema
thin, shiny, loss of hair over foot/toes, nail thickening
ulceration if present will involve toes or areas of trauma on feet (painful)
gangrene may develop
don’t use compressions

63
Q

chronic venous insufficiency s/s

A 
none to aching pain
normal pulses (may be hard to palpate r/t edema)
normal color (may see petechiae or brown pigmentation with chronic)
normal temp
edema
brown pigmentation around ankles
possible thickening of skin
scarring
ulceration if present on sides of ankles
no gangrene
compression

NCLEX (17 decks)

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