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2024DM Med Surg > cardiac disorder > Flashcards

cardiac disorder Flashcards

1
Q

Age-Related Changes

A

Heart
Increased density of connective tissue and decreased elasticity
Number of pacemaker cells in the SA node decreases, as does the number of nerve fibers in the ventricles
Blood vessels
Changes in connective tissue and elastic fibers in arteries cause them to become stiffer.
Veins stretch and dilate, leading to venous stasis and sometimes impaired venous return

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2
Q

Creatine Kinase (CK, CK-MB)

A

this enzyme found in brain, heart (CK-MB) and skeletal muscle. Levels rise 4-6 hours after muscle cell damage, peak in 12-24 hours, and diminish in 2-3 day if no new injury to muscle cells. CK-MB after MI can  more than 6 times the normal value

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3
Q

Troponin

A

protein involved in contraction of muscles. Two types (T and I) are specific to cardiac muscle and are released into circulation after a MI. Elevate in 3-6 hours, peak in 24, and circulate for up to 2 weeks

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4
Q

Myoglobin

A

less reliable as an indicator of MI, a protein found in cardiac and skeletal muscles released quickly after cell damage, rises in 2-3 hours after an MI

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5
Q

slow HR and increase force of myocardial contraction

A

Cardiac glycosides- lanoxin

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6
Q

treat acute anginal episodes mostly by vasodilation

A

Anti-anginals nitroglycern; calcuim channel blockers

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7
Q

in general they work by decrease HR, decrease automaticity or  resistance to premature stimulation. Also used in chronic angina

A

Anti-dysrhythmics betablockers

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8
Q

work against the renin-angiotensin-aldosterone system to dilate arteries and decrease resistance to blood flow in arteries (dcrease afterload)

A

Angiotensin-converting enzyme inhibitors (ACE-Inhibitors)- Plavix, ASA

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9
Q

decrease fluid retention

A

Diuretics Lasix

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10
Q

prevent clot formation

A

Anti-coagulants Heparin Low-molecular-weight heparin (LMWH) Warfarin

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11
Q

decreased platelet aggregation, prolongs bleeding time

A

Anti-platelet Agents

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12
Q

(also called thrombolytics) “clot busters”

A

Fibrinolytic agents r-tPA

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13
Q

Abnormal thickening, hardening, loss of elasticity of arterial walls

A

Arteriosclerosis

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14
Q

Form of arteriosclerosis; inflammatory disease that begins with endothelial injury and progresses to the complicated lesion seen in advanced stages of the disease process

A

Atherosclerosis

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15
Q

naturally occurring, yellow streaking of coronary arteries and aorta, no symptomology, onset as early as age 10

A

progression of lesions

Fatty streak

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16
Q

builds over fatty streaks, protrudes our from wall of artery , other substances can adhere to and collect within plaque, white or grayish colored

A

Fibrous plaque

progression of lesions

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17
Q

develop as ulceration or rupture of plaque, platelets adhere and can trigger formation of a thrombus

A

progression of lesions

Complicated lesions-

18
Q

Branches grow from existing arteries; provide increased blood flow

A

Collateral circulation

19
Q

risk factors of coronary artery disease

A

Nonmodifiable
Age, gender, heredity, and race
Modifiable
Increased serum lipids, high blood pressure, cigarette smoking (nicotine), diabetes mellitus with elevated blood glucose, obesity, sedentary lifestyle
Other factors
Stress, sex hormones, birth control pills, excessive alcohol intake, high homocysteine levels

20
Q

The most common symptom of CAD

Demand for oxygen by myocardial cells exceeds supply

A

angina pectoris

21
Q

Occurs with exercise or activity and usually subsides with rest

A

Stable angina

22
Q

Pain more severe, occurs at rest or with minimal exertion, is often not relieved by NTG or requires more frequent NTG administration, and is not predictable

A

Unstable angina

23
Q

Caused by coronary artery spasm
may not be associated with CAD
Unpredictable and often occurs
at rest

A

Variant angina

24
Q

medical treatment for angina pectoris

A 
Initial therapy for patients 
    with angina
A  Aspirin and antianginal therapy
B  Beta-blocker and blood pressure
C  Cigarette smoking and cholesterol
D  Diet and diabetes
E  Education and exercise
25
Q

risk factors for Acute Myocardial Infarction

A

Obesity, smoking, a high-fat diet, hypertension, family history, male gender, diabetes mellitus, sedentary lifestyle, and excessive stress

26
Q

Acute Myocardial Infarction Acute Myocardial Infarction

A

Begins with occlusion of a coronary artery
Over 4-6 hours, ischemia, injury, infarction develop
Ischemia results from a lack of blood and oxygen to a portion of the heart muscle
If ischemia is not reversed, injury occurs
Deprived of blood and oxygen, the affected tissue becomes soft and loses its normal color
Continued ischemia: infarction of myocardial tissue
Ischemia lasting 20 minutes or more is sufficient to produce irreversible tissue damage

27
Q

Complications

Acute Myocardial Infarction

A

Heart failure, cardiogenic shock, thromboembolism, and ventricular aneurysm/rupture

28
Q

Signs and symptoms

Acute Myocardial Infarction

A

Pain
Heavy or constrictive pain located below or behind sternum
May radiate to the arms, back, neck, or jaw
Patient becomes diaphoretic and lightheaded and may experience nausea, vomiting, and dyspnea
The skin is frequently cold and clammy
Patient experiences great anxiety; feeling of impending doom

29
Q

Medical diagnosis

Acute Myocardial Infarction

A

History and the physical signs and symptoms

30
Q

Medical treatment
Drug therapy
Acute Myocardial Infarction

A 
Sublingual or intravenous nitroglycerin 
Morphine or Demerol
Oxygen 
Fibrinolytic therapy 
Aspirin and beta-adrenergic blockers
31
Q

Percutaneous coronary intervention (PCI)

Acute Myocardial Infarction

A

Intracoronary stents
Coronary atherectomy (widens arteries by shaving off plaque)
Laser angioplasty (stimulation of collateral growth or revascularization)
Radiation therapy

32
Q

Acute Myocardial Infarction

Assessment

A

Ask patient to describe the pain, including type, location, duration, and severity
Cardiac rehabilitation

33
Q

intervention

Acute Myocardial Infarction

A

Pain
Decreased cardiac output (those interventions to decrease O2 demands on heart)
Anxiety

34
Q

Heart Failure

Two Types

A

Disorders that increase the workload of the heart

Disorders that interfere with heart’s pumping ability

35
Q

Who are at risk for HF

A

Patients at risk for HF: those with CAD, AMI, cardiomyopathy, hypertension, COPD, pulmonary hypertension, anemia, disease of the heart valves, and fluid volume overload

36
Q

The left or right ventricle or both fail as pumps

Usually left side of heart fails first; right side fails as a result of the left-sided failure

A

Heart Failure

37
Q

Compensation

A

Sympathetic compensation
Renal compensation
Natriuretic peptides (neuro-hormones released from stretching of heart muscles)
Ventricular hypertrophy

38
Q

Left-sided heart failure

A 
Anxious
Pale
Consecutive blood pressure readings may show a downward trend
Fatigue
Tachypnea
 Paroxysmal nocturnal dyspnea
Orthopnea
Auscultation of the lung fields reveals crackles, wheezes, dyspnea, and cough 
Tachycardia
S3 and S4 heart sounds heard
Arrhythmias
39
Q

Right-sided heart failure

A 
Increased central venous pressure
Tachycardia
Jugular venous distention
Fatigue
Weight gain 
Dependent edema 
Anorexia 
N/V secondary to abdominal engorgement 
Hepatomegaly
Ascites
Decreased urinary output
40
Q

Medical treatment of Heart failure

A

Drug therapy
ACE inhibitors, diuretics, beta-adrenergic blockers, inotropic agents, cardiac glycosides, and nitrates. In addition, certain patients will benefit from B-type natriuretic peptide
Intra-aortic balloon pump (IABP)
Ventricular assist devices (VADs)
Biventricular pacing - conduction delays in R or L ventricle
Surgery
Coronary artery bypass grafting, valve repair or replacement, partial left ventriculectomy, and cardiac transplantation

41
Q

Nursing Assessment of Heart Failure

A

Heart sounds, rate, and rhythm
Jugular vein distention
Baseline respiratory assessment of rate, rhythm, and breath sounds is vital
Measure weight and blood pressure accurately
Inspect skin and palpate for turgor and edema
Intake and output records and daily weig

2024DM Med Surg (35 decks)

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