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critical care > cardiac disorders pt. 3 > Flashcards

cardiac disorders pt. 3 Flashcards

1
Q

impairment of the abilityof the ventricle to fill or eject blood effectively (pump issue)

A

heart failure

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2
Q

what can heart failure result from?

A

acute MI
uncontrolled HTN
valvular dysfunction
infection
cardiomyopathy

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3
Q

what is a complication of HF that is stiffening and enlarging of the heart

A

ventricular remodeling (bad)

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4
Q

L sided HF sx

A

Left side = backed up to lungs
-SOB
-orthopnea
-crackles
-elevated PAWP (wedge), PAOP, PAP

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5
Q

R sided HF sx

A

R side = backed up from entering heart
-lower extremity edema
-JVD
-hepatojugular reflux
elevated CVP

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6
Q

what is secreted by the ventricles in response to excessive stretching of heart muscle cells (compensating)

A

B-tyoe natriuretic peptide (BNP)

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7
Q

what does BNP do to the body

A

stops RAAS

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8
Q

what is the BNP diagnostic level for HF

A

> 100

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9
Q

what is the marker of cardiac dysfxn and is correlated with LV preload

A

BNP

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10
Q

Interventions management of HF (3)

A

-meds
-cardiac resynchronization therapy (pacing)
-ICD (defibrillator)

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11
Q

elements of self-management of HF

A

adherence to drug regimen
daily weight
low sodium diet
exercise
smoking and alcohol cessation

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12
Q

what kind of meds should be used for HF (in regards to preload, afterload, and contractility)

A

preload reduction
afterload reduction
+ inotropes

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13
Q

what 2 devices are used for HF?

A

intraaortic balloon pump
levt ventricular assist devices (LVAD)

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14
Q

what 2 meds reduce preload for HF?

A

diuretics
nitrates (nitroglycerin)

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15
Q

which 3 meds decrease afterload for HF?

A

ACE-I/ARB
hydralazine
nitroprusside

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16
Q

what is important to monitor with nitroprusside?

A

BP

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17
Q

what can taking nitroprusside long term lead to?

A

cyandide toxicity

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18
Q

which meds are given for inotropic support for HF? (3)

A

dobutamine
dopamine
milrinone

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19
Q

describe the dosing difference of dopamine

A

mid-dose increases contractility
high-dose vasoconstricts and increases afterload

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20
Q

the nurse is caring for an acute exacerbation of HF, which of the following should the nurse anticipate?
a) metoprolol
b) 0.9% NS bolus
c) morphine
d) dobutamine

A

d) dobutamine (+ inotrope)

21
Q

what is an abdominal aortic aneurysm?

A

localized dilation of a portion of the aorta >1.5x its normal diameter (usually at a weakened point)

22
Q

risk factors for abdominal aortic aneurysm (AAA)

A

smoking
age
HTN
lipid disorders
atherosclerosis
genetic predisposition

23
Q

what syndrome has a genetic predisposition for AAA

A

marfan syndrome

24
Q

sx related to STABLE AAA

A

-palpable, pulsatile mass in umbilical area
-abd pain
-lower back pain

25
Q

sx of acute rupture of AAA

A

-sudden onset of severe abd pain
-hypoTN w/ abrupt loss of consciousness

26
Q

what is the management of AAA IF STABLE?

A

risk factor modification and elimination

27
Q

what would qualify someone for aurgucal repair of AAA (3 things)

A

-aneurysm >4.5-5.5 cm
-rapidly expanding
-symptomatic regardless of size

28
Q

what is aortic dissection?

A

-weakened aortic medial layers
-false channel/lumen is created as blood is pumped through tear
-classified based on location

29
Q

which location of aortic dissection is most severe?

A

proximal (type A)

30
Q

sx of acute aortic dissection

A

-severe/sudden HTN (200s)
-excruciating pain in the back between shoulder blades
-RIPPING/TEARING SNESATION in chest
-UNEQUAL PULSES

31
Q

medical management if aortic dissection

A

BP reduction: beta blockers, IV vasodilators like nitroprusside
pain relief/sedation

32
Q

post op management of aortic dissection

A

IV nitroprusside to KEEP BP UNDER 120
monitor cardiac rhythm, hemodynamics, output (chest tube), temp, neuro assessment

33
Q

complications from aortic dissection surgery

A

stem from bypass effects (dec. perfusion on bypass)
-acute renal failure
-ischemic colitis
-spinal cord ischemia

34
Q

labs to monitor after aortic dissection surgical repair

A

-creatinine/BUN
-hgb/hct
-platelets (thrombocytopenia)
-WBC & differential
-electrolytes

35
Q

what disease obstructs blood supply of upper/lower extremities

A

peripheral arterial disease

36
Q

risk factors for PAD

A

atherosclerosis
smoking
diabetes
age >70
males
HTN
hyperlipids
family hx

37
Q

signs/manifestations of PAD

A

5 P’s
Pain intermittent claudication
pulselessness
pallor
paresthesia
paralysis

38
Q

what is pain from in PAD

A

intermittent claudication

39
Q

how much is occluded in intermittent claudication

A

> 75% of the vessel

40
Q

what does early intermittent claudication feel like?

A

cramping, burning, aching pain in legs/buttocks with activity that is relieved by rest

41
Q

what does late intermittent claudication feel like?

A

pain at rest is a warning sign of anoxic limb

42
Q

describe rating scale for pulse strength

A

0- absent
1- palpable, thready, weak, easily obliterated
2- normal, not easily obliterated
3- full, bounding, easily palpable, cannot obliterate

43
Q

what does lower extremity skin look like with PAD?

A

-cool, atrophic, shiny
-alopecia
-reddened
-pale upon elevation
-thick, brittle nails
-ulcers/lesions non-healing

44
Q

what do paralysis and paresthesias suggest?

A

limb threatening ischemia and mandate emergent evaluation and consultation

45
Q

describe ankle brachial index (ABI)

A

-apply blood pressure cuff to upper arm and above ankle and obtain BP readings
-systolic ankle pressure is divided by systolic brachial pressure

46
Q

medical management of PAD

A

-modify/eliminate risk factors
-meds (anti-thrombotics)
-lipid lowering drugd
-stenting
-surgical vascular bypass for severe obstruction

47
Q

what does chronic venous insuffiency look like

A

-brown pigmentation of skin
-edema
-thick, flaky skin
-ulcerations

48
Q

nurse is caring for post aortic dissection repair with vitals 189/102, 98bpm, RR 20, 98 F, SpO2 99. what is priority action?
a) draw CBC
b) start nitroprusside to keep BP <120
c) start norepi to keep BP >130
d) assess urine output

A

b

49
Q

which med is for PAD?
a) clopidogrel
b) tenecteplase (TNK)
c) norepi
d) nitroprusside

A

a

critical care (23 decks)

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