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N3102: Adult > Cardiac: HF and ACS > Flashcards

Cardiac: HF and ACS Flashcards

1
Q

Define heart failure

A

inability of the heart to pump sufficient blood to meet needs of tissues for oxygen and nutrients

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2
Q

What is HF characterized by?

A

fluid overload or inadequate tissue perfusion

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3
Q

What type of heart failure does this describe? (systolic/diastolic): more common, characterized by weakened heart muscle, EF is reduced

A

systolic

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4
Q

What type of heart failure does this describe? (systolic/diastolic): characterized by stiff and noncompliant heart muscle = difficulty filling ventricle, EF is normal

A

diastolic

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5
Q

What are risk factors for HF? (8)

A

ischemic heart disease
hypertension
diabetes mellitus
metabolic syndrome
hyperlipidemia
smoking
coronary artery disease (CAD)
myocardial infarction (MI)

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6
Q

Define forward failure effects in HF

A

Forward failure = insufficient cardiac pumping manifested by poor CO

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7
Q

Define backward failure effects in HF

A

Backward failure = congestion of blood behind the pumping chamber

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8
Q

what is the main symptom of left sided HF?

A

pulmonary congestion
increased systemic vascular resistance

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9
Q

What are some other S&S of left sided HF? (9)

A

Dyspnea
cough
fatigue
crackles
low O2 sat
orthopnea
frothy sputum
oliguria
tachycardia

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10
Q

What are some of the main S&S of right sided HF?

A

jugular vein distention
increased hydrostatic pressure
fluid retention
peripheral/dependent edema

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11
Q

What are some of the manifestations of fluid retention and edema in R sided HF? (6)

A

peripheral/dependent edema: when standing or sitting
increased JVD
Hepatomegaly (enlargement of liver)
Anorexia & GI discomfort (nausea)
Pleural effusion (fluid in pleural space)
Ascites (fluid in peritoneal cavity)

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12
Q

What is the key diagnostic indicator for HF?

A

Brain natriuretic peptide (BNP):
- high = high cardiac filling pressure

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13
Q

What diagnostics are included in HF? (3 main)

A
  • Brain natriuretic peptide (BNP) - high
  • Ejection fraction (EF) = low
  • echocardiogram
  • other: electrocardiogram (ECG), labs (electrolytes, blood urea nitrogen (BUN), creatinine, thyroid stimulating hormone, CBC, urinalysis
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14
Q

What does echocardiogram do?

A

echocardiogram uses ultrasound to check for anomalies in the heart’s structure

identify underlying cause and determines EF (for type and severity of HF)

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15
Q

What are some nursing interventions for pulmonary edema? (6)

A

Oxygen
Sitting up /sleeping with extra pillows
Avoid cold or extreme heat
Balance between exercise & rest
Reduce fluid & sodium intake
Pharmacology (diuretics)

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16
Q

What are some nursing interventions for peripheral edema? (4)

A

Skin care
Elevate extremities
Reduce sodium & fluid intake (Replace with ice chips etc)
Balance between rest & exercise

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17
Q

What are some medications used for HF? (7)

A

ACE-Inhibitors
Beta-Blockers
calcium channel blockers
Angiotensin Receptor Blockers
Diuretics
Cardiac Glycosides (digoxin)
Phosphodiesterase Inhibitors

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18
Q

What is the action of angiotensin-converting Enzyme inhibitors (ACE-inhibitors)?

A

Promote vasodilation and diuresis by decreasing afterload and prelaod

Reduces BP and kidneys excrete sodium and fluid (diuresis) = decreased O2 demand

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19
Q

What are some contraindications for ACE-I?

A

hypotension, hyponatremia, hypovolemic, hyperkalemic

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20
Q

What are some side effects from ACE-I? (5)

A

dry persistent cough

hypotension

renal insufficiency (MONITOR serum creatinine, serum electrolytes, blood urea nitrogen)

angioedema (swelling of the deeper layers of the skin)caused by a build-up of fluid - usually in eyes, lips, genitals)

hyperkalemia

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21
Q

What are some things to monitor with ACE-I? (6)

A

BP, urine output, serum sodium, potassium, creatinine, COUGH

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22
Q

What is an example of ACE-I?

A

Lisinopril (“prils”)

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23
Q

What is the action of angiotensin II receptor blockers (ARB)?

A

Decrease activation of angiotensin II = decrease BP and systemic vascular resistance and improve CO

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24
Q

What is an example of ARBs?

A

Valsartan (“sartan”)

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25
Q

What is the action of beta-adrengeric blockers/antagonists?

A

Blocking beta-adrenergic sympathetic stimulation to the heart

Reduces heart rate, slows conduction of impulses, decreases BP, reduces myocardial contractility to balance myocardial oxygen demands and oxygen supply = helps control chest pain and delays onset of ischemia during exercise

Reduce incidence of recurrent angina, infarction, and cardiac mortality

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26
Q

What are some side effects of beta blockers? (9)

A

dizziness
hypotension
bradycardia
advanced atrioventricular block
decompensated heart failure
depression
fatigue
decreased libido
masks symptoms of hypoglycemia

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27
Q

When are beta blockers contraindicated?

A

Contradicted in patients with pulmonary obstructive diseases (ex. Asthma): Can affect beta-adrenergic receptors = bronchoconstriction

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28
Q

What is an important assessment to take before administration of beta blockers?

A

take apical pulse prior to administration. If heart rate is less than 50 bpm or if arrhythmias occur, hold medication and notify health care provider

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29
Q

T or F: you can stop taking beta blockers at any time

A

False: discontinue gradually, can worsen angina or MI may develop

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30
Q

What is an example of a beta blocker?

A

Carvedilol (Coreg) and metoprolol (lopressor, toprol) (“lol”)

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31
Q

What is the action of calcium channel blockers (CCB) in HF?

A

Decrease sinoatrial node automaticity and atrioventricular node conduction = Slower heart rate and decrease in strength of heart muscle contraction = decrease workload

Relax blood vessels = decrease in BP and increase in coronary artery perfusion (decrease afterload)

Prevent and treat vasospasm

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32
Q

What are some SE of CCB? (5)

A

hypotension
atrioventricular block
bradycardia
constipation
gastric distress

33
Q

What is an example of CCB?

A

Ex. Amlodipine (norvasc) and diltiazem (cardizem, tiazac) -usual suffix (“dipine”)

34
Q

Does CCB decrease afterload or preload?

A

afterload

35
Q

Do diuretics decrease preload or afterload?

A

preload

36
Q

What is the action of digoxin for HF?

A

Help the heart pump more efficiently by inhibiting normal function of Na+K+ pump.

increases contractility, beats slower (decreased HR)

Result: increased SV increased output (decreases afterload)

37
Q

does digoxin decrease preload or afterload?

A

afterload

38
Q

what is important to monitor with digoxin?

A

heart rate (if below 60bpm, DO NOT administer)

potassium intake.

toxicity

39
Q

What can cause digoxin toxicity?

A

hypokalemia (loop diuretics), hypomagnesemia, hypercalcemia

40
Q

What are S&S of digoxin toxicity? (6)

A

GI distress
vision changes
dysthymias
anorexia
fatigue
depression

41
Q

What is the antidote for digoxin?

A

digidine

42
Q

What are some complications of HF? (5)

A

Cor pulmonale (in resp)
a fibrillation
MI
pulmonary edema
cardiac tamponade

43
Q

how does cor pulmonale occur in HF?

A

Pulmonary hypertension: Long-term high blood pressure in the arteries of the lung and right ventricle of the heart can lead to cor pulmonale

44
Q

How does atrial fibrillation occur in HF?

A

heart failure can actually stretch your atria and cause tissue in your heart to thicken and scar. Those changes throw off the electrical signals, and that messes up the heart’s rhythm and can cause AFib

45
Q

Define pulmonary edema

A

abnormal accumulation of fluid in the lungs. Fluid may accumulate in interstitial spaces and alveoli

46
Q

what is a classic symptom of pulmonary edema?

A

frothy pink sputum

47
Q

What are S&S of pulmonary edema? (9)

A

dyspnea
tachycardia
tachypnea
nasal flaring and use of accessory breathing muscles,
wheezing and crackles
expectoration (coughing up) of blood-tinged frothy sputum
sweating
cold and clammy skin
cyanosis

48
Q

how can you prevent pulmonary edema? (4)

A

Recognize early stages: dry hacking cough, weight gain, worsening edema, decreased activity tolerance

Upright position with feet and legs dependent

Eliminating overexertion

Minimizing emotional stress

49
Q

How do you treat pulmonary edema?

A

Diuretics: First line = laxis/furosemide

O2 to relieve dyspnea and hypoxemia

Morphine: reduce peripheral resistance and venous return so that blood can be redistributed from pulmonary circulation to other areas

Infusion of vasodilators (nitroglycerin) for dyspnea, oxygenation, and support cardiac function

50
Q

Define cardiac tamponade

A

pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle and the outer covering sac (pericardium) of the heart

51
Q

T or F: cardiac tamponade is a lifethreatening condition

A

True

52
Q

What are cardinal signs of cardiac tamponade? and other?

A

falling systolic BP, narrowing pulse pressure, increased JVD, and distant heart sounds

SOB, low BP, feeling of fullness within chest

53
Q

What is the treatment for cardiac tamponade?

A

Pericardiocentesis: puncture of pericardial sac to aspirate pericardial fluid

Pericardiotomy: portion of pericardium is excised to allow fluid to drain into lymphatic system

54
Q

Define acute coronary syndrome and what does it include?

A

occurs when there is coronary obstruction caused by thrombus formation over a ruptured atherosclerotic plaque

includes: unstable angina and myocardial infarction

55
Q

What are the S&S of an unstable angina? (4)

A

dyspnea
diaphoresis
anxiety
pulmonary congestion

56
Q

What is the management for unstable angina?

A

Go to hospital right away before it turns into MI

oxygen, aspirin (ASA), nitrates, morphine

57
Q

What is a ST-segment elevation MI (STEMI)?

A

patient has ECG evidence of MI w/ characteristic changes ub two contiguous leads on a 12-lead ECG. (significant damage to myocardium)

58
Q

What is a non-ST-segment elevation MI (NSTEMI)?

A

pt has elevated cardiac biomarkers but not ECG evidence

59
Q

What are risk factors for ACS? (10)

A

Gender
Race
Family history
Elevated blood lipid levels
Hypertension
Diabetes
Obesity
Smoking history
Recreational Drug Use
Stress

60
Q

What are symptoms of an atypical MI? (5)

A

Short of breath, Diaphoresis, Nausea, Indigestion, Anxiety

61
Q

Who is at risk for an atypical MI?

A

elderly, people with diabetes, women

62
Q

What are S&S of an MI? (8)

A

constant chest pain
SOB
indigestion
nausea
anxiety
cool/pale skin
tachycardia
tachypnea

63
Q

What are some diagnostics included for ACS? and what do each do/indicate

A

electrocardiogram: determine STEMI or NSTEMI

Echocardiogram: evaluate ventricular function

cardiac biomarkers:
- increased troponin = 4 hrs after event to detect
- increased myoglobin = less than 30 mins to detect
- increased creatine kinase

64
Q

What are the treatment goals for ACS?

A

minimize myocardial damage (restore perfusion), preserve myocardial function (reduce myocardial O2 demand), and prevent complications (dysrhythmias)

65
Q

What may be included in the treatment for ACS?

A

Emergent percutaneous coronary intervention (PCI)

cardiac rehabilitation

66
Q

What medications are used in ACS? (9)

A

nitroglycerin

Beta blockers

CCB

aspirin

Heparin

fibrinolytics/thrombolytics

ACE-I

statins

analgesics (morphine)

67
Q

What is the action of nitroglycerin?

A

Vasoactive agent that can reduce myocardial oxygen consumption: Decrease ischemia and relieves pain

68
Q

When would you hold nitroglycerin?

A

HOLD if systolic BP is 90 mmHg or less = hypotension

69
Q

What is nitroglycerin the primary treatment for?

A

angina

70
Q

What is the action of aspirin (ASA) for ACS?

A

prevents platelet activation and reduces incidence of MI and death

  • this is an NSAID
71
Q

What are some side effects of aspirin (ASA)? (2)

A

GI upset, bleeding

72
Q

What is the action of heparin for ACS?

A

prevents formation of new blood clots

Reduce occurrence of MI

73
Q

What are S&S of an increased risk of bleeding? (4)

A

low BP, increased heart rate, decreased serum hemoglobin and hematocrit

74
Q

What is an example of a heparin?

A

Enoxaparin (lovenox) or dalteparin (fragmin)

“parin”

75
Q

What is the action of a fibrinolytic/thrombolytic?

A

dissolve and lyse the thrombus in a coronary artery (thrombolysis)

76
Q

How soon should a fibrinolytic be administered to be beneficial?

A

need to be administered ASAP (within 6 hours)

77
Q

What is the action of statins for ACS?

A

lowers total and LDL cholesterol and triglycerides. Small increase in HDL. Slows progression of coronary atherosclerosis

78
Q

What are SE of statins? (8)

A

rash
abdominal cramps
constipation
diarrhea
flatus
heartburn
rhabdomyolysis
hypersensitivity reactions

N3102: Adult (5 decks)

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