Cardiac Test #2 Flashcards
1
Q
What is CHF?
A
• Congestive Heart Failure • Inability of heart to pump effectively • Syndrome that gets worse over time • Long term dx- lifetime but manageable • Back flow of bld in pulmonary or systemic system • Development of compensatory mechanisms
2
Q
What is left-sided heart failure?
A
- Blood backs up into lungs bc bld in lt side of heart come from the lungs
- The heart not giving the kidneys enough bld to do its job
3
Q
What does left-sided heart failure cause?
A
• Pulmonary edema
Cough
Dyspnea
Orthopnea
Crackles
• Impaired Kidney function
• Cerebral Anoxia
4
Q
What is Dyspnea?
A
• labored breathing that occurs because of low O2
5
Q
What is Orthopnea?
A
- Labored breathing that occurs when laying flat.
* Relieved by sitting up or leaning over bedside table
6
Q
What is BUN?
A
- Blood Urea Nitrogen (a blood test)
* Measures kidney function (urine waste)
7
Q
What is Cerebral Anoxia?
A
• Lack of 02 to the brain
8
Q
What is right-sided heart failure?
A
• Blood backs up into extremeties ex edema in feet
9
Q
What does right-sided heart failure cause?
A
- Dependent edema
- Weight gain
- Liver and GI tract complications
- Frequent urination at night
- JVD
10
Q
What is dependent edema?
A
- means dependent on gravity.
* fluid accumulates in lower extremities ie ankles and feet
11
Q
What causes weight gain?
A
Fluid retention
12
Q
What is JVD?
A
- Jugular Vein Distention
* Major symptom of heart dz
13
Q
What is cor pulmonale?
A
- Right sided heart failure
- Enlargement of rt ventricle due to ↑BP in lungs
- Caused by chronic lung dz ex COPD
14
Q
How is CHF diagnosed?
A
- BUN/ Creatinine bld test
- BNP bld test
- Thyroid bld test
15
Q
What is BNP?
A
> Brain Natriuretic Peptide
• Hormone produced in response to over stretching of the ventricles
16
Q
What is a low sodium diet?
A
- Tx of CHF
- Limit of sodium to approx 2.5 Gm/day
- Avoiding ↑ sodium foods
- Some pts restricted to 2 Gm/day
- Be aware of other sources of sodium in foods
17
Q
What is allowed on a low sodium diet?
A
- Salt substitute
* Ex Mrs Dash
18
Q
What must be considered when choosing a salt substitute?
A
• Remember some salt substitutes are high in potassium
19
Q
What foods are high in sodium?
A
- Salted pretzels
- Salted popcorn
- Ham
- Salami
- Cheese
- Can vegs
- Ketchup
- Olives
20
Q
What does Digoxin do?
A
- A diuretic
- Slows & strengthens heart contractions
- Increase cardiac output by allowing heart to fill better
21
Q
What are nrsg considerations for a pt on Digoxin?
A
- Check heart rate before giving
* Apical rate must b> 60 bpm
22
Q
What are signs of Digoxin toxicity?
A
- Bradycardia
- Arrhythmias
- Abdominal pain, N/V, anorexia
- Visual problems (halo)
- Low potassium levels
23
Q
Why do the elderly run a risk for developing digoxin toxicity?
A
- Have slower metabolism so digoxin takes a longer time to pass thru system (liver)
- Low potassium level makes risk for toxicity ↑ (bc of taking diuretics)
24
Q
What is the generic name for Lasix?
A
Furosemide
25
What does Lasix do?
* Inhibits reabsorption of sodium & chloride from loop of Henle & distal renal tubule.
* ↑ renal excretion of water, sodium, chloride, magnesium, potassium, & calcium.
* ↓ BP
* Main effect: fluid loss
* Diuresis-act of kidneys filtering out & making future urine
26
What are lab values for Potassium?
• 3.6-5.0 MMOL/L
27
What are lab values for Sodium?
• 137-145 MMOL/L
28
What are complications if Potassium is too high?
* Hyperkalemia
| * Wh leads to arrhythmias
29
What are complications if Potassium is too low?
* Hypokalemia
| * Wh leads to arrhythmias
30
What is Raynaud's Dz?
• A problem involving artery blood flow
31
What does Raynaud's Dz do?
• Vasospasm and constriction usually in the hands
32
What are S&S of Raynaud's Dz?
* skin of hands and nailbeds get pale or cyanotic from lack of circulation
* very painful
33
What brings on an attack of Raynaud's Dz?
* When skin is exposed to cold temps
| * Prolonged exposure to vibrations such as jackhammers – drills etc.
34
What is Tx for Raynaud's
* avoid triggers (jackhammers – drills etc)
* wear gloves
* May need to take Calcium Channel Blockers for vasodilatation effect
35
What is Rheumatic heart Dz?
• It is a consequence of rheumatic fever which develops after repetitive consequences of strep throat.
36
What does Rheumatic Dz cause?
• It causes the valves of the heart to become calcified and not work properly
37
What parts do Rheumatic Dx affect?
• The heart valves
38
What is Endocarditis?
* Inflammation of the inner lining of the heart
* Bacteria enters the bld stream & settles in the inner lining of the heart (colonies)
* Primarily affects the heart valves-they become calcified and do not work properly
39
Who is at risk for Endocarditis?
* People who already have heart valve abnormalities such as rheumatic hrt dz.
* Have mitral valve prolapse
* Have had a valve replacement
* IV drug users
40
What are symptoms of Endocarditis?
* Intermittent low grade fever
* fatigue
* wt loss
* pain in joints
* little bleeds under fingernails
41
What is Tx for Endocarditis?
* IV antibiotics
| * Usually need for 4-6 weeks
42
What is an Aneurysm?
* a bulging – weakened, outpouching of an arterial wall
* tends to enlarge over time
* Most common is AAA (abdominal Aortic Aneurysm)
43
What are varicose veins?
* Abnormally dilated veins
| * Secondary to incompetent valves
44
What causes vericose veins?
* Occupational
* Obesity
* Pregnancy
* Hereditary
45
What to do to keep varicose veins from getting worse?
* Promote venous return
* Elevate legs
* Use non restrictive clothing
* Leg exercises
* Losing weight
* Avoid long periods of standing
* AE hose (compression stocking)
46
What are Txs for varicose veins?
* Sclerotherapy-injection of solution into the affected vein
* Laser surgeries-energy heats up vein and collapses it
* Vein ablation-use of hot tipped catheter (like laser technique)
47
What is Thrombophlebitis?
* Thrombophlebitis is inflam of vein (usually extremity, especially legs)
* occurs in response to a blood clot in the vessel
* When it occurs in a vein near the surface of the skin, it is known as superficial thrombophlebitis, a minor disorder commonly identified by a red, tender vein.
48
What is DVT?
* Deep Vein Thrombosis
* An abnormal blood clot development in a VEIN (not an artery)
* Usually in the legs
* Clot obstructs blood flow in the vein
49
What is a thrombus?
• A clot that is stationary-fixed in place
50
What is an embolus?
* Clot that breaks free from the thrombus
| * Floats around in the bld stream
51
What are symptoms of DVT?
* pain
* swelling
* warmth
* discoloration/mottled skin
52
How can DVT be avoided?
* be active – moving
* leg exercises if bed-bound
* stop smoking
* weight loss
* If traveling get out of seat qhr or q 2 hrs
* stay hydrated
* Compression stockings
53
What are basic Tx for DVT?
* Elevate extremity on pillows
* Apply heat to the area-moist heat is best
* Medications-heparin and Coumadin
54
What are the do's and don'ts in the care of a pt w/DVT?
* Do not massage the are-may cause part of the thrombus to break off
* Do check lab values and for bld in stools
55
What does Coumadin do?
• Coumadin/Warfarin helps to pevent blood clots from forming or from getting bigger, but it does not dissolve blood clots
56
What are the risks of Coumadin to the pt?
* Abnormal bleeding
* paralysis
* pink or brown urine
* sudden shortness of breath
* unexplained bruising
* unusual pain or swelling
57
What does Heparin do?
* helps to keep blood flowing smoothly and from clotting by making a certain natural substance in your body (anti-clotting protein) work better.
* An anticoagulant-prevents formation of clots
* Does not break down existing clots
58
What are the risks of Heparin to a pt?
* sudden numbness or weakness, especially on one side of the body;
* sudden severe headache, confusion, problems w/vision, speech, or balance;
* chest pain, sudden cough, wheezing, rapid breathing, fast heart rate;
* pain, swelling, warmth, or redness in one or both legs;
* trouble breathing
* fever, chills, runny nose, or watery eyes.
* Abnormal bleeding
59
what is the relationship btw a PTT test and Heparin?
* Partial thromboplastin time (PTT) a blood test that looks at how long it takes for blood to clot. It can help tell if you have bleeding or clotting problems.
* Done to check the clotting time for pts on heparin
60
What is the relationship btw PT/INR test and Coumadin?
* The PT and INR are used to monitor the effectiveness of the anticoagulant warfarin (COUMADIN)
* Checking the clotting time for pts on Coumadin
61
What is HTN?
* hypertension
* a persistent elevation of blood pressure (not just one time reading)
* Medical dx
62
What is essential HTN?
* When there is no identifiable cause of ↑ BP
* This type of ↑ BP, called essential hypertension or primary hypertension
* tends to develop gradually over many years
63
What is secondary HTN?
* ↑BP caused by an underlying condition
| * When another known cause like kidney dz is responsible for the HTN.
64
What are the risks factors for HTN?
* Older age
* Race/ethnicity (Afr Amer)
* Family hx/genetics (immediate family member with elevated BP before age 60)
* Overweight (body mass >25)
* Diet (salt sensitive – high fat)
* Smoking
* Alcohol (excessive use can elev BP)
* Lack of exercise
* DIabetes (leads to atherosclerosis)
* Stress
65
Whare are possible findings on a physical exam for HTN?
* enlarged thyroid
* distended neck veins
* bruits in the carotid arteries
* Clubbing of fingers
* Edema in lower extremities
* Retina changes
66
What are standard Txs for HTN?
* Limit alcohol
* Stop smoking
* Reduce caffeine intake
* Reduce stress
* Exercise
* Weight control
* Reduce sodium intake
* Monitor BP regularly
* DASH diet
67
What is the DASH diet?
* Dietary Approach to Stop Hypertension
* Low in saturated fats and cholesterol
* Whole grains
* Fruits
* Vegetables
* Low-fat dairy products
68
What medications are given for HTN?
* Diuretics
* Beta Blockers
* Calcium Channel Blockers
* ACE inhibitors
69
What are general side effects of antihypertensive medications?
* dizziness
* Orthostatic hypertension
* Annoying cough
70
What are "lol's"?
• Beta blockers
71
What are "pine's?
• Calcium Channel blockers
72
What are "prils"
• ACE Inhibitors
73
What are statins?
• Cholesterol lowering
74
What are some Diuretics?(3)
* Thiazides – (HCTZ)
* Loop diuretics – Lasix
* Potassium sparing – Aldactone
75
Name some Beta blockers (3)
* Atenolol (Tenormin)
* Metoprolol (Lopressor)
* Propranolol (Inderal)
76
Name some Calcium Channel Blockers (2)
* Amlodipine (Norvasc)
| * Nifedipine (Procardia)
77
Name some ACE Inhibitors (2)
* Enalapril (Vasotec)
| * Lisinopril (Zestril)
78
How can you tell a med category by looking at the generic name?
* Beta Blockers-"lol's"
* Calcium Channel Blockers-"pines"
* ACE inhibitors-"prils"
* Cholesterol meds-"statins"
79
Who is gonna ROCK this Cardio test?
I AM ! ! ! !
