Cardiac Test #2 Flashcards
What is CHF?
• 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
What is left-sided heart failure?
- 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
What does left-sided heart failure cause?
• Pulmonary edema
Cough
Dyspnea
Orthopnea
Crackles
• Impaired Kidney function
• Cerebral AnoxiaWhat is Dyspnea?
• labored breathing that occurs because of low O2
What is Orthopnea?
- Labored breathing that occurs when laying flat.
* Relieved by sitting up or leaning over bedside table
What is BUN?
- Blood Urea Nitrogen (a blood test)
* Measures kidney function (urine waste)
What is Cerebral Anoxia?
• Lack of 02 to the brain
What is right-sided heart failure?
• Blood backs up into extremeties ex edema in feet
What does right-sided heart failure cause?
- Dependent edema
- Weight gain
- Liver and GI tract complications
- Frequent urination at night
- JVD
What is dependent edema?
- means dependent on gravity.
* fluid accumulates in lower extremities ie ankles and feet
What causes weight gain?
Fluid retention
What is JVD?
- Jugular Vein Distention
* Major symptom of heart dz
What is cor pulmonale?
- Right sided heart failure
- Enlargement of rt ventricle due to ↑BP in lungs
- Caused by chronic lung dz ex COPD
How is CHF diagnosed?
- BUN/ Creatinine bld test
- BNP bld test
- Thyroid bld test
What is BNP?
> Brain Natriuretic Peptide
• Hormone produced in response to over stretching of the ventricles
What is a low sodium diet?
- 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
What is allowed on a low sodium diet?
- Salt substitute
* Ex Mrs Dash
What must be considered when choosing a salt substitute?
• Remember some salt substitutes are high in potassium
What foods are high in sodium?
- Salted pretzels
- Salted popcorn
- Ham
- Salami
- Cheese
- Can vegs
- Ketchup
- Olives
What does Digoxin do?
- A diuretic
- Slows & strengthens heart contractions
- Increase cardiac output by allowing heart to fill better
What are nrsg considerations for a pt on Digoxin?
- Check heart rate before giving
* Apical rate must b> 60 bpm
What are signs of Digoxin toxicity?
- Bradycardia
- Arrhythmias
- Abdominal pain, N/V, anorexia
- Visual problems (halo)
- Low potassium levels
Why do the elderly run a risk for developing digoxin toxicity?
- 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)
What is the generic name for Lasix?
Furosemide
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
What are lab values for Potassium?
• 3.6-5.0 MMOL/L
What are lab values for Sodium?
• 137-145 MMOL/L
What are complications if Potassium is too high?
- Hyperkalemia
* Wh leads to arrhythmias
What are complications if Potassium is too low?
- Hypokalemia
* Wh leads to arrhythmias
What is Raynaud’s Dz?
• A problem involving artery blood flow
What does Raynaud’s Dz do?
• Vasospasm and constriction usually in the hands
What are S&S of Raynaud’s Dz?
- skin of hands and nailbeds get pale or cyanotic from lack of circulation
- very painful
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.
What is Tx for Raynaud’s
- avoid triggers (jackhammers – drills etc)
- wear gloves
- May need to take Calcium Channel Blockers for vasodilatation effect
What is Rheumatic heart Dz?
• It is a consequence of rheumatic fever which develops after repetitive consequences of strep throat.
What does Rheumatic Dz cause?
• It causes the valves of the heart to become calcified and not work properly
What parts do Rheumatic Dx affect?
• The heart valves
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
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
What are symptoms of Endocarditis?
- Intermittent low grade fever
- fatigue
- wt loss
- pain in joints
- little bleeds under fingernails
What is Tx for Endocarditis?
- IV antibiotics
* Usually need for 4-6 weeks
What is an Aneurysm?
- a bulging – weakened, outpouching of an arterial wall
- tends to enlarge over time
- Most common is AAA (abdominal Aortic Aneurysm)
What are varicose veins?
- Abnormally dilated veins
* Secondary to incompetent valves
What causes vericose veins?
- Occupational
- Obesity
- Pregnancy
- Hereditary
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)
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)
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.
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
What is a thrombus?
• A clot that is stationary-fixed in place
What is an embolus?
- Clot that breaks free from the thrombus
* Floats around in the bld stream
What are symptoms of DVT?
- pain
- swelling
- warmth
- discoloration/mottled skin
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
What are basic Tx for DVT?
- Elevate extremity on pillows
- Apply heat to the area-moist heat is best
- Medications-heparin and Coumadin
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
What does Coumadin do?
• Coumadin/Warfarin helps to pevent blood clots from forming or from getting bigger, but it does not dissolve blood clots
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
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
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
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
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
What is HTN?
- hypertension
- a persistent elevation of blood pressure (not just one time reading)
- Medical dx
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
What is secondary HTN?
- ↑BP caused by an underlying condition
* When another known cause like kidney dz is responsible for the HTN.
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
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
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
What is the DASH diet?
- Dietary Approach to Stop Hypertension
- Low in saturated fats and cholesterol
- Whole grains
- Fruits
- Vegetables
- Low-fat dairy products
What medications are given for HTN?
- Diuretics
- Beta Blockers
- Calcium Channel Blockers
- ACE inhibitors
What are general side effects of antihypertensive medications?
- dizziness
- Orthostatic hypertension
- Annoying cough
What are “lol’s”?
• Beta blockers
What are “pine’s?
• Calcium Channel blockers
What are “prils”
• ACE Inhibitors
What are statins?
• Cholesterol lowering
What are some Diuretics?(3)
- Thiazides – (HCTZ)
- Loop diuretics – Lasix
- Potassium sparing – Aldactone
Name some Beta blockers (3)
- Atenolol (Tenormin)
- Metoprolol (Lopressor)
- Propranolol (Inderal)
Name some Calcium Channel Blockers (2)
- Amlodipine (Norvasc)
* Nifedipine (Procardia)
Name some ACE Inhibitors (2)
- Enalapril (Vasotec)
* Lisinopril (Zestril)
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”
Who is gonna ROCK this Cardio test?
I AM ! ! ! !
