Cardio Flashcards
What are the cardiac disorders?
Hypertension
Cardiac dysrhythmia
Coronary artery disease
Heart failure
What is hypertension
When SBP > 130
When DBP > 80
What are consequences of HTN
Cardiac disease
Stroke
Renal disease
Peripheral artery disease
Blindness
What is coronary artery disease (CAD)
CAD is caused by plaque buildup in the wall of the arteries
What are symptoms of CAD
angina/chest pain
Shortness of breath
GI symptoms
Myocardial infarction
What are cardiac dysrhythmias/arrhythmias?
Abnormal heart rate and/or rhythm
What are signs and symptoms of cardiac dysrhythmias/arrhythmias
Low CO
heart failure
What is heart failure?
Heart failure occurs when the heart can no longer pump effectively and cannot supply adequate blood to the body
What are the signs and symptoms of left sided heart failure?
Low blood delivered to periphery
Low renal function
Low GI function
Chest pain
Fatigue
Lung congestion
What are the signs and symptoms of right sided heart failure?
Hypoxia
Peripheral edema
Jugular venous distention (JVD)
Hepatic congestion
Hepatomegaly
Ascites
What are the HTN drugs?
ACE inhibitors
A2RBs
Calcium blockers
Alpha 1 and 2 blockers
Beta blockers
MOA for ace inhibitors
Blocks the enzyme (ACE) that converts angiotensin 1 to angiotensin 2. This action promotes vasodilation and excretion of sodium and water from the kidneys
From graph:
Produces vasodilation.. decreases blood pressure.. Lowers hearts workload.. increased blood flow.. increases O2 supply
What is angiotensin 2
A potent vasoconstrictor and also stimulates the release of aldosterone from the adrenal cortex and antidiuretic hormone (ADH).
What is aldosterone
It’s a hormone that causes retention of sodium by the kidneys and ADH acts on the hypothalamus to stimulate thirst and on the kidneys to retain water. These actions attempt to increase blood volume and BP
How do ace inhibitors increase UO?
It blocks aldosterone. The kidneys will no longer hold sodium and retain water, therefore decreasing blood volume which will decrease BP
Prototype for ACEI
Lisinopril
Adverse effects of ACEI
Hypotension- dizziness, light headedness, syncope
Arrhythmias, angina, HF
sexual dysfunction
Hyperkalemia
Angioedema
Persistent dry cough
What is the MOA of angiotensin 2 receptor blockers?
Blocks angiotensin 2 to produce vasodilation
Adverse effects for A2RBs
Hypotension- dizziness, light headedness, syncope
Arrhythmias, angina, HF
sexual dysfunction
Hyperkalemia
Angioedema
Cough (less)
What are teachings for ACE and ARBs?
Monitor electrolytes especially K
Monitor renal function: BUN, creatine, EGFR
Avoid salt substitutes and foods with high potassium
What are specific teachings for all HTN drugs?
Same time and stagger if > 1
Don’t abruptly stop
No hot weather
No excess alcohol
MOA for calcium channel blockers
Blocks Ca+ channels in vascular smooth muscle walls which increases vasodilation
Generic names for calcium blockers
Nifedipine
Diltiazem
Verapamil
Amlodipine
Adverse effects for calcium blockers
Bradycardia or reflex tachycardia
Orthostatic hypotension
Constipation (with Verapamil)
Edema
Teachings for calcium channel blockers
Monitor bowel function and add fiber to diet
Check BP, HR
Check cardiac enzymes: troponin, CK, LDH, myoglobin
Routes for ACEIs
PO; but IV for rapid action
What do ACEIs treat?
Hypertension by lowering BP
Heart failure by lowering afterload and preload
Nursing considerations for ACEIs?
Assess BP and pulse routinely— watch for hypotension
Monitor— Potassium levels, make sure they are not experiencing hyperkalemia
Monitor renal function— BUN and creatine and UOP
Angioedema which is swelling of dermis and Sub Q tissue.. so it’s really deep swelling
Watch for dry cough
Prototype for A2RBs
Losartan
Valsartan
Route for A2RB
PO; IV for rapid action
What do ARBs treat?
It treats hypertension
Heart failure: lowering preload and afterload
What do calcium channel blockers treat
Hypertension
Angina
Arrhythmia
Prototypes for alpha blockers
Prazosin
Doxazosin
Adverse effects of alpha blockers
1st dose hypotension
What do alpha blockers treat?
Hypertension
Prototype for nitrates
Nitroglycerin
Specific teaching for short acting nitroglycerin
Have the patient stop activity
1 tablet sublingual every 5 mins x 3 for chest pain.. PRN
For patches and ointments:
Apply to clean, dry, hairless area, rotate sites, avoid distal portions
12 hours on- 12 hours off
Prototype for angiotensin receptor neprilysin inhibitors
Valsartan/sacubitril
Therapeutic effect for ARNIs
Decrease signs of heart failure
Improved ejection fraction
Prototype for k+ channel blockers
Amiodarone
What does amiodarone treat?
Dysthymia
HR returns to baseline (60-100 beats per min)
Rhythm will return to regular
No signs of HF
Adverse effects of amiodarone
Pulmonary toxicity
Visual disturbances
Liver/thyroid dysfunction
GI and CNS symptoms
Teachings for anti dysthymics?
How to take pulse for 1 full min
Have BP monitored regularly
Use OTC cold remedies, appetite suppressants, and anti sleep with caution
Timing of medications especially if taking more than one
Safety about reposition changes
Follow up labs- electrolytes
Report any worsening SOB, palpitations, chest pain
What does digoxin treat?
Dysthymia
Therapeutic effects for digoxin
HR returned to baseline
Rhythm becomes regular
Narrow therapeutic range
Serum blood levels: 0.5-2 ng/ml
Adverse effects for digoxin
Bradycardia
Hypotension
S/SX of decreased cardio output or HF
Anorexia is common early sign of digoxin toxicity
Visual changes- yellow halos around objects, blurring
Nursing considerations for digoxin
It has a long half life due to high protein binding so give once a day and loading dose is required
Antidote: digoxin immune fab (Digibind)
What kind of electrolyte imbalance is associated with digoxin
Hypokalemia
Hypomagnesemia
Hypercalcemia
