Cardio (333E2) Flashcards
afterload
The pressure the ventricles must work against to pump blood out of the heart (opens semilunar valves) affected by vascular resistance, increases w/ vasocon, aortic stenosis & pulmonary htn
cardiac output (CO) equation
CO (ml/min) = stroke volume (systolic-diastolic) x heart rate (beats/min)
ejection fraction (%)
the % of blood pumped out of left ventricle with each contraction
hypertension
high blood pressure, pressure in arteries is higher than it should be (prolong changes make up & causes damage)
hypotension
SBP <90 mm/hg (do not only treat number bc some pt trend low)
infarction/necrosis
complete cut off of blood and oxygen to an area of the body
ischemia
blood flow (& oxygen) is restricted or reduced to an area in the body
myocardial contractility
how hard the heart contracts regardless of the stretch factor
orthostatic hypotension
upon standing, blood pressure drops (safety hazard, dizziness) blood pools, in healthy person no pooling
preload
The amount the ventricles stretch at the end of diastole (the amount of fluid in the ventricle) aka end diastolic volume -> increased preload increases SV which increases CO
pulmonary embolism
pulsus alternans
regular rhythm but strength of pulse varies with each beat (possible etiology = heart failure)
stroke
stroke volume
the amount of blood that is ejected from the left ventricle (into the body) every time it pumps in mL
venous thromboembolism
perfusion
passage of fluid through the circulatory system or lymphatic system to an organ or tissue (w/o this, tissues die bc O2 cannot get where it is needed)
if low perfusion to the brain, what are some symptoms
dizziness, might pass out, confused
if low perfusion to the toes, what are some symptoms
pale, weak pulses, sluggish cap refill
cardiac output
volume of blood pumped by the heart in one minute
what is the indirect measure of cardiac output
blood pressure (& heart rate)
what might alter cardiac output
-change in heart rate (in or de)
-decrease of stroke volume
-myocardial contractility
ex: meds, disease processes, activity
if stroke volume lowers, what will heart rate do in attempt to maintain cardiac output
heart rate will increase (a compensatory mechanism)
classifications of ejection fraction
-normal: 50-70%% [comfy during activity]
-borderline: 41-49% [pos symp during activity]
-heart failure: <40% [pos symp at rest]
what is the power house chamber of the heart
the left ventricle
diastole means & example in left ventricle relating to ejection fraction
relaxation ; when the left vent is in diastole it might have 100ml of blood sitting in it and if 50ml are pumped out on contraction, the EF is 50%
when would someone get a heart transplant
when their ejection fraction is incompatible to life
blood pressure
force exerted by the blood against the blood vessel walls (must be adequate to maintain perfusion during rest & activity)
pulse pressure
the difference between systolic and diastolic BP, usually about 1/3 of sbp (ex: 120-80 = pp of 40)
high pulse pressure might indicate
-atherosclerosis (hardening of arteries)
-exercise
low pulse pressure might indicate
-severe heart failure
-hypovolemia (fluid volume deficit)
CAB for CPR
compression (hard &fast - always first), airway, breathing
there will be a question on CPR
know numbers, rate, depth, do’s & dont’s of chest recoil, tilting the airway for adults
when is CPR needed
when someone doesn’t have a pulse or respiration
common perfusion concerns
-hypertension (decreased profu)
-hypotension
-hyperlipidemia
-venous thromboembolism
htn causes adverse affects of the arterial walls which causes what
increased peripheral vascular resistance
peripheral vascular resistance
the amount of effect that the heart has to overcome in order to get the blood out of the heart into the periphery (increased prolong will cause heart failure)
decreased profusion to the heart ; brain ; kidneys ; legs will cause
a heart attack ; a stroke ; kidney failure ; lose legs
BP categories
-normal: 120/80
-elevated: 120-129/<80
-HTN 1: 130-139 or 80-89
-HTN 2: 140+ or 90+
-HTN crisis: >180 and/or >120
factors influencing blood pressure
-age
-stress (sympathetic res)
-ethnicity (AA & hispanics)
-genetics
-gender (after puberty higher in males, after menopause higher in females)
-daily variation
-medications
-activity
-weight
-smoking (vasoconstriction, smaller)
daily variation of BP
lower at rest
-midnight-3am lowest
-slow rise until 6am
-surge when you wake up
-10am - 6pm BP is at the highest
HTN risk factors - modifiable
-DM (choose to control)
-elevated serum lipids (alter diet & ~meds)
-excessive Na intake (H2o follows Na, limit)
-obesity (diet & lifestyle)
-sedentary lifestyle (move)
-stress (manage)
-tobacco use (stop)
-alcohol use (decrease)
HTN risk factors - non modifiable
-family hx
-race/ethnicity
-increasing age
-gender
-CKD
-Obstructive SA
hypertension is a “” killer
“silent”, pts are usually asym until severe
how to diagnose HTN
average of 2 or more readings on at least 2 subsequent health care visits is above 120/80 (also maybe ekg or chest x ray)
HTN symptoms
dizziness, headache, heart palpitation, nosebleed, short breath, anger, reddened face, visual problems, fatigue, insomnia, sore knee, raised temp
complications of htn
-CVD
-MI (heart attack)
-heart failure
-stroke
-peripheral vascular disease
-renal disease
retinal disease
nursing care - blood pressure readings for someone w/ htn
pt rest for 5 mins, wait 1 minute in between readings, do both arms, record highest reading, observe patterns/baseline
nursing intervention goals of pt w/ htn
prevent heart disease, stroke or renal disease
nursing care for htn
assist w/ changing risk factors, heart healthy diet, wt reduction if needed, balance rest & activity, stop smoking, mgn meds, monitor BP, collab w/ provider & dietitian, pt ed
pt education for HTN
-bp screening program (have a cuff? can they use the cuff? when to hold meds? when to notify PCP? how to record?)
-discuss risks
-how to manage
-lifestyle modification
-proper nutrition & exercise
-stress mgt
-drug therapy ed
when to seek immediate care for htn
- BP >180/110
- severe headache
- dyspnea or chest pain
-dizziness, numbness, weakness
-loss of vision
-difficulty speaking
-nose bleeds
-severe anxiety
-unresponsive
lifestyle modifications for htn
-mgn blood pressure
-control cholesterol
-reduce blood sugar
-get active , lose wt
-stop smoking
-limit alc
-stress modification
dash diet
- 6 to 8 serving whole grains /d
- 4 to 5 serving /d of fruits
- 4 to 5 serving /d of veggies
- 2 to 3 servings /d of low fat dairy
- 4 to 5 serving /w of legumes
- <6 servings /d lean meat & fish
- <5 servings /w of sweets
- 2 to 3 servings/d fats & oils
-limit salt
why are we concerned about hypotension
low perfusion to organs
causes of hypotension
-dilation of arteries
-loss of blood volume (dehy, bleeds, weak heart)
-failure of heart muscle to pump
symptoms low hypotension
-pale, modeled clammy skin
-light headedness, dizziness (syncope), confusion
-blurred vision
-chest pain (angina)
-increased HR
-decreased urine output
-nausea / vomiting
treatment of hypotension
treat the cause
-if vasodilation: find things to increase resistance of vasculature (give meds)
-if loss of blood volume: supplement perfusion insider the intravascular space (IV fluids)
-if failure to pump: may give meds to increase contractility of the heart
nursing implementation of hypotension
-monitor VS more frequently
-assess for symptoms
-interventions for treatment of cause
-consider adding more salt to diet
-drink water or IVF
-wear compression hose
-meds
what type of people get orthostatic hypotension
-w/ who don’t have very high blood volume
-elderly
-people who have been immobilized / bedrest
-pregnant women
diagnosis of orthostatic hypotension
-SBP: decrease of 20mmHg or more
-DBP: decrease of 10mmHg or more
-same symptoms as hypotension
when you go from lying to standing
how to check for orthostatic hypotension
-measure BP & HR supine, sitting & standing
-measure BP within 3 mins of position changes
-monitor BP, pulse & symptoms
-CDC: 5mins after lying down, 1 min after standing, 3 mins after standing
nursing care for orthostatic hypotension
-change position slowly
-dangle feet at bedside
-do not cross legs
-early ambulation
-if immobile, balance rest & activity
-perform isometric exercises (squeezing rubber ball)
-wear compression (venous return
-prevent falls
what are lipids
-cholesterol & triglycerides
-made by liver and consumed in diet from animal sources
what is the most common fat in the body
triglycerides, body makes it and we consume it
hyperlipidemia diagnostic tests
-start at 20, test every 4-6 years until 40 and then assess every 10 unless risk factors
-needs to be fasting (9-12 hrs)
desired chol, LDL, & HDL levels (serum lipid profile)
-chol: <200mg/dL
-LDL: <130 mg/dL
-HDL: >45 (M), >55mg/dL (F)
nursing care for hyperlipidemia
check, change, control
-be active
-diet mods
-healthy wt
-limit smoking & alc
-lipid lowering therapy
dietary modifications for hyperlipidemia
-reduce sat & trans fat
-increase complex carbs (WG, F/V) & fiber
-limit cholesterol
-limit alc & simple sugar (esp for high tags)
-eat fatty fish weekly + omega 3s
foods high in omega 3s
soybean oils, canola, walnuts, flax seeds
DVT + PE =
VTE
a pulmonary embolism enters the heart on which side?
right side and then gets pumped into the lung
what is a VTE
obstruction of a blood vessel by a blood clot that has become dislodged from another site (usually legs) in the circulation
who is at risk for a VTE
-someone with venous stasis (the blood isn’t moving back to your heart from your legs)
-person w/ hyper coagulability
-endothelial damage
-hx of DVT
-diabetes
what causes venous stasis
obesity, immobility, surgery, pregnancy, anyone with thickened blood (hyper-coagulability)
what causes endothelial damage
-some kinds of IV fluids / having an IV site
-certain drugs / drug abuse
-fractures & dislocations
signs & symptoms of VTE
-localized redness, tenderness, swelling over vein sites
-warm, tenderness firmness of muscle in calf
-calf pain when ambulating
-usually unilateral pain
assessment for DVT
usually redness will not show due to depth & early phases wont be swollen
-palpate legs and ask/watch about pain
VTE diagnosis
-obtain hx
-physical assessment
-vascular ultrasound studies (only reliable tool to detect)
Nursing care for VTE
-assess for symptoms
-measuring calf circumference
-calf tenderness/phlebitis check
-early ambulation/activity
-ted hose (expose tips of toes to check for profusion)
-SCDs (compression machines)
-calf pumping
VTE treatment
prevention is key
-anticoagulation
-thrombolytic
-IVC filter
-nursing interventions
diagnostic tests related to cardiovascular system for fundamentals
-complete blood count (CBC) for hgb & hct
-fasting lipid panel for chol/tags/ldl/hdl
-chest x ray (fluid build up in lungs & heart size)
-electrocardiography (EKG)
hemoglobin
the iron containing pigment of the red blood cells ; need it in order for the oxygen to travel on the rbc
hemoglobin normal range
need to know for exam
14-18 (M), 12-16 (F)
hematocrit
the percentage of total volume of that is made up of RBCs
hematocrit normal range
need to know for exam
42-52% (M), 37-47% (F)
electrocardiogram (EKG)
reflects the normal electrical conduction (we want it to be in normal sinus rhythm) a snap shot in time
normal sinus rhythm
originates in the SA nodes, follows normal sequence through conduction system (means the ateria contracts, the ventricles contract, the rate is good and the heart is happy)
the difference between EKG & telemetry
-EKG is a detailed snap shot in time
-telemetry is less detailed but is continuous
what implies fluid volume excess
jugular venous distention more than 45 degrees
S3
ventricular gallop “Ken-TUCK-y”
S4
atrial gallop “TEN-nes-see”
murmurs
-swishing sound
-within a valve
click sounds in the heart
pt has mechanical valve
rubbing heart sounds
rubbing of theh pericardial sac and it sounds scratchy
peripheral vascular checks
feet tell you so much
-pain
-pulse (0-4+)
-pallor (pale)
-paresthesia (feeling)
-paralysis
nursing implementation for the cardiovascular pt
-strict I&Os
-oxygen prn
-telemetry
-administer medications
-monitor labs
-implement heart healthy diet
-limit stress
-prevent thrombus formation
nursing collaborations for the cardiovascular pt
cardio pul rehab, HCP, cardiologist, res therapy, code team/rapid, dietitian, PT, cardiac nurse navigators, support groups, social / cae mgt
hypertension does what to cardiac output, peripheral resistance and hematocrit levels
increases them
How to increase preload
IV fluids, stimulating SNS w/ meds (vasopressors) venous return to the heart
How to decrease preload
Diuretics (pts usually in volume overload) , vasodilation
