Cardio Random Flashcards
0
Q
Alpha blocker -(minipress)
A
it often causes severe hypotension after the first dose so Patients should be advised to take the first dose before bedtime to avoid syncope, dizziness, or lightheadedness
1
Q
Beta -1 & 2 receptors locations
A
Beta 1 found mostly n the heart
Beta 2 found n the bronchi , arteries and uterus
2
Q
Apical pulse
A
Palpated at the fifth intercostal space on the left midclavicular line. Also known as the point of maximal impulse(PMI)
3
Q
Electrolyte imbalances are common causes of
A
ventricular tachycardia and hypo magnesium, hypokalemia, and hyperkalemia
So should obtain serum levels of potassium and calcium
Calcium imbalances may cause QT and ST changes
4
Q
Pitting edema description
A
1+= barely detectable impression, immediate rebound.
2+= slight indentation, 15 seconds to rebound
3+= deep indentation, 30 seconds to rebound
4+= greater than 30 seconds to rebound
5
Q
Digoxin (Lanoxin) has which effects on hemodynamics
A
Digoxin has a positive inotropic effect and a negative chronotropic effect, producing increase contractility and cardiac output while decreasing the heart rate. So it increases BP & decreases HR
6
Q
Thromboangiitis obliterans
A
Inflammation and thrombosis of the vessels of the hand and feet. It is strongly associated with smoking
Usually treated with vasodilators and sometimes bypass surgery
Smoking is the number one risk factor. The patient should quit smoking entirely in order to slow the progression of the disease
The patient should keep extremities warm. Cold temperatures can cause vasoconstriction and worsen symptoms
7
Q
Procainamide
A
Is antiarrhythmic used for both ventricular and atrial arrhythmia. The nurse should assess the patient’s vital signs, particularly blood pressure and heart rate before a ministry any antiarrhythmic
8
Q
Elevated potassium levels cause
A
Lethal arrhythmias! The nurse should access the patient’s EKG immediately
9
Q
Nitroglycerin infusion should be administered
A
A glass bottle because most plastics absorbs the Drug diminishing its potency and effectiveness
10
Q
A measures to relieve claudication
A
Avoid smoking because smoking cessation prevent symptoms of claudication and also reduces progression of the disease
Warm compress are recommended to promote circulation
Discomfort can be relieved with rest, as exercise will aggrevate get the legs
11
Q
Clopidogrel ( Plavix)
A
is an anti platelet med used in the prevention of vascular ischemic events and during and acute myocardial infarction
Unlike aspirin, this med reduces platelet aggregation by inhibiting the ADP pathway of platelets and doesn’t not affect prostaglandin metabolism
12
Q
Major risk factors for coronary heart disease (CAD)are
A
Diabetes
Smoking
Increase in LDL levels
Hypertension
13
Q
Pericarditis S&S
A
Chest pain Fever Leukocytosis Pericardial friction rub ST-segment elevation
14
Q
Chest pain is a symptom of
A
Myocardial infraction
15
Q
Edema and low urine output are associated with
A
Heart failure
16
Q
Spironolactone(Aldactone) can cause
A
Is a potassium sparing diuretic that can calls hyperkalemia potentially resulting in cardiac arrhythmias
17
Q
Hypokalemia is associated with Loop diuretics
A
Hypokalemia is associated with Loop diuretics
18
Q
PTCA
A
During a PTCA a balloon tipped catheter is inserted into the Femoral or radial and is advanced artery into the coronary arteries. Then the balloon is inflated to compress the atheromatous plaque against the walls of the vessel, resulting in a patent vessel
19
Q
After a cardiac catheterization using the femoral artery,
A
the patient should remain on flat bed rest and be reminded not to flex or move the affected extremity. Doing so may result in hemorrhage or arterial occlusion
Fluids are encouraged after any procedure that uses contrast dye. After a cardiac catheterization, the patient must keep the affected extremity straight, so the nurse can’t place the patient in reverse Trendelenburg to facilitate drinking
Assessing the motor functions of the patients foot is important to confirm adequate perfusion
Medications should be resume to treat all other diseases and conditions
20
Q
Endocarditis risk factors
A
Artificial valves,
dental procedures
IV drug use
immunosuppressive
21
Q
Weber test
A
Is a screening tool for conductive hearing loss
22
Q
Romberg’s test
A
Evaluates proprioception
23
Q
Tinel’s sign
A
Is used to determine median nerve damage in carpal tunnel syndrome
24
Isolated PVCs
Are not life-threatening but should be monitored closely for other rhythm changes
25
Life threatening arrhythmias are
Ventricular fibrillation
| ventricular tachycardia
26
Claudication
Refers to pain in the leg muscle after small amount of physical activity. It is caused by poor circulation to the extremity
27
Raynaud's phenomenon
A vasosplastic disorder that compromises blood flow to the extremities
28
Lazarus syndrome
Is the spontaneous return of circulation after failed attempts at resuscitation
29
Atropine
An Anti-chlorogenic medication that may cause
```
urinary retention
dry mouth
dry eyes
tachycardia
dilated pupils
blurry vision
constipation
```
30
Peripheral Vascular disease (PVD)
Leads to compromised blood flow to the extremities. Regular exercise is a great way to improve circulation and Collateral blood flow!!
31
Endocarditis S&S
```
Fever
Malaise
Murmur
Weight loss
Splinter hemorrhages
Osler's nodes
```
Infective endocarditis mostly commonly occur in
IV DRUG USER
AT THE VALVE SURGERY
AFTER DENTAL PROCEDURES
32
Splinter hemorrhages
Are tiny clots that run vertically under the fingernails
33
Osler's nodes
Are painful subcutaneous lesions in the distal fingers
34
Charcoal
Only use if large amounts of the drug are still in the stomach
35
Digibind
Is an antidote use for digitalis Toxicity by binding to digoxin in the blood. This is only use with unstable patients or doing a severe overdose
36
A stable patient with drug toxicity
For a stable patient the best treatment is to wait for the patient's body to excrete the drug metabolites and treat the symptoms ss needed. Symptoms include arrhythmia and nausea
37
Pulmonary edema
Elevating the patient legs with increased venous return to rapidly this could overload the heart and worsen the patient's condition
38
Cardiac catheterization
The patient may feel warmth, flushing, a flattering feeling, palpitations or a desire to cough. The symptoms are from the injection of dye catheter passage
39
Right-sided heart failure signs and symptoms
Peripheral edema
ascites
jugular vein distention
Hepatomegaly
The symptoms are caused by a diminished ability of the right ventricle to pump blood. This causes blood to pool in the extremities, abdomen, Neck, and living
40
Left-sided symptoms S&S
Dry cough
Crackles
Cyanosis
Left-sided symptoms r caused by a diminished ability of the left ventricle to pump blood. This leads to pooling in the pulmonary circulation causing pulmonary edema
41
ARBs May be beneficial for patients who cannot tolerate the adverse effects of which class of medications
Ace inhibitors are often not tolerated due to the dry cough that many patients experience. ARBs provides a similar mechanism of action without the dry cough
42
Deep vein thrombosis (DVT) S&S
Pain In the calf
Redness
Swelling
Heart signs
Having the pt ambulate or massaging the calf would dislodge thrombosis and create an embolus
43
Atropine is contraindicated in patients with
angle closure glaucoma because it would increase optic pressure
44
Intra-aortic ballon pump
Inflates during the diastole to increase perfusion ito the coronary arteries and deflates During systole to decrease afterload
The timed inflation and deflation contribute to
45
Digoxin toxicity
```
Cardiac arrhythmias
Nausea
Vomiting
Diarrhea
Visual disturbance
Headache
Lethargy
Irritability
Abdominal cramps
```
46
Austin Flint murmur
Is best heard over the apex of the heart. It's describe is a low pitch and rumbling and can be heard during mid-late diastole
47
Pulmonic stenosis
Second in the coastal space, left sternal border is the best location for hearing
48
Aortic stenosis
Second intercostal space, right sternal border is the best location for hearing
49
Failure to capture
Is when the pacer fires a signal, but the heart does not respond with a beat. This is often caused by pacer lead migration on the epicardium .
50
Failure to pace
Is when the pacer fail to fire a signal when it should. This often leads to bradycardia and hypotension because the heart cannot beat at the same rate as a pacer
51
Failure to sense
Is when the pacer cannot sense the heartbeat, leading to poorly timed firing by the pacer!
52
Asystole
Is the absence of a heart rate
53
Angina pectoris
Caused by increased oxygen demand and decreased oxygen supply to the heart! When activity cardiac output increases. Without an adequate oxygen supply to the heart, ischemia and pain develop
Usually self-limiting often last for only 10-15minute
Patient may have chest pain related to eating (heartburn) and breathing(pleurisy ) but this is generally not relate to angina pectoris.
54
What food should a pt way while taking -Furosemide (Lasix)
The pt should be instructed to consume foods high in potassium due to furosemide's potassium-wasting effect
```
Foods high in potassium include
Spinach
Potatoes
Beans
Raisins
Tomatoes
Bananas
Squash
Dried apricots
```
55
Colestipol (Colestid)
A bile acid sequestrants commonly cause constipation and can be used to treat diarrhea associated with bile acid malabsorption
Bile acid sequestrants bind to bile in the GI tract and can be used safely in a pt with active liver disease
56
Myocardial infarction. Interventions
Administration of nitroglycerin and morphine
Placement of a cardiac monitor
Administration of 2-4L of oxygen and I.V. Catheter insertion
High levels of oxygen should only be administered if specifically ordered by the physician
57
Hypertension symptoms
Headache
Tinnitus
Blurred vision
Dizziness
58
Diltiazem (Cardizem)
Is a nondihydropyridine calcium channel blocker user in treatment of arrhythmias
59
Nitroglycerin
A vasodilator , leading to a reduction in blood pressure. It's strong venodilating effects cause a decrease in preload leading to a decrease in cardiac output. This causes a reflex response by sympathtic nervous system increasing heart rate in order to maintain cardiac output
60
Corrugated's pulse
Is a bounding and forceful pulse with a rapid rise and fall. This associated with increase stroke volume and decrease in peripheral resistance !
Commonly found in aortic regurgitation and often leads to a widening pulse pressure.
61
Pulse tardus
Is a weak pulse with a slow upstroke and prolonged peak. It is seen in aortic stenosis
A weak, threads pulse is a sign of low blood pressure or reduced cardiac output.
62
Abdominal aortic aneurysm (AAA)
Worsening pain in the back and abdomen may indicate that the aneurysm is pressing against the lumbar nerve root!
Hypotension and tachycardia expected with AAA extension
63
CholecystItis S&S
Right upper quadrant pain that worsens with palpitations
64
Implantable cardioverter-defibrillator (ICD)
We will not harm a person touching the patient. The shock may be felt but the charge is not high enough to cause harm
A.m. alarm will sound if the patient is near a magnetic field that may deactivate the device
Contact with the patient should not be avoided
65
Hypertension risk factor
```
High salt and fat intake
Obesity
Stress
Alcohol consumption
Inactivity
caffeine
Vitamin D deficiency
```
66
Secondary hypertension risk factors
```
Renal disease
Cushing's syndrome
hyperthyroidism
Hyperaldosteronism
Pheochromocytoma
Hormonal contraceptives
diabetes
```
67
Raynaud's disease
Characterizes by intermittent vasospastic attacks. These acute attacks are often precipitated by stress, cold, caffeine, smoking!!
68
Alcohol and extreme heat cause
Vasodilation
69
Normal cardiac output
4-8L per min
70
Low heart rate or low blood pressure indicates
Poor cardiac output
71
Cardiogenic shock results in
In adequate circulation of blood due to failure of the heart to pump effectively
```
Manifestations of reduce circulation include
tachycardia
hypotension
weak and Thready pulse
decrease in urinary output
cool and clammy skin
```
72
Prinzmetal's and Angina also known as variant angina
Is characterized by cyclic chest pain. It is caused by vasospasms leading to narrowing of the coronary arteries
73
What is a contraindications for intra-aortic ballon pump (IABP)
Absolute contraindicates to IABP include significant aortic regurgitation and aortic dissection
74
Which of the following common symptoms resolve spontaneously with Coronary artery bypass graft (CABG)
Depression is common after undergoing a CABG. It usually resolves within several weeks and does not generally require medical intervention
Edema after a CABG may indicate heart failure
Dizziness may signal a decrease in cardiac output. This is an abnormal findings and requires immediate attention
75
During the early stages of heart failure which 'specific compensatory mechanism occurs
Hypotension stimulates the baroreceptors to decrease sympathetic activity(as blood pressure falls, baroreceptors of the carotid and aorta are stimulated. This causes a release of Catecholmines resulting in vasoconstriction increased heart rate)
76
Niacin ( Niaspan)
Is a water-soluble vitamin that decrease lipoprotein and triglyceride synthesis. Common side effects include flushing of the face and neck, rash, diarrhea, cough, pruritus, nausea and vomiting, hypotension, hyperglycemia
77
Echocardiogram
The echocardiogram is painless and will record images of your heart
78
Abdominal aortic aneurysm (AAA) common sites
90% of AAAs occur below the renal arteries
79
Small boxes on EKG represent what
0. 04 sec on the horizontal axis(time) and 1mm on the vertical axis(voltage)
0. 04 sec x 4 boxes= 0.16sec
80
Hepatojugular reflex test
Is used to measure jugular vein distention
The nurse places the pt head at 45degrees and firmly presses the right upper quadrant or center of the abdomen for 10-60
If there is a sustained rise in the jugular vein, then the result is positive
81
Malignant hypertension or hypertension crisis
Is most commonly caused by untreated hypertension
```
Less coming causes include
abrupt discontinuation of antihypertensive medication i
illicit drug use
certain prescription drugs
neoplasms
Glomerulonephritis
Pheochromocytoma
```
82
Mitral stenosis complication
Mitral stenosis impedes blood flow in the left side of the heart. This creates fluid and pressure builds in the pulmonary circulation, causing pulmonary hypertension
Other complications of my mitral stenosis includes
edema
right-sided heart failure hand
reduced cardiac output
Myocardial infraction is likely if the patient has underlying coronary artery disease
Fluid overload of the pulmonary circulation can impaired gas exchange potentially leading to respiratory acidosis
83
Which abnormal heart sounds is associated with myocardial infarction
Pericardial fraction rub often occurs within one week of having a myocardial infarction due to inflammation of pericardial sac It sounds like squeaky leather
84
Myocardial infarction
Cardiac arrhythmias are the most common complication associated with a myocardial infarction. They frequently cause disability and death.
Hearty failure and cardiogenic shock are known complications of a myocardial infarction, but they are not as common as arrhythmias
85
Myocardial infarction pain
Usually lasts longer than 30mins radiates to the left arm and shoulder and requires morphine for relief.
Angina pain usually caused by activity or excretion radiates to the left arm and is relieved by nitroglycerin
86
Cardiac arrhythmias tornadoes de pointes
tornadoes de pointes is a type of ventricular tachycardia is often caused by hypomagnesemia. The nurse should prepare to administer magnesium sulfate
Diltiazem and amigos stone can be used with ventricular arrhythmias but tornadoes de pointes is first treated with magnesium sulfate
87
Nitroglycerin transdermal patch
Application sites for nitroglycerin transdermal patches must be rotated every application to Prevent skin irritation sensitization
Nitroglycerin patches must be applied for 12-14 hours followed by 10 to 12 hour nitrate free period to avoid developing tolerance
The preferred site for nitroglycerin patch is the chest. It must be dry cleaned and hairless. Avoid placing the patch on irritated sites or areas with cuts
88
After undergoing a cardiac catheterization the nurse should
The insertion site usually the femoral artery should be checked frequently for signs of bleeding or hematoma formation ! The insertion site is at risk for bleeding due to the high pressure of the femoral artery and the large diameter of the catheter
Fluids should be encouraged to flush out the dye used during the procedure
89
Most commonly used indicator for poor peripheral circulation
The ankle brachial index is the blood pressure ratio between the lower legs and arms. Blood pressure in the lower legs is normally higher than arm. A ratio 1.0 indicate peripheral vascular disease
Peripheral pulses are not a good indicator of peripheral vascular disease
90
Allen test
Used to asses blood supply to the hand
91
Cardiac stress test
used to measure the hearts ability to respond to stress
92
Defibrillate for a pt with a ventricular fibrillation
Ventricular fibrillation is not shockable when the synchronizer is turn on.
93
Premature ventricular contractions ( PVCs)
Are wide bizarre QRS complexes in the absence of P waves . There is generally a pause that follows the PVC
94
Ezetimibe ( zetia)
inhibits absorption of cholesterol and is often combine with a strain .
Use to treat hyperlipidemia
95
Sublingual Nitroglycerin should be place ?
Sublingual mess should be place on the mucosa below the tongue on the floor of the mouth. The superior to the sublingual gland
96
Troponin-I
Is highly specific for cardiac muscle necrosis and us the most accurate lab test for myocardial infraction
97
Varicose veins
Results from a genetic predisposition that results in less elastic veins
Sclerotheraphy is user to treat varicose veins it is not a cure
Varicose veins r more common n women
98
During a myocardial infraction pain
During a myocardial infraction pain is usually felt n the left shoulder, arm , neck, jaw
99
What should the nurse do if the client shows symptoms of Myocardial infraction
When a patient has symptoms of a myocardial infarction the nurse should administer oxygen to increase myocardial oxygen supply
Telemetry will help diagnose an MRI because of changes in the EKG. Vital signs should be check before administering nitroglycerin
So administer oxygen via nasal cannula, initiating the telemetry, check vital signs, administer nitroglycerin
100
How do you determine inadequate stroke volume
Use pulse deficit
Pulse deficit is when the apical pulse is greater then the radial pulse. This is due to a low stroke volume in which most blood flow is not reaching the periphery
A narrow pulse pressure is expected with a low stroke volume. A narrow pulse pressure is when the difference between the systolic and diastolic pressure is less then 25% of the systolic value
Corrida pulse is associated with increased stroke volume and peripheral resistance
101
Serum CK-MB levels
start to elevate 4 to 6hrs after the onset of chest pain. Levels usually peak around 12 to 18 hours after onset of chest pain
102
Which of the following drugs can prevent a common side effect of nitroglycerin
Acetaminophen (Tylenol ) headaches are a common side effect of nitroglycerin. The nurse make Acetaminophen to prevent or treat headaches caused by nitrates
103
Preload is decreased by
Conditions that reduce circulation volume or venous return this includes hemorrhage,sepsis and anaphylaxis
104
Ventricular depolarization is represented by
The QRS complex
105
Ventricular reporter Repolarization is represented by
The T wave
106
Atrial Repolarization is
Is hidden within the QRS complex and cannot be distinguished
107
Angioplasty of the iliac artery
After an angioplasty of the iliac artery bleeding may develop accumulate in the retroperitonal space. Measuring a abdominal girth is the best way to assess blue accumulation
108
Pericarditis interventions
Pericarditis is inflammation of the percardium caused by infections autoimmune disorders and trauma
Pain related to pericarditis worsens while in a lying position
Instructing the patient to lean forward will pull the heart away from the Lungs, preventing pericardial irritation caused by the lungs
109
Aspirin
Is a cyclooxygenase(COX) inhibitor that interferes with platelet aggregation
Heparin inactivates clotting factors
Coumadin ( Warfarin) blocks vitamin K synthesis
Nitrates promote coronary vasodilation
110
Hydrochlorothiazide
Is a thiazides diuretic that is used to treat hypertension and edema
```
Common side effects include
Hypokalemia
Hyperuricemia
Glucose intolerance
Hypotension
Hyperlipidemia
```
111
Chronic congestive heart failure results from
```
Infections
Arrhythmias
Hypertension
Anemia
Hyperthyroidism
Inadequate diet
Meds such as NSAIDs
```
112
Proteinuria & albuminuria r early inductors of
Renal injury often causes by hypertension
113
Which lab results is the goal of treatment for this patient taking Coumadin (Warfarin)
Patient taking Coumadin for atrial fibrillation need to maintain an INR between 2 and 3 ( normal is 0.9-1-2) to reduce the risk of emboli formation
114
Foods a pt with CHF should avoid r
Pt with CHF should avoid foods high in sodium.
Monitoring sodium intake is an important part of ongoing treatment for CHF
115
ACE inhibitors lower blood pressure thru
ACE inhibitors block the actions of aldosterone and angiotensin II
Aldosterone is responsible for sodium and water retention in the kidneys. Angiotensin II causes potent vasoconstriction
116
DVT
Bed rest is not advised. Ambulation is encourage to reduce complications and promote recovery.
Interventions
Heat
Pain meds
Elevation of the leg
117
Atropine
Is the only drug listed that used for symptomatic bradycardia
118
Epinephrine
Is used for ventricular fibrillation, flutter and unstable tachycardia
119
Dopamine
Is used to maintain adequate blood pressure during shock and to maintain kidney perfusion
120
Dobutamine
Is used to increase cardiac output in heart failure.
121
What can interact with the effects of Coumadin ( Warfarin)
Dark leafy green vegetables r high n vitamin K and will reduce the effects of warfarin. However the patient should maintain a consistent intake of vitamin K to prevent adverse reactions of warfarin particularly bleeding
122
Sign and symptoms of low cardiac output
```
Hypotension
Dizziness
Weakness
Fatigue
Shortness of breath
Syncope
```
123
Raynaud's disease( phenomenon)
Is vasospastic disorder affectioning the hands and feet. It leads to impaired perfusion
```
S&S
diminished peripheral pulses,
palor
Numbness in the extremities
Brittle finger nails
Thin skin
Cyanosis
```
Vasospasms generally occur due to exposure to cold or stress
124
Myocarditis
Is inflammation of the myocardium or the heart muscle of the heart
125
Pericarditis
Is inflammation of the outermost layer if the heart
126
Endocarditis
Is the inflammation of the innermost layer of the heart
127
Valvular disease
Affects the hearts valves
128
IVC filters
Is a vascular used to trap emboli floating in vena cava. It helps prevent pulmonary emboli.
129
Signs of cardiac tamponade
```
Muffle heart sounds
Tachycardia
Hypotension
Jugular vein distention
Paradoxical pulse
```
Cardiac tamponade occur when fluids fills the pericardial space, causing an increase in pressure . As pressure increases around the heart, less blood enters the ventricles this results in decreased stroke volume.
