Cardiovascular Flashcards
Perfusion
Passage of fluid and oxygen thru circulatory system or lymphatic system to organs or tissues
Symptoms of poor peripheral perfusion
Sluggish, cold
Sx of poor central perfusion
Dizzy and confused
Cardiac output
Stroke volume X HR; amount of blood pumped out of by the heart in 1 minute
Stroke volume
Amt of blood pumped by the left ventricle with every beat
Factors that affect cardiac output
Changes in heart rate, how hard the heart contracts, myocardial contractility, meds, disease, activity
What happens when stroke volume decreases?
HR increases as a compensatory mechanism
Ejection fraction
% of blood pumped out of the L ventricle with each contraction; normally greater than 50
What does it mean when ejection fraction less than 40%
Heart failure; weak heart muscles
Blood pressure
Amount of force exerted by blood on the vessel walls; must be adequate to maintain tissue perfusion during activity and rest
Pulse pressure
Diastolic minus systolic (normally 1/3 of systolic BP)
Causes of high pulse pressure
Atherosclerosis, exercise
Causes of low pulse pressure
Severe heart failure, hypovolemia (low fluid)
Pulsus alternans
Regular rhythm but strength of pulse varies with each beat (ex: heart failure)
What to do in cardiac arrest?
CALL FOR HELP, then Compressions, Airway, Breathing
How to do CPR?
30:2 compressions to respirations with tilted chin; rate of 100-120 bpm with depth of at least 2 inches (allow proper recoil)
HTN and perfusion
HTN changes the makeup of the arteries, which causes adverse effects including increased peripheral vascular resistance
Peripheral vascular resistance
The amt of effort the heart has to overcome to get blood out to the periphery
What can happen if HTN is untreated?
Decreased blood flow and perfusion, heart attack, stroke, kidney failure, CVD, MI, PVD, retinal disease
Modifiable risk factors for HTN
DM, elevated serum lipids, excess sodium intake, obesity, sedentary lifestyle, tobacco use, alcohol use, stress
Nonmodifiable risk factors for HTN
Family, race, age, increasing age, gender, chronic kidney disease, obstructive sleep apnea
HTN diagnosis
Average of at least 2 readings at subsequent HC visits above 120/80; might check with EKG
HTN sx
Dizzy, headache, heart palpitations, nosebleed, SOB, anger, red face, visual problems, fatigue, insomnia, increased temperature, sore knee and back (calcium levels)
Goal of HTN tx
Prevent further complications
HTN tx
Meds, control cholesterol, be more active, decrease blood sugar, decrease weight, smoking cessation, pt education; determine risk factors and assist with change, DASH diet
Patient education for HTN
Do they have a BP cuff at home? Lifestyle mods, exercise, stress management, drug therapy. KNOW WHEN TO SEEK HCP
When to seek immediate care for BP?
BP over 180/110; hypertensive crisis with SOB, chest pain, severe headache, dyspnea, dizzy, numb, loss of vision, speaking probs, nosebleed, severe anxiety, unresponsive
Hypotension
Symptomatic and BP under 90; organs not getting enough perfusion, caused by arteries dilating which decreases blood volume and resistance, failure of heart to pump, heart dysrhythmias (pump too fast), pregnant, heat stroke, heart failure, dilation of BVs
Hypotension sx
Confusion, clammy, lightheaded, blurred vision, increased HR, chest pain (angina), syncope, confusion, decreased urine output, nausea, vomit
How to treat hypotension
Treat the cause; vasodilation with meds, give IVF for loss of blood volume, failure of heart to pump
Nursing implementation of hypotension
Monitor VS, add salt, assess for sx, IVF and drink water, wear compression hose, meds
Orthostatic hypotension
Prob with perfusion to brain; low blood volume, immobile, bed rest, old, pregnant; diagnosed by decrease in 20 of systolic or 10 in diastolic; measure BP laying, sitting, standing
Nursing care for hypotension
Change position slowly, dec leg crossing, mobilize, balance rest and activity, isometric exercises (squeeze stress ball), compression hose, avoid standing for long times
Hyperlipidemia
Excess lipids in blood (cholesterol and TGs)
Lipids
Fat-like particles in blood cells
Cholesterol
Waxy fat-like substance in all body cells
Complications of Hyperlipidemia
Atherosclerosis and plaques, build up in arterial walls causing decreased elasticity and widening, CAV, PAD, MI, Heart attack risk, coronary peripheral artery disease
HLD screening
Begin at age 20 and screen every 5 years; reassess risk factors at age 40; fast 9-12 hours before screening
What should your lipid levels be?
Cholesterol under 200, LDL under 130, HDL over 45 in men and 55 in women
Nursing care of HLD
Check, change, control cholesterol, active, healthy weight, limit smoke and alcohol, lipid lowering drugs, diet mods
Diet mods for HLD
Decreased trans and saturated fat, more complex carbs and fiber, decreased major cholesterol sources (egg yolk, red meat, whole milk), less alcohol and sugar, eat fatty fish and high omega 3 (soybean, flax, walnuts)
Venous thrombo embolism
Obstruction of a BV by a clot that has been dislodged in circulation
Risk factors for VTE
Venous stasis, pregnancy, less mobile, surgery, thickened blood, contraceptives, endothelial damage, IVF or drugs, drug abuse, new IV, history of VTE or DVT, DM history, fractures or dislocations
S/S of VTEs
Localized swelling, redness, tender over veins; warm, tender, firm calves, calf pain with ambulation
DVT diagnosis
Early inspection won’t help, palpate legs and watch face; ultrasound to confirm
VTE diagnosis
Obtain history, physical assessment, vascular ultrasounds,
Nursing care for DVTs
Measure calves with tape for circumference, assess symptoms, tender and phlebitis check, early mobility, tedhose (check perfusion at toes) to promote venous return, SCDs, calf pumps
Tx for VTEs
Anticoagulants, thrombolytics, IVC filters (intravenacava filter blocking clots)
CBC
Complete blood count; drawn near daily in the hospital; gives hemoglobin and hematocrit
Normal hemoglobin
F: 12-16; M: 14-18
Normal hematocrit
% total blood volume made of RBCs; F: 37-47%; M: 42-52%
Fasting lipid panel
Cholesterol, LDL, HDL, TGs
Chest X-ray
Shows fluid accumulation in the chest and heart size
ECG/EKG
Gives snapshot of normal electrical conduction (sinus rhythm); beginning in SA node and sequence thru conduction wave
Jugular venous distention
Swollen jugular vein; distended at 45 degrees, fluid volume excess
Nursing assessment for CVD
Inspect, palpate, and auscultation, health history, VS and O2, skin, LOC, edema, peripheral pulses, calves for tenderness and phlebitis, JVD, S1 and S2, murmurs, clicks, rubs, 5Ps of feet
5Ps of feet
Pallor, paralysis, pain, pulse, paresthesia
Nursing care for CVD
Strict I and O, tele, O2 PRN, admin meds, monitor labs, implement heart healthy diet, limit stress, prevent thrombus formation, pt-centered plans, goal setting, smoke cessation, dec stress and alc, control HTN, HLD, DM, evaluate
Afterload
The pressure the heart has to contract to eject blood
Preload
Initial stretching of cardiac muscle prior to contraction