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Med Surg 1 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is the pump of the heart?

A

Left ventricle

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2
Q

When should you listen to apical pulse?

A

When radial pulse is irregular

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3
Q

What does 0-3 means when documenting pulse?

A

0: absent
1: thread, dissappear with slight pressure
2: normal
3: bounding, strong and palpable with slight pressure

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4
Q

What is the natural pacemaker of the heart?

A

SA node

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5
Q

What does SA node do?

A

Cause atrial muscle to contract and fill blood to ventricles

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6
Q

What does PEA stand for?

A

Pulseless electrical activity

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7
Q

What does PEA mean?

A

Heart still has electrical activity but is not pumping

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8
Q

How does blood flow through the heart?

A

Starts at left atrium
Goes through mitral valve to left ventricle
Goes out from aorta to head and feet
Comes back from superior and inferior vena cava to right atrium (deoxygenated blood)
Goes through tricuspid valve to right ventricle
Goes out through pulmonary artery to lungs and get oxygenated
Goes back to left atrium through pulmonary veins
And the cycle starts again

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9
Q

Which side of the ventricle wall is thicker?

A

Left

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10
Q

What is cardiac output?

A

The amount of blood ejected by left ventricle in 1 minute

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11
Q

What is the stroke volume?

A

Amount of blood ejected by left ventricle in one contraction (ave 60-80 ml/beat)

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12
Q

How do you calculate cardiac output?

A

Stroke volume × heart rate

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13
Q

What is ejection fraction?

A

Total amount of blood in left ventricle that is ejected with each heart beat

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14
Q

What is the normal ejection fraction?

A

55-70%

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15
Q

What does epinephrine do to the heart?

A

Increase heart rate, force contraction, and dilate coronary vessells

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16
Q

What does aldosterone do?

A

Regulate Na and K

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17
Q

What does atrial natriuretic peptide (ANP) do?

A

Increase secretion of Na inhibiting secretion of aldosterone

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18
Q

Epinephrine vs acetylcholine

A

Epinephrine:
Sympathetic: fight and flight (active)
Pupil: dilate
Saliva: low
Hr: high
Bronchi: dilate
Digestion: slow
Rectum: relax
vs
Acetylcholine:
Parasympathetic: rest and digest (calm)
Pupil: constrict
Saliva: high
Hr: low
Bronchi: relax
Digestion: fast
Rectum: contract

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19
Q

Arteries carry oxygen ____ blood

A

Rich

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20
Q

Do arteries have pulse?

A

Yes

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21
Q

Veins carry ____________ blood

A

Deoxygenated

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22
Q

Do veins have a pulse?

A

No

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23
Q

Where does the exchange between blood and tissue fluids occur?

A

At the capillary

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24
Q

What is peripheral vascular resistance (PVR)?

A

Blood vessels’ ability to stretch

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25
Q

What is venous return?

A

Ability of blood returning to right atrium

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26
Q

What would be suspected if no venous return?

A

DVT, edema, or blood clots in lower extremities

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27
Q

How should you take orthostatic blood pressures?

A

Wait at least 1 min between supine and sitting bp, another min between sitting and standing bp

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28
Q

What is a murmur?

A

Swishing sound when valve failed to close correctly (blackflow)

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29
Q

What is pericardial rub?

A

Sandpaper rubbing sound due to inflammation of pericardium
Common after MI or chest trauma

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30
Q

What is S3?

A

Ventricular gallop
Sounds like ken-tu-cky
Will hear better with the bell of stethoscope on the apex of heart
Common in hypervolemia, left-side HF, and mitral valve regurgitation

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31
Q

What is S4?

A

Atrial gallop
Sounds like ten-nes-see
Common in HTN, coronary artery disease, and pulmonary stenosis

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32
Q

What should you do before pt receives a CT angiography?

A

Ask for allergies b/c dye will be injected into pt

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33
Q

Classic tests for cardiac enzymes?

A

CK
CK-MB
troponion (norm: <0.05)

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34
Q

What are 2 invasive studies that can be done on the heart?

A

Angiograms and cardiac catheterization

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35
Q

What do angiograms and cardiac catheterization use?

A

Dye

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36
Q

What data should the nurse collect before pt receives an angiogram or cardiac catheterization?

A

Allergies and renal function (creatinine)

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37
Q

What is the primary risk factor for CV disease and stroke?

A

HTN

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38
Q

HTN s/s

A

Headache, anxiety, epistaxis, shortness of breath

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39
Q

Why are African Americans at higher risk for HTN?

A

Because they have high renin activity genetically, and that can increase the risk for HTN

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40
Q

What diet do pt get for HTN?

A

DASH diet

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41
Q

How well does limiting salt intake help with HTN?

A

bp may not respond to salt restrictions alone and meds may be needed

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42
Q

What is rheumatic fever?

A

Autoimmune reaction 2-3 weeks after upper resp infection such as strep throat

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43
Q

How long can rheumatic heart disease stay not evident?

A

Can be not evident for years after rheumatic fever

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44
Q

Rheumatic fever s/s

A

Pneumonitis, arthralgia, carditis, chorea, polyarthritis, subcutaneous nodules (not painful)

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45
Q

What is mitral valve prolapse (MVP)?

A

Valve fails to close during LV contraction, blood leaks back to LA, causing mitral regurgitation

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46
Q

What will you hear with a mitral valve prolapse?

A

Murmur b/c of backflow

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47
Q

When is tx needed for mitral valve prolapse?

A

When pt becomes symptomatic (angina, dizziness, palpitations, dysrhythmias)

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48
Q

What is the major cause of mitral stenosis?

A

Rheumatic fever

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49
Q

What is mitral stenosis?

A

Narrow mitral valve opening

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50
Q

What happens with mitral stenosis?

A

Decreased blood flow from LA to LV, causing LA enlargement and increased pressure
Blood backs up into pulmonary veins, RA, RV, eventually causing right sided HF due to excessive workload

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51
Q

Mitral stenosis s/s

A

Activity intolerance, dizziness, syncope, A fib, A flutter, fatigue, resp infections and cough

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52
Q

What can form from blood stasis in left ventricle due to mitral stenosis?

A

Emboli

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53
Q

What is mitral regurgitation?

A

Incomplete closure of mitral valve causing backflow into LA

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54
Q

What can mitral regurgitation cause?

A

Left and right side HF, A fib, emboli

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55
Q

What can cause mitral regurgitation?

A

HTN, MI, MVP, rheumatic fever, endocarditis

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56
Q

Mitral regurgitation s/s

A

Murmur, palpitation, fatigue, dyspnea

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57
Q

What’s the most commonly acquired valvular disease in adults?

A

Aortic stenosis

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58
Q

What is aortic stenosis?

A

Aortic valve obstructs blood flow from LV

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59
Q

What will you hear with aortic stenosis?

A

Systolic murmur right after S1 and right before S2

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60
Q

What can cause aortic stenosis?

A

Rheumatic heart disease, age

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61
Q

Aortic stenosis early s/s

A

Angina, activity intolerance, syncope, dizziness

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62
Q

Aortic stenosis late s/s

A

Angina, syncope, HF (start with left side, resulting in pulmonary edema and right side HF)

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63
Q

What is TAVR?

A

Transcatheter aortic valve replacement

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64
Q

What are 2 types of TAVR?

A

Mechanical: lifelong anticoagulant
Biological: from animals, lasts 12 years

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65
Q

What is aortic regurgitation?

A

Blackflow of blood from the aortic into LV, increase of LV blood volume

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66
Q

What happens with aortic regurgitation?

A

Heart wears out quicker and lead to left sided heart failure and decreased cardiac output

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67
Q

What can cause aortic regurgitation?

A

Severe hypertension, rheumatic heart disease, ankylosing spondylitis (arthritis that causes chronic inflammation to certain parts of spine)

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68
Q

What will you find in a pt with aortic regurgitation?

A

Forceful pulse, murmur, palpitations, fatigue, dyspnea

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69
Q

What is infective endocarditis?

A

Infection of endocardium

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70
Q

What can endocarditis lead to?

A

Emboli caused by vegetative lesions forming and breaking

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71
Q

What is one important contributing factor to endocarditis?

A

Dental disease

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72
Q

What can you find on the palm and soles of feet in pt with endocarditis?

A

Janeway lesions

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73
Q

What are janeway lesions?

A

Small, painless, red-blue lesions
(Acute findings!)

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74
Q

TX for endocarditis?

A

At least 6 weeks of IV antibiotics

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75
Q

What is pericarditis?

A

Acute or chronic inflammation of pericardium

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76
Q

What is the pericardium?

A

The sack around the heart to reduce friction with movements

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77
Q

What can you find in pt with pericarditis?

A

Chest pain, fatigue, edema, palpitations, fever, dyspnea, orthopnea

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78
Q

What is the most common complication resulted from pericarditis?

A

Pericardial effusion

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79
Q

What is cardiac tamponade?

A

A complication resulted from pericarditis
Life-threatening compression of the heart due to fluids accumulated within the pericardial sack

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80
Q

Tx for pericarditis

A

Antibiotics, anti-inflammatory, colchicine, diuretics, digoxin, or surgically remove the pericardium to prevent complications

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81
Q

What is myocarditis?

A

Inflammation of myocardium (middle layer of heart wall)

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82
Q

What can cause myocarditis?

A

Viral infection
Ex: covid, parasites, fungi, bacteria

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83
Q

How long does myocarditis usually occur after viral infections?

A

About 2 weeks

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84
Q

S/s of myocarditis

A

Fatigue, chest pain, fever, malaise, muscle aches, GI discomfort, enlarged lymph nodes, tachycardia, palpitations, dyspnea

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85
Q

What can myocarditis cause?

A

Cardiomegaly

86
Q

Tx for myocarditis

A

Bed rest, ACE inhibitors, ARBs, beta-blockers, diuretics

87
Q

What to avoid if you have myocarditis?

A

NSAIDs, alcohol, smoking

88
Q

what is cardiomyopathy?

A

Enlargement of heart muscle, reduces cardiac output

89
Q

What can cardiomyopathy lead to?

A

HF, MI, myocardial ischemia

90
Q

Why is cardiac output decreased with cardiomyopathy?

A

Dilated myocardium too weak to pump blood effectively

91
Q

What is restrictive cardiomyopathy?

A

Ventricular walls stiff

92
Q

What is hypertrophic cardiomyopathy?

A

Ventricular walls too thick

93
Q

Does hypertrophic cardiomyopathy have any tx?

A

Tx is not required for hypertrophic

94
Q

Pt education for cardiomyopathy

A
  1. Family CPR training
  2. Med regimen
  3. Place emergency contact in wallet with pt or on fridge
95
Q

What is venous thromboembolism?

A

Blood clot in the veins
Ex: DVT with risk of PE

96
Q

What is thrombophlebitis?

A

Formation of a clot followed by inflammation within a vein

97
Q

What pt are in high risk of VTE?

A

Immobile and post op

98
Q

Common sites of VTE?

A

Legs, thighs, and pelvis

99
Q

Interventions for VTE

A

Ambulate early, low molecular weight heparin, monitor PLT, hydration, ted hose, elevate extremity, warm heat, analgesics, NSAIDs

100
Q

What are the 2 types of cardiac trauma?

A

Penetrating and non-penetrating

101
Q

Is cardiac trauma an emergency?

A

Yes!

102
Q

What causes non-penetrating cardiac trauma?

A

Blunt force, injure the heart without piercing the skin

103
Q

What can non-penetrating cardiac trauma lead to?

A

Cardiac tamponade (blood fills pericardial sac, increase pressure on the heart)

104
Q

What can be done to treat cardiac tamponade?

A

Pericardiocentesis, to drain the blood and restore function

105
Q

What causes penetrating cardiac trauma?

A

Stabbing injury, gun shot injury

106
Q

What can penetrating cardiac trauma cause?

A

Tamponade, hemothorax (pleural sac filled with blood and not draining, lungs can’t expand, tx: chest tube)

107
Q

What is atherosclerosis?

A

Plaque forming on the interior wall of arteries

108
Q

What is arteriosclerosis?

A

Thinning of arteries, less elasticity, no flex on the arteries

109
Q

What is coronary artery disease?

A

Obstruction if coronary artery blood flow from atherosclerosis (plaque build up)

110
Q

What can coronary artery disease lead to?

A

Angina, MI, sudden death

111
Q

How to prevent coronary artery disease?

A

Low cholesterol diet
Lipid-lowering agents (meds)
Low dose aspirin (prevent clot)

112
Q

What is angina?

A

Chest pain, decreased blood flow and O2 to heart muscle

113
Q

Typical angina s/s

A

Heavy tight crushing pain in chest center in the morning
Pale
Dyspneic
Diaphoretic (sweaty)

114
Q

Female angina s/s

A

Chest jaw lower back pain, heartburn, fatigue, nausea, vomiting, breathlessness

115
Q

What is a stable angina?

A

Moderate exertion in a pattern that’s familiar to the pt, pain predictable, may last a few minutes, usually relieved by rest/nitroglycerin tablets

116
Q

What is an unstable angina?

A

When rest/meds doesn’t work

117
Q

What does nitroglycerin do?

A

Vasodilation, lower bp

118
Q

What is MI?

A

Death of heart muscle due to decrease in O2

119
Q

MI patho

A

Coronary artery blockage, less cardiac blood supply

120
Q

NSTEMI vs STEMI

A

NSTEMI: partial blockage
STEMI: complete blockage

121
Q

What is a common sign of MI?

A

Hands gripping the chest

122
Q

What does 12 lead EKG help determine during MI?

A

If it’s STEMI or NSTEMI

123
Q

MI s/s

A

Crushing pain that radiates to arm/shoulder/neck/jaw, dyspneic, restlessness, dizziness, fainting, nausea, disphoresis

124
Q

Intervention for MI

A

“MONA”
1. Morphine
2. O2
3. Nitro/nitrate
4. Aspirin (golden dose: 325mg tab, or 4 81mg chewables)

125
Q

Intervention for MI other than “MONA”

A

Bedrest, glucose check, daily weight, low-sodium clear liquids, low-fat/cholesterol/sodium diet, no caffeine, fluid restriction, weight loss, smoking cessation, antiplatelets, statins/ACE inhibitors/beta-blockers/nitro PRN/low molecular weight heparin

126
Q

Pre-hospital care for MI

A

325mg aspirin
Nitroglycerin
Call 911 in 5 minutes if unrelieved chest pain
Pt should not drive themselves to the hospital!

127
Q

What is ApoB?

A

ApoB: blood lipid test
Indicate coronary artery disease
>=90: high risk for CAD

128
Q

What should you ask the pt before cardiac catheterization?

A

Ask for allergies!

129
Q

Which vein is the most common for blood clot?

A

Saphenous vein

130
Q

Peripheral artery disease patho

A

Chronic, progressive arterial narrowing, reduced blood supply

131
Q

PAD s/s

A

Intermittent pain, cool skin, diminished/absent pulses, pain/cramping after walking, extremity reddish-purple when dependent and pale when elevated

132
Q

What do you do if you see a pale cool extremity?

A

Notify charge nurse immediately b/c the tissue in there might be dying

133
Q

Diet for PAD?

A

Low fat/cholesterol/calorie diet

134
Q

Meds for PAD

A

Lipid-lowering agents
Pentoxifylline (Trental)
Thrombolytics

135
Q

What to assess and monitor for PAD?

A

Assess for pain, monitor extremities for color, motion, sensation, pulse, and ulcers

136
Q

Pt education for PAD

A

Inspect skin daily
Exercise to increase arterial blood flow
Avoid cold exposure, tobacco, and caffeine b/c causes vasoconstriction

137
Q

What is Raynaud’s disease?

A

Vasoconstriction with cold/stress causing ischemia

138
Q

What does Raynaud’s disease mainly affect?

A

Hands

139
Q

Interventions for Raynaud’s disease

A

Keep warm, avoid vasoconstriction, keep cold and stress low, take vasodilators

140
Q

What is Buerger’s disease?

A

Recurring inflammation of small and medium arteries and veins if hands/feet

141
Q

What is the primary contribution factor to Buerger’s disease?

A

Heavy cigarette smoking

142
Q

Buerger’s disease s/s

A

Vein inflammation
Intermittent claudication（跛行）
Lower extremities red or cyanotic in dependent position

143
Q

Interventions for buerger’s disease

A

Smoking cessation, calcium channel blocker, skin assessment

144
Q

What are aneurysms?

A

Tumor in arteries（动脉瘤）

145
Q

What is fusiform aneurysms?

A

The entire circumference of artery is dilated

146
Q

What is saccular aneurysms?

A

Only one side of the artery is dilated

147
Q

What is dissecting aneurysms?

A

There is a tear in the inner layer of artery causing cavity to form between layers, fills with blood and expands with each heart beat

148
Q

What can cause venous stasis ulcer?

A

Chronic venous insufficiency

149
Q

Where does venous stasis ulcer usually appear at?

A

At the ankle

150
Q

What will you see on pt with venous stasis ulcer?

A

Leg/foot edema, brownish/discoloration, hardened/leathery skin

151
Q

Interventions for venous stasis ulcers

A

Compression wraps, elevate leg, bed rest, avoid prolonged standing/sitting/dependent posture of legs and walking
Skin graft should be the last resort!

152
Q

What is lymphangitis?

A

Inflammation/infection of lymphatic channels

153
Q

What are lymphangitis most often caused by?

A

Strep bacteria

154
Q

What will pt experience if they have lymphangitis?

A

Pain, red streak, fever/chills

155
Q

Intervention for lymphangitis

A

Decrease edema, increase circulation
Antibiotic, heat, elevation, pneumatic pressure devices

156
Q

What is the natural pacemaker of the heart?

A

SA node

157
Q

What is the isoelectric line on the cardiac movement strips?

A

The baseline where nothing is happening

158
Q

What does P wave represent?

A

Atrial depolarization

159
Q

What is PR interval?

A

The time it takes for electricity to move from SA to AV node

160
Q

What does QRS waves represent?

A

Ventricular depolarization

161
Q

what does QT interval represent?

A

Ventricular depolarization and repolarization

162
Q

What can prolonged/shortened QT interval lead to?

A

Ventricular dysrhythmias

163
Q

What does T wave represent?

A

Ventricular repolarization

164
Q

What does it mean when T wave is abnormal (pointing downward)?

A

Tissue ischemia in the ventricles

165
Q

What should you monitor when you see a U wave?

A

Electrolyte balance

166
Q

What does a pointed T wave mean?

A

Hyperkalemia

167
Q

What does a flatter and wider T wave and U wave mean?

A

Hypokalemia

168
Q

When are U waves usually seen?

A

When pt has medication toxicity
Ex: digoxin

169
Q

Six step process of reading strips?

A
  1. Regularity of rhythm
  2. hr
  3. P wave
  4. PR interval
  5. QRS complex
  6. QT interval
170
Q

What does premature Atrial Contractions look like?

A
  1. Rhythm: PAC interrupts rhythm
  2. hr: Per underlying rhythm
  3. P waves: early beat, abnormal shape
  4. PR interval: 0.12-0.2 sec (norm)
  5. QRS interval: <=0.10 sec (norm)
171
Q

What does atrial flutter look like?

A
  1. Rhythm: atrial rhythm regular
  2. hr: depends
  3. P waves: 4 F waves (sawtooth) pattern
  4. PR interval: not measurable
  5. QRS: <=0.10 sec
172
Q

What to do when Premature Atrial Contraction happens?

A

No s/s, no interventions, but we want to treat the underlying cause and potentially give beta-blockers

173
Q

What’s the F waves in atrial flutter?

A

4 F waves = 1 ventricular beat

174
Q

What does A fib look like?

A
  1. Rhythm: irregularly irregular
  2. hr: not measurable
  3. P wave: not identifiable
  4. PR interval: not measurable
  5. QRS interval: <=0.10 sec
175
Q

What does Premature ventricular contraction look like?

A

Opposite of PAC
1. Rhythm: PVC interrupts rhythm
2. hr: per underlying rhythm
3. P wave: absent
4. PR interval: none
5. QRS interval: >0.10 sec

176
Q

Premature ventricular contraction s/s

A

Palpitation, fatigue, dizziness, potentially lead to dysrhythmia

177
Q

What can we give to pt who has PVC?

A

Antiarrhythmics
Ex: amiodarone, beta-blocker

178
Q

What is bigeminal PVC?

A

It means every other heart beat will be followed by an early beat (PVC)

179
Q

What does ventricular tachycardia (V tach) look like?

A
  1. Rhythm: regular
  2. hr: 150-250
  3. P wave: absent
  4. PR interval: none
  5. QRS interval: >0.10 sec
180
Q

What can V tach result in?

A

Significant decrease of cardiac output

181
Q

Causes of V tach

A

Hypovolemia, hypoxia, acidosis, toxins, cardiac tamponade

182
Q

Tx for V tach with pulse:

A

Give amiodarone (antiarrhythmics), replace electrolytes

183
Q

Tx for pulseless V tach:

A

CPR!
Defibrillation, epinephrine, vasopressor, antiarrhythmics (amiodarone)

184
Q

V tach with pulse s/s

A

Dyspnea, palpitation, cardiac arrest

185
Q

Pulseless V tach s/s

A

Lightheaded, angina

186
Q

What does V fib look like?

A
  1. Rhythm: chaotic, extremely irregular
  2. hr: not measurable
  3. P wave: none
  4. PR interval: none
  5. QRS interval: none
187
Q

What does V fib do?

A

Preventing ventricle from pushing blood out of heart, stopped cardiac output, can lead to death

188
Q

Causes of V fib

A

Similar to V tach
Hypovolemia, hypoxia, acidosis, toxins, electrolyte imbalance

189
Q

Tx for V fib

A

CPR! (immediate high quality CPR!)
Med follow up
Correct underlying cause

190
Q

What does asystole look like?

A

No heart muscle contraction
1. None
2. None
3. None
4. None
5. None

191
Q

What tondo when asystole occurs?

A

Start high quality CPR and call for help immediately

192
Q

What are cardiac pacemakers for?

A

Generate impulse, override tachycardia

193
Q

What meds do pt with A fib need to be on?

A

Blood thinners b/c atriums are not emptying completely

194
Q

when A fib hr <100 is called?

A

Controlled response

195
Q

When A fib hr >100 is called?

A

Rapid ventricular response (RVR)

196
Q

What is synchronized cardioversion used for?

A

Used in dysrhythmias when R wave is present!

197
Q

When to use defibrillator?

A

Pulseless V Tach, V fib

198
Q

When to use synchronized cardioversion?

A

V Tach with pulse, A fib, A flutter

199
Q

What will pt receive before synchronized cardioversion?

A

Conscious sedation

200
Q

What’s the most common cause for HF in elderly?

A

Ischemia

201
Q

Where does left sided HF cause blood to go?

A

Backflow into lungs

202
Q

What is the major cause of right sided HF?

A

Left sided HF

203
Q

Where does right sided HF cause blood to go?

A

Backflow into systemic circulation

204
Q

Left sided HF s/s

A

Night dyspnea, cough, crackles, wheezes, blood-tinged sputum, tachypnea, orthopnea, tachycardia, confusion, fatigue, cyanosis

205
Q

Right sided HF s/s

A

Fatigue, dependent edema, distended jugular veins, anorexia, GI distress, weight gain, enlarged liver and spleen

206
Q

What is pulmonary edema?

A

Life-threatening!
Acute HF, severe fluid congestion in alveoli, feel like drowning in own secretion

207
Q

Pulmonary edema s/s

A

Pink frothy sputum
tachypnea w/accessory muscles
crackles, wheezes
Severe dyspnea, orthopnea
Clammy, cold skin
Anxiety, restlessness

208
Q

Interventions for pulmonary edema

A

Reduce workload of LV
Fowler’s
O2
IV diuretics/morphine/vasodilators

209
Q

Which route should we administer meds when pt have pulmonary edema

A

IV b/c we are not waiting on oral to take affect!

210
Q

Chronic HF s/s

A

Fatigue, weakness
Dyspnea all the time
Cough
Crackles, wheezes
Tachycardia
Chest pain
Edema
Cyanosis
Confusion
Cheyne-stokes respiration

211
Q

Chronic HF interventions

A

Decrease heart’s O2 demand and workload
Daily weight
Low sodium
Avoid alcohol, caffeine, fried food

Med Surg 1 (3 decks)

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