Cardiovascular Flashcards
1
Q
Perfusion
A
passage of fluid through the circulatory system or lymphatic system to an organ or tissue
2
Q
Cardiac output formula
A
stroke volume (ml/min) * heart rate
3
Q
Cardiac output
A
volume of blood pumped by the heart in one minute
4
Q
Stroke volume
A
amount of blood that is ejected from the left ventricle every time it pumps
5
Q
Alterations in cardiac output
A
HR, stroke volume, myocardial contractility
ex: medications, disease processes, activity
6
Q
Ejection fraction
A
the % of blood pumped out of the left ventricle with each contraction normal = > 50%
less than 40% = heart failure
7
Q
Blood pressure
A
force exerted by the blood against the blood vessel walls
- it must be adequate to maintain tissues perfusion during activity and rest
- maintaining normal BP and tissue perfusion requires integration of systemic factors and local peripheral vascular effects
8
Q
Pulse pressure
A
difference between systolic and diastolic BP
- normal 1/3 of SBP
9
Q
High pulse pressure
A
atherosclerosis
exercise
10
Q
Low pulse pressure
A
severe heart failure
hypovolemia/fluid volume deficit
11
Q
Pulse alternans
A
regular rhythm but strength of pulse varies with each beat
- possible etiology and significance ex: heart failure
12
Q
Cardiac Emergency/Arrest
A
CPR is as easy as C-A-B
C = compressions
A = airway
B = breathing
13
Q
CPR
A
cardiopulmonary resuscitation
- pt doesn’t have pulse or respirations or both
- Chest compressions hard and fast FIRST
14
Q
Common perfusion concerns
A
- HTN
- hypotension
- HLD
- venous thromboembolism VTE
15
Q
Hypertension
A
- pressure in arteries that is higher than it should be
- broken into stages
- causes adverse effects of the arterial walls
- changes in arterial walls causes increased peripheral vascular resistance (PVR)
- left untreated causes decreased blood flow and perfusion
16
Q
PVR
A
amount of effort that the heart has to overcome in order to get the blood out of the heart and into the periphery, starts to wear heart out
17
Q
Factors influencing BP
A
- age
- stress (stimulates SNS)
- ethnicity
- genetics
- gender (males higher, then after menopause it is women)
- daily variation
- medications
- activity
- weight
- smoking (causes vasoconstriction, makes perfusion more difficult)
18
Q
Modifiable risk factors for HTN
A
- DM
- elevated serum lipids
- excess sodium intake (causes water retention)
- obesity
- sedentary lifestyle
- stress
- tobacco and alcohol use
19
Q
Non-modifiable risk factors for HTN
A
- family history
- race/ethnicity
- increasing age
- gender
- chronic kidney disease
- sleep apnea
20
Q
HTN Diagnosis
A
average of 2 or more readings on at least 2 subsequent healthcare visits that is above 120/80
- might check EKG or CXR to evaluate heart
21
Q
HTN symptoms
A
dizziness, HA, heart palpitations, nosebleed, SOB, anger, red face, visual problems, fatigue, insomnia, sore knee, raised temp
22
Q
Complications of HTN
A
- cardiovascular disease
- MI (heart attack)
- heart failure
- stroke
- peripheral vascular disease (amputation)
- renal disease
- retinal disease (retinopathy is issue)
23
Q
Nursing care and treatment of HTN
A
- blood pressure measurement
- implement a pt-centered plan for lifestyle modifications
- goal is to prevent heart disease, stroke, renal disease, etc.
- determine risk factors and assist with changing
- promote heart healthy nutrition
- weight reduction if needed
- encourage balance of rest and activity
- smoking cessation
- medication management
- BP monitoring
- collaboration and pt education
24
Q
Pt education on HTN
A
- develop a BP screening program based on BP
- explain potential dangers
- management of HTN
- lifestyle modifications
- proper nutrition and exercise
- stress management techniques
- drug therapy education
- when to seek IMMEDIATE care
25
When to seek immediate care for HTN
- BP > 180/110
- severe HA
- dyspnea or chest pain (unstable angina)
- dizziness, numbness, weakness
- blurry or loss of vision
- difficulty speaking
- nosebleed
- severe anxiety
- unresponsive
26
Lifestyle modifications for HTN
- manage BP
- control cholesterol
- reduce blood sugar
- get active
- lose weight
- decrease alcohol and smoking
- eat better
- stress modification
27
DASH diet
rich in fruits, vegetables, low-fat dairy, whole grains
restrict sodium intake
28
Hypotension
SBP falls < 90 and patient is symptomatic
- don't treat number only
- are organs getting perfused adequately
29
Causes of hypotension
- dilation of arteries
- loss of blood volume
- failure of heart muscle to pump
- pregnancy
- hormonal issues
- medications
- heat stroke
- heart arrhythmias
- liver disease
- heart failure
30
Symptoms of hypotension
- skin - pallor, mottling, clamminess
- decreased perfusion to brain = lightheadedness, dizziness, syncope, confusion
- blurred vision
- angina (decreased perfusion to heart muscle)
- increased HR (rapid or weak)
- decreased urine output (UOP)
- nausea/vomiting
31
Treatment of hypotension
treat the cause
- vasodilation = meds to increase resistance of vascular system (vasoconstriction)
- loss of blood volume = supplement perfusion, IV fluids
- failure of heart muscle to pump = meds to increase contractility of heart
32
Nursing implementation for hypotension
- monitor VS more frequently
- assess for symptoms
- interventions aimed to treat with cause
- consider adding more salt
- drink more water or IV fluids
- wear compression hose (promote venous return)
33
Orthostatic hypotension
- stand up, blood pressure drops
- people that don't have high blood volume, people on bed rest, people that don't have very good perfusion, people with decreased mobility
34
Ortho Hypo diagnosis
SBP = decrease of 20 or more
DBP = decrease of 10 or more
35
How to check ortho hypotension
Measure BP and HR supine, sitting, and standing
- Lay down for 5 minutes, then BP, then stand for 1 min, then BP, then stand for another 3 minutes, then BP
- Measure BP within 3 MINUTES of position changes
36
Nursing care with ortho hypo
- change positions slowly
- don't cross legs when sitting
- early ambulation
- if immobile, balance rest and activity
- Perform isometric exercises (squeezing) - helps to raise BP before standing
- wear compression hose
- avoid standing for long periods
- risk factor for falls
37
Hyperlipidemia
too many lipids (cholesterol and triglycerides) in bloodstream
- liver makes cholesterol, remainder comes from food derived from animals
38
Triglycerides
most common fat in body (body makes it and we ingest it)
39
Lipids
fat-like particles in blood stream
40
Cholesterol
waxy, fat-like substance found in all cells of body
41
Why is hyperlipidemia important?
- Form hard deposit inside arteries, worry about it building up on the arterial walls causing it to narrow and less elastic/flexible
- atherosclerosis - CAD or PAD
42
HLD diagnostic tests
- tests at age 20, test every 4-6 years
- at age 40 = HCP assess 10-year risk for experiencing cardiovascular disease or stroke
- fasting for 9-12 hours, LDL will be affected if not
- cholesterol < 200
- LDL < 130
- HDL > 45 in men, > 55 in women
test = serum lipid profile
43
Nursing care + HLD
- Check, change, control
- maintain healthy wt
- be active
- limit smoking and alcohol
- dietary modifications
- lipid lowering drug therapy
44
Dietary modifications for HLD
- reduce saturated and trans fats
- increase complex carbs and fiber
- limit major sources of cholesterol (red meats, whole milk, egg yolks)
- eat fatty fish weekly
- eat foods high in omega 3 fatty acid
- high triglycerides = need to limit alcohol and simple sugars
45
Venous Thromboembolism
peripheral vascular alterations and VTE
46
VTE
DVT + PE = VTE
DVT = deep vein thrombosis
embolism = DVT dislodges
PE = pulmonary embolism
47
VTE is
obstruction of a blood vessel by a blood clot that has become dislodged from another site in the circulation
- most commonly starts in legs and moves to lungs = PE
48
Risk of VTE
- venous stasis = blood is pooling (obesity, pregnancy, surgery, immobility, heart disease)
- hypercoagulability (dehydrated, platelet disorder, oral contraceptives, pregnancy)
- endothelial damage (IV fluids or drugs, fractures, dislocations, hx of diabetes, DVT, or VTE)
49
VTE s/s
- localized redness, tenderness, swelling over the vein sites
- warmth, tenderness, firmness of muscle in calf
- complaints of calf pain with ambulation
- usually unilateral
- PALPATION
50
VTE Diagnosis
- obtain history
- physical assessment
- vascular ultrasound studies
- ultrasound only reliable tool to detect
51
Why do we care
can cause PE
52
VTE nursing care
- assess for s/s
- measure calf circumference
- calf tenderness/phlebitis check
- early ambulation/activity
- TED hose (thrombo embolic deterrent) (leave toes out for perfusion) (promotes venous return)
- SCDs
- calf pumping
53
Calf pumping
- dorsiflexion
- plantar flexion
- circumduction
54
VTE treatment
- prevention is key
- anticoagulants
- thrombolytic (lyses the thrombus)
- IVC filter (place strainer in vena cava)
55
Diagnostics related to cardiovascular system
Complete blood count = Hgb and Hct only
Fasting lipid panel = cholesterol, LDL, HDL, triglycerides
CXR
EKG
56
Hemoglobin
iron containing pigment of the red blood cells
- we need hemoglobin for oxygen to travel on RBCs
females = 12-16
males = 14-18
57
Hematocrit
percentage of the total volume of blood that is made up of RBCs
37-47% for women
42-52% for men
58
Electrocardiogram (EKG)
- normal sinus rhythm = originates in SA node, follows normal sequence through conduction system
- only for about 5 minutes
59
EKG placement
smoke over fire
snow/clouds over grass (white on right)
chocolate at the heart
60
Nursing problems with cardiovascular problems
- Fatigue
- Risk for unstable BP
- Activity intolerance
- decreased cardiac output
- risk for decreased tissue perfusion
- risk for injury (fall)
- knowledge deficit
- ineffective health management
- fluid volume excess or deficit
- impaired gas exchange
- ineffective airway clearance
- ineffective breathing pattern
- ineffective tissue perfusion
- risk for decreased CO
61
Nursing assessment cardiovascular
- inspect and palpate
- auscultate
- obtain nursing hx of heart assessment
- assess and monitor VS
- skin
- changes in LOC
- peripheral pulses
- calf tenderness/phlebitis check
- edema
- JVD (jugular venous distention)
- S1 S2
- S3 = ventricular gallop, ken-TUCK-y
- S4 = atrial gallop, TEN-nes-see
- murmurs, clicks, rubs
62
Rubs
pericardial sac rubs
63
Clicks
from mechanical valve
64
Murmurs
extra or unusual sound heard during a heartbeat, often described as a whooshing or swishing noise, caused by turbulent blood flow through the heart valves or near the heart
65
5 Ps in feet in cardio
Pain
Pulse
Pallor - skin color
Paresthesia - can you feel this
Paralysis - can you move this
66
Nursing implementation in cardio
- strict I&O
- oxygen PRN
- telemetry
- administer meds
- monitor labs
- implement heart healthy diet
- limit stress
- prevent thrombus formation
67
Nursing collaboration for cardio
- cardiopulmonary rehab
- HCP
- cardiologist
- RT
- code team/rapid response
- dietician
- PT
- cardiac nurse navigators
- support groups
- social work/case manager
68
Pt teaching in cardio
- plan in pt centered
- set goals and provide resources
- avoid smoking
- avoid alcohol
- limit stress
- control HTN, HLD, DM
- nutrition + exercise
69
Afterload
the resistance that the heart faces when ejecting blood during systole (contraction). It is the pressure that the heart must overcome to pump blood into the arteries
- Higher BP increases afterload.
- higher afterload -> reduced stroke volume
- Vasodilation reduce afterload
70
Infarction
obstruction of the blood supply to an organ or region of tissue, typically by a thrombus or embolus, causing local death of the tissue
71
Necrosis
necrosis is a broader term that refers to the death of cells or tissues due to various causes.
72
Ischemia
reduced blood flow
73
Myocardial contractility
refers to the ability of the heart muscle (myocardium) to contract and pump blood effectively. It is a measure of the force and velocity of cardiac contractions
74
Preload
preload refers to the volume of blood in the ventricles before contraction, while afterload is the pressure the heart must overcome to eject blood during systole
75
S1
tricuspid and mitral
76
S2
aortic and pulmonic
77
S3
often indicates ventricular dilation or systolic dysfunction
78
S4
forcible atrial contraction related to decreased ventricular compliance
- left ventricle issues
- heart failure
