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Int. Med Surge > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is HF?

A

the inability of the heart to provide sufficient blood to meet the O2 needs of tissues and organs

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2
Q

Etiology of HF

A

Decrease in CO

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3
Q

Which factors affect CO?

A
  1. preload
  2. afterload
  3. myocardial contractility
  4. HR
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4
Q

List the primary causes of HF

A
  1. HTN
  2. CAD
  3. Rheumatic heart disease
  4. congenital heart defects
  5. pulmonary HTN
  6. cardiomyopathy
  7. hyperthyroidism
  8. valvular disorders
  9. myocarditis
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5
Q

What are the primary RFs for HF?

A
  1. HTN

2. CAD

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6
Q

What are the contributing factors of HF?

A
  1. Advanced age
  2. diabetes
  3. tobacco use
  4. obesity
  5. High serum cholesterol
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7
Q

What does the term precipitating causes mean?

A

these causes aggravate and decrease workload causing a decrease cardiac fxn

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8
Q

List the precipitating causes of HF

A
  1. anemia
  2. infxn
  3. thyrotoxicosis
  4. hypothyroidism
  5. dysrhythmias
  6. bacterial endocarditis
  7. obs. sleep apnea
  8. PE
  9. hypervolemia
  10. nutritional deficiencies
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9
Q

What is the most common form of HF?

A

Left-sided HF

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10
Q

Left-sided HF results from the inability of the LV to do what? (2)

A
  1. empty adequately during Sys or fill adequately during Dia
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11
Q

What is the patho of left-sided HF?

A

The LV loses its ability to generate enough pressure to eject blood forwards through the aorta overtime becoming dilated and hypertrophied

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12
Q

Causes of SYS left-side HF

A
  1. impaired contractile fxn
  2. increased afterload
  3. Cardiomyopathy
  4. mechanical abnormalities
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13
Q

Define EF

A

amt of blood ejected from the LV w/ each contraction

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14
Q

What is the normal EF

A

55%-60%

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15
Q

What % is considered to be Sys HF?

A

<40%

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16
Q

If the blood cannot be pumped by the LV effectively what occurs to blood when LV fails?

A

the blood backs up the LA which then goes back to the lungs causing pulmonary congestion and edema

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17
Q

What is Dia left-side HF?

A

Impaired ability of the ventricles to relax and fill during Dia resulting in decreased SV and CO

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18
Q

Causes of Dis left-side HF

A
  1. HTN
  2. Age
  3. female gender
  4. diabetes
  5. obesity
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19
Q

List SI/SX of left-sided HF

A
  1. frothy sputum (can be serosanguenous)
  2. dyspnea, orthopnea
  3. fatigue
  4. hypertrophy
  5. pulmonary congestion
  6. alt. mental status
  7. Sis of organ failure (oliguria)
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20
Q

List Si/Sx of right- sided HF

A
  1. JVD
  2. Peripheral edema
  3. fatigue, weakness,
  4. ascites
  5. nausea and anorexia
  6. nocturia
  7. hepatomegaly
  8. weight gain
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21
Q

What are some ways to prevent HF?

A
  1. Exercise regularly
  2. Consume a low-sodium diet
  3. fluid restriction
  4. smoking cessation
  5. take meds as prescribed
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22
Q

Which 2 hormones are released by the heart? State location

A
  1. ANP- atria

2. BNP- ventricles

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23
Q

When is BNP released? ANP?

A

both are released as a response to increased blood vol in the heart

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24
Q

What effects do the natriuretic peptides have?

A
  1. increased GFR rate
  2. diuresis
  3. excretion of sodium
    (natriuresis)
  4. vasodilation
  5. decreased BP
  6. inhibition of aldosterone and renin secretion
  7. interference w/ ADH release
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25
Q

What is the purpose of obtaining an echo?

A

an ECG shows L&R ventricular EF, provides structure and fxn of valves

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26
Q

What is the purpose of a chest X-ray for HF?

A

reveals cardiomegaly and pleural effusions

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27
Q

What is the purpose of an ECG, cardiac enzymes, electrolytes, and ABGs?

A

assess factors contributing to heart failure and/or impact of heart failure

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28
Q

What is the outcome or expectation if you give your patient a diuretic?

A
  1. decrease preload
  2. reduce edema, pulmonary venous pressure
  3. promote sodium and eater excretion
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29
Q

What are the 3 types of diuretics?

A
  1. loop
  2. K+ sparing
  3. thiazide
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30
Q

What are the 2 prototype loop diuretic?

A
  1. furosemide (Lasix)

2. bumetanide (Bumex)

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31
Q

What is the prototype for K+ sparing diuretic?

A

aldactone (Spironolactone)

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32
Q

What is the prototype for thiazide diuretic?

A

hydrochlorothiazide (Novo-hydrazide)

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33
Q

If you give Lasix IVP, how fast should you push?

A

no faster than 20 mg/min

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34
Q

What are your nursing considerations for a pt on a diuretic?

A
  1. daily weight
  2. I&Os
  3. Obtain K+ serum levels
  4. Hearing screenings
  5. monitor BP closely
  6. assess males for gynecomastia (spironolactone)
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35
Q

What are some pt teachings for a pt on a diuretic?

A
  1. take meds as prescribed = same time qd
  2. eat foods and drinks high in K+ (except in spironolactone)
  3. change positions slowly due to orthostatic hypotension
  4. take in the am to prevent nocturia
  5. check weight
  6. check blood glucose levels
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36
Q

What are some foods and drinks high in K+?

A
  1. Bananas
  2. spinach
  3. salmon
  4. avocados
  5. lentils
  6. sweet potatoes
  7. oranges
  8. dried apricots
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37
Q

What is the normal range of K+?

A

3.5-5.0

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38
Q

Si/Sx of hypokalemia

A
  1. decreased BP
  2. thready weak pulse
  3. alt mental status
  4. lethargy
  5. weakness
  6. hypoactive bowel sounds possible paralytic ileus
  7. N/V
  8. abdominal distention
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39
Q

Si/Sx of hyperkalemia

A
  1. slow irregular pulse
  2. hypotension
  3. restlessness
  4. irritability
  5. weakness
  6. oliguria
  7. increased motility
  8. diarrhea
  9. hyperactive bowel sounds
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40
Q

What is the primary drug of choice for sys HF?

A

ACE inhibitors

41
Q

MOA ACE inhibitors

A
  1. dilate venules and arterioles
  2. improve renal blood flow
  3. relieve Sx of HF
  4. Promote reverse remodeling
  5. decrease morbidity and mortality
  6. improve renal blood flow
42
Q

What are some examples of ACE inhibitors?

A
  1. captopril (Capoten)
  2. Benazepril (Lotensin)
  3. Enalapril (Vaotec)
43
Q

What are some nursing considerations for ACE inhibitors?

A
  1. monitor for hypotension and hyperkalemia

2. monitor for angioedema

44
Q

Side effects of ACE inhibitors

A
  1. intractable cough
  2. renal insufficiency
  3. symptomatic hypotension
45
Q

What type of pts are ACE inhibitors contraindicated?

A

pts w/ renal problems

46
Q

What are some pt teachings for ACE inhibitors?

A
  1. Inform pt can cause a dry cough
  2. Notify provider if swelling of the face or extremities occur
  3. Notify provider if there is a rash or decreased sense of taste
  4. Monitor BP
47
Q

MOA of beta blockers

A

block the negative effects of the SNS by lowering the HR and reducing myocardial contractility

48
Q

List the Beta blockers

A
  1. carvedilol (Coreg)
  2. bisoprolol (Zebata)
  3. metoprolol (Toprol)
49
Q

What are some nursing considerations when taking beta blockers?

A
  1. monitor blood pressure, pulse, activity tolerance, and orthopnea
  2. check orthostatic blood pressure readings
  3. obtain standing BP 1 hr after dosing to assess tolerance
50
Q

What are some pt teachings for beta blockers?

A
  1. weigh themselves daily
  2. monitor bp regularly
  3. follow the med regimen as prescribed
  4. do not stop med abruptly
51
Q

List adverse effects of beta blockers

A
  1. sweating
  2. palpitations
  3. headaches
52
Q

What is the difference between inotropes and chrontropes?

A

inotropic meds affect contractility and chronotropic meds affect HR

53
Q

Which agents are inotropic?

A
  1. digoxin
  2. dobutamine- short-term
  3. dopamine
  4. milrinone
54
Q

What is the therapeutic serum level of digoxin?

A

0.5-0.8 ng/ml

55
Q

What level is considered dig toxicity?

A

> 1.8-2.0

56
Q

Si/Sx of dig toxicity

A
  1. fatigue
  2. weakness
  3. vision changes (halo)
  4. GI effects
57
Q

What are some interventions for dig toxicity?

A
  1. Stop dig and K+ sparing meds immediately
  2. Monitor K+ levels
  3. treat dysrthymias with phenytoin or lidocaine
  4. treat bradycardia w/ atropine
  5. administer antidote digoxin immuneFab (Digibind)
58
Q

What are some pt teachings for a pt taking Dig?

A
  1. advise the pt take med as prescribed
  2. check the apical pulse for a full 1 min
  3. take at the same day and same time
  4. report signs of toxicity
  5. regularly have K+ and dig levels checked
59
Q

What type of pts or meds is dix contraindicated?

A
  1. antacids must be separated by 2 hrs
  2. decrease dig levels if taken with verapamil
  3. sympathomimetic
  4. thiazides
  5. ACE inhibitors
60
Q

What are the 2 types vasodilators?

A
  1. Nitroglyercin

2. isosorbide monoitrate

61
Q

MOA OF vasodilators `

A

dilates veins which reduces circulating blood vol and improve coronary artery circulation

62
Q

What are some nursing considerations for vasodilators?

A
  1. used to treat angine and help control blood pressure
  2. use cautiously with other anihtnsive meds
  3. change positions slowly to pevent orthostatic hypotension
  4. administer aspirin or acetaminophen and relaxation therapy to relieve headache
63
Q

What are some pt teachings for vasodilators?

A
  1. remind the pt that a headache is a common side effect

2. encourage the pt to sit and lie down slowly

64
Q

According to ATI when are anticoagulants prescribed?

A

if the pt has a history of thrombus formation

65
Q

What are some nursing considerations for anticoagulants?

A
  1. assess for active bleeding, PUD, history CVA, and recent trauma
  2. Monitor bleeding times: PT, aPTT, INR, and CBC
66
Q

Normal PT range

A

11-12.5 sec

67
Q

Normal aPPT range

A

1.5-2.5x the control value (heparin) 30-40 sec (normal)

68
Q

Normal INR range

A

2-3

69
Q

Pt teachings for anticoagulants

A
  1. remind the pt the risk of bruising and bleeding
  2. routinely monitor bleeding times
  3. electric razors
  4. be careful when flossing
70
Q

What is the purpose of acronym FACES?

A

to recognize the SI/Sx of HF

71
Q

What does FACES stand for?

A 
Fatigue 
Activities limitations
Chest congestion 
Edema 
SOB
72
Q

After cardiac transplant, what is monitored?

A
  1. acute rejection
  2. infxn
  3. malignancy
  4. accelerated cardiac vasculopathy
  5. sudden cardiac death
  6. immunosuppressive therapy
73
Q

What are some nursing care focuses?

A
  1. promoting pt adaptation to the transplant process
  2. monitoring cardiac fxn
  3. managing lifestyle changes
  4. Providing ongoing teaching
74
Q

What type of test is used to detect rejection fro heart transplant?

A

EMB- endomyocardial biopsies

75
Q

What are nursing actions for heart transplants?

A
  1. prepare the pt for procedure: NPO and informed consent

2. Monitor postOP

76
Q

What are some pt teachings for heart transplant?

A
  1. take meds as prescribed
  2. take diuretics in the am and afternoon
  3. maintain fluid and sodium restriction diet
  4. increase dietary intake of Kt
  5. Check weight daily and notify 2lbs in 24 hrs or 5 lbs in 1 week
  6. Get vaccinations
77
Q

SI/Sx of pulmonary edema

A
  1. anxiety
  2. tachycardia
  3. ARD
  4. dyspnea at rest
  5. change in LOC
  6. crackles during auscultation
  7. frothy sputum
78
Q

Nursing actions for pulmonary edema

A
  1. administer meds to improve CO
  2. teach pt how to improve tolerance to activity
  3. Position in high-Fowlers
  4. Administer O2
  5. IV morphine
  6. IV Lasix
79
Q

Si/Sx of cardiogenic shock

A
  1. tachycardia
  2. hypotension
  3. decreased urine output
  4. alt LOC
  5. crackles and tachypnea
  6. cool and clammy skin
  7. decreased peripheral pulses
  8. chest pain
80
Q

Nursing actions for cardiogenic shock

A
  1. monitor breath and heart sounds
  2. administer O2, intubation and ventilation
  3. administer IV morphine, diuretics, and/or nitro or vasopressors
  4. continuous hemodynamic monitoring
81
Q

Si/Sx of cardiac temponade

A
  1. hypotensions
  2. JVD
  3. muffled heart sounds
  4. paradoxical pulse
82
Q

Nursing actions for cardiac temponade

A
  1. notify provider immediately
  2. administer IV fluids to combat hypotensions
  3. obtain chest x-ray or echo
  4. prepare pt for pericardiocentesis
  5. monitor for hemodynamics, heart rhythm, and reoccurrence
83
Q

Describe angina

A

reversible myocardial ischemia

84
Q

What is the cause of angina

A

it caused by the increased demand for O2 or decreased O2 supply

85
Q

What is the most common reason for angina to develop?

A

narrowing of one or more coronary arteries by atherosclerosis, typically >75%

86
Q

What is the difference between an MI and angina?

A
  1. pain unrelieved by rest or nitroglycerin and lasting for more than 15 min differentiates.
  2. MI is irreversible damage and angina has reversible interruption of oxygen
  3. MI there is a STEMI and angina have NSTEMI
87
Q

What is the relationship between ischemia and infarction?

A

ischemia can lead to tissue necrosis (infarction) if blood supply and oxygen are not restored.

88
Q

What can trigger angina?

A
  1. physical exertion
  2. stress
  3. emotional upset
89
Q

How can an individual prevent angina?

A
  1. maintain an exercise regimen
  2. have cholesterol level and BP checked regularly
  3. consume a diet low in sat fats and Na+
  4. promote smoking cessation
90
Q

What are the 3 types of angina?

A
  1. Stable/ exertional
  2. Unstable/Preinfarction
  3. Variant/Prinzmetal’s
91
Q

List some clinical manifestations of angina

A
  1. pressure/ache
  2. squeezing, heavy choking, or suffocating sensation
  3. rarely sharp or stabbing
  4. does not change w/ position or breathing
  5. indigestion or burning at epigastric region
92
Q

Where is the pain most experienced with angina?

A

substernal

93
Q

Where does the pain radiate in the angina?

A
  1. jaw
  2. shoulder
  3. down the arms
94
Q

What is the first line of therapy in chronic stable angina?

A

short-acting nitrate- Nitroglycerin

95
Q

MOA of nitroglycerns

A
  1. dilate peripheral blood vessels

2. dilate coronary arteries and collateral vessels

96
Q

What are 2 routes Nitroglycerin can be given?

A
  1. SL: nitrostat

2. spray: nitrolingual

97
Q

When should you call the provider regarding nitroglycerin?

A
  • if no relief in 5 mind call EMS

- if SX do not improve, repeat q5mins for max of 3 doses

98
Q

Pt. teaching for nitroglycerin

A
  1. place tab under tongue and allow to dissolve
  2. causes a tingling sensation
  3. Warn of side effectsL headache, dizziness, flushing, and orthostatic hypotension

Int. Med Surge (2 decks)

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