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Adult Nursing Final > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

Diastole

A
  • period where the atria & ventricles are relaxed

- allows ventricles to fill with blood

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2
Q

Atrial systole

A
  • at end of diastole

- the atria contract forcing the remaining blood into the ventricles

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3
Q

Ventricular systole

A

increased pressure in the ventricles

  • closes the AV valves & forces the semilunar valves to open
  • permits one way flow of blood from right ventricle into the pulmonary artery into the lungs, from the left ventricle into the aorta and into systemic circulation
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4
Q

Depolarization

A

electrical activation of cell

-cause by influx of sodium into cell while potassium exits cell

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5
Q

Repolarization

A

return of cell to resting state

-caused by re-entry of postassium into cell while sodium exits

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6
Q

Cardiac Output

A

amount of blood pumped by ventricles in liters per minute; 4-6 liters/minute
-CO= SV x HR

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7
Q

Control of heart rate

A

ANS baroreceptors-specialized nerve cells

  • changes in heart rate
  • sensitive to changes in blood pressure
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8
Q

Stroke volume

A

amount of blood ejected with each heartbeat; about 70 ml/beat

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9
Q

Preload

A

-the volume of blood being returned to right side of the heart from the systemic circulation

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10
Q

Frank-Starling Law

A

the more the stretch, the stronger the contraction

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11
Q

Afterload

A
  • resistance to ejaction of blood from ventricle

- affected by systemic vascular resistance & pulmonary vascular resistance

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12
Q

Contractility

A
  • ability of heart to squeeze blood from the ventricles

- prepares for next contraction

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13
Q

Ejection Fraction

A
  • measurement of the percentage of blood leaving ventricles with each contraction
  • measurement of myocardial contractility
  • normal from left ventricle is 55-65%
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14
Q

Left Ventricle Ejection fraction

A

measurement of how blood is being pumped out of the left ventricle with each contraction

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15
Q

Right ventricle ejection fraction

A

measurement of how much blood is pumped out of the right ventricle to the lungs

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16
Q

what are the cardiac biomarkers?

A
  • CK, CK-MB
  • myoglobin
  • Troponin T and I
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17
Q

Stress testing

A

exercise, pharmacologic stress test, combined with imaging techniques

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18
Q

Echocariography

A

traditional or TEE

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19
Q

Radionuclide Imaging

A

radioisotopes to evaluate coronary arter perfusion noninvasively

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20
Q

Cardiac CT

A

looks at calcium deposits

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21
Q

Cardiac Catheterization

A
  • invasive procedure to measure cardiac chamber pressure & assess patency of coronary arteries
  • Angiography involves injection of a contrast agent in the vascular system to visualize heart & blood vessels
  • preparation includes ECG, blood tests, allergies
  • Post-procedure: assess bleeding, hematoma formation, circulation, arrhythmias, bedrest
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22
Q

Coronary Artery Disease

A
  • most common cardiovascular disease in adults

- is leading cause of death in US for men & women of all racial & ethnic groups

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23
Q

Atherosclerosis

A

is the abnormal accumulation of lipid deposits & fibrous tissue with in arterial walls ->. inflammatory response

  • most common cause of CV disease
  • Blockages & narrowing reduce blood flow to the myocardium
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24
Q

myocardial ischemia

A
  • an increase in oxygen demand
  • a decrease in oxygen supply
  • related to location & degree of vessel obstruction
  • development of collateral circulation
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25
Q

Angina Petoris

A
  • a symptom of coronary atherosclerosis, characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow
  • physical exertion or emotional stress increases myocardial oxygen demand and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand
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26
Q

Stable angina

A
  • effort induced & predictable pattern

- subsided with rest or NTG

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27
Q

Unstable angina

pre-infarction angina

A
  • increased frequency, severity & duration
  • unpredictable
  • not relieved by rest or NTG
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28
Q

Intractable: (refractory) angina

A

debilitating

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29
Q

Variant (Prinzmetals)

angina

A

coronary arter vasospasm; often at rest

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30
Q

Silent ischemia

A

elderly & DM -> autonomic neuopathy

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31
Q

Characteristics of Angina pain

A
  • described as tightness, choking, or heavy sensation, indigestion
  • poorly localized & may radiate to neck, jaw, shoulders, back or arms
  • anxiety frequently accompanies the pain
  • other: dyspnea, SOA, dizziness, N/V, numbness in upper extremities
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32
Q

Treatment for Angina

A
  • measures to decrease myocardial oxygen demand & to increase oxygen sypply
  • medications
  • O2
  • Reduce & control risk factors
  • A, B, C, D, E
  • percutaneous coronary interventions
  • CABG
  • TIME IS MUSCLE
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33
Q

what do you assess for in angina pectoris?

A

-symptoms & activities, especially those that precede & precipitate attacks

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34
Q

Nursing interventions for the patient with Angina Pectoris

A
  • treat pain a priority, IV site
  • stop all activity, sit or rest in bed
  • Assess: pain, VS, respiratory status, ECG pattern
  • Oxygen
  • Follow medication protocol: NTG, ASA, MS
  • control anxiety
  • Lab & ECG
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35
Q

patient teaching for Angina

A
  • lifestyle changes & risk factor reduction to avoid future episodes of ischemia
  • Disease process
  • Medications: carry NTG, ASA protocol
  • stress reduction
  • prevent constipation
  • When to seek emergency care
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36
Q

Acute Coronary Syndrome

A

CAD can lead to ACS which is a condition characterized by signs & symptoms of sudden myocardial ischemia

  • a sudden decrease in blood flow to the heart
  • a continuum of intensity that results in myocardial death
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37
Q

what happens in unstable angina?

A

the plaque ruptures but the artery is not completely occluded

38
Q

MI patho

A
  • an area of the myocardium is permanently destroyed
    • usually caused by a reduced blood flow in a coronary artery
    • due to rupture of an atherosclerotic plaque & subsequent occlusion of the artery by a thrombus
      - cardiac cells deprived of oxygen -> ischemia develops ->cellular injury -> infarction or death of cells
39
Q

Ischemia

A

blood supply to the tissues is not keeping up with the demand

40
Q

Injury

A

MI is happening now

41
Q

Infarction

A

death of heart cells

42
Q

NSTEMI

A

non ST segment elevation myocardial infarction: thrombus partially. or intermittently occluded the coronary artery

43
Q

STEMI

A

ST elevation myocardial infarction: thrombus fully occluded the coronary arter

44
Q

Symptoms of MI

A
  • chest pain, BP elevated or decreased
  • SOA, dyspnea, tachy
  • N/V
  • decreased UO
  • Cool, clammy, diaphoretic, pale
  • anxiety, restlessness, dizziness
  • Atypical symptoms: N/V, weakness, dizziness
45
Q

What are the gender differences with an MI

A

men have more CVD events prior to age 75

women more likely to die than men

  • higher prevalence of total CVD
    - may delay seeking care
46
Q

What are the cardiac biomarkers

A

release of cellular contents into the circulation when myocardial cells die

  • CK-MB
  • Troponin
  • Myoglobin
  • CRP
47
Q

Treatment for an MI

A
  • follow institution and/or professional organizations guidelines
  • Reestablish coronary blood flow
  • NSTEMI vs STEMI
  • injury location
  • acute, evolving, old
48
Q

Treatment for Acute MI

A
  • lab draw & ECG within 10 min of admission to the ED
  • Oxygen
  • Aspirin, NTG, Morphine
  • Beta Blocker and/or ACE within 24 hours
  • MONA
  • Evaluate for percutaneous coronary intervention or thrombolytic therapy
  • With STEMI, patient taken directly for a cardiac cath (or transport)
  • Thrombolytics within 30 minutes if PCI unavailable or transport to long
49
Q

PTCA

A

door to balloon time

  • a balloon tipped catheter used to open blocked coronary vessels to resolve ischemia
  • performed in cardiac catheterization lab under fluoroscopy
  • to prevent re-stenosis, a stent is placed
50
Q

CTO PCI

A

minimally invasive technique used to treat patients with chronic total occlusion or complete blockages of the coronary arteries

51
Q

CABG

A

surgical procedure in which a blood vessel is grafted to the occluded coronary artery to allow blood flow beyond the occlusion

52
Q

What are the indications for a CABG

A
  • when angina cant be controlled with medications or PCI
  • multi-vessel CAD or treatment for LAD stenosis
  • Treat complications from unsuccessful PCI
  • Prevention & treatment of MI, arrhythmias, or HF
53
Q

What are commonly used for bypass graft procedures?

A

Greater and lesser saphenous veins

54
Q

Heart Failure

A

the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen & nutrients
-Impaired contraction or filling of the heart

55
Q

Heart Failure with Reduced ejection fraction

A

<40%

  • systolic HF
  • emptying problem reduced left ventricular contractility and strength
  • Causes: HTN, CAD, MI, valve disorders
56
Q

Heart Failure with preserved ejection fraction

A

> 50%

  • diastolic HF
  • Left ventricle unable to fill
  • Stiff ventricle
  • Cause: HTN, CAD, valve disorders, aging, arrhythmias, inflammatory heart
57
Q

Left sided heart failure

A

results in inadequate left ventricle output followed by inadequate tissue perfusion; an ejection fraction is performed to help determine type of HF

58
Q

Systolic Failure

A

weaken heart muscle; an emptying problem

59
Q

Diastolic Failure

A

stiff and noncompliant heart muscle, preventing adequate ventricular filling

60
Q

Right sided heart failure

A

usually occurs as a result of left sided failure

  • when the left ventricle fails, increased fluid pressure is transferred back through the lungs, eventually damaging the hearts right side
  • When the right side loses pumping power, blood backs up in the bodys veins causing swelling or congestion in the legs, ankles, GI, and liver
61
Q

Preload

A

pressure generated in the ventricles at the end of diastole and the resultant stretching of the muscle fibers

62
Q

Afterload

A

the amount of resistance to ejection of blood from the ventricle

63
Q

Contractility

A

the force generated by the contracting myocardium under any given condition

64
Q

stroke volume

A

amount of blood ejected with each heartbeat

65
Q

CO

A

amount of blood pumped by ventricles in liters per minute

66
Q

Ejection fraction

A

percentage of blood leaving ventricles with each contraction

Hallmark of heart failure

67
Q

ANP and BNP

A

released in response to increase blood volume and increase BP that increase stretching of the heart tissue

  • inhibit sodium reabsorption in the kidney and increase GFR
  • Net effect is the increase urine excretion, relax blood vessels and decrease BP and decrease heart workload
68
Q

Labs that can be drawn for heart failure

A

electrolytes, BUN, creatinine, TSH, CBC, ABGs, UA, BNP, glucose, albumin, liver function, PT/INR

69
Q

Diuretics

A

decrease preload by excretion of sodium and fluid

70
Q

Digoxin

A

inatropic agent to increase contractility and improves CO and perfusion

71
Q

Entresto

A

works to relax blood vessels; causes an increase in levels of natriuretic peptides to decrease blood pressure

72
Q

Corlanor

A

a specific type of channel blocker that lowers HR within the SA node

73
Q

ACE inhibitors

A

promote diuresis and vasodilation by decreasing afterload; blocks conversion of angiotension I to II

74
Q

ARBs

A

blocks agiotension II; decrease systemic vascular resistance, increase CO, reduces afterload

75
Q

Beta Blockers

A

decrease adverse effects of the SNS, slows HR allowing left ventricle to fill more completely increase EF

76
Q

Vasodilators

A

nitrates to decrease preload and afterload; increase blood flow to the heart

77
Q

Human B-type natriuretic peptide

A

causes diuresis and vasodilation

78
Q

anticoagulants

A

to prevent thrombus formation; risk associated with congestion, stasis and atrial fibrillation

79
Q

Milrinone

A

IV inotrope

  • promotes vasodilation to decrease preload & afterload
  • Reduces cardiac workload
80
Q

Dobutamine

A

IV inotrope

  • increases cardiac contraction
  • improves renal perfusion
81
Q

Ultra filtration (aquapheresis)

A

remove fluid from extravascular compartment

82
Q

ICD

A

implantable cardiac defibrillator

83
Q

Life Vest

A

wearable defibrillator

84
Q

Cardiac Resynchronization

A

Biventricular pacemaker

85
Q

VAD

A

ventricular assist device

86
Q

Cardiogenic pulmonary edema

A

fluid accumulates in the interstitial spaces and alveoli of the lungs

87
Q

Noncardiac pulmonary edema

A

renal failure, liver failure, or an oncologic condition

88
Q

What are symptoms of pulmonary edema?

A
  • Frothy pink sputum and cough
  • hypoxemia
  • tachy, dyspnea, and orthopnea
  • cold, moist skin and cyanotic nail beds
  • weak and rapid pulse, crackles, JVD, decrease UO
89
Q

MADDOG

for pulmonary Edema

A 
M morphine
A aminophylline
D digoxin
D diuretics
O oxygen
G blood gases
90
Q

Pericardial effusion

A

accumulation of fluid in the pericardial sac

  • venous return to the heart is obstructed and amount of blood pumped is reduced, decreasing CO
  • result in cardiac tamponade
91
Q

What is cardiac tamponade

A

compression of the heart from fluid accumulation in the pericardial sac

Adult Nursing Final (13 decks)

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