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NUR 195 > Cardiovascular and Circulatory Function > Flashcards

Cardiovascular and Circulatory Function Flashcards

1
Q

Risk factors for CV disease:

A
  • Modifiable: hyperlipidemia, HTN, cigarettes, diabetes, obesity, physical inactivity
  • Non-modifiable: older age, male gender, heredity, race
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2
Q

What are some common complaints of CV disease?

A
  • chest pain/discomfort
  • pain/discomfort in: upper body, arms, back, jaw, stomach
  • dizziness, syncope, changes in LOC
  • intermittent claudication
  • palpitations or tachycardia
  • peripheral edema, weight gain, ascites, abdominal distention
  • SOB/dyspnea
  • unusal fatigue
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3
Q

Heart sounds:

Snaps and clicks

A
  • opening and closing of diseased valve leaflets, murmurs-turbulent blood flow across ridged, calcified values, allows backward flow (regurgitation), or defects
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4
Q

Heart sounds:

friction rub

A
  • harsh, grating sound, heard best when the patient is sitting up and leaning forward.
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5
Q

What do you assess in CV assessment (physical):

A
  • skin
  • vital signs
  • pulses
  • respiratory
  • abdominal
  • auscultation of the heart
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6
Q

Pulsating masses in the abdomen can indication?

A

abdominal aortic aneurysm

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7
Q

Gerontological considerations for CV assessment:

A
  • peripheral pulses have decreased elasticity
  • intermittent claudication (limping)
  • increased risk for postural hypotension
  • risk for ulceration
  • infection in toes/feet (prolonged pressure compromises arterial perfusion.
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8
Q

Cardiac biomarkers are useful in diagnosing?

A
  • acute MI
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9
Q

What are the cardiac biomarkers?

A
  • troponin T and I
  • CK-MB
  • Myoglobin
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10
Q

Cardiac biomarkers are leaked into?

A

the blood stream when heart muscle cells are injured.

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11
Q

What cardiac biomarker rises within 3 -4 hours, peak 4 - 24 hours and returns to normal in 1 - 3 weeks?

A

Troponin T and I

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12
Q

Which cardiac biomarker is helpful in early diagnosis of acute MI and for late diagnosis for patients who delay getting treatment?

A

Troponin T and I, because it rises early and last longer.

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13
Q

What cardiac biomarker rises within 4 to 8 hours, peaks in 12 to 14 hours, and returns to normal in 3 -4 days?

A

CK-MB

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14
Q

CK-MB is released for three different types of damaged tissues what are they?

A
  • myocardium
  • skeletal muscle
  • brain
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15
Q

What cardiac biomarker rises within 1 to 3 hours, peaks in 4 to 12 hours and returns to normal in 24 hours?

A
  • myoglobin
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16
Q

Which biomarker is not used alone to diagnose MI?

A
  • myoglobin b/c it rises with other disease as well.
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17
Q

lipid profile labs:

A

LDL, HDL, cholesterol, triglycerides

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18
Q

Normal level for LDL:

A
  • optimal < 100 gm/dL

- near optimal 100 - 129 mg/dL

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19
Q

Elevated LDL levels are associated with?

A

CAD

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20
Q

Normal level for HDL:

A

levels greater than 60 mg/dL

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21
Q

Risk factors for lowering HDL are?

A
  • smoking
  • diabetes
  • obesity
  • physical inactivity
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22
Q

Elevated cholesterol increases the risk of?

A

atherosclerosis

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23
Q

Normal cholesterol levels are?

A

140 - 199mg/dl

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24
Q

Triglyerides normal value?

A

<150mg/dL

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25
Q

Triglyerides have a direct correlation with?

A

LDL

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26
Q

aPTT is used for?

A

heparin

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27
Q

PT/INR is used for?

A

warfarin

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28
Q

An BNP greater than 100mg/mL is an indicator of?

A

heart failure

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29
Q

A C-reactive protein (CRP) greater than 3.0mg/dL is an indicator of the progression of?

A

atherosclerosis and CAD

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30
Q

ECG is used to diagnose?

A
  • arrhythmias
  • conduction abnormalities
  • enlarged heart chamber
  • MI or infractions
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31
Q

What test evaluates the response of the cardiovascular system to increased demands for oxygen and nutrients.

A
  • stress testing
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32
Q

Stress testing is used to determine?

A
  • atherosclerosis
  • functional capacity of the heart after MI or heart surgery
  • effectiveness of medical regimen
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33
Q

What is the procedure for stress testing?

A
  • walks of treadmill
  • pedal bike/arm pedals
  • intensity increases
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34
Q

If the patient is unable to exercise for a stress test what do that do?

A

inject a vasodilation agent to mimic the physiologic effects

dipyridamole or adenosine

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35
Q

What do you monitor for signs and symptoms of myocardial or leg ischemia (claudication) during a stress test?

A
  • ECG
  • BP
  • physical appearance
  • perceived exertion and symptoms: including chest pain, dyspnea, dizziness, leg cramping, and fatigue
  • *positive indications for additional testing
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36
Q

Instructions for stress testing:

A
  • fast 4 hours before test
  • avoid tabacco
  • avoid caffeine
  • avoid stimulants
    (take meds with a sip of water)
  • wear clothes suitable for exercise
    **if vasodilator is given patient my having nausea or flushing
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37
Q

What is a noninvasive ultrasound test, painless, patient may be asked to turn on the left side and hold breath at times:

A

echocardiography

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38
Q

What is test uses a transducer thread through the mouth into the esophagus for a clearer image?

A

trandesophageal echocardiography

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39
Q

What is the procedure of the trans esophageal echocardiography?

A
  • topical anesthetic and moderate sedation.

- ask patient to swallow several times until the transducer is positioned in the esophagus

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40
Q

What is the post procedure for the esophageal echocardiography?

A
  • elevate HOB
  • assess for swallowing ability
  • VS
  • O2 stat
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41
Q

To identify the areas of decreased myocardial perfusion more precisely what type of imaging do you do?

A
  • radionuclide imaging

the first sets of images are taken right after radioisotopes are injected and the second is taken 3 hours later

42
Q

Doppler ultrasound studies are used to?

A
  • detect blood flow to extremities or head due to thrombus

- determine if atherosclerosis is present in the lower extremities with patients who have intermittent claudication

43
Q

What is an invasive procedure using fluoroscopy, visualizes the heart on an x-ray to guide catheter placement into the heart to view chambers and coronary arteries?

A
  • heart cath
44
Q

What is a heart cath gold standard for diagnosing?

A
  • CAD
45
Q

What do you do pre-procedure for a heart cath?

A
  • blood tests: BUN, creatinine, CBC, electrolytes, PT/INR or aPTT.
  • IV catheter
  • assess for allergies
  • BP and tele
  • may experience: palpitations, flushing, sensation to void d/t contrast
46
Q

right heart cath for?

A

-evaluation of heart chambers and the function of the tricuspid and pulmonary valves

47
Q

left heart cath for?

A
  • evaluation of latency of the coronary arteries and the function of the left ventricle and the mitral and aortic valves
48
Q

heart cath procedure:

A
  • IV sedation
  • meds and fluids
  • ECG
49
Q

Post heart cath procedure:

A
  • assess insertion site for bleeding/hematoma
  • assess for arrhythmias, pulses
  • maintain bedrest 2 to 6 hours
  • analgesics for discomfort
  • *must report CP, bleeding, sudden discomfort at catheter insertion site
  • asses for contrast induced renal failure
  • up with assistance
  • avoid letting for 24 hours
50
Q

What are common causes of valvular disorders?

A
  • degenerative disease
  • rheumatic heart disease
  • infective endocarditis
51
Q

Progression of valvular disorders can lead to?

A
  • sudden death
  • HF
  • arrhythmias
  • stroke
52
Q

Management and treatment of valvular disorders?

A
  • prevention
  • avoid thromboembolism
  • treat a fib
  • treat HF
  • treat pulmonary artery hypertension
53
Q

What is it called when the opening of the valve is narrow making blood flow reduced?

A
  • stenosis
54
Q

Usually the mitral valve it as wide as the diameter of three fingers; marked stenosis would be the width of a?

A
  • pencil
55
Q

With mitral valve stenosis what happens?

A
  • left atrial pressure increases d/t slowed blood flow into the LV
  • left atrium dilates and hypertrophies d/t increase blood volume *can cause clot formation/thromboembolism
  • pulmonary venous pressure rises and circulation becomes congested
  • RV must contract against an abnormally high pulmonary pressure
  • RV and and RA become enlarged
  • the ventricle will eventually fail
  • LOUD s1 and a low-pitched, rumbling, diastolic murmur heard of s2
56
Q

Manifestations of mitral stenosis:

A
  • DOE
  • fatigue
  • paroxysmal nocturnal dyspnea
  • a-fib
  • dyspnea at rest
  • heavy coughing
  • hemotypsis
  • hoarseness
  • palpitations
  • orthopnea
  • recurrent resp, infections
  • HF
  • edema
  • ascites
57
Q

Treatment for mitral stenosis:

A
  • treat symptoms
  • monitor severity
  • antiarrhythmics
  • electrical cardio version (to restore SR)
  • digoxin
  • beta blockers
  • calcium channel blockers
  • diuretics
    • surgery if severe
58
Q

Aortic stenosis:

  • progress occurs?
  • which ventricular overcomes the stenosis? HOW?
A
  • over several years to decades

- LV overcomes stenosis by contracting more slowly and more strongly than normal.

59
Q

When the LV overcomes aortic stenosis by working harder to compensate the increased pressure causes?

A
  • LV failure
  • elevated LA pressure
  • pulmonary congestion
  • RIGHT HF**
60
Q

Treatment of aortic stenosis?

A
  • prevent complications
  • nitrates for angina
  • for severe cases avoid: strenuous exercise
  • digoxin
  • diuretics
  • valve repair/replacement
61
Q

What is regurgitation?

A

when a valve does not close completely, blood flows back through the valve.

62
Q

What is the most common regurgitation?

A

aortic

63
Q

Regurgitation put you at risk for?

A
  • rheumatic heart disease

- infective endocarditis

64
Q

S/S of regurgitation:

A
  • palpitations
  • visible neck pulsations
  • dyspnea
  • fatigue
  • angina
  • orthopnea
  • widening pulse pressure
65
Q

what is the best option for regurgitation?

A

surgical valvular replacement

66
Q

When a valve does not close properly and the valve leaflets ballon back what is it called?

A

prolapse

67
Q

What type of valve repair is this:

  • more durable
  • need anticoagulation therapy such as warfarin and you want INR between 2 and 3.5
  • risk for thromboembolism and endocarditis
A

mechanical valves

68
Q

What type of valve is this:

  • less durable
  • does not require anticoagulation
  • lack longevity
  • risk for endocarditis
A

tissue valve

69
Q

Endocarditis is infection of the?

A

endocardium

70
Q

What are some causes of endocarditis?

A
  • prosthetic heart valves
  • structural cardiac defects
  • IV drug use
  • NOSOCOMIAL IV therapy
71
Q

What are some vague symptoms of endocarditis?

What are some other symptoms?

A
  • anorexia
  • myalgia
  • fever chills
  • weight loss
  • back and joint pain
  • night sweats
    other:
  • fever
  • HF
  • embolic events
  • new murmur
72
Q

What should you monitor for with endocarditis?

A
  • arrhythmias

- hemolytic anemia

73
Q

With endocarditis there are certain things to note when assessing what are they?

A
  • Osler nodes
  • Janeway lesions
  • Roth spots
  • splinter hemorrhages
  • petechiae
74
Q

What are Osler nodes?

A
  • painful, erythematous nodules on pads of fingers or toes
75
Q

What are Janeway lesions?

A
  • painless, red or purple macule on palms and soles
76
Q

What are Roth spots?

A
  • oval retinal hemorrhages with pale centers
77
Q

Where are splinter hemorrhages?

A
  • under finger nails and toes.
78
Q

What are some further complications of endocarditis?

A
  • cardiomegaly
  • HF
  • tachycardia
  • splenomegaly
79
Q

What are some diagnostic tests for endocarditis?

A
  • echocardiography: detection of presence or absence of vegetations or abscesses, prosthetic valve dehiscence, new regurgitation, or HF
  • ECG: AV block, BBB, and fascicular blocks
80
Q

What are some labs that indicate endocarditis?

A
  • elevated WBC
  • elevated RBC sedimentation rate
  • elevated C-reactive protein
81
Q

Remember prevention is KEY for endocarditis EX:

A
  • long term antibiotics

- prophylaxis antibiotics

82
Q

What is it called when you have inflammation of the pericardium, the same surrounding the heart?

A

pericarditis

83
Q

What is pericarditis most frequently caused by?

A

viral illness

84
Q

Pericarditis may lead to accumulation in the space between the layers of the heart, resulting in increased pressure on the heart what is this called?

A

pericardial effusion

85
Q

pericarditis restrict the hearts ability to?

A

fill with blood

86
Q

With less filling of the heart with blood pericarditis leads too decreased?

A

cardiac output

87
Q

Pericarditis may lead to increased systemic venous pressure causing?

A
  • peripheral edema

- hepatic failure

88
Q

Clinical manifestation of pericarditis:

A
  • pericardial friction rub
  • chest pain: aggravated by coughing, deep inspiration, lying down, or turning **MAY BE RELIEVED BY LEANING FORWARD
  • mild fever
  • increased WBC
  • elevated ESR
  • elevated CRP
  • anemia
  • non productive cough
  • SOB
89
Q

Pericardial friction rub:

  • sounds like:
  • is best heard:
  • have the patient _____ to better hear.
A
  • creaky/scratchy sounds heard at the end of exhalation
  • sitting leaning forward
  • hold there breath
90
Q

Diagnosis of pericarditis:

A
  • echocardiography
  • ECG changes
  • HX: S/S
91
Q

Management of pericarditis:

A
  • NSAID’s
  • corticosteroids
  • if constructive* surgical removal of the pericardium
  • positioning
  • psychological support
92
Q

What is inflammation of the heart muscle, commonly cause by viral infection?
(can also be caused by bacterial infection, autoimmune, or toxic agents)

A

myocarditis

93
Q

Clinical manifestations of myocarditis:

A
  • DX: is DIFFICULT
  • fever
  • myalgia
  • fatigue
  • dyspnea
  • ventricular arrhythmias*
  • cardiogenic shock
  • DCM*
  • S3 gallop*
  • tachycardia
  • orthopenia
  • palpatations
  • HR
  • sudden cardiac death*
94
Q

Nursing management for myocarditis:

A
  • supportive care
  • oxygenation
  • telemetry
  • fluid status
  • VAD/transplant
95
Q

What is a disorder of the myocardium associated with mechanical and or electrical dysfunction?

A

cardiomyopathy

96
Q

What are the s/s of cardiomyopathy?

A
  • impaired cardiac output
  • decreased stroke volume
  • sodium and fluid retention
  • severe HR possible
  • lethal arrhythmias
  • death
97
Q

How do you DX cardiomyopathy?

A

echocardiography

98
Q

How do you care for cardiomyopathy?

A
  • HF therapy
  • ACE inhibitors
  • aldosterone antagonists
  • diuretics
99
Q

How do you prevent cardiomyopathy?

A
  • avoid complications such as life threatening arrhythmias and thrombi
100
Q

Cardiomyopathy may require?

A
  • LVAD

- heart transplant

NUR 195 (13 decks)

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