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Adult Health Nursing I > Cardiovascular Disorders > Flashcards

Cardiovascular Disorders Flashcards

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1
Q

Nursing Diagnoses Related to Cardivascular Disorders

A 
Activity Intolerance
Anxiety
Decreased cardiac output
Ineffective coronary tissue perfusion
Fluid volume excess
Impaired gas exchange
Knowledge, deficient
Pain
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2
Q

Decreased Cardiac Output is Related to…

A

Altered heart rate or rhythm
Altered stroke volume
Altered preload (decreased venous return)
Altered afterload (increased systemic venous return, increased BP)
Altered contractility

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3
Q

Risk Factors for Ineffective Tissue Perfusion

A

Hypertension, hyperlipidemia, coronary artery spasm, diabetes mellitus, cardiac surgery

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4
Q

Autonomic Nervous System

A

Controls the heart rate

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5
Q

Sympathetic/Parasympathetic Nervous System

A

Stimulates norepinephrine to increase heart rate

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6
Q

Baroreceptors

A

Pressure receptors located in the aortic arch, carotid sinuses

Have special nerve endings to detect changes in arterial blood pressure

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7
Q

Stretch Receptors

A

Found in the vena cava, respond to pressure changes

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8
Q

Antidiuretic Hormone (Vasopressin)

A

Influences blood pressure by regulating vascular volume

Keeps blood pressure high by retaining water

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9
Q

Renin

A

Vasoconstrictor to increase blood pressure

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10
Q

Aldosterone

A

Promotes water and sodium retention to increase blood pressure

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11
Q

S1

A

First heart sound, closing of the AV valves

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12
Q

S2

A

Second heart sound, closing of the semilunar valves

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13
Q

S3

A

Normal if under 30 years old, caused by decreased ventricular compliance

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14
Q

S4

A

Ventricular resistance to filling, caused by injury

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15
Q

Cardiac Catheterization and Angiography

A

Helps to visualize the heart’s chambers, valves, great vessels, and coronary arteries

Measures pressures inside of the heart

Uses contrast iodine

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16
Q

Nursing Interventions for Pre-Op Cardiac Catheterization and Angiography

A

Education, teach about “warm” feeling of iodine, screen for iodine allergy, keep NPO, get consent, observe recent vital signs, know the coags, review the lab work (CBC, BMP, potassium level), mark pedal pulses

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17
Q

Nursing Interventions for Post-Op Cardiac Catheterization and Angiography

A

Get vital signs every 15 minutes, assess circulation-sensation-movement of extremity accessed, assess pressure dressing, position on their back, encourage fluids

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18
Q

Complications of Cardiac Catheterization and Angiography

A

Diabetic patients taking Glucophage have increased risk of kidney damage with the contrast dye

Hemorrhage

Reocclusion

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19
Q

Echocardiography

A

Ultrasound directed at the heart

Helps to get information about the CO, EF, and valves

Cardiac Output = HR x SV (EF is the same)

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20
Q

Normal Cardiac Output for Left Ventricle

A

60-65%

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21
Q

Cardiac Output with Moderate Heart Failure

A

40-60%

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22
Q

Cardiac Output for Moderate to Severe Heart Failure

A

20-40%

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23
Q

Cardiac Output with Severe Heart Failure

A

< 20%

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24
Q

Electrophysiology

A

Stimulation of the heart with equipment to cause lethal rhythms in order to locate accessory pathways and cauterize them

Electron Beam Computer Tomography is used for accurate location of calcium in the heart

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25
Q

Stress Tests

A

Monitoring cardiac function under stress (treadmill, exercise bike)

With or without echo or nuclear imaging (Thallium)

If unable to exercise –> give drugs to mimic exercise (Dipyridamole [Persantine], Adenosine [Adenocard])

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26
Q

Nursing Interventions for Stress Tests

A

Keep NPO, hold beta blockers (decrease heart rate), prepare patients for long tests

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27
Q

Electrocardiography

A

ECG/EKG

Typically 12 leads

Measures heart rhythms

Holter Monitor: wear for 48 hours, press button if you have chest pain or dizziness

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28
Q

P Wave

A

Depolarization of the atria

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29
Q

QRS Complex

A

Depolarization of the ventricles

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30
Q

T Wave

A

Repolarization of the ventricles

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31
Q

Cardiac Monitoring

A

Have patient notify if they experience chest pain, SOB, palpitations

Check surrounding skin, make sure there is a tight seal, change pads

Communicate with person watching telemetry monitor

Never remove the telemetry monitor just do the patient can shower

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32
Q

Red Blood Cell Values

A

Men: 4.5-6.2 million cells/microliter

Women: 4.0-5.5 million cells/microliter

Polycythemia: result of chronic hypoxemia, increased red blood cells

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33
Q

White Blood Cell Values

A

5-10 cells/mm3

Differential: neutrophils, bands, eosinophils, basophils, lymphocytes, monocytes

“Shift to the Left” = increased immature neutrophils

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34
Q

Platelet Values

A

150,000-400,000 cells/mm3

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35
Q

Hemoglobin/Hematocrit Values

A

Male: 14-18 g/dL and 42-52%

Female: 12-16 g/dL and 37-47%

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36
Q

Erythrocyte Sedimentation Rate

A

Inflammatory condition indicator

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37
Q

Sodium Values

A

135-145 mEq/L

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38
Q

Potassium Values

A

3.5-5.1 mEq/L

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39
Q

Calcium Values

A

8.6-10 mg/dL

40
Q

Magnesium Values

A

1.6-2.6 mg/dL

41
Q

Total Cholesterol Goal

A

Less than 200

42
Q

HDL

A

Healthy, high density lipoprotein

43
Q

LDL

A

Increased risk of cardiovascular disease

44
Q

VLDL

A

Increased risk of cardiovascular disease

45
Q

Hyperlipidemia

A

Increased concentration of any/all lipids in the blood

46
Q

Cardiac Enzymes

A

Proteins from the cell that are released when there is cell death in the tissue

47
Q

CK-MB (Creatine Kinase, Myocardial Muscle)

A

Increases with cell death

48
Q

LDH (Lactic Dehydrogenase)

A

Increases with cell death

49
Q

TROPONIN 1

A

Gold standard of cardiac markers

Normal level is 0.6ng/mL

Increases with cell death within 3 hours of heart damage

50
Q

Myoglobin

A

Released after MI or skeletal muscle injury

51
Q

B-Type Natriuretic Peptide

A

100 pg/mL

Increases with heart failure

52
Q

Homocysteine

A

< 14 mmol/dL

Increases risk of cardiovascular disease

53
Q

C-Reactive Protein

A

Indication of inflammation

54
Q

Hypertension

A

Blood pressure above 149/90

55
Q

Diabetes and Coronary Artery Disease

A

Accelerates heart disease, hyperglycemia causes increased aggregation, alters RBCs

56
Q

Angina Pectoris

A

Chest pain

Diagnosed by history, cardiac tests

Anti-platelet aggregation therapy (low-dose aspirin, Plavix)

Vasodilators: Nitroglycerin

Beta-adrenergic blocking agents (decrease heartbeat and blood pressure)

Calcium channel blockers (vasodilate)

57
Q

Coronary Artery Bypass Graft (CABG)

A

Treatment for angina pectoris, uses a saphenous vein graft and/or left internal mammary artery

58
Q

Percutaneous Transluminal Coronary Angioplasty

A

Goes through an artery, uses a ballon, opens up the occluded area

Need consent because it is invasive and the balloon could pop, warranting an emergency CABG

59
Q

Complications of CABG and PTCA

A

Vascular injury, bleeding, heart attack

60
Q

Nursing Care for Angina

A

Promote comfort (decrease contributing factors, give morphine)

Promote tissue perfusion

Promote rest/relief of anxiety/feeling of well-being

Teach patient and family

61
Q

Nursing Interventions for Angina

A

Stop all activities, place patient in Semi-Fowler’s, administer oxygen

Give nitroglycerine every 5 minutes 3 times as needed for pain (if there is still pain after the third one, contact the physician)

Assess pain, blood pressure, and pulse before each drug

DO NOT give if they take medications for sexual dysfunction

62
Q

Valvular Heart Diseases

A

Prolapse, Regurgitation, Stenosis

Caused by congenital abnormalities or rheumatic fever

63
Q

Signs and Symptoms of Valvular Heart Disease

A

Fatigue, angina, oliguria, pale skin, weight gain, edema, dyspnea, abnormal breath and heart sounds

Symptoms of decreased cardiac output

64
Q

Diagnosing Valvular Heart Diseases

A

Echocardiogram and/or heart catheterization are best

Chest X-Ray, ECG

65
Q

Pharmacological Management of Valvular Heart Diseases

A

Diuretics (decrease extra fluid; need to restrict sodium)

Digoxin (slows and strengthens the heart)

Antidysrhythmics (helps with conduction problems)

66
Q

Commissurotomy

A

Surgically splitting fused valves

67
Q

Annuloplasty

A

Tightening leaflets

68
Q

Cardiomyopathy

A

Group of heart muscle diseases

Primary (genetic cause) or secondary (infective, metabolic, nutritional, alcohol, peripartum, drugs, radiation, SLE, rheumatoid arthritis)

69
Q

Effects of Primary Cardiomyopathy

A

Decreased cardiac output

Sympathetic nervous system is stimulated

Renin-Angiotensin-Aldosterone response (systemic vascular resistance increases)

Increased sodium and fluid retention

Increased workload on heart and heart failure

70
Q

Types of Cardiomyopathy

A

Dilated, Restrictive, Hypertrophic

71
Q

Signs and Symptoms of Cardiomyopathy

A

Angina, syncope, fatigue, dyspnea on exertion, severe exercise intolerance

Signs and symptoms of left- and right-sided heart failure

72
Q

Pharmacological/Medical Management of Cardiomyopathy

A

Diuretics (Lasix, furosemide –> decreased K+)

ACE Inhibitors (vasodilate)

Beta-Adrenergic Blocking Agents (slows everything down)

Treat the underlying cause

Internal defibrillators and/or cardiac transplants may be necessary

73
Q

Rheumatic Endocarditis

A

Rheumatic fever occurs after a streptococcal infection (beta-hemolytic streptococci)

Causes scar tissue in the heart and develops into heart disease

74
Q

Pharmacological/Medical Management of Rheumatic Endocarditis

A

NSAIDs

Treat infections rapidly and completely

Bed rest, application of heat to joints, well-balanced diets, encourage fluids

Commissurotomy or valve replacement

75
Q

Endocarditis

A

Can be caused by bacteria, virus, or fungus

“Flicking of clots”

Seen frequently in IV drug users

76
Q

Signs and Symptoms of Endocarditis

A

Influenza-like symptoms, petechiae, anemia, splinter hemorrhages, weight loss, heart murmur

77
Q

Medical Management of Endocarditis

A

Bed rest, IV antibiotics for 1-2 months, prophylactic antibiotics, analgesics, antipyretics

Surgical repair/replacement of diseased valves

78
Q

Pathophysiology of Myocarditis

A

Rheumatic heart disease

Viral, fungal, or bacterial infection

Endocarditis

Pericarditis

Tell patients to complete their course of antibiotics

79
Q

Medical Management of Myocarditis

A

Bed rest, oxygen, antibiotics, anti-inflammatory agents

Monitor for cardiac enlargement, gallop, tachycardia

80
Q

Pathophysiology of Pericarditis

A

Inflammation of the pericardium resulting in thickening and constriction

Caused by infections, Lupus, rheumatoid arthritis, immune reaction, MI, pneumonia, radiation, renal failure

81
Q

Signs and Symptoms of Pericarditis

A

Debilitating chest pain that increases with movement, dyspnea, fever, chills, leukocytosis, signs and symptoms of heart failure

82
Q

Medical Management of Pericarditis

A

Analgesics, salicylates (decrease inflammation), antibiotics, anti-inflammatory agents, corticosteroids, oxygen, IV fluids

83
Q

Cardiac Tamponade

A

Heart unable to pump efficiently due to pressure from fluid buildup with pericarditis

Treatment includes a pericardial window, pericardial tap/pericardiocentesis

84
Q

Causes of Heart Failure

A

Inflow of blood greatly reduced (trauma, hemorrhage, venous insufficiency, dehydration)

Outflow from heart obstructed (valves)

Damaged heart muscle (MI, pericarditis)

Metabolic demands increased (pregnancy, hyperthyroidism)

Arteriosclerosis

Neurohormonal conditions (brain trauma, tumors)

85
Q

Left Ventricular Heart Failure

A

Most common, blood backs up into the lungs

Pulmonary congestion that leads to paroxysmal nocturnal dyspnea, orthopnea, cough, frothy pink sputum, pulmonary crackles, wheezing

X-Ray shows pleural effusion, pulmonary vascular congestion

86
Q

Heart Failure Generalized Symptoms

A

Fatigue, shortness of breath, tachycardia

Angina, anxiety, restlessness, insomnia

Oliguria, decreased GI motility

Pale, cool, skin

Weight gain due to fluid buildup

87
Q

Right Ventricular Failure

A

Distended jugular veins

Anorexia, nausea, and abdominal distention

Liver enlargement, ascites

Edema in the feet, ankles, sacrum that may progress up the legs into the thighs, external genitalia, and lower trunk

88
Q

Diagnosis of Heart Failure

A

Chest X-Ray shows pulmonary effusion, cardiomegaly, pulmonary vascular congestion

ECG shows rhythm disturbances

Echo is gold standard, shows ejection fraction, stroke volume, valve problems, pericardial fluid

Heart Catheter shows ventricular function, checks occlusion of arteries

Stress testing checks activity tolerance

BNP > 100 pg/mL indicates heart failure

89
Q

Pharmacological Management of Heart Failure

A

Digoxin (increases force of contraction, decreases heart rate): count apical HR for a full minute

Vasodilators (nitroglycerine, isosorbide)

ACE Inhibitors (decrease blood pressure): Vasotec, Enalopril, Capoten, Captopril

Beta Blockers prevent cardiac remodeling (left ventricle dilates and hypertrophies which stresses walls of ventricles and causes mitral regurgitation

90
Q

Nursing Interventions of Heart Failure

A

Vital signs, head to toe assessment

Medications and oxygen

Increase position and activity gradually

Monitor fluid retention; weigh daily

Low sodium diet

91
Q

Pulmonary Edema

A

Caused by left ventricular failure, fluid overload

Characterized by restlessness, agitation, panic, disorientation, diaphoresis, pallor, tachycardia, frothy pink sputum

92
Q

Medical Management of Pulmonary Edema

A

Morphine sulfate (decreases anxiety and respiratory effort), nitroglycerin, diuretics, inotropic agents (Digoxin), vasodilators

Position in a high Fowler’s position with legs hanging down

Oxygen, Foley catheter, stay with patients until stable

93
Q

Shock

A

Inadequate tissue perfusion caused by systemic vascular resistance

Signs include hypotension, tachycardia, tachypnea, change in mental status, decreased urinary output

94
Q

Cardiac Arrest

A

Cessation of cardiac output and circulatory collapse

Caused by v tach, v fib, asystole

Signs and symptoms include loss of consciousness, apnea, no pulse and no blood pressure, pupil dilation, pallor and cyanosis

Initiate CPR

95
Q

V Tach

A

Shockable rhythm, with or without pulse, McDonald’s arches

Adult Health Nursing I (22 decks)

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