Cardiovascular- Exam 1 Flashcards
A physiological state where cardiac output is insufficient to meet the needs of the body
heart failure
Heart failure can be a problem with ___ or ___ of the heart
structure
function
Causes of heart failure
CAD
Uncontrolled HTN
MI
Renal Dysfunction
Cardiomyopathy
DM
Heart valve disorders
Causes of atherosclerosis
Tobacco
Elevated lipids
Diet
Sedentary
Causes of renal dysfunction
volume overload
Volume of blood pumped throughout the body per minute
Cardiac output
Cardiac output equation
HR x SV = CO (L/min)
Volume of fluid in ventricles at end of diastole
preload
The amount ventricles stretch at end of diastole
Preload
Relaxation and filling phase
Preload
AV valves are ____ in the preload
Open
Name the AV valves
Mitral
Tricuspid
The resistance that the left ventricle must overcome to eject and circulate blood
afterload
______ is the squeeze
Afterload
Name the semilunar valves
Pulmonic and aortic
Pressure opens semilunar valves to push blood out through circulation
Right to lungs, left to peripheral
Afterload
The right side of the heart pushes blood to the
lungs
The left side of the heart pushes blood to the
peripheral/systemic
The afterload is affected by the
Systemic Vascular Resistance (SVR)
Increasing the preload will increase what two other factors?
Stroke volume and cardiac output
How to increase preload amount?
IV Fluids
Stimulate SNS
How do you decrease preload?
Diuretics
Vasodilation
Diagnosis requiring increased preload
hypovolemic shock
Diagnosis requiring decreased preload
fluid overload in HF
HowTo increase afterload:
increase vasoconstriction
Diagnoses requiring increased afterload
Aortic stenosis
Pulmonary HTN
Measurement in percentage of total blood volume that the left ventricle pumps out with each contraction
Ejection fraction
The right ventricle plays a supporting yet important role in?
Circulation
The right ventricle sends deoxygenated blood to the?
Lungs for oxygenation and then back to the left side of the heart
The right ventricle pumps what kind of blood?
Deoxygenated
Right-sided HF is AKA
Systolic failure
Systolic failure is a _____ problem
contraction
The left ventricle is the _________ of the heart
Powerhouse
The left side of the heart sends blood where?
To the peripherals or systemically
Left-sided HF is AKA
Diastolic failure
Left-sided HF is a ______ problem
Relaxation
Deterioration of a structure or system previously working with the help of compensatory mechanisms
Decompensated
Organ that functions to circulate blood and perfuse tissue
Heart
A state of insufficiency or declined performance leading to dysfunction of a body system or organ
Failure
Symptoms of Acute Decompensated HF (ADHF)
Increased respiratory rate
Fluid shift with interstitial edema
Tachypnea and SOB
Pulmonary edema with hemoptysis
Symptoms of pulmonary edema with hemoptysis
Crackles
Tachycardia
Hypotension
Severe dyspnea
Orthopnea
Use of accessory muscles to breathe
Where does liquid accumulate in the lungs with pulmonary edema?
tissue
alveoli
What are some concerns for patients with pulmonary edema?
Impaired gas exchange
Acute respiratory failure
What are the 5 things we are trying to prevent with ADHF?
Acute respiratory distress
Cardiogenic pulmonary edema
Acute respiratory failure
Cardiogenic shock
Death
ADHF Rapid Interventions:
ABC’s
Place on monitor
Position
What does oxygen therapy treat in a patient with ADHF?
treat hypoxemic respiratory failure
What questions would you ask a pt presenting to the ED with ADHF?
-Are you allergic to any meds?
-What is your med hx?
-Are you taking any rx meds?
-Are you taking your meds as prescribed?
What may you see in the physical assessment portion of a pt with ADHF?
Decreased activity tolerance
Increased respirations and dyspnea
Rales or crackles on auscultation
Increased HR
Abnormal heart sounds
Peripheral edema
Jugular venous distention
High BP
Cardiac arrhythmias
How is HF diagnosed?
med hx
assessing s/s
diagnostic tests
What is HFpEF?
Heart failure preserved ejection fraction
What is HFrEF?
Heart failure reduced ejection fraction
Why is an ECG used on a patient who presents to the ED with heart symptoms?
To assess and rule out MI
What heart structure changes might you see on an ECG?
left ventricle hypertrophy
What is the cause of left ventricular hypertrophy?
The heart pumping too hard
A patient with heart symptoms presents to the ED - his CXR shows fluid in the lungs. What does this suggest?
pulmonary edema
A patient with heart symptoms presents to the ED - his CXR shows an enlarged heart suggesting?
Pulmonary arterial hypertension
A patient with heart symptoms presents to the ED - her CXR shows air between her lung and chest wall, what does this suggest?
pneumothorax
A patient with heart symptoms presents to the ED - the CXR shows infiltrates (blood, pus), what does this indicate?
Pneumonia
What labs may be run to determine if a cardiac event has occurred?
- Cardiac biomarkers (troponins, CK-MB, BNP, myoglobin)
- Renal function (BUN/cr)
- Electrolytes (K+, mg)
Normal range of BNP
<100 pg/mL
the hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume
BNP (brain natriuretic peptide)
Why is a loop diuretic given to a patient with HF?
fluid excretion and elimination
(furosemide)
Why is nitroprusside given to a patient with HF?
To generate rapid onset vasodilation
Why is an ACE inhibitor given to a patient during a cardiac event like HF?
To reduce cardiac workload by increasing vasodilation to lower BP
(Lisinopril)
How does an angiotensin receptor blocker affect a patient in HF?
It decreases BP and cardiac workload
(Valsartan)
Why is hydralazine given to HF patients?
to lower BP by vasodilation
What does digitalis accomplish for a patient in HF?
Increases cardiac contractility and LV function
What medication directly blocks negative effects of SNS on a failing heart by decreasing the HR to allow the L ventricle time to fill more completely?
Beta blockers
Why is morphine given to a patient in HF?
Vasodilation to decrease dyspnea, anxiety, and cardiac workload
When would you not give morphine to a HF patient?
When their RR are too low
What do you give a patient if they become hypotensive during HF treatment?
Give vasopressin
(Dopamine or dobutamine)
What are the priority nursing interventions for a patient in HF?
Monitor vital signs
Admin O2
Positioning
Intake & Output - Na and fluids?
Daily weights
Venous thromboembolism Prevention: SCD, heparin
Admin medications
What is a VTE?
Venous thromboembolism
Possible nursing diagnoses for HF
Impaired gas exchange
Decreased CO
Excess fluid volume
Activity intolerance
What are the outcome goals for patients with HF?
Improved cardiac function
Decreased symptoms
Increased function and independence
Decrease rehospitalization
Promote lifestyle changes to delay disease progression
What education will you as a nurse provide your patient with HF?
Meds: compliance, action, toxicity s/s
Diet: low NA+, read labels, fluids
Daily weight
S/s of worsening heart failure
When to call for help
Activity tolerance and rest
Stress reduction
How would a patient with HF know their medications are effective?
Increased activity tolerance, decreased dyspnea, and decreased edema
What is the leading cause of death in the United States?
Cardiovascular disease
Heart disease is a chronic and often progressive condition and can lead to what?
Heart Failure
A clinical syndrome resulting from structural and functional cardiac disorders that impair the ability of a ventricle to fill or eject blood is what?
Heart Failure
HF indicates myocardial disease, when there is a problem with the contraction of the heart (systolic dysfunction) or filling of the heart (diastolic dysfunction) that can lead to what? (2)
- Pulmonary congestion
- Systemic congestion
Is heart failure reversible?
Yes, some cases are reversible depending on the cause.
How is HF managed?
Lifestyle modifications & medications
Approximately 20% of patients discharged after treatment for HF are readmitted to the hospital within 30 days and nearly 50% within 6 months. How can a nurse prevent this?
Patient education
Clinical manifestations of Right Sided HF?
-Viscera & peripheral congestion
-JVD
-Dependent edema
-Hepatomegaly
-Ascites
-Weight Gain
Clinical manifestations of Left Sided HF?
-Pulmonary congestion, crackles
-S3 or “ventricular gallop”
-Dyspnea on exertion (DOE)
-Low O2 sat
-Dry, nonproductive cough initially
-Oliguria (retaining fluid in other places)
Depending on the severity of HF, what are some treatments?
-Oral & IV medications (Diuretics)
-Lifestyle modifications (exercise, cardiac rehab)
-Supplemental O2
-Surgical interventions (ICD & heart transplant)
What is the #1 medication used for treatment of HF?
Diuretics- decreases fluid volume, monitor serum electrolytes
What types of medications are used to treat HF?
-Diuretics
-ACE inhibitors
-ARB’s
-Beta-blockers
-Digitalis/Digoxin- Cardiac glycoside
-Ivabradine- HCN channel blockers
-Hydralazine or Isosorbide Dinitrate- Vasodilators
How do diuretics work in the treatment of HF?
decreases fluid volume
How do ACE inhibitors work in treatment of HF?
vasodilation, diuresis, DECREASES AFTERLOAD = decreased BP
Name common ACE inhibitors.
‘ace’
Lisinopril
Capropril
What are side effects to assess when taking an ACE inhibitor?
Cough, hypotension, hyperkalemia, AMS
What drugs used in the treatment of HF work similar to ACE inhibitors?
ARB’s- Angiotensin II receptor blockers
How do Beta-blockers work in the treatment of HF?
Negative chronotrope- decreases workload of the heart
What are medications that are used in the treatment of HF focused on achieving?
Decreasing the workload of the heart
How does Ivabradine work in the treatment of HF?
decreases rate of conduction through the SA node
What change would you assess for in patients taking Ivabradine for HF?
decrease in HR & BP
What change would you assess for in patients taking ACE inhibitors, ARB’s, or vasodilators in the treatment of HF?
decreased BP
How does digoxin work in the treatment of HF?
slows down the HR- improves contractility
What side effect can be life threatening when taking digoxin?
Digoxin toxicity
What should a nurse assess for in older men taking a diuretic for HF?
Bladder distention caused by urethral obstruction from an enlarged prostate gland
Which classification of medications play a pivotal role in the management of HF caused by systolic dysfunction?
ACE inhibitors
What medications are used for hospitalized patients admitted for acute decompensated HF?
Dopamine
Dobutamine
Milrinone
Vasodilators (Nitroglycerin, nitroprusside, nesiritide)
What should be included in the physical examination of a patient with HF?
Mental status
Lung sounds- crackles and wheezes
Heart sounds- S3
Fluid status or signs of fluid overload
Daily weight & I&O
Response to medications
Name some potential complications of HF.
Pulmonary edema
Hypotension
Poor perfusion
Cardiogenic shock
Arrhythmias
Thromboembolism
Pericardial effusion
What are the goals in patients with HF?
-Promote activity & reduce fatigue
-Relieve fluid overload symptoms
-Decrease anxiety & increase the patients ability to manage anxiety
-Encourage the pt to verbalize his or her ability to make decisions & influence outcomes
-Educate pt & family about management of the therapeutic regimen
How is promotion of activity & reduced fatigue achieved in pts with HF?
Exercise & medications
Name ways of promoting activity tolerance in pts with HF
-Bed rest for acute exacerbations
-Regular physical activity, building up
-Pacing of activities, wait 2 hrs after eating for physical activity
-Avoid activities in temperature extremes
-Modify activities to conserve energy
-Positioning- elevation of the head of bed to facilitate breathing & rest
Nursing interventions for management of fluid volume in HF
-Assess for symptoms of fluid overload (JVD, edema, ascites)
-Daily weight
-I&O
-Diuretic therapy, timing of meds
-Pt teaching of fluid intake/fluid restriction
-Maintenance of Na restriction
Pts with HF should consume how much Na per day?
<2000 mg/day or <2 g/day
Pulmonary edema can result in what?
Hypoxemia, decreased gas exchange
Clinical manifestations of pulmonary edema….
Restlessness
Anxiety
Tachypnea
Dyspnea
Cool & Clammy skin
Cyanosis
Weak & Rapid pulse
Cough
Lung congestion (noisy respirations)
Decreased level of consciousness
Increased sputum production
Definition: What is the end result of a failing heart?
Cardiogenic Shock
Patients with cardiovascular disorders are at risk for the development of what conditions?
Thromboembolism
(arterial thromboembolism, venous thromboembolism, intracardiac thrombi, pulmonary embolism)
How is sudden cardiac death or cardiac arrest treated? (4 steps- ABCD)
A: Airway
B: Breathing
C: Circulation
D: Defibrillation for VT or VF
What is the most reliable sign of cardiac arrest in an adult & child?
Absence of carotid pulse
What is the hallmark sign of PAD?
Intermittent Claudication (pain with ambulation)
What medications are used to treat symptomatic claudication?
Antiplatelets
Statins
Pentoxifylline & Cilostazol
What diagnostics are commonly used in PAD? (noninvasive)
-Ankle-Brachial index
-Doppler Ultrasound
-Computed Tomography (CT) Scanning
-Angiography
When is a bypass graft used in the management of PAD?
When the artery as 50% or more occlusion
Describe Critical Limb Ischemia
-Severe obstruction
-PAIN AT REST
-Non healing wounds
-Gangrene
What medications are used to prevent or reduce blood clots?
-Unfractionated Heparin
-Low molecular weight heparins
-Oral anticoagulants
-Thrombolytic agents
What is the antidote of heparin?
Protamine sulfate
What laboratory test is used to monitor heparin?
aPTT
What is the normal range of aPTT?
Lower limit of normal is 21-35 seconds
What is the antidote of warfarin?
Vitamin K
What is the laboratory test to monitor warfarin levels?
INR
What is the therapeutic range of INR?
2-3.5
Name a medication used in thrombolytic therapy.
Alteplase
Microvascular vasoconstriction
Coolness, pain, pallor
Avoid stimuli to decrease
Calcium channel blockers are used for treatment
What condition am I?
Raynaud’s Phenomenon
What are the 6 P’s of acute arterial occlusion?
- Pain
- Pallor
- Poikilothermia
- Pulselessness
- Paresthesia
- Paralysis
Why do the 6 P’s of acute arterial occlusion occur?
decreased perfusion
Name 2 treatments of Chronic venous insufficiency.
- Leg elevation
- Compression stockings
Condition characterized by abnormally dilated veins.
Varicose Veins
Condition characterized by swollen and inflamed skin.
Cellulitis
If you are working in the ER and have a patient come in complaining of chest pain and you can only ask one question, what would it be?
Are you allergic to any medications?
How is DVT diagnosed?
Medical history
Physical exam
Test results- radiology, ultrasound, D-Dimer
What laboratory test is ordered to aid in diagnosis of DVT?
D-Dimer
What is the normal level of D-Dimer?
Below 250 ng/mL
What does a D-Dimer tell you?
Measures a substance in the blood released when a blood clot dissolves
What diagnostic imagery will the physician order to confirm the presence of a DVT?
Venous Ultrasound
What are the 3 main goals of treatment with a DVT?
- Stop the clot from growing larger.
- Prevent clot from breaking off & moving to the lungs.
- Decrease the risk of having another clot.
What medications are used for DVT?
Heparin
Warfarin
During bridge therapy, do you stop heparin when you start warfarin?
No, heparin and warfarin are both taken until warfarin therapeutic levels are achieved.
What is the therapeutic range of aPTT?
30-100 seconds
What is the normal range of INR?
1 or less
If a patient suddenly becomes SOB and states “I feel like I’m going to die”. What will you do?
Sit up in fowler’s position, administer oxygen
Nursing diagnoses for Pulmonary Embolism
-Risk for impaired gas exchange
-Altered peripheral tissue perfusion
-Knowledge deficit
-Risk for bleeding
-Acute pain
Risk factors for DVT/PE
-Sedentary lifestyle
-Recent sedentary behavior (travel, prolonged bed rest, surgery)
-HF
-Birth control or hormone supplementation
-Smoking
-Obesity
-Pregnancy
-Cancer
-Genetic Clotting disorder
What are the functions of the vascular system?
-Circulatory needs of tissues (perfusion, nutrients, wastes)
-Blood flow
-BP
-Capillary filtration & reabsorption
-Hemodynamic resistance (vasoconstriction/vasodilation)
-Peripheral vascular regulating mechanisms (CNS, SNS)
What are the 2 interdependent systems of the cardiovascular system?
Right side of heart & Left side of heart
What all is included in the vascular system?
-Right & left side of heart
-Arteries & arterioles
-Capillaries
-Veins & venules
-Lymphatic vessels
Stiffening of blood vessels can result in what?
-Increased peripheral resistance
-Impaired blood flow
-Increased left ventricular workload
What indications of a vascular problem could you find during a physical assessment?
Skin- cool, pale, pallor, rubor, loss of hair, brittle nails, dry & scaling skin, atrophy, ulcerations
Decreased or absent pulses
What kind of diagnostics can be used to assess the vasculature?
-Doppler ultrasound flow studies (ABI)
-Exercise stress testing
-Duplex ultrasonography
-Computed tomography scanning
-Angiography & magnetic resonance angiography
-Contrast phlebography (venography)
-Lymphoscintigraphy
What is a continuous wave doppler ultrasound used for?
Detects blood flow, shows PVD
What assessments are important in a patient with PV problems?
-Health history
-Medications
-Risk factors
-S/S of arterial insufficiency
-Claudication & rest pain
-Color changes
-Weak or absent pulses
-Skin changes & skin b/d
What kinds of goals would be appropriate for PV problems?
-^ arterial blood supply
-Decrease in venous congestion
-Relief of pain
-Attainment/maintenance of tissue integrity
-Adherence to self-care program
What are some ways to improve PAC? (peripheral arterial circulation)
-Position body part below the level of the heart
-Exercise program & activities
-Discontinue nicotine
-Stress reduction
Definition: Hardening of the arteries. Diffuse process whereby the muscle fibers & the endothelial lining of the walls of the small arteries & arterioles become thickened.
Arteriosclerosis
Definition: Different process, affecting the intimacy of large & medium-sized arteries. Accumulation of lipids, calcium, blood components, carbohydrates, & fibrous tissue on the intimal layer of the artery. Atheromas or plaques.
Atherosclerosis
What are 3 problems that atherosclerosis can lead to?
- Myocardial infarction
- Stroke
- Gangrene
What are modifiable risk factors for Atherosclerosis & PAD? (9)
-Nicotine use
-Diabetes
-HTN
-Hyperlipidemia
-Diet
-Stress
-Sedentary lifestyle
-C-reactive protein
-Hyperhomocysteinemia
What are some non modifiable risk factors for Atherosclerosis & PAD? (2)
-Increasing age
-Familial predisposition/genetics
What is the hallmark sign of PAD?
Intermittent claudication
How is intermittent claudication relieved?
Rest
Pharmacologic therapies used for PAD?
-Phosphodiesterase III inhibitor: Cilostazol
-Antiplatelet agents: Aspirin & Clopidogrel
-Statins
Keeping the lower extremities in a neutral or dependent position is recommended for which condition? (PAD or Venous Insufficiency)
PAD
Keeping the lower extremities elevated is indicated in what condition? (PAD or Venous Insufficiency)
Venous Insufficiency
Definition: Localized sac or dilation formed at a weak point in the wall of the artery.
Aneurysm
What are triggers of Raynaud’s phenomenon? (Raynaud’s disease or Raynaud’s syndrome)
Cold
Stress
Name 4 venous disorders.
- Venous thromboembolism (VTE) : DVT & PE
- Chronic venous insufficiency/postthrombotic syndrome
- Leg ulcers
- Varicose veins
What are some preventive measures in the development of VTE?
-Early ambulation & leg exercises
-SCD’s
-TED stockings
-Subcutaneous heparin or LMWH
-Lifestyle changes: weight loss, smoking cessation, regular exercise
What nutrients are recommended for enhanced healing?
Protein, zinc, iron, vitamins A & C
What are 2 complications associated with leg ulcers?
- Infection
- Gangrene
TRUE or FALSE: Heat be used in the treatment of leg ulcers.
False
How can you promote lymphatic drainage & prevent edema in a patient with lymphedema?
Constant elevation of the affected extremity
What are S/S of cellulitis?
-Localized swelling or redness
-Fever
-Chills
-Sweating
TRUE or FALSE: Heat can be applied in the treatment of cellulitis.
True
