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Nursing 105 > Cardiovascular- Exam 1 > Flashcards

Cardiovascular- Exam 1 Flashcards

1
Q

A physiological state where cardiac output is insufficient to meet the needs of the body

A

heart failure

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2
Q

Heart failure can be a problem with ___ or ___ of the heart

A

structure
function

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3
Q

Causes of heart failure

A

CAD
Uncontrolled HTN
MI
Renal Dysfunction
Cardiomyopathy
DM
Heart valve disorders

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4
Q

Causes of atherosclerosis

A

Tobacco
Elevated lipids
Diet
Sedentary

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5
Q

Causes of renal dysfunction

A

volume overload

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6
Q

Volume of blood pumped throughout the body per minute

A

Cardiac output

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7
Q

Cardiac output equation

A

HR x SV = CO (L/min)

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8
Q

Volume of fluid in ventricles at end of diastole

A

preload

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9
Q

The amount ventricles stretch at end of diastole

A

Preload

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10
Q

Relaxation and filling phase

A

Preload

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11
Q

AV valves are ____ in the preload

A

Open

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12
Q

Name the AV valves

A

Mitral
Tricuspid

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13
Q

The resistance that the left ventricle must overcome to eject and circulate blood

A

afterload

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14
Q

______ is the squeeze

A

Afterload

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15
Q

Name the semilunar valves

A

Pulmonic and aortic

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16
Q

Pressure opens semilunar valves to push blood out through circulation
Right to lungs, left to peripheral

A

Afterload

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17
Q

The right side of the heart pushes blood to the

A

lungs

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18
Q

The left side of the heart pushes blood to the

A

peripheral/systemic

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19
Q

The afterload is affected by the

A

Systemic Vascular Resistance (SVR)

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20
Q

Increasing the preload will increase what two other factors?

A

Stroke volume and cardiac output

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21
Q

How to increase preload amount?

A

IV Fluids
Stimulate SNS

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22
Q

How do you decrease preload?

A

Diuretics
Vasodilation

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23
Q

Diagnosis requiring increased preload

A

hypovolemic shock

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24
Q

Diagnosis requiring decreased preload

A

fluid overload in HF

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25
Q

HowTo increase afterload:

A

increase vasoconstriction

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26
Q

Diagnoses requiring increased afterload

A

Aortic stenosis
Pulmonary HTN

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27
Q

Measurement in percentage of total blood volume that the left ventricle pumps out with each contraction

A

Ejection fraction

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28
Q

The right ventricle plays a supporting yet important role in?

A

Circulation

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29
Q

The right ventricle sends deoxygenated blood to the?

A

Lungs for oxygenation and then back to the left side of the heart

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30
Q

The right ventricle pumps what kind of blood?

A

Deoxygenated

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31
Q

Right-sided HF is AKA

A

Systolic failure

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32
Q

Systolic failure is a _____ problem

A

contraction

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33
Q

The left ventricle is the _________ of the heart

A

Powerhouse

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34
Q

The left side of the heart sends blood where?

A

To the peripherals or systemically

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35
Q

Left-sided HF is AKA

A

Diastolic failure

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36
Q

Left-sided HF is a ______ problem

A

Relaxation

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37
Q

Deterioration of a structure or system previously working with the help of compensatory mechanisms

A

Decompensated

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38
Q

Organ that functions to circulate blood and perfuse tissue

A

Heart

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39
Q

A state of insufficiency or declined performance leading to dysfunction of a body system or organ

A

Failure

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40
Q

Symptoms of Acute Decompensated HF (ADHF)

A

Increased respiratory rate
Fluid shift with interstitial edema
Tachypnea and SOB
Pulmonary edema with hemoptysis

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41
Q

Symptoms of pulmonary edema with hemoptysis

A

Crackles
Tachycardia
Hypotension
Severe dyspnea
Orthopnea
Use of accessory muscles to breathe

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42
Q

Where does liquid accumulate in the lungs with pulmonary edema?

A

tissue
alveoli

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43
Q

What are some concerns for patients with pulmonary edema?

A

Impaired gas exchange
Acute respiratory failure

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44
Q

What are the 5 things we are trying to prevent with ADHF?

A

Acute respiratory distress
Cardiogenic pulmonary edema
Acute respiratory failure
Cardiogenic shock
Death

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45
Q

ADHF Rapid Interventions:

A

ABC’s
Place on monitor
Position

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46
Q

What does oxygen therapy treat in a patient with ADHF?

A

treat hypoxemic respiratory failure

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47
Q

What questions would you ask a pt presenting to the ED with ADHF?

A

-Are you allergic to any meds?
-What is your med hx?
-Are you taking any rx meds?
-Are you taking your meds as prescribed?

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48
Q

What may you see in the physical assessment portion of a pt with ADHF?

A

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

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49
Q

How is HF diagnosed?

A

med hx
assessing s/s
diagnostic tests

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50
Q

What is HFpEF?

A

Heart failure preserved ejection fraction

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51
Q

What is HFrEF?

A

Heart failure reduced ejection fraction

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52
Q

Why is an ECG used on a patient who presents to the ED with heart symptoms?

A

To assess and rule out MI

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53
Q

What heart structure changes might you see on an ECG?

A

left ventricle hypertrophy

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54
Q

What is the cause of left ventricular hypertrophy?

A

The heart pumping too hard

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55
Q

A patient with heart symptoms presents to the ED - his CXR shows fluid in the lungs. What does this suggest?

A

pulmonary edema

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56
Q

A patient with heart symptoms presents to the ED - his CXR shows an enlarged heart suggesting?

A

Pulmonary arterial hypertension

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57
Q

A patient with heart symptoms presents to the ED - her CXR shows air between her lung and chest wall, what does this suggest?

A

pneumothorax

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58
Q

A patient with heart symptoms presents to the ED - the CXR shows infiltrates (blood, pus), what does this indicate?

A

Pneumonia

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59
Q

What labs may be run to determine if a cardiac event has occurred?

A
  • Cardiac biomarkers (troponins, CK-MB, BNP, myoglobin)
  • Renal function (BUN/cr)
  • Electrolytes (K+, mg)
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60
Q

Normal range of BNP

A

<100 pg/mL

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61
Q

the hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume

A

BNP (brain natriuretic peptide)

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62
Q

Why is a loop diuretic given to a patient with HF?

A

fluid excretion and elimination
(furosemide)

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63
Q

Why is nitroprusside given to a patient with HF?

A

To generate rapid onset vasodilation

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64
Q

Why is an ACE inhibitor given to a patient during a cardiac event like HF?

A

To reduce cardiac workload by increasing vasodilation to lower BP
(Lisinopril)

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65
Q

How does an angiotensin receptor blocker affect a patient in HF?

A

It decreases BP and cardiac workload
(Valsartan)

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66
Q

Why is hydralazine given to HF patients?

A

to lower BP by vasodilation

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67
Q

What does digitalis accomplish for a patient in HF?

A

Increases cardiac contractility and LV function

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68
Q

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?

A

Beta blockers

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69
Q

Why is morphine given to a patient in HF?

A

Vasodilation to decrease dyspnea, anxiety, and cardiac workload

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70
Q

When would you not give morphine to a HF patient?

A

When their RR are too low

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71
Q

What do you give a patient if they become hypotensive during HF treatment?

A

Give vasopressin
(Dopamine or dobutamine)

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72
Q

What are the priority nursing interventions for a patient in HF?

A

Monitor vital signs
Admin O2
Positioning
Intake & Output - Na and fluids?
Daily weights
Venous thromboembolism Prevention: SCD, heparin
Admin medications

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73
Q

What is a VTE?

A

Venous thromboembolism

74
Q

Possible nursing diagnoses for HF

A

Impaired gas exchange
Decreased CO
Excess fluid volume
Activity intolerance

75
Q

What are the outcome goals for patients with HF?

A

Improved cardiac function
Decreased symptoms
Increased function and independence
Decrease rehospitalization
Promote lifestyle changes to delay disease progression

76
Q

What education will you as a nurse provide your patient with HF?

A

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

77
Q

How would a patient with HF know their medications are effective?

A

Increased activity tolerance, decreased dyspnea, and decreased edema

78
Q

What is the leading cause of death in the United States?

A

Cardiovascular disease

79
Q

Heart disease is a chronic and often progressive condition and can lead to what?

A

Heart Failure

80
Q

A clinical syndrome resulting from structural and functional cardiac disorders that impair the ability of a ventricle to fill or eject blood is what?

A

Heart Failure

81
Q

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)

A
  1. Pulmonary congestion
  2. Systemic congestion
82
Q

Is heart failure reversible?

A

Yes, some cases are reversible depending on the cause.

83
Q

How is HF managed?

A

Lifestyle modifications & medications

84
Q

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?

A

Patient education

85
Q

Clinical manifestations of Right Sided HF?

A

-Viscera & peripheral congestion
-JVD
-Dependent edema
-Hepatomegaly
-Ascites
-Weight Gain

86
Q

Clinical manifestations of Left Sided HF?

A

-Pulmonary congestion, crackles
-S3 or “ventricular gallop”
-Dyspnea on exertion (DOE)
-Low O2 sat
-Dry, nonproductive cough initially
-Oliguria (retaining fluid in other places)

87
Q

Depending on the severity of HF, what are some treatments?

A

-Oral & IV medications (Diuretics)
-Lifestyle modifications (exercise, cardiac rehab)
-Supplemental O2
-Surgical interventions (ICD & heart transplant)

88
Q

What is the #1 medication used for treatment of HF?

A

Diuretics- decreases fluid volume, monitor serum electrolytes

89
Q

What types of medications are used to treat HF?

A

-Diuretics
-ACE inhibitors
-ARB’s
-Beta-blockers
-Digitalis/Digoxin- Cardiac glycoside
-Ivabradine- HCN channel blockers
-Hydralazine or Isosorbide Dinitrate- Vasodilators

90
Q

How do diuretics work in the treatment of HF?

A

decreases fluid volume

91
Q

How do ACE inhibitors work in treatment of HF?

A

vasodilation, diuresis, DECREASES AFTERLOAD = decreased BP

92
Q

Name common ACE inhibitors.

A

‘ace’
Lisinopril
Capropril

93
Q

What are side effects to assess when taking an ACE inhibitor?

A

Cough, hypotension, hyperkalemia, AMS

94
Q

What drugs used in the treatment of HF work similar to ACE inhibitors?

A

ARB’s- Angiotensin II receptor blockers

95
Q

How do Beta-blockers work in the treatment of HF?

A

Negative chronotrope- decreases workload of the heart

96
Q

What are medications that are used in the treatment of HF focused on achieving?

A

Decreasing the workload of the heart

97
Q

How does Ivabradine work in the treatment of HF?

A

decreases rate of conduction through the SA node

98
Q

What change would you assess for in patients taking Ivabradine for HF?

A

decrease in HR & BP

99
Q

What change would you assess for in patients taking ACE inhibitors, ARB’s, or vasodilators in the treatment of HF?

A

decreased BP

100
Q

How does digoxin work in the treatment of HF?

A

slows down the HR- improves contractility

101
Q

What side effect can be life threatening when taking digoxin?

A

Digoxin toxicity

102
Q

What should a nurse assess for in older men taking a diuretic for HF?

A

Bladder distention caused by urethral obstruction from an enlarged prostate gland

103
Q

Which classification of medications play a pivotal role in the management of HF caused by systolic dysfunction?

A

ACE inhibitors

104
Q

What medications are used for hospitalized patients admitted for acute decompensated HF?

A

Dopamine
Dobutamine
Milrinone
Vasodilators (Nitroglycerin, nitroprusside, nesiritide)

105
Q

What should be included in the physical examination of a patient with HF?

A

Mental status
Lung sounds- crackles and wheezes
Heart sounds- S3
Fluid status or signs of fluid overload
Daily weight & I&O
Response to medications

106
Q

Name some potential complications of HF.

A

Pulmonary edema
Hypotension
Poor perfusion
Cardiogenic shock
Arrhythmias
Thromboembolism
Pericardial effusion

107
Q

What are the goals in patients with HF?

A

-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

108
Q

How is promotion of activity & reduced fatigue achieved in pts with HF?

A

Exercise & medications

109
Q

Name ways of promoting activity tolerance in pts with HF

A

-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

110
Q

Nursing interventions for management of fluid volume in HF

A

-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

111
Q

Pts with HF should consume how much Na per day?

A

<2000 mg/day or <2 g/day

112
Q

Pulmonary edema can result in what?

A

Hypoxemia, decreased gas exchange

113
Q

Clinical manifestations of pulmonary edema….

A

Restlessness
Anxiety
Tachypnea
Dyspnea
Cool & Clammy skin
Cyanosis
Weak & Rapid pulse
Cough
Lung congestion (noisy respirations)
Decreased level of consciousness
Increased sputum production

114
Q

Definition: What is the end result of a failing heart?

A

Cardiogenic Shock

115
Q

Patients with cardiovascular disorders are at risk for the development of what conditions?

A

Thromboembolism
(arterial thromboembolism, venous thromboembolism, intracardiac thrombi, pulmonary embolism)

116
Q

How is sudden cardiac death or cardiac arrest treated? (4 steps- ABCD)

A

A: Airway
B: Breathing
C: Circulation
D: Defibrillation for VT or VF

117
Q

What is the most reliable sign of cardiac arrest in an adult & child?

A

Absence of carotid pulse

118
Q

What is the hallmark sign of PAD?

A

Intermittent Claudication (pain with ambulation)

119
Q

What medications are used to treat symptomatic claudication?

A

Antiplatelets
Statins
Pentoxifylline & Cilostazol

120
Q

What diagnostics are commonly used in PAD? (noninvasive)

A

-Ankle-Brachial index
-Doppler Ultrasound
-Computed Tomography (CT) Scanning
-Angiography

121
Q

When is a bypass graft used in the management of PAD?

A

When the artery as 50% or more occlusion

122
Q

Describe Critical Limb Ischemia

A

-Severe obstruction
-PAIN AT REST
-Non healing wounds
-Gangrene

123
Q

What medications are used to prevent or reduce blood clots?

A

-Unfractionated Heparin
-Low molecular weight heparins
-Oral anticoagulants
-Thrombolytic agents

124
Q

What is the antidote of heparin?

A

Protamine sulfate

125
Q

What laboratory test is used to monitor heparin?

A

aPTT

126
Q

What is the normal range of aPTT?

A

Lower limit of normal is 21-35 seconds

127
Q

What is the antidote of warfarin?

A

Vitamin K

128
Q

What is the laboratory test to monitor warfarin levels?

A

INR

129
Q

What is the therapeutic range of INR?

A

2-3.5

130
Q

Name a medication used in thrombolytic therapy.

A

Alteplase

131
Q

Microvascular vasoconstriction
Coolness, pain, pallor
Avoid stimuli to decrease
Calcium channel blockers are used for treatment

What condition am I?

A

Raynaud’s Phenomenon

132
Q

What are the 6 P’s of acute arterial occlusion?

A
  1. Pain
  2. Pallor
  3. Poikilothermia
  4. Pulselessness
  5. Paresthesia
  6. Paralysis
133
Q

Why do the 6 P’s of acute arterial occlusion occur?

A

decreased perfusion

134
Q

Name 2 treatments of Chronic venous insufficiency.

A
  1. Leg elevation
  2. Compression stockings
135
Q

Condition characterized by abnormally dilated veins.

A

Varicose Veins

136
Q

Condition characterized by swollen and inflamed skin.

A

Cellulitis

137
Q

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?

A

Are you allergic to any medications?

138
Q

How is DVT diagnosed?

A

Medical history
Physical exam
Test results- radiology, ultrasound, D-Dimer

139
Q

What laboratory test is ordered to aid in diagnosis of DVT?

A

D-Dimer

140
Q

What is the normal level of D-Dimer?

A

Below 250 ng/mL

141
Q

What does a D-Dimer tell you?

A

Measures a substance in the blood released when a blood clot dissolves

142
Q

What diagnostic imagery will the physician order to confirm the presence of a DVT?

A

Venous Ultrasound

143
Q

What are the 3 main goals of treatment with a DVT?

A
  1. Stop the clot from growing larger.
  2. Prevent clot from breaking off & moving to the lungs.
  3. Decrease the risk of having another clot.
144
Q

What medications are used for DVT?

A

Heparin
Warfarin

145
Q

During bridge therapy, do you stop heparin when you start warfarin?

A

No, heparin and warfarin are both taken until warfarin therapeutic levels are achieved.

146
Q

What is the therapeutic range of aPTT?

A

30-100 seconds

147
Q

What is the normal range of INR?

A

1 or less

148
Q

If a patient suddenly becomes SOB and states “I feel like I’m going to die”. What will you do?

A

Sit up in fowler’s position, administer oxygen

149
Q

Nursing diagnoses for Pulmonary Embolism

A

-Risk for impaired gas exchange
-Altered peripheral tissue perfusion
-Knowledge deficit
-Risk for bleeding
-Acute pain

150
Q

Risk factors for DVT/PE

A

-Sedentary lifestyle
-Recent sedentary behavior (travel, prolonged bed rest, surgery)
-HF
-Birth control or hormone supplementation
-Smoking
-Obesity
-Pregnancy
-Cancer
-Genetic Clotting disorder

151
Q

What are the functions of the vascular system?

A

-Circulatory needs of tissues (perfusion, nutrients, wastes)
-Blood flow
-BP
-Capillary filtration & reabsorption
-Hemodynamic resistance (vasoconstriction/vasodilation)
-Peripheral vascular regulating mechanisms (CNS, SNS)

152
Q

What are the 2 interdependent systems of the cardiovascular system?

A

Right side of heart & Left side of heart

153
Q

What all is included in the vascular system?

A

-Right & left side of heart
-Arteries & arterioles
-Capillaries
-Veins & venules
-Lymphatic vessels

154
Q

Stiffening of blood vessels can result in what?

A

-Increased peripheral resistance
-Impaired blood flow
-Increased left ventricular workload

155
Q

What indications of a vascular problem could you find during a physical assessment?

A

Skin- cool, pale, pallor, rubor, loss of hair, brittle nails, dry & scaling skin, atrophy, ulcerations
Decreased or absent pulses

156
Q

What kind of diagnostics can be used to assess the vasculature?

A

-Doppler ultrasound flow studies (ABI)
-Exercise stress testing
-Duplex ultrasonography
-Computed tomography scanning
-Angiography & magnetic resonance angiography
-Contrast phlebography (venography)
-Lymphoscintigraphy

157
Q

What is a continuous wave doppler ultrasound used for?

A

Detects blood flow, shows PVD

158
Q

What assessments are important in a patient with PV problems?

A

-Health history
-Medications
-Risk factors
-S/S of arterial insufficiency
-Claudication & rest pain
-Color changes
-Weak or absent pulses
-Skin changes & skin b/d

159
Q

What kinds of goals would be appropriate for PV problems?

A

-^ arterial blood supply
-Decrease in venous congestion
-Relief of pain
-Attainment/maintenance of tissue integrity
-Adherence to self-care program

160
Q

What are some ways to improve PAC? (peripheral arterial circulation)

A

-Position body part below the level of the heart
-Exercise program & activities
-Discontinue nicotine
-Stress reduction

161
Q

Definition: Hardening of the arteries. Diffuse process whereby the muscle fibers & the endothelial lining of the walls of the small arteries & arterioles become thickened.

A

Arteriosclerosis

162
Q

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.

A

Atherosclerosis

163
Q

What are 3 problems that atherosclerosis can lead to?

A
  1. Myocardial infarction
  2. Stroke
  3. Gangrene
164
Q

What are modifiable risk factors for Atherosclerosis & PAD? (9)

A

-Nicotine use
-Diabetes
-HTN
-Hyperlipidemia
-Diet
-Stress
-Sedentary lifestyle
-C-reactive protein
-Hyperhomocysteinemia

165
Q

What are some non modifiable risk factors for Atherosclerosis & PAD? (2)

A

-Increasing age
-Familial predisposition/genetics

166
Q

What is the hallmark sign of PAD?

A

Intermittent claudication

167
Q

How is intermittent claudication relieved?

A

Rest

168
Q

Pharmacologic therapies used for PAD?

A

-Phosphodiesterase III inhibitor: Cilostazol
-Antiplatelet agents: Aspirin & Clopidogrel
-Statins

169
Q

Keeping the lower extremities in a neutral or dependent position is recommended for which condition? (PAD or Venous Insufficiency)

A

PAD

170
Q

Keeping the lower extremities elevated is indicated in what condition? (PAD or Venous Insufficiency)

A

Venous Insufficiency

171
Q

Definition: Localized sac or dilation formed at a weak point in the wall of the artery.

A

Aneurysm

172
Q

What are triggers of Raynaud’s phenomenon? (Raynaud’s disease or Raynaud’s syndrome)

A

Cold
Stress

173
Q

Name 4 venous disorders.

A
  1. Venous thromboembolism (VTE) : DVT & PE
  2. Chronic venous insufficiency/postthrombotic syndrome
  3. Leg ulcers
  4. Varicose veins
174
Q

What are some preventive measures in the development of VTE?

A

-Early ambulation & leg exercises
-SCD’s
-TED stockings
-Subcutaneous heparin or LMWH
-Lifestyle changes: weight loss, smoking cessation, regular exercise

175
Q

What nutrients are recommended for enhanced healing?

A

Protein, zinc, iron, vitamins A & C

176
Q

What are 2 complications associated with leg ulcers?

A
  1. Infection
  2. Gangrene
177
Q

TRUE or FALSE: Heat be used in the treatment of leg ulcers.

A

False

178
Q

How can you promote lymphatic drainage & prevent edema in a patient with lymphedema?

A

Constant elevation of the affected extremity

179
Q

What are S/S of cellulitis?

A

-Localized swelling or redness
-Fever
-Chills
-Sweating

180
Q

TRUE or FALSE: Heat can be applied in the treatment of cellulitis.

A

True

Nursing 105 (11 decks)

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