Cardiovascular- Exam 1 Flashcards
1
Q
A physiological state where cardiac output is insufficient to meet the needs of the body
A
heart failure
2
Q
Heart failure can be a problem with ___ or ___ of the heart
A
structure
function
3
Q
Causes of heart failure
A
CAD
Uncontrolled HTN
MI
Renal Dysfunction
Cardiomyopathy
DM
Heart valve disorders
4
Q
Causes of atherosclerosis
A
Tobacco
Elevated lipids
Diet
Sedentary
5
Q
Causes of renal dysfunction
A
volume overload
6
Q
Volume of blood pumped throughout the body per minute
A
Cardiac output
7
Q
Cardiac output equation
A
HR x SV = CO (L/min)
8
Q
Volume of fluid in ventricles at end of diastole
A
preload
9
Q
The amount ventricles stretch at end of diastole
A
Preload
10
Q
Relaxation and filling phase
A
Preload
11
Q
AV valves are ____ in the preload
A
Open
12
Q
Name the AV valves
A
Mitral
Tricuspid
13
Q
The resistance that the left ventricle must overcome to eject and circulate blood
A
afterload
14
Q
______ is the squeeze
A
Afterload
15
Q
Name the semilunar valves
A
Pulmonic and aortic
16
Q
Pressure opens semilunar valves to push blood out through circulation
Right to lungs, left to peripheral
A
Afterload
17
Q
The right side of the heart pushes blood to the
A
lungs
18
Q
The left side of the heart pushes blood to the
A
peripheral/systemic
19
Q
The afterload is affected by the
A
Systemic Vascular Resistance (SVR)
20
Q
Increasing the preload will increase what two other factors?
A
Stroke volume and cardiac output
21
Q
How to increase preload amount?
A
IV Fluids
Stimulate SNS
22
Q
How do you decrease preload?
A
Diuretics
Vasodilation
23
Q
Diagnosis requiring increased preload
A
hypovolemic shock
24
Q
Diagnosis requiring decreased preload
A
fluid overload in HF
25
HowTo increase afterload:
increase vasoconstriction
26
Diagnoses requiring increased afterload
Aortic stenosis
Pulmonary HTN
27
Measurement in percentage of total blood volume that the left ventricle pumps out with each contraction
Ejection fraction
28
The right ventricle plays a supporting yet important role in?
Circulation
29
The right ventricle sends deoxygenated blood to the?
Lungs for oxygenation and then back to the left side of the heart
30
The right ventricle pumps what kind of blood?
Deoxygenated
31
Right-sided HF is AKA
Systolic failure
32
Systolic failure is a _____ problem
contraction
33
The left ventricle is the _________ of the heart
Powerhouse
34
The left side of the heart sends blood where?
To the peripherals or systemically
35
Left-sided HF is AKA
Diastolic failure
36
Left-sided HF is a ______ problem
Relaxation
37
Deterioration of a structure or system previously working with the help of compensatory mechanisms
Decompensated
38
Organ that functions to circulate blood and perfuse tissue
Heart
39
A state of insufficiency or declined performance leading to dysfunction of a body system or organ
Failure
40
Symptoms of Acute Decompensated HF (ADHF)
Increased respiratory rate
Fluid shift with interstitial edema
Tachypnea and SOB
Pulmonary edema with hemoptysis
41
Symptoms of pulmonary edema with hemoptysis
Crackles
Tachycardia
Hypotension
Severe dyspnea
Orthopnea
Use of accessory muscles to breathe
42
Where does liquid accumulate in the lungs with pulmonary edema?
tissue
alveoli
43
What are some concerns for patients with pulmonary edema?
Impaired gas exchange
Acute respiratory failure
44
What are the 5 things we are trying to prevent with ADHF?
Acute respiratory distress
Cardiogenic pulmonary edema
Acute respiratory failure
Cardiogenic shock
Death
45
ADHF Rapid Interventions:
ABC's
Place on monitor
Position
46
What does oxygen therapy treat in a patient with ADHF?
treat hypoxemic respiratory failure
47
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?
48
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
49
How is HF diagnosed?
med hx
assessing s/s
diagnostic tests
50
What is HFpEF?
Heart failure preserved ejection fraction
51
What is HFrEF?
Heart failure reduced ejection fraction
52
Why is an ECG used on a patient who presents to the ED with heart symptoms?
To assess and rule out MI
53
What heart structure changes might you see on an ECG?
left ventricle hypertrophy
54
What is the cause of left ventricular hypertrophy?
The heart pumping too hard
55
A patient with heart symptoms presents to the ED - his CXR shows fluid in the lungs. What does this suggest?
pulmonary edema
56
A patient with heart symptoms presents to the ED - his CXR shows an enlarged heart suggesting?
Pulmonary arterial hypertension
57
A patient with heart symptoms presents to the ED - her CXR shows air between her lung and chest wall, what does this suggest?
pneumothorax
58
A patient with heart symptoms presents to the ED - the CXR shows infiltrates (blood, pus), what does this indicate?
Pneumonia
59
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)
60
Normal range of BNP
<100 pg/mL
61
the hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume
BNP (brain natriuretic peptide)
62
Why is a loop diuretic given to a patient with HF?
fluid excretion and elimination
(furosemide)
63
Why is nitroprusside given to a patient with HF?
To generate rapid onset vasodilation
64
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)
65
How does an angiotensin receptor blocker affect a patient in HF?
It decreases BP and cardiac workload
(Valsartan)
66
Why is hydralazine given to HF patients?
to lower BP by vasodilation
67
What does digitalis accomplish for a patient in HF?
Increases cardiac contractility and LV function
68
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
69
Why is morphine given to a patient in HF?
Vasodilation to decrease dyspnea, anxiety, and cardiac workload
70
When would you not give morphine to a HF patient?
When their RR are too low
71
What do you give a patient if they become hypotensive during HF treatment?
Give vasopressin
(Dopamine or dobutamine)
72
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
73
What is a VTE?
Venous thromboembolism
74
Possible nursing diagnoses for HF
Impaired gas exchange
Decreased CO
Excess fluid volume
Activity intolerance
75
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
76
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
77
How would a patient with HF know their medications are effective?
Increased activity tolerance, decreased dyspnea, and decreased edema
78
What is the leading cause of death in the United States?
Cardiovascular disease
79
Heart disease is a chronic and often progressive condition and can lead to what?
Heart Failure
80
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
81
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)
1. Pulmonary congestion
2. Systemic congestion
82
Is heart failure reversible?
Yes, some cases are reversible depending on the cause.
83
How is HF managed?
Lifestyle modifications & medications
84
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
85
Clinical manifestations of Right Sided HF?
-Viscera & peripheral congestion
-JVD
-Dependent edema
-Hepatomegaly
-Ascites
-Weight Gain
86
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)
87
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)
88
What is the #1 medication used for treatment of HF?
Diuretics- decreases fluid volume, monitor serum electrolytes
89
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
90
How do diuretics work in the treatment of HF?
decreases fluid volume
91
How do ACE inhibitors work in treatment of HF?
vasodilation, diuresis, DECREASES AFTERLOAD = decreased BP
92
Name common ACE inhibitors.
'ace'
Lisinopril
Capropril
93
What are side effects to assess when taking an ACE inhibitor?
Cough, hypotension, hyperkalemia, AMS
94
What drugs used in the treatment of HF work similar to ACE inhibitors?
ARB's- Angiotensin II receptor blockers
95
How do Beta-blockers work in the treatment of HF?
Negative chronotrope- decreases workload of the heart
96
What are medications that are used in the treatment of HF focused on achieving?
Decreasing the workload of the heart
97
How does Ivabradine work in the treatment of HF?
decreases rate of conduction through the SA node
98
What change would you assess for in patients taking Ivabradine for HF?
decrease in HR & BP
99
What change would you assess for in patients taking ACE inhibitors, ARB's, or vasodilators in the treatment of HF?
decreased BP
100
How does digoxin work in the treatment of HF?
slows down the HR- improves contractility
101
What side effect can be life threatening when taking digoxin?
Digoxin toxicity
102
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
103
Which classification of medications play a pivotal role in the management of HF caused by systolic dysfunction?
ACE inhibitors
104
What medications are used for hospitalized patients admitted for acute decompensated HF?
Dopamine
Dobutamine
Milrinone
Vasodilators (Nitroglycerin, nitroprusside, nesiritide)
105
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
106
Name some potential complications of HF.
Pulmonary edema
Hypotension
Poor perfusion
Cardiogenic shock
Arrhythmias
Thromboembolism
Pericardial effusion
107
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
108
How is promotion of activity & reduced fatigue achieved in pts with HF?
Exercise & medications
109
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
110
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
111
Pts with HF should consume how much Na per day?
<2000 mg/day or <2 g/day
112
Pulmonary edema can result in what?
Hypoxemia, decreased gas exchange
113
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
114
Definition: What is the end result of a failing heart?
Cardiogenic Shock
115
Patients with cardiovascular disorders are at risk for the development of what conditions?
Thromboembolism
(arterial thromboembolism, venous thromboembolism, intracardiac thrombi, pulmonary embolism)
116
How is sudden cardiac death or cardiac arrest treated? (4 steps- ABCD)
A: Airway
B: Breathing
C: Circulation
D: Defibrillation for VT or VF
117
What is the most reliable sign of cardiac arrest in an adult & child?
Absence of carotid pulse
118
What is the hallmark sign of PAD?
Intermittent Claudication (pain with ambulation)
119
What medications are used to treat symptomatic claudication?
Antiplatelets
Statins
Pentoxifylline & Cilostazol
120
What diagnostics are commonly used in PAD? (noninvasive)
-Ankle-Brachial index
-Doppler Ultrasound
-Computed Tomography (CT) Scanning
-Angiography
121
When is a bypass graft used in the management of PAD?
When the artery as 50% or more occlusion
122
Describe Critical Limb Ischemia
-Severe obstruction
-PAIN AT REST
-Non healing wounds
-Gangrene
123
What medications are used to prevent or reduce blood clots?
-Unfractionated Heparin
-Low molecular weight heparins
-Oral anticoagulants
-Thrombolytic agents
124
What is the antidote of heparin?
Protamine sulfate
125
What laboratory test is used to monitor heparin?
aPTT
126
What is the normal range of aPTT?
Lower limit of normal is 21-35 seconds
127
What is the antidote of warfarin?
Vitamin K
128
What is the laboratory test to monitor warfarin levels?
INR
129
What is the therapeutic range of INR?
2-3.5
130
Name a medication used in thrombolytic therapy.
Alteplase
131
Microvascular vasoconstriction
Coolness, pain, pallor
Avoid stimuli to decrease
Calcium channel blockers are used for treatment
What condition am I?
Raynaud's Phenomenon
132
What are the 6 P's of acute arterial occlusion?
1. Pain
2. Pallor
3. Poikilothermia
4. Pulselessness
5. Paresthesia
6. Paralysis
133
Why do the 6 P's of acute arterial occlusion occur?
decreased perfusion
134
Name 2 treatments of Chronic venous insufficiency.
1. Leg elevation
2. Compression stockings
135
Condition characterized by abnormally dilated veins.
Varicose Veins
136
Condition characterized by swollen and inflamed skin.
Cellulitis
137
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?
138
How is DVT diagnosed?
Medical history
Physical exam
Test results- radiology, ultrasound, D-Dimer
139
What laboratory test is ordered to aid in diagnosis of DVT?
D-Dimer
140
What is the normal level of D-Dimer?
Below 250 ng/mL
141
What does a D-Dimer tell you?
Measures a substance in the blood released when a blood clot dissolves
142
What diagnostic imagery will the physician order to confirm the presence of a DVT?
Venous Ultrasound
143
What are the 3 main goals of treatment with a DVT?
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
What medications are used for DVT?
Heparin
Warfarin
145
During bridge therapy, do you stop heparin when you start warfarin?
No, heparin and warfarin are both taken until warfarin therapeutic levels are achieved.
146
What is the therapeutic range of aPTT?
30-100 seconds
147
What is the normal range of INR?
1 or less
148
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
149
Nursing diagnoses for Pulmonary Embolism
-Risk for impaired gas exchange
-Altered peripheral tissue perfusion
-Knowledge deficit
-Risk for bleeding
-Acute pain
150
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
151
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)
152
What are the 2 interdependent systems of the cardiovascular system?
Right side of heart & Left side of heart
153
What all is included in the vascular system?
-Right & left side of heart
-Arteries & arterioles
-Capillaries
-Veins & venules
-Lymphatic vessels
154
Stiffening of blood vessels can result in what?
-Increased peripheral resistance
-Impaired blood flow
-Increased left ventricular workload
155
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
156
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
157
What is a continuous wave doppler ultrasound used for?
Detects blood flow, shows PVD
158
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
159
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
160
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
161
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
162
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
163
What are 3 problems that atherosclerosis can lead to?
1. Myocardial infarction
2. Stroke
3. Gangrene
164
What are modifiable risk factors for Atherosclerosis & PAD? (9)
-Nicotine use
-Diabetes
-HTN
-Hyperlipidemia
-Diet
-Stress
-Sedentary lifestyle
-C-reactive protein
-Hyperhomocysteinemia
165
What are some non modifiable risk factors for Atherosclerosis & PAD? (2)
-Increasing age
-Familial predisposition/genetics
166
What is the hallmark sign of PAD?
Intermittent claudication
167
How is intermittent claudication relieved?
Rest
168
Pharmacologic therapies used for PAD?
-Phosphodiesterase III inhibitor: Cilostazol
-Antiplatelet agents: Aspirin & Clopidogrel
-Statins
169
Keeping the lower extremities in a neutral or dependent position is recommended for which condition? (PAD or Venous Insufficiency)
PAD
170
Keeping the lower extremities elevated is indicated in what condition? (PAD or Venous Insufficiency)
Venous Insufficiency
171
Definition: Localized sac or dilation formed at a weak point in the wall of the artery.
Aneurysm
172
What are triggers of Raynaud's phenomenon? (Raynaud's disease or Raynaud's syndrome)
Cold
Stress
173
Name 4 venous disorders.
1. Venous thromboembolism (VTE) : DVT & PE
2. Chronic venous insufficiency/postthrombotic syndrome
3. Leg ulcers
4. Varicose veins
174
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
175
What nutrients are recommended for enhanced healing?
Protein, zinc, iron, vitamins A & C
176
What are 2 complications associated with leg ulcers?
1. Infection
2. Gangrene
177
TRUE or FALSE: Heat be used in the treatment of leg ulcers.
False
178
How can you promote lymphatic drainage & prevent edema in a patient with lymphedema?
Constant elevation of the affected extremity
179
What are S/S of cellulitis?
-Localized swelling or redness
-Fever
-Chills
-Sweating
180
TRUE or FALSE: Heat can be applied in the treatment of cellulitis.
True
