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MED/SURG: CARDIOVASCULAR > CARDIOVASCULAR/NCLEX RN Mastery > Flashcards

CARDIOVASCULAR/NCLEX RN Mastery Flashcards

1
Q

Cardiovascular

  1. Describe Acute kidney injury
  2. How is it dx?
A
  1. abrupt loss of kidney fxn due to decrease renal blood flow
  2. dx via
  • Increase BUN
  • Increase Creatinine
  • anuria
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2
Q

Cardiovascular

Monitoring progressive Cr levels tells you what?

A

If kidney fxn is improving by the process of effective tissue perfusion. The monitoring promotes/data collection, this can support that kidneys are improving perfusion

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3
Q

Cardiovascular

Left-sided heart failure

Left ventricle diminshed ability to pump blood leading to __1?__ in the pulmonary circulation causing pulmonary __2?__

A
  1. back pressure
  2. pulmonary edema
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4
Q

Cardiovascular

Left-sided heart failure s/s (5)

A
  1. dry cough
  2. crackles
  3. cyanosis
  4. dyspnea
  5. tachycardia
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5
Q

Cardiovascular

Right-sided heart symptoms are caused by diminished ability of right ventricle to pump blood.

  1. This causes blood to pool in 4 places
A
  1. extremities
  2. abd
  3. neck
  4. liver
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6
Q

Cardiovascular

Right-sided heart failure s/s (4)

A
  1. Peripheral edema
  2. ascites
  3. Jugular vein distention
  4. hepatomegly
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7
Q

Cardiovascular

Can decreased Cardiac Output cause angina and dyspnea with activity?

A

Yes

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8
Q

Cardiovascular

Normal cardiac output range in liters per min

A

4-8 L/min

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9
Q

Cardiovascular

4 physical conditions that can cause Malignant HTN or Hypertensive crisis

Hint

  1. neo___
  2. glomerulon___
  3. Hyper___
  4. Pheo___
A
  1. Neoplasm
  2. glomerulonephritis
  3. hyper thyroidism
  4. pheochromocytoma
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10
Q

Cardiovascular

HTN Treatment Mnemonic

A

B

C

D

A

ACE inhibitors/ARGs

Beta blockers

Calcium channel blockers

Diuretics

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11
Q

Cardiovascular

Mobitz Type 1 Block

  1. What is a second-degree AV block?
  2. Mobitz type 1: what degree heart block? Mild or Moderate
  3. Rhythm stable or unstable
  4. Mobitz type 1 aka Wenckebach phenomenon what is this?
  5. Mobitz type 1 caused by?
  6. PR intervals
  7. followed by blocked ? wave and dropped ?
  8. Is treatment needed?
  9. Prognosis?
  10. Mobitz type 1 does not often result in clinical manifestations why?
A
  1. Problem with electrical conduction system between atria and ventricles
  2. Second-degree heart block, mildest form
  3. Rhythm stable
  4. QRS complexes are grouped into 2s, 3s, 4s ect
  5. Block of AV node
  6. PR intervals are prolonged
  7. blocked P wave and dropped QRS complex then the cycle starts again
  8. usually benign no tx
  9. better than type 2
  10. because ventricular rate is adequate
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12
Q

Cardiovascular

  1. S/S of acute MI? (3)
  2. Is this a medical emergency?
  3. initial assessment?
  4. Priority nursing intervention?

If using ABC…ciruculation is impaired thus oxygenation to the heart is impaired PRIORITY OXYGEN adm followed by call MET medical emergency team

Norepinephrine is a catecholamine affect of on oxygen? (2)

A
  1. s/s
  • chest and shoulder pain radiates down left arm
  • sweating
  • SOB
  1. yes
  2. already indicated by pt currently manifesting s/s of MI
  3. Oxygen via nasal cannula, admin nitro
  4. Norepinephrine increases use of oxygen thus decreasing the supply
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13
Q

Cardiovascular

Claudation to extremities

  1. Cold or warm compress? (we want to promote circulation)
  2. claudation caused by narrowed or occluded ?
A
  1. Warm
  2. ARTERIES
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14
Q

Cardiovascular

Axillofemoral bypass graft?

no belts

ok to exercise and stand

A

Axillofemoral bypass is an extra-anatomical grafting procedure performed for patients with severe aortoiliac occlusive disease to improve arterial blood flow to the lower extremities. Revascularization procedure. The axillary artery is connected to the femoral artery via an artificial graft. femoral artery anastomosis

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15
Q

Cardiovascular

  1. What is secondary HTN?
  2. What is primary HTN?
A

Secondary hypertension (secondary high blood pressure) is high blood pressure that’s caused by another medical condition. CAUSE IS IDENTIFIABLE

  • Renal disease
  • Cushing
  • Hyperthyroidism
  • Hormonal contraceptives
  • diabetes
  • hyperaldosteronisn
  • pheochromocytoma

Secondary hypertension differs from the usual type of high blood pressure (essential hypertension), which is often referred to simply as high blood pressure. Essential hypertension, also known as primary hypertension, has no clear cause and is thought to be linked to genetics, poor diet, lack of exercise and obesity and Vit D deficiency

Secondary hypertension can be caused by conditions that affect your kidneys, arteries, heart or endocrine system. Secondary hypertension can also occur during pregnancy.

Proper treatment of secondary hypertension can often control both the underlying condition and the high blood pressure, which reduces the risk of serious complications — including heart disease, kidney failure and stroke.

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16
Q

Cardiovascular

  1. ACUTE DECOMPENSATED HEART FAILURE is the potentially fatal cause of __?___
  2. Lung sounds?
  3. Position
  4. Oxygen therapy will improve gas exchange by increasing?
  5. ADHF usuall have fluid overload, adm what?
  6. How is excess fluid assessed? (2)
  7. CARDIAC MONITORING IS A MUST! What does dysrhythmias affect cardiac output?
A
  1. Acute Respiratory Distress
  2. Crackes may indicate pulmonary congestion
  3. Sit upright
  4. Increase amt of oxygen delivered
  5. IV diuretics relieves s/s and improves gas exchange
  6. hepatomegaly, JVD
  7. dysrhythmias decrease cardiac output
17
Q

Cardiovascular

Acute Decompensated Heart Failure: Nursing Interventions

  1. Dobutamine: Why?
  2. Dobutamine what kind of drug?
  3. Dobutamine what kind of monitoring?
  4. Do not admin if taking (3) Hint: Beta?, Anti?, Breastfeeding
  5. Leg elevation?
  6. Fluid restriction
A
  1. Dobutamine is used to help your heart pump better by strengthening the heart muscle. Dobutamine also improves blood flow and relieves symptoms of heart failure.
  2. Dobutamine is indicated for patients who require a positive inotropic support in the treatment of cardiac decompensation due to depressed contractility.

In cardiogenic shock characterised by heart failure with severe hypotension and in case of septic shock Dobutamine may be useful if added to dopamine in case of disturbed ventricular function, raised filling pressure of the ventricles and raised systemic resistance.

Dobutamine may also be used for detection of myocardial ischaemia and of viable myocardium within the scope of an echocardiographic examination (dobutamine stress echocardiography), if patients cannot undergo a period of exercise or if the exercise yields no information of value.

  1. During the course of dobutamine administration, heart rate, heart rhythm, blood pressure, diuresis and infusion rate should be closely monitored. Cardiac output, central venous pressure (CVP) and pulmonary capillary pressure (PCP) should be monitored if possible.
  2. antidepressants, beta blockers , or pregnant
  3. No leg elevation because of venous return to HF
  4. Fluid restriction only in advance case limit to 1000ml/daily
18
Q

Cardiovascular

Pt with coronary artery disease (CAD).

  1. The heart monitor will show?
  2. What should the nurse do?
  3. Frequent PVCs may cause development of? (2)
A
  1. Isolated PVC not life threating but monitor for rhythm change
  2. 2;;;
  3. Artrial fibrillation, and ventricular tachy or VFib
19
Q

Cardiovascular

Implanted pacemaker

  1. Failure to capture?
  2. Common cause?
A
  1. pacer fires a signal but heart does not respond
  2. Pacer lead migration on the epicardium
20
Q

Cardiovascular

Implanted Pacemaker

  1. Failure to pace?
  2. Which leads to?
A
  1. pacer fails to fire signal when it should. The heart cannot beat at the same rate as the pacer
  2. bradycardia and hypotension
21
Q

Cardiovascular

Implanted Pacemaker

  1. Failure to Sense?
A
  1. pacer cannot sense the heartbeat leading to poorly timed firing by the pacer
22
Q

Cardiovascular

Acute Chest Pain

  1. Angina pectoris/stable angina cause?
  2. Stable angina s/s (length, relieve, location)
  3. Stable angina possible triggers
  4. Tx
A
  1. Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn’t get as much blood as it needs. This usually happens because one or more of the heart’s arteries is narrowed or blocked, also called ischemia.
  2. Symptoms of Stable Angina - The pain or discomfort:

Occurs when the heart must work harder, usually during physical exertion
Doesn’t come as a surprise, and episodes of pain tend to be alike
Usually lasts a short time (5 minutes or less)
Is relieved by rest or medicine
May feel like gas or indigestion
May feel like chest pain that spreads to the arms, back, or other areas

  1. Possible triggers of stable angina include:

Emotional stress – learn stress management
Exposure to very hot or cold temperatures – learn how cold and hot weather affect the heart.
Heavy meals
Smoking – learn more about quitting smoking.

  1. Normally this type of chest discomfort is relieved with rest, nitroglycerin or both. Nitroglycerin relaxes the coronary arteries and other blood vessels, reducing the amount of blood that returns to the heart and easing the heart’s workload. By relaxing the coronary arteries, it increases the heart’s blood supply.
23
Q

Cardiovascular

Unstable angina aka acute coronary syndrome

  1. Common cause?
  2. s/s
  3. Treatment
  • Cardiac Cathterization purpose?
  • Percutaneous coronary intervention (PCI) purpose?
  • Coronary artery bypass graft surgery
A

Unstable angina or sometimes referred to as acute coronary syndrome causes unexpected chest pain, and usually occurs while resting. The most common cause is reduced blood flow to the heart muscle because the coronary arteries are narrowed by fatty buildups (atherosclerosis) which can rupture causing injury to the coronary blood vessel resulting in blood clotting which blocks the flow of blood to the heart muscle.

Unstable angina should be treated as an emergency. If you have new, worsening or persistent chest discomfort, you need to go to the ER. You could be having a heart attack which puts you at increased risk for severe cardiacarrhythmias or cardiac arrest, which could lead to sudden death. Learn about an unstable form of angina calledPrinzm

  1. Causes of Unstable Angina: Blood clots that block an artery partially or totally are what causes unstable angina. Blood clots may form, partially dissolve, and later form again and angina can occur each time a clot blocks blood flow in an artery. Learn more about excessive blood clotting.
  2. Symptoms of Unstable Angina - The pain or discomfort:

Often occurs while you may be resting, sleeping, or with little physical exertion
Comes as a surprise
May last longer than stable angina
Rest or medicine usually do not help relieve it
May get worse over time
Can lead to a heart attack

Treatment for Unstable Angina
First, your healthcare provider will need to find the blocked part or parts of the coronary arteries by performing

  • a cardiac catheterization. In this procedure, a catheter is guided through an artery in the arm or leg and into the coronary arteries, then injected with a liquid dye through the catheter. High-speed X-ray movies record the course of the dye as it flows through the arteries, and doctors can identify blockages by tracing the flow. An evaluation of how well your heart is working also can be done during cardiac catheterization. View an illustration of a cardiac catheterization.

Next, based on the extent of the coronary artery blockage(s) your doctor will discuss with you the following treatment options:

  • Percutaneous coronary intervention (PCI) may be required to 1) open a blocked coronary artery. Briefly, this procedure involves undergoing cardiac catheterization followed by using a 2) catheter with a small inflatable balloon at the tip (View an illustration of a cardiac catheter). The balloon is inflated, squeezing open the fatty plaque deposit located on the inner lining of the coronary artery. Then the balloon is deflated and the catheter is withdrawn. 3) This procedure is often followed by insertion of a stent to then keep the coronary artery vessel propped open to allow for improved blood flow to the heart muscle.
  • Coronary artery bypass graft surgery may be indicated depending on the extent of coronary artery blockages and medical history. In this procedure, a blood vessel is used to route blood around the blocked part of the artery, forming a kind of detour.

Before any of these procedures, a doctor must find the blocked part or parts of the coronary arteries. He or she will guide a catheter through an artery in the arm or leg and into the coronary arteries, then inject a liquid dye through the catheter. High-speed X-ray movies record the course of the dye as it flows through the arteries, and doctors can identify blockages by tracing the flow. An evaluation of how the heart works also can be done during cardiac catheterization.

24
Q

Cardiovascular

Types of Unstable Angina

Prinzmetal’s angina almost always occurs when a person is at rest, usually between midnight and early morning. These attacks can be very painful.

  1. Prinzmetal angina may also be referred to as?

Pinzmetal’s angina is rare, representing about two out of 100 cases of angina, and usually occurs in younger patients than those who have other kinds of angina.

  1. Causes
  2. s/s
  3. TX (2 types of meds)
A
  1. Variant angina, Prinzmetal’s variant angina. Angina inversa
  2. Causes of Variant (Prinzmetal) Angina: The pain from variant angina is caused by a spasm in the coronary arteries (which supply blood to the heart muscle).

The coronary arteries can spasm as a result of:

Exposure to cold weather
Stress
Medicines that tighten or narrow blood vessels
Smoking
Cocaine use

  1. Symptoms of Variant (Prinzmetal) Angina:

The pain or discomfort:

Usually occurs while resting and during the night or early morning hours
Are usually severe
Can be relieved by taking medication

  1. Treatment of Variant Angina | Prinzmetal’s Angina

Medicines can help control the spasms. Drugs such as calcium antagonists and nitrates are the mainstays of treatment.

The spasms tend to come in cycles – appearing for a time, then going away. After six to 12 months of treatment, doctors may gradually reduce the medication.

Prinzmetal’s angina is a chronic condition that will need to be followed by your healthcare provider even though the prognosis is generally good.

25
Q

Cardiovascular

Infective endocarditis

  1. What is it?
  2. s/s
  3. Most important test for dx?
  4. Transesophageal echocardiogram: Purpose?
  5. ECG: Purpose?
  6. Chest x-ray or x-ray image: Purpose?
  7. Computerized tomography (CT) or MRI: Purpose
  8. TX and risk factors
A
  1. Infective endocarditis (IE) is defined as an infection of the endocardial surface of the heart (see the image below), which may include one or more heart valves, the mural endocardium, or a septal defect
  2. Fever and chills
    A new or changed heart murmur — heart sounds made by blood rushing through your heart
    Fatigue
    Aching joints and muscles
    Night sweats
    Shortness of breath
    Paleness
    Persistent cough
    Swelling in your feet, legs or abdomen
    Unexplained weight loss
    Blood in your urine (either visible or found in a doctor’s viewing of your urine under a microscope)
    Tenderness in your spleen — an infection-fighting abdominal organ on your left side, just below your rib cage
    Osler’s nodes — red, tender spots under the skin of your fingers
    Petechiae (puh-TEE-key-ee) — tiny purple or red spots on the skin, whites of your eyes or inside your mouth

The infection can mimic other illnesses in its early stages. Various tests may be necessary to help make the diagnosis:

  1. Blood tests. The most important test is a blood culture used to identify bacteria in the bloodstream. Blood tests can also help your doctor identify certain conditions, including anemia — a shortage of healthy red blood cells that can be a sign of endocarditis.
  2. Transesophageal echocardiogram. An echocardiogram uses sound waves to produce images of your heart at work. This type of echocardiogram allows your doctor to get a closer look at your heart valves.

It’s often used to check for signs of infection. During this test, an ultrasound device is passed through your mouth and into your esophagus — the tube that connects your mouth and stomach.

  1. Electrocardiogram (ECG). Your doctor may order this noninvasive test if he or she thinks endocarditis may be causing an irregular heartbeat. During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat.
  2. Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. Your doctor can use X-ray images to see if endocarditis has caused your heart to enlarge or if infection has spread to your lungs.
  3. Computerized tomography (CT) scan or magnetic resonance imaging (MRI). You may need a CT or MRI scan of your brain, chest or other parts of your body if your doctor thinks that infection has spread to these areas.
  4. Because people with the following heart conditions are at risk of more-serious outcomes from endocarditis, they may need to take preventive antibiotics before certain medical or dental procedures to prevent endocarditis:

Artificial (prosthetic) heart valve
Previous endocarditis infection
Certain types of congenital heart defects
Heart transplant complicated by heart valve problems

Antibiotics are recommended before only the following procedures:

Certain dental procedures (those that cut your gum tissue or part of the teeth)
Procedures involving the respiratory tract, infected skin or tissue that connects muscle to bone

Antibiotics are no longer recommended before all dental procedures or for procedures of the urinary tract or gastrointestinal system.

26
Q

Cardiovascular

  1. Sinus Tachycardia what is it?
A
  1. rate greater than 100 beats/minute
  2. fever emotional and physical stress, HF, fluid vol loss. hyperthyroidism, hypercalemia
27
Q

Cardiovascular

  1. Sinus Bradycardia
  2. Causes?
  3. a medication that can cause this?
A
  1. beat/min <
  2. valsalve maneuver, MI, hyperkalemia, severe hypoxia, increase ICP
  3. Digitalis NOT digoxin
28
Q

Cardiovascular

Pt with insulin dependent diabetes and acute HF. What meds would you administer to reduce myocardial workload and improve ventricular pump performance?

  1. Morphine IV: why?
  2. Beta blockers: why?
  3. Dobutamine: why
A
  1. Morphine: anxiolytic, analgesic, VENODILATION WHICH REDUCES PRELOAD
  2. Beta-blockers: inhibit effects of sympathetic NS (catacholamines) reduce oxygen needs of the myocardium
  3. Dobutamine: Ionotropic, increase strength of contraction, some chronotropic properties increases HR and AV conduction
29
Q

Cardiovascular

FYI

Leukotriene Modifiers use to tx?

A

Asthma

30
Q

Cardiovascular

FYI

Dantrolene

  1. Purpose
  2. Only tx for ?
A
  1. skeletal muscle relaxant
  2. malignant hyperthemia
31
Q

Cardiovascular

  1. Pulse Deficit?
  2. Pulse Deficit due to?

Pt with uncontrolled atrial fibrillation to determine if pt has INADEQUATE stroke volume use pulse deficit

A
  1. Apical pulse is greater than radial pulse
  2. low stroke vol in which most of the blood flow is not reaching the periphery
32
Q

Cardiovascular

pulse pressure

A

Difference between systolic and diastolic

33
Q

Cardiovascular

Corrigan’s Pulse

A

associated with increase stroke vol and decrease peripheral resistance

34
Q

Cardiovascular

  1. ACE Inhibitors inprove lung function by?
  2. side effects (3)
  3. dry hacking cough can be tx with?
  4. Pregnancy use?
A
  1. increasing alveolar-cappillary membrane diffusing capacity and pulmonary vascular functionin patients HF
  2. hypotension. acute renal failure, hyperkalemia
  3. NSAIDs
  4. NO
35
Q

Cardiovascular

Risk factors of Heart failure

  1. Extrinsic Factors
  2. Examples
  3. Most common cause of HF
A
  1. Extrinsic Factors are external to the heart an can contribute to HF
  2. CAD, HTN, diet, pregnancy, congenital defects
  3. CAD
36
Q

Cardiovascular

  1. Cardiac Catheterization post procedure nurse monitors for which potential complications? (3)
  2. Grey Turner’s sign
  3. Cullens sign
A
  • Arteriovenous fistula
  • hematoma,
  • pseudoaneurysm

A pseudoaneurysm may be a complication of cardiac catheterization, a procedure in which a catheter is inserted in an artery in your groin (femoral artery) and is threaded through your blood vessels to your heart. Cardiac catheterization is used to capture images of your heart to diagnose heart disease and to treat certain types of heart disease. A pseudoaneurysm can occur if blood leaks and pools outside your femoral artery where it was punctured when the catheter was inserted. Pseudoaneurysms can also occur in other arteries throughout the body related to either surgery or trauma, or from the rupture of an aneurysm.

Pseudoaneurysms can also occur in the heart chambers, such as the left ventricle, after damage from a heart attack causes blood to leak and pool outside the injured heart muscle.

If a pseudoaneurysm of a femoral artery related to cardiac catheterization is small, it may go undetected and not cause any complications. But if a small pseudoaneurysm is detected, your doctor may recommend a watchful-waiting approach to see if it resolves on its own. However, most often, when a femoral artery pseudoaneurysm is detected, your doctor will recommend one of these treatments:

  • *Ultrasound-guided compression repair.** In this treatment, your doctor will look for your pseudoaneurysm using ultrasound imaging. Once the pseudoaneurysm is found, your doctor presses on it to release the built-up blood.
  • *Ultrasound-guided medications. Your doctor may recommend having a dose of blood clot-forming medication (thrombin**) injected into your pseudoaneurysm to treat it by causing the pooled blood to clot. The medication is injected into the pseudoaneurysm after it’s found using ultrasound imaging.
  • *Surgery.** If your doctor doesn’t think either ultrasound-guided treatment will work, he or she may recommend surgery to correct it.
  • Retroperitoneal hemorrhage (or retroperitoneal hematoma) refers to an accumulation of blood found in the retroperitoneal space. It can present with Grey Turner’s sign (flank bruising). Ecchymosis around the umbilicus (Cullen’s sign) Causes include: anticoagulation. a ruptured aortic aneurysm.
37
Q

Cardiovascular

After MI and PTCA is often done. Heparin is often used with PTCA procedure. Before nurse removes the sheath used during the procedure from the femoral or radial ARTERY, the PTT should be =< than what?

PRESSURE IS APPLIED FOR APPX 15 MINS AFTER SHEATH IS REMOVED

A

ptt should be equal to or less an 50

normal ptt is 25-35

38
Q

Cardiovascular

CORONARY ATHERECTOMY

A

CAUTERZINE THE PLAQUE

39
Q

Cardiovascular

Paroxysmal means?

A

“Paroxysmal” means from time to time.

MED/SURG: CARDIOVASCULAR (4 decks)

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