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Cardiovascular Nursing part 3 Flashcards

Antihypertensive Drugs (Adrenergic receptors, ACE Inhibitors, ARBs, Diuretics, Vasodilators), Coronary Artery Disease (Angina, MI), Heart Failure, Cardiotonic Drugs, Sympathomimetic Drugs, Cardiac Glycosides

1
Q

drug for all kinds of hypertension

A

Antihypertensive Drugs

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2
Q

stimulates receptors / SNS response

A

Adrenergic Agonist

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3
Q

blocks receptors / SNS response

A

Adrenergic Antagonist

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4
Q

Adrenergic Receptors

A

Alpha receptors
Beta receptors

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5
Q

receptors that are excitatory

A

beta 1
alpha 1

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6
Q

receptors that are inhibitory / relaxation

A

alpha 2
beta 2

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7
Q

[Adrenergic Receptors]

  • vasoconstriction
  • mydriasis (iris constrict)
  • urinary retention
A

alpha 1 receptor agonist

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8
Q

[Adrenergic Receptors]

  • vasodilation
  • miosis (dilate)
  • bladder emptying
A

alpha 1 receptor antagonist (BV)
- Prazosin
- Doxazosin
- Terazosin

*avoid warm shower, prolonged standing (orthostatic hypotension occurs)

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9
Q

[Adrenergic Receptors]
CNS: ↓ NE flow = ↓SNS

*only agonist that decreases sympathetic NS

A

alpha 2 receptor agonist (CNS)
- Clonidine (Catapres)
-Methyldopa (Aldomet)

*centrally acting
s/e: Drowsiness (give at night)

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10
Q

[Adrenergic Receptors]
CNS: ↑ NE flow = ↑SNS

A

alpha 2 receptor antagonist

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11
Q

beta receptor in the heart

A

Beta 1

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12
Q

beta receptor in the lungs

A

Beta 2

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13
Q

[Adrenergic Receptors]
↑HR ↑contractility

A

beta 1 receptor agonist

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14
Q

[Adrenergic Receptors]
↓HR ↓contractility

A

beta 1 receptor antagonist

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15
Q

[Adrenergic Receptors]
Bronchodilation

A

beta 2 receptor agonist

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16
Q

[Adrenergic Receptors]
Bronchoconstriction

A

beta 2 receptor antagonist

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17
Q

Drugs to DECREASE SNS

A
  • Alpha 1 antagonists (BV)
  • Alpha 2 agonists (CNS)
  • Betablockers
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18
Q

antiHPN drugs that vasodilates and has side effect of COUGH

A

ACE Inhibitors “-pril”
- Captopril
-Quinapril
-Enalapril

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19
Q

antiHPN drugs that vasodilates and has side effect of GI toxicity

A

ARBs “-sartan”
- Losartan
-Candesartan
- Telmisartan

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20
Q

antiHPN drugs given during morning as it can cause increased urine output

A

Diuretics
- Thiazide: Metolazone, Hydrochlorothiazide
-Loop: Furosemide

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21
Q

antiHPN drugs that directly relaxes smooth muscles of the blood vessels

A

Vasodilators

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22
Q

[Vasodilators]

  • Hydralazine (Apresoline)
    -Nitrates (NTG, Isosorbide nitrate, Nitroprusside)
A

Direct Acting Vasodilators

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23
Q

[Vasodilators]
1. Calcium Channel Blockers
>Short-acting CCB: Nifedipine, Amlodipine, Felodipine

> Long-acting CCB: Diltiazem, Verapamil

A

Indirect Acting Vasodilators
- ↓ Ca = ↓ contractility

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24
Q

Sid effect of Calcium Channel Blockers “-pine”

A

Headache

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25
Q

also known as Ischemic Heart Disease (IHD)

A

Coronary Artery Disease (CAD)

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26
Q

artery that supply anterior and lateral wall of heart

A

LEFT Coronary Artery

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27
Q

artery that supply posterior and inferior wall of heart

A

RIGHT Coronary Artery

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28
Q

part of left coronary artery that is most affected in Myocardial Infarction

A

Left Anterior Descending (LAD)

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29
Q

etiology of Coronary Artery Disease / Ischemic HD

A

Atherosclerosis

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30
Q

Typical symptom of CAD/ IHD

A

Angina (due to ischemia)

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31
Q

2 venous drainage

A
  1. Great Cardiac Vein
  2. Middle Cardiac Vein
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32
Q

manifestation of CAD on elderly

A

ATYPICAL: confusion (not angina)

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33
Q

(+) Atherosclerosis gene

A

3x higher risk for CAD

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34
Q

chest pain or discomfort that most often occurs with activity or emotional stress; increased cardiac workload

A

Stable angina

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35
Q

condition in which your heart doesn’t get enough blood flow and oxygen due to severe atherosclerosis

A

Unstable angina

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36
Q

chronic, severe pain (+) Levine sign

A

Refractory / Intractable Angina

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37
Q

condition in which your heart doesn’t get enough blood flow and oxygen due to coronary vasospasm

A

Prinzmetal / Variant Angina

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38
Q

occurs when the heart temporarily doesn’t receive enough blood (and thus oxygen), but the person with the oxygen-deprivation doesn’t notice any effects ; asymptomatic

A

Silent Ischemia

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39
Q

-imbalance between O2 supply and cardiac workload
- reversible
-timing: <15mins
-Relieving factors: rest, NTG

A

Angina Pectoris

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40
Q

-ischemia and necrosis of cardiac cells
-irreversible
-timing: >30mins
-No relieving factors

A

Myocardial Infarction

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41
Q

PQRST

A

P-ain assessment, Position (location), Provocation

Q-uality (constant, heaviness, stabbing)

R-adiation, Relieving

S-everity (pain scale)

T-iming

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42
Q

Priority nursing diagnosis of Angina Pectoris

A
  1. Ineffective myocardial tissue perfusion
  2. Acute pain
  3. Anxiety r/t fear of withdrawal (Restless)
  4. Ineffective health maintenance
  5. Non compliance
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43
Q

Management for Stable Angina

A

Independent NI:
REST!

(reduce cardiac workload)

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44
Q

Management for Unstable and Prinzmetal Angina

A

Dependent NI:
Nitroglycerin, Oxygen

(dilate blood vessels first before giving oxygen)

45
Q

[Angina]

↑ Homocysteine level
↑ C - Reactive Protein

A

Risk for CAD

46
Q

ECG finding present in Angina

A

T-wave inversion (myocardial injury/ischemia)

47
Q

best time to perform ECG for angina and MI

A

During PAIN!
Angina: <15mins
MI: >30mins

48
Q

Medical Management for Angina

A
  1. Nitrogylcerin (fast onset)
  2. Isosorbide Nitrate (Peripheral Vasodilators)
  3. Betablocker
  4. Calcium Channel Blockers (Peripheral Vasodilators)
  5. Ranolazine (for chronic angina; not during acute attack)
    ↓ electrical activity = ↓ O2 demand
49
Q

How to administer NTG

A

Sublingually, 3 doses, 5 mins interval ; during acute attack

Update:
NTG 1
NTG 2- Call 911
NTG 3 - Bring to hospital (even pain subsides)

50
Q

Surgery for Angina

A

Percutaneous transluminal coronary angioplasty (PTCA)

also called percutaneous coronary intervention (PCI)

51
Q

Priority nursing diagnosis for Myocardial Infarction

A

Acute Pain

52
Q

Priority intervention for pain in myocardial infarction

A

Dependent Intervention: DOC: Morphine (Narcotics)

53
Q

What must be monitored when taking Morphine?

A

Monitor Respiratory Rate

54
Q

What is the most common side effect of Myocardial Infarction?

A

Premature Ventricular Contraction / Complex

55
Q

What is the intervention when the nurse observes there is more than 6 Premature Ventricular Contraction in the ECG of a patient with MI?

A

Give antidysrhythmic drug

56
Q

What ECG finding is an early sign of MI, seen in the zone of infarction?

A

ST Elevation

57
Q

3 zones of Ischemia

A
  • Zone of Ischemia (outermost)
  • Zone of Injury (middle)
  • Zone of Infarction (innermost)
58
Q

What ECG finding is present on the zone of injury?

A

ST Depression

59
Q

What ECG finding is present on the zone of ischemia?

A

T-wave inversion

60
Q

2 Types of MI

A

STEMI - occurs when a ruptured plaque blocks a major artery completely

NSTEMI - atypical sign; caused by a block in a minor artery or a partial obstruction in a major artery

61
Q

What ECG finding is a late sign of MI?

A

Pathological Q wave
(scar, old MI)

62
Q

What is the most specific enzyme for MI?

A

CK-MB Isoenzyme

63
Q

What is the most reliable / sensitive blood test for MI?

A

Troponin (protein)

64
Q

What cardiac enzyme increases first 3-4 hours onset of pain?

A
  1. Troponin
    then CK-MB isoenzyme, Total CK
65
Q

What does increased troponin indicate?

A

Myocardial infarction

66
Q

What cardiac enzyme increases within 2 hours and is only suggestive?

67
Q

Management for MI

A
  1. Morphine (Priority: PAIN CONTROL)
  2. Oxygen
  3. Thrombolytic Drugs -USA
  4. Anti-Thrombotic / Antiplatelet / Anticoagulant
68
Q

MONA TASS is for acute management of MI (not in prioritization order). What does it stand for?

A

Morphine
Oxygen
Nitroglycerin
Aspirin

Thrombolytic
Anticoagulant
Stool Softener
Sedatives

69
Q

Surgical management for MI done within small vessels to treat coronary artery disease, the buildup of plaques in the arteries of the heart.

A

Coronary Artery Bypass Graft (CABG) / Heart Bypass Surgery

70
Q

Condition wherein there is inability of the heart to pump effectively / cardiac decompensation

A

Heart Failure

71
Q

Most common non-cardiac cause of Heart failure

72
Q

Type of heart failure where:
1. Left ventricle fails
2. Right Ventricle fails

A
  1. Left-sided HF
  2. Right-sided HF
73
Q

Type of Heart failure with respiratory symptoms such as pulmonary edema, progressive cough, orthopnea, crackles/rales, dyspnea, paroxysmal nocturnal dyspnea (PND)

A

Left-sided HF

74
Q

Heart sound heard on a patient with Congestive HF

A

S3 Ventricular gallop (Lub-Dub-Dub)

75
Q

[NYHA 4 Classification of HF]
- no limit on physical activity
-Risk for activity intolerance

76
Q

[NYHA 4 Classification of HF]
- slight limitation of physical activity
-Activity Intolerance

77
Q

[NYHA 4 Classification of HF]
- there is marked limitation
- Decreased Cardiac Output

78
Q

[NYHA 4 Classification of HF]
-all s/sx manifests, unable to carry any physical activity

79
Q

What is the normal levels of Brain/Beta type Natriuretic Peptide (BNP)?

A

<100 pcg/mL

80
Q

What is the levels of Brain/Beta type Natriuretic Peptide (BNP) in a patient with Congestive Heart Failure?

A

> 400 - >800 pcg/mL

81
Q

What is the PRIORITY for a patient with HF?

A

AIRWAY and Breathing Problems

82
Q

Position for a patient with HF?

A

High fowler’s

83
Q

What must be monitored upon giving diuretics for a patient with HF?

A

Monitor Urine Output accurately

84
Q

2 Nursing Diagnosis for Heart Failure

A

-Fluid Volume Excess
-Decreased Cardiac Output

85
Q

[HF] Fluid Volume Excess Interventions

A
  1. Restrict fluids
  2. Restrict sodium
  3. Monitor I and O
  4. Monitor VS
  5. Weigh pt daily
  6. Oral Diuretics (adjunct - Furosemide, Spironolactone)
  7. Monitor serum potassium level
86
Q

what is the normal value of serum potassium?

A

3.5 - 5.0 mg/dL

87
Q

[HF] Decreased Cardiac Output Goals

A
  • to decrease cardiac workload
  • to improve contractility
88
Q

Interventions to Decrease Cardiac Workload in a patient with HF

A
  1. Provide rest
  2. avoid stress
  3. support cardiac function
    - ACE Inhibitors
    -Angiotensin II Receptor Blockers
    -Betablocker
    -Calcium Channel Blocker
89
Q

Interventions to increase Contractility of heart in a patient with HF

A

CARDIOTONIC DRUGS (Inotropic effect)
1. Sympathomimetic Drugs
2. Cardiac glycosides
3. Phosphodiesterase Inhibitor

90
Q

What is inotropic effect of drugs?

A

Positive inotropic drugs help your heart beat with more force

91
Q

What is contraindicated for drugs with inotropic effect / cardiotonic drugs?

A

Calcium channel blockers “-pine”

  • Inotropic effect: increased release of Ca in cardiac cells
92
Q

What is the effect of MILRINONE (IV), a Phosphodiesterase Inhibitor [cardiotonic drug]?

A

Peripheral Vasodilation
(not on HR)

93
Q

What must be monitored for a patient taking Milrinone?

A

Monitor for HYPOTENSION !
(bc effect is peripheral vasodilation)

94
Q

what is the mechanism of action of Sympathomimetic Drugs [cardiotonic drug]?

A

Agonists
PIPC
(+) inotropic = ↑ contractility
(+) chronotropic = ↑HR

95
Q

Dobutamine and Dopamine is what type of cardiotonic drug?

A

Sympathomimetic Drugs

96
Q

Why Sympathomimetic Drugs, such as dopamine and dobutamine, are given through infusion pumps?

A

Risk for Renal Failure

97
Q

what is the mechanism of action of Cardiac Glycosides [cardiotonic drug]?

A

PINC
(+) inotropic = ↑ contractility
(-) chronotropic = ↓HR

98
Q

2 examples of Cardiac Glycosides

A

-Digoxin
-Digitalis

99
Q

What happens on (-) chronotropic effect?

A

there is Prolonged Repolarization = ↓HR
= Bradycardia

99
Q

What is the contraindication for drugs with negative chronotropic effect?

A

Beta Blockers -olol

(-) Chronotropic effect: ↓HR
as betablockers also ↓HR

100
Q

What drug is contraindicated to adjunct with Digoxin (oral), as if combined will cause prolong repolarization?

A

Amiodarone (antiarrhythmics)

It works directly on the heart tissue and will slow the nerve impulses in the heart.

101
Q

Priority to monitor prior to administration of Digoxin

A

Heart Rate

102
Q

Electrolyte imbalance that can cause digoxin toxicity

A

Hypokalemia!
- monitor serum K+

103
Q

Therapeutic level of Digoxin

A

0.5 - 2.0 ng/mL

104
Q

What must be monitored while taking Digoxin (to prevent toxicity)

A
  • bradycardia
    -GI toxicity (lack of apetite, n/v)
    -ECG changes (dysrhythmia)
105
Q

3 Drugs contraindicated while taking Digoxin

A
  1. Calcium Channel blockers
  2. Beta blockers
  3. Amiodarone
106
Q

Priority nursing intervention when noticed Digoxin toxicity

A

Withhold dose and Refer!

106
Q

Hallmark Side Effect of Digoxin Toxicity

A

Visual Disturbances
-blurry vision
- halo vision
-yellow vision

107
Q

Antidote for Digoxin Toxicity

A

Digibind

MOA: binds molecules of digoxin, making them unavailable for binding at their site of action on cells in the body

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