Cardiovascular Panopto Flashcards (Part 2)
1
Q
Preload, Contractility, & Afterload all affect-
A
Your Stroke Volume (Even if your HR is unchanged)
2
Q
What is Contractility?
A
The ability of heart fibers to shorten/contract
3
Q
What increases myocardial workload?
A
Increased Preload, Poor Contractility, Increased Afterload
4
Q
If the heart has an increased workload, then it needs more-
A
Oxygen
5
Q
The more myocardial fibers are stretched (within limits), the greater the-
This is an example of-
A
Force of the contraction.
Frank Starling’s Law, or the “Rubberband Law”.
6
Q
The stretching force in the ventricles during Diastole =
A
Preload (Because preload is the amount of blood that fills the ventricles during Diastole)
7
Q
What is Preload determined by?
A
The amount of blood returning to the heart from circulation.
The amount of blood in ventricles at the end of Diastole, before contraction.
8
Q
What does Preload determine?
A
The amount of stretch on myocardial fibers
9
Q
Why do the ventricles stretch during Diastole?
A
Because the ventricles are stretching with blood
10
Q
Normally:
More Preload = More Stretch =
A
Stronger Contraction = More SV = More Cardiac Output
11
Q
Exercise is a good factor for Preload. Why?
A
Because it helps with Veinous Return (More blood volume returning to the heart)
12
Q
Hypovolemia is a bad factor for Preload. Why?
A
Because it causes there to be less blood volume returning to the heart (This results in less blood filling the heart)
13
Q
Diuretics and Nitroglycerine both-
A
Lower Preload
14
Q
What things increase Preload?
A
Prescribed Volume Expansion (IV Fluid)
Prescribed Meds (Dopamine, Vasoconstrictors)
Illnesses (Hypervolemia, Stenosis, Myocardial Infarction)
15
Q
What is Stenosis?
A
When the Aortic Valve narrows and blood can’t flow normally
16
Q
Both Chronic Excessive Preload and Low Preload will cause a -
A
Poor Cardiac Output
17
Q
Increased Preload means that the heart has to work-
A
Harder
18
Q
Excess Preload over time =
A
Over stretched ventricles = Chronic overwork of heart = Weak force of contraction = Eventual failure of left or right side of the heart
19
Q
The Right Ventricle can meet resistance from-
A
The Pulmonary Artery
20
Q
The Left Ventricle can meet resistance from-
A
Arterial Circulation
21
Q
What is Afterload determined by?
A
Condition of Aortic Valve
Blood Viscosity
Arterial BP
Systemic Vascular Resistance (SVR)
Pulmonary Vascular Resistance (PVR)
22
Q
Increased Afterload causes-
A
Increased Cardiac Workload + Cardiomyopathy + Left Ventricular Hypertrophy
23
Q
What is Cardiomyopathy?
A
An Enlarged Heart
24
Q
What can Cardiomyopathy cause?
A
Left Ventricular Hypertrophy
25
What is Left Ventricular Hypertrophy?
An increase in the size of the heart muscle without an increase in the size of the chambers
26
Left Ventricular Hypertrophy leads to a-
Decreased CO
27
Ventricles can overwork and-
Enlarge
28
A patient receives a drug to decrease Afterload. To evaluate the patient’s response to this drug, what is most important for the nurse to assess?
A.) HR
B.) Lung Sounds
C.) BP
D.) JVD
C
29
Ejects blood to the aorta + Systemic Circulation =
Left Ventricle
30
Systemic Resistance will affect the Left Ventricular Afterload. How?
It will cause a Higher Blood Pressure (Which is More Work)
31
Which side of the heart works harder?
The Left works harder than the Right
32
Pulmonary Congestion can cause-
Left Sided Heart Failure (Because the blood isn’t getting to the Left side of the heart like it should)
33
What ejects blood to the pulmonary circulation?
The Right Ventricle
34
Which one is stronger, Pulmonary Resistance or Systemic Resistance?
Pulmonary Resistance is less powerful than Systemic Resistance
35
Can Left Sided Heart Failure cause Right Sided Heart Failure?
Yes
36
What Pulmonary Edema caused by? How?
Left Sided Heart Failure.
This occurs because the the heart isn’t pumping enough blood out. If the left side of the heart can’t pump enough blood out, then the blood goes backwards (Regurgitates) backwards into the Pulmonary Arteries.
37
What are the characteristics of Left-Sided Heart Failure?
Increased Afterload.
Left Ventricle is Overworked and Stretched.
The blood regurgitates into the pulmonary system (Pulmonary Edema).
38
What are the characteristics of Left-Sided Heart Failure?
Increased Afterload.
Right Ventricle is overworked and fails.
Blood Regurgitates into the Systemic Circulation (Bodily Edema).
39
Will Left-Sided Heart Failure cause a higher or lower SV & CO?
Lower
40
Left ventricular overstretch =
Left-Sided Heart Failure
41
Pulmonary Edema causes there to be blood or fluid in the -
Alveolia. This means that there should be an impaired gas exchange.
42
What can you expect to see whenever Veinous Blood backing up into the body?
Bodily Edema (JVD, Peripheral Edema)
43
To try to simplify Heart Failure, Heart Failure is all about-
The chambers getting to overworked and filled with blood to be able to pump out all of it. The blood doesn’t have anywhere else to go but backwards.
Right Sided means it’ll go backwards into the body.
Left Sided means it’ll go backwards into the pulmonary arteries and alveoli.
44
Clinical Manifestations of Right Sided Heart Failure?
Dependent Edema (Legs & Sacrum)
JVD
Abdominal Distention
Hepatomegaly
Splenomegaly
Anorexia
Nausea
Weight Gain
Nocturnal Diuresis
Swelling of Hands & Fingers
Increased BP (from Fluid Excess) or Decreased BP (from Pump Failure)
45
Clinical Manifestations of Left Sided Heart Failure?
Signs of Pulmonary Congestion
Dyspnea
Tachypnea
Crackle Sounds
Dry, Hacking Cough
Paroxysmal Nocturnal Dyspnea
Increased BP (from Fluid Excess) or Decreased BP (from Pump Failure)
46
How does Right Sided Heart Failure cause Weight Gain?
Well, the deoxygenated blood is going backwards into the circulation, and so it’s not getting sent to the Kidneys like it should be. This means that your deoxygenated blood is holding onto its waste for longer and that waste buildup is what causes the extra weight gain.
47
Causes of Left-Sided Heart Failure include-
Cardiac Disease + Hypertension
48
Name some Early Clinical Signs of Left-Sided Heart Failure:
Tissue Hypoxia
Fatigue
Light-Headedness
Confusion
49
Name some Late Clinical Signs of Left-Sided Heart Failure:
Pulmonary Congestion
Dyspnea
Abnormal Lung Sounds
50
Decreased function of the left ventricle causes =
Decreased function of the right ventricle causes =
Left-Sided Heart Failure.
Right-Sided Heart Failure.
51
Name some Clinical Signs of Left-Sided Heart Failure:
Weight Gain
JVD
Peripheral Edema
All Signs/Symptoms of Hypervolemia
52
What is the number 1 choice for the treatment of Heart Failure?
Diuretics are the number 1 choice
53
Name some of the meds that you can use for the treatment of Heart Failure:
Diuretics, Lanoxin (Digoxin)
54
What is Lanoxin?
The brand name for Digoxin
55
What is Hepatomegaly?
Enlarged Liver
56
What is Splenomegaly?
Enlarged Spleen
57
SOB that causes the patient to wake up after one or two hours of sleep. This is usually relieved in an upright position =
Paroxysmal Nocturnal Dyspnea
58
The nurse is caring for a patient with left-sided heart failure. Which clinical manifestations would the nurse expect with this diagnosis?
Select all that apply:
A.) Pulmonary Crackles
B.) Respirations 26 per minute
C.) Weight gain
D.) Jugular vein distention
E.) Dry hacking, cough
A, B, E
59
Before administering Digoxin, how long would you assess the patient’s apical and radial pulse?
1 Minute
60
When should you hold an order of Digoxin, not give it to your patient, and contact the HCP?
If their HR is below 60 BPM
61
What are are Digoxin lab results given in?
Nanograms per mL
62
Digoxin toxicity can cause-
Anorexia, Nausea, Vomiting, Neurological Symptoms
63
The normal Digoxin level range =
0.8 or 1 to up to 2 Nanograms per mL
64
You have a patient who is taking Digoxin. What do you need to monitor for?
Heart Dysrhythmias, Respiratory Congestion, Peripheral Edema.
Monitor Weight Daily, Regulate/Monitor I&O, Give Regular EKG’s.
65
Orders for Digoxin must be taken off by how many RN’s?
2
66
How much does it take to overdose with Digoxin?
It is a high risk med. A decimal place can cause a huge overdose.
67
The nurse provides home care instructions to a parent of a child with heart failure. The patient is being discharged home on digoxin. Which statement by the parent indicates a need for further instruction?
A.) “I will not mix the digoxin with my child’s food.”
B.) “If more than one dose is missed, I will call the pediatrician.”
C.) “I will count my child’s pulse before administering the digoxin.”
D.) “If my child vomits after I administer the digoxin, I will repeat the dose.’
D
68
If a dosage of Digoxin is missed, then it should not be administered until-
4 Hours Later
69
What are some major Factors that cause decreased CO:
Heart Failure
Loss of blood flow to the myocardium (Ischemia or Infarction)
Effects of irregular heartbeat (Tachycardia or Bradycardia)
Hypervolemia / Hypovolemia
An increased Workload (Hypertension, Atherosclerotic Heart Disease)
70
Decreased CO =
Insufficient amount of blood ejected from the heart to systemic and pulmonary circulation to meet the oxygen demands of the body
71
What is Atherosclerotic Heart Disease?
Thickening and Hardening of the walls of the Coronary Arteries
72
Quality of blood flow + it’s ability to oxygenate and nourish tissues at the cellular level =
Tissue Perfusion
73
List some conditions that interfere with Tissue Perfusion:
Any condition that obstructs/narrows blood vessels (Hypertension, Diabetes, Atherosclerosis. These are the most common cause.) Nicotine & High Lipids in the blood also have an impact on Tissue Perfusion.
Conditions that impair peripheral circulation (Arterial Spasms, Blood Clots, Peripheral Vascular Disease)
Conditions that impair cell nutrition like Edema.
74
Manifestations of Arterial Ineffective Tissue Perfusion:
Decreased Peripheral Pulse, Cool Extremities, Pallor, Activity Intolerance
75
Manifestations of Veinous Ineffective Tissue Perfusion:
Incompetent Valves, Blood Pools in Veins, Peripheral Edema, Phlebitis, Increased Risk of Thrombosis Formation (A Blood Clot)
76
Inflammation of vein walls=
Phlebitis
77
Estrogen has a protective effect from-
Cardiovascular Problems
78
What are some nice cardiac changes to make for someone with cardiac problems?
Decrease the fat & sodium in their diet + Replace saturated fats with poly-unsaturated fats + Eat foods that are rich in fiber + Eat Whole-Grains, Fresh Fruits, Vegetables, Lean Meats (Like Chicken) + Avoid foods high in cholesterol (Liver, Eggs, Animal Fats like Veal & Pork) + Eat Low Cholesterol Foods (Fish, Low-Fat Dairy Products, Oils other than Vegetable Oil, Iron-Rich Foods) + Avoid Caffeine
79
Iron-Rich foods are helpful with people who have Anemia. This is because Iron-Rich Foods help with-
Red Blood Cell Production
80
How much Exercise is recommended?
30 - 60 Minutes (Daily)
81
Exercise gives us a-
Low Pulse Rate, Low BP, Decreased Cholesterol Levels, Increased CO
82
Subjective symptoms of cardiac problems include:
Chest Pain, Palpitations, Dyspnea, Fatigue, Impacted ADL’s
83
Hypoxia is caused by-
Not enough CO
84
If you smoke and take oral contraceptives, this puts you at an increased risk for-
Blood Clots
85
Clinical Signs of Heart Problems can be different from Men & Women.
Name off the signs for Men:
Discomfort or Tingling in the Arms, Back, Neck, Shoulder, or Jaw.
Chest Pain.
SOB.
86
Clinical Signs of Heart Problems are different from Men & Women.
Name off the signs for Women:
Heart-Burn Like Feeling.
Sudden Dizziness.
Cold Sweat.
Unusual Tiredness.
Nausea or Vomiting.
87
What are your palpation sites again?
Carotid, Brachial, Radial, Ulnar, Femoral, Popliteal, Posterior Tibial, Dorsalis Pedis
88
What are some observations that you can make from a patient with heart problems?
Skin Color (Pallor?)
Cough & Sputum? (Left-Sided Heart Failure)
Peripheral Vascular Disease? (Cold Feet, Weak Pulses, Shiny Hairless Shins, Edema due to Poor Venous Return,
Arterial Ulcers due to No Blood Perfusion
Venous Ulcers (Phlebitis, Waste Build-Up)
89
What are some auscultations that you’d look out for on a patient with heart problems?
BP & Apical HR
Auscultation Points
Check Carotid Arteries for Bruits
Lung Sounds (Especially those that can be cause by Pulmonary Congestion)
90
A bruit can indicate-
Atherosclerosis & Narrow Arteries
91
Your BP on your left and right sides, should be within how many mm Hg of each other?
Within 10 mm Hg of each other
92
What palpation sites should you compare?
Your Proximal and your Distal Sites
93
What is Venous Stasis?
This is when blood pools in your veins
94
What does exercise prevent?
Veinous Stasis
95
You should avoid exercise in-
Cold Weather
96
Stress Management is helpful for people with cardiac problems because it helps prevent-
The Systemic Response of Vasoconstriction
97
Processed foods are loaded with-
Sodium
98
Nicotine increases your heart rate by increasing your-
Blood Pressure
99
Smoking causes:
An Instant & Long-Term Rise in BP + An Instant & Long-Term Increase in HR + Reduces the Blood Flow from the Heart + It Reduces the Amount of Oxygen that reaches the Body Tissues + Increases Risk of Blood Clots + Damages Blood Vessels + Doubles the Risk of Stroke (Because of Reduced Blood Flow to the Brain) + Linked to Depression & Stress
100
How do you promote Veinous Circulation?
Keep legs elevated to promote Veinous return.
Avoid knee flexion with pillows.
Promote leg exercises, especially with immobility.
101
How do you promote Cardiac Circulation?
Position the pt into a Semi- or High- Fowler’s Position to reduce Preload.
AVOID legs up with Congestive Heart Failure because it increases Preload.
102
How do you prevent Veinous Stasis?
Positioning & Leg Exercises
Antiembolic Stockings (TEDs)
Sequential Compression Devices
103
What are things that you’d measure for TED’s?
What would you do next after taking these measurements?
You’d measure from the heel to the gluteal fold.
You’d measure the circumference of each calf and thigh at the widest point.
You’d compare these measurements to a size chart, obtain 2 different sizes if there is a significant difference between the two measurements.
104
What are things that you’d measure for knee-high TED’s?
You’d measure from the heel to the popliteal space.
105
How often can you remove TEDS? For how long?
For 30 Minutes, 1-3 Times a Day for Skin Care + Inspection
106
How long does it take for permanent heart, brain, and tissue damage to occur?
4 - 6 Minutes
107
Cardiac Rehab Programs include:
Exercise Training, Education on Heart-Healthy Living, Counseling to Reduce Stress + Help you return to Active Life
108
Cardiac Rehab Programs are for people who have experienced-
Heart Attacks
Coronary Artery Disease
Angina
Heart Failure
A Coronary Artery Bypass Graft
A Percutaneous Coronary Intervention (Coronary Angioplasty)
Valve Replacement
Pacemaker
Implantable Cardioversion Defibrillator
109
A Coronary Artery Bypass Graft =
Open Heart Surgery
110
Balloon Angioplasty =
Coronary Angioplasty
111
What enzyme does the MB Blood Test look for?
It looks for the cardiac enzyme called Creatine Kinase (CK).
112
A patient takes the MB Test, what are they testing for?
Myocardial Cell Injury
113
High levels of CK is indicative of-
Myocardial Infarction (A Heart Attack)
114
The CK in a MB Blood Test is what you’d call a-
‘Marker’ for Myocardial Damage
115
After a Heart Attack occurs, your CK should increase within-
When should the CK peak?
When should the CK return to normal again?
3 to 6 Hours.
12 to 24 Hours.
Should return to normal again in 2 Days.
116
What is Troponin?
It is a Protein-Based cardiac enzyme that has 3 different types. It’s used as a ‘marker’ specifically for Cardiac Disease
117
Which type of Troponin has a high affinity for Myocardial Injury?
Troponin 1
118
What are the three different types of Troponin?
Troponin 1
Troponin C
Troponin T
119
What are the normal values for Troponin 1?
Normally Very Low (Less than 0.35 Nanograms per mL)
120
How long does it take for Troponin 1 to rise after a Myocardial Cell Injury/Myocardial Infarction (MI)
How long does it persist for?
Rises within 3 hours of the MI.
Up to 7 to 10 Days.
121
The normal lab value for Troponin T is-
Less than 0.1 Nanograms per L
122
A rise of Troponin T can indicate-
Myocardial Cell Injury
123
What does a Troponin Test measure?
Troponin 1 + Troponin T proteins in the blood
124
What is the normal value for the CK-MB (Can also be called the CK-2) Blood Test if your patient is a Male?
2-6 Nanograms per mL
125
What is the normal value for the CK-MB (Can also be called the CK-2) Blood Test if your patient is a Female?
2-5 Nanograms per mL
126
What is Myoglobin?
An oxygen binding protein found in Cardiac + Skeletal Muscle
127
Is Troponin-C a cardiac marker?
Nope, because it’s not a cardiac-specific enzyme. It’s increased presence can mean a lot of things that are non-cardiac related, so it’s not measured for anything cardiac related
128
When do Myoglobin levels begin to rise after myocardial cell death?
When does it have a rapid decline?
Within 2 Hours
After 7 Hours
129
Is Myoglobin Cardiac Specific?
No
130
So, what are the cardiac specific Cardiac Enzymes?
Creatine Kinase (CK)
Troponin 1
Troponin T
131
Is Myoglobin still considered a cardiac enzyme even though it isn’t cardiac specific?
Yes
132
Remember,
LDL =
HDL =
LDL = Bad Fats
HDL = Good Fats
133
Name some example of Serum Lipids =
Cholesterol
Triglycerides
Phospholipids
134
What’s a desirable Fasting Total Cholesterol lab value? *(Important)*
Below 200 mg/dl
135
Cholesterol & Triglycerides are both-
LDL’s (Bad Cholesterol)
136
Increased Cholesterol or Triglycerides puts the pt at risk for-
Coronary Artery Disease
137
What is LDL short for?
What is HDL short for?
Low-Density-Lipoprotein
High-Density-Lipoprotein
138
Are HDL’s Protective?
Yes
139
What foods would you want to eat in a low cholesterol diet?
Salmon & Other Fish, Sweet Potatoes, Whole Grains, Legumes, Avocados & Other Fruits, Legumes, Vegetables, Leafy Greens, Nuts, Rice, Oils that aren’t Vegetable Oil, Fat-free or Low-Fat Dairy Products, Soy, etc.
140
What does Hypokalemia cause?
Increased Cardiac Instability + Ventricular Dysrhythmias + Increased Risk of Digoxin Toxicity
141
If a patient has Hypokolemia, then what should their EKG look like?
It should show flattening & Inversion of the T Wave.
Should show the appearance of a U Wave.
Should show ST Depression.
142
What does Hyperkalemia cause?
Asystole + Ventricular Dysrhythmias
143
What is Asystole?
Whenever your heart’s Conductive System (Electrical System) fails entirely, which causes Systole to completely stop
144
What might a ECG look like for patient’s with Hyperkalemia?
Tall, Peaked T Waves.
Widened QRS Complexes.
Prolonged PR Intervals.
Flat P Waves.
145
The Serum Sodium Level decreases with the use of-
Diuretics
146
When does the Serum Sodium Level decrease?
What does this drop of Serum Sodium indicate?
During Heart Failure.
Indicates Water Excess (Hypervolemia).
147
What can Hypocalcemia cause?
Ventricular Dysrhythmias.
Prolonged ST & QT Intervals.
Cardiac Arrest.
148
What can Hypercalcemia cause?
Shortened ST Segment
Widened T Wave
Atrioventricular Block
Tachycardia or Bradycardia
Digitalis Hypersensitivity
Cardiac Arrest
149
How should Phosphorus Level be interpreted?
Why?
With Calcium Levels.
Because the Kidneys retain + Excrete one electrolyte in an inverse relationship to the other.
150
What can Hypomagnesemia cause?
Ventricular Tachycardia + Fibrillation
151
What is Atrial Fibrillation?
A buncha signals fire from different locations around the upper layers of the heart. This causes the heart to beat fast and chaotically.
152
What ECG changes might you observe in a patient who is experiencing Hypomagnesemia?
Tall T Waves.
Depressed ST Signals.
153
What can Hypermagnesemia cause?
Muscle Weakness, Hypotension, Bradycardia
154
What ECG changes might you observe in a patient who is experiencing Hypomagnesemia?
Prolonged PR Interval.
Widened QRS Complex.
155
When is the BUN elevated?
In heart disorders like heart failure + Cardiogenic shock that reduces renal circulation
156
What can elevate a pt’s blood glucose level?
An Acute Cardiac Episode
157
When is B-Type Natriuretic Peptide (BNP) released?
In response to Atrial + Ventricular Stretch
158
What does BNP serve as a ‘Marker’ for?
Heart Failure
159
What should BNP Levels be less than?
Under 100 ng/mL (Less than 100 mcg/L)
160
The higher the BNP Level, the-
More Severe the Heart Failure is
161
What is Digitalis?
A type of drug that is used to treat congestive heart failure
