Cardiovascular Part 2 and pulmonary Flashcards
Another name for diastolic heart failure is what?
HF-PEF
What medication prevents cardiac remodeling in HF patients?
ACEI
What medication prevents sudden cardiac death in HF patients?
Beta blocker
What medications would you prescribe a CHF patient?
Vasodilators to reduce preload and afterload–hydralazine or isodil
BB
ACEI
Diuretics
Inotropes? I’d cool and clammy
An IABP improved cardiovascular function how in HF patients?
It decreases afterload and increasing diastolic pressure which improves coronary perfusion
Which of the following applies to systolic failure?
A. Problems associated with ventricular filling
B. Associated with low CO/CI
C. Filling pressure will be high initially
D. Elevated PAP
B- the problem is poor ventricular contractility
Inverted T wave on an EKG indicates what?
Ischemia, which is reversible
ST elevations on an EKG indicate what?
Injury
Q waves on an EKG indicate what?
Infarct
ST elevations in 2,3,AVF indicate what?
Inferior MI
Usually the RCA
ST elevations in V2 V3 and V4 indicate what?
Anterior MI
Usually the LAD
Septal MI show ST elevations where?
V1 and some V2
LAD
A lateral MI shows ST elevation where? Which vessel is involved?
I, AVL, V5, V6
Circumflex artery
GP IIb/IIIa inhibitors are given to which patients?
Patients prior to and after PCI
Ab ixia band Integrillin
Screen as you would for a fibrinolytic
Post MI patients should get a ACEI if their EF is what?
NSTEMIs are characterized by what findings?
ST depressions and T inversions
What meds will you discharge an MI patient on?
Plavix
ASA
ACEI (if EF
How do you monitor post MI with angioplasty for acute closure of target vessel?
ST segment monitoring
Post MI a patient develops a new loud systolic murmur, a decreases BP, and a large V wave on PAOP tracing. What has likely occurred?
Papillary muscle rupture
Post MI a patient has decreased BP and CO, a narrowing PP, tachycardic, muffled heart tones and PEA. What has likely occurred?
Cardiac tamponade
Aortic insufficiency/aortic regurgitation leads to what kind of symptoms?
Left ventricular volume overload
Aortic stenosis patients develop what condition?
Lavage due to narrowing of aorta.
What is detrimental in aortic stenosis?
Don’t lower BP too much
No tachycardia
No AF
Mitral insufficiency/ regurg is associated with what on PA waveform?
Large V waves
Peripheral artery disease signs and symptoms are what?
Pain, especially with elevation of extremities Cool, pale skin Hair loss to extremities, Ulcers Sluggish cap refill Weak or absent peripheral pulse
What are the 6 Ps of PAD?
Pain Pallor Pulselessness Poiklothermia Paralysis Parasthesia
Ankle-brachial index is a tool used how? Why do we do it?
Take the ankle systolic pressure and divide by the systolic BP in the arm to derive an index
ABI scoring
Normal 0.9-1.3 ( pressure normally higher in ankle)
If
Which type(s) of aortic aneurysm occur in the ascending aorta?
Type 1 & 2
Which type(s) of aortic aneurysm originated in the descending aorta
Type 3
Which aneurysm(s) are surgical emergencies?
Ascending aortic aneurysms
Type 1 & 2
What are the goals for type B (descending aortic aneurysms)
Medical management
Systolic BP as low as possible
Decrease left ventricular contractility
What is the Bohr effect? What causes this?
A right shift on the oxyhemoglobin dissociative curve
Can be caused by: Acidosis Increase 2,3 DPG Hypercapnia Hyperthermia
All of these cause oxygen to unload into tissues
What causes a left shift on the oxyhemoglobin dissociative curve?
A reverse Bohr or left shift can be caused by:
Hypothermia Hypocapnia Alkalosis Decreased 2,3 DPG Decreased phosphate
There will be a decrease in unloading O2 into the tissues
Which acid-base imbalance is more common in renal failure patients?
Metabolic acidosis
What are the two types of ventilation?
Pressure and volume
What is different about ARDS ventilator support
Inverse ratio ventilation
Where the inhalation is longer than the exhalation
What is the best way to prevent VAP in a vented patient.
Keep HOB 30 degrees
This condition is caused by direct or indirect injury to the lungs. Leading to significant inflammation and mediator release. This resulting in increased capillary permeability
ARDS
A P/F ratio of less than this is a sign of ARDS
Which of the following assessment data would indicate that a patient was ready for a SBT?
A. He has been on the ventilator for a week
B. He is breathing over the set ventilator rate
C. The vasopressor was discontinued yesterday
D. He has been reached for 3 days
C
Restabilization is the indicator
An intubated patient post-op is beginning to wake up. Vent settings are AC with a rate of 14, TV 450, FIO2 60%, 5 PEEP. Other assessments: RR 36; ABG: PAO2 150, PaCO2 28, pH 7.52, HCO3 24. What changes should the nurse anticipate?
A. No changes to vent settings; administer an antianxiety agent
B. Decrease the FIO2 and consider pain medication
C. Decrease the tidal volume (TV) and increase the PEEP
D. Changes in mode to PC and decrease the FIO2
B
Hyper oxygenation and hyperventilation must be addressed
Decreasing the FIO2 will decrease the PaO2
Adding pain meds will decrease hyperventilation
Note if you were to increase PEEP that would make the hyper oxygenation worse
COPD and ARDS are both what type of lung diseases?
Restrictive
Name 3 exclusion criteria for SBT?
- PEEP > 10
- Inverse ratio ventilation (IRV) ARDS
- Closed head injury
Why do COPDers have Afib?
Decreased oxygen causes pulmonary construction and pulmonary HTN to compensate. This leads to cor polmonale and afib
Does the body make bicarbonate?
No. It excreted acid to raise bicarbonate levels. Bicarbonate is a ratio
What is a important diet for the COPD sufferer?
High calorie (5,000/day) Low carbohydrate
