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CCRN > Cardiovascular Part 2 and pulmonary > Flashcards

Cardiovascular Part 2 and pulmonary Flashcards

1
Q

Another name for diastolic heart failure is what?

A

HF-PEF

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2
Q

What medication prevents cardiac remodeling in HF patients?

A

ACEI

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3
Q

What medication prevents sudden cardiac death in HF patients?

A

Beta blocker

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4
Q

What medications would you prescribe a CHF patient?

A

Vasodilators to reduce preload and afterload–hydralazine or isodil

BB
ACEI
Diuretics
Inotropes? I’d cool and clammy

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5
Q

An IABP improved cardiovascular function how in HF patients?

A

It decreases afterload and increasing diastolic pressure which improves coronary perfusion

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6
Q

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

A

B- the problem is poor ventricular contractility

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7
Q

Inverted T wave on an EKG indicates what?

A

Ischemia, which is reversible

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8
Q

ST elevations on an EKG indicate what?

A

Injury

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9
Q

Q waves on an EKG indicate what?

A

Infarct

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10
Q

ST elevations in 2,3,AVF indicate what?

A

Inferior MI

Usually the RCA

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11
Q

ST elevations in V2 V3 and V4 indicate what?

A

Anterior MI

Usually the LAD

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12
Q

Septal MI show ST elevations where?

A

V1 and some V2

LAD

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13
Q

A lateral MI shows ST elevation where? Which vessel is involved?

A

I, AVL, V5, V6

Circumflex artery

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14
Q

GP IIb/IIIa inhibitors are given to which patients?

A

Patients prior to and after PCI

Ab ixia band Integrillin

Screen as you would for a fibrinolytic

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15
Q

Post MI patients should get a ACEI if their EF is what?

A
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16
Q

NSTEMIs are characterized by what findings?

A

ST depressions and T inversions

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17
Q

What meds will you discharge an MI patient on?

A

Plavix
ASA
ACEI (if EF

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18
Q

How do you monitor post MI with angioplasty for acute closure of target vessel?

A

ST segment monitoring

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19
Q

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?

A

Papillary muscle rupture

20
Q

Post MI a patient has decreased BP and CO, a narrowing PP, tachycardic, muffled heart tones and PEA. What has likely occurred?

A

Cardiac tamponade

21
Q

Aortic insufficiency/aortic regurgitation leads to what kind of symptoms?

A

Left ventricular volume overload

22
Q

Aortic stenosis patients develop what condition?

A

Lavage due to narrowing of aorta.

23
Q

What is detrimental in aortic stenosis?

A

Don’t lower BP too much
No tachycardia
No AF

24
Q

Mitral insufficiency/ regurg is associated with what on PA waveform?

A

Large V waves

25
Q

Peripheral artery disease signs and symptoms are what?

A 
Pain, especially with elevation of extremities
Cool, pale skin
Hair loss to extremities,
Ulcers
Sluggish cap refill
Weak or absent peripheral pulse
26
Q

What are the 6 Ps of PAD?

A 
Pain
Pallor 
Pulselessness
Poiklothermia
Paralysis 
Parasthesia
27
Q

Ankle-brachial index is a tool used how? Why do we do it?

A

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

28
Q

Which type(s) of aortic aneurysm occur in the ascending aorta?

A

Type 1 & 2

29
Q

Which type(s) of aortic aneurysm originated in the descending aorta

A

Type 3

30
Q

Which aneurysm(s) are surgical emergencies?

A

Ascending aortic aneurysms

Type 1 & 2

31
Q

What are the goals for type B (descending aortic aneurysms)

A

Medical management
Systolic BP as low as possible
Decrease left ventricular contractility

32
Q

What is the Bohr effect? What causes this?

A

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

33
Q

What causes a left shift on the oxyhemoglobin dissociative curve?

A

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

34
Q

Which acid-base imbalance is more common in renal failure patients?

A

Metabolic acidosis

35
Q

What are the two types of ventilation?

A

Pressure and volume

36
Q

What is different about ARDS ventilator support

A

Inverse ratio ventilation

Where the inhalation is longer than the exhalation

37
Q

What is the best way to prevent VAP in a vented patient.

A

Keep HOB 30 degrees

38
Q

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

A

ARDS

39
Q

A P/F ratio of less than this is a sign of ARDS

A
40
Q

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

A

C

Restabilization is the indicator

41
Q

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

A

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

42
Q

COPD and ARDS are both what type of lung diseases?

A

Restrictive

43
Q

Name 3 exclusion criteria for SBT?

A
  1. PEEP > 10
  2. Inverse ratio ventilation (IRV) ARDS
  3. Closed head injury
44
Q

Why do COPDers have Afib?

A

Decreased oxygen causes pulmonary construction and pulmonary HTN to compensate. This leads to cor polmonale and afib

45
Q

Does the body make bicarbonate?

A

No. It excreted acid to raise bicarbonate levels. Bicarbonate is a ratio

46
Q

What is a important diet for the COPD sufferer?

A 
High calorie (5,000/day)
Low carbohydrate

CCRN (9 decks)

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