Cardiovascular System Flashcards
normal PR interval
.10-.20
normal QRS complex
.05-.12
saw tooth waves are characteristic of…
atrial flutter
causes of atrial flutter
heart disease
MI
CHF
pericarditis
tx for atrial flutter
If hemodynamically stable → vigilant observation
If hemodynamically unstable → digitalis, beta blockers
Lastly - cardioversion
causes of atrial fibrillation
heart disease
pulmonary disease
stress
alcohol
caffeine
tx for a fib
If a common rhythm disturbance in a hemodynamically stable patient → might be no treatment
Digitalis, CCBs, BBs
Cardioversion if unstable
Sync cardioversion shocks on R wave
how to tx v tach
Patient is awake and alert with adequate vital signs → amiodarone
-150 mg IV bolus over 10 minutes
-Might add BB to prevent from coming back
If patient has inadequate vital signs and is not awake → treat with defib/cardioversion
what is v fib referred to as?
sudden cardiac death
tx for v fib
Defibrillate
CPR
Defibrillate
CPR, epinephrine 3-5 mins
Defibrillate
Continue with CPR, ACLS protocol
Second drug of choice = amiodarone high dose (300 mg IV)
do you have a pulse with v fib
rhythm does not generate a pulse
which receptors are in the heart
beta 1
when heart rate goes up, what is it called
chornotropy
when contractility increases, what is it called
inotrophy
what is CO
amount of blood heart pumps per minute
SV x HR
normal CO
4-8 l / minute
normal CVP
2-8 mmhg
MOA of ace inhibitors
blocks conversion of angiotensin to angiotensin II
results in decreased renin levels –> decreased aldosterone
results in vasodilation
3 nursing considerations for ACE inhibitors
can cause dry cough - need to manage so it doesn’t lead to angioedema
monitor BP
contraindicated during pregnancy
which drugs are the sartans?
ARBs
nursing considerations for CCBs
avoid grapefruit
monitor for orthostatic hypotension
gingival hyperplasia
what kind of drug is amlodipine
CCB (selective)
do patients on CCBs need to stop taking calcium supplements
no
what are 2 examples of arterial vasodilator
hydralazine
minoxidil
when is hydralazine used
hypertensive crisis
what are 2 venous dilators
nitroglycerine
isosorbide dinitrate
3 nursing considerations for beta blockers
do not discontinue abruptly
can mask signs of hypoglycemia
caution with asthma and COPD - can cause bronchospasm
what kind of med is amiodarone
k+ channel blocker
MOA of amiodarone
stops K+ from leaving cells and prolongs resting period
which clients should not receive atropine
clients with glaucoma because it’ll cause blurred vision (it is an anticholinergic)
when should adenosine be used
SVT
how should adenosine be administred
rapid push
what does digoxin do
increased contractility (+ inotrope)
decrease HR (- chronotrope)
what are therapeutic lab levels for digoxin
.5-2ng/ml
early signs of digoxin toxicity
n/v
anorexia
vision changes
late signs/symptoms of digoxin
bradycardia –> arrythmias
which electrolyte abnormalities increases digoxin toxicity
hypokalemia
hypomagnesemia
hypercalcemia
what does licorice extract act like
aldosterone –> Na/H2O retention, and K+ loss
when should you hold digoxin
HR < 60
what is the antidote for digoxin
digoxin immune fab
do you have a pedal pulse in peripheral vascular disease
YES because when you palpate pulses you are feeling for pulsation through an artery
what is peripheral vascular disease
inadequate venous return over a long period
s/s of peripheral vascular disease
brown discoloration
uneven wound edges around ankle
swelling
tx for peripheral vascular disease
elevate legs
focus on proper wound care
superior vena cava syndrome: what is the patho
blood can’t drain from upper body d/t tumor or solid body putting pressure on SVC
s/s of superior vena cava syndrome
headache
blurry vision
glossitis
distension of veins above chest
upper extremity edema
dyspnea
facial plethora
what is facial plethora
facial swelling and puffiness
redness
symptom of SVC
what are 4 causes of aneurysms
atherosclerosis
HTN
smoking
family history
what is an aneurysm?
local dialation of a vessel wall
most common = aorta
s/s of abdominal aortic aneurysm
abdominal/back pain
gnawing/sharp pain
s/s of thoracic aortic aneurysm
SOB
hoarseness/struggling to swallow
upper back pain
which patients are at risk for embolism
pregnancy d/t hypercoagulable state
a fib
long bone fracture (fat embolism)
s/s of fat embolism
hypoxia
dyspnea
tachypnea
confusion
altered LOC
petechial rash
what is peripheral arterial disease
atherosclerosis of arteries that perfuse limbs
4 signs of PAD
pallor
pulselessness
hairlessness
intermittent claudication
poor/absent pedal pulses
eschar in wounds
what is intermittent claudication
pain that occurs in legs when walking
pain that gets better with rest
tx for PAD
dangle legs
antiplatelet therapy
tx for PVD
elevate legs
proper wound care
instructions for nitroglycerine
do not swallow
sublingual
administered 1 pill q5 mins for 3 doses
expect a headache!
keep in a dark bottle in dry, cool place
is a myocardial infarction reversible or irreversible damage
irreversible
what does ST elevation inidcate
injury
QRS does not come back to baseline
inverted T wave
what would show ischemia on a EKG
ST depression and/or T wave inversion
what is door to balloon time? (PCI)
90 minutes
3 causes of pericarditis
infection
tumor
drugs
4 findings for pericarditis
sharp chest pain
tachypnea
fever & chills
weakness
tx for pericarditis
NSAIDs
2 findings for pericardial effusion
chest pain
muffled heart sounds d/t fluid
tx or pericardial effusion
pericardiocentesis to remove fluid
cardiac tamponande s/s
chest pain
SOB
decreased CO
muffled heart sounds
JVD
narrowed pulse pressure (<40)
what is endocarditis
infection and inflammation of the endocardium
what is the number 1 cause of HF
HTN
LHF symtpoms (FORCED)
fatigue
orthopnea
rales/restlessness
cyanosis/confusion
extreme weakness
dyspnea
8 signs of RHF
JVD
dependent edema
hepatomegaly
splenomegaly
ascites
weight gain
fatigue
anorexia
how do you decrease workload of the heart
ACEs to decrease afterload
ARBs to decrease afterload
diuretics
digoxin to increase contractility
what does hyperkalemia look like on an EKG
wide flat P
prolonged PR
widened QRS
depressed ST
tall peaked T waves
if you see prominent u-waves on an EKG, what electrolyte imbalance exists
hypokalemia
what electrolyte disturbance can cause long QT
hypo calcemia –> can lead to v tach
hypomagnesemia EKG
prolonged PR
long QT
can go into torsades!
hypermagnesemia EKG
wide flat P wave
tall T wave (not peaked)
what receptors does norepi work on
alpha 1
causes peripheral vasoconstriction
when is dopamine used
low doses used in kidney failure to increase renal blood flow
low doses increases contractility
high doses cause vasoconstriction
when is milrinone used
cardiogenic shock
decreased CO
congenital/aquired heart defects
what kind of drug is milrinone
phosphodiesterase inhibitor
phosphodiesterase breaks down cAMP
allows heart o contract more
s/s of cardiac tamponade
tachycardia
tachypnea
pericardial rub
JVD
hypotension
narrowed pulse pressure
