CARDIOVASCULAR SYSTEM Flashcards
-1st heart sound
-“lubb”
-systole
S1
-2ND HEART SOUND
-dubb
-t-wave
S2
ventricular repolarization (relax)
s2
closure of AV valve
“lubb” s1
closure of tricuspid/mitral valve
“systole” s1
closure of semilunar valve
dubb ; s2
closure of aortic/pulmonic
diastole; s2
-3rd heart sound
-murmur heard
S3
what causes s3 heart sound
ventricular gallop
normal occurence of s3:
-infants upto 6 mons
-pregnancy
-athletes
heart sound:
-Hypertension
s4
s4 is due to?
rapid filling of blood in ventricle
commonly assessed in elderly
s4
what causes s4?
atrial gallop
medication that delays impulses from SA to AV nodes
calcium channel blockers (dipine)
medication that decreases ventricular contractions; promote healing
beta-blockers
Nursing alert for CCB & BB
check HR & RR
SIDE EFFECTS OF CALCIUM CHANNEL & BETA BLOCKERS
-bradycardia
-hypotension
-vasodilation
-impotence
CONTRAINDICATIONS while taking Beta-blockers & calcium channel blocker
-asthma/bronchitis
-heart block: lowers ventricular contraction
-CHF: decrease cardiac output
-DM: increase viscosity + beta-blockers= thrombus (clot) formation
5 waves of ECG
P-WAVE
PR- INTERVAL
QRS-COMPLEX
ST- SEGMENT
T-WAVE
QT SEGMENT
atrial depolarization : ecg
p-wave
ecg:
-travel of impulse from SA to AV node
-drop of blood from atrium to ventricle
PR interval
ecg:
-s1 lubb
-ventricular depolarization
QRS complex
ecg:
-point of ventricular contraction just before relaxation
ST segment
ecg:
-s2 dubb
-ventricular repolarization
t-wave
whole phase of ventricular contraction to relaxation
QT segment
decrease myocardial oxygenation
CAD (Coronary artery disease)
ACS (acute corony syndrome)
AKA heart attack
-myocardial tissue necrosisdue to ischemia (low oxygen)
MI (myocardial infarction)
type of MI:
Both right & left coronary artery are obstructed
TRANSMURAL
type of MI:
1 coronary artery is only obstructed
SUBENDOCARDIAL
MI/ISCHEMIA
Short pathophysio
OCCLUSION
—->
Myocardial ischemia/ insufficiency
—->
Chest pain
occlusion in MI/ Ischemia
-Thrombus
-Atherosclerosis
-Arterioscelorosis
plaque formation
atherosclerosis
hardened plaques
arteriosclerosis
Universal sign of chest pain:
Levine’s sign
Characteristic of Chest pain:
Chest tightness
-Permanent/total blockage
-long in duration (>10 mins)
-cant be relieved by rest
MI
DOC for Angina pectoris
Nitroglycerin
Complication of MI
Ventricular arrhythmia/ Dysrrythmia
-Most life threatening
-Unstable: 1st 6-8 hours
-Safest: after 24 hours
DOC: MI
Morphine Sulfate
CARDIOGENIC SHOCK
DECREASE/LOW:
-Ventricular contraction
-HR
-cardiac output
-BP (shock)
Ventricular arrhythmia; SAFEST TIME
After 24 hours
Ventricular arrhythmia: unstable
1st 6-8 hours
Type of angina that is unpredictable and occurs at rest
unstable/atypical angina
Type of angina that is predictable and occurs on activity
stable/ typical angina
Type of angina that is due to vasospasm or exposure to cold
prinzmetal/ variant angina
DOC: Cardiogenic shock
ADRENALINE : E-N-D
-sympathetic
-Norepinephrine
-Epinephrine
-Dopamine
Left sided
s3 murmur
fluid shift to the lungs
CHF
Complications of MI
-Ventricular arrhythmia/ dysrhythmias
-Cardiogenic shock
-CHF
No. 1 cause of death in MI
PVC
(Premature ventricular contraction)
Characteristics of PVC:
-No P-waves
-Bizzare QRS
-Widening of QRS
DOC: PVC
lidocaine (xylocaine)
SE: lowers HR
SE of Lidocaine
lowers HR
DOC: PVC w/ bradycardia
Atropine Sulfate
Diagnostic test for MI
-Tropinin I
-CPK-MB
-SGOT (AST)
-LDL
-ECG
troponin r/t heart
troponin I
troponin not r/t heart
troponin T
Most sensitive: Troponin
onset; 1-3 hours & remains elevated to 1 week
Most specific: Troponin
only becomes positive to necrosis
Onset & Peak of CPK-MB
onset: 4-6 hours
peak: 3-4 days
cpk- ____ for brain
cpk-BB
cpk-___ heart
cpk-mb
these enzymes is significant to indicate/diagnose tissue damage
CPK-MB
CPK-BB
AST
SGOT (HEART) Omega 3= Sweet heart
ALT
SGPT (LIVER) hePa = Liver
bad cholesterol (due to HPN)
-lead to atheroscelosis
LDL
Most commonly used to dx MI
ECG
ECG Zones of MI
3 I’s
-Ischemia: low oxygen (Inverted T-wave)
-Injury: damage (ST elevation)
-infarction: occlusion (Pathologic q-wave)
low oxygen (Inverted T-wave)
ischemia
damage (ST elevation)
cardiac injury
occlusion (Pathologic q-wave)
infarction
MANAGEMENT FOR ANGINA OR CHEST PAIN
R-O-N-P-A-T-H
-rest (sit): lowers 02 demand, lower 02 consumption
-oxygen administration: saturate ischemic myocardium
-nitroglycerine: parasympathetic stimulation
-morPhine sulfate: anticipate MI; Vasodilator
-aspirin
-thrombolytic
-heparin
***aspirin,thrombolyitc,heparin = bleeding precautions
how to administer nitroglycerin
3 tabs @ 5 minutes interval
SE of nitroglycerin
hypotension
Nursing responsibility when administering NITROGLYCERIN
check BP before administering
Hold if SBP= <100 mmhg
Most common complain upon 1st take of nitroglycerin
Headache
-NORMAL SIDE EFFECT
Burning/tingling sensation under tongue upon 1st take
-NORMAL SIDE EFFECT
Route of Nitroglycerin
Sublingual
where to store nitroglycerin
dark & airtight container
-photosensitive
nitroglycerin can be stored up to
6 months
Health educate: When to take nitroglycerin
Taken before strenous activity
plan of care for MI
M-O-N-A-YAN
-Morphine sulfate
-Narcotic analgesic
-CNS depressant
-Decrease O2 demand; low o2
consump.
-O2 administration
-Nitroglycerin
-Aspirin (Antiplatelet)
Antidote for morphine sulfate
Naloxone (Narcan)
If the cause of MI is due to thrombus (clot)
M-O-N-A-T
THROMBOLYTICS
-dissolves thrombus
Effective within: 24 hours
Most effective: within 2-3 hours
If the cause of MI is due to HPN
M-O-N-A-B
BETA-BLOCKERS (Metropolol)
PTT is for
Partial Thromboplastin Time: HEPARIN
PT is for
Protamine Time: WARFARIN
Uses dye (contrast) where thin catheter is inserted to locate occlusion (blockage)
CARDIAC CATHERIZATION
Site for Cardiac catherization
Brachial or Femoral
Complications of cardiac Catheterization on site
-Bleeding
-hematoma
-vasospasm
-edema/swelling
Uses balloon to inflate & deflate
-to relieve blockage or occlusion
PTCA (Percutaneous transluminal coronary angioplasty)
Complication of PTCA:
Vasospasm
Thrombus
DOC: Vasospam
vasodilator
DOC: thrombus
anticoagulant
by-pass- or diversion of blood flow to maintain circulation
-indicated for 2 or more occlusion
CABG (coronary artery bypass grafting)/ heart by pass
-Attached to heart-lung machine during surgery
-unconscious
-endotracheal tube
-Problem: communication
Nrsg intervention: Pen & paper
S3 Murmur
CHF
Types of CHF
Left sided CHF
Right sided CHF
Mixed combined L&R
Cause of Right sided CHF
-Tricuspid stenosis
-pulmonic stenosis
-ventricular hypertrophy (r)
-COPD
Causes of Left sided CHF
-Mitral stenosis
-MI
-aortic stenosis
-Rheumatic heart disease: cause by GHABS
RIGHT SIDED CHF
S/SX
SYSTEMIC MANIFESTATION:
SEEN BY NAKED EYES
-jugular vein distention
-edema
-ascites
-hepatomegaly
-jaundice
-oliguria
-weight gain
LEFT SIDED CHF
S/SX
BREATHING MANIFESTATION:
-dyspnea
-orthopnea
-rales or crackles
-pulmonary edema
DECREASE CARDIAC OUTPUT:
-dizziness
-fainting
-syncope
-restlessness (1st sign of hypoxia)
-muscle weakness
-fatigue
-apathy
PLAN OF CARE FOR CHF
GOAL:
Decrease workload;
-low O2 consumption
-bedrest
-diazepam (valium): sedative & muscle relaxant
L-CHF: o2 admin
R-CHF: restrict fluid & administer diuretics
DOC to increase cardiac output
DIGOXIN (LANOXIN)
S/SX that is expected/document: POLYURIA
S/sx that is reportable: OLIGURIA (toxicity)
Position of choice for LEFT CHF
Sitting; upright; high-fowlers (dyspnea)
Position of choice for RIGHT CHF
Low fowlers (30 degrees); to measure JVD
(+) R- CHF
JVD is measured more than 4cm = positive Right sided CHF
how to determine if diuretic is effective?
(-) lung clear sound upon auscultation
(-) crackles
Nursing responsibility when giving digoxin?
Check: HR & Apical Pulse
Hold: <60 bpm
S/SX of digitalis toxicity
BANDAV
-bradycardia
-anorexia
-nausea
-abdominal cramping
-visual disturbances (GREEN/YELLOW; HALO VISION)
Antidote: Digitalis toxicity
DIGIBAND; IMMUNO FAB
What heart sound is commonly assesed in elderly?
S4
is the only VS tha increases (due to stiffening of blood vessels) with aging and the rest decreases.
BP
heeart chamber that is the most damaged in pt with MI.
left Ventricle
Common cause of non-compliance of beta-blockers among male pt.
IMPOTENCE
Why there is no atrial repolarization?
The resting phase of atrium was overpowered by the contractions of ventricles.
common cause of MI is
THROMBUS/ CORONARY ARTERY THROMBOSIS
To relieve chest pain; “To saturate the ischemic myocardium.”
O2 Admin. (6-8 LPM)
Universal sign of MI
LEVINE’S SIGN ;Chest hand clutching
Intermittent Claudation; Decrease Leg muscular O2.
Buerger’s Disease
-the nurse is caring for the pt wth MI, which of the ff cardiac enzyme is least specific?
A.Troponin B. cpk-mb C. SGPOT
D.Cpk-bb
c
Reportable PVC
6-8 pvc/minute or Trigeminal PVC
EPINEPHRINE AND LIDOCAINE EFFECT:
Epinephrine is vasoconstriction; thus delays/prolonged the effect of anesthesia
1st drug of choice for PVC
Lidocaine
(However, Atropine sulfate is used for bradypneic pt)
Priority, best, initial should prepare, 1st
Morphine Sulfate
chest pain
o2
-Mr. C is rush to the Hospital with Diagnosis of MI while transporting in ambulance, the pt complains of chestpain. Which of the ff drug will the nurse administer first?
A. Morphine B.aspirin C. Oxygen D.Nitroglycerine
aspirin (bc it is readily accessible)
when to bring patient with MI to hospital if taking nictroglycerin
AFTER 2ND DOSE.
INR (Imterntional Normalize Ratio)- Most specific for coumadin
-PT= 10-12 Secs
-PTT= 30-45 Secs
-INR= 1-2 secs
la lang
Sex is resumed in MI
6 weeks post MI (1 1/2 month) and able to climb atleast 2 flights of stairs without SOB; Should be done before meal.
When to resume ADL after cardiac catheterization?
:WHEN VS IS ALREADY STABLE.
Due to alcohol TYPE OF CIRRHOSIS
Leannec’s/Portal Cirhossis
Due to Right sided heart failure
CARDIAC CIRRHOSIS