Cardiovascular System (Exam One) Flashcards
1
Q
What is the purpose of the cardiovascular system?
A
To perfuse the organs and tissues with oxygenated blood
2
Q
What three protective layers make up the pericardial sac?
A
- Fibrous pericardium
- Parietal pericardium
- Visceral pericardium (Epicardium)
3
Q
What is the fibrous pericardium?
A
A loose fitting sac that outlines and hold the heart
4
Q
What is the parietal pericardium?
A
- A serous membrane
- Fluid lines this area and helps reduce friction
5
Q
What is the visceral pericardium (epicardium)?
A
- The inner most protective layer of the pericardial sac
- Covers the heart muscle directly
- The outermost cardiac layer
- Prevents friction as the heart beats
6
Q
Name the cardiac layers.
A
- Epicardium
- Myocardium
- Endocardium
7
Q
What is the myocardium?
A
- Actual muscle within the heart
- Aides in contraction of the heart
8
Q
What is the endocardium? What is its primary purpose?
A
- Composed of smooth epithelial tissue
- The inside cardiac chamber
- Lines the inside of the heart
- Lines all cardiac chambers and valves
-Prevents abnormal clotting
9
Q
What are coronary arteries?
A
- Arteries that surround the heart and provide the heart with oxygenated blood
- Oxygenated blood travels from the aorta to the cardiac arteries
- Without the coronary arteries, the heart wouldn’t receive oxygenated blood and would not function = death
10
Q
Name the four cardiac chambers.
A
-Superior Chambers:
Right Atrium
Left Atrium
-Inferior Chambers:
Right Ventricle
Left Ventricle
11
Q
What is the purpose of cardiac valves?
A
- Prevent the back flow of blood
- Keep blood moving in a forward direction
12
Q
What are the two classes of cardiac valves?
A
- Atrioventricular valves (AV Valves)
- Semilunar Valves
13
Q
What are the two atrioventricular valves?
HINT: Always “tri” to do the “right” thing
A
- Right Atrioventricular Valve (Tricuspid Valve)
- Left Atrioventricular Valve (Bicuspid Valve)
14
Q
What are the two semilunar valves?
A
- Pulmonary/Pulmonic Valve
- Aortic Valve
15
Q
Blood enters the heart through the right atrium by:
A
- Coronary sinus
- Superior vena cava (upper body)
- Inferior vena cava (lower body)
16
Q
What is the coronary sinus?
A
-Collection of veins that collects blood from the myocardium
17
Q
When blood is flowing from the atria to the ventricles, what valves are open?
A
- The atrioventricular valves are open(tricuspid & bicuspid)
* The semilunar valves are closed (pulmonic and aortic)
18
Q
When blood is flowing from the ventricles to the lungs and body, what valves are open?
A
- The semilunar valves are open (pulmonic and aortic)
* The atrioventricular valves are closed (tricuspid & bicuspid)
19
Q
In order, list the structures that blood flows through in the heart.
A
Inferior/Superior Vena Cava » Right Atrium » Tricuspid Valve » Right Ventricle » Pulmonic/Pulmonary Valve » Pulmonary Artery » Lungs (oxygenation occurs) » Pulmonary Veins » Left Atrium » Mitral Valve » Left Ventricle » Aortic Valve » Aorta » Body Tissue/Organs
20
Q
The only vein within the body that carries oxygenated blood is what?
A
Pulmonary vein
21
Q
The only artery within the body that carries deoxygenated blood is what?
A
Pulmonary artery
22
Q
One cycle of cardiac activity can be divided into what two phases?
A
Systole and Diastole
23
Q
Define systole.
A
- Systole is when the chambers are contracting (squeezing)
- Blood is being pushed from the chambers out to body
- Also known as period of ejection
24
Q
Define diastole.
A
- Diastole is when the chambers are relaxing (filling with blood)
- Blood is filling into the chambers
25
What is occurring during atrial systole?
- Atria are contracting, squeezing blood out
- Atrioventricular valves (tricuspid & bicuspid) are open, allowing blood to flow from atria to ventricles
- Ventricles are in diastole, filling with blood sent from atria
- Semilunar valves (pulmonic & aortic) are closed, to keep blood in ventricles
26
What is occurring during atrial diastole?
- Atria are relaxing & filling (blood is flowing from the body via inferior and superior vena cava)
- Atrioventricular valves (tricuspid & bicuspid) are closed, to keep blood in the atria
- Ventricles are in systole, contracting and squeezing blood into the lungs and body
- Semilunar valves (pulmonic & aortic) are open, allowing blood to flow out of the ventricles
27
What is occurring during ventricular systole?
- Ventricles are contracting, squeezing blood out
- Semilunar valves (pulmonic & aortic) are open, allowing blood to flow out of the ventricles
- Atria are relaxing & filling (blood is flowing from the body via inferior and superior vena cava)
- Atrioventricular valves (tricuspid & bicuspid) are closed, to keep blood in the atria
28
What is occurring during ventricular diastole?
- Ventricles are relaxing, filling with blood from the atria
- Semilunar valves (pulmonic & aortic) are closed, to keep blood in ventricles
- Atria are contracting, squeezing blood out
- Atrioventricular valves (tricuspid & bicuspid) are open, allowing blood to flow from atria to ventricles
29
Heart sounds are made from what?
Closure of valves
30
What is the equation for cardiac output?
Cardiac Output = Stroke Volume * Heart Rate
CO = SV * HR
31
What is cardiac output? What is the average resting cardiac output?
- Amount of blood ejected from left ventricle in one minute
| - 5L to 6L per minute (considered normal)
32
Define ejection fraction.
Total amount of blood the left ventricle pumps out with each contraction
33
Normal range for ejection fraction for a healthy adult?
55% to 70%
34
What affect does epinephrine and norepinephrine have on the heart?
- Activates beta one receptors
- Increases heart rate
- Increases force of cardiac contraction
- Increases cardiac output
- Dilates coronary vessels
- Blood pressure increases due to increased cardiac output
35
How does aldosterone work on the heart?
- Regulates sodium and potassium which are needed for electrical activity of the heart
- When sodium is retained, fluid follows increasing intravascular volume within the body, thus increasing blood pressure
36
What is atrial natriuretic peptide (ANP)? How does ANP work on the heart?
- Increases excretion of sodium, by inhibiting the secretion of aldosterone
- Sodium loss accompanied by water loss will decrease blood volume, thus decreasing blood pressure
37
List what occurs within the cardiovascular system as a person ages
- Blood vessels begin aging in childhood
- Atherosclerosis
- Resting blood pressure increases
- Left ventricle workload increases, causing the heart muscle to become less efficient
- Vein valves are less competent
- Resting heart rate decreases
- Dysrhythmias are common
- Heart sounds are distant due to kyphosis
38
What subjective data is part of the nursing assessment regarding the cardiovascular system?
- Alcohol, tobacco, illicit drug use
- Angina
- Dyspnea
- Orthopnea
- Cough
- Fatigue
- Cyanosis, pallor
- Edema
- Personal cardiac history
- Family cardiac history
39
What objective data is part of inspection regarding the cardiovascular system?
HINT: Look but do not touch!
- Inspection begins when you first see the patient!
- SOB
- Cyanosis
- Leg discoloration/edema
- Jugular venous distention (JVD)
- Visible pulsations/exaggerated lifts
40
A capillary refill < 3 seconds indicates what?
Appropriate arterial blood flow & oxygenation to the extremities
41
A capillary refill > 3 seconds indicated what?
A decrease in arterial blood flow & oxygenation to the extremities
42
What is the purpose of palpating a pulse? Which pulses can be palpated?
To assess volume and pressure quality
- Carotid
- Radial
- Dorsalis pedis
- PMI
43
What is a thready pulse?
Pulse that disappears when pressure is applied and returns when pressure is removed
44
What is a bounding pulse?
Pulse that is strong and present when pressure is applied
45
When should you auscultate an apical pulse?
-When heart rate is abnormal, <60 or >100
46
When palpating temperature, what would the nurse expect if the limbs are cool?
Decreased arterial blood flow
47
When palpating temperature, what would the nurse expect if the limbs are warm/hot?
Issue with venous blood flow
48
What is a ventricular gallup? When does this occur?
Normal heart sounds, followed by an additional sound (S3) right after the dubb (S2) sound
- Can occur in children and young adults (normal)
- Also occurs in older adults and may be indicative of an underlying condition
49
What is an atrial gallup? When does this occur?
- Presence of an S4 sound (usually occurs right before S1)
| - Occurs in patients with severe hypertension, coronary artery disease, pulmonary stenosis
50
What is a pulse deficit?
- Fewer radial beats than apical beats
| - Notify the physician!
51
What are the five areas for listening to heart sounds?
HINT: All Physicians Enjoy Taking Money
- Aortic
- Pulmonic
- ERBs Point
- Tricuspid
- Mitral
52
What is the definition of blood pressure?
- The pressure/force exerted on the artery walls
| - The greater the pressure/force, the higher the blood pressure
53
What factors influence and determine blood pressure?
- Cardiac Output (stroke volume x heart rate)
- Peripheral Vascular Resistance
- Viscosity of the blood
- Fluid volume
- Sympathetic Nervous System Response
- Renin release
54
What factors can affect a blood pressure reading?
- Size of cuff
- Clothing
- Unsupported extremity
- Talking
55
What is the purpose of the Renin-Angiotensin-Aldosterone System?
- To retain sodium, thus retaining fluid
- Increasing blood volume & increasing blood pressure
- Increasing serum sodium levels
- Increase renal perfusion
56
What are the steps of the Renin-Angiotensin-Aldosterone System?
1. Kidneys release Renin
2. Renin meets up with Angiotensinogen (which comes from the liver)
3. Chemical reaction occurs between Renin & Angiotensinogen --> Angiotensin I is created
4. Angiotensin Converting Enzyme (which comes from the lungs) converts Angiotensin I to Angiotensin II
5. Angiotensin II promotes vasoconstriction of the arteries/arterioles
6. Angiotensin II acts on the adrenal cortex, releasing aldosterone
7. Aldosterone acts on the kidneys to retain sodium
8. Retention of sodium causes fluid to be retained & potassium to be excreted
9. Blood volume increases, blood pressure increases, renal perfusion increases, serum sodium levels increases
10. When blood pressure is an appropriate level, the kidneys will stop releasing Renin and will stop RAAS
57
What conditions would cause the kidneys to activate the Renin-Angiotensin-Aldosterone System?
- Decreased blood pressure
- Decreased fluid volume
- Decreased serum sodium
- Decreased renal perfusion
- Increased urine sodium
58
Angiotensin II is a what?
Potent vasoconstrictor
59
List signs and symptoms of hypertension.
HINT: The silent killer
- Often no s/sx
| - Rare s/sx include: Headache, bloody nose, severe anxiety, dyspnea
60
List modifiable risk factors that have the ability to cause hypertension.
- Decreased activity level
- Smoking
- Poor diet
- Insufficient sleep
- Blood glucose level elevated
- Increased weight
- Poor stress management
- Diabetes Mellitus Type 2
- Excessive salt intake
- Excessive alcohol intake
61
List nonmodifiable risk factors that have the ability to cause hypertension
- Family history of HTN
- Increased age
- Race & Ethnicity
- Diabetes Mellitus Type 1
62
What blood pressure ranges fall under "elevated blood pressure"?
- Systolic: 120-129
| - Diastolic: <80
63
What blood pressure ranges fall under "stage one hypertension"?
- Systolic: 130-139
| - Diastolic: 80-89
64
What blood pressure ranges fall under "stage two hypertension"?
- Systolic: > or equal to 140
| - Diastolic: > or equal to 90
65
Define primary hypertension.
Chronic BP elevation without known cause
66
Define secondary hypertension.
Chronic BP elevation due to another issue within the body
67
What type of hypertension occurs primarily in older adults? What is it?
- Isolated Systolic Hypertension (ISH)
| - Systolic press of >140 with a diastolic pressure of <90 (high systolic with a normal or low diastolic)
68
List therapeutic measurements for hypertension control.
Modify lifestyle (adjust modifiable risk factors that are present), such as:
- Weight reduction
- Diet changes: DASH diet, more whole foods, less sugars, less fats, follow Mediterranean diet
- Increase physical activity
- Stop smoking
- Reduce stress
- Increase Sleep
-Start on antihypertension medications
69
What self care measures must a patient take to control blood pressure?
Decrease stress
Adjust lifestyle
Control modifiable risk factors
70
What education must a patient be provided with when starting on antihypertensive medication?
- Medication must be continued even if s/s are not present
- Get up slowly
- Change positions slowly
- Don't abruptly discontinue medications
* Always ask if the patient is taking their medication and if they are taking it as directed
71
Which two complications fall under a Hypertensive Crisis
- Hypertensive Urgency
| - Hypertensive Emergency
72
Who is at risk for going into a hypertensive crisis?
- A patient who doesn't adhere to their therapy
| - A patient who stops their medications abruptly
73
What is more concerning with a hypertensive crisis? The blood pressure reading or the rate of increase of the blood pressure?
The rate of increase of the blood pressure
74
Describe hypertensive urgency
- It is a severe elevation of the blood pressure that develops slowly: hours to days
- There is no target organ dysfunction!!
- Symptoms may or may not be present (severe headaches, nosebleeds, SOB, anxiety)
75
How is a hypertensive urgency treated?
- Oral medications
| - Follow up with HCP
76
Describe hypertensive emergency
- It is a severe elevation of the blood pressure that develops rapidly: acute increase in BP 180/120
- Target organ dysfunction may or has developed during this episode
- Can result in MI, HF, hypertensive encephalopathy
77
How is a hypertensive emergency treated?
- Hospital admission; critical care
| - BP gradually decreased
78
List the complications that can occur when hypertension remains unmanaged long term.
- Atherosclerosis
- Coronary artery disease
- Myocardial Infarction
- Heart Failure
- Left Ventricular Hypertrophy
- Stroke
- Kidney Disease
- Retina Damage
79
What medications fall under the drug class of a loop diuretic?
- Bumetanide (Bumex)
- Furosemide (Lasix)
- Tosemide (Demadex)
80
How does a diuretic work in the body?
- Increase urine output by inhibiting sodium and water reabsorption by the kidneys
- When fluid is removed, it will decrease intravascular fluid volume, thus lowering blood pressure and decreasing cardiac workload
81
For all diuretics the nurse should:
- Monitor I&Os and weight to determine fluid loss
- Monitor electrolyte imbalances which may occur quickly
- Teach patient to take in morning to reduce nocturia
- Monitor blood pressure before giving
- Teach patient to limit salt intake
82
The nurse should be cautious of causing what if IV loop diuretics are administered too quickly?
Ototoxicity (hearing loss)
83
How does a loop diuretic work?
- Acts in the loop of Henle to promote sodium and water loss
- It is a potent diuretic
- It increases renal secretion of sodium, chloride, potassium, and water
84
What should the nurse monitor when giving a loop diuretic?
Monitor for hypokalemia
85
What medications fall under the drug class of a Thiazide and Thiazide-Like Diuretics?
- Hydrochlorothiazide (HydroDIURIL)
| - Chlorothiazide (Diuril)
86
How does a Thiazide and Thiazide-Like diuretic work?
- Acts in the distal tubule to promote sodium, chloride, and water excretion
- Weak diuretic
87
What should the nurse monitor when giving a Thiazide or Thiazide-Like diuretic?
Monitor for:
- Hypokalemia
- Hypercalcemia
- Blood sugar in diabetics
88
How does a Potassium-Sparing diuretic work?
- Interferes with sodium-potassium exchange
- Act as an antagonist to aldosterone
- Retains potassium
- Weakest diuretic
89
What medication falls under the drug class of a Potassium-Sparing diuretic?
- Spironolactone (Aldactone)
| - Amiloride (Midamor)
90
What should the nurse monitor when giving a Potassium-Sparing diuretic?
Monitor for hyperkalemia
91
What medications fall under the drug class of a Beta Blocker? (differentiate between cardio selective and non selective)
HINT: “olol” MMANB
Cardio Selective (specifically target beta-1 receptors):
Metoprolol Tartrate (Lopressor)
Metoprolol Succinate Extended Release (Toprol XL)
Atenolol (Tenormin)
Bisoprolol
Nebivolol
```
Non Selective (can target beta-1 and beta-2 receptors):
Propranolol
Nadolol
Labetalol
Cavedilol
Sotalol
```
92
How does a Beta Blocker work?
HINT: Think opposite of fight or flight
-Decrease response from sympathetic nervous system
-Blocks beta receptors from binding to epinephrine and norepinephrine, which causes:
Decreased heart rate
Decreased cardiac output
Decreased cardiac workload
Decreased blood pressure
93
What nursing considerations should be made when administering a beta blocker?
- Check heart rate and blood pressure prior to administration
- Monitor for bronchospasm/SOB
- Educate patient to rise slowly and do not stop abruptly
94
What medications fall under the drug class of an Alpha-1 Blocker?
- Prazosin (Minipres)
| - Terazosin (Hytrin)
95
How does an Alpha-1 Blocker work?
HINT: Alpha=Arteries
-Block the epinephrine or norepinephrine from binding to alpha receptor thus dilating the arteries and decreasing the blood pressure
96
What should the nurse consider when giving an Alpha-1 Blocker?
- Check heart rate and blood pressure prior to administration
- May cause hypotension/tachycardia
- Educate patient to rise slowly and do not stop abruptly
97
What medications fall under the drug class of combined Alpha and Beta Blockers?
- Carvedilol (Coreg)
| - Labetalol (Normodyne)
98
How do the combined Alpha and Beta Blockers work?
-Block the binding of epinephrine and norepinephrine to both alpha- and beta-receptors
99
What should the nurse consider when giving a combined Alpha and Beta Blocker?
- Check heart rate and blood pressure prior to administration
- Monitor for bradycardia and hypotension
- Educate patient to rise slowly and do not stop abruptly
100
What medications fall under the drug class of Angiotensin-Converting Enzyme (ACE) Inhibitors?
HINT: "pril"
- Benazepril
- Enalapril
- Lisinopril
- Quinapril
- Ramipril
101
How do Angiotensin-Converting Enzyme (ACE) Inhibitors work?
- Affect RAAS by blocking the conversion of angiotensin I into angiotensin II causing dilation of the arteries and veins
- Reduce venous and arterial pressures
- Reduce preload and afterload
- Decrease blood volume
102
What side effects should be monitored with ACE Inhibitors?
- Cough
| - Angioedema
103
What should the nurse consider when administering an ACE Inhibitor?
- Check blood pressure prior to administration
- Monitor potassium levels if on other drugs that cause retention of potassium (hyperkalemia)
- Educate patient to rise slowly and do not stop abruptly
- Educate patient to report onset of new dry cough
104
What medications fall under the drug class of Angiotensin II Receptor Blockers (ARB)?
- Candesartan
- Losartan
- Olmesartan
- Valsartan
105
How do Angiotensin II Receptor Blockers (ARB) work?
HINT: "sartan"
- Blocking angiotensin II from binding to blood vessels and heart
- Block angiotensin II from simulating aldosterone secretion
106
What should the nurse consider when administering an Angiotensin II Receptor Blocker (ARB)?
- Check blood pressure prior to administration
- Educate patient to rise slowly and do not stop abruptly
- Educate patient to use sunscreen
107
Patients should never take what to medication classes together?
ACE Inhibitor and ARB
108
What medications fall under the drug class of Calcium Channel Blockers?
HINT: "pine"
- Diltiazem
- Verapamil
- Amlodipine
- Clevidipine
- Nifedipine
109
How does a Calcium Channel Blocker (CCB) work?
- Prevents movement of extracelluar calcium from entering the cell
- Promotes vasodilation
- Decreases afterload
- Slows cardiac conduction system
110
What should the nurse consider when administering a Calcium Channel Blocker?
- Check blood pressure and heart rate prior to administration
- Assess for angina
- Monitor digoxin levels and signs of toxicity
111
What are the side effects of Calcium Channel Blockers?
- Headaches
- Flushing
- Edema (only with amlodipine)
112
What medications fall under the drug class of Direct Vasodilators?
- Hydralazine
| - Minoxidil
113
How does a Direct Vasodilator work?
- Relaxes smooth muscles of vessels and causes vasodilation
- Short half-life
- More frequent dosing
114
What are the common side effects of a Direct Vasodilator?
- Headaches
- Flushing
- Tachycardia
115
What considerations must the nurse make when administering a Direct Vasodilator?
-Check blood pressure and heart rate prior to administration
116
What are some reasons diuretic (all types) are given?
```
To manage:
Hypertension
Chronic Heart Failure
Pulmonary Edema
Edema
```
117
Why is an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) given?
Treatment of:
Hypertension
Chronic Heart Failure
118
Why is an Angiotensin II Receptor Blocker (ARB) given?
Treatment of:
Hypertension
Chronic Heart Failure
119
Why is a Calcium Channel Blocker (CCB) given?
Treatment of:
Hypertension
Cardiac dysrhythmias (atrial fibrillation)
120
Why is a Beta Blocker given?
Treatment of:
Hypertension
Tachycardia
121
Why is a combo drug (Alpha and Beta Blocker) given?
Treatment of:
Hypertension
Tachycardia
122
Why is a direct vasodilator given?
Treatment of:
| Hypertension
123
What structures ensure a tight close of the bicuspid (mitral) and tricuspid valves?
- Chordae tendineae
| - Papillary muscles
124
What are the common causes of valvular disorders?
- Congenital defects
- Rheumatic fever
- Infection
- Hypertension
- Obesity
- Overall aging
- Pregnancy
125
What is stenosis? What type of blood flow is affected
HINT: StenOsis = Open
- Valve does not open fully
- Forward blood flow is affected
* Someone squeezing a straw as you try to push liquid through
126
What is regurgitation? What type of blood flow is affected
- Valve does not close fully
| - Blood backs up
127
What type of diagnostic test would a nurse use for valvular disorders?
Echocardiogram
128
What is a heart murmur?
- Turbulent blood flow through the heart
| - "Swishing" sound
129
What is a mitral valve prolapse?
- During systole the mitral valves buckle back into the left atrium (like a parachute)
- Most common
- Can lead to mitral regurgitation
- Usually benign
130
What are the signs and symptoms of mitral valve prolapse?
- Asymptomatic
- Murmur
- Atypical chest pain
- Dysrhythmias
- Palpations
- Dizziness
- Syncope
- Fatigue
- Dyspnea
- Anxiety
131
What causes mitral valve prolapse?
- Hereditary
- Infection damaging the valve
- Ischemic heart disease
- Cardiomyopathy
132
What is mitral regurgitation?
- Mitral valve does not close completely allowing backflow of blood into the left atrium
- Causes left atrium to dilate
133
What are the causes of mitral regurgitation?
- Rheumatic heart disease
- Endocarditis
- Rupture of chordae tendiineae/papillary muscle
- MVP
- HTN
- MI
- Cardiomyopathy
- Aging
- Congenital defects
134
What are the signs and symptoms of mitral regurgitation?
- Asymptomatic
- Murmur
- HF Symptoms
- Exertional dyspnea
- Fatigue
- Syncope
- Pulmonary edema
- Shock symptoms
135
What are possible treatments for mitral regurgitation?
- Medication (Beta Blocker, CCB, digitalis, anticoagulants)
- Surgery for severe MR
- Repair/replacement
- Vasodilators for non-surgical patients
136
What is mitral stenosis?
- Narrowing of the mitral valve opening
- Obstructs blood flow from the left atrium to the left ventricle
- Left ventricle does not receive all of the blood, reducing cardiac output
137
What causes mitral stenosis?
- Thickening of the mitral valve flaps and shortening of the chordae tendineae
- Rheumatic fever
- Congenital defects
- Tumor
- Rheumatoid arthritis
- Lupus
- Calcium deposits
138
What are the signs and symptoms of mitral stenosis?
- Asymptomatic
- Murmur
- Pulmonary symptoms
- Hemoptysis
- Fatigue
- Activity intolerance
- Syncope
- Palpations/chest pain
- Afib or Aflutter
139
What is aortic stenosis?
- Aortic valve does not open completely due to narrowing or thickening
- Left ventricle has difficulty pushing blood into the aorta
- Left ventricle can fail causing reduced cardiac output = decrease tissue perfusion
140
What are the causes of aortic stenosis?
- Congenital defects
- Rheumatic heart disease
- Calcification of aortic valve with aging
141
What are the signs and symptoms of aortic stenosis?
- Dizziness
- Syncope
- Exertional dyspnea
- Activity intolerance
- Angina
- HF s/sx !!!
- Narrowed pulse pressure (<40)
142
When do symptoms begin to occur with aortic stenosis?
When valve reaches 1/3 of its normal size
143
What is narrowed pulse pressure?
Difference between systolic and diastolic blood pressure
144
List complications of aortic stenosis?
- Arrhythmias
- Sudden death
- Endocarditis
- Heart failure!
- Emboli
145
What are the treatment options for aortic stenosis?
- Aortic valve replacement (most effective)
- Valvotomy
- Treatment of HF symptoms
146
Why must HCPs be cautious about giving a cardiac medication to a patient with aortic stenosis? What will they recommend instead?
- Blood pressure and cardiac output are already decreased, do not want medication to decrease them further
- Aortic valve replacement
147
What is aortic regurgitation?
- Improper closing of the aortic valve
- Results in backflow of blood to left ventricle from aorta during diastole
- Causes left ventricle to fail, cardiac output decreases
148
What causes aortic regurgitation?
- Congenital defects
- Aging
- Rheumatic heart disease
- Severe hypertension
- Endocarditis
- Aortic dissection
149
What are signs and symptoms of aortic regurgitation?
- Severe dyspnea
- Chest pain
- Fatigue
- Hypotension
- Atypical angina
- HF symptoms
- Forceful pulse that quickly collapses
150
What are the treatment options for aortic regurgitation?
- Vasodilators, digitalis, diuretics
| - Aortic valve repair/replacement
151
What is a Valvotomy (valvuloplasty)?
Balloon used to widen opening of stenosed valve
152
What is a Commissurotomy?
- Repairs stenosed valve
- Major surgery
- Patient placed on bypass
153
What is an Annuloplasty?
- Repair or reconstruction of valve flaps or annulus
| - Usually done on mitral valve
154
Which side of the heart do regurgitation and stenosis usually occur?
Left side
155
List the different types of valve replacements.
- Mechanical
- Biological
- TAVR
156
What must be considered when performing a valve replacement on a patient?
Religious preferences
157
If a patient receives a mechanical valve replacement, what medication do they have to be on? For how long? Why?
- Anticoagulant (Warfarin)
- Will be on it for life
- Due to turbulent blood flow which can cause clots
158
Who is the best candidate for a mechanical valve?
- Younger patient
| - Last longer
159
You can hear a click with this valve replacement.
Mechanical valve replacement
160
What is a biologic valve replacement?
- Valve constructed from tissue
- Does not last as long
- Do not have to be on blood thinner
161
Which valve replacement is done on high-risk patients?
- TAVR
| - Minimally invasive
162
What are all patients at risk for with any valve replacement?
Infective endocarditis
163
Patients who have had a valve replacement must be placed on what before having dental work done?
Prophylactic antibiotics
164
What diagnostic test is done to monitor a patient who has had a valve replacement? How often is this done?
- Echocardiogram
| - Yearly
165
What is infective endocarditis?
- Infection of the endocardium, which can also involve valves
- Can be acute or subacute
- Bacterial endocarditis is the main cause
- Can also be caused by fungus or virus
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List the risk factors for infective endocarditis.
- Age
- IV drug abuse
- Renal dialysis
- Gingival gum disease
- Men are more prone than women
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What is a potential complication with infective endocarditis?
Vegetations may break off and become an emboli
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What are the treatment options for infective endocarditis?
- IV antibiotics
- Antipyretics
- Rest
- Valve replacement
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What are the clinical manifestations of infective endocarditis?
- Fever
- Chills
- Muscle aches
- Fatigue
- Dyspnea
- Cough
- Hematuria
- Edema
- Murmur
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What are the vascular manifestations of infective endocarditis?
HINT: FROM JANE
- Fever
- Roth spots
- Osler nodes (painful)
- Murmur
- Janeway lesions (not painful)
- Anemia
- Nail bed hemorrhage
- Emboli
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What is pericarditis?
Inflammation of the pericardium causing restriction of heart movement during systole
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What are the signs and symptoms of pericarditis?
- Chest pain (worse with inspiration)
- Fever
- Orthopnea
- Fatigue
- Cough
- Palpatations
- Headache
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What complications are associated with pericarditis? Which is the most common?
- Pericardial effusion (most common)
| - Cardiac tamponade (life threatening!!)
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What can be done to treat pericarditis?
* Largely based on cause
- Antibiotics
- Bedrest
- NSAIDs
- Corticosteroids
- Pericardialcentesis
- Pericardial window
- Pericardiectomy
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What is pericardial effusion?
- Build-up of fluid in the pericardial space
| - Leads to cardiac tamponade which is life-threatening, EMERGENCY!!
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What is myocarditis?
- Rare inflammation of the myocardium
| - Often follows a virus
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What are the common causes of myocarditis?
- Viral infection
- Bacteria, parasites, fungi
- Medications
- Lead toxicity
- HIV
- Rheumatic fever
- Lupus
- Pericarditis of IE
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What are the signs and symptoms of myocarditis?
- None
- Fatigue
- Fever
- Pharyngitis
- Malaise, dyspnea
- Palpations
- GI discomfort
- Chest pain
- Tachycardia
- Sudden death
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What are the treatment options for myocarditis?
- Bedrest
- Avoid exercise
- Avoid alcohol/tobacco
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What is venous insufficiency?
- Damaged or aging valve no longer prevent backflow when blood is returning to the heart
- Blood pools in the lower extremities
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What are risk factors for venous insufficiency?
- Smoking
- History of DVT
- Family history
- Inactivity
- Professions that stand a lot
- Pregnancy
- Obesity
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What are the signs and symptoms of venous insufficiency?
- Swelling
- Itching
- Pain
- Cramping
- Discoloration of legs
- Restless legs
- Varicose veins
- DVT
- Ulcers
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Chronic venous insufficiency is _____.
Progressive
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What causes venous insufficiency ulcers?
Increased pressure and rupture of small veins
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What are treatment and prevention options for venous insufficiency?
- Compression hose/stockings
- Elevation of legs
- Avoid standing or sitting for long periods of time
- Move legs
- Avoid crossing legs
- Avoid restrictive clothing
- Unna boot
- Wound care
- Vein stripping
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What is Homan's Sign?
- Assessment for venous thrombosis
- Pain in calf or behind knee
- Not accurate
- Should not be performed if blood clot is diagnosed or confirmed
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What is thrombophlebitis?
Formation of a clot followed by inflammation of the vein
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What is the most serious complication of thrombophlebitis?
Pulmonary embolism
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What are the treatment options for thrombophlebitis?
- Compression stockings
- ASA
- Anticoagulants
- Warm, moist heat
- Early ambulation
- Thrombolytics
- Leg elevation
- Thrombectomy
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What is the therapeutic range for INR?
2-3
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What is the antidote for Warfarin?
Vitamin K
192
What education should you provide to a patient taking anticoagulants?
- Must take every day
| - Increased risk for bleeding
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What is the most common reason for hospitalization and readmission in older adults?
Heart failure
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Who is at highest risk for heart failure?
African American females
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What can cause heart failure?
- Coronary artery disease
- Myocardial Infarction
- Myocarditis
- Chronic HTN
- Heart valve disease/disorders
- Dysrhythmias such as Atrial Fibrillation
- Atrial Septal Defect
196
What events lead to left sided heart failure?
- Increased peripheral vascular resistance
| - Increased afterload
197
What is the most common form of heart disease and most common cause cause of heart failure?
Coronary artery disease
198
What compensatory mechanisms occur to increase cardiac output during heart failure?
- Activation of Sympathetic Nervous System
- Activation of Renin Angiotensin Aldosterone System
- Dilation of heart chambers (cardiac remodeling)
- Hypertrophy of heart chambers
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List the different types of heart failure.
- Left sided heart failure
- Right sided heart failure
- Congestive heart failure
- Pulmonary edema
- Chronic heart failure
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If left sided heart failure occurs, what happens to blood flow?
- The left ventricle weakens and is unable to keep up with the high demand of work
- Blood backs up from the left ventricle, through the mitral valve, to the left atrium, through the pulmonary vein, and into the lungs
201
Left-sided heart failure can be divided into what two categories?
- Systolic HF
| - Diastolic HF
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What happens during systolic heart failure?
- Left ventricle loses its ability to contract
- Blood can not be pushed into circulation
- Associated with low ejection fraction
203
What happens during diastolic heart failure?
- Left ventricle loses its ability to relax
| - Heart cannot properly fill with blood
204
List signs and symptoms of left sided heart failure.
HINT: Left=Lungs
- Paroxysmal Nocturnal Dyspnea
- Elevated pulmonary pressure
- Pulmonary Congestion/Edema
- Cough
- Crackles
- Wheezes
- Pink frothy sputum
- Tachypnea
- Restlessness & confusion
- Orthopnea
- Tachycardia
- Exertional Dyspnea
- Fatigue
- Cyanosis
- Shortness of breath
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What ventricle usually fails first?
Left ventricle
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What is a primary reason right sided heart failure develops?
Due to left sided heart failure
207
List signs and symptoms of right sided heart failure.
- Fatigue
- Increased peripheral venous pressure
- Ascites
- Hepatomegaly (enlarged liver)
- Spleenomegaly (enlarged spleen)
- Jugular Venous Distention
- Anorexia
- GI Distress: feelings of fullness, loss of appetite
- Weight gain
- Dependent edema
208
What is cor pulmonale?
- Most commonly arises out of complication from high blood pressure in the pulmonary arteries
- Right sided heart failure fails because of disorders in the lungs
209
What is congestive heart failure?
- Results in congestion or fluid build up
- Must have evidence of fluid build up
- Can be left or right sided
- Not all heart failure is congestive heart failure
210
What nursing interventions should be implemented when a patient has chronic heart failure?
- Weigh the patient daily
- Apply oxygen if necessary
- Balance rest and activity
- Position in high fowlers
- Restrict fluids
- Create an individualized activity plan
- Administer medications and educate on medications the patient is taking
- Encourage a low sodium diet
- Educate on s/s of heart failure
- Help patient learn to cope with the disease
211
Pulmonary edema is also known as what? What is pulmonary edema?
- Acute heart failure
| - Sudden, severe fluid congestion within lung alveoli
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What are the signs and symptoms of pulmonary edema?
- Cough
- Crackles
- Wheezes
* *Pink frothy sputum
- Tachypnea
213
What are nursing management can be provided to a patient with pulmonary edema?
- Vitals
- Semi-Fowlers or high-Fowlers position
- Give O2 as ordered
- Give medications as ordered
214
What is the treatment for pulmonary edema? What is the nursing goal?
- IV medications
- Goal: reduce anxiety, relax airway, decrease preload/afterload, reduce fluid congestion, strengthen heart contractions,
215
What common medications may be given for pulmonary edema?
- Nitro
- Lasix
- Morphine
216
What is chronic heart failure? What are the signs and symptoms?
- Chronic, progressive condition
- Signs and symptoms depend on which sided heart failure is present
- May developed altered mental status due to decreased oxygen
217
Chronic heart failure progression can be slowed by implementing what?
- Appropriate treatment
| - Lifestyle modifications
218
What are therapeutic interventions for chronic heart failure?
- O2
- Activity
- Sodium restriction
- Fluid restriction
- Decrease weight
- Daily weights
- Medications
219
What blood test can diagnose heart failure?
Brain Natriuretic Peptide
220
BNP is directly correlated with what?
Severity of the heart failure or exacerbation
221
Which medication drug class is the first line therapy for chronic heart failure treatment?
Angiotensin Converting Enzyme (ACE) Inhibitor
222
What medication drug classes can be administered either together or separately to help manage chronic heart failure and its symptoms?
- Diuretic
- Angiotensin Converting Enzyme inhibitor
- Angiotensin 2 Receptor Blocker
- Beta Blocker
- Digoxin
- Vasdilator
223
What does an echocardiogram meausure?
Ejection Fraction (EF)
224
When should the nurse be considered about weight gain in the patient with chronic heart failure?
Greater than 2 pounds gained in 24-48 hours
| Greater than 5 pounds in a week
225
What are the signs and symptoms of digoxin toxicity?
- Nausea
- Vomiting
- Diarrhea
- Arrhythmias
- Vision changes
- Decreased appetite
- Confusion
226
What is the therapeutic range for digoxin?
0.8 - 2.0 mg/mL
