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Nsg 102 Cardiovascular > Cardiovascular Unit 5 > Flashcards

Cardiovascular Unit 5 Flashcards

1
Q

Afterload

A

the amount of resistance to ejection of blood from the ventricle

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2
Q

Apical Impulse

A

impulse normally palpated at the 5th intercostal space, left MCL; caused by contraction of the left ventricle; also called PMI (point of maximal impulse)

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3
Q

Atrioventricular node (AV)

A

secondary pacemaker of the heart, located in the right atrial wall near the tricuspid valve. “gatekeeper”

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4
Q

Cardiac Conduction System

A

specialized heart cells strategically located throughout the heart that are responsible for methodically generating and coordinating the transmission of electrical impulses to the myocardial cells

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5
Q

Cardiac Output

A

amount of blood pumped by each ventricle in liters per minute

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6
Q

Contractility

A

ability of the cardiac muscle to shorten in response to an electrical impulse

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7
Q

Depolarization

A

electrical activation of a cell caused by the influx of sodium into the cell while potassium exits a cell

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8
Q

Diastole

A

period of ventricular relaxation resulting in ventricular filling

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9
Q

Ejection fraction

A

percentage of the end-diastolic blood volume ejected from the ventricle with each heartbeat

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10
Q

Hemodynamic monitoring

A

the use of pressure monitoring device to directly measure cardiovascular function

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11
Q

Hypertension (HTN)

A

blood pressure that is persistently greater than 140/90 mmHG

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12
Q

Hypotension

A

a decrease in blood pressure to less than 100/60 mmHG that compromises systemic perfusion

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13
Q

Murmurs

A

sounds created by abnormal, turbulent flow of blood to the heart

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14
Q

Myocardial Ischemia

A

condition in which heart muscle cells receive less oxygen than needed

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15
Q

Myocardium

A

muscle layer of the heart responsible for the pumping action of the heart

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16
Q

Normal heart sounds

A

sounds produced when the valves close; normal heart sounds are S1 (AV Valves) and S2 (SL Valves)

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17
Q

Pulmonary vascular resistance

A

resistance to blood flow out of the right ventricle created by the pulmonary circulatory system

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18
Q

pulse deficit

A

the difference between the apical and radial pulse rates

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19
Q

repolarization

A

return of the cell to resting state, cause by reentry of potassium into the cell while sodium exits the cell

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20
Q

sinoatrial node (SA)

A

primary pacemaker of the heart, located in the right atrium

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21
Q

Stroke volume

A

amount of blood ejected from one of the ventricles per heartbeat

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22
Q

Systole

A

period of ventricular contraction resulting in ejection of blood from the ventricles into the pulmonary artery and aorta

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23
Q

Primary function of the vascular system and what is used to accomplish this?

A
  • deliver oxygenated blood to the tissues
  • return deoxygenated blood to the heart
  • uses Heart, arteries, veins
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24
Q

Arteries carry ____ blood (except the ____ ____). Veins carry ____ blood to go through the _____ to become ______.

A
  • Arteries carry (oxygenated) blood (except the [pulmonary artery]). Veins carry (deoxygenated) blood to go through the (heart) system to become (oxygenated).
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25
Q

Primary functions of the heart

A
  • pump: circulation of blood throughout coronary, pulmonary, and systemic system.
  • Stimulation and control of heart action (conduction system)
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26
Q

Three layers of the heart

A

Endocardium - outer
Myocardium - middle layer
Epicardium - inner layer

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27
Q

Encasement of the heart

A

Pericardium

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28
Q

Cardiac electrical activity is result of movement of ions (__, __, __) across the cell membrane

A

Na, Ca, K

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29
Q

Cardiac conduction order

A
  • SA node fires, signal follows
  • internodal pathways
  • atrial contraction
  • continues to AV node
  • bundle of HIS
  • R/L Bundle branches
  • Purkinje fibers
  • results in ventricular contraction
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30
Q

Automaticity

A

ability to initiate an electrical impulse

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31
Q

Excitability

A

ability to respond to automaticity

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32
Q

Conductivity

A

Is the electrical impulse going to conduct through all the steps to have full contraction

33
Q

how many BPM does the SA node fire at?

A

60-100

34
Q

how many BPM does the AV node fire at?

A

40-60

35
Q

how many BPM do the purkinje fibers fire at?

A

30-40

36
Q

Depolarization

A

contraction - exchange of ions = positively charged intracellular space/negatively charges extracellular space (Na K Pump)

37
Q

Repolarization

A

rest - return of ions to previous resting state, causes relaxation of myocardial muscle

38
Q

absolute refractory period

A

period where it is impossible for any other action potential to be activated. cell is unresponsive to any electrical stimulus until repolarization is complete.

39
Q

relative refractory period

A

is electrical stimulus is stronger than the normal, the cell may be polarized prematurely

40
Q

systolic blood pressure

A

pressure exerted when blood is ejected into arteries

41
Q

diastolic blood pressure

A

pressure blood exerts within arteries between heartbeats

42
Q

Cardiac output equation

A

CO = SV x HR

43
Q

stroke volume

A

amount of blood ejected from one of the ventricles per heart beat

44
Q

preload:

A

degree of stretch of the ventricular cardiac muscle fibers at the end of diastole.

45
Q

afterload:

A

the resistance to the ejection of the blood from the ventricle *second determinant of SV

46
Q

Contractility

A

force generated by the myocardium contracting

47
Q

Ejection Fraction (EF%)

A

% of the end diastolic blood that is ejected with each heartbeat. NORMAL = 55-65%.
Below 40%: decreased left ventricular function. unable to get forceful pump to get blood to rest of body - ends in heart failure.

48
Q 
Gerontological considerations assoc. with Cardiovascular disease. 
Atria:
Left Ventricle:
Cardiac valves:
Aorta/large arteries:
Conduction system:
A

Atria: left atria increases in size
Left Ventricle: larger, still, less distensible, fibrotic changes
Cardiac valves: thickening and rigidity of tri+bi valves
Aorta/large arteries: thick, stiff, less distensible
Conduction system: slower SA and AV node

49
Q

5 P’s

A

Pain, pulse, pallor, paresthesia, paralysis

50
Q

A drop of what is considered orthostatic hypotension?

A

> 10

51
Q

What is coronary artery disease? Caused by? Risk factors?

A

fatty plaque build up causing blockages in the arteries of the heart. caused by atherosclerosis. risk factors: smoking, drinking, sedentary lifestyle, age, obesity, high cholesterol, diabetes.

52
Q

stable vs. unstable angina

A

stable angina - chest pain with activity, goes away with rest. Not a medical emergency.
unstable angina - chest pain continues at rest, does not go away, intense, Nitro does not help. Medical emergency.

53
Q

What medications treat coronary artery disease? and what tests MUST you have prior to starting?

A
  • Statins (give evening around 8pm) (HMG-CoA, atorvastatin/Lipitor, rosuvastatin/Crestor, pravastatin/Pravachol).
  • Fibric acids (gemfibrozil, fenofibrate, Zetia).
  • Bile acid sequestrants (resins, pre meal) (cholestyramine/questran, colesevelam/welchol).
  • cholesterol absorption inhibitors
  • omega-3 acid-ethyl esters (fish oil) High cholesterol is treated w/ fish oil.

***must have LFTs! These meds go through the liver.

54
Q

What is hypertension and how to diagnose?

A

BP exceeding 140/90. To diagnose, 2+ readings taken at least 1-4 weeks apart by HCP

55
Q

What is the silent killer?

A

Hypertension, asymptomatic

56
Q

Primary vs. secondary hypertension

A 
primary = standalone, 90%. 
secondary = previous diagnosis causes HTN
57
Q

Blood pressure is a result of ___ (equation)

A

CO x PVR (peripher vascular resistance)

CO = HR x SV

58
Q

Clinical manifestations of hypertension

A

Asymptomatic until vascular damage/target organ damage.

  • Retinopathy (headaches, vision changes)
  • CAD (left ventricle hypertrophy, heart failure)
  • Cerebrovascular disease (stroke)
  • aneurysm
  • PAD
  • CKD
59
Q

Hypertension risk age groups:

A

Men > risk until age 45
45-64 equal risk
> 65 women higher risk

60
Q

normal BUN levels

A

7-20

61
Q

Diagnostics and assessment for HTN

A 
Urinalysis (protein, kidney fx, glucose)
Blood (electrolytes)
Renal (BUN, Creat, micro/macroalbuminaria)
Cholesterol (LDL,HDL)
EKG (baseline)
CXR, Echo (LV Hypertrophy)
62
Q

HTN Medical management

A

Smoking cessation, Diet (low fat, manage cholesterol, lean protein, less red meat, less sodium), sleep apnea?, physical activity (clear with PCP first), Diabetes (follow treatment), hyperlipidemia (manage cholesterol w/ statin?), DASH diet

63
Q

HTN Pharm management

A
  • Diuretic (decr. fluid volume)(thiazide renal safe, loop/lasix, K Sparing)
  • Beta blockers (-olol, blocks sympathetic nervous system)
  • Ace inhibitors (-pril, inhibits conversion of angiotensin 1&2 = lower total periph. resistance, can be used w/ thiazides)
  • ARBs
  • Calcium channel blockers
64
Q

Treatment algorithm for HTN

A

<55 = A, A+C/A+D, A+C+D

>55 or black patient any age = C or D, A+C/A+D, A+C+D

65
Q

What is Peripheral Vascular disease categorized by? (3 items)

A

Arterial, venous, lymphatic

66
Q

Common clinical manifestations of PVD (Caused by ischemia)

A

pain, skin changes, diminished pulse, possible edema

67
Q

PAD (3 things)

A

Blocked, narrowed, weakened (think atherosclerosis)

68
Q

PVD (3 things)

A

blood clots, incompetent venous valves, increased competency of surrounding muscles

69
Q

PAD Arterial s/s

A

intermittent claudication pain (cramp, comes and goes with rest), no edema, no pulse or weak pulse, no drainage, round smooth sores, black eschar. BETTER WITH dAngle. Toes + bottom of foot. cool + pale.

70
Q

PVD venous s/s

A

dull, achy pain, lower leg edema, pulse present, drainage, sores with irregular borders, yellow sough or ruddy skin, ankles/calf, pain with dorsiflexion, dry skin, better with eleVation

71
Q

PAD clinical manifestations

A
  • Femoral/Aortic artery bruits (swooshing)
  • cap refill >3 seconds
  • < or non-palp pulses
  • loss of hair on lower calf, ankle, foot (no O2)
  • dry, scaly, mottled skin
  • thick toenails
  • cold/cyanotic extremity
  • pallor w/ elevation, ruddy w/ dependent
  • muscle atrophy
  • ulcers, gangrene of toes
72
Q

PVD/PAD diagnostic and eval

A 
doppler US, 
ABI (ankle brachial index), 
Exercise tolerance testing (stress test), 
Plethysmography, 
MRA (angiogram)
73
Q

Which extremities have higher blood pressure?

A

Legs 10-20% more than brachial. If lower in legs, look for PVD

74
Q

ABI ranges

A

Normal, low risk 0.9-1.2
Vascular disease, moderate risk 0.6-0.9
Severe disease, high risk <0.5

75
Q

PVD/PAD medical management

A
  • Prevention/reducing risk factors (weight, smoking, exercise, low fat diet, low sodium, DASH diet)
  • medications (antiplatelet d/t clot risk), antihypertensives (lower BP), statins (cholesterol)
  • promote vasodilation (positioning, do not cross legs, avoid restrictive clothing, temperature[warm-infection, cold no circulation]).
76
Q

Arteriography (two types), + complications (2)

A

Invasive!!!

  • percutaneous transluminal angioplasty (stent to push open vessel)
  • laser-assisted angioplasty (vaporize plaque)
  • complications: incr. risk for bleeding, risk for infection
77
Q

Atherectomy

A

removal of plaque using scraping procedure

78
Q

Revascularization + complications (2)

A

bypass grafting. *complications: bleeding, graft doesn’t take

79
Q

Post procedure for PAD

A
  • monitor for bleeding (arterial can bleed out!)
  • VS, Pulses, CRT. Compare!
  • Bed rest 6 hours.
  • Monitor Pt/INR if anticoag were used.
  • admin antiplatelet meds as ordered
  • bypass graft pulses will be marked

Nsg 102 Cardiovascular (1 decks)

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