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NURS 2501 > Chronic Cardiac > Flashcards

Chronic Cardiac Flashcards

1
Q

Beta-adrenergic blockers - Beta-blockers : action

A

block beta1 adrenergic receptors ( SNS ) found in cardiac muscle ; high dose - block beta2 in airways ( asthma & COPD !!! )

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2
Q

BB & HF

A

reverse effects of sympathetic stimulation

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3
Q

BB - SE

A
  1. Dizziness

2. Hypotension & bradycardia

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4
Q

Angiotensin-converting enzyme (ACE) inhibitors - Key role in HF ( - pril )

A

inhibit renin-angiotensin-aldosterone mechanism - block conversion of angiotensin I to angiotensin II - prevents peripheral vasoconstriction; reduces blood volume ( inhibit aldosterone )

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5
Q

Angiotensin II receptor blockers (antagonists) (ARBs)

A

Losartan (Cozaar) - no cough

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6
Q

ACE inhibitors - SE

A
  1. Headache, dizziness
  2. Hypotension
  3. Persistent dry cough
  4. Hyperkalemia ( !!! K )
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7
Q

Vasodilators

A

Hydralazine ( Apresoline )

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8
Q

Vasodilators - action

A

act directly on arterial smooth muscles - produce peripheral vasodilation - lower BP , increase HR, increase CO

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9
Q

Nitrates

A
  1. Isosorbide dinitrate ( Isordil )

2. Nitroglycerin ( Nitrostat )

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10
Q

Nitrates - action

A

increases oxygenated blood flow to myocardium by dilating coronary and systemic blood vessels - pooling of blood in peripheral BVs - reduce preload & afterload & myocardial O2 demand
SE: Headache !

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11
Q

Sympatholytics

A
  1. Methyldopa ( Aldomet )

2. Clonidine ( Catapres )

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12
Q

Sympatholytics - action

A

stimulate alpha2 receptors in CNS to inhibit sympathetic cardio-accelerator and vasoconstrictor centers - decrease sympathetic outflow from CNS - decrease arterial pressure

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13
Q

Alpha-adrenergic blocker

A

Prazosin ( Minipress )

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14
Q

Alpha - adrenergic blocker - action

A

blocking the alpha1-receptors of vascular smooth muscle, thus preventing the uptake of catecholamines by the smooth muscle cells. This causes vasodilation and allows blood to flow more easily.

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15
Q

Calcium-Channel blockers

A
  1. Nifedipine ( Procardia)
  2. Diltiazem ( Cardizem )
  3. Verapamil ( Isoptin )
  4. Amlodipine ( Norvasc )
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16
Q

CCB - action

A

inhibit calcium ( contraction ) ion influx via slow channels into cells of myocardial and arterial smooth muscles - negative inotropic ; dilation !!!

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17
Q

Cardiac glycosides

A

Digoxin ( Lanoxin )

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18
Q

Cardiac glycosides

A

used primarily to treat HF ( & dysrhythmias); increase contractility - positive inotropic ; decrease conduction velocity via AV node ( negative dromotrope )

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19
Q

Anticoagulants

A
  1. Heparin
  2. LMWH - Enoxaparin ( Lovenox) - SQ
  3. Warfarin (Coumadin )
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20
Q

Warfarin ( Coumadin ) - oral - action - PT + INR

A

prevent conversion of vitamin K - decreasing its production in liver - reducing several clotting factors ; vitamin K - role in extrinsic pathway ( forms fibrin ) in clotting cascade.

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21
Q

Foods high in Vitamin K

A

liver, cheese, egg yolk, leafy vegetables and oils

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22
Q

Heparin - IV ( PTT)

A

role in intrinsic pathway - inhibits conversion of fibrinogen to fibrin - prevents formation of fibrin clot - inhibits thrombin ; given IV

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23
Q

HF : DX

A
  1. Echocardiogram - determines ejection fraction
  2. EKG - electrical abnormalities
  3. CXR - size
  4. B-type Natriuretic Peptide ( BNP ) - elevated
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24
Q

B-type Natriuretic Peptide (BNP)

A

neurohormone released by stressed ventricles ( fluid overload) - promote vasodilation and diuresis via Na loss in the renal tubules. Not strong enough !

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25
Q

Ejection fraction - to determine type of heart failure - echocardiogram - systolic vs diastolic

A

Volume of blood ejected with each contraction ; (EDV - ESV) / EDV ; normal 50-70 % ; systolic HF - drops below 40 %; diastolic - normal

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26
Q

HF: causes

A
  1. Atherosclerosis - CAD - primary cause !!! - MI cause muscle necrosis and loss of contractility
  2. HTN - increased afterload - increased workload of the heart
  3. Valvular disease - difficult for blood to move forward
  4. Severe anemia , hypoxia
  5. Dysrhythmias
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27
Q

Right-sided HF causes

A
  1. Left ventricular failure
  2. Right ventricular MI
  3. Pulmonary hypertension & COPD - cor pulmonale
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28
Q

HF - medications - IV drip

A
  1. Nesiritide ( Natrecor )
  2. Milrinone
  3. Dobutamine - increase contractility and CO
  4. Morphine
  5. Nitrates
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29
Q

Phosphodiesterase 3 Inhibitor, positive inotropic + vasodilator ( decrease preload + afterload )

A

Milrinone

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30
Q

Natriuretic peptide; combats effects of epinephrine and norepinephrine ; vasodilator ; recombinant form of human B-type natriuretic peptide (hBNP)

A

Nesiritide ( Natrecor )

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31
Q

CAD - non-modifiable risk factors

A
  1. Age - older
  2. Gender - men up to age 65
  3. Family hx
  4. Race - Afro-Americans
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32
Q

CAD - modifiable risk factors

A
  1. Elevated lipids
  2. Hypertension
  3. Smoking
  4. Inactivity/ obesity
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33
Q

Lipids panel

A

Total < 200

  1. triglyceride < 150
  2. LDL < 130 ( < 100 high risk )
  3. HDL > 45 ( higher better )
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34
Q

Smoking & CAD

A
  1. Nicotine increases HR + causes vasoconstriction

2. Carbon monoxide circulating in the bloodstream - chemical injury to vessel wall

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35
Q

Exercise & CAD

A
  1. AHA - 30 min/day

2. increase HDL + collateral circulation

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36
Q

CAD - contributing risk factors

A
  1. Diabetes Mellitus
  2. Stress - type A personality, hostility
  3. High homocysteine levels - amino acid - damages lining of vessels
  4. Metabolic syndrome - abdom. obesity, insulin resistance (FBS > 100 ) ; high lipids; hypertension .
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37
Q

CAD - DX

A
  1. Exercise stress test
  2. Echocardiogram
  3. Transesophageal echocardiogram
  4. Cardiac catheterization
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38
Q

Exercise stress test

A

EKG with exercise ; pt on treadmill - rate and incline gradually increased; drugs may be added to promote vasodilation and indicate compromised areas - Persantine + Dobutamine
Watch - ST elevation or depression - ischemia ; Stop - chest pain or EKG changes

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39
Q

Echocardiogram

A

ultrasound of heart ; assess ventricular walls, valves, cardiac output, ejection fraction of heart

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40
Q

Transesophageal Echocardiogram

A

Start IV
Tube passed down the throat into stomach ;
NPO prior
Check gag reflex ( tongue depressor) post test ;

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41
Q

Fluoroscopy

A

is an imaging technique that uses X-rays to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope.

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42
Q

Cardiac catheterization

A

invasive; fluoroscopy ; NPO; dye injected ( flushed, warm feeling) ; via groin or arm ( post - keep staright) ;
Shows blockages; can measure pressures and pumping ability of heart ; post - 4-6 hours in bed ; oral + IV fluids; monitor urine output (kidneys)

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43
Q

CAD - Diet recommendations

A
  1. Fish - 2 x wk - omega-3 fatty acids
  2. Salt < 2300 mg of sodium/day
  3. Limit ETOH - 1 W; 2 M
  4. Fiber 25 g
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44
Q

Antihyperlipidemics

A
  1. Statins
  2. Fibric acids
  3. Bile acid sequestrants
  4. Nicotinic acid
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45
Q

Statins ( - statin )

A
  1. inhibit cholesterol synthesis in liver ( Monitor liver enzymes - baseline ; 6 mo later !!! ) ;
  2. Reduce LDL + triglycerides
  3. Increase HDL
    SE - rare - muscle weakness; liver abnormalities ; take at night ( cholesterol synthesis)
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46
Q

Colestipol ( Colestid )

Cholestyramine ( Questran )

A

Bile acid sequestrants

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47
Q

Bile acid sequestrants ( - choles )

A

Work in GI tract to bind ( !! may interfere with absorption of drugs and nutrients ) with bile acids ( excreted in stool ) - liver cells respond by sending cholesterol to maintain bile acid synthesis, lowering plasma levels of LDL cholesterol ; SE: GI symptoms - N/V

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48
Q

Clofibrate ( Atromid )
Gemfibrozil ( Lopid )
Fenofibrate ( Tricor )

A

Fibric acids

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49
Q

Fibric acids ( - fibr )

A

decreases VLDL - hepatic synthesis + secretion - which will reduce triglycerides ; increase HDL; SE - GI; may increase effects of anticoagulants + hypoglycemics

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50
Q

Niacin, Vitamin B3

A

Nicotinic acid

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51
Q

Nicotinic acid

A

water-soluble vitamin ; inhibits synthesis of LDL, VLDL; increase HDL ;
SE: - GI ; flushing ( upper torso and face)
Caution !!! liver disease and DM - liver enzymes !!!
Lower risk of MI ( pts that had MI)

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52
Q

Food sources high in niacin

A

dairy, meats, tuna, egg

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53
Q

Stable angina - classic

A

predictable - occurs with activity; consistent; relieved with rest

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54
Q

Unstable angina - preinfarction

A

can occur at rest; unpredictable

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55
Q

Prinzmetal’s angina

A

occurs ta rest ; due to spasm of coronary artery and not plaque

56
Q

Compensation - HF

A
  1. Stimulation of the sympathetic NS
  2. Vasopressin (ADH ) - post pituitary ( decreased cerebral perfusion)
  3. Renin-Angiotensin System Activation - Aldosterone
57
Q

HF - DX

A
  1. Echocardiogram - EF
  2. EKG
  3. CXR - size of heart
  4. BNP - elevated
58
Q

Digoxin toxicity

A

level > 2 ng/ml ( 0.5-2 ) halos, nausea, anorexia; Monitor K ( provide foods if takes loop diuretic) ; apical 1 min;

59
Q

Digoxin antidote for extreme toxicity

A

digoxin immune Fab - Digibind

60
Q

Diuretics :

A
  1. Thiazide - Hydrochlorothiazide (HCTZ)
  2. Loop - Furosemide ( Lasix )
  3. Potassium sparing - Spironolactone ( Aldactone)
61
Q

CCB + HF

A

contraindicated with systolic HF

62
Q

PE and HF - interventions - Prevent !!!

A
  1. High-fowlers with legs dangling - decrease venous return
  2. O2 - mask or intubated
  3. Diuretics - Lasix - rapid
  4. Morphine - small doses - decrease peripheral resistance, venous return, anxiety
  5. Emotional support
  6. Monitor - telemetry, I/O, VS
63
Q

Stenosis

A

opening narrows

64
Q

Regurgitation

A

valve does not completely close

65
Q

Mitral stenosis

A

obstruction of blood from LA to LV - LA stretches ( hypertrophies - pulmonary conjestion - RHF

66
Q

Mitral stenosis + regurgitation - cause

A

Rheumatic heart disease - rheumatic endocarditis

67
Q

Mitral regurgitation

A

LA + LV dilate + hypertrophy - LHF - RHF

68
Q

Mitral valve prolapse

A

functions normally - isn’t closing properly ; PVCS, tachycardia; risk for endocarditis ; can progress to regurgitation; most asymptomatic

69
Q

Aortic stenosis

A

difficult for LV to eject blood; sudden death; vascular collapse - angina, syncope, exertional dyspnea ! NTG is contraindicated

70
Q

Aortic regargitation

A

blood flow back into LV - LV hypertrophy - decrease SV - weakness, SOB, fatigue …

71
Q

Valvular disorders DX

A
  1. Echocardiogram
  2. Transesophageal echo - detect stenosis or regurgitation
  3. CXR - size of ventricles
72
Q

Valvular disorders - reparative procedures - buys time

A
  1. Balloon valvuloplasty
  2. Valve commissurotomy
  3. Annuloplasty
73
Q

Balloon valvuloplasty

A

invasive ( cardiac cath lab ) ; catheter via groin or femoral vein - balloon inflated to enlarge mitral or atrial opening ; Monitor - bleeding, regurgitation, thrombi

74
Q

Valve commissurotomy

A

open heart surgery ; only damaged area of valve removed ; thrombi ; debride calcium from leaflets

75
Q

Annuloplasty

A

repair of annulus ( ring that is attached to leaflets) and leaflets - regurgitation is eliminated or greatly reduced

76
Q

Valvular disorders - replacement procedures

A
  1. Biological ( tissue ) valves

2. Mechanical valves

77
Q

Biological ( tissue ) valves

A

cow or pig - Xenograft ; 6 weeks on Coumadin post op; life span for valve 7-10 years

78
Q

Mechanical valves

A

Coumadin for the rest of the life; much more durable

79
Q

Coumadin - INR - therapeutic range

A

2-3

80
Q

Valvular disorders - post op teaching

A
  1. Regular blood work to titrate Coumadin
  2. Vitamin K foods teaching - keep steady
  3. Report bleeding or bruising
  4. Care of sternal incision
  5. Avoid invasive dental procedures for 6 mo
  6. Report changes in cardiac status
  7. Medical alert bracelet
81
Q

Protamine sulfate

A

antidote for heparin

82
Q

INR - normal

A

1.3-2

83
Q

aPTT - partial thromboplastin time, activated - heparin

A

30-40 sec

84
Q

Dilated cardiomyopathy (DCM) - men + AA

A

chambers are larger - decreased contractile function; no increase in muscle wall size - blood remains in ventricle - causes backup
TX as for heart failure

85
Q

Dilated cardiomyopathy causes

A

alcohol abuse; chemotherapy, viral infection; pregnancy; inflammation; poor nutrition

86
Q

Hypertrophic cardiomyopathy (HCM)- genetic

A

heart muscle asymmetrically increases in size + mass - reduces size of ventricles - poor filling ; can block aorta - athletes who die suddenly

87
Q

Hypertrophic cardiomyopathy TX

A

Beta- Adrenergic Blockers and Calcium Channel Blockers

Contraindicated - vasodilators, diuretics, nitrates, cardiac glycosides

88
Q

Restrictive cardiomyopathy

A

impaired ventricular stretching - stiff ventricles restrict filling during diastole ; No TX; SX- heart transplant; < 12 mo to live

89
Q

DCM - SX

A
  1. Cardiac transplant - preferred

2. Cardiomyoplasty - muscle wrapped around ventricles

90
Q

HCM - SX

A

Ventricular septal myectomy - excision of hypertrophied tissue ; can take out mitral valve and replace it with smaller

91
Q

Transplanted heart - is denervated

A

no longer connected via vagus nerve to autonomic NS; keeps consistent HR and responds slowly to exercise, stress, position changes - !!! orthostatic hypotension

92
Q

Heart transplant - signs of rejection

A

SOB, fatigue, fluid gain, hypotension, decreased activity tolerance

93
Q

Heart Transplant - immunosuppressants for life

A

Infection is major cause of death

94
Q

Endocarditis - causes

A
  1. Valvular disease
  2. Prosthetic valves
  3. Older pts
  4. IV drug use
  5. High risk invasive procedures
95
Q

Endocarditis S/s

A
  1. Fever with chills, night sweats, fatigue
  2. Cardiac murmur
  3. Anorexia and weight loss
96
Q

Endocarditis - systemic embolization

A
  1. Petechiae
  2. Osler’s nodes - PAINFUL, on pads of fingers or toes
  3. Janeway’s lesions - PAINLESS; red, purple, macules on fingers or toes
97
Q

Pericarditis causes

A
  1. Following MI - Dressler’s syndrome ; or open heart surgery
  2. Autoimmune cause - lupus
  3. Lung cancer - result of chemo or radiation
  4. Lung infection
98
Q

Pericarditis S/s

A
  1. Chest pain - left side neck, shoulder
  2. Pain worse with deep inspiration
  3. Eased when sitting and leaning forward
  4. PERICARDIAL FRICTION RUB
    Chronic - S/s of RHF
99
Q

Pericarditis TX

A
  1. NSAIDS, corticosteroids;
  2. Antibiotics
  3. Comfort - sitting upright, leaning forward
  4. Pericardial drainage ( window)
100
Q

Pericardila Effusion

A

fluid in pericardial space - constricts myocardium + impair ability to pump - can lead to cardiac tamponade

101
Q

Cardiac Tamponade - S/s

A
  1. Sudden onset - SOB, chest tightness, restless
  2. Pulsus Paradoxus - SBP drops ( during inspiration) + DBP remains same
  3. Distant heart sounds
  4. Tychycardia
  5. Decreased CO
  6. Blood backing up - JVD
  7. Circulatory collapse
102
Q

Cardiac Tamponade - DX

A

EMERGENCY

  1. Echocardiogram or x-ray to confirm
  2. CVP, PA, PCWP all similar and elevated
103
Q

Cardiac Tamponade - TX

A

Pericardiocentesis - needle inserted to drain fluid ; monitor for recurrence of tamponade following procedure

104
Q

Myocarditis causes

A

may be associated with pericarditis, infection or due to metabolic or connective tissue disorder - Lupus

105
Q

Myocarditis S/s

A
  1. Fatigue, dyspnea, palpitations

2. Flu-like symptoms

106
Q

Venous stasis ulcers - TX

A
  1. Hydrocolloid dressings
  2. Artificial skin products
  3. Unna boot
107
Q

Unna boot

A

for ambulatory pts; with venous stasis ulcers ; applied - affected limb from toes to knee; covered with elastic wrap ( hard like a cast); change 1/week;May be too tight ; bandage works because it is infused with a thick, creamy mixture of zinc oxide and calamine. This mixture helps to promote healing.

108
Q

Peripheral arterial disease ( PAD) - cause,

A
  1. atherosclerosis

2. blockage of the arteries that supply the lower legs + feet

109
Q

PAD - S/s

A
  1. Intermittent claudication - cramping pain; with activity; gone with rest; 50 % obstructed
  2. Rest pain - late sign ; better when legs are down
  3. Skin - rubor ( dpendent position), cyanotic, pallor, loss of hair, brittle nails, dry skin, ulcers, edema, gangrene (elderly)
110
Q

PAD - DX

A
  1. Arteriography - similar to cardiac cath; dye used
    Noninvasive
  2. segmental systolic BP - normal - BP in thigh + calf > BP in upper extremities ; arterial disease - BP in thigh and calf are lower.
  3. Ankle-brachial index - ankle BP / brachial BP
  4. Exercise tolerance test - asses when leg pain starts
111
Q

PAD - non-surgical management

A
  1. Exercise ( collateral circulation) - walk - pain - stop + rest - walk further ; contraindicated - severe pain, venous ulcers, gangrene
  2. Position - keep legs below level of the heart ( swelling - elevate feet)
  3. Don’t cross legs, restrictive clothing; inspect feet daily
112
Q

PAD - promote vasodilation

A
  1. Warmth to extremity
  2. No direct heat
  3. Avoid cold, stress, caffeine, nicotine
113
Q

PAD - Trental

A
  1. Antiplatelet
  2. Increase flexibility of RBC
  3. Decrease blood viscosity
114
Q

PAD - nonsurgical interventions

A
  1. Percutaneous Transluminal Angioplasty - balloon
  2. Laser assisted angioplasty
  3. Atherectomy - rotary burr
    Post procedure - bed rest 6-8 hrs; bleeding; distal pulses, vitals
115
Q

PAD - surgical management and post-op care

A

Arterial revascularization : inflow ( larger) + outflow (smaller) - bypass graft (GABA)

  1. Pain !!! throbbing - OK; ischemic ( like before) - clotted graft
  2. Bed rest for 1 day - no bending ( hip or knee)
  3. Vascular (neuro) checks - 1st hr - every 15 min ; then every hour !!!
116
Q

Aneurysm - bulging out

A

localized dilation of a portion of an artery - abdominal aortic ( common) and thoracic aortic.

117
Q

Aneurysm - causes

A
  1. Arteriosclerosis - 85 %
  2. Hypertension
  3. Smoking
  4. Hyperlipidemia
  5. Genetic
  6. Marfan syndrome - disorder of the connective tissue
118
Q

Thoracic aortic aneurysm - S/s

A
  1. SOB, hoarseness, difficulty swallowing

2. Rupture - sudden back or chest pain

119
Q

Abdominal aortic aneurysm - S/s

A
  1. Pain - abdominal, flank, back
  2. Pulsation in upper abdomen - listen for bruit. Don’t palpate !!!
  3. Feeling of fullness after eating
  4. Malaise + weight loss
120
Q

Aneurysm - impending rupture - S/S

A
  1. Sudden, severe back, abdominal pain
  2. Pulsating abdominal mass
  3. Hypovolemic shock
    Sx !!! right away
121
Q

Ruptured aneurysm - S/s

A
  1. Hypotension
  2. Diaphoresis
  3. Decreased LOC
  4. Oliguria
  5. Loss of pulses
  6. Retroperitoneal bleeding
122
Q

Aneurysm - nonsurgical management

A
  1. Monitor growth - CT scan every 6 mo

2. Maintain BP - antihypertensives

123
Q

Aneurysm - surgical

A

Stent graft - to strengthen arterial wall !!! to avoid Aneurysmectomy - resection.

124
Q

Aneurysm - post op

A
  1. Graft occlusion - hypovolemia or renal failure
  2. Rupture - hypovolemic shock
  3. Paralytic ileus - abdominal distention ; N/V
  4. MI
  5. Spinal cord ischemia ( thoracic ) - asses sensation + motion
  6. No heavy lifting or driving for 6 weeks
  7. No pushing, pulling or straining
125
Q

Aortic dissection

A

aorta tears and splits apart ; Due to poorly controlled hypertension ; blunt chest trauma, cocaine use.

126
Q

Aortic dissection - S/s

A
  1. Sudden - tearing chest pain radiating to back ( mistaken for MI )
  2. Diaphoresis, pale, tachycardia
    dx - ct scan ;
    Complications - paraplegia ( decreased blood flow to spine ; renal failure ; CVA, MI.
127
Q

Buerger’s disease - Smoking

A

Inflammatory thrombotic disorder - affects small and medium arteries in distal arms and legs ; early sign - claudication in arch of foot, intermittent shock-like pain ; TX - Procardia (CCB)

128
Q

Raynaud’s disease

A

Vasospastic disorder - vasospasm precipitated by cold, emotional upset, caffeine, smoking ; Fingers - white then cyanotic with pain; TX: Procardia (CCB)
SX: sympathectomy ( cuts nerve fibers) ; can lose fingers

129
Q

Venous disorders :

A
  1. DVT

2. Chronic venous insufficiency ; complication - venous stasis ulcers

130
Q

Chronic venous insufficiency - interventions

A

due to prolonged venous hypertension - stretches veins + damages valves - edema

  1. Elevate legs 20 min 4-5 x per day ; elastic or compression stockings , sequentials
  2. Buildup of waste - ulcers - Vitamin A+C and high protein to promote healing
131
Q

Protamine sulfate

A

antidote for heparin

132
Q

DVT - risk for PE ( if above knee )

A

due to venous stasis and endothelial damage; hypercoagulability of blood ;

133
Q

DVT - S/s

A
  1. Tenderness + pain - calf or groin
  2. Unilateral edema
  3. Warmth, redness, pain
  4. Upper extremity - cyanosis
134
Q

DVT - DX

A
  1. Duplex - noninvasive - combines ultrasound and doppler

2. Venogram - invasive

135
Q

DVT - TX

A
  1. Anticoagulants
  2. legs elevated
  3. Compression hose
  4. Measure calves and thighs

NURS 2501 (11 decks)

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