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Med Surg > Disorders of Cardiac System > Flashcards

Disorders of Cardiac System Flashcards

1
Q

the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells and removing cellular waste products

A

tissue perfusion

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2
Q

reduced blood flow

A

ischemia

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3
Q

cardiac output

A

central perfusion

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4
Q

impaired perfusion risk factors

A

Age, race, gender, family history

Smoking, hyperlipidemia, sedentary, obestity, diabetes, hypertension

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5
Q

impaired perfusion can occur because of

A

Pump failure, obstruction, electrical conduction, hypovolemia, vasodilation

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6
Q

describe preload of cardiac output

A

Left ventricular end-diastolic volume
Laplace law
Frank-Starling law of the heart
(end diastolic pressure)

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7
Q

describe afterload of cardiac output

A

Load muscle must move after it starts to contract

Determined by system vascular resistance in aorta, arteries, and arterioles

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8
Q

describe myocardial contractility

A

Stroke volume
Inotropic agents
Oxygen and carbon dioxide levels

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9
Q

Volume of blood flowing through either the systemic or pulmonary circuit in liters per minute

A

cardiac output

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10
Q

preload is increased in

A

hypervolemia
heart failure
regurgitation of cardiac valves

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11
Q

increased afterload =

A

increased cardiac workload

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12
Q

afterload is increased in

A

HTN

vasoconstriction

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13
Q

Significant public health problem
Accounts for ~500,000 American deaths each year
Single largest killer or men and women for all ethnic groups

A

coronary artery disease (CAD)

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14
Q

exists along a continuum

Treatments and therapies are designed to limit damage or prevent infarct

A

CAD

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15
Q

Supply the heart with oxygen and nutrients

Continuous supply required- Because of constant beating of the heart

A

coronary arteries

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16
Q

Left main coronary artery

A

arises from aorta

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17
Q

Left Anterior Descending Artery

A

called the widow maker

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18
Q

Right coronary artery

A

Supplies most of the right ventricle

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19
Q

what does coronary artery disease include

A

stable angina & acute coronary syndromes

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20
Q

what is ACS

A

myocardial infarction and unstable angina

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21
Q

Insufficient oxygen supply to meet requirements of myocardium

A

ischemia

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22
Q

Necrosis or cell death that occurs when severe ischemia is prolonged and decreased perfusion causes irreversible damage to tissue

A

infarction

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23
Q

most common cause of CAD

A

atherosclerosis

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24
Q

what does CAD result in

A

Results in progressive narrowing of the lumen of the vessel
Limits the ability of the artery to deliver oxygen
Fat build up results in the progressive narrowing

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25
Q

nonmodifiable risk factors of CAD

A

Family history / ethnicity
Gender and estrogen
Advancing age

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26
Q

modifiable risk factors of CAD

A 
Cholesterol intake
Diabetes / glucose control
Hypertension control
Smoking
Lack of exercise
Obesity
Metabolic syndrome
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27
Q

what are the types of angina pectoris

A

Stable / chronic angina

28
Q

Imbalance between the arteries ability to provide oxygen and the muscle’s demand
Ischemia limited in duration and does not cause permanent damage to myocardial tissue
Usually caused by a fixated plaque

A

angina pectoris

29
Q

what is angina pectoris characterized and relieved by

A

Characterized by pain that is predictable
Relieved by Rest, NTG and drug therapy
Patient is taught when to seek medical help

30
Q

drugs for angina

A

Nitrates/nitrites
Beta blockers
Calcium channel blockers

31
Q

therapeutic objectives for angina

A

Minimize the frequency of attacks and decrease the duration and intensity of anginal pain
Improve the patient’s functional capacity with as few adverse effects as possible
Prevent or delay the worst possible outcome: MI

32
Q

what do nitrates do

A

By decreasing the pre and afterload, this will decrease the workload AND oxygen demands of the heart
Causes dilation of coronary arteries which will increase the bld flow to the actual heart muscle or the myocardium

33
Q

what forms of nitrate Bypass the liver and the first-pass effect

A

sublingual, IV, transdermal, translingual sprays

34
Q

what are the adverse effects of nitrates

A

Headaches: Usually diminish in intensity and frequency with continued use- can treat with Acetaminophen
Reflex tachycardia
Postural hypotension (SLOWLY SIT UP)
Tolerance may develop

35
Q

how do you prevent nitrate tolerance

A

Prevented by allowing a regular nitrate-free period to allow enzyme pathways to replenish
Transdermal forms: remove patch at bedtime for 8 hours, then apply a new patch in the morning

36
Q

nitrate nursing implications/ pt education

A

Proper technique and guidelines for taking sublingual nitroglycerin for anginal pain
Never to chew or swallow the sublingual form
Burning sensation felt with sublingual forms indicates that the drug is still potent
Keep a fresh supply of sublingual medication on hand; potency is lost in about 3 months after the bottle has been opened
To preserve potency, medications should be stored in an airtight, dark glass bottle with a metal cap and no cotton filler

37
Q

what are nitrates aka

A

Nitroglycerin

38
Q

important education about when to take nitrates

A

Take prn nitrates at the first hint of anginal pain
Monitor vital signs frequently during acute exacerbations of angina and during IV administration
If experiencing chest pain, the patient taking sublingual nitroglycerin should lie down to prevent or decrease dizziness and fainting that may occur because of hypotension

39
Q

what should pt do If anginal pain occurs

A

Stop activity and sit or lie down, and take a sublingual tablet
If no relief in 5 minutes (after first dose), call 911/Emergency Services immediately and take a second sublingual tablet
If no relief in 5 minutes, take a third sublingual tablet
Do not try to drive to the hospital

40
Q

what is the #1 thing nitroglycerin is used for

A

acute attacks of angina

41
Q

used to PREVENT angina! They are NOT for acute attacks

A

Beta Blockers, Calcium Channel Blockers and Aspirin

42
Q

types of beta blockers

A

atenolol (Tenormin)
metoprolol (Lopressor)
propranolol (Inderal)
nadolol (Corgard)

43
Q

mechanism of action of beta blockers

A

Block beta1 receptors on the heart
Decrease HR, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart
Decrease myocardial contractility, helping to conserve energy or decrease demand

44
Q

how do beta blockers help after an MI

A

Beta blockers block the harmful effects of catecholamines, thus improving survival after an MI

45
Q

what are beta blockers used for

A

Angina
Antihypertensive
Cardiac dysrhythmias
Cardioprotective effects, especially after MI
Some used for migraine headaches, essential tremors, and stage fright

46
Q

pt education for beta blockers

A

Monitor pulse rate daily and report any rate lower than 60 beats per minute or symptoms of relative bradycardia
Report dizziness or fainting
Medications should never be abruptly discontinued
Medications are for long-term prevention of angina, not for immediate relief

47
Q

examples of calcium channel blockers

A 
verapamil (Calan, Isoptin)
diltiazem (Cardizem)
nifedipine (Procardia)
amlodipine (Norvasc)
nicardipine (Cardene)
48
Q

calcium channel blockers mechanism of action

A

Cause coronary artery vasodilation
Cause peripheral arterial vasodilation, thus decreasing systemic vascular resistance
Reduce the workload of the heart
Result: decreased myocardial oxygen demand

49
Q

*common problem with calcium channel blockers (adverse effect)

A

Constipation is a common problem; instruct patients to take in adequate fluids and eat high-fiber foods

50
Q

Keeps platelets from sticking together
NOT to treat the pain
Keeps the blood flowing because platelets don’t stick together more blood flow more oxygen less pain

A

aspirin

51
Q

what is the maintenance dose of aspirin

A

Maintenance dose can range from 81-325mg

81mg is “baby aspirin”

52
Q

client education for stable angina

A

Rest frequently; balance activity and rest
Avoid overeating; low-fat high fiber diet
Avoid excessive caffeine or any drugs that increase the heart rate
Temperature extremes can precipitate a heart attack
Take nitroglycerin prophylactically
Smoking cessation
Reduce stress

53
Q

why should you avoid isometric exercises if you have stable angina

A

Increases workload of the heart

54
Q

Used in the diagnosis of heart disease

Most definitive but also most invasive

A

cardiac catheterization

55
Q

pre procedure for cardiac cath

A

Assess for allergy to Iodine and shellfish
Warn patients about the “hot shot” when dye is injected
May report a warm/flushed feeling
Assess kidney function b/c dye is excreted through kidneys
(Acetylcysteine may be ordered pre-procedure if clients have kidney problems to protect the kidneys)
Palpitations are normal

56
Q

what is imperative you assess post cardiac cath procedure

A

Assess for the 5 P’s- Pulselessness, Pain, Paresthesia, Paralysis
ALSO skin temp and capillary refill- circulation and neuro-vascular status

57
Q

post cardiac cath interventions

A

Monitor Vital signs
#1 thing you should be worried about post-procedure is HEMORRHAGE!
Bed rest and remain flat & straight for 4-6 hours
Exact time may depend on HCP
Assess the puncture site
Usually groin
Watch for Bleeding and hematoma formation
Hold Metformin for 48 hours post procedure (due to lactic acidosis and acute nephropathy)
Assess the extremity distal to the puncture site

58
Q

Term for either unstable angina or an acute Myocardial Infarction

A

ACS- Acute Coronary Syndrome

59
Q

Atherosclerotic plaque in the coronary artery ruptures, resulting in platelet aggregation, thrombus and vasoconstriction
Needs at least 40% blockage before it blocks blood flow

A

ACS

60
Q

Chest pain or discomfort that occurs at rest or on exertion

Pain may last longer than 15 minutes and is unrelieved by rest and NTG

A

unstable angina pectoris

61
Q

types of unstable angina pectoris

A

New Onset angina- first symptoms after exertion or with increased demands
Prinzmetal’s angina-Variant, coronary artery spasm and occurs after rest
Pre-infarction angina- prior to an MI

62
Q

________ of patients with unstable angina will have MI within 1 year and 29% die from MI in 5 years

A

10-30 %

63
Q

Myocardial tissue is abruptly deprived of oxygen, when blood flow is decreased by 80-90%
Besides atherosclerosis, it can also occur by coronary artery vasospasm, platelet aggregation and emboli from the walls of the heart

A

Myocardial Infarction

64
Q

zones of cardiac damage

A 
Zone of Necrosis
Begins in the subendocardial layer- poorest oxygen supply
Zone of Injury
Tissue that is injured, but not necrotic
Zone of Ischemia
Tissue that is oxygen deprived
65
Q

describe how cardiac damage develops

A

Damage is not immediate, it develops over hours; this is why it is so important to get oxygen to the heart quickly to decrease the amount of damage

66
Q

extent of cardiac damage relies on 3 things…

A

Collateral circulation
Anaerobic metabolism
Workload demands

67
Q

leading cause of pre-hospital deaths in patients with ACS

A

dysrhythmias

Med Surg (23 decks)

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