Exam 1 Flashcards
5 causes of sinus bradycardia
sleep
athletic training
hypothyroidism
vagal stimulation
increased intracranial pressure
MI
if sinus bradycardia is consistent with SOB, altered mental status, angina, or hypotension then treat with ___ mg of _______ rapid IV and repeat every ____ to ____ minutes until the max dose of ____ mg is given
0.5, atropine, 3-5 minutes, 3 mg
2 treatments of sinus bradycardia if unresponsive to atropine
emergency transcutaneous pacing
catecholamines (dopamine, epi)
8 causes of sinus tachycardia
acute blood loss
anemia
shock
heart failure
pain
fever
exercise
anxiety
stimulants that can cause sinus tachycardia
caffeine
nicotine
illicit drugs
syndrome that can cause sinus tachycardia
postural orthostatic tachycardia syndrome (POTS)
if sinus tachycardia is causing hemodynamic instability, treat with _________ _______
synchronized cardioversion
5 vagal maneuvers that are used to treat sinus tachycardia
carotid sinus massage
gagging
bearing down
forceful cough
cold stimuli to the face
medication used to treat sinus tachycardia
adenosine
sinus arrhythmia is when SA node pacing rate changes with _______
respirations
irregular heart rate caused by atrial foci become irritable and cause spontaneous firing og impulse causing depolarization
premature atrial contraction (PAC)
PAC causes an early and different __ wave
P
6 causes of PAC
adrenaline
increased sympathetic stimulation
stimulants
hyperthyroidism
anxiety
hyokalemia
most common dysrhythmia
A fib
heart rhythm caused by continuous rapid firing of multiple atrial foci that dont depolarize the atria
A fib
in A fib you do not see a __ wave
P
9 risk factors of A fib
heart failure
hypertension
diabetes
obesity
valvular heart disease
obstructive sleep apnea
alcohol
hyperthyroidism
post op cardiac surgery
atrial and ventricular A fib rate
atrial: 300-600
ventricular: 120-200
if a patient has A fib and is low stroke risk, treat with ______ _______ mg once daily
asprin 75-325 mg
if the patient has A fib and has moderate stroke risk treat with oral _______ such as warfarin or _______ ___ inhibitors
anticoagulants, factor XA
factor XA inhibitors
dabigatran (pradaxa)
rivarixaban (xarelto)
apixaban (eliquis)
antiarrhythmic medications for A fib
beta blockers and calcium channel blockers
2 nonpharmacological treatments for A fib
electrical cardioversion
catheter ablation therapy
atrial flutter is when atrial foci are ______ and fire rapidly
irritated
atrial flutter atrial and ventricular rate
atrial: 250-400
ventricular: 75-150
in atrial flutter the P wave is saw tooth shaped and called __ wave
F
physical treatment for atrial flutter
vagal maneuvers
medication used to treat atrial flutter
adenosine
adenosine is followed by 20 ml _____ flush and elevation of the _____
saline, arm
atrial flutter has a lot of the same treatments as _____ _____
atrial fibrillation
a syndrome that occurs in A fib when there is congenital tissue in the heart
wolff parkinson white syndrome
treatment for wolff parkinson white syndrome
electrical cardioversion
_________ phenomenon is intermittent arterial vaso-occlusion or vasospasm on the fingers or toes
Raynauds
Raynauds disease is often associated with _______ diseases
autoimmune
autoimmune diseases that can cause Raynauds pehnomenon
systemic erythematous lupus
rheumatoid arthritis
scleroderma
symptoms of Raynauds may result from a defect in _____ ____ production and decrease the cutaneous blood vessels ability to _______
basal heat, dilate
Raynauds disease is associated with ________
smoking
variant of Raynauds that is also agitated by stress or extreme cold
Acrocyanosis
acrocyanosis and raynauds make the fingers _____ and cause ________
blue, hyperhidrosis
in raynauds the fingers turn ______ due to vasoconstriction
pale
in raynauds the fingers turn _____ due to deoxygenated blood pooling during vasospasm
blue
in raynauds the fingers turn _____ due to exaggerated reflow due to vasodilation after
red
medication taken to treat Raynaud’s syndrome because it causes vasoconstriction
calcium channel blockers
people with Raynauds should avoid ______ and ______ because it triggers it
cold, tobacco
varicose veins are cause by reflux of venous blood that causes venous _______
stasis
varicose veins are causes by ______ or _______ valves
damaged or incompentent
dilated intradermal veins that are distended 1-3 mm in diameter and are visible on the skins surface
telangiectasias (spider veins)
high _____ states are a risk factor for vericose veins
estrogen
with vericose veins the skin may turn _____ due to extravastated veins
brown
_______ ultrasound can show where the reflux of vericose veins are and how severe
duplex
2 positions of patient when using duplex ultrasound
trendelenberg or standing
rarely used diagnostic test for vericose veins that involves IV contrast
venography
3 E’s to medical management of vericose veins
elastic compression socks
exercise
elevation
3 things to avoid with vericose veins
crossing legs, sitting or standing for long, wearing socks that are too tight
treatment used for small variscosities
sclerotherapy
nonsurgical treatment for varicose veins
thermal ablation
acute inflammation of the lymphatic chain usually in the extremity
lymphangitis
bacteria that usually causes lymphangitis
hemolytic streptococcus
what lymphangitis looks like
red streaks extend up the extremity outlining the course of the lymphatic vessels
acute inflammation of the lymph node
lymphadenitis
lymphadenitis can become _____ and form an ______
necrotic, abcess
3 places lymphadenitis usually affects
groin, axilla, cervical region
3 treatments for lymphangitis and lymphadentitis
antibiotics
NSAIDs
compression socks
tissue swelling due to increased lymph from obstruction of lymph vessels
lymphedema
cause of primary lymphedema
congenital malformations
cause if secondary lymphedema
aqcuired obstructions
lymphedema is most commonly ______ and occurs in women before the age of ____
primary, 35
in lymphedema the swelling is ______ and ______ and then becomes ______ and _____
soft and pitting, hard and nonpitting
lymphedema is commonly seen with ______ _____ _____ due to breast cancer
axillary node dissection
lymphedema can happen with _____ veins
varicose
chronic lymphedema leads to outbursts of ______ that are characterized by fever and chills
infection
3 things that happen to the extremity when chronic lymphedema becomes infectious
- chronic fibrosis
- thickening of the subcutaneous tissue
- hypertrophy of the skin
type of lymphedema when chronic swelling only slightly goes away with elevation
elephantisias
diuretic given to help with lymphedema
Lasix
other medication class used with lymphedema
antibiotics
surgical management is used for severe lymphedema one of these three things happens
uncontrolled by medical management
mobility id severly impaired
infection persists
a patient who undergoes surgical management for lymphedema must avoid _____ _____ and stay out of the ____
heating pads, sun
most common infectious cause of limb swelling
cellulitis
cellulitis occurs when bacteria enters the ____ and ______ tissues
skin, subcutaneous
2 bacteria that mostly cause cellulitis
streptococcus and staphylococcus aureus
cellulitis usually has the cardinal signs of inflammation, but can sometimes have systemic signs of a _____
fever
in cellulitis, there will be ______ _____ enlargement
lymph node
treat cellulitis with oral ______ if mild or IV _______ if severe
antibitoics
to treat cellulitis apply ___ packs every 2 to 4 hours until swelling resolves and then switch to ____ packs
cool to warm
most common type of heart failure
systolic heart failure
a syndrome from functional or structural cardiac disorders so that the heart is unable to pump enough blood to meet the bodys demands
heart failure
heart failure can cause impaired contraction which is a ______ dysfunction or problems filling the heart which is a _______ dysfucntion
systolic, diastolic
systolic heart failure is an alteration in ________ _______
ventricular contraction
systolic HF is characterized by ______ heart muscle
weakened
diastolic HF is characterized by ______ heart muscle
stiff
diastolic HF makes it hard for the ____ _____ to fill
left ventricle
both types of HF are identified by assessment of the _____ _____ function with an ______
left ventricle, echocardiogram
ultrasound of the heart that shows us ejection fraction
echocardiogramp
calculation of how much blood is being ejected from the heart during systole
ejection fraction
normal ejection fraction
55% - 65%
people with HF with have a ______ ejection fraction
lower
an ejection fraction lower than ____% is indicative of a heart transplant
15
class __ HF is no limitations of physical activity, ordinary activity does not undue fatigue, palpitations, or dyspnea
1
class __ HF where there is slight limitations of physical activity, comfortable at rest, but ordinary physical activity causes fatigue, palpitations, or dyspnea
2
class __ HF is marked limitation of physical activity, comfortable at rest, but less than ordinary activity causes fatigue, palpitations, or dyspnea
3
class ___ HF is unable to carry out any physical activity without discomfort, symptoms of cardiac insufficiency at rest, physical activity increased discomfort
4
HF occurs over time and is _______
progressive
5 common causes of HF
MI
HTN
cardiomyopathy
valvular heart disease
renal failure
in left sided HF the blood will back up to the ______
lungs
left sided HF can cause _____ which is difficulty breathing when laying flat
orthopnea
left sided HF can cause ______ _____ _____ which is a sudden attack of dyspnea at night
paroxysmal nocturnal dyspnea
left sided HF causes a _______ cough
nonproductive
with left sided HF you can hear _____ in the lungs
crackles
in left sided HF you will hear ___ heart sound
S3
left sided HF causes weak ______ pulses and tachycardia
peripheral
right sided HF is usually _______ to left sided HF
secondary
right sided HF increases venous pressure which causes ______ _____ _____
jugular vein distention
right sided HF will cause edema in the _____ exrtremities
lower
right sided HF can cause enlargement of the liver known as ________
hepatomegaly
right sided HF can lead to fluid accumulation in the abdomen known as ______
ascites
ejection fraction less than ___% is HF
55
blood test that measures cardiac filling pressures and can diagnose HF
B-type Natriuretic peptide (BNP)
normal BNP range
0.5
2 things used to determine if HF is caused by coronary artery disease or ischemia
cardiac stress test
cardiac catheritization
first-line therapy drug for heart failure
ACE inhibitors
2 examples of ACE inhibitors
lisinopril
enalapril
ACE inhibitors and ARBs promote ______ and _____ thus decreasing afterload and preload
vasodilation, diuresis
ACE inhibitors and ARBs may increase _____ levels
potassium
ACE inhibitors can often cause a _____ and is the reason most people do not take them
cough, renal
ACE inhibitors and ARBs often decrease _____ function
renal
2 examples of ARBs
valsartan
losartan
combo therapy of _____ and _____ ____ is often used for people who cannot tolerate ACE inhibitors
hydralazine, isosorbide
isosorbide dinitrate is a nitrate and causes _______, which decreased preload
vasodilation
hydralazine decreases _______ ____ ______ which decreased after-load
systemic vascular resistance
first line therapy used in combo with ACE inhibitors for CHF
beta blockers
beta blockers relax _____ ____, lowers ____ _____, decreases _______ as well as workload
blood vessels, blood pressure, afterload
beta blockers improve ________ capacity
exercise
observe for decreased ____ ___ with beta blockers
heart rate
beta blockers may cause _______ and ________
dizziness and fatigue
beta blockers needs to be used carefully with lung diseases because they cause ________
bronchoconstriction
example of loop diuretic
lasix
loop diuretics inhibit ______ and ______ reabsorption in the ascending loop of Henle
sodium, chloride
loop diuretic increase _____ excretion
potassium
first line diuretic therapy for HF
loop diuretic
3 things to monitor with loop diuretics and thiazides
hypokalemia
hypotension
kidney injury
2 examples of thiazide diuretics
metolazone
hydrochlororhiazide
thiazides inhibit ________ and ________ reabsorption in the early distal tubules
sodium and chloride
thiazides increase ______ excretion
potassium
thiazides can be used in combo with _____ diuretics
loop
aldosterone antagonists are ________ ______ diuretics
potassium sapring
example of aldosterone antagonists
spirolactone
aldosterone antagonists block the effect of ______ in the distal tubule and collecting duct
aldosterone
with potassium sparing diuretics monitor for _______ and serum _____
hyperkalemia, creatine
