Exam 1 Flashcards
1
Q
what is the most common chronic disease in adults?
A
hypertension
2
Q
normal BP
A
120/80
3
Q
elevated BP
A
120s/ less than 80
4
Q
HTN stage 1
A
130s/ 80s
5
Q
HTN stage 2
A
140/90
6
Q
hypertensive crisis
A
180/120
7
Q
normal cardiac output
A
4-6 L
8
Q
peripheral vascular resistance
A
resistance of arteries to blood flow
- elasticity of arterial wall
- diameter of arteries
- blood viscosity
9
Q
equation for BP
A
CO x PVR
10
Q
what do signs and symptoms of hypertension indicate?
A
target organ damage has already occured
11
Q
signs and symptoms of hypertension
A
headaches
fatigue
epistaxis
vision loss
chest pain
palpitations
SOB
renal failure
TIA, stroke = hemiplegia, speech difficulties
12
Q
rate to deflate BP cuff
A
2-3 mm Hg per second
13
Q
measuring BP considerations
A
- avoid smoking, caffeine, activity 30 mins prior
- empty bladder
- both feet on ground
- sit quietly for 5 mins
14
Q
BP goal for hypertension
A
130/80
15
Q
first line HTN medications
A
- thiazides
- ACE inhibitors
- ARBs
- Calcium channel blockers
16
Q
second line HTN medications
A
other diuretics
beta blockers
alpha blockers
direct renin inhibitors
vasodilators
17
Q
evidence of target organ damage in hypertensive emergency
A
MI
dissecting aortic aneurysm
intracranial hemorrhage
18
Q
coronary arteries
A
Left main artery
Left anterior descending artery
Left circumflex artery
Right coronary artery
19
Q
what kind of plaque is more dangerous?
A
a plaque with a thin cap because it is prone to rupture and cause embolic event
20
Q
clinical manifestations of CAD
A
epigastric distress
SOB
radiating pain
angina
21
Q
women’s manifestations of CAD
A
indigestion
N/V
palpitations
numbness
back pain
22
Q
metabolic syndrome
A
Enlarged waist circumference
Elevated triglycerides
Low HDL
HTN
Elevated FBG
23
Q
Normal lipid profile
A
cholesterol <200
triglycerides <150
LDL <100
HDL >40-50
24
Q
medications for hyperlipidemia/ cholesterol
A
Statins
Fibrates
Bile acid sequestrants
cholesterol absorption inhibitor
PCSK9 agents
25
when to check blood sugar
wake up, before bed
before food
2 hrs after food
26
blood sugar targets
80-130 before meals
<180 after meals
27
why is tobacco bad for HTN
- causes coronary artery vasoconstriction
- increases oxidation of LDLs
- increases clotting
28
angina precipitating factors: 4 Es
exertion
eating
emotional distress
extreme temps
29
angina symptoms
anxiety, doom
sweating
lightheadedness
also symptoms listed for CAD
30
normal troponin levels
< 0.034
31
ADRs to nitroglycerin
- headache (think vasodilation in migraines)
- tachycardia (compensating for hypotension)
- flushing
- hypotension
32
unstable angina vs MI
unstable angina = partial occlusion will progress to MI
MI = complete occlusion or vasospasm
33
EKG for NSTEMI
T wave inversion
ST depression
normal EKG
34
EKG for STEMI
ST elevation
35
EKG for unstable angina
normal EKG
36
Which conditions cause elevated troponin?
NSTEMI and STEMI
37
respiratory findings of acute coronary syndrome (Unstable angina and MI)
SOB
dyspnea
tachypnea
crackles
38
when should EKG be obtained
within 10 minutes of arrival to ED
39
how long does troponin stay elevated after MI?
two weeks
40
besides MI, what can cause elevated troponin
congestive heart failure
sepsis
41
what does elevated creatinine kinase indicate?
MI
42
when does elevated creatinine kinase peak?
within 24 hours of MI
43
myoglobin
- heme protein that transports O2
- increases for 1-3 hours of MI, peaks within 12 hours
44
how soon should artery be stented?
within 60 minutes of arrival for STEMI
45
when are thrombolytics used
when PCI is not available, should be given within 30 mins
46
nursing interventions for acute coronary syndrome
- assess VS and pain
- establish 2 PIVs
- EKG
- draw labs for cardiac enzymes
- prep for PCI
- administer O2
47
complications of acute coronary syndrome
pulmonary edema
heart failure
cardiogenic shock
dysrhythmias
cardiac arrest
pericardial effusion
48
how many people will have heart failure at 40?
20%
49
how to calculate stroke volume
End diastolic volume - End systolic volume
50
ejection fraction
percentage of blood pumped out of the heart in one heartbeat
stroke volume / end diastolic volume
51
HFrEF
systolic dysfunction
reduced ejection fraction r/t weakened heart muscle
ejection fraction <40%
52
causes of systolic heart failure
cardiomyopathy
reduced blood supply d/t CAD
regurgitation or stenosis of valve disease
arrhythmia
53
HFmrEF
Heart Failure mid ranged Ejection Fraction
ejection fraction 40-49%
54
HFpEF
Heart Failure preserved Ejection Fraction
diastolic failure: heart can't relax enough to fill with blood
ejection fraction >50%
55
causes of diastolic heart failure
chronic HTN
aortic stenosis
cardiomyopathy (hypertrophic and restrictive)
56
normal ejection fraction
around 60%
50-75%
57
congestive heart failure
blood returning to the heart through the veins gets backed up
58
left sided heart failure manifestations
SOB when lying down
pulmonary edema
- cough
- crackles
- wheezing
- pink sputum
- tachypnea
59
right sided heart failure manifestations
- edema in legs and ankles
- GI symptoms due to fluid in abdominal organs
- hepatospelnomegaly
- ascites d/t liver congestion
- JVD
60
compensated vs decompensated HF
compensated - heart works well enough you don't notice symptoms
decompensated - worsening signs and symptoms
61
preload
stretching of myocardium during ventricular filling
62
afterload
force needed to eject blood from ventricles
63
how do beta blockers help heart failure
improve cardiac contractility
64
how do angiotensin receptor neprilysin inhibitors help heart failure
relax blood vessels and decrease BP so blood can be pumped more easily
65
VAD
- ventricular assistive device
- supports failing ventricles
66
ICD
detects and corrects arrhythmias
67
OTC meds to avoid in heart failure
NSAIDs
pseudophedrine etc SNS stimulants
68
mortality for heart failure
20% die within 1 year of diagnosis
69
when to notify provider of fluid gain
3 lbs in one day
5 lbs in one week
70
sodium intake
most adults consume >3400 mg sodium
recommendation of 2300 mg limit
HF patients limit of 2000 mg
71
caring for HF patients
daily weights
track I/Os
72
valvular disease
stenosis or prolapse = regurgitation
73
what two valves are more likely to have vavular disorders?
aortic and mitral because they are on the left side
74
mitral stenosis
sluggish blood flow into left ventricle d/t hardening
atrial pressure increases
pulmonary congestion
75
mitral regurgitation
blood flows backwards because leaflets don't close completely
atrial pressure increases
pulmonary congestion
76
effects of both aortic stenosis and regurgitation
left ventricular hypertrophy
left ventricular failure
pulmonary congestion
77
valvular disorder risk factors
calcification with age
endocarditis
congenital
rheumatic fever
pregnancy d/t increased fluid volume
smoking
high lipoprotein
hypertension
78
cardinal sign of valvular disorder
new murmur
other symptoms are same as HF
79
identifying valvular disease
new murmur
EKG
echo
cardiac cath
80
surgical treatment of valvular disease
valve repair: vavluloplasty or commissurotomy
replacement: open heart or TAVI
81
who gets heterographs?
childbearing age women
patients >70 years
bleeding disorders
medication non-compliance
82
how long do heterographs last?
7-15 years
83
how long do mechanical valves last?
life long, with use of anticoagulants
84
normal INR vs INR goal for warfarin
normal: 1
warfarin goal: 2-3
85
dilated cardiomyopathy
muscle becomes thin and weak
86
hypertrophic cardiomyopathy
thickening of both ventricles and septum
87
restrictive cardiomyoathy
left ventricular hypertrophy
88
risk factors for cardiomyopathy
viral infections
the rest are same as valvular disorders:
DM, HTN, high lipoprotein, genetics, pregnancy, sedentary, smoking, alcohol, cocaine, chemo
89
cardiomyopathy symptoms
angina and HF symptoms
90
LVAD
bridge to heart transplant
91
where is cardiac cath inserted?
femoral or radial
92
why is there risk of kidney injury with cardiac cath?
contrast dye is nephrotoxic
93
DES
drug-eluted stent
endothelium will grow to cover stent
high risk for thrombus formation, requires ASA for life
94
what is given IV during cardiac cath?
heparin
95
what is used to prevent uncontrolled bleeding during cardiac cath?
vascular closure device
96
care for after cardiac cath
bedrest 2-4 hours
EKG
telemetry
VS Q15 min x4, Q30 min x4, Q1 hr
analgesics - no NSAIDs
monitor for bleeding
monitor UOP - kidney risk
CSMTs
Neuro assessment
97
CSMTs
circulation/color
sensation
movement
temperature
98
complications of cardiac cath
CA dissection
perforation
vasospasm, arterial occlusion
MI, cardiac arrest
dysrhythmia
bleeding at insertion site, hematoma
retroperitoneal bleeding
AKI
99
where does graft come from for CABG?
mammary arteries
greater saphenous vein
100
care after CABG
pulmonary toileting and PAIN CONTROL
insulin to prevent hyperglycemia and sternal wound infection
ambulation ASAP when safe
ongoing neuro, cardiac, resp eval
strict I/Os
CSMTs
labs
101
most common organisms to cause endocarditis
strep and staph aureus
102
risk factors for endocarditis
prosthetic heart valves
congenital defects
IVDA
immunodeficiency
intravascular access device
surgeries and dental procedures
body piercing and tattoos
103
s/sx of endocarditis
weight loss
night sweats
new or changing murmur
osler's nodes (swollen finger tips)
janeway lesions (red marks on palms)
roth spots (bacterial clumps in eyes)
splinter hemorrhages (streaks under nails)
fever, fatigue, confusion, rigors
104
identifying endocarditis
echo
blood cultures
EKG
105
managing endocarditis
prophylactic antibiotics for high risk patients
4-6 weeks IV antibiotics in PICC
valve repair or replacement
106
pericarditis
inflammation of sac around the heart
107
normal amount of pericardial fluid
10-50 mL
108
causes of pericarditis
pathogens - bacterial, viral, fungal
renal failure
aortic dissection
MI
cancer
50% idiopathic
109
s/sx pericarditis
friction rub
fever
SOB
sweating
chest pain
ST elevation and PR depression
pericardial effusion
110
pericarditis treatment
Pericardiocentesis
pain managements
NSAIDs - colchicine
steroids to reduce inflammation
