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Adult Health I final > Exam 1 Cardiac > Flashcards

Exam 1 Cardiac Flashcards

1
Q

AV valves

A
  • Tricuspid valve (Flows blood from right atrium to right ventricle)
  • Mitral valve (Flows blood from left atrium to left ventricle)
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2
Q

Semilunar valves

A
  • Pulmonic valve (Flows blood from right ventricle through pulmonary arteries to lungs)
  • Aortic valve (Flows blood from left ventricle through the aorta to the body)
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3
Q

What causes the S1 sound (lub)

A

When the AV valves (tricuspid and mitral valves) close

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4
Q

What causes the S2 sound (dub)

A

When the semilunar valves (pulmonic and aortic valves) close

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5
Q

What is Diastole?

A
  • Atria and ventricles are relaxed & the atrioventricular valves are open
  • Caused by SA node
  • The tricuspid valve prevents the blood from flowing back into the right atrium.
  • The mitral valve prevents the oxygenated blood from flowing back into the left atrium
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6
Q

What is Systole?

A
  • Right and Left ventricles contract (squeeze)
  • The AV valves close and the semilunar valves open
  • The pulmonary artery carries the blood to the lungs. There the blood picks up oxygen and is returned to the left atrium of the heart by the pulmonary veins.
  • The aorta branches out to provide oxygenated blood to all parts of the body. The oxygen depleted blood is returned to the heart via the vena cava
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7
Q

Cardiac Output (CO) normal value

A

Normal CO: 4-7 L/min

- Amount of blood pumped out by the ventricle per minute

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8
Q

Central Venous Pressure (CVP or RAP) normal value

A

Normal RAP 2-5 mmHg

- Reflects filling pressures of the right side of the heart

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9
Q

Mean arterial pressure (MAP) normal value

A

Normal 70-100 mmHg

- Average perfusion pressure

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10
Q

Cardiac Index (CI) normal value

A

Normal CI : 2.2-4.0 L/min/m2

  • Adjusts CO for body size
  • More precise
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11
Q

Stroke Volume (SV) normal value

A

Normal 60-70ml

- Amount of blood ejected by ventricle with each heart beat

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12
Q

Systemic Vascular Resistance (SVR) normal value

A

Normal 800-1400 dynes/sec/cm

- The resistance against which the left ventricle must pump to eject its volume

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13
Q

Pulmonary Artery Wedge Pressure (PAWP) normal value

A

Normal: 4-12 mmHg

- reflects the filling pressures in the pulmonary vasculature LEFT sided pressures

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14
Q

Pulmonary Artery Systolic Pressure (PAS) normal value

A

PAS normal: 15-26 mmHg

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15
Q

Pulmonary Artery Diastolic Pressure (PAD) normal value

A

PAD normal: 5-10 mmHg

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16
Q

Stroke volume variation (SVV) normal range

A

Normal SVV < 10-15%

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17
Q

SVO2 (return of blood back to the right side of the heart) normal value

A

Normal value 60%-80%

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18
Q

What is Preload?

A

amount of blood going to the heart (PAWP & CVP)

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19
Q

What is Afterload?

A

the pressure against which the heart must work to eject blood during systole (SVR mainly & PVR)

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20
Q

Elevated Preload (CVP & PAWP) causes what?

A
  • Crackles in lungs
  • Jugular vein distention
  • Hepatomegaly
  • Peripheral Edema
  • Taut skin turgor
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21
Q

Decreased Preload (CVP & PAWP) causes what?

A
  • Poor skin turgor

- Dry mucous membranes

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22
Q

Elevated Afterload (SVR mainly & PVR) causes what?

A
  • Cool extremities

- Weak peripheral pulses

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23
Q

Decreased Afterload (SVR mainly & PVR) causes what?

A
  • Warm extremities

- Bounding peripheral pulses

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24
Q

Drugs to increase SVR? (Afterload)

A

Dopamine, Norepinephrine (causes vasoconstriction)

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25
Q

Drugs to decrease SVR? (Afterload)

A

Nitroprusside, NTG, Hydralazine (causes vasodilation)

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26
Q

Treatment for Abnormal values for Right side preload (CVP)

A
  • Diuretics
  • Fluid restriction
  • Fluid bolus
  • Blood or blood products
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27
Q

Treatment for Abnormal values for Left side preload (PAWP)

A
  • Fluid restriction
  • Venodilation
  • Diuretics
  • Fluid
  • Blood and blood products
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28
Q

High values (80%-90%)of SVO2 could mean?

A
  • Hyperoxygenation
  • Anesthesia
  • Sepsis
  • False reading
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29
Q

Low values (<60%) of SVO2 could mean?

A
  • Anemia, bleeding
  • Cardiogenic shock
  • Hyperthermia, seizures, activity
  • Hypoxemia
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30
Q

The nurse caring for a patient with an arterial line notes the reading of 182/130. The priority action at this time will be:

  1. Notify the MD
  2. Increase the nitroprusside IV gtt
  3. Verify the transducer level
  4. Verify the flush solution
A
  1. Verify the transducer level (make sure the equipment is working
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31
Q

The patient with a FloTrac monitor is noted to have a SVV of 19%. The nurse can anticipate which treatment ordered?

  1. Fluid bolus
  2. Dopamine IV gtt
  3. Nitroglycerine IV gtt
  4. Lasix per IV
A
  1. Fluid bolus (If SVV is >15%, patient’s cardiac output will increase with fluid infusion)
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32
Q

The nurse notes a SVR of 550 dynes/sec/cm-5. This is an indicator of:

  1. Vasoconstriction
  2. Increased right heart preload
  3. Increased left heart preload
  4. Vasodilation
A
  1. Vasodilation (lower SVR is vasodilation and higher SVR is vasoconstriction)
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33
Q

Nursing care for Angiography

A
  • maintain NPO status for at least 8 hours
  • obtain vital signs, heart and lung sounds, and peripheral pulses
  • Consent form is signed
    After operation:
  • Assess vital signs every 15 min x 4, every 30 min x 2, every hour x 4, and then every 4 (follow protocol)
  • Assess incision site
  • Maintain bed rest in supine position with extremity straight for prescribed time.
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34
Q

Complications with angiography

A
  • Cardiac tamponade (fluid accumulation in pericardial sac)
  • Hematoma formation (blood clots can form near the insertion site
  • Restenosis of treated vessel (Clot reformation in the coronary artery can occur immediately or several weeks after procedure)
  • Retroperitoneal bleeding (bleeding into retroperitoneal space can occur due to femoral artery puncture)
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35
Q

Sinus tachycardia (Rate: 101-150 bpm) management

A
  • Treat cause (fever, exercise)
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36
Q

Sinus bradycardia (Rate: <60 bpm) management

A
  • If client is symptomatic: Atropine, isoproterenol, Pacemaker
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37
Q

Atrial flutter and fibrillation management

A

Rhythm control
- Pharmacological:
Amiodarone, adenosine, ibutilide, disopyramide, flecainide, dofetilide, sotalol

Electrical cardioversion ** only if < 48 hours **

Surgical:
MAZE procedure, requires open heart surgery

Ablation procedure

Rate control:
Ca channel blockers, beta blockers, digoxin

Complication prevetion (stroke)
anticoagulate
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38
Q

Premature Atrial Contractions (PAC) management

A

No treatment, usually benign

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39
Q

Junctional rhythm (40-60 bpm and p wave inverted) management

A
  • if symptomatic:

Atropine

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40
Q

Accelerated junctional rhythm (61-100 bpm and p wave inverted) management

A

No treatment necessary

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41
Q

Junctional tachycardia (101-180 bpm and p wave inverted) management

A

-Control rapid rate with Ca channel blocker, Beta blocker, or Amiodarone

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42
Q

Premature junctional contractions management

A
  • Observe
43
Q

Supraventricular Tachycardia (Rate: 100-280 with a mean of 170 bpm in adults) management

A

Amiodarone, adenosine, and verapamil

44
Q

Premature Ventricular Contraction (PVCs) management

A
  • Treat the cause

- Antidysrhythmic medication

45
Q

Ventricular tachycardia (140-180 bpm (or more)) management

A
  • VTach (Pulseless) Defibrillate, CPR, Epinephrine, Vasopressin
  • VTach (With Pulse), Amiodarone, Sotalol, Lidocaine, Cardioversion
46
Q

ventricular fibrillation

A

amiodarone, lidocaine, epinephrine, and defibriillate

47
Q

Ventricular asystole (No electrical activity)

A
  • Check in different lead
  • CPR
  • Epinephrine every 3-5 minutes
48
Q

PEA: Pulseless electrical activity 5 H’s and 5 T’s

A

5 H’s

  • Hypovolemia
  • Hypoxia
  • Hydrogen ions (acidosis)
  • Hyper or hypokalemia
  • Hypothermia

5 T’s

  • Tables (drug overdose)
  • Tamponade
  • Tension pneumothorax
  • Thrombosis (coronary)
  • Thrombosis (pulmonary)
49
Q

First degree heart block management

A
  • None, other than treating any possible cause
50
Q

second degree heart block management

A
  • Possible transcutaneous pacing or transvenous pacing
51
Q

Third degree heart block management

A
  • Requires pacemaker

Transcutaneous or transvenous

52
Q

Hyperkalemia changes to ECG

A
  • Tall, peaked T-waves
  • Widened QRS complex, Ventricular fibrillation, Cardiac standstill
  • Prolongation of the P wave & PRI
  • Flattens P wave
53
Q

Hyperkalemia treatment

A
  • D50 W and IV Insulin
    temporary measure for life-threatening levels
  • Calcium Chloride
    temporary measure, increases threshold potential
  • Cation exchange resin products into GI tract such as Kayexalate
    permanent measure
  • Hemodialysis or peritoneal dialysis
    permanent measure
54
Q

Hypokalemia changes to ECG

A
  • PVCs
  • Deterioration into V-tach or V-fib
  • Depressed T-waves, inverted T-waves
  • U waves
  • 2nd and 3rd heart blocks
55
Q

Hypokalemia treatment

A

K+ replacement (10 meq per hour)

  • High Alert Medication
  • NEVER IV push
  • Monitor for phlebitis

If hypomagnesemia exists, Mg+ replacement has to take place before K+ replacement can be successful

56
Q

Hypermagnesemia changes to ECG

A

Similar to Hyperkalemia

  • Tall, peaked T-waves
  • Widened QRS complex, Ventricular fibrillation, Cardiac standstill
  • Prolongation of the P wave & PRI
  • Flattens P wave
57
Q

Hypermagnesemia treatment

A

calcium gluconate

58
Q

Hypomagnesemia changes to ECG

A

Similar to K+

  • Prolonged PR & QT intervals
  • Presence of U waves
  • T-wave flattening
  • Widened QRS complex
59
Q

Hypomagnesemia treatment

A 
Magnesium IV replacement
- No Pulse
       1-2 gm in 10 ml D5W over 5-20 minutes
- With a pulse
       1-2 gm over 5 to 60 minutes
60
Q

Hypercalcemia changes to ECG

A
  • Shortened QTc interval
  • Bradycardia
  • Heart block (1º, 2º, and 3º) & BBB
61
Q

Hypercalcemia treatment

A

-Loop diuretics (acute management)
Furosemide 1mg/kg along with NS to maintain stable
body water, along with a K+ replacement

  • Calcitonin (slower to work)
    SQ or IM
  • Biphosphonates
  • Hemodialysis
62
Q

Hypocalcemia changes to ECG

A
  • Variable
  • Bradycardia
  • V-tach
  • Asystole
  • Prolonged QT interval (leads to torsades de pointes)
63
Q

Hypocalcemia treatment

A
  • Seizure precautions
  • Oral and IV replacement
    - Calcium chloride
    - Calcium gluconate
64
Q

What is Lead I

A
  • Positive electrode - left arm (or under left clavicle)
  • Negative electrode - right arm (or below right clavicle)
  • Ground electrode - left leg (or left side of chest in midclavicular line just beneath last rib)
  • Waveforms are positive
65
Q

What is Lead II

A
  • Positive electrode - left leg (or on left side of chest in midclavicular line just beneath last rib)
  • Negative electrode - right arm (or below right clavicle)
  • Ground electrode - left arm (or below left clavicle)
  • Waveforms are positive
66
Q

What is Lead III

A
  • Positive electrode - left leg (or left side of the chest in midclavicular line just beneath last rib)
  • Negative electrode - left arm (or below left clavicle)
  • Ground electrode - right arm (or below right clavicle)
  • Waveforms are positive or biphasic
67
Q

What is lead aVR

A
  • Positive electrode placed on right arm

- Waveforms have negative deflection

68
Q

What is lead aVL

A
  • Positive electrode placed on left arm

- Waveforms have positive deflection

69
Q

What is lead aVF

A
  • Positive electrode located on left leg

- Waveforms have a positive deflection

70
Q

How does the ventricular axis work

A
  • Normal
    - Lead I is +
    - Lead aVF is +
  • Right Axis Deviation
    - Lead I is –
    - Lead aVF is +
  • Left Axis Deviation
    - Lead I is +
    - Lead aVF is –
  • NW (indeterminate) (Left ventricle to Right ventricle
    - Lead I is –
    - Lead aVF is -
71
Q

What causes Left Axis Deviation

A
  • Q waves of inferior myocardial infarction
  • artificial cardiac pacing
  • emphysema
  • hyperkalaemia
  • injection of contrast into left coronary artery
  • left ventricular hypertrophy
72
Q

What causes Right Axis Deviation

A
  • normal finding in children and tall thin adults
  • right ventricular hypertrophy
  • chronic lung disease even without pulmonary hypertension
  • anterolateral myocardial infarction
  • pulmonary embolus
73
Q

What causes No Man’s Land (Northwest Axis)

A
  • emphysema
  • hyperkalemia
  • lead transposition
  • artificial cardiac pacing
  • ventricular tachycardia
74
Q

What is defibrillation and when do you use it

A
  • Electrical countershock to stop chaotic electrical activity so that normal conduction can resume
    • Pulseless ventricular tachycardia and ventricular fibrillation
75
Q

How many joules does the biphasic waveform defibrillator (safer) use

A

120-200 joules

76
Q

Safety for defibrillation

A
  • Check for the pulse…never defibrillate a palpable pulse.
  • Do not shock systole.
  • Always use gel pads to protect pt’s skin
  • Keep paddles/pads away from each other
  • I’m clear, you’re clear, we all are clear
77
Q

What is cardioversion

A

It is synchronized: Low energy shock to convert stable supraventricular or ventricular tachycardias to normal sinus rhythms

78
Q

How to do cardioversion and safety

A
  • Shock synchronized with pt’s R wave to avoid falling on T wave.
  • 50j, 100 j, 200j, 300j, 360j
  • Sedate patient if possible
  • Have emergency cart at bedside
79
Q

What is the three letter pacemaker code

A 
- Position I =Chambers Paced
            0 = none
            A= atrial
            V= ventricle
            D= dual (atrial &amp; ventricle)
- Position II = Chambers Sensed
           0= none
           A= atrial
           V= ventricle
           D= dual
- Position III = Response to sensing
           0= none
           T= triggered
            I= inhibited
           D= dual (T and I)
80
Q

When to use a pacemaker

A
  • symptomatic bradycardia
  • severe asymptomatic bradycardia
  • AV block
  • complete block (3rd degree)
  • atrial flutter/atrial fib with slow ventricular response
  • sick sinus syndrome
  • tachybrady syndrome
81
Q

Risk for pacemakers

A
  • catheter dislodgment
  • lead fracture
  • pacemaker system failure
  • erosion of pulse generator
  • pacer induced tachycardia
  • infection/local sepsis
  • cardiac perforation with tamponade
  • thrombosis of superior vena cava or right atrium
  • dysrhythmias
82
Q

Temporary pacemakers

A
  • Transcutaneous (pads)
  • Epicardial (wires to the heart)
  • Transvenous (vein through the leg)
83
Q

Permanent pacemakers

A

Transvenous

84
Q

When are transcutaneous (pads) pacemakers used

A
  • less than 24 hours

- waiting for someone to put one in

85
Q

Asynchronous pacemaker mode

A
  • Pacemaker does not sense pt’s intrinsic rate. Rate is fixed
86
Q

Synchronous pacemaker mode

A
  • pacemaker senses pt’s intrinsic rate and fires on demand
87
Q

What is hypertension (HTN)

A
  • Systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 in people who do not have diabetes mellitus
  • Patients with DM should have BP < 130/90
88
Q

How to help prevent hypertension

A
  • Diet
    - Low sodium, low fat diet.
    - Lower cholesterol levels to < 200 mg/dl total
  • Weight reduction
  • Reduced alcohol intake
  • Exercise
    - At least 5 days a week
  • Decrease stress levels
  • Relaxation techniques
  • Avoid alcohol, smoking
89
Q

Hypertension management

A
  • Monitoring BP at home
    - Goal of 140/90 or lower
    - Keep a record and bring to visits with provider
  • Warning signs
    - MI, CVA, PAD, Kidney disease
  • Medications
    - What they are for and the side effects
    - Adherence to medication regimen
90
Q

Hypertension drug therapy

A
  • Diuretics
    - Thiazide diuretics first choice
  • Calcium channel blockers
    - Verapamil, amlodipine
  • ACE inhibitors
    - captopril, lisinopril, enalapril
  • Beta-adrenergic blockers
    - atenolol, metoprolol,
  • Renin inhibitors
    - aliskiren
  • Angiotensin II receptor antagonists
    - valsartan, losartan
  • Central alpha agonists
    - clonidine
  • Alpha-adrenergic agonists
    - prazosin, terazosin
  • Aldosterone receptor antagonists
    - Eplerenone
91
Q

The 6 P’s of arterial insufficiency

A
  • Pain
  • Pallor
  • Pulselessness
  • Paresthesia
  • Paralysis
  • Poikilothermia (coolness)
92
Q

What are aneurysms of central arteries

A

Permanent localized dilation of artery, enlarging artery to twice its normal diameter

Types:

  • Fusiform
  • Saccular
  • Dissecting (aortic dissection)
  • Abdominal aortic
  • Thoracic aortic
93
Q

Symptoms of abdominal aortic aneurysm (AAA)

A
  • usually steady pain with a gnawing quality, unaffected by movement, may last for hours or days
  • Pain in abdomen, flank, back
  • Abdominal mass is pulsatile
  • Bruit
  • Rupture is most frequent complication and is life threatening
94
Q

Rupture of abdominal aortic aneurysm (AAA)

A

Sudden ripping, tearing, stabbing abdominal or back pain and legs

symptoms:

  • Diaphoresis, faintness, N&V, apprehension
  • Hypotension, tachycardia
95
Q

Symptoms of Thoracic Aortic Aneurysm

A

Symptoms often do not occur until the aneurysm is larger and causing pressure from the aorta on adjacent structures:

  • coughing and wheezing
  • Horner’s syndrome (drooping eyelid, constricted pupil and dry skin on one side of the face)
  • Hoarse voice
  • Difficulty swallowing
  • Back pain
  • Mass may be visible above suprasternal notch
96
Q

Rupture of Thoracic Aortic Aneurysm

A

Sudden excruciating back or chest pain symptomatic of thoracic rupture. Pain can travel into arms, abdomen and lower back

Symptoms:

  • Diaphoresis, faintness, N&V, apprehension
  • Hypotension, tachycardia
97
Q

Nonsurgical management of aneurysm

A
  • Monitor aneurysm growth

- Maintain BP at normal level to decrease risk of rupture

98
Q

Indications for aneurysm repair

A
  • Aneurysm > 6 cm
  • Progressively increasing in size
  • Impending rupture
  • Sx of cerebral or coronary ischemia
  • Pericardial tamponade
  • Uncontrollable pain
  • Aortic insufficiency
99
Q

Complicationsfor surgical repair of aneurysm

A
  • Bleeding
  • Graft occlusion
  • Myocardial infarction
  • Acute renal failure
  • Distal embolization
  • Colon ischemia
  • Spinal cord ischemia
100
Q

What is an aortic dissection

A
  • May be caused by sudden tear in aortic intima, opening way for blood to enter aortic wall
  • Creates false lumen
  • Pain described as tearing, ripping, stabbing
  • Life threatening
101
Q

Aortic dissection management

A
  • Assess 6 “P”s
    Pain, pallor, paresthesia, paralysis, pulselessness,
    poikilothermia
  • Control pain
    - Morphine
  • Control HTN
    -Labetolol, Esmolol
    - Nipride
  • Diagnostic tests
    -CT scan for emergent, MRI for stable, chronic
    Transesophageal echocardiography (TEE)
  • Surgical intervention
    - Resection and replacement with graft
    - Cardiopulmonary bypass machine
102
Q

Nonsurgical Management of Venous thromboembolism (VTE)

A
  • Rest, preventive measures
  • Drug therapy:
    - Unfractionated heparin
    - Low–molecular weight heparin
    - Warfarin
    - Thrombolytics
103
Q

Surgical management of Venous thrombembolism (VTE)

A
  • Thrombectomy
  • Inferior vena caval interruption
  • Ligation or external clips
104
Q

Ankle Brachial Index scores

A
  • normal (0.91 to 1.30)
  • mild (0.71 to 0.90) (blood thinners)
  • moderate (0.41 to 0.70) (blood thinners)
  • severe (≤ 0.40)

Adult Health I final (16 decks)

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